The impact of the availability of school vending machines on eating behavior during lunch: the Youth Physical Activity and Nutrition Survey.

Childhood obesity is a major public health concern and is associated with substantial morbidities. Access to less-healthy foods might facilitate dietary behaviors that contribute to obesity. However, less-healthy foods are usually available in school vending machines. This cross-sectional study examined the prevalence of students buying snacks or beverages from school vending machines instead of buying school lunch and predictors of this behavior. Analyses were based on the 2003 Florida Youth Physical Activity and Nutrition Survey using a representative sample of 4,322 students in grades six through eight in 73 Florida public middle schools. Analyses included χ2 tests and logistic regression. The outcome measure was buying a snack or beverage from vending machines 2 or more days during the previous 5 days instead of buying lunch. The survey response rate was 72%. Eighteen percent of respondents reported purchasing a snack or beverage from a vending machine 2 or more days during the previous 5 school days instead of buying school lunch. Although healthier options were available, the most commonly purchased vending machine items were chips, pretzels/crackers, candy bars, soda, and sport drinks. More students chose snacks or beverages instead of lunch in schools where beverage vending machines were also available than did students in schools where beverage vending machines were unavailable: 19% and 7%, respectively (P≤0.05). The strongest risk factor for buying snacks or beverages from vending machines instead of buying school lunch was availability of beverage vending machines in schools (adjusted odds ratio=3.5; 95% confidence interval, 2.2 to 5.7). Other statistically significant risk factors were smoking, non-Hispanic black race/ethnicity, Hispanic ethnicity, and older age. Although healthier choices were available, the most common choices were the less-healthy foods. Schools should consider developing policies to reduce the availability of less-healthy choices in vending machines and to reduce access to beverage vending machines.

Association of maternal smoking status with breastfeeding practices: Missouri, 2005.

OBJECTIVE: We sought to determine the association of smoking status as a risk factor for reduced initiation and duration of breastfeeding. METHODS: The Missouri Pregnancy Related Assessment and Monitoring System collected a stratified sample of new mothers in 2005. Surveys were mailed, with telephone follow-up, and completed within 2 to 12 months after delivery. Respondents were classified as nonsmokers, smokers who quit during pregnancy, light smokers (10 cigarettes per day). Multivariable binomial regression and Cox proportional hazards models were used to assess breastfeeding initiation and duration according to smoking status. RESULTS: Overall, 1789 women participated (weighted response rate: 61%). Approximately 74% of the women ever breastfed; 31% of the women ever smoked while pregnant. Compared with nonsmokers, the moderate/heavy smokers and light smokers were less likely to initiate breastfeeding, after controlling for sociodemographic characteristics, the presence of other smokers in the household, alcohol use, mode of delivery, and infant hospitalization. Compared with nonsmokers, the moderate/heavy smokers, light smokers, and smokers who quit during pregnancy were more likely to wean over time, controlling for the same covariates. There were no significant differences between nonsmokers and smokers regarding reasons for not initiating or ceasing breastfeeding. CONCLUSIONS: Mothers who smoked initiated breastfeeding less often and weaned earlier than nonsmoking mothers. Incorporating knowledge of the association between smoking and breastfeeding into existing smoking-cessation and breastfeeding programs could provide opportunities to reduce perinatal exposure to tobacco smoke, improve interest in breastfeeding, and address other barriers to breastfeeding that smoking mothers may face.