Date on Master's Thesis/Doctoral Dissertation

5-2025

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Health Management and Systems Sciences

Degree Program

Public Health Sciences with a specialization in Health Management, PhD

Committee Chair

Karimi, Seyed

Committee Member

Cohen, Juliana

Committee Member

Little, Bertis

Committee Member

Fu, Wei

Author's Keywords

nutrition; public health; school food; competitive food; child health

Abstract

OBJECTIVES: School food can have a profound effect on the population’s health. Thirty million children receive food at school and consume half their daily calorie intake at school. Competitive foods are foods sold outside of school breakfast and lunch, such as those sold in vending machines. A new ruling for Smart Snacks Standards, a set of competitive food guidelines, started in the school year 2014-2015. It is known that competitive foods undermine school lunch participation, and a decrease in school lunch consumption is associated with poorer student health. Additionally, an increase in competitive foods tends to be of nutrient-poor foods. This research investigates the utility of the Smart Snacks Standards on the student food environment and, therefore, student health. METHODS: For a baseline understanding of competitive food regulation, a scoping review determined the effect of previous competitive food regulations. To determine how state-level competitive food policies affect the foods offered at schools, data collected on the competitive food content in a national set of schools was analyzed using linear regressions, comparing the foods offered to the strength of statewide competitive food policy. To determine how competitive food content changed before and after the Smart Snacks Standards, a nationally representative survey of schools from the CDC was used to find a relationship between competitive policy strength before and after implementation and foods offered in schools. RESULTS: The review revealed that regulating competitive foods is associated with healthier student food choices and favorable student weight. The regression model showed that states with stronger competitive food policies had better compliance with the Institute of Medicine calorie guidelines but no other policy-related effects. It also revealed that schools that provide free meals to all students had healthier competitive food offerings. The associations from the CDC survey data show a decrease in competitive food offerings after implementing the Smart Snack Standards. CONCLUSIONS: Regulating food in schools should correlate with healthier food offerings and, therefore, healthier food choices and student health. However, regulation alone does not cause healthier food options in schools. Further factors influence the competitive food environment in schools and student health.

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