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

https://doi.org/10.1016/j.jada.2006.07.007Get rights and content

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

χ2 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.

Section snippets

Setting

In the 2002/2003 and 2003/2004 school years, 13 Massachusetts middle schools participated in 5-2-1-Go!, a group randomized trial of an intervention to reduce obesity conducted by the Massachusetts Department of Public Health. Schools invited to participate in the study were the 289 serving grades 6 to 8 that were participants in the Massachusetts Department of Public Health Enhanced School Health Services program. Of these, 16 agreed to participate and to be randomized into an intervention or

Results

The number of vending machines at each school ranged from one to five, for a total of 20. All of the 10 schools sold soda and/or other sweetened drinks in their vending machines. Two sold regular (sweetened) soda, seven sold other sweetened drinks, and one sold both categories of beverages. Other items observed in vending machines and the number of schools where they were sold were: water (four schools), 100% fruit juice (two schools), salty snacks (one school), cookies (one school), and ice

Discussion

In this study, the number of items youths purchased at school vending machines was directly associated with sugar-sweetened beverage purchase and intake. Moreover, sugar-sweetened beverages were purchased by more students than any other type of item, among those who used the school vending machine, and were purchased by roughly three times as many students as purchased the next most popular item (water). Number of visits to fast-food restaurants was also directly associated with sugar-sweetened

J. L. Wiecha is a senior research scientist, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA.

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      Vending machine density is particularly high at high schools and universities: around 75% to 80% of these institutions facilitate snack foods and beverages through one or more vending machines (Larson and Story, 2010; Mikolajczak et al., 2012). Since vending-machine use is associated with detrimental dietary behaviours (e.g. Wiecha et al., 2006), implementing interventions that stimulate low-calorie choices in vending machines is a promising avenue to lower caloric intake through snacking. Previous research on vending-machine interventions show mixed results.

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    J. L. Wiecha is a senior research scientist, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA.

    D. Finkelstein is a researcher, Mathematica Policy Research, Inc, Cambridge, MA.

    P. J. Troped is an assistant professor, Department of Health and Kinesiology, Purdue University, West Lafayette, IN.

    M. Fragala is a doctoral fellow, Department of Kinesiology, University of Connecticut, Storrs.

    a

    At the time of the study, D. Finkelstein was a senior data analyst, P. J. Troped was a research associate, and M. Fragala was a research assistant, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA. K. E. Peterson is an associate professor, Department of Nutrition, Harvard School of Public Health, Boston, MA.

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