Abstract
BackgroundSodas are widely sold in vending machines and other school venues in the United States, particularly in high school. Research suggests that policy changes have reduced soda access, but the impact of reduced access on consumption is unclear. This study was designed to identify student, environmental, or policy characteristics that modify the associations between school vending machines and student dietary behaviors.MethodsData on school vending machine access and student diet were obtained as part of the National Youth Physical Activity and Nutrition Study (NYPANS) and linked to state-level data on soda taxes, restaurant taxes, and state laws governing the sale of soda in schools. Regression models were used to: 1) estimate associations between vending machine access and soda consumption, fast food consumption, and lunch source, and 2) determine if associations were modified by state soda taxes, restaurant taxes, laws banning in-school soda sales, or student characteristics (race/ethnicity, sex, home food access, weight loss behaviors.)ResultsContrary to the hypothesis, students tended to consume 0.53 fewer servings of soda/week (95% CI: -1.17, 0.11) and consume fast food on 0.24 fewer days/week (95% CI: -0.44, -0.05) if they had in-school access to vending machines. They were also less likely to consume soda daily (23.9% vs. 27.9%, average difference = -4.02, 95% CI: -7.28, -0.76). However, these inverse associations were observed primarily among states with lower soda and restaurant tax rates (relative to general food tax rates) and states that did not ban in-school soda sales. Associations did not vary by any student characteristics except for weight loss behaviors.ConclusionIsolated changes to the school food environment may have unintended consequences unless policymakers incorporate other initiatives designed to discourage overall soda consumption.
Highlights
Sugar-sweetened beverage (SSB) consumption has become one of the primary targets of childhood obesity prevention efforts in the United States (U.S.) [1]
The exception was that students with vending machines were more likely to be from the Midwest (30.0%) and less likely to be from the Northeast (11.1%) relative to students without vending machines (15.8% and 24.9%, respectively.) Students without vending machines were less likely to be obese but more likely to be overweight, and they reported slightly more servings of fast food and soda, relative to students with vending machines
Soda servings/week Daily soda consumption c Days of fast food/week Lunch outside school/home c aAME = Average marginal effect, adjusted for race/ethnicity, sex, grade, state median income, and Census region average marginal effects (AME) represents the average difference in outcome of interest associated with presence of vending machines that sell sugar-sweetened beverages in school, the state measure of interest; and interaction between the two. bDisfavored tax. cBinary measure. dState laws that ban the sale of soda in vending machines, school stores, and cafeterias. doi:10.1371/journal.pone.0098249.t003
Summary
Sugar-sweetened beverage (SSB) consumption has become one of the primary targets of childhood obesity prevention efforts in the United States (U.S.) [1]. Recent evidence suggests that adolescents have gradually been replacing soda with other SSBs, but soda remains the most heavily consumed sweetened beverage [6]. Numerous policy initiatives have been proposed to reduce consumption of soda and other SSBs, including taxes, marketing regulations, limits on portion sizes, and limits on sugar content [9,10,11,12]. Evidence at all grade levels suggests that policies that ban SSBs have succeeded in reducing students’ access to SSBs [15,16,17,18], though policies at the high school level tend to focus exclusively on soda. This study was designed to identify student, environmental, or policy characteristics that modify the associations between school vending machines and student dietary behaviors
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