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Potential Impact of National School Nutritional Environment Policies: Cross-sectional Associations With US Secondary Student Overweight/Obesity, 2008-2012.

Terry-McElrath YM, O'Malley PM, Johnston LD. JAMA Pediatrics, 169(1):78-85, 2014.

Importance: The latest US Department of Agriculture school meal and competitive venue standards (USDA standards) aim to improve student nutrition and health. However, significant opposition has been raised to their implementation.

Objective: To examine (1) the percentages of US middle and high school students who currently attend schools that have specific components of the USDA standards; (2) evidence that the identified USDA standard components may be associated with student overweight/obesity; and (3) evidence of sociodemographic differences in the observed associations.

Design, Setting, and Participants: We used data from annual nationally representative cross-sectional studies of students and school administrators in US public middle and high schools from the 2007-2008 through 2011-2012 school years.

Exposures: Administrator-reported school meal and competitive venue food and beverage availability.

Main Outcomes and Measures: Body mass index and overweight/obesity calculated from student self-reported height and weight.

Results: Analytical samples included 22 716 eighth grade students in 313 schools and 30 596 tenth and 12th grade students in 511 schools. The mean student response rate was 86.5%; mean school administrator response rate, 83.1%. During the study period, 21.1% of middle school and 30.1% of high school students attended schools without any of the identified components; all 5 identified components were in schools attended by only 1.8% and 0.3% of middle school and high school students, respectively. No significant associations between standard components and self-reported overweight/obesity were observed among middle school students overall. Among high school students, significantly lower odds of overweight/obesity were associated with having fruits or vegetables available wherever foods were sold (adjusted odds ratio [AOR], 0.86 [95% CI, 0.77-0.96]; P = .009), the absence of milk with higher fat levels (AOR, 0.92 [95% CI, 0.85-1.00]; P = .04), and having 3 or more USDA standard components (AOR, 0.89 [95% CI, 0.79-1.00]; P = .04). A significant association between the absence of sugar-sweetened beverages and lower overweight/obesity was found for Hispanic middle school students (AOR, 0.65 [95% CI, 0.51-0.82]; P < .001) and nonwhite high school students (AOR, 0.80 [95% CI, 0.70-0.91]; P = .001).

Conclusions and Relevance: Because only 2% of middle school and less than 1% of high school students attended schools with all 5 identified USDA standard components in place, full implementation has the potential to substantially improve school nutritional environments. Some USDA standard components were associated with a lower risk for student overweight/obesity, especially for high school and nonwhite students.

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