A healthy trend: less food used in fundraising and as rewards and incentives in Minnesota middle and high schools.

OBJECTIVE To assess change in the 4-year prevalence (2006-2009) of the use of food in school fundraising and as rewards and incentives for students, following implementation of federal legislation in the USA in 2006. DESIGN Serial cross-sectional design using trend analysis to assess school-level data collected over four consecutive years from 2006/2007 to 2009/2010. SETTING Minneapolis/St. Paul, MN. SUBJECTS Convenience sample of middle and high schools participating in two longitudinal, aetiological studies that examined youth, their environment and obesity-related factors. RESULTS A significant and sustained decrease was demonstrated in the use of low-nutrient, energy-dense foods in school fundraising activities and the use of food and food coupons as rewards and incentives by teachers and school staff. CONCLUSIONS Results support the utility of policy and legislative action as a tool for creating healthy, sustainable environmental change.