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Original Investigation |

Association Between District and State Policies and US Public Elementary School Competitive Food and Beverage Environments

Jamie F. Chriqui, PhD, MHS1,2; Lindsey Turner, PhD1; Daniel R. Taber, PhD, MPH1; Frank J. Chaloupka, PhD1,3
[+] Author Affiliations
1Bridging the Gap Research Program, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago
2Departments of Political Science, University of Illinois at Chicago
3Economics, University of Illinois at Chicago
JAMA Pediatr. 2013;167(8):714-722. doi:10.1001/jamapediatrics.2013.32.
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Importance  Given the importance of developing healthy eating patterns during early childhood, policies to improve the elementary school food and beverage environments are critical.

Objective  To examine the association between district and state policy and/or law requirements regarding competitive food and beverages and public elementary school availability of foods and beverages high in fats, sugars, and/or sodium.

Design and Setting  Multivariate, pooled, cross-sectional analysis of data gathered annually during elementary school years 2008-2009 through 2010-2011 in the United States.

Participants  Survey respondents at 1814 elementary schools (1485 unique) in 957 districts in 45 states (food analysis) and 1830 elementary schools (1497 unique) in 962 districts and 45 states (beverage analysis).

Exposures  Competitive food and beverage policy restrictions at the state and/or district levels.

Main Outcome and Measure  Competitive food and beverage availability.

Results  Sweets were 11.2 percentage points less likely to be available (32.3% vs 43.5%) when both the district and state limited sugar content, respectively. Regular-fat baked goods were less available when the state law, alone and in combination with district policy, limited fat content. Regular-fat ice cream was less available when any policy (district, state law, or both) limited competitive food fat content. Sugar-sweetened beverages were 9.5 percentage points less likely to be available when prohibited by district policy (3.6% vs 13.1%). Higher-fat milks (2% or whole milk) were less available when prohibited by district policy or state law, with either jurisdiction’s policy or law associated with an approximately 15 percentage point reduction in availability.

Conclusions  Both district and state policies and/or laws have the potential to reduce in-school availability of high-sugar, high-fat foods and beverages. Given the need to reduce empty calories in children’s diets, governmental policies at all levels may be an effective tool.

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Figure.
Prevalence of Competitive Beverage and Food Items by Policy Status

SSB indicates sugar-sweetened beverage. Data were weighted to the percentages of public elementary schools nationwide (unadjusted for demographic covariates). The unadjusted, overall prevalence of each food or beverage item (regardless of policy status) is presented in Table 2. The comparison of soda prevalence by policy status is not presented because only 2.2% of public elementary schools sold soda.

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