title: Variation in access to sugar-sweetened beverages in vending machines across rural, town and urban high schools.
abstract: OBJECTIVE
  The 2010 Dietary Guidelines for Americans include reducing consumption of sugar-sweetened beverages. Among the many possible routes of access for youth, school vending machines provide ready availability of sugar-sweetened beverages. The purpose of this study was to determine variation in high school student access to sugar-sweetened beverages through vending machines by geographic location - urban, town or rural - and to offer an approach for analysing school vending machine content.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  Between October 2007 and May 2008, trained coders recorded beverage vending machine content and machine-front advertising in 113 machines across 26 schools in New Hampshire and Vermont, USA.
  
  
  RESULTS
  Compared with town schools, urban schools were significantly less likely to offer sugar-sweetened beverages (P = 0.002). Rural schools also offered more sugar-sweetened beverages than urban schools, but this difference was not significant. Advertisements for sugar-sweetened beverages were highly prevalent in town schools.
  
  
  CONCLUSIONS
  High school students have ready access to sugar-sweetened beverages through their school vending machines. Town schools offer the highest risk of exposure; school vending machines located in towns offer up to twice as much access to sugar-sweetened beverages in both content and advertising compared with urban locations. Variation by geographic region suggests that healthier environments are possible and some schools can lead as inspirational role models.
authors.affiliation: Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03756-0001, USA. anna.adachi-ejia@dartmouth.edu
authors.forename: A M
authors.initials: AM
authors.lastname: Adachi-Mejia
authors.forename: M R
authors.initials: MR
authors.lastname: Longacre
authors.forename: M
authors.initials: M
authors.lastname: Skatrud-Mickelson
authors.forename: Z
authors.initials: Z
authors.lastname: Li
authors.forename: L A
authors.initials: LA
authors.lastname: Purvis
authors.forename: L J
authors.initials: LJ
authors.lastname: Titus
authors.forename: M L
authors.initials: ML
authors.lastname: Beach
authors.forename: M A
authors.initials: MA
authors.lastname: Dalton
mesh_terms: D000329:Advertising; D001628:Beverages / Q000600:supply & distribution*; D003430:Cross-Sectional Studies; D019422:Dietary Sucrose; D005509:Food Dispensers, Automatic / Q000706:statistics & numerical data*; D006801:Humans; D009513:New Hampshire; D012424:Rural Population; D012574:Schools / Q000706:statistics & numerical data*; D013549:Sweetening Agents / Q000600:supply & distribution*; D014505:Urban Population; D014707:Vermont
chemical_list: D019422:Dietary Sucrose; D013549:Sweetening Agents