Multi-Level Health Outcomes of Local Food Procurement in United States Farm-to-School Programs: a Systematic Review

Area of Science:

• Nutrition Science
• Public Health
• Agricultural Economics

Background:

• Farm-to-school (F2S) activities are common in U.S. schools, with 74% participating in 2022-2023.
• The health impacts of specific F2S activities, especially local food procurement, across multiple levels are not well-established.

Purpose of the Study:

• To systematically review the literature on the health outcomes associated with local food procurement in F2S programs.
• To identify economic impacts, barriers, and facilitators of local food procurement in F2S settings.

Main Methods:

• Systematic review of peer-reviewed and grey literature (PROSPERO# CRD420250624067).
• Searches yielded 520 records; 9 sources (7 peer-reviewed, 2 grey literature) met inclusion criteria.
• Included studies comprised 3 cross-sectional, 1 prospective cohort, and 5 quasi-experimental designs.

Main Results:

• Local food procurement in F2S programs was associated with increased children's vegetable intake, particularly for those with low intake and high F2S exposure.
• No significant association was found with children's fruit intake.
• Evidence was insufficient to conclude on other health outcomes or multi-level impacts (family, producer, community).
• Facilitators included program champions, culturally relevant food, and community engagement; barriers involved school capacity and finances.

Conclusions:

• Local food procurement in F2S programs positively impacts children's vegetable consumption.
• More rigorous research is required to understand the comprehensive multi-level health and economic effects of F2S local food procurement.