Author Affiliations: Institute for Social Research, University of Michigan, Ann Arbor.
Competitive beverages include all beverages served or sold in schools outside of federally reimbursable meal programs.1 The Alliance for a Healthier Generation developed a set of criteria known as the School Beverage Guidelines,2 which identify approved beverage types, caloric content, and volume by school level. Approved beverages for all school levels include water, fat-free/low-fat milks, and 100% juices (approved volume and caloric content vary across grades). Additional beverages approved only for high school include no-/low-calorie beverages and drinks with up to 66 calories per 8 ounces. The Alliance guideline approval of drinks with up to 66 calories per 8 ounces currently includes the top sports drinks sold in the United States, which are classified as sugar-sweetened beverages because of added sugars.3 This article (1) uses the Alliance guidelines as a framework to present trends in competitive venue beverage availability in US secondary schools from 2006-2007 to 2010-2011 and (2) examines differences in access between middle and high school students.
Analyses used annual data from school years 2006-2007 to 2010-2011 collected through the Youth, Education, and Society study from nationally representative samples of US schools that have eighth, 10th, or 12th grades. Questionnaires were collected from 1477 middle schools and 1575 high schools for a combined response rate of 82.5%. Mailed questionnaires were sent to each sampled school's principal with the suggestion that food service personnel complete the detailed questions on cross-venue beverage availability. Participants indicated whether beverages were available in each of the various venues noted and were then asked about the availability of specific beverages in each venue. Detailed methods are available elsewhere.4
Ninety-one percent of middle school students and 99% of high school students attended schools with beverages sold through a competitive venue in the 2010-2011 school year, representing a significant decrease of 6 percentage points for middle school students and 1 percentage point for high school students from 2006-2007 (Table). Vending machine beverage availability significantly declined for both middle and high school students during the 4-year interval examined.
The significant decline observed in overall middle school competitive venue beverage availability occurred across most beverage types. However, middle school availability of beverages with Alliance approval only for high school remained very high (71% of students) in 2010-2011. Middle school availability also remained high for high-calorie fruit drinks (23%) and higher-fat milks (36%)—beverages not approved for either middle or high schools. Other than approved beverages (waters, 100% juices, lower-fat milks), the beverage with the highest middle school availability was a sugar-sweetened beverage: sports drinks (55% of students in 2010-2011).
High school students had significantly higher availability of all beverages examined than did middle school students. High school availability of regular soft drinks dropped by more than half across the study period, from 54% of students in 2006-2007 to 25% in 2010-2011. Significant decreases also were observed for higher-fat milks and high-calorie fruit drinks; still, their availability rates remained high at 48% and 31% of students, respectively. Overall high school student sugar-sweetened beverage availability also showed a significant decline (down to 88% by the 2010-2011 school year). However, sports drink availability showed no significant decline, with 83% of high school students having availability at school in 2010-2011.
The American Academy of Pediatrics has reaffirmed its 2004 policy statement calling for the elimination of sweetened drinks in schools.5,6 Sweetened drinks have been found to be the primary source of added dietary sugars in children,7 and sugar-sweetened beverages obtained at school have been found to significantly contribute to secondary school student caloric intake.8 As of 2011, 1 in 4 high school students had access to regular soft drinks in competitive venues at school. Competitive venues are currently exempt from nutrition regulations that govern federally sponsored meal programs. However, the Healthy, Hunger-Free Kids Act (S 3307, 111th Congress) has provided the US Department of Agriculture with authority to set nutritional standards for school competitive venue foods and beverages.9 These standards are currently under development.10
The Institute of Medicine has recommended nutrition standards for foods and beverages in schools,11 including removal of regular colas or sodas with sugar or caffeine; limiting access to sugar-free, caffeine-free beverages to high school students only (and only after school hours); and strongly limiting sports drinks, with use only “when provided by the school for student athletes participating in sport programs involving vigorous activity of more than 1 hour's duration.” Overall, the Institute of Medicine recommendations appear to be highly relevant as the US Department of Agriculture works to develop competitive venue nutritional standards for US schools.
Correspondence: Ms Terry-McElrath, PO Box 1248, Ann Arbor, MI 48106-1248 (firstname.lastname@example.org).
Author Contributions:Study concept and design: Terry-McElrath and Johnston. Acquisition of data: Johnston. Analysis and interpretation of data: Terry-McElrath, Johnston, and O’Malley. Drafting of the manuscript: Terry-McElrath. Critical revision of the manuscript for important intellectual content: Terry-McElrath, Johnston, and O’Malley. Statistical analysis: Terry-McElrath and O’Malley. Obtained funding: Johnston. Study supervision: Johnston.
Financial Disclosure: None reported.
Funding/Support: Research support was provided by the Robert Wood Johnson Foundation to the Youth, Education, and Society study, a part of the foundation's Bridging the Gap initiative.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Pediatrics editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 6
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.