Children Select Unhealthy Choices when Given a Choice among Snack Offerings.

Out-of-school-time programs serve snacks to millions of children annually. State and national snack policies endorse serving more-healthful options, such as fruits, yet often allow less-healthful options, such as cookies and chips, to be served simultaneously. To date, no studies have examined the choices children make when provided with disparate snack options in out-of-school-time programs. An experimental study with randomized exposures was conducted that exposed children (5 to 10 years old) to the following conditions: whole or sliced fruit; whole/sliced fruit, sugar-sweetened snacks (eg, cookies) and flavored salty (eg, nacho cheese-flavored tortilla chips) snacks; and whole/sliced fruit and less-processed/unflavored grain snacks (eg, pretzels), during a 2-week period representing 18 snack occasions (morning and afternoon) during summer 2013. The percentage of children who selected snacks, snack consumption, and percent of serving wasted were calculated and analyzed using repeated-measures analyses of variance with Bonferroni adjustments. A total of 1,053 observations were made. Sliced fruit was selected more than whole fruit across all conditions. Fruit (sliced or whole) was seldom selected when served simultaneously with sugar-sweetened (6% vs 58%) and flavored salty (6% vs 38%) snacks or unflavored grain snacks (23% vs 64%). More children consumed 100% of the sugar-sweetened (89%) and flavored salty (82%) snacks compared with fruit (71%); 100% consumption was comparable between fruit (59%) and unflavored grain snacks (49%). Approximately 15% to 47% of fruit was wasted, compared with 8% to 38% of sugar-sweetened, flavored salty, and unflavored grain snacks. Snack policies that encourage out-of-school-time programs to serve fruit require clear language that limits offering less-healthful snack options simultaneously.