| Summary: | Nearly one-third of children in the United States (U.S.) are classified as overweight or obese. Weight status in childhood and adolescence has been tied to adult obesity, which also affects more than one-third of adults in the U.S. Availability of foods and beverages can affect dietary habits, particularly in schools. Students spend most of their waking hours and consume almost half of their daily energy intake in schools. In July of 2014, competitive foods and beverages were required to meet the U.S. Department of Agriculture's Smart Snacks in School nutrition standards. Competitive foods and beverages are items sold outside of the National School Lunch Program and School Breakfast Program. Competitive foods include items offered à la carte, in vending machines, in school stores, and as fundraisers. The goals of this study were to: 1) examine the nutritional quality of competitive foods and beverages in vending machines and as à la carte available to students and 2) assess snack food and beverage intake by students before and after the implementation of the new standards in a sample of middle schools in rural Appalachian Virginia. Eight middle schools with higher than 50% of student eligibility for free or reduced priced lunches were included in the sample. Audits of food and beverage products sold in vending machines and à la carte were completed in the spring of 2014 and 2015. Food frequency questionnaires were completed by students in participating schools. Results showed improvements in school food offerings, though no schools were completely compliant with the new standards. The components of students' diets did not change significantly during the study period, suggesting that improved compliance may not be enough to create a dietary shift. Foods were often replaced with reformulated versions of the same products sold before the
implementation of the standards. Incentives for schools to sell more nutrient-dense options such as fruits and vegetables may be helpful to create changes in student's diets. Schools may also require additional training and assistance to fully implement nutrition standards and reach full compliance. Further research is needed to understand barriers to and possible solutions for offering healthier foods and beverages to students in middle schools. === Ph. D.
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