title: State but not district nutrition policies are associated with less junk food in vending machines and school stores in US public schools.
abstract: BACKGROUND
  Policy that targets the school food environment has been advanced as one way to increase the availability of healthy food at schools and healthy food choice by students. Although both state- and district-level policy initiatives have focused on school nutrition standards, it remains to be seen whether these policies translate into healthy food practices at the school level, where student behavior will be impacted.
  
  
  OBJECTIVE
  To examine whether state- and district-level nutrition policies addressing junk food in school vending machines and school stores were associated with less junk food in school vending machines and school stores. Junk food was defined as foods and beverages with low nutrient density that provide calories primarily through fats and added sugars.
  
  
  METHODS
  A cross-sectional study design was used to assess self-report data collected by computer-assisted telephone interviews or self-administered mail questionnaires from state-, district-, and school-level respondents participating in the School Health Policies and Programs Study 2006. The School Health Policies and Programs Study, administered every 6 years since 1994 by the Centers for Disease Control and Prevention, is considered the largest, most comprehensive assessment of school health policies and programs in the United States.
  
  
  METHODS
  A nationally representative sample (n=563) of public elementary, middle, and high schools was studied.
  
  
  METHODS
  Logistic regression adjusted for school characteristics, sampling weights, and clustering was used to analyze data. Policies were assessed for strength (required, recommended, neither required nor recommended prohibiting junk food) and whether strength was similar for school vending machines and school stores.
  
  
  RESULTS
  School vending machines and school stores were more prevalent in high schools (93%) than middle (84%) and elementary (30%) schools. For state policies, elementary schools that required prohibiting junk food in school vending machines and school stores offered less junk food than elementary schools that neither required nor recommended prohibiting junk food (13% vs 37%; P=0.006). Middle schools that required prohibiting junk food in vending machines and school stores offered less junk food than middle schools that recommended prohibiting junk food (71% vs 87%; P=0.07). Similar associations were not evident for district-level polices or high schools.
  
  
  CONCLUSIONS
  Policy may be an effective tool to decrease junk food in schools, particularly in elementary and middle schools.
authors.affiliation: School of Nursing, University of Minnesota, 308 Harvard St SE, Minneapolis, MN 55455, USA. kubik002@umn.edu
authors.forename: Martha Y
authors.initials: MY
authors.lastname: Kubik
authors.forename: Melanie
authors.initials: M
authors.lastname: Wall
authors.forename: Lijuan
authors.initials: L
authors.lastname: Shen
authors.forename: Marilyn S
authors.initials: MS
authors.lastname: Nanney
authors.forename: Toben F
authors.initials: TF
authors.lastname: Nelson
authors.forename: Melissa N
authors.initials: MN
authors.lastname: Laska
authors.forename: Mary
authors.initials: M
authors.lastname: Story
mesh_terms: D000293:Adolescent; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005509:Food Dispensers, Automatic / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007881:Legislation, Food; D009111:Local Government; D016015:Logistic Models; D008297:Male; D018673:Nutrition Policy; D009753:Nutritive Value; D009765:Obesity / Q000517:prevention & control; D012574:Schools; D013219:State Government; D014481:United States