摘要：Objectives. We assessed the impact of access to school snack bars on middle school students’ fruit, vegetable, milk, and sweetened beverage consumption. Methods. Five hundred ninety-four fourth- and fifth-grade students completed lunch food records 4 times during a 2-year period. Results. The fourth-grade cohort consumed fewer fruits, regular (not fried) vegetables, and less milk and consumed more sweetened beverages and high-fat vegetables during year 2. Conclusions. Middle school students who gained access to school snack bars consumed fewer healthy foods compared with the previous school year, when they were in elementary schools and only had access to lunch meals served at school. Healthy food choices and school policies that require healthier foods at school snack bars should be promoted. American children, as a group, do not consume the recommended 5 daily servings of fruits, 100% juice, and vegetables. 1– 6 Their calcium consumption is low, likely owing to low milk consumption, while their soft drink consumption has been increasing, raising concerns about increased risks for osteoporosis and obesity. 7, 8 National School Lunch Program (NSLP) meals offer 2 servings of fruits and vegetables and 8 ounces of milk to about 95% of US children on a daily basis during the school year. 9, 10 Students who participated in the NSLP were almost twice as likely to report eating vegetables at lunch and consuming more fruits compared with nonparticipants (73% vs 40% and 48% vs 32%, respectively). 9 Students who did not eat NSLP meals were 3 times more likely to report sugar consumption (i.e., sweetened beverages, sweets) compared with NSLP participants (64% vs 21%). 9 When students transition to middle schools, they often gain access to snack bar/à la carte meals and school stores not available in elementary schools. 9 Descriptive studies have noted that the top-selling snack bar foods (e.g., pizza, chips, soda, french fries, candy, and ice cream) are high in fat and calories. 11 In middle schools, 88.5% of the foods sold in school stores are high in fat/sugar. 12 This environment does not foster healthy eating practices that are consistent with the Dietary Guidelines for Americans. 13 A cross-sectional study identified a significantly lower consumption of fruits and vegetables by fifth-grade students who had access to snack bar foods compared with fourth grade students who received only NSLP meals. 14 Fifth-grade students who selected only the NSLP lunch consumed 0.8 servings of fruits and vegetables compared with 0.4 servings for the fifth-grade students who chose only snack bar foods for lunch and 0.2 servings for the fifth grade students who brought their lunches from home. The fifth-grade students who selected the NSLP lunch had similar fruit and vegetable consumption totals as the fourth-grade students who selected the NSLP lunch (0.8 serving). 14 Our study assessed longitudinal change in fruit, vegetable, milk, and sweetened beverage consumption for 2 cohorts of students over a 2-year period during the 1998–1999 and 1999–2000 school years. Cohort 1 students attended the fourth grade during Year 1 and ate only NSLP meals. During Year 2, Cohort 1 students transitioned to the fifth and sixth grade middle school and had access to a snack bar in addition to NSLP meals; Cohort 2 students were in the middle school for both years and acted as a control for secular events during the 2-year period. We hypothesized that there would be a significant decline in fruit, regular-vegetable, and milk consumption and that there would be an increase in high-fat–vegetable and sweetened beverage consumption among the Cohort 1 students during the 2-year period because of the change in cafeteria environment. We also hypothesized that the consumption of these foods among the Cohort 2 students would remain stable during the 2-year period.
