1. Trends in the Availability of Less Nutritious Competitive Foods and Beverages at Schools: Results from School Health Profiles Howell Wechsler, EdD, MPH Director, Division of Adolescent and School Health Southern Obesity Summit, Austin TX, October 5, 2009 Howell Wechsler, EdD, MPH Director, Division of Adolescent and School Health Southern Obesity Summit, Austin TX, October 5, 2009

2. Greater Access to Low-Nutrient, Energy Dense Competitive Foods at School is Associated With: ■ intake of total calories, soft drinks, total fat, and saturated fat Cullen K et al. JADA 100(12): 1482-1486; Cullen K & Thompson D. JADA 105(12): 1952-1954 ■ intake of fruits, vegetables, milk, and key nutrients Cullen K & Zakeri I. AJPH 94(3): 463-467 ■BMI among middle school students Fox MK et al. JADA 109(2):S108-S117; Kubik M et al. AJPH 93(7): 1168-1173

3. In 2006: 89% of high schools and 71% of middle schools had either vending machines or a school store, canteen or snack bar where students could purchase foods or beverages Source: CDC, School Health Policies and Programs Study 2006

4. Food or Beverage Middle Schools High Schools Chocolate candy2550 Cookies or other baked goods not low in fat2858 Salty snacks not low in fat (e.g., potato chips)3061 Soda pop or fruit drinks that are not 100% juice4577 Sport drinks (e.g., Gatorade)5275 Percentage of Schools in Which Students Could Purchase Selected Food and Beverages From Vending Machines or in a School Store, Canteen, or Snack Bar, by School Level, 2006 Source: CDC, School Health Policies and Programs Study

5. Percentage of Secondary Schools in Which Students Could Purchase Selected Food and Beverages From Vending Machines or in a School Store, Canteen, or Snack Bar, 2000 and 2006 Source: CDC, School Health Policies and Programs Study

6. Recent Developments in the Competitive Foods Issue ■Local Wellness Policy requirement ■Action for Healthy Kids ■Alliance for Healthier Generation ■CSPI state report cards ■States with nutritional standards for comp. foods: 2004: 6 2009: 27 ■Local Wellness Policy requirement ■Action for Healthy Kids ■Alliance for Healthier Generation ■CSPI state report cards ■States with nutritional standards for comp. foods: 2004: 6 2009: 27

7. ■Federally reimbursable school nutrition programs should be the main source of nutrition in schools. ■Opportunities for competitive foods should be limited. ■If competitive foods are available, they should consist primarily of fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.

8. ■A system of surveys assessing school health policies and programs in states, territories, large urban school districts, and tribal governments ■Conducted during even- numbered years ■Administered to middle and high school principals and lead health education teachers ■A system of surveys assessing school health policies and programs in states, territories, large urban school districts, and tribal governments ■Conducted during even- numbered years ■Administered to middle and high school principals and lead health education teachers http://www.cdc.gov/schoolhealthprofiles

9. Topics Monitored by Profiles ■School health education requirements and content ■Physical education requirements ■School health policies related to HIV infection/AIDS, tobacco-use prevention, and nutrition ■Asthma management activities ■Family and community involvement in school health programs

10. 2008 School Health Profiles State Participation Map Weighted Results Unweighted Results

11. Median Percentage of Secondary Schools That Did Not Sell Less Nutritious Foods and Beverages Among 34 States, 2006 and 2008 CDC, School Health Profiles, 2006 and 2008 *Chocolate candy, other candy, salty snacks low in fat **Not 100% juice 20062008# States With Increases Less nutritious foods* 46 Soda pop or fruit drinks** 38 Sports drinks 28 64 25 34 63 23 44

12. Percentage of Middle and High Schools That Did Not Sell Less Nutritious Foods and Beverages* Outside the School Food Service Program — Selected States and Median Among 47 States, 2008 *Baked goods and salty snacks not low in fat, chocolate and other kinds of candy, soda pop or fruit drinks that are not 100% juice CDC, School Health Profiles

13. Percentage of Secondary Schools That Did Not Sell Less Nutritious Foods and Beverages* Anywhere Outside the School Food Service Program, 2008 *Baked goods not low in fat, salty snacks not low in fat, chocolate candy, other kinds of candy, and soda pop or fruit drinks that are not 100% juice 13% - 36% 37% - 45% 46% - 57% 58% - 75% No Data School Health Profiles, 2008

14. Percentage of Secondary Schools That Did Not Sell Less Nutritious Foods and Beverages* Outside the School Food Service Program— Selected Southern States and Median Among 47 States, 2008 * Baked goods and salty snacks not low in fat, chocolate and other kinds of candy, soda pop or fruit drinks that are not 100% juice CDC, School Health Profiles 32 33 3438 39 41 46 020406080100 MO OK SC VA NC FL Median States Percentage of middle and high schools

15. Percentage of Secondary Schools That Did Not Sell Less Nutritious Foods and Beverages* Outside the School Food Service Program— Selected Southern States and Median Among 47 States, 2008 * Baked goods and salty snacks not low in fat, chocolate and other kinds of candy, soda pop or fruit drinks that are not 100% juice CDC, School Health Profiles 46 495355 59 6265 020406080100 Median AR TX WV AL KY MS TN States Percentage of middle and high schools

16. Percentage of Schools in Which Students Could Not Purchase Soda Pop or Fruit Drinks That Are Not 100% Juice — Selected States and Median Among 34 States, 2006 and 2008 % of Schools CDC, School Health Profiles 38 22 27 93 60 75 74 63 0 10 20 30 40 50 60 70 80 90 100 Median, 34 StatesMSTNCT 20062008

17. Percentage of Schools in Which Students Could Not Purchase Candy and Salty Snacks Not Low in Fat — Selected States and Median Among 34 States, 2006 and 2008 % of Schools CDC, School Health Profiles 46 23 31 72 64 0 10 20 30 40 50 60 70 80 90 100 Median, 34 StatesMSTN 20062008

18. Percentage of Schools in Which Students Could Not Purchase Soda Pop or Fruit Drinks Not 100% Juice and Candy or Salty Snacks Not Low in Fat — Alabama, 2006 and 2008 % of Schools CDC, School Health Profiles

19. Percentage of Schools in Which Students Could Not Purchase Soda Pop or Fruit Drinks Not 100% Juice and Candy or Salty Snacks Not Low in Fat — West Virginia, 2006 and 2008 % of Schools CDC, School Health Profiles

20. Percentage of Schools in Which Students Could Not Purchase Soda Pop or Fruit Drinks Not 100% Juice and Candy or Salty Snacks Not Low in Fat — Texas, 2006 and 2008 % of Schools CDC, School Health Profiles

21. Percentage of Schools in Which Students Could Not Purchase Soda Pop or Fruit Drinks Not 100% Juice and Candy or Salty Snacks Not Low in Fat — Arkansas, 2006 and 2008 % of Schools CDC, School Health Profiles

22. Percentage of Schools in Which Students Could Not Purchase Candy or Salty Snacks Not Low in Fat — Arkansas, 2002, 2004, 2006, and 2008 % of Schools CDC, School Health Profiles

23. Percentage of Schools in Which Students Could Not Purchase Soda Pop or Fruit Drinks Not 100% Juice and Candy or Salty Snacks Not Low in Fat — Florida, 2006 and 2008 % of Schools CDC, School Health Profiles

24. Percentage of Schools in Which Students Could Not Purchase Soda Pop or Fruit Drinks That Are Not 100% Juice — South Carolina and Missouri, 2006 and 2008 % of Schools CDC, School Health Profiles

25. Percentage of Schools in Which Students Could Not Purchase Soda Pop or Fruit Drinks That Are Not 100% Juice — North Carolina and Virginia, 2006 and 2008 % of Schools CDC, School Health Profiles

26. Conclusions (1) ■Survey data are critical ■Great progress has been made, albeit unevenly; much more progress is still needed ■Availability of less nutritious foods and beverages varies dramatically across states ■Survey data are critical ■Great progress has been made, albeit unevenly; much more progress is still needed ■Availability of less nutritious foods and beverages varies dramatically across states

27. Conclusions (2) ■State policies can make a huge difference ■A strong commitment to school health can make a huge difference ■Large improvements can occur in a relatively short period of time ■We can eliminate less nutritious foods and beverages from school campuses ■State policies can make a huge difference ■A strong commitment to school health can make a huge difference ■Large improvements can occur in a relatively short period of time ■We can eliminate less nutritious foods and beverages from school campuses

28. Trends in the Availability of Less Nutritious Competitive Foods and Beverages at Schools: Results from School Health Profiles Howell Wechsler, EdD, MPH Director, Division of Adolescent and School Health Southern Obesity Summit, Austin TX, October 5, 2009 Howell Wechsler, EdD, MPH Director, Division of Adolescent and School Health Southern Obesity Summit, Austin TX, October 5, 2009