School lunch debit card payment systems are associated with lower Nutrition and higher calories.

Objective Debit card payment systems are known to induce more frivolous purchases in adults, but their impact on children is unknown. Design and Methods Using a national survey of 2,314 public school students in the United States, food purchases in schools with debit-only systems to those in schools with both debit and cash options are compared. Results Students in debit and cash schools purchase more fresh fruit and vegetables and fewer total calories. Conclusions Payment systems with cash options have a lower purchase incidence of less healthy foods and higher purchase incidence of more healthy foods. [ABSTRACT FROM AUTHOR]