title: School vending machine use and fast-food restaurant use are associated with sugar-sweetened beverage intake in youth.
abstract: OBJECTIVE
  To examine associations between use of school vending machines and fast-food restaurants and youth intake of sugar-sweetened beverages.
  
  
  METHODS
  A cross-sectional observational study.
  
  
  METHODS
  From a group randomized obesity intervention, we analyzed baseline data from 1,474 students in 10 Massachusetts middle schools with vending machines that sold soda and/or other sweetened drinks.
  
  
  METHODS
  Daily sugar-sweetened beverage consumption (regular soda, fruit drinks, and iced tea), purchases from school vending machines, and visits to fast-food restaurants in the preceding 7 days were estimated by self-report.
  
  
  METHODS
  Chi(2) and nonparametric tests were performed on unadjusted data; multivariable models adjusted for sex, grade, body mass index, and race/ethnicity, and accounted for clustering within schools.
  
  
  RESULTS
  Among 646 students who reported using school vending machines, 456 (71%) reported purchasing sugar-sweetened beverages. Overall, 977 students (66%) reported eating at a fast-food restaurant. Sugar-sweetened beverage intakes averaged 1.2 servings per day. In adjusted models, relative to no vending machine purchases, servings per day increased by 0.21 for one to three purchases per week (P=0.0057), and 0.71 with four or more purchases (P<0.0001). Relative to no fast-food restaurant visits, sugar-sweetened beverage servings per day increased by 0.13 with one visit per week (P=0.07), 0.49 with two to three visits (P=0.0013), and by 1.64 with four or more visits (P=0.0016).
  
  
  CONCLUSIONS
  Among students who use school vending machines, more report buying sugar-sweetened beverages than any other product category examined. Both school vending machine and fast-food restaurant use are associated with overall sugar-sweetened beverage intake. Reduction in added dietary sugars may be attainable by reducing use of these sources or changing product availability.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA. jwiecha@hsph.harvard.edu <jwiecha@hsph.harvard.edu>
authors.forename: Jean L
authors.initials: JL
authors.lastname: Wiecha
authors.forename: Daniel
authors.initials: D
authors.lastname: Finkelstein
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Troped
authors.forename: Maren
authors.initials: M
authors.lastname: Fragala
authors.forename: Karen E
authors.initials: KE
authors.lastname: Peterson
mesh_terms: D000293:Adolescent; D001628:Beverages / Q000706:statistics & numerical data; D002253:Carbonated Beverages / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004034:Diet Surveys; D019422:Dietary Sucrose / Q000008:administration & dosage*; D005260:Female; D005509:Food Dispensers, Automatic / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D009765:Obesity / Q000209:etiology / Q000517:prevention & control; D012147:Restaurants / Q000706:statistics & numerical data*; D012650:Self Disclosure; D018709:Statistics, Nonparametric
chemical_list: D019422:Dietary Sucrose