State laws governing competitive foods and beverages sold in schools and childhood obesity among children with special healthcare needs, 2007-2016

Objective: In this study, we assessed the impact of state laws governing competitive foods/beverages sold in schools on childhood overweight/obesity among children aged 10-17 years with and without special healthcare needs (SHCN). Methods: Individual-level data from 2007-2008, 2011-2012, and 2016 National Survey of Children's Health (N = 108,009) were merged to data on state codified laws regulating competitive foods/beverages sold in schools based on children's residential state and survey year. State random-effect logistic regressions were performed to estimate the odds of childhood overweight/obesity in relation to the presence and strength of competitive food/beverage laws, adjusting for child/family characteristics and state soda sales tax. Results: No association between state laws governing competitive foods/beverages sold in schools and childhood overweight/obesity was identified among children with and without SHCN. In addition, no impact of state soda sales tax on childhood overweight/obesity was found among children with SHCN. Conclusions: No protective effect of state laws governing competitive foods/beverages sold in schools against obesity risk among children with SHCN was revealed. This study has design and measurement limitations. Future research should replicate findings of this study and assess school district competitive food/beverage policies in relation to adiposity among this highly vulnerable child population.