title: Identifying sources of children's consumption of junk food in Boston after-school programs, April-May 2011.
abstract: BACKGROUND
  Little is known about how the nutrition environment in after-school settings may affect children's dietary intake. We measured the nutritional quality of after-school snacks provided by programs participating in the National School Lunch Program or the Child and Adult Care Food Program and compared them with snacks brought from home or purchased elsewhere (nonprogram snacks). We quantified the effect of nonprogram snacks on the dietary intake of children who also received program-provided snacks during after-school time. Our study objective was to determine how different sources of snacks affect children's snack consumption in after-school settings.
  
  
  METHODS
  We recorded snacks served to and brought in by 298 children in 18 after-school programs in Boston, Massachusetts, on 5 program days in April and May 2011. We measured children's snack consumption on 2 program days using a validated observation protocol. We then calculated within-child change-in-change models to estimate the effect of nonprogram snacks on children's dietary intake after school.
  
  
  RESULTS
  Nonprogram snacks contained more sugary beverages and candy than program-provided snacks. Having a nonprogram snack was associated with significantly higher consumption of total calories (+114.7 kcal, P < .001), sugar-sweetened beverages (+0.5 oz, P = .01), desserts (+0.3 servings, P < .001), and foods with added sugars (+0.5 servings; P < .001) during the snack period.
  
  
  CONCLUSIONS
  On days when children brought their own after-school snack, they consumed more salty and sugary foods and nearly twice as many calories than on days when they consumed only program-provided snacks. Policy strategies limiting nonprogram snacks or setting nutritional standards for them in after-school settings should be explored further as a way to promote child health.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave, SPH3, Floor 7, Boston, MA 02115. E-mail: elk782@mail.harvard.edu.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Kenney
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: S Bryn
authors.initials: SB
authors.lastname: Austin
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Angie L
authors.initials: AL
authors.lastname: Cradock
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Giles
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Rebekka M
authors.initials: RM
authors.lastname: Lee
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Davison
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
mesh_terms: D001628:Beverages; D001900:Boston; D002182:Candy; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D005247:Feeding Behavior; D063427:Food Quality; D006801:Humans; D015596:Nutrition Assessment; D009753:Nutritive Value; D012572:School Health Services / Q000706:statistics & numerical data; D012574:Schools; D062410:Snacks