Association for Public Policy Analysis & Management

Sugar-sweetened beverages (SSBs) are a significant source of both calories and added sugar for youth ages 14-18 in the United States(1). The 2010 Dietary Guidelines recommend that Americans of all ages reduce their intake of SSBs, citing strong evidence that children and adolescents who consume more SSBs have increased adiposity compared to those who drink less (2). Higher consumption of SSBs has been associated with adverse health outcomes, including dental decay and diabetes (3, 4).

The school environment is a priority setting for influencing students’ health behaviors, such as SSB consumption, and for anchoring childhood obesity prevention efforts (5). Two CDC surveillance systems, the School Health Policies and Practices Study (SHPPS) and the Youth Risk Behavior Surveillance System (YRBSS) provide information about the school environment and individual student behavior, respectively. The two data sets have yet to be combined to better understand the relationship between district policies and practices and dietary-related behaviors among students in those districts.

SHHPS 2012 provide information about district-level policies and practices related to the access, availability, sales, and advertising and promotion of beverages in school districts. YRBSS 2013 describe student behavior at the individual level, including self-reported intake of select foods and beverages, including SSBs. Weighted data are available from 12 large urban school districts for both cycles of both surveys.

This paper examines the relationship between district-level SSB policies and practices and students’ self-reported SSB intake. It uses a repeated cross-sectional design to assess whether SSB consumption among students in districts that revised their policies and practices changed more than among students’ consumption in districts where policies stayed the same. To estimate the relationship between policies and youth SSB consumption patterns, we propose to analyze data from SHPPS on district policies that are believed to influence availability, access, and appeal of SSBs and healthier alternatives.

This research question is particularly relevant to adolescents, who consume a greater percentage of their calories from SSBs than younger children (1). Further, a recent literature review observed that it is easier to change school-policies around access to SSBs at the high school (HS)level, but there is less evidence of effectiveness at the HS level compared to middle and elementary schools(8).

This research will follow the random utility framework and utilize a multinomial logistic model to determine the impact of district level polices on SSB consumption. The dependent variable is determined by the YRBS data and is reported by the student. The independent variables are derived from the SHPPS data using district level matching. Confirmatory Factor Analysis and the calculation of Cronbach’s Alpha will be used to assess internal consistency. Models will look at both the coefficients for the policy categories as well as the relationship between SSB consumption and individual policies.

Understanding the existing relationship between policies and consumption, and changes in policy and consumption, may provide a useful baseline in advance of the implementation of Smart Snacks in School standards, which will further restrict the sale of SSBs in high schools.