Association between district and state policies and US public elementary school competitive food and beverage environments.

IMPORTANCE Given the importance of developing healthy eating patterns during early childhood, policies to improve the elementary school food and beverage environments are critical. OBJECTIVE To examine the association between district and state policy and/or law requirements regarding competitive food and beverages and public elementary school availability of foods and beverages high in fats, sugars, and/or sodium. DESIGN AND SETTING Multivariate, pooled, cross-sectional analysis of data gathered annually during elementary school years 2008-2009 through 2010-2011 in the United States. PARTICIPANTS Survey respondents at 1814 elementary schools (1485 unique) in 957 districts in 45 states (food analysis) and 1830 elementary schools (1497 unique) in 962 districts and 45 states (beverage analysis). EXPOSURES Competitive food and beverage policy restrictions at the state and/or district levels. MAIN OUTCOME AND MEASURE Competitive food and beverage availability. RESULTS Sweets were 11.2 percentage points less likely to be available (32.3% vs 43.5%) when both the district and state limited sugar content, respectively. Regular-fat baked goods were less available when the state law, alone and in combination with district policy, limited fat content. Regular-fat ice cream was less available when any policy (district, state law, or both) limited competitive food fat content. Sugar-sweetened beverages were 9.5 percentage points less likely to be available when prohibited by district policy (3.6% vs 13.1%). Higher-fat milks (2% or whole milk) were less available when prohibited by district policy or state law, with either jurisdiction's policy or law associated with an approximately 15 percentage point reduction in availability. CONCLUSIONS Both district and state policies and/or laws have the potential to reduce in-school availability of high-sugar, high-fat foods and beverages. Given the need to reduce empty calories in children's diets, governmental policies at all levels may be an effective tool.