Smart Snacks in School Legislation Does Not Change Self-Reported Snack Food and Beverage Intake of Middle School Students in Rural Appalachian Region.

OBJECTIVE: To assess the effects of the national Smart Snacks in School standards, which include nutrient and ingredient limitations for school competitive foods and beverages effective July, 2014, on student intake in low-income rural Appalachian middle schools. METHODS: Food-frequency questionnaires were administered to students before and after implementation. Multiple ordinal logistic regression models were conducted to examine effects from year of data collection, grade, and free or reduced price lunch participation rates. RESULTS: No significant changes were observed after implementation except a decrease in consumption of 1% or nonfat flavored milk at school. CONCLUSIONS AND IMPLICATIONS: Smart Snacks in School standards did not result in significant dietary changes in this study. Longitudinal studies could evaluate long-term impacts of nutrition standards.