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Encouraging Trends in Student Access to Competitive Beverages in US Public Elementary Schools, 2006-2007 to 2010-2011

Encouraging Trends in Student Access to Competitive Beverages in US Public Elementary Schools,... Access to competitive foods and beverages in schools—via vending machines, stores/snack bars, and à la carte lines—leads to consumption of unhealthy products,1,2 such as sugar-sweetened beverages (SSBs), which are associated with obesity.3,4 To reverse the childhood obesity epidemic, authorities have called for schools to limit the availability of high-calorie beverages5-7; the Institute of Medicine (IOM) recommends that competitive beverages in elementary schools be limited to water, 100% juice, and nonfat or 1% milk.8 Previously, we reported on competitive beverage availability in elementary schools from 2006-2007 to 2008-2009.9 Herein, we extend those findings with 2 additional years of data. Methods Methods We gathered data on school practices via mail-back surveys at nationally representative samples of public elementary schools in the contiguous United States. The samples were developed at the Institute for Survey Research at the University of Michigan, based on public use data sets from the National Center for Education Statistics. Surveys were completed by school principals and food service staff during the spring (second half) of each school year, from 2006-2007 to 2010-2011. The institutional review board at the University of Illinois at Chicago approved the study protocol and survey materials. Extensive methodological detail is given elsewhere.9,10 Methods We conducted analyses in Stata/SE version 10.0 (StataCorp) to account for sampling stratum and for clustering of schools within districts and states. Weights were developed based on student enrollment and adjusted for potential school nonresponse; all analyses were conducted using these weights, which provide inference to public elementary school students across the United States. Time trends were evaluated in multivariate logistic regression models (controlling for school characteristics) with a linear term and a quadratic term to examine curvilinear trends; both were centered at zero. Results Results Student access to beverages in any competitive venue on campus peaked at 61.3% in 2008-2009 and dropped thereafter (Table). The percentage of students who could purchase only IOM-approved competitive beverages increased linearly. Considering specific venues, vending machine access decreased steadily. There were significant curvilinear trends in access to stores/snack bars and á la carte lines, peaking during 2008-2009 and dropping thereafter. In those venues, availability of high-fat milks peaked in 2007-2008, which appears to be driving the corresponding curvilinear trend in availability of non–IOM-approved beverages in stores/snack bars and á la carte lines. Results Table. Percentage of Students in US Public Elementary Schools With Access to Competitive Beverages in School During the 2006-2007 to 2010-2011 School Years, Stratified by Venuea View LargeDownload Comment Comment Beverage vending and the availability of SSBs anywhere on campus decreased steadily since 2006-2007. Student access to stores/snack bars and á la carte beverage lines peaked in 2008-2009 and decreased thereafter. As of 2010-2011, one-third of public elementary school students had access to non–IOM-approved beverages in any competitive venue on campus, and only 11.9% had SSBs available. Comment In May 2006, the Alliance for a Healthier Generation reached an agreement with the American Beverage Association to limit portion sizes and energy content of beverages offered to students. Those guidelines11 are consistent with the IOM recommendations. An evaluation released by the American Beverage Association reported that beverage shipments to schools dropped by 72% from 2004 to 2009, but that analysis relied on bottler-supplied reports of shipments to schools that mostly had exclusive distribution contracts. In contrast, our previous analyses9 indicated that higher-fat milks and SSBs continued to be offered in 2008-2009, perhaps because those products were sourced outside of formal distribution contracts. The American Beverage Association analysis included data for the first half of the 2009-2010 school year, which we then did not include; however, our current data also show that during 2009-2010, the trend of increasing access to competitive venues reversed, as did the availability of higher-fat milks in stores/snack bars and á la carte lines. This is encouraging, as is the current finding that SSB availability in vending machines (ie, the venue most often covered by distribution contracts) steadily decreased. Increases in district policies pertaining to competitive beverages12 may have contributed to these improvements and that association will be examined in forthcoming reports. Comment While subject to the typical limitations of survey research (eg, reporting bias), the current analyses are based on large, nationally representative data sets. Although there is still progress to be made, the trends are encouraging and show not only that change in the school beverage environment is possible, but that it is already under way. Back to top Article Information Correspondence: Dr Turner, Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W Roosevelt Rd, Ste 558, Chicago, IL 60608 (lindseyt@uic.edu). Author Contributions: Dr Turner had full access to the data and takes responsibility for the integrity of the data and the accuracy of the analyses. Study concept and design: Turner and Chaloupka. Acquisition of data: Turner and Chaloupka. Analysis and interpretation of data: Turner and Chaloupka. Drafting of the manuscript: Turner and Chaloupka. Critical revision of the manuscript for important intellectual content: Turner and Chaloupka. Statistical analysis: Turner and Chaloupka. Obtained funding: Chaloupka. Administrative, technical, and material support: Turner and Chaloupka. Study supervision: Turner and Chaloupka. Financial Disclosure: None reported. Funding/Support: Research support was provided by the Robert Wood Johnson Foundation. Disclaimer: This article was written by the Bridging the Gap Research Program and the conclusions therein do not necessarily reflect the views of the foundation. Additional Contributions: We thank Anna Sandoval, MPH, for assistance with data collection. We thank the Robert Wood Johnson Foundation for financial support. References 1. Fox MK, Gordon A, Nogales R, Wilson A. Availability and consumption of competitive foods in US public schools. J Am Diet Assoc. 2009;109(2):(suppl) S57-S6619166673PubMedGoogle ScholarCrossref 2. Briefel RR, Wilson A, Gleason PM. Consumption of low-nutrient, energy-dense foods and beverages at school, home, and other locations among school lunch participants and nonparticipants. J Am Diet Assoc. 2009;109(2):(suppl) S79-S9019166676PubMedGoogle ScholarCrossref 3. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84(2):274-28816895873PubMedGoogle Scholar 4. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97(4):667-67517329656PubMedGoogle ScholarCrossref 5. Institute of Medicine Committee on Prevention of Obesity in Children and Youth. Childhood Obesity: Health in the Balance. Washington, DC: National Academy of Sciences; 2005 6. Story M, Kaphingst KM, French S. The role of schools in obesity prevention. Future Child. 2006;16(1):109-14216532661PubMedGoogle ScholarCrossref 7. Brownell KD, Schwartz MB, Puhl RM, Henderson KE, Harris JL. The need for bold action to prevent adolescent obesity. J Adolesc Health. 2009;45(3):(suppl) S8-S1719699441PubMedGoogle ScholarCrossref 8. Institute of Medicine. Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth. Washington, DC: The National Academies Press; 2007 9. Turner L, Chaloupka FJ. Wide availability of high-calorie beverages in US elementary schools. Arch Pediatr Adolesc Med. 2011;165(3):223-22821041590PubMedGoogle ScholarCrossref 10. Turner L, Chaloupka FJ, Chriqui JF, Sandoval A. School Policies and Practices to Improve Health and Prevent Obesity: National Elementary School Survey Results. School Years 2006-07 and 2007-08. Vol 1. Chicago: Bridging the Gap, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago; 2010 11. Competitive beverage guidelines. Alliance for a Healthier Generation website. http://www.healthiergeneration.org/companies.aspx?id=1376. Accessed July 27, 2010 12. Chriqui JF, Schneider L, Chaloupka FJ. School District Wellness Policies: Evaluating Progress and Potential for Improving Children's Health Three Years After the Federal Mandate. School Years 2006-07, 2007-08 and 2008-09. Vol 2. Chicago: Bridging the Gap, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago; 2010 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Encouraging Trends in Student Access to Competitive Beverages in US Public Elementary Schools, 2006-2007 to 2010-2011

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Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpediatrics.2012.487
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Abstract

Access to competitive foods and beverages in schools—via vending machines, stores/snack bars, and à la carte lines—leads to consumption of unhealthy products,1,2 such as sugar-sweetened beverages (SSBs), which are associated with obesity.3,4 To reverse the childhood obesity epidemic, authorities have called for schools to limit the availability of high-calorie beverages5-7; the Institute of Medicine (IOM) recommends that competitive beverages in elementary schools be limited to water, 100% juice, and nonfat or 1% milk.8 Previously, we reported on competitive beverage availability in elementary schools from 2006-2007 to 2008-2009.9 Herein, we extend those findings with 2 additional years of data. Methods Methods We gathered data on school practices via mail-back surveys at nationally representative samples of public elementary schools in the contiguous United States. The samples were developed at the Institute for Survey Research at the University of Michigan, based on public use data sets from the National Center for Education Statistics. Surveys were completed by school principals and food service staff during the spring (second half) of each school year, from 2006-2007 to 2010-2011. The institutional review board at the University of Illinois at Chicago approved the study protocol and survey materials. Extensive methodological detail is given elsewhere.9,10 Methods We conducted analyses in Stata/SE version 10.0 (StataCorp) to account for sampling stratum and for clustering of schools within districts and states. Weights were developed based on student enrollment and adjusted for potential school nonresponse; all analyses were conducted using these weights, which provide inference to public elementary school students across the United States. Time trends were evaluated in multivariate logistic regression models (controlling for school characteristics) with a linear term and a quadratic term to examine curvilinear trends; both were centered at zero. Results Results Student access to beverages in any competitive venue on campus peaked at 61.3% in 2008-2009 and dropped thereafter (Table). The percentage of students who could purchase only IOM-approved competitive beverages increased linearly. Considering specific venues, vending machine access decreased steadily. There were significant curvilinear trends in access to stores/snack bars and á la carte lines, peaking during 2008-2009 and dropping thereafter. In those venues, availability of high-fat milks peaked in 2007-2008, which appears to be driving the corresponding curvilinear trend in availability of non–IOM-approved beverages in stores/snack bars and á la carte lines. Results Table. Percentage of Students in US Public Elementary Schools With Access to Competitive Beverages in School During the 2006-2007 to 2010-2011 School Years, Stratified by Venuea View LargeDownload Comment Comment Beverage vending and the availability of SSBs anywhere on campus decreased steadily since 2006-2007. Student access to stores/snack bars and á la carte beverage lines peaked in 2008-2009 and decreased thereafter. As of 2010-2011, one-third of public elementary school students had access to non–IOM-approved beverages in any competitive venue on campus, and only 11.9% had SSBs available. Comment In May 2006, the Alliance for a Healthier Generation reached an agreement with the American Beverage Association to limit portion sizes and energy content of beverages offered to students. Those guidelines11 are consistent with the IOM recommendations. An evaluation released by the American Beverage Association reported that beverage shipments to schools dropped by 72% from 2004 to 2009, but that analysis relied on bottler-supplied reports of shipments to schools that mostly had exclusive distribution contracts. In contrast, our previous analyses9 indicated that higher-fat milks and SSBs continued to be offered in 2008-2009, perhaps because those products were sourced outside of formal distribution contracts. The American Beverage Association analysis included data for the first half of the 2009-2010 school year, which we then did not include; however, our current data also show that during 2009-2010, the trend of increasing access to competitive venues reversed, as did the availability of higher-fat milks in stores/snack bars and á la carte lines. This is encouraging, as is the current finding that SSB availability in vending machines (ie, the venue most often covered by distribution contracts) steadily decreased. Increases in district policies pertaining to competitive beverages12 may have contributed to these improvements and that association will be examined in forthcoming reports. Comment While subject to the typical limitations of survey research (eg, reporting bias), the current analyses are based on large, nationally representative data sets. Although there is still progress to be made, the trends are encouraging and show not only that change in the school beverage environment is possible, but that it is already under way. Back to top Article Information Correspondence: Dr Turner, Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W Roosevelt Rd, Ste 558, Chicago, IL 60608 (lindseyt@uic.edu). Author Contributions: Dr Turner had full access to the data and takes responsibility for the integrity of the data and the accuracy of the analyses. Study concept and design: Turner and Chaloupka. Acquisition of data: Turner and Chaloupka. Analysis and interpretation of data: Turner and Chaloupka. Drafting of the manuscript: Turner and Chaloupka. Critical revision of the manuscript for important intellectual content: Turner and Chaloupka. Statistical analysis: Turner and Chaloupka. Obtained funding: Chaloupka. Administrative, technical, and material support: Turner and Chaloupka. Study supervision: Turner and Chaloupka. Financial Disclosure: None reported. Funding/Support: Research support was provided by the Robert Wood Johnson Foundation. Disclaimer: This article was written by the Bridging the Gap Research Program and the conclusions therein do not necessarily reflect the views of the foundation. Additional Contributions: We thank Anna Sandoval, MPH, for assistance with data collection. We thank the Robert Wood Johnson Foundation for financial support. References 1. Fox MK, Gordon A, Nogales R, Wilson A. Availability and consumption of competitive foods in US public schools. J Am Diet Assoc. 2009;109(2):(suppl) S57-S6619166673PubMedGoogle ScholarCrossref 2. Briefel RR, Wilson A, Gleason PM. Consumption of low-nutrient, energy-dense foods and beverages at school, home, and other locations among school lunch participants and nonparticipants. J Am Diet Assoc. 2009;109(2):(suppl) S79-S9019166676PubMedGoogle ScholarCrossref 3. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84(2):274-28816895873PubMedGoogle Scholar 4. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97(4):667-67517329656PubMedGoogle ScholarCrossref 5. Institute of Medicine Committee on Prevention of Obesity in Children and Youth. Childhood Obesity: Health in the Balance. Washington, DC: National Academy of Sciences; 2005 6. Story M, Kaphingst KM, French S. The role of schools in obesity prevention. Future Child. 2006;16(1):109-14216532661PubMedGoogle ScholarCrossref 7. Brownell KD, Schwartz MB, Puhl RM, Henderson KE, Harris JL. The need for bold action to prevent adolescent obesity. J Adolesc Health. 2009;45(3):(suppl) S8-S1719699441PubMedGoogle ScholarCrossref 8. Institute of Medicine. Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth. Washington, DC: The National Academies Press; 2007 9. Turner L, Chaloupka FJ. Wide availability of high-calorie beverages in US elementary schools. Arch Pediatr Adolesc Med. 2011;165(3):223-22821041590PubMedGoogle ScholarCrossref 10. Turner L, Chaloupka FJ, Chriqui JF, Sandoval A. School Policies and Practices to Improve Health and Prevent Obesity: National Elementary School Survey Results. School Years 2006-07 and 2007-08. Vol 1. Chicago: Bridging the Gap, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago; 2010 11. Competitive beverage guidelines. Alliance for a Healthier Generation website. http://www.healthiergeneration.org/companies.aspx?id=1376. Accessed July 27, 2010 12. Chriqui JF, Schneider L, Chaloupka FJ. School District Wellness Policies: Evaluating Progress and Potential for Improving Children's Health Three Years After the Federal Mandate. School Years 2006-07, 2007-08 and 2008-09. Vol 2. Chicago: Bridging the Gap, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago; 2010

Journal

Archives of Pediatrics & Adolescent Medicine – American Medical Association

Published: Jul 1, 2012

Keywords: beverages,elementary schools

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