BackgroundStudents attending alternative high schools are an at-risk group of youth for poor health behaviors and obesity. However, little is known about their dietary practices. ObjectiveTo examine associations between sex, race/ethnicity, and socioeconomic status and selected dietary practices, including consumption of sugar-sweetened beverages, high-fat foods, and fruits and vegetables and fast-food restaurant use, among students attending alternative high schools. DesignPopulation-based, cross-sectional study. Subjects/settingA convenience sample of adolescents (n=145; 52% men; 63% aged <18 years; and 39% white, 32% African American, and 29% other/multiracial) attending six alternative high schools in the St Paul/Minneapolis, MN, metropolitan area completed a survey. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention trial. Statistical analyses performedDescriptive statistics were used to describe dietary practices. Mixed model multivariate analyses were used to assess differences in dietary practices by sex, race/ethnicity, and socioeconomic status. ResultsRegular soda was consumed at least five to six times per week by more than half of students. One half of students reported eating or drinking something from a fast-food restaurant at least three to four times a week. African-American students had the highest consumption of sugar-sweetened beverages (P=0.025), high-fat foods (P=0.002), and highest frequency of fast-food restaurant use (P<0.025). Mean fruit/vegetable intake was 3.6 servings/day; there were no sociodemographic differences in fruit/vegetable consumption. Higher socioeconomic status was associated with a higher consumption of regular soda (P=0.027). ConclusionsRacial/ethnic and sex differences in the consumption of regular soda, high-fat foods, and fast-food restaurant use among alternative high school students underscores the importance of implementing health promotion programs in alternative high schools.