Commercialism in US Elementary and Secondary School Nutrition Environments: Trends From 2007 to 2012.

IMPORTANCE Schools present highly desirable marketing environments for food and beverage companies. However, most marketed items are nutritionally poor.

OBJECTIVE To examine national trends in student exposure to selected school-based commercialism measures from 2007 through 2012.

DESIGN, SETTING, AND PARTICIPANTS Annual nationally representative cross-sectional studies were evaluated in US public elementary, middle, and high schools with use of a survey of school administrators.

EXPOSURES School-based commercialism, including exclusive beverage contracts and associated incentives, profits, and advertising; corporate food vending and associated incentives and profits; posters/advertisements for soft drinks, fast food, or candy; use of food coupons as incentives; event sponsorships; and fast food available to students.

MAIN OUTCOMES AND MEASURES Changes over time in school-based commercialism as well as differences by student body racial/ethnic distribution and socioeconomic status.

RESULTS Although some commercialism measures-especially those related to beverage vending-have shown significant decreases over time, most students at all academic levels continued to attend schools with one or more types of school-based commercialism in 2012. Overall, exposure to school-based commercialism increased significantly with grade level. For 63.7% of elementary school students, the most frequent type of commercialism was food coupons used as incentives. For secondary students, the type of commercialism most prevalent in schools was exclusive beverage contracts, which were in place in schools attended by 49.5% of middle school students and 69.8% of high school students. Exposure to elementary school coupons, as well as middle and high school exclusive beverage contracts, was significantly more likely for students attending schools with mid or low (vs high) student body socioeconomic status.

CONCLUSIONS AND RELEVANCE Most US elementary, middle, and high school students attend schools where they are exposed to commercial efforts aimed at obtaining food or beverage sales or developing brand recognition and loyalty for future sales. Although there have been significant decreases over time in many of the measures examined, the continuing high prevalence of school-based commercialism calls for, at minimum, clear and enforceable standards on the nutritional content of all foods and beverages marketed to youth in school settings.