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Purpose: To test the feasibility of Kids SIP smartER, a school-based intervention to reduce consumption of sugar-sweetened beverages (SSBs)., Design: Matched-contact randomized crossover study with mixed-methods analysis., Setting: One middle school in rural, Appalachian Virginia., Participants: Seventy-four sixth and seventh graders (5 classrooms) received Kids SIP smartER in random order over 2 intervention periods. Feasibility outcomes were assessed among 2 teachers., Intervention: Kids SIP smartER consisted of 6 lessons grounded in the Theory of Planned Behavior, media literacy, and public health literacy and aimed to improve individual SSB behaviors and understanding of media literacy and prevalent regional disparities. The matched-contact intervention promoted physical activity., Measures: Beverage Intake Questionnaire-15 (SSB consumption), validated theory questionnaires, feasibility questionnaires (student and teacher), student focus groups, teacher interviews, and process data (eg, attendance)., Analysis: Repeated measures analysis of variances across 3 time points, descriptive statistics, and deductive analysis of qualitative data., Results: During the first intervention period, students receiving Kids SIP smartER (n = 43) significantly reduced SSBs by 11 ounces/day ( P = .01) and improved media ( P < .001) and public health literacy ( P < .01) understanding; however, only media literacy showed between-group differences ( P < .01). Students and teachers found Kids SIP smartER acceptable, in-demand, practical, and implementable within existing resources., Conclusion: Kids SIP smartER is feasible in an underresourced, rural school setting. Results will inform further development and large-scale testing of Kids SIP smartER to reduce SSBs among rural adolescents.

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., (Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

The study objective was to examine the nutritional quality of competitive foods and beverages (foods and beverages from vending machines and à la carte foods) available to rural middle school students, before implementation of the US Department of Agriculture's Smart Snacks in School standards in July 2014. In spring 2014, we audited vending machines and à la carte cafeteria foods and beverages in 8 rural Appalachian middle schools in Virginia. Few schools had vending machines. Few à la carte and vending machine foods met Smart Snacks in School standards (36.5%); however, most beverages did (78.2%). The major challenges to meeting standards were fat and sodium content of foods. Most competitive foods (62.2%) did not meet new standards, and rural schools with limited resources will likely require assistance to fully comply.