Impact of Connecticut Legislation Incentivizing Elimination of Unhealthy Competitive Foods on National School Lunch Program Participation

摘要

Objectives. We analyzed the impact of Connecticut legislation incentivizing voluntary school district–level elimination of unhealthy competitive foods on National School Lunch Program (NSLP) participation. Methods. We analyzed data on free, reduced, and paid participation in the NSLP from 904 schools within 154 Connecticut school districts from the 2004–2005 to the 2009–2010 school year, resulting in 5064 observations of annual school-level meal participation. We used multilevel regression modeling techniques to estimate the impact of the state competitive food legislation on the count of NSLP lunches served per student in each school. Results. Overall, the state statute was associated with an increase in school lunch participation. We observed increases between 7% and 23% for middle- and high-school meal programs, and a slight decrease of 2.5% for the elementary school free meal eligibility category, leading to an estimated revenue increase of roughly $30?000 for an average school district per school year. Conclusions. This study provides support for national implementation of proposed rigorous competitive food standards that can improve the health of students while supporting local school district finances. Federal meal programs in the United States serve more than 30 million students every day, providing an unparalleled opportunity to improve the diet of the nation’s youths. 1 Recent changes to school meal program regulations will substantially improve the nutritional quality of meals that have already succeeded at preventing childhood nutritional deficiencies in the United States. 2–4 Public health efforts to reduce childhood obesity rates and improve diet quality in the United States have increasingly focused on improving the food environment in schools. 5–7 The sale of foods in schools outside the school meal programs, known as competitive foods, has been consistently linked with unhealthy diet and, in some but not all studies, 8 with increased risk of obesity. 9 Energy-dense, nutrient-poor competitive foods and beverages are widely available in US schools and are regularly consumed by children. 10–13 A number of local school district and statewide policy changes reducing or eliminating the sale of unhealthy competitive food and beverages at school have been shown to improve dietary outcomes, including reduced sugar-sweetened beverage consumption and increased consumption of fruits and vegetables. 14–16 Sanchez-Vaznaugh et al. reported that removing unhealthy competitive foods may be linked to a lower incidence of overweight in children in California. 17 Taber et al. reported findings based on the Early Childhood Longitudinal Study–Kindergarten showing that adolescents in states with strong competitive food standards from 2003 to 2006 gained 0.44 body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) units less than adolescents in states without such standards. 18 Despite the success of some state and local policies, national policy efforts have so far failed to sufficiently address the negative impact of the sale of unhealthy competitive foods on children’s health. The Child Nutrition and WIC Reauthorization Act of 2004 required all school districts participating in the National School Lunch Program (NSLP) to develop wellness policies that include nutrition guidelines for all foods available at schools by the 2006–2007 school year. 19 However, the legislation did not require districts to implement specific competitive food policies. 5 A review of a nationally representative sample of wellness policies and related regulations from 2006–2007 up to 2008–2009 found that, although some districts have implemented strong policies, in general, rules governing competitive food sales were weak or nonexistent. 20 In response to concerns about the role of both the school meal programs and competitive foods in addressing the obesity epidemic, Congress passed The Healthy, Hunger-Free Kids Act of 2010. 21 The act required the US Department of Agriculture (USDA) to update the nutrition standards for the NSLP and the School Breakfast Program while providing a performance-based increase in reimbursement rate for lunches. The bill also for the first time gave the USDA authority to set nutrition standards for competitive foods sold throughout the school day. 21 Congress instructed the USDA to develop nutrition standards for competitive foods that align with the current Dietary Guidelines for Americans 22 while giving consideration to practical application of the standards. The USDA is currently developing competitive food standards with the goal of releasing final regulations in 2013. Reactions to the USDA’s revised nutrition standards for the school meal program suggest that the USDA may face strong opposition to nutritionally rigorous competitive food standards. 23,24 In addition to objections raised by food industry associations, the School Nutrition Association, which repres