Abstract
INTRODUCTION: The Healthy, Hunger-Free Kids Act of 2010 gave the U.S. Department of Agriculture authority to regulate school wellness policies, which include nutritional standards for foods advertised in schools. Brand marketing programs, which encourage students to purchase a company's products in exchange for money or rewards, were not explicitly prohibited. This study assesses the nutritional quality of products participating in "Box Tops for Education" ("Box Tops"), one of the largest national brand marketing programs in schools. METHODS: Participating foods and beverages were obtained from the Box Tops product list and matched to nutrient information and ingredients from manufacturer websites in 2016 (N=949). Products were categorized as beverages (n=13); entrees (n=171); snacks (n=677); or fruits and vegetables exempt from the Smart Snacks in School Standards ("Smart Snacks" standards) (n=88) to assess the percentage that met the Smart Snacks standards. RESULTS: Of the foods participating in the Box Tops program, 69% of beverages, 26% of entrees, and 23% of snacks met the Smart Snacks standards. Most foods met the standards for trans fats (98%); calories (90%); and sugar (89%); but fewer met the requirements for sodium (60%). Noncompliant snacks contained more than twice the recommended sodium (mean=420 mg, SD=191 mg) and percent calories from saturated fat (mean=22%, SD=13%). CONCLUSIONS: Fewer than one third of Box Tops foods met the Smart Snacks standards. Schools should consider whether the benefit of participation outweighs the harm of exposing kids to unhealthful marketing. Alternatively, schools could opt not to participate unless companies limit redeemable products to household items or healthful options meeting the Smart Snacks standards.