摘要：Objectives. We examined state laws affecting the school food environment and changes in these laws between 2003 to 2008. Methods. We used the Westlaw legal database to identify state-codified laws, with scoring derived from the updated School Nutrition–Environment State Policy Classification System, obtained from the Classification of Laws Associated With School Students Web site. Results. States significantly changed their school nutrition laws from 2003 to 2008, and many increased the stringency of the laws targeting competitive foods (snacks and entrées sold in competition with the school meal) and beverages sold in school and for in-school fundraising. Many states enacted laws that mandated the establishment of a coordinating or advisory wellness team or council. Stronger laws were enacted for elementary grades. We found tremendous variability in the strength of the laws and plenty of room for improvement. Conclusions. State law governing school nutrition policies significantly changed from 2003 to 2008, primarily affecting the competitive food environment in schools. The extent to which changes in school nutrition laws will lead to desired health outcomes is an area for additional research. Childhood obesity is on the rise in many industrialized nations, and prevalence in the United States has reached alarming proportions. 1 Obesity is a complex and multifactorial problem that requires population-based preventive solutions. 2,3 Focusing on the school food environment is considered to be an important starting point because almost all children attend school, and they consume about one third of their caloric requirements there. 4 In the past decade, ideas about school nutrition policies to optimize the nutritional environment of schools have undergone a drastic shift. In the intervention literature, modification of the school nutrition environment has been associated with student eating behaviors, but its influence on obesity is unclear. 5–7 Evidence suggests that food and beverage availability, 8–12 quality of the food offered in schools, 13,14 length of the lunch period, 15 and pricing and marketing practices 16–19 in schools have had an impact on student eating behaviors (total intake, fat consumption, and food preferences). In cross-sectional studies, the school nutrition environment has been linked with children's eating behaviors and body mass index (BMI). 20,21 In light of this evidence, it is not surprising that policymakers are resorting to strategies to modify the school nutrition environment to ultimately affect childhood obesity. As school nutrition policies are increasingly being used to curb the rise in childhood obesity, support for such policies in the scientific literature is emerging. 22–29 State laws and district policies have been found to influence the school nutrition environment: studies reveal an inverse association between school nutrition policies and the availability of less healthy foods and beverages at school. 22–29 For example, Mendoza et al. noted significant improvements in the energy density of the foods and beverages consumed at lunchtime among sixth and eighth graders after the Texas nutrition policy was implemented. 28 In addition, school nutrition policies have been favorably associated with the prevalence of overweight and obesity in children; some studies report that the increase in prevalence has been halted as a result of these policies. 16,26,30–32 When researchers have evaluated the influence of both state and district school nutrition policies, state laws have been found to be more important in influencing behaviors and BMI. 33 Because state laws and policies will likely have wider influence on the school environment, it is essential to monitor the enactment of laws and the strength of these laws across states. We aimed to (1) update the status of state laws for school nutrition–related policies with the revised School Nutrition–Environment State Policy Classification System (SNESPCS), which was previously published in 2007, 34 and (2) examine whether state laws focused on school nutrition–related policies changed from 2003 to 2008. Improvements were expected during this period because the US Congress mandated significant improvement in the school environment as part of the Child Nutrition and Women, Infants, and Children Reauthorization Act of 2004. 35 Specifically, Congress required all school districts that participate in the National School Lunch Program and other federal child nutrition programs to develop and implement a local school wellness policy by the 2006 to 2007 school year that includes, but is not limited to goals for nutrition education, guidelines for food and beverage availability at school, assurance that federal regulations for the reimbursable school meal are followed, a plan for assessing implementation of the policy as well as designation of staff responsible for the implementation of the wellness policy, and involvement of the school community in the development of the policy. Although the wellness policy was required at the district level, many states enacted laws around this time related to the school nutrition environment to provide a framework for districts to follow. Our previous assessment of state laws in this area indicated wide variations by grade, 34 so we examined changes by elementary, middle, and high school levels.
