Evaluation of Alabama public school wellness policies and state school mandate implementation

State Wellness Policy Requirement Laws Matter for District Wellness Policy Comprehensiveness and Wellness Policy Implementation in the United States

Beginning with the school year 2006-2007, U.S. school districts participating in the federal Child Nutrition Programs were required to adopt and implement a local wellness policy (LWP) that included goals and/or standards for nutrition education, school meals, other foods sold or served in schools, and physical activity. A primary challenge with LWPs has been inconsistent implementation. This study examined whether state wellness policy requirement laws and district LWP comprehensiveness influence district level implementation, using law/policy data from the National Wellness Policy Study and school food authority (SFA)-reported district LWP implementation from the School Nutrition and Meal Cost Study. Generalized linear and structural equation models were used, controlling for SFA and district characteristics. SFAs in states with wellness policy requirement laws (vs. those in states without) reported implementing significantly more practices (59.56% vs. 44.57%, p < 0.01). State wellness policy requirement laws were associated with district LWP comprehensiveness (coeff.: 0.463; 95% CI: 0.123, 0.803) and district-level implementation (coeff.: 1.392; 95% CI: 0.299, 2.485). District LWP comprehensiveness was associated with district implementation (coeff.: 0.562; 95% CI: 0.072, 1.053), but did not mediate the state law-district implementation relationship. This study highlights the important role that state laws and district LWPs can play in facilitating wellness policy implementation.

School Wellness in Wisconsin: Evaluating Policies for Practices to Prevent Pediatric Obesity

BACKGROUND

We examined written language in Wisconsin school wellness policies (SWPs) for federal mandate compliance, quality related to obesity prevention, and school characteristics associated with variations in quality. This is the first near census of Wisconsin SWPs and examines whether adhering to federal mandates results in strong policies aimed at preventing pediatric obesity.

METHODS

Policies were coded using the WellSAT 2.0. Policy quality was computed as comprehensiveness and strength based on 6 subscales and 2 overall scores. Variations in policy quality were examined by district size, free/reduced lunch percentage, and year of last revision.

RESULTS

We received SWPs from 91% of districts. Six of the 8 federal mandates were addressed by the majority of districts, although less than one fourth addressed all. Most comprehensiveness scores were weak to moderate, and strength scores were weak. All school characteristics were significantly related to overall policy quality; effect sizes were small.

CONCLUSIONS

Our results confirm the necessity of statewide focus on SWP improvement and suggest that while districts may be meeting federal mandates related to pediatric obesity, few policies include health promotion practices beyond those required. Policies remain fragmented and lack focus on obesity prevention practices; we identify modifiable areas for improvement.

School Wellness Committees Are Associated With Lower Body Mass Index Z-Scores and Improved Dietary Intakes in US Children: The Healthy Communities Study

BACKGROUND

Our objective was to examine the association between school wellness committees and implementation of nutrition wellness policies and children's weight status and obesity-related dietary outcomes.

METHODS

A cross-sectional study was conducted of 4790 children aged 4-15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z-score [BMIz]) and nutrition measures, adjusting for child and community-level covariates.

RESULTS

Children had lower BMI z-scores (-0.11, 95% confidence interval [CI]: -0.19, -0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02-0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy-dense foods (p = .0004), lower sugar intake from sugar-sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district.

CONCLUSIONS

A more active wellness committee was associated with lower BMI z-scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity.

Pilot-Testing an Intervention to Enhance Wellness Policy Implementation in Schools: Wellness Champions for Change

OBJECTIVE

To develop and pilot-test Wellness Champions for Change (WCC) to enhance local wellness policy (LWP) implementation by forming wellness teams.

DESIGN

Randomized, controlled school-level pilot study.

SETTING

Five Maryland school districts.

PARTICIPANTS

A total of 63 elementary, middle, or high schools.

INTERVENTION(S)

Developed from stakeholder interviews, focus groups, and existing programs. Schools were randomized within district to (1) WCC training (6-hour, single-day teacher training), (2) WCC training plus technical assistance (TA), or (3) delayed training (control).

MAIN OUTCOME MEASURE(S)

Online teacher/administrator survey pre-post (spring, 1 year apart) that examined the direct effect of the intervention on active wellness team formation (postintervention, 8-item sum score) and LWP implementation (29 items, not implemented to fully implemented)/indirect effect of intervention on LWP implementation via active wellness team formation.

ANALYSIS

Adjusted linear or logistic regression and mediation modeling.

RESULTS

Postintervention, WCC plus TA and WCC had more active wellness teams (vs control, β = 1.49, P = .02 and β = 1.42, P = .03, respectively). No direct effect of intervention on LWP implementation was found. Formation of active wellness teams mediated the association between both WCC plus TA and WCC and LWP implementation (WCC plus TA confidence interval [CI], 1.22-16.25; WCC CI, 10.98-15.61 [CI was significant without 0]).

CONCLUSIONS AND IMPLICATIONS

The WCC intervention approaches indirectly affected LWP implementation through the formation of active wellness teams. These results support building and school-level wellness teams.

Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities

BACKGROUND

Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students).

METHODS

Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression.

RESULTS

Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05).

CONCLUSIONS

Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities.

Strength and Comprehensiveness of School Wellness Policies in Southeastern US School Districts

BACKGROUND

In 2004, Congress passed legislation mandating that all public school districts participating in federal school meal programs develop a school wellness policy (SWP) to direct efforts related to nutrition and physical activity. We examined the extent to which SWPs varied in comprehensiveness and strength in a representative sample of school districts in the southeastern United States, the area of the country with the highest rates of childhood obesity.

METHODS

Policies were assessed using an established 96-item coding tool by 2 raters to ascertain the comprehensiveness and strength of the policies as a whole, and across distinct subsections specified by federal legislation. In addition, variability in SWP comprehensiveness and strength was assessed based on district sociodemographic characteristics.

RESULTS

Overall, SWPs in the southeastern states are weakly written, fragmented, and lack requirements necessary for healthy school environments. District size, which was the only sociodemographic factor related to policy characteristics, yielded an inverse association.

CONCLUSIONS

To encourage continued promotion of healthy school environments, school districts will require technical support to improve the quality of their school wellness policies.

A review of methods and tools to assess the implementation of government policies to create healthy food environments for preventing obesity and diet-related non-communicable diseases

BACKGROUND

Policies to create healthy food environments are recognized as critical components of efforts to prevent obesity and diet-related non-communicable diseases. There has not been a systematic review of existing methods and tools used to assess the implementation of these government policies. The purpose of this study was to review methods and tools used for assessing the implementation of government policies to create healthy food environments. The study conducted a systematic literature search. Multiple databases as well as the grey literature were searched. All study designs and review papers on assessing the implementation of government policies to create healthy food environments were included. A quality assessment of the methods and tools identified from relevant studies was carried out using the following four criteria: comprehensiveness, relevance, generalizability and feasibility. This quality assessment was completed by two independent reviewers.

RESULTS

The review identified 52 studies across different policy areas, levels and settings. Self-administered questionnaires and policy checklists were most commonly applied to assess the extent of policy implementation, whereas semi-structured interviews were most commonly used to evaluate the implementation process. Measures varied widely, with the existence of policy implementation the aspect most commonly assessed. The most frequently identified barriers and facilitators for policy implementation were infrastructure support, resources and stakeholder engagement. The assessment of policy implementation on food environments was usually undertaken in combination with other policy areas, particularly nutrition education and physical activity. Three tools/methods were rated 'high' quality and 13 tools/methods received 'medium' quality ratings.

CONCLUSIONS

Harmonization of the available high-quality methods and tools is needed to ensure that assessment of government policy implementation can be compared across different countries and settings and over time. This will contribute to efforts to increase government accountability for their actions to improve the healthiness of food environments.

Allowing and Using Foods of Low Nutritional Value in Elementary School Classrooms: The Implications of Teachers' Beliefs

OBJECTIVE

To investigate elementary teachers' behavior toward allowing and using foods with low nutritional value in the classroom.

DESIGN/SETTING

A survey guided by the Theory of Planned Behavior was administered in fall, 2012 in 10 schools.

PARTICIPANTS

Elementary public school teachers in grades pre-kindergarten through 6.

MAIN OUTCOME MEASURES

Teachers' behavior and beliefs regarding allowing and using foods with low nutritional value in the classroom and Theory of Planned Behavior determinants.

ANALYSIS

Pairwise correlation coefficients and multivariate linear regression to assess relationships between theory determinants and descriptive statistics.

RESULTS

All 3 determinants, Attitude Toward the Behavior (t = 4.04; P < .01), Subjective Norms (t = 3.78; P < .01), and Perceived Behavioral Control (t = 5.19; p < .01), were statistically significant predictors of behavior. The majority of teachers (94%) allowed foods of low nutritional value for celebrations at least some of the time, and 75% stated that they had control over what foods they allow.

CONCLUSIONS AND IMPLICATIONS

Discussions among teachers and school health professionals should ensue to improve nutritional content of foods allowed in classrooms. School policies can be developed and evaluated for effectiveness to have a positive impact on childhood obesity and school nutrition environments.

Little association between wellness policies and school-reported nutrition practices

BACKGROUND

The Child Nutrition and WIC Reauthorization Act of 2004 mandated written school wellness policies. Little evidence exists to evaluate the impact of such policies. This study assessed the quality (comprehensiveness of topics addressed and strength of wording) of wellness policies and the agreement between written district-level policies and school-reported nutrition policies and practices in 48 low-income Michigan school districts participating in the School Nutrition Advances Kids study.

METHOD

Written wellness policy quality was assessed using the School Wellness Policy Evaluation Tool. School nutrition policies and practices were assessed using the School Environment and Policy Survey. Analysis of variance determined differences in policy quality, and Fisher's exact test examined agreement between written policies and school-reported practices.

RESULTS

Written wellness policies contained ambiguous language and addressed few practices, indicating low comprehensiveness and strength. Most districts adopted model wellness policy templates without modification, and the template used was the primary determinant of policy quality. Written wellness policies often did not reflect school-reported nutrition policies and practices.

CONCLUSIONS

School health advocates should avoid assumptions that written wellness policies accurately reflect school practices. Encouraging policy template customization and stronger, more specific language may enhance wellness policy quality, ensure consistency between policy and practice, and enhance implementation of school nutrition initiatives.

Local Wellness Policy 5 years later: is it making a difference for students in low-income, rural Colorado elementary schools?

INTRODUCTION

The federally mandated Local Wellness Policy (LWP) was intended to promote student health in schools. This study assesses the 5-year effects of the LWP on the health practices of rural elementary schools in Colorado.

METHODS

One year before and 5 years after the LWP mandate, a survey was administered to a random sample of principals, physical education (PE) teachers, and food-service managers in 45 rural, low-income elementary schools in Colorado. Response rates were 71% in 2005 and 89% in 2011.

RESULTS

Minutes for PE and recess did not increase, nor did offerings of fresh fruits and vegetables. More schools adopted policies prohibiting teachers from taking recess away as punishment (9.7% in 2005 vs 38.5% in 2011, P = .02) or for making up missed instructional time, class work, or tests in other subjects (3.2% in 2005 vs 28.2% in 2011, P = .03). More schools scheduled recess before lunch (22.6% in 2005 vs 46.2% in 2011, P = .04) and developed policies for vending machines (42.9% in 2005 vs 85.7% in 2011, P = .01) and parties (21.4% in 2005 vs 57.9% in 2011, P = .004).

CONCLUSION

Changes in school practices are modest, and arguably the important school practices such as increased PE and recess time and increased offerings of fruits and vegetables in the lunch line have not changed in the 5 years since the mandate went into effect. Further investigation is needed to identify the knowledge, skills, and attitudes as well as financial and physical resources required for school administrators to make changes in school practices.

Withholding recess from elementary school students: policies matter

BACKGROUND

Recess is a key aspect of a healthy elementary school environment and helps to keep students physically active during the school day. Although national organizations recommend that students not be withheld from recess, this practice occurs in schools. This study examined whether district policies were associated with school practices regarding the withholding of recess for behavior management or academic reasons, as well as the use of physical activity (eg, running laps) for behavior management.

METHODS

Data were gathered from administrators at US public elementary schools by mail-back surveys conducted during the spring of the 2008-2009, 2009-2010, and 2010-2011 school years. Corresponding school district policies were gathered and coded. Each year's sample was nationally representative and data were analyzed as a stacked cross-sectional sample. A total of 1,919 surveys were received (61.2% response rate).

RESULTS

Averaged over the 3 years, students were not withheld from recess for poor behavior or academic reasons at 28.3% and 26.7% of elementary schools, respectively. Strong district policy was associated with an increased odds of not withholding students from recess for poor behavior (adjusted odds ratio [OR] = 2.27, p < .001) or completing schoolwork (adjusted OR = 1.99, p < .001). Withholding recess was less common in the South versus the West, Midwest, and Northeast. Use of physical activity for behavior management was rare and not associated with district policy.

CONCLUSIONS

Strengthening district policies may be an effective strategy for changing school practices pertaining to withholding of recess, and to ensure that all students have opportunities to be physically active during the school day.

School wellness policies and foods and beverages available in schools

BACKGROUND

Since 2006-2007, education agencies (e.g., school districts) participating in U.S. federal meal programs are required to have wellness policies. To date, this is the only federal policy that addresses foods and beverages sold outside of school meals (in competitive venues).

PURPOSE

To examine the extent to which federally required components of school wellness policies are associated with availability of foods and beverages in competitive venues.

METHODS

Questionnaire data were collected in 2007-2008 through 2010-2011 school years from 892 middle and 1019 high schools in nationally representative samples. School administrators reported the extent to which schools had required wellness policy components (goals, nutrition guidelines, implementation plan/person responsible, stakeholder involvement) and healthier and less-healthy foods and beverages available in competitive venues. Analyses were conducted in 2012.

RESULTS

About one third of students (31.8%) were in schools with all four wellness policy components. Predominantly white schools had higher wellness policy scores than other schools. After controlling for school characteristics, higher wellness policy scores were associated with higher availability of low-fat and whole-grain foods and lower availability of regular-fat/sugared foods in middle and high schools. In middle schools, higher scores also were associated with lower availability of 2%/whole milk. High schools with higher scores also had lower sugar-sweetened beverage availability and higher availability of 1%/nonfat milk, fruits/vegetables, and salad bars.

CONCLUSIONS

Because they are associated with lower availability of less-healthy and higher availability of healthier foods and beverages in competitive venues, federally required components of school wellness policies should be encouraged in all schools.

School Nutrition Programs

Schools in the United States serve more than 12 million breakfasts and 32 million lunches every school day, as well as multiple snacks and supper meals in some cases. These meals are funded by federal legislation and regulated by nutrition standards that follow the Dietary Guidelines for Americans. School nutrition professionals face many challenges when improving campus food environments and are using multiple, innovative strategies to serve healthier meals to students.

Alliance for a Healthier Generation's competitive beverage and food guidelines: do elementary school administrators know about them and do they report implementing them?

BACKGROUND

The availability of competitive foods in schools is a modifiable factor in efforts to prevent childhood obesity. The Alliance for a Healthier Generation launched the Healthy Schools Program in 2006 to encourage schools to create healthier food environments, including the adoption of nutritional guidelines for competitive beverages and foods. This study examines nationwide awareness and implementation of the guidelines in US public elementary schools.

METHODS

Data were collected from a nationally representative sample of elementary schools using mail-back surveys in 2006-2007, 2007-2008, 2008-2009, and 2009-2010.

RESULTS

From 2006-2007 to 2009-2010, awareness of the Alliance's beverage guidelines increased from 35.0% to 51.8% among school administrators (p < .01); awareness of the food guidelines increased from 29.4% to 40.2% (p < .01). By 2009-2010, almost one third of the schools that sold competitive beverages and foods reported having implemented or being in the process of implementing the guidelines. Implementation was higher among schools from Southern states. Schools with a majority of Black or Latino students were less likely to implement the guidelines.

CONCLUSIONS

Awareness and implementation of the Alliance's beverage and food guidelines has significantly increased since the 2006-2007 school year, indicating successful diffusion of the guidelines. However, many administrators at schools who sold competitive products were not aware of the guidelines, indicating a need for continued efforts. In addition, lower implementation among schools serving minority students suggests that the Alliance's targeted efforts to provide intensive technical assistance to such schools is warranted and necessary.

School wellness policies: effects of using standard templates

BACKGROUND

Public school policies related to physical activity and nutrition recently have become the focal point for policymakers to evaluate the effect of regulations on the childhood obesity epidemic. State school board associations have begun to provide school districts templates for wellness policies, and little research exists that evaluates the effect of a template on the strength and comprehensiveness of these policies.

PURPOSE

To determine the strength and comprehensiveness of school wellness policies developed using a standard template when compared to those that do not.

METHODS

In 2011, a random sample of wellness policies from school districts in Virginia (ten locally developed wellness policies and ten template-based policies) was coded using a previously validated audit tool for strength and comprehensiveness. Data were reduced to a scale ranging from 0 to 1, with higher scores representing stronger and more-comprehensive policies, and compared using t-tests.

RESULTS

Overall, only 17% of school wellness policies met all federal requirements. On average, locally developed policies met five of six federal requirements, whereas VSBA policies met four of six, t(2, 21)=2.161, p<0.05. Both types of policies were ranked on a scale from 0 (weakest) to 1 (strongest); both types were weak (M=0.16±0.13) and only mildly comprehensive (M=0.37±0.16). There was a difference in policy comprehensiveness and strength between locally developed policies and template-based policies. Locally developed policies were stronger, t(2, 21)= -1.82, p<0.05, and more comprehensive, t(2, 21)= -2.5, p<0.05, than template-based policies.

CONCLUSIONS

In this sample, locally developed policies were stronger than template-based policies. If replicated in large studies, these findings suggest that further research is needed about how best to support schools that wish to develop school wellness policies.

Calories in the classroom: celebration foods offered and consumed during classroom parties at an elementary school in a low-income, urban community

BACKGROUND

The school food environment is an important area of exploration in investigating the potential for schoolchildren to consume foods and beverages containing excess calories on school grounds. Several venues offer schoolchildren access to lownutrient, calorie-dense foods and beverages. Classroom celebrations offer such a venue; however, little is known about current practices during these events.

METHODS

Trained observers recorded foods and beverages offered, activities engaged in, and goody bag distribution during six separate classroom celebrations. Additionally, foods and beverages consumed by 24 individual students were recorded in detail for calorie estimation.

RESULTS

The majority of food items offered during classroom celebrations were low-nutrient, calorie-dense items. The mean caloric contribution for all 24 students was 444 ± 221 calories, with a range of 130–905 calories, and a median intake of 386 calories. Mean total estimated calorie intake per grade level was 225 ± 90, 286 ± 105, and 550 ± 212 calories for students in prekindergarten, kindergarten, and 1st grade, respectively. Only one-third of all the parties observed included activities other than eating.

CONCLUSIONS

Our observations reveal that food items offered during classroom celebrations offer children opportunities to consume low-nutrient, calorie-dense foods and beverages on the school campus. More research is needed to support these findings, and to identify the best practice to implement for effective school wellness policies aimed at regulating classroom celebrations.

Strength and comprehensiveness of district school wellness policies predict policy implementation at the school level

BACKGROUND

In 2006, all local education agencies in the United States participating in federal school meal programs were required to establish school wellness policies. This study documented the strength and comprehensiveness of 1 state's written district policies using a coding tool, and tested whether these traits predicted school-level implementation and practices.

METHODS

School wellness policies from 151 Connecticut districts were evaluated. School principal surveys were collected before and after the writing and expected implementation of wellness policies. Sociodemographic variables were assessed for each district, including enrollment, population density, political climate, racial composition, and socioeconomic status. Changes in school-level policy implementation before and after the federal wellness policy mandate were compared across districts by wellness policy strength; policies were compared based on district-level demographics.

RESULTS

Statewide, more complete implementation of nutrition and physical activity policies at the school level was reported after adoption of written policies. Districts with stronger, more comprehensive policies were more successful in implementing them at the school level. Some sociodemographic characteristics predicted the strength of wellness policies.

CONCLUSIONS

Written school wellness policies have the potential to promote significant improvements in the school environment. Future regulation of school wellness policies should focus on the importance of writing strong and comprehensive policies.

Food as a reward in the classroom: school district policies are associated with practices in US public elementary schools

The use of food as a reward for good student behavior or academic performance is discouraged by many national organizations, yet this practice continues to occur in schools. Our multiyear cross-sectional study examined the use of food as a reward in elementary schools and evaluated the association between district policies and school practices. School data were gathered during the 2007-2008, 2008-2009, and 2009-2010 school years via mail-back surveys (N=2,069) from respondents at nationally representative samples of US public elementary schools (1,525 unique schools, 544 of which also participated for a second year). During every year, the corresponding district policy for each school was gathered and coded for provisions pertaining to the use of food as a reward. School practices did not change over time and as of the 2009-2010 school year, respondents in 42.1% and 40.7% of schools, respectively, indicated that food was not used as a reward for academic performance or for good student behavior. In multivariate logistic regression analyses controlling for school characteristics and year, having a district policy that prohibited the use of food as a reward was significantly associated with school respondents reporting that food was not used as a reward for academic performance (P<0.05) or for good student behavior (P<0.05). School-level respondents in the West and the Midwest were less likely to report that food was not used as a reward than were respondents in the South and Northeast. As of 2009-2010, only 11.9% of the districts in our study prohibited the use of food as a reward. Strengthening district policies may reduce the use of food rewards in elementary schools.