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Effects of Federal Legislation on Wellness Policy Formation in School Districts in the United States
RESEARCH Perspectives in Practice
Effects of Federal Legislation on Wellness Policy Formation in School Districts in the United States CAROL HEARD LONGLEY, PhD, RD; JEANNIE SNEED, PhD, RD
ABSTRACT The Reauthorization Act of 2004 required local education agencies sponsoring school meal programs to establish a wellness policy by the beginning of school year 2006-2007. The purpose of this study was to examine the process and outcome of wellness policy development in school districts. Phase 1 examined states’ school nutrition legislation. Phase 2 consisted of qualitative interviews with foodservice directors. Phase 3 utilized an e-mail and mail survey. The sampling frame was a stratified random sample selected from medium-sized or larger schools (n⫽847). Factor analysis was conducted with Cronbach’s ␣. Correlations tested relationships among variables using analysis of variance with Tukey’s post hoc test. Before the federal mandate, few wellness components (37.4%) were in place for foodservice outside of the federally regulated meal program. Following the legislation, 72.4% of the wellness components were in place. Nutrition components were the variables that changed the most and were reported as the components most frequently implemented. Changes particularly noted in foodservice operations were the use of nutrition guidelines for a la carte foods, beverages, fundraisers, parties, and vending. Foodservice directors noted improvements in nutrition education and physical education. Foodservice directors reported less progress in the implementation and monitoring of the wellness policy than in the development of the policy. The top barriers to wellness policy development and implementa-
C. H. Longley is an assistant professor, Department of Nutrition and Food Science, Texas Women’s University, Denton; at the time of the study, she was a graduate student, Iowa State University, Ames. J. Sneed is with Sneed Consulting, Stillwater, OK; at the time of the study, she was a professor, Department of Apparel, Educational Studies, and Hospitality Management, Iowa State University, Ames. Address correspondence to: Carol Heard Longley, PhD, RD, 1566 Hwy 17, Aledo, IL 61231. E-mail: carollongley@ qconline.com Manuscript accepted: June 13, 2008. Copyright © 2009 by the American Dietetic Association. 0002-8223/09/10901-0009$36.00/0 doi: 10.1016/j.jada.2008.10.011
© 2009 by the American Dietetic Association
tion were the need to use food in fundraising and competition for time. J Am Diet Assoc. 2009;109:95-101.
T
he increasing incidence of childhood obesity (1) is creating concern about the health of American children (2). The Child Nutrition and WIC Reauthorization Act of 2004 required local education agencies sponsoring school meal programs to establish a wellness policy beginning with the 2006-2007 school year that addresses obesity because students spend a significant part of the day, and much of the year, in school. This mandate required schools to address both nutrition and physical activity and involve key stakeholders. Schools are well positioned to play an important role in fighting childhood obesity. It has been argued that schools can play this role by altering various policies and practices (3) to provide a healthful school environment, ensuring coordination of a comprehensive nutrition education program, providing well-run child nutrition programs, and engaging the support of community partners (4). Schools have become a reflection of society. Foods high in energy, fat, and sugar are readily available. There is limited regulation of food sale or use in schools (5). Federal regulations have limited jurisdiction over food sold in schools outside of the federal meal programs. The unfunded wellness mandate is the first federal legislative effort to address foods sold in schools and obesity prevention. School districts not complying with the federal mandate will be cited during administrative reviews, placing the program at risk of losing federal funding. In 2002, 31 states had no state competitive food policies other than US Department of Agriculture regulations (6). In 2005, state legislators introduced nearly 200 bills to address the nutritional quality of school foods (7). As of August 2006, state legislatures in 39 states considered or enacted legislation related to the nutritional quality of school food and beverages (7). French and colleagues (8) suggested that district health councils provide the best mechanism to facilitate school-level policy development. The School Health Policies and Program Study found that about two thirds of schools had existing health councils that develop policies or coordinate activities on health issues (9). Kubik, Lytle, and Story (10) offered a less optimistic picture of the ability of school district administrators to form nutrition policies. They concluded that establishing a nutrition policy at the local school level is complex and
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time intensive, and school administrators do not know how to establish and implement nutrition policies. The purpose of this study was to examine the process of wellness policy development in school districts in the United States following the 2004 mandate. Specific research objectives included examinations of the legislative environment of states for wellness before development of the wellness policy, assessment of district wellness policies in place before and after the federal mandate, and examination the internal and external environments in school districts that supported or hindered districtwide policy development. Results could assist school district administrators with implementation of wellness policies and lawmakers as they consider further legislation for school nutrition and physical fitness. METHODS Study Design and Sample Districts participating in the National School Lunch Program were included in the study. The research study consisted of three phases. In Phase 1, all 50 states were reviewed for their regulatory environment for wellness policy formation before (2004) and after (2006) the wellness policy enactment. States were evaluated for policy for fat, energy, and sugar content of a la carte foods; beverage portion and nutrition standards, time and place rules for food sales, and statewide training on the development of wellness policies. Each criterion was assigned one point. States scoring five points or greater were classified as strong legislative environments (11). In Phase 2, state nutrition directors were contacted in randomly selected strong and weak states for names of foodservice directors involved in wellness policy development. Foodservice directors attending the School Nutrition Association Leadership Meeting in fall 2006 were utilized as participants from some states (n⫽21). Twenty-one participants from the state directors’ referral list and leadership list were interviewed by telephone using a qualitative survey. In Phase 3, school foodservice directors in medium-sized (2,500 to 9,999 students) or larger public school districts were the target population. A random national sample of foodservice directors in public school districts was drawn from the Digest for Educational Statistics (12). A sampling frame of 3,924 school districts consisted of 3,077 medium-sized school districts, 717 large-sized (10,001 to 39,999 students) districts, and 130 extra large-sized (⬎40,000 students) districts. Based on school size, a stratified random sample of 847 foodservice directors was surveyed. Socioeconomic status (SES) of school districts was determined by the reported level of free and reduced meal applications. Phase 3 utilized an E-mail and mail quantitative survey to contact 847 foodservice directors through out the United States. Research Instruments For Phase 2, a qualitative questionnaire with open-ended questions was used as a formative evaluation to determine information about the wellness policy committee development and working process, barriers, and support for the wellness policy; status of the wellness policy; and
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demographic questions. The constructs and issues found in Phase 2 were used to develop the quantitative survey (Phase 3). The questionnaire for Phase 3 consisted of six parts. Table 1 presents a list of components evaluated. Yes and no, Likert-type rating scales, and multiple choice responses were used. Data Collection Interviews for Phase 2 were conducted during January and February 2007. The national survey (Phase 3) was conducted during April 2007. An introduction e-mail was sent to a sample of 717 randomly selected foodservice directors using an electronic survey (SurveyMonkey.com, SurveyMonkey, Portland, OR). Three days after the original contact, an e-mail with a cover letter from the principal investigator accompanied the survey. One week after the initial mailing, a follow-up E-mail was sent to all survey recipients thanking them for responding or reminding them to return the survey. One week later a second survey was sent to each nonrespondent. One week after sending the second survey to nonrespondents, a third survey was e-mailed to each nonrespondent (13). The same survey, letters, and notes were mailed to directors with only mailing addresses. This study was approved by the Institutional Review Board at Iowa State University before data collection. Data Analysis In Phase 2, the telephone interviews, the six steps recommended by Creswell (14) for qualitative data analysis were used. Notes were taken during the phone interviews as well as tape-recorded. The transcribed interviews were double-checked with the notes for accuracy. Themes and connecting strategies were developed for each question. Study reliability was checked by having two foodservice directors with graduate degrees read transcripts independently to review categorized information and themes. The multiple themes found by the three reviewers were compared for consistency. In Phase 3, data collected in the SurveyMonkey.com instrument was reviewed for duplicate responses. Duplicate responses and returned surveys with no questioned answered were eliminated. In Phase 3, descriptive statistics (ie, means, standard deviations, and frequencies) were used to examine survey results assessing wellness components in place. Exploratory factor analysis of the study variables was conducted using the principal components analysis with varimax rotation to evaluate barriers and supporting factors. Factors were retained when there was a minimum eigenvalue of one. Factors were tested for significance using Cronbach’a ␣. Analysis of variance was used with Tukey’s Honest Significant Difference post hoc test to test relationships among variables. Attitudes, barriers, and support were dependent latent variables. Independent variables included certification, enrollment, level of education, legislative environment, school district SES, and US Department of Agriculture region. The Statistical Package for the Social Sciences (version 13.0 for Windows, 2004, SPSS Inc, Chicago, IL) was used for all data analyses.
Table 1. Components district school foodservice directors in strong legislative environmentsa before federal legislation on wellness policy reported to be included in school district wellness policies (n⫽363) Before Legislationb States with Strong Environment
National Sample Components Nutrition education component Followed state-specified standards for nutrition and health education Integrated nutrition education into current curriculum Utilized the foodservice department for nutrition education Offered nutrition education for each grade level Required professional standards/development for nutrition education instructors Offered nutrition education for adults Physical education component Followed state-specified standards for physical education Required professional standards/development for physical education instructors Established specified number of minutes of physical activity per day Incorporated physical activity into classroom activities Nutrition policy component Nutrition guidelines for reimbursable school meals Time food can be sold during the school day Location food can be sold on school campus A la carte nutrition policy for fat content A la carte nutrition policy for saturated fat Beverage nutrition standard A la carte nutrition policy for sugar content Nutrition guidelines for vending machines Beverage portion size limitation A la carte nutrition policy for total energy per portion Nutrition guidelines for food and beverages served/available at classroom parties Nutrition guidelines for fundraisers Nutrition guidelines for use of food and beverages as a reward Other school-based activities component Scheduled recess before lunch Ensured adequate time for meals Staff wellness programs encouraged staff to serve as role model for wellness behavior Implementation and monitoring Principals responsible for implementation Principals responsible for evaluation Superintendent responsible for implementation Superintendent responsible for evaluation Wellness team responsible for implementation Wellness team responsible for evaluation Meanⴞstandard deviation of wellness components
After Legislationb States with Strong Environment
National Sample
n
%
n
%
n
%
n
%
262
72.2
26
66.6
326
89.8
37
95
205
56.5
22
56.4
295
81.3
33
84.6
189
52.1
22
56.4
275
75.8
27
69.2
122
33.6
13
33.3
222
61.2
21
53.8
101 58
21.8 16.0
8 8
20.5 20.5
178 169
49.0 46.6
15 19
38.5 48.7
244
67.2
24
61.5
294
81.0
30
76.9
193
53.2
17
43.5
247
68.0
23
59
167
46.0
23
59
248
68.3
26
66.7
115
31.7
13
33.3
220
60.6
21
53.8
306
84.3
31
79.5
338
93.1
36
92.3
192
52.9
20
51.2
300
82.6
38
97.4
159 109 103 103 86 82 79
43.8 30.0 28.4 28.4 23.7 22.6 21.8
17 10 11 14 5 13 13
43.5 25.6 28.2 35.9 12.8 33.3 33.3
264 289 276 291 270 287 268
72.7 79.6 76.0 80.2 74.4 79.1 73.8
30 36 36 36 33 32 35
76.9 92.3 92.3 92.3 84.6 82.1 89.7
71
19.6
5
12.8
241
66.4
34
87.2
26 25
7.2 6.9
1 4
2.6 10.3
254 247
70.0 68.0
33 35
84.6 89.7
25
6.9
2
5.1
248
68.3
31
79.5
248 205
68.3 56.5
6 22
15.4 56.4
273 257
75.2 70.8
12 26
30.8 66.7
74
20.4
7
17.9
257
70.8
29
74.3
53 39
14.6 10.7
5 4
12.8 10.3
191 149
52.6 41.1
15 13
38.4 33.3
33 27
9.1 7.4
1 0
2.6 0
135 101
37.2 27.8
11 11
28.2 28.2
20 16
5.5 4.4
4 2
10.3 5.1
219 230
60.3 63.4
24 29
61.5 74.4
26.6⫾21.9
218.3⫾54.1
60.1⫾14.9
24⫾8.6
61.7⫾22
103.8⫾82
28.4⫾22.65
10.4⫾8.5
a
States were evaluated for policy for fat, energy, and sugar content of a la carte foods; beverage portion and nutrition standards, time and place rules for food sales, and statewide training on the development of wellness policies. Each criterion was assigned 1 point. States scoring 5 points or greater were classified as strong legislative environments (11). b The Child Nutrition and WIC Reauthorization Act of 2004 required local education agencies sponsoring school meal programs to establish a wellness policy beginning with the 2006-2007 school year.
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Table 2. Characteristics of district school foodservice directors in Phase 3 (n⫽363) of a study examining the effect of federal legislation on wellness policy formation in school districts in the United States Factor Education level (nⴝ317)a High school Some college Bachelor’s degree Graduate degree Educational background (nⴝ312)a Nutrition Business Hotel, restaurant, and institution management Education Business/nutrition Business/hotel, restaurant, and institution management Other Education/nutrition Marketing Credentials (nⴝ254)a Certified by School Nutrition Association Other Registered dietitian No other credentials School Nutrition Specialist credential Teacher’s certificate Job title (nⴝ318)a Foodservice director Other Superintendent Health coordinator Nurse
n
%
14 65 130 109
4.4 20.5 41.0 34.4
166 117 83 74 50
53.2 37.5 26.6 23.7 16.0
43 31 28 12
13.8 9.9 9.0 3.8
90 59 55 53 47 42
35.4 23.2 21.7 20.9 18.5 16.5
290 21 5 1 0
91.2 6.6 1.5 .3
a Frequency does not add up to 363 because of nonresponse or opportunity for multiple responses.
RESULTS AND DISCUSSION In Phase 1, 30 states scored zero and only three states, California, Tennessee, and Mississippi, scored five or greater to meet the criteria for a state with a strong environment for wellness policy development in 2004. In 2006, 22 states scored five or greater to meet the criteria. In Phase 3, the overall response rate was 43% (n⫽363). Respondent characteristics are summarized in Table 2. Respondents were well educated (75% [n⫽239] were college graduates) 53.2% (n⫽166) had degrees in nutrition, 21.7% (n⫽55) were registered dietitians, 37.5% (n⫽117) had a business background, and 26.6% (n⫽83) had experience in institutional management. Eleven percent (n⫽39) of respondents were from strong states, and 89% (n⫽326) from weak states. More than 90% (n⫽290) of respondents were foodservice directors; 6.6% (n⫽21) noted other job responsibilities in their school district. The education level was higher than the typical education level of foodservice directors (15,16). More directors from medium-sized districts responded than expected, and fewer directors from large districts
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Table 3. Characteristics of school districts in Phase 3 (n⫽363) of a study examining the effect of federal legislation on wellness policy formation in school districts in the United States Factor School district enrollment (nⴝ322)a Medium-sized district (2,500-9,999 students) Large district (10,000-39,999 students) Extra-large district (⬎40,000 students) Percent of free and reduced meal applications (nⴝ320)a 0%-10% 11%-20% 21%-30% 31%-40% 41%-50% 51%-60% 61%-70% 71%-80% 81%-90% 91%-100% Average daily participation (nⴝ322)a 0%-10% 11%-20% 21%-30% 41%-50% 51%-60% 61%-70% 71%-80% 81%-90% 91%-100% School management (nⴝ322)a Self-operated Management company US Department of Agriculture region (nⴝ321)a Midwest region Southeast region Southwest region Western region Mid-Atlantic region Northeast region Mountain region
n
%
236 76 10
73.3 23.6 3.1
32 38 65 6 69 44 24 36 2 4
10.0 11.9 20.3 1.9 21.6 13.8 7.5 11.3 .6 1.3
1 2 4 15 51 60 87 56 11
.3 .6 1.2 4.7 15.8 18.6 27.0 17.4 3.4
278 44
86.3 13.7
81 62 44 44 38 29 23
25.2 16.9 13.7 13.7 11.8 9 7.2
a Frequency does not add up to 363 because of nonresponse or multiple response answers.
responded. The SES of students represented was diverse (Table 3). Table 1 presents foodservice directors’ reports of components in place before the wellness legislation was enacted in 2004 and components in place April 2007. All factors showed significant change (t⬍0.05). Before the federal wellness mandate, school district staff had in place state-specified physical education standards (n⫽244, 67.2%), federal meal requirements (n⫽306, 84.3%), recess before meals (n⫽248, 68.3%), and adequate time for meals (n⫽205, 56.5%). This study also noted before the wellness legislation, few foodservice directors reported nutrition guidelines in place for student rewards, fundraisers, or classroom parties. Nutrition
Table 4. District school foodservice director’s perceived factors supporting wellness policy development and implementation (n⫽363) Not in Place Supporting factors Federal mandate for a wellness policy in schools Concerns for children’s health supported the development of the wellness policy Additional state nutrition standards or guidelines Wellness policy template developed by your state department Having a superintendent that championed the wellness policy supported the development of the policy Determination of baseline wellness activities in your school district Training on wellness policy writing Having public meeting about the wellness policy assisted in the development process District health committee existed before the wellness policy mandate
n
%
No Support n
Somewhat Supportive
%
n
%
Moderate Support n
Very Supportive
%
n
%
Meanⴞstandard deviationa
3
0.9
9
2.8
52
16.3
75
23.4
181
56.6
4.3⫾0.9
7
2.3
15
4.8
80
25.7
98
31.5
111
35.7
3.9⫾1.0
16
5.1
13
4.2
73
23.5
104
33.4
104
33.8
3.9⫾1.1
28
9.2
21
9.2
72
23.5
90
29.4
95
31
3.7⫾1.2
23
7.6
39
12.8
80
26.3
81
26.6
81
26.6
3.5⫾1.2
22 45
7.1 14.9
25 44
8.0 14.5
116 100
37.2 33
101 62
32.4 20.5
48 52
15.4 17.2
3.4⫾1.1 3.1⫾1.3
72
23.4
57
18.5
85
27.6
60
19.5
34
11
2.8⫾1.3
117
38.9
33
11.0
59
19.6
53
17.6
39
13.0
2.6⫾1.5
Score based on a 5-point scale where 0⫽not in place and 5⫽very supportive. Cronbach’s ␣⫽.76.
a
guidelines for a la carte food were reported by only onefourth of foodservice directors. Staff wellness programs and requirements for professional standards for nutrition education instructors were noted by less than one fifth of respondents. Foodservice directors reported that before the wellness legislation, 37.4% of the wellness components were in place. Wellness policy legislation has had a marked effect. Following the legislation, 72.4% of the wellness components were in place. This study found the nutrition policy components were the variables that changed the most and reported as the components most frequently implemented. As schools have developed wellness policies and teams for implementation and evaluation, it appears there is a more organized structure and overriding policy to regulate the sale of competitive food. Foodservice directors observed the wellness committee brought together for the first time entities that work independently in schools. The committee was brought together to focus on wellness. Future research is needed to evaluate the success of this new collaboration. Foodservice directors noted after the law’s enactment the integration of nutrition into the curriculum increased from 56.5% (n⫽203) of districts to 81.3% (n⫽295) of districts, use of the foodservice department for nutrition education increased from 52.1% (n⫽189) to 75.8% (n⫽275), nutrition education offered for all grades increased from 33.6% (n⫽122) to 61.2% (n⫽222), requirements for professional standards for nutrition educators increased from 21.8% (n⫽101) to 49% (n⫽178), and nutrition education offered adults increased from 16% (n⫽58) to 46.6% (n⫽169). In Phase 2, foodservice directors demonstrated limited knowledge of the curriculum used for nutrition education. However, directors sug-
gested infusing nutrition education into the curriculum to support goals of the No Child Left Behind Act of 2001. Foodservice directors further noted time constraints do not allow for both No Child Left Behind Act curriculum and a separate nutrition education curriculum. In Phase 3 foodservice directors reported nutrition components in place with marked changes. Foodservice directors observed positive changes in physical education. There was an increase from 31.7% (n⫽115) to 60.6% (n⫽220) in the incorporation of physical education into the classroom and an increase from 46% (n⫽167) to 68.3% (n⫽248) requiring specific minutes of physical education a day. Staff wellness policies in school districts increased from 20.4% (n⫽74) to 70.8% (n⫽257). Story and colleagues (17) suggested school personnel may affect young people by modeling healthful practices and behavior. The increase in staff wellness programs after the mandate shows a major change in efforts by school staff to provide positive modeling for students. Wellness teams were designated by 219 (60.3%) of school districts for implementing and by 230 (63.4%) of school districts for evaluating the progress of the wellness policy. Foodservice directors reported less progress in the implementation and monitoring of the wellness policy than in the development of the policy. There was no difference in the percentage of components reported in wellness policies in strong environment states in 2004 (26.6%⫾21.9%) compared to the national sample in 2004 (28.4%⫾22.7%). Likewise in 2006 there was no difference in the states with strong environment mean of 61.7%⫾22% compared to the national sample in 2006 (60.1%⫾14.9%). A state’s legislative environment
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Table 5. District school foodservice directors’ perceived barriers to wellness policy development and implementation (n⫽363)
Barrier Resource barrier factor (␣ⴝ.81) Need for fundraiser with food Requirement of No Child Left Behind Act on teacher time Requirements of No Child Left Behind Act on principal leadership time Organizational barrier factor (␣ⴝ.89) Lack of support from teachers Lack of perceived need for the policy Lack of support from parents Lack of organizational structure in the district to make changes needed for wellness policy Lack of connection in the power structure of the district Lack of support by administration Lack of connection in the power structure of the district
Not a Barrier
Somewhat a Barrier
n
n
%
Moderate Barrier
Major Barrier
%
n
%
n
%
Meanⴞstandard deviationa
35
85
28.1
2.7⫾1.1
53
17.5
59
19.5
106
85
29.3
64
22.1
64
22.1
77
26.6
2.4⫾1.2
89
31.2
59
20.7
67
23.5
70
24.6
2.4⫾1.2
65 82 91
21.5 27.1 30.0
98 84 108
32.5 27.7 35.6
86 87 65
12.4 28.7 21.5
53 50 39
14.4 16.5 12.9
2.4⫾1.0 2.4⫾1.0 2.2⫾1.0
105
34.3
94
30.7
65
21.2
42
13.7
2.1⫾1.0
114 127
37.7 41.2
89 80
29.5 26.0
59 62
19.5 20.1
40 39
13.2 12.7
2.1⫾1.1 2.0⫾2.0
114
37.7
89
29.5
59
19.5
40
13.2
2.1⫾1.1
a
Score based on a 4-point scale where 1⫽not a barrier and 4⫽major barrier.
for wellness appears to have limited correlation with the development of a wellness policy in schools. In Table 4, key supporting factors for the development and implementation of the wellness policy included the federal mandate (4.3⫾0.9 on a 5-point scale with one being not in place and five being very supportive), concern for children’s health (3.9⫾1.0), and state laws and guidelines for school foods (3.8⫾1.1). Cronbach’s ␣ value for supporting factors was .76, indicating a strong correlation and notes strong internal consistency items within a factor. The research indicated school districts’ SES, F(8,266)⫽1.79, P⬎0.05; geographic region, F(6,267)⫽2.1, P⬎0.05; school district enrollment, F(2,274)⫽0.87, P⬎0.05; and the state legislative environment, F(2,274)⫽ 2.83, P⬎0.05 made no significant difference in supporting the development of the school district wellness policy. The top barrier (Table 5) to wellness policy development and implementation was the need to use food in fundraising (2.7⫾1.1). The second highest barrier noted was the competition for time of teachers (2.5⫾1.2) and principals (2.4⫾1.2) because of the demands of No Child Left Behind Act legislation. Foodservice directors noted lack of administrative support (2.0⫾2.0) and a lack of connection to the power structure (2.1⫾1.1) as less of a barrier than the need for money and time in the school district. The scores for all barriers to wellness policy implementation were between 2.1 and 2.7 on a 4-point scale, indicating barriers were present, but not insurmountable. Exploratory factor analysis yielded two factors for barriers: resource barriers (items included need for fundraisers with food, No Child Left Behind Act teacher time, and No Child Left Behind Act principal time) and organizational barriers (items included wellness policy perceived as not needed, no teacher support, no parent support, no administration support, lack of connection to power structure, and lack of
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organizational structure). Cronbach’s ␣ for these factors were .81 and .89, respectively. Western region foodservice directors noted more resource barriers in development and implementation of the wellness policy than foodservice directors in the midwest and northeast regions. Significant differences by the SES of school districts, F(8,290)⫽2.356, P⬍0.05 was noted. It appears that the foodservice directors from highincome school districts had significantly fewer barriers to implementing the wellness policy than did foodservice directors from middle income schools. There were no differences in the resource barrier by state legislative environment, F(2,298)⫽2.69, P⬎0.05; certification credentials of foodservice directors, F(3,11)⫽1.99, P⬎0.05; education of foodservice director, F(3,295)⫽1.73, P⬎0.05; or district enrollment, F(2,298)⫽2.51, P⬎0.05. Significant differences in the organizational barriers by school enrollment, F(2,305)⫽3.37, P⬍0.05 were shown between medium-sized (2.1⫾0.8) and large (2.4⫾0.8) school districts. Similarly, significant differences were shown in organizational barriers by US Department of Agriculture region, F(6,298)⫽2.51, P⬍0.05; with significant differences (P⬍0.05) between the southwest (2.5⫾0.8) and midwest (2.0⫾0.8) regions. There were no differences in organizational barriers by SES of the school districts, F(8,297)⫽0.667, P⬎0.05; state legislative environment, F(2,305)⫽1.25, P⬎0.05; certification credentials, F(3,11)⫽1.35, P⬎0.05; or education, F(3,302)⫽ 0.248, P⬎0.05. Results indicating few nutrition guidelines in place before the federal mandate are consistent with the findings of French, Story, and Fulkerson in 2002 (8). Results of wellness components in place in spring 2007 are similar to Serrano and colleagues’ (18) findings. Foodservice directors reported ambitious goals with adopted wellness policies.
Studies on school funding support findings on policy barriers. Potential difficulty anticipated in discontinuing fundraisers supports the level of involvement in competitive food sales reported by the School Health Policies and Programs study (9) and the Government Accountability Office (19). The need for fundraisers supports reported decrease in school funding (20). The results did not support the findings of Barratt and colleagues (21) who indicated the lack of administrative and teacher support were barriers to a policy concerning the use of food as a reward or punishment. Several limitations of this study are recognized. All self-reported data relies on respondents to provide accurate information. Another limitation is the time lapse in the study. Data recollected from June 2004 reflects a long time to have accurate recall of information. The response rate of 43%, although higher than typical for surveys, is a limitation. The study did not contact small and very small school districts. Further, the education level of participants, as expected in larger districts, was higher than the general population of foodservice directors. CONCLUSIONS Federally mandated wellness policies in public schools have brought about change in the types of food offered students, time and place of food availability, and nutrition and physical education. The wellness policy development has brought together key players who normally work independently to determine food choices. Competition for curriculum time and a need for additional funds are prime barriers to wellness policy implementation. Federal legislation mandating the wellness policy was the primary supporting factor for the development and implementation of the policy. The federal legislation further propelled states to develop legislation to support the wellness initiative. Despite the confusion created by a variety of state laws and wellness policies, progress in the nutrition integrity of foods available in schools is evident. The major implication is specific laws at the federal level are needed to achieve transformational change in school nutrition and physical activity programs. The wellness policy mandate provides opportunities for food and nutrition professionals to support and take leadership in the legislative process and grassroots implementation. Mandating training materials to support future changes would be helpful. Laws and funding specifically targeted toward physical education are needed. Recommendations for future practice include the development of nutrition education material that supports No Child Left Behind Act and federal nutrition standards for all school foods. Further research is needed to establish how wellness policy implementation progresses and is evaluated.
References 1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among United States children, adolescents, and adults, 1999-2002. JAMA. 2004;29:2847-2850. 2. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among United States children and adolescents, 1999-2000. JAMA. 2002;288:1728-1732. 3. Shek K. Schools should increase role in fighting obesity. Educ Daily. 2004;37:6. 4. American Dietetic Association, Society for Nutrition Education, and American School Food Service Association. Nutrition services: An essential component of comprehensive health programs. J Am Diet Assoc. 2003;103:505-514. 5. Changing the scene: Improving the school nutrition environment—A guide to local action. US Dept of Agriculture, Food and Nutrition Service Web site. http://www.fns.usda.gov/tn/Resources/guide.pdf. Accessed September 9, 2007. 6. US Government Accountability Office. School Meal Programs: Competitive Foods are Widely Available and Generate Substantial Revenues for Schools. Washington, DC: US Government Printing Office; 2005. GAO Publication No. GAO-05-563. 7. Childhood obesity: 2005 update and overview of policy options. National Conference of State Legislators Web site. http://www.ncsl.org/ programs/health/ChildhoodObesity-2005.htm.Accessed September 9, 2007. 8. French SA, Story M, Fulkerson JA. School food policies and practices: A statewide survey of secondary school principals. J Am Diet Assoc. 2002;102:1785-1789. 9. Wechsler H, Brener ND, Kuester S, Miller C. Foodservice and foods and beverages available at school: Results from the School Health Policies and Programs Study 2000. J Sch Health. 2001;71:313-324. 10. Kubik MY, Lytle LA, Story M. A practical, theory-based approach to establishing school nutrition advisory councils. J Am Diet Assoc. 2001;101:223-228. 11. Setting nutrition guidelines for all foods and beverages available on school campuses during the school day. US Department of Agriculture, Food and Nutrition Service Web site. http://teamnutrition.usda. gov/HealthierUS/index.html. Accessed April 15, 2008. 12. National Center of Educational Statistics. Digest for Educational Statistics. Washington, DC: US Department of Education; 2004. 13. Dillman DA. Mail and Internet Surveys: The Tailored Design Method. 2nd ed. Hoboken, NJ: John Wiley & Sons; 2007. 14. Creswell JW. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 2nd ed. Thousand Oaks, CA: Sage; 2003. 15. Giampaoli J, Sneed J, Cluskey M, Koenig H. School foodservice directors’ attitudes and perceived challenges in implementing food safety and HACCP programs. J Child Nutr Mgmt. 2002;26. 16. Hwang JH, Sneed J. Benchmarking financial performance in school foodservice. J Child Nutr Mgmt. 2004;28. 17. Story M, Hayes M, Kalina B. Availability of foods in high schools: Is there cause for concern? J Am Diet Assoc. 1996;96:123-126. 18. Serrano E. Kowaleska B, Hosig K, Fuller C, Fellin L, Wigand V. Status and goals of local school wellness policies in Virginia: A response to the Child Nutrition and WIC Reauthorization Act of 2004. J Nutr Ed and Behavior. 2007;39:95-100. 19. US Government Accountability Office. Public Education: Commercial Activities in Schools. Washington, DC: US Government Printing Office; 2000. GAO Publication No. GAO/HEHS-00-156. 20. Timar TB. Categorical school finance: Who gains, who loses? Policy Analysis for California Education Web site. http://pace.berkeley.edu/ reports/WP.04_2.pdf. Accessed November 8, 2008. 21. Barratt RD, Cross NA, Mattfeldt-Beman MK, Katz BM. School policies that promote healthy eating: A survey of foodservice directors in North Carolina public schools. J Child Nutr Mgt. 2004;28:1.
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Effects of Federal Legislation on Wellness Policy Formation in School Districts in the United States CAROL HEARD LONGLEY, PhD, RD; JEANNIE SNEED, PhD, RD
ABSTRACT The Reauthorization Act of 2004 required local education agencies sponsoring school meal programs to establish a wellness policy by the beginning of school year 2006-2007. The purpose of this study was to examine the process and outcome of wellness policy development in school districts. Phase 1 examined states’ school nutrition legislation. Phase 2 consisted of qualitative interviews with foodservice directors. Phase 3 utilized an e-mail and mail survey. The sampling frame was a stratified random sample selected from medium-sized or larger schools (n⫽847). Factor analysis was conducted with Cronbach’s ␣. Correlations tested relationships among variables using analysis of variance with Tukey’s post hoc test. Before the federal mandate, few wellness components (37.4%) were in place for foodservice outside of the federally regulated meal program. Following the legislation, 72.4% of the wellness components were in place. Nutrition components were the variables that changed the most and were reported as the components most frequently implemented. Changes particularly noted in foodservice operations were the use of nutrition guidelines for a la carte foods, beverages, fundraisers, parties, and vending. Foodservice directors noted improvements in nutrition education and physical education. Foodservice directors reported less progress in the implementation and monitoring of the wellness policy than in the development of the policy. The top barriers to wellness policy development and implementa-
C. H. Longley is an assistant professor, Department of Nutrition and Food Science, Texas Women’s University, Denton; at the time of the study, she was a graduate student, Iowa State University, Ames. J. Sneed is with Sneed Consulting, Stillwater, OK; at the time of the study, she was a professor, Department of Apparel, Educational Studies, and Hospitality Management, Iowa State University, Ames. Address correspondence to: Carol Heard Longley, PhD, RD, 1566 Hwy 17, Aledo, IL 61231. E-mail: carollongley@ qconline.com Manuscript accepted: June 13, 2008. Copyright © 2009 by the American Dietetic Association. 0002-8223/09/10901-0009$36.00/0 doi: 10.1016/j.jada.2008.10.011
© 2009 by the American Dietetic Association
tion were the need to use food in fundraising and competition for time. J Am Diet Assoc. 2009;109:95-101.
T
he increasing incidence of childhood obesity (1) is creating concern about the health of American children (2). The Child Nutrition and WIC Reauthorization Act of 2004 required local education agencies sponsoring school meal programs to establish a wellness policy beginning with the 2006-2007 school year that addresses obesity because students spend a significant part of the day, and much of the year, in school. This mandate required schools to address both nutrition and physical activity and involve key stakeholders. Schools are well positioned to play an important role in fighting childhood obesity. It has been argued that schools can play this role by altering various policies and practices (3) to provide a healthful school environment, ensuring coordination of a comprehensive nutrition education program, providing well-run child nutrition programs, and engaging the support of community partners (4). Schools have become a reflection of society. Foods high in energy, fat, and sugar are readily available. There is limited regulation of food sale or use in schools (5). Federal regulations have limited jurisdiction over food sold in schools outside of the federal meal programs. The unfunded wellness mandate is the first federal legislative effort to address foods sold in schools and obesity prevention. School districts not complying with the federal mandate will be cited during administrative reviews, placing the program at risk of losing federal funding. In 2002, 31 states had no state competitive food policies other than US Department of Agriculture regulations (6). In 2005, state legislators introduced nearly 200 bills to address the nutritional quality of school foods (7). As of August 2006, state legislatures in 39 states considered or enacted legislation related to the nutritional quality of school food and beverages (7). French and colleagues (8) suggested that district health councils provide the best mechanism to facilitate school-level policy development. The School Health Policies and Program Study found that about two thirds of schools had existing health councils that develop policies or coordinate activities on health issues (9). Kubik, Lytle, and Story (10) offered a less optimistic picture of the ability of school district administrators to form nutrition policies. They concluded that establishing a nutrition policy at the local school level is complex and
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time intensive, and school administrators do not know how to establish and implement nutrition policies. The purpose of this study was to examine the process of wellness policy development in school districts in the United States following the 2004 mandate. Specific research objectives included examinations of the legislative environment of states for wellness before development of the wellness policy, assessment of district wellness policies in place before and after the federal mandate, and examination the internal and external environments in school districts that supported or hindered districtwide policy development. Results could assist school district administrators with implementation of wellness policies and lawmakers as they consider further legislation for school nutrition and physical fitness. METHODS Study Design and Sample Districts participating in the National School Lunch Program were included in the study. The research study consisted of three phases. In Phase 1, all 50 states were reviewed for their regulatory environment for wellness policy formation before (2004) and after (2006) the wellness policy enactment. States were evaluated for policy for fat, energy, and sugar content of a la carte foods; beverage portion and nutrition standards, time and place rules for food sales, and statewide training on the development of wellness policies. Each criterion was assigned one point. States scoring five points or greater were classified as strong legislative environments (11). In Phase 2, state nutrition directors were contacted in randomly selected strong and weak states for names of foodservice directors involved in wellness policy development. Foodservice directors attending the School Nutrition Association Leadership Meeting in fall 2006 were utilized as participants from some states (n⫽21). Twenty-one participants from the state directors’ referral list and leadership list were interviewed by telephone using a qualitative survey. In Phase 3, school foodservice directors in medium-sized (2,500 to 9,999 students) or larger public school districts were the target population. A random national sample of foodservice directors in public school districts was drawn from the Digest for Educational Statistics (12). A sampling frame of 3,924 school districts consisted of 3,077 medium-sized school districts, 717 large-sized (10,001 to 39,999 students) districts, and 130 extra large-sized (⬎40,000 students) districts. Based on school size, a stratified random sample of 847 foodservice directors was surveyed. Socioeconomic status (SES) of school districts was determined by the reported level of free and reduced meal applications. Phase 3 utilized an E-mail and mail quantitative survey to contact 847 foodservice directors through out the United States. Research Instruments For Phase 2, a qualitative questionnaire with open-ended questions was used as a formative evaluation to determine information about the wellness policy committee development and working process, barriers, and support for the wellness policy; status of the wellness policy; and
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demographic questions. The constructs and issues found in Phase 2 were used to develop the quantitative survey (Phase 3). The questionnaire for Phase 3 consisted of six parts. Table 1 presents a list of components evaluated. Yes and no, Likert-type rating scales, and multiple choice responses were used. Data Collection Interviews for Phase 2 were conducted during January and February 2007. The national survey (Phase 3) was conducted during April 2007. An introduction e-mail was sent to a sample of 717 randomly selected foodservice directors using an electronic survey (SurveyMonkey.com, SurveyMonkey, Portland, OR). Three days after the original contact, an e-mail with a cover letter from the principal investigator accompanied the survey. One week after the initial mailing, a follow-up E-mail was sent to all survey recipients thanking them for responding or reminding them to return the survey. One week later a second survey was sent to each nonrespondent. One week after sending the second survey to nonrespondents, a third survey was e-mailed to each nonrespondent (13). The same survey, letters, and notes were mailed to directors with only mailing addresses. This study was approved by the Institutional Review Board at Iowa State University before data collection. Data Analysis In Phase 2, the telephone interviews, the six steps recommended by Creswell (14) for qualitative data analysis were used. Notes were taken during the phone interviews as well as tape-recorded. The transcribed interviews were double-checked with the notes for accuracy. Themes and connecting strategies were developed for each question. Study reliability was checked by having two foodservice directors with graduate degrees read transcripts independently to review categorized information and themes. The multiple themes found by the three reviewers were compared for consistency. In Phase 3, data collected in the SurveyMonkey.com instrument was reviewed for duplicate responses. Duplicate responses and returned surveys with no questioned answered were eliminated. In Phase 3, descriptive statistics (ie, means, standard deviations, and frequencies) were used to examine survey results assessing wellness components in place. Exploratory factor analysis of the study variables was conducted using the principal components analysis with varimax rotation to evaluate barriers and supporting factors. Factors were retained when there was a minimum eigenvalue of one. Factors were tested for significance using Cronbach’a ␣. Analysis of variance was used with Tukey’s Honest Significant Difference post hoc test to test relationships among variables. Attitudes, barriers, and support were dependent latent variables. Independent variables included certification, enrollment, level of education, legislative environment, school district SES, and US Department of Agriculture region. The Statistical Package for the Social Sciences (version 13.0 for Windows, 2004, SPSS Inc, Chicago, IL) was used for all data analyses.
Table 1. Components district school foodservice directors in strong legislative environmentsa before federal legislation on wellness policy reported to be included in school district wellness policies (n⫽363) Before Legislationb States with Strong Environment
National Sample Components Nutrition education component Followed state-specified standards for nutrition and health education Integrated nutrition education into current curriculum Utilized the foodservice department for nutrition education Offered nutrition education for each grade level Required professional standards/development for nutrition education instructors Offered nutrition education for adults Physical education component Followed state-specified standards for physical education Required professional standards/development for physical education instructors Established specified number of minutes of physical activity per day Incorporated physical activity into classroom activities Nutrition policy component Nutrition guidelines for reimbursable school meals Time food can be sold during the school day Location food can be sold on school campus A la carte nutrition policy for fat content A la carte nutrition policy for saturated fat Beverage nutrition standard A la carte nutrition policy for sugar content Nutrition guidelines for vending machines Beverage portion size limitation A la carte nutrition policy for total energy per portion Nutrition guidelines for food and beverages served/available at classroom parties Nutrition guidelines for fundraisers Nutrition guidelines for use of food and beverages as a reward Other school-based activities component Scheduled recess before lunch Ensured adequate time for meals Staff wellness programs encouraged staff to serve as role model for wellness behavior Implementation and monitoring Principals responsible for implementation Principals responsible for evaluation Superintendent responsible for implementation Superintendent responsible for evaluation Wellness team responsible for implementation Wellness team responsible for evaluation Meanⴞstandard deviation of wellness components
After Legislationb States with Strong Environment
National Sample
n
%
n
%
n
%
n
%
262
72.2
26
66.6
326
89.8
37
95
205
56.5
22
56.4
295
81.3
33
84.6
189
52.1
22
56.4
275
75.8
27
69.2
122
33.6
13
33.3
222
61.2
21
53.8
101 58
21.8 16.0
8 8
20.5 20.5
178 169
49.0 46.6
15 19
38.5 48.7
244
67.2
24
61.5
294
81.0
30
76.9
193
53.2
17
43.5
247
68.0
23
59
167
46.0
23
59
248
68.3
26
66.7
115
31.7
13
33.3
220
60.6
21
53.8
306
84.3
31
79.5
338
93.1
36
92.3
192
52.9
20
51.2
300
82.6
38
97.4
159 109 103 103 86 82 79
43.8 30.0 28.4 28.4 23.7 22.6 21.8
17 10 11 14 5 13 13
43.5 25.6 28.2 35.9 12.8 33.3 33.3
264 289 276 291 270 287 268
72.7 79.6 76.0 80.2 74.4 79.1 73.8
30 36 36 36 33 32 35
76.9 92.3 92.3 92.3 84.6 82.1 89.7
71
19.6
5
12.8
241
66.4
34
87.2
26 25
7.2 6.9
1 4
2.6 10.3
254 247
70.0 68.0
33 35
84.6 89.7
25
6.9
2
5.1
248
68.3
31
79.5
248 205
68.3 56.5
6 22
15.4 56.4
273 257
75.2 70.8
12 26
30.8 66.7
74
20.4
7
17.9
257
70.8
29
74.3
53 39
14.6 10.7
5 4
12.8 10.3
191 149
52.6 41.1
15 13
38.4 33.3
33 27
9.1 7.4
1 0
2.6 0
135 101
37.2 27.8
11 11
28.2 28.2
20 16
5.5 4.4
4 2
10.3 5.1
219 230
60.3 63.4
24 29
61.5 74.4
26.6⫾21.9
218.3⫾54.1
60.1⫾14.9
24⫾8.6
61.7⫾22
103.8⫾82
28.4⫾22.65
10.4⫾8.5
a
States were evaluated for policy for fat, energy, and sugar content of a la carte foods; beverage portion and nutrition standards, time and place rules for food sales, and statewide training on the development of wellness policies. Each criterion was assigned 1 point. States scoring 5 points or greater were classified as strong legislative environments (11). b The Child Nutrition and WIC Reauthorization Act of 2004 required local education agencies sponsoring school meal programs to establish a wellness policy beginning with the 2006-2007 school year.
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Table 2. Characteristics of district school foodservice directors in Phase 3 (n⫽363) of a study examining the effect of federal legislation on wellness policy formation in school districts in the United States Factor Education level (nⴝ317)a High school Some college Bachelor’s degree Graduate degree Educational background (nⴝ312)a Nutrition Business Hotel, restaurant, and institution management Education Business/nutrition Business/hotel, restaurant, and institution management Other Education/nutrition Marketing Credentials (nⴝ254)a Certified by School Nutrition Association Other Registered dietitian No other credentials School Nutrition Specialist credential Teacher’s certificate Job title (nⴝ318)a Foodservice director Other Superintendent Health coordinator Nurse
n
%
14 65 130 109
4.4 20.5 41.0 34.4
166 117 83 74 50
53.2 37.5 26.6 23.7 16.0
43 31 28 12
13.8 9.9 9.0 3.8
90 59 55 53 47 42
35.4 23.2 21.7 20.9 18.5 16.5
290 21 5 1 0
91.2 6.6 1.5 .3
a Frequency does not add up to 363 because of nonresponse or opportunity for multiple responses.
RESULTS AND DISCUSSION In Phase 1, 30 states scored zero and only three states, California, Tennessee, and Mississippi, scored five or greater to meet the criteria for a state with a strong environment for wellness policy development in 2004. In 2006, 22 states scored five or greater to meet the criteria. In Phase 3, the overall response rate was 43% (n⫽363). Respondent characteristics are summarized in Table 2. Respondents were well educated (75% [n⫽239] were college graduates) 53.2% (n⫽166) had degrees in nutrition, 21.7% (n⫽55) were registered dietitians, 37.5% (n⫽117) had a business background, and 26.6% (n⫽83) had experience in institutional management. Eleven percent (n⫽39) of respondents were from strong states, and 89% (n⫽326) from weak states. More than 90% (n⫽290) of respondents were foodservice directors; 6.6% (n⫽21) noted other job responsibilities in their school district. The education level was higher than the typical education level of foodservice directors (15,16). More directors from medium-sized districts responded than expected, and fewer directors from large districts
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Table 3. Characteristics of school districts in Phase 3 (n⫽363) of a study examining the effect of federal legislation on wellness policy formation in school districts in the United States Factor School district enrollment (nⴝ322)a Medium-sized district (2,500-9,999 students) Large district (10,000-39,999 students) Extra-large district (⬎40,000 students) Percent of free and reduced meal applications (nⴝ320)a 0%-10% 11%-20% 21%-30% 31%-40% 41%-50% 51%-60% 61%-70% 71%-80% 81%-90% 91%-100% Average daily participation (nⴝ322)a 0%-10% 11%-20% 21%-30% 41%-50% 51%-60% 61%-70% 71%-80% 81%-90% 91%-100% School management (nⴝ322)a Self-operated Management company US Department of Agriculture region (nⴝ321)a Midwest region Southeast region Southwest region Western region Mid-Atlantic region Northeast region Mountain region
n
%
236 76 10
73.3 23.6 3.1
32 38 65 6 69 44 24 36 2 4
10.0 11.9 20.3 1.9 21.6 13.8 7.5 11.3 .6 1.3
1 2 4 15 51 60 87 56 11
.3 .6 1.2 4.7 15.8 18.6 27.0 17.4 3.4
278 44
86.3 13.7
81 62 44 44 38 29 23
25.2 16.9 13.7 13.7 11.8 9 7.2
a Frequency does not add up to 363 because of nonresponse or multiple response answers.
responded. The SES of students represented was diverse (Table 3). Table 1 presents foodservice directors’ reports of components in place before the wellness legislation was enacted in 2004 and components in place April 2007. All factors showed significant change (t⬍0.05). Before the federal wellness mandate, school district staff had in place state-specified physical education standards (n⫽244, 67.2%), federal meal requirements (n⫽306, 84.3%), recess before meals (n⫽248, 68.3%), and adequate time for meals (n⫽205, 56.5%). This study also noted before the wellness legislation, few foodservice directors reported nutrition guidelines in place for student rewards, fundraisers, or classroom parties. Nutrition
Table 4. District school foodservice director’s perceived factors supporting wellness policy development and implementation (n⫽363) Not in Place Supporting factors Federal mandate for a wellness policy in schools Concerns for children’s health supported the development of the wellness policy Additional state nutrition standards or guidelines Wellness policy template developed by your state department Having a superintendent that championed the wellness policy supported the development of the policy Determination of baseline wellness activities in your school district Training on wellness policy writing Having public meeting about the wellness policy assisted in the development process District health committee existed before the wellness policy mandate
n
%
No Support n
Somewhat Supportive
%
n
%
Moderate Support n
Very Supportive
%
n
%
Meanⴞstandard deviationa
3
0.9
9
2.8
52
16.3
75
23.4
181
56.6
4.3⫾0.9
7
2.3
15
4.8
80
25.7
98
31.5
111
35.7
3.9⫾1.0
16
5.1
13
4.2
73
23.5
104
33.4
104
33.8
3.9⫾1.1
28
9.2
21
9.2
72
23.5
90
29.4
95
31
3.7⫾1.2
23
7.6
39
12.8
80
26.3
81
26.6
81
26.6
3.5⫾1.2
22 45
7.1 14.9
25 44
8.0 14.5
116 100
37.2 33
101 62
32.4 20.5
48 52
15.4 17.2
3.4⫾1.1 3.1⫾1.3
72
23.4
57
18.5
85
27.6
60
19.5
34
11
2.8⫾1.3
117
38.9
33
11.0
59
19.6
53
17.6
39
13.0
2.6⫾1.5
Score based on a 5-point scale where 0⫽not in place and 5⫽very supportive. Cronbach’s ␣⫽.76.
a
guidelines for a la carte food were reported by only onefourth of foodservice directors. Staff wellness programs and requirements for professional standards for nutrition education instructors were noted by less than one fifth of respondents. Foodservice directors reported that before the wellness legislation, 37.4% of the wellness components were in place. Wellness policy legislation has had a marked effect. Following the legislation, 72.4% of the wellness components were in place. This study found the nutrition policy components were the variables that changed the most and reported as the components most frequently implemented. As schools have developed wellness policies and teams for implementation and evaluation, it appears there is a more organized structure and overriding policy to regulate the sale of competitive food. Foodservice directors observed the wellness committee brought together for the first time entities that work independently in schools. The committee was brought together to focus on wellness. Future research is needed to evaluate the success of this new collaboration. Foodservice directors noted after the law’s enactment the integration of nutrition into the curriculum increased from 56.5% (n⫽203) of districts to 81.3% (n⫽295) of districts, use of the foodservice department for nutrition education increased from 52.1% (n⫽189) to 75.8% (n⫽275), nutrition education offered for all grades increased from 33.6% (n⫽122) to 61.2% (n⫽222), requirements for professional standards for nutrition educators increased from 21.8% (n⫽101) to 49% (n⫽178), and nutrition education offered adults increased from 16% (n⫽58) to 46.6% (n⫽169). In Phase 2, foodservice directors demonstrated limited knowledge of the curriculum used for nutrition education. However, directors sug-
gested infusing nutrition education into the curriculum to support goals of the No Child Left Behind Act of 2001. Foodservice directors further noted time constraints do not allow for both No Child Left Behind Act curriculum and a separate nutrition education curriculum. In Phase 3 foodservice directors reported nutrition components in place with marked changes. Foodservice directors observed positive changes in physical education. There was an increase from 31.7% (n⫽115) to 60.6% (n⫽220) in the incorporation of physical education into the classroom and an increase from 46% (n⫽167) to 68.3% (n⫽248) requiring specific minutes of physical education a day. Staff wellness policies in school districts increased from 20.4% (n⫽74) to 70.8% (n⫽257). Story and colleagues (17) suggested school personnel may affect young people by modeling healthful practices and behavior. The increase in staff wellness programs after the mandate shows a major change in efforts by school staff to provide positive modeling for students. Wellness teams were designated by 219 (60.3%) of school districts for implementing and by 230 (63.4%) of school districts for evaluating the progress of the wellness policy. Foodservice directors reported less progress in the implementation and monitoring of the wellness policy than in the development of the policy. There was no difference in the percentage of components reported in wellness policies in strong environment states in 2004 (26.6%⫾21.9%) compared to the national sample in 2004 (28.4%⫾22.7%). Likewise in 2006 there was no difference in the states with strong environment mean of 61.7%⫾22% compared to the national sample in 2006 (60.1%⫾14.9%). A state’s legislative environment
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Table 5. District school foodservice directors’ perceived barriers to wellness policy development and implementation (n⫽363)
Barrier Resource barrier factor (␣ⴝ.81) Need for fundraiser with food Requirement of No Child Left Behind Act on teacher time Requirements of No Child Left Behind Act on principal leadership time Organizational barrier factor (␣ⴝ.89) Lack of support from teachers Lack of perceived need for the policy Lack of support from parents Lack of organizational structure in the district to make changes needed for wellness policy Lack of connection in the power structure of the district Lack of support by administration Lack of connection in the power structure of the district
Not a Barrier
Somewhat a Barrier
n
n
%
Moderate Barrier
Major Barrier
%
n
%
n
%
Meanⴞstandard deviationa
35
85
28.1
2.7⫾1.1
53
17.5
59
19.5
106
85
29.3
64
22.1
64
22.1
77
26.6
2.4⫾1.2
89
31.2
59
20.7
67
23.5
70
24.6
2.4⫾1.2
65 82 91
21.5 27.1 30.0
98 84 108
32.5 27.7 35.6
86 87 65
12.4 28.7 21.5
53 50 39
14.4 16.5 12.9
2.4⫾1.0 2.4⫾1.0 2.2⫾1.0
105
34.3
94
30.7
65
21.2
42
13.7
2.1⫾1.0
114 127
37.7 41.2
89 80
29.5 26.0
59 62
19.5 20.1
40 39
13.2 12.7
2.1⫾1.1 2.0⫾2.0
114
37.7
89
29.5
59
19.5
40
13.2
2.1⫾1.1
a
Score based on a 4-point scale where 1⫽not a barrier and 4⫽major barrier.
for wellness appears to have limited correlation with the development of a wellness policy in schools. In Table 4, key supporting factors for the development and implementation of the wellness policy included the federal mandate (4.3⫾0.9 on a 5-point scale with one being not in place and five being very supportive), concern for children’s health (3.9⫾1.0), and state laws and guidelines for school foods (3.8⫾1.1). Cronbach’s ␣ value for supporting factors was .76, indicating a strong correlation and notes strong internal consistency items within a factor. The research indicated school districts’ SES, F(8,266)⫽1.79, P⬎0.05; geographic region, F(6,267)⫽2.1, P⬎0.05; school district enrollment, F(2,274)⫽0.87, P⬎0.05; and the state legislative environment, F(2,274)⫽ 2.83, P⬎0.05 made no significant difference in supporting the development of the school district wellness policy. The top barrier (Table 5) to wellness policy development and implementation was the need to use food in fundraising (2.7⫾1.1). The second highest barrier noted was the competition for time of teachers (2.5⫾1.2) and principals (2.4⫾1.2) because of the demands of No Child Left Behind Act legislation. Foodservice directors noted lack of administrative support (2.0⫾2.0) and a lack of connection to the power structure (2.1⫾1.1) as less of a barrier than the need for money and time in the school district. The scores for all barriers to wellness policy implementation were between 2.1 and 2.7 on a 4-point scale, indicating barriers were present, but not insurmountable. Exploratory factor analysis yielded two factors for barriers: resource barriers (items included need for fundraisers with food, No Child Left Behind Act teacher time, and No Child Left Behind Act principal time) and organizational barriers (items included wellness policy perceived as not needed, no teacher support, no parent support, no administration support, lack of connection to power structure, and lack of
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organizational structure). Cronbach’s ␣ for these factors were .81 and .89, respectively. Western region foodservice directors noted more resource barriers in development and implementation of the wellness policy than foodservice directors in the midwest and northeast regions. Significant differences by the SES of school districts, F(8,290)⫽2.356, P⬍0.05 was noted. It appears that the foodservice directors from highincome school districts had significantly fewer barriers to implementing the wellness policy than did foodservice directors from middle income schools. There were no differences in the resource barrier by state legislative environment, F(2,298)⫽2.69, P⬎0.05; certification credentials of foodservice directors, F(3,11)⫽1.99, P⬎0.05; education of foodservice director, F(3,295)⫽1.73, P⬎0.05; or district enrollment, F(2,298)⫽2.51, P⬎0.05. Significant differences in the organizational barriers by school enrollment, F(2,305)⫽3.37, P⬍0.05 were shown between medium-sized (2.1⫾0.8) and large (2.4⫾0.8) school districts. Similarly, significant differences were shown in organizational barriers by US Department of Agriculture region, F(6,298)⫽2.51, P⬍0.05; with significant differences (P⬍0.05) between the southwest (2.5⫾0.8) and midwest (2.0⫾0.8) regions. There were no differences in organizational barriers by SES of the school districts, F(8,297)⫽0.667, P⬎0.05; state legislative environment, F(2,305)⫽1.25, P⬎0.05; certification credentials, F(3,11)⫽1.35, P⬎0.05; or education, F(3,302)⫽ 0.248, P⬎0.05. Results indicating few nutrition guidelines in place before the federal mandate are consistent with the findings of French, Story, and Fulkerson in 2002 (8). Results of wellness components in place in spring 2007 are similar to Serrano and colleagues’ (18) findings. Foodservice directors reported ambitious goals with adopted wellness policies.
Studies on school funding support findings on policy barriers. Potential difficulty anticipated in discontinuing fundraisers supports the level of involvement in competitive food sales reported by the School Health Policies and Programs study (9) and the Government Accountability Office (19). The need for fundraisers supports reported decrease in school funding (20). The results did not support the findings of Barratt and colleagues (21) who indicated the lack of administrative and teacher support were barriers to a policy concerning the use of food as a reward or punishment. Several limitations of this study are recognized. All self-reported data relies on respondents to provide accurate information. Another limitation is the time lapse in the study. Data recollected from June 2004 reflects a long time to have accurate recall of information. The response rate of 43%, although higher than typical for surveys, is a limitation. The study did not contact small and very small school districts. Further, the education level of participants, as expected in larger districts, was higher than the general population of foodservice directors. CONCLUSIONS Federally mandated wellness policies in public schools have brought about change in the types of food offered students, time and place of food availability, and nutrition and physical education. The wellness policy development has brought together key players who normally work independently to determine food choices. Competition for curriculum time and a need for additional funds are prime barriers to wellness policy implementation. Federal legislation mandating the wellness policy was the primary supporting factor for the development and implementation of the policy. The federal legislation further propelled states to develop legislation to support the wellness initiative. Despite the confusion created by a variety of state laws and wellness policies, progress in the nutrition integrity of foods available in schools is evident. The major implication is specific laws at the federal level are needed to achieve transformational change in school nutrition and physical activity programs. The wellness policy mandate provides opportunities for food and nutrition professionals to support and take leadership in the legislative process and grassroots implementation. Mandating training materials to support future changes would be helpful. Laws and funding specifically targeted toward physical education are needed. Recommendations for future practice include the development of nutrition education material that supports No Child Left Behind Act and federal nutrition standards for all school foods. Further research is needed to establish how wellness policy implementation progresses and is evaluated.
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