Background: The purposes of this study are to examine the extent to which (1) more-healthy and less-healthy food choices are available to American secondary students in their schools, and (2) there are differences in the availability of such foods as a function of grade, racial/ethnic background, and socioeconomic status (SES). Methods: United States nationally representative samples of over 37,000 students in 345 secondary schools were surveyed in 2004 and 2005 as part of the Youth, Education, and Society (YES) study and the Monitoring the Future (MTF) study. In the YES study, school administrators and food service managers completed self-administered questionnaires on food policies and food offerings in their schools. In the MTF study, students in the same schools completed self-administered questionnaires. Data were analyzed in 2006. Results: A greater percent of high school students have access to both more-healthy and less-healthy food choices than middle school students. Compared to white students, fewer black students have access to certain healthy foods (lowfat salty snacks, lowfat cookies and pastries). Hispanic high school students have greater access to regular ice cream and to fruits and vegetables. Otherwise the racial/ethnic group differences are modest. However, there is a positive linear association between SES (as indicated by parental education) and (1) access to most types of healthier snacks from vending machines, school/student stores, or snack bars/carts and (2) the number of healthier foods offered A la carte in the cafeteria. The association between SES and access to less-healthy snacks varies more by item. Conclusions: Indisputably, less-healthy foods are more available than more-healthy foods in the nation's schools. At a time when food and beverage offerings are under intense policy scrutiny, this study provides a comprehensive assessment of the types of foods made available to students. While it is encouraging to see schools offering healthy food alternatives, such as lowfat snacks and fruits and vegetables, the findings strongly suggest that the availability of more-healthy snacks needs to be increased, particularly for racial/ethnic minorities and youth of lower SES. Simultaneously, schools could considerably decrease the availability of less-healthy snack choices available to students. Future monitoring is needed to evaluate the effectiveness of the food industry's recent agreement to play a role in helping to solve these problems.
