associated with a decline in fruit intake among students compared to those in schools that did not have snack vending machines.

Cullen and Zakeri (2004) found that when children transitioned into middle schools with additional competitive food and beverage options, consumption of fruits, milk, and non-starchy vegetables tended to be lower. Consumption of high-fat vegetables went up.

Templeton et al. (2005) examined sixth graders in three middle schools who sometimes bought competitive foods and beverages, including snack items and sweetened beverages, at school. They found that purchase of these items tended to be associated with higher food energy intakes and higher consumption of fats.

Each of these studies included a relatively small sample, but the results support the view that competitive foods and beverages may be associated with less healthful eating practices at school. It is likely that more studies will become available in the coming years as evaluations are conducted of policies designed to limit the availability of competitive foods and beverages.

Other studies have focused on factors influencing food choice by student age. O’Dea (2003) examined the ability of children and adolescents to select benefits and barriers to healthful food choices and to suggest ways to overcome them. The older students (fifth and sixth grades) were found to be able to articulate the benefits of selecting healthful foods and the adverse effects of non-healthful food choices. Neumark-Sztainer et al. (1999) assessed perceptions about factors influencing food choices among adolescents. This study found a broad range of factors that contributed to food choices, including concern for health. Among the most important factors were food appeal, convenience, and time involved in eating. However, the study also revealed that by addressing the range of factors influencing adolescent food choices, interventions could be designed to improve their choices.


There has been growing awareness among both health professionals and educators that it is important to coordinate school nutrition policies within the broader context of all school health-related programs. In particular, considering these programs in this broader context makes it possible to set priorities and to make sure that the relevant programs work in complementary ways for maximum effectiveness. Described below are components to consider in coordination of health-related policies. More detail is provided about two areas that are particularly closely linked to nutrition policy: physical education and nutrition education.

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