School Vending Machine Use and Fast-Food Restaurant Use Are Associated with Sugar-Sweetened Beverage Intake in Youth

Abstract

Objective To examine associations between use of school vending machines and fast-food restaurants and youth intake of sugar-sweetened beverages. Design A cross-sectional observational study. Subjects/setting From a group randomized obesity intervention, we analyzed baseline data from 1,474 students in 10 Massachusetts middle schools with vending machines that sold soda and/or other sweetened drinks. Main Outcome Measures Daily sugar-sweetened beverage consumption (regular soda, fruit drinks, and iced tea), purchases from school vending machines, and visits to fast-food restaurants in the preceding 7 days were estimated by self-report. Statistical Analyses Performed χ 2 and nonparametric tests were performed on unadjusted data; multivariable models adjusted for sex, grade, body mass index, and race/ethnicity, and accounted for clustering within schools. Results Among 646 students who reported using school vending machines, 456 (71%) reported purchasing sugar-sweetened beverages. Overall, 977 students (66%) reported eating at a fast-food restaurant. Sugar-sweetened beverage intakes averaged 1.2 servings per day. In adjusted models, relative to no vending machine purchases, servings per day increased by 0.21 for one to three purchases per week ( P=0.0057), and 0.71 with four or more purchases ( P<0.0001). Relative to no fast-food restaurant visits, sugar-sweetened beverage servings per day increased by 0.13 with one visit per week ( P=0.07), 0.49 with two to three visits ( P=0.0013), and by 1.64 with four or more visits ( P=0.0016). Conclusions Among students who use school vending machines, more report buying sugar-sweetened beverages than any other product category examined. Both school vending machine and fast-food restaurant use are associated with overall sugar-sweetened beverage intake. Reduction in added dietary sugars may be attainable by reducing use of these sources or changing product availability.