title: Accessibility over availability: associations between the school food environment and student fruit and green vegetable consumption.
abstract: BACKGROUND
  No national studies have examined associations between (1) school food availability and accessibility and (2) secondary student fruit and vegetable (FV) consumption. This article uses 5 years of nationally representative data from secondary school students to examine associations between the school food environment and student fruit and green vegetable consumption.
  
  
  METHODS
  From 2008 to 2012, cross-sectional, nationally representative data from US middle and high school students were collected annually on self-reported fruit and green vegetable consumption. Each year, data from administrators at each relevant school were collected on food item availability (any venue) and accessibility (total number of school sources). Data were obtained from 10,254 eighth-grade students in 317 schools and 18,898 tenth- and 12th-grade students in 518 schools. Associations were estimated by multi-level models controlling for student- and school-level characteristics.
  
  
  RESULTS
  Availability showed minimal association with student consumption. Candy/regular-fat snack accessibility was associated negatively with middle school fruit consumption. Salad bar availability and accessibility were positively associated with middle school green vegetable consumption; FV accessibility was associated positively with high school fruit and green vegetable consumption. Significant associations were consistent across student racial/ethnic and socioeconomic groups.
  
  
  CONCLUSIONS
  Forthcoming USDA nutrition standards for school foods and beverages sold outside of reimbursable meal programs should result in the removal of school candy/regular-fat snacks. In deciding which items to make available under the new standards, schools should consider increasing the number of FV sources-including salad bars-thereby potentially increasing student FV consumption.
authors.affiliation: Institute for Social Research, University of Michigan , Ann Arbor, MI.
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Terry-McElrath
authors.forename: Patrick M
authors.initials: PM
authors.lastname: O'Malley
authors.forename: Lloyd D
authors.initials: LD
authors.lastname: Johnston
mesh_terms: D000293:Adolescent; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D005518:Food Preferences; D005522:Food Services / Q000331:legislation & jurisprudence / Q000592:standards*; D005523:Food Supply / Q000592:standards*; D005638:Fruit; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D018673:Nutrition Policy; D009751:Nutritional Requirements; D012574:Schools; D013334:Students; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D016885:United States Department of Agriculture; D014675:Vegetables