School Wellness Policies

School Wellness Policies Effects of Using Standard Templates Erin M. Smith, MA, Kristen L. Capogrossi, PhD, Paul A. Estabrooks, PhD

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 fıve 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 fındings suggest that further research is needed about how best to support schools that wish to develop school wellness policies. (Am J Prev Med 2012;43(3):304 –308) © 2012 American Journal of Preventive Medicine

Introduction

P

ublic school policies related to physical activity and eating behaviors recently have become the focal point for policymakers to evaluate the effect of rules and regulations on the childhood obesity epidemic.1–9 Although previous literature has demonstrated a link between school physical activity/nutrition environments and many health-related outcomes,1,10 –16 school wellness policies may provide the spark to implement environmental change.8 Previous research17–20 includes a small number of evaluations of school wellness policies

From the Department of Human Nutrition, Foods and Exercise (Smith, Estabrooks), Department of Agricultural and Applied Economics (Capogrossi), Virginia Tech, Blacksburg, Virginia Address correspondence to: Erin M. Smith, MA, 1981 Kraft Drive, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg VA 24061. E-mail: [email protected]. 0749-3797/$36.00 http://dx.doi.org/10.1016/j.amepre.2012.05.009

304 Am J Prev Med 2012;43(3):304 –308

that have investigated the degree to which policies addressed the fıve federal requirements of wellness policies and/or goals identifıed during the policy planning process. However, few have evaluated quality beyond the simple adherence to the federal requirements. Local educational agencies are responsible for writing, adopting, implementing, and evaluating their school wellness policies; however, state school board associations have emerged as a dissemination tool of pertinent governance and wellness policy information across school districts.21 These school board associations are providing model wellness policy templates for local school boards to adopt and refıne to comply with the federal mandate,21 and in Virginia, a majority of the districts have adopted a third-party wellness policy provided by the Virginia School Boards Association (VSBA), a private nonpartisan organization that provides service, training, and advocacy to school boards throughout the Commonwealth of Virginia.22

© 2012 American Journal of Preventive Medicine • Published by Elsevier Inc.

Smith et al / Am J Prev Med 2012;43(3):304 –308

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Methods

and other foods and beverages; (4) physical education; (5) physical activity; (6) communication and promotion; and (7) evaluation. Each item was coded using a 3-point scale (a detailed description of the coding protocol is available elsewhere23), and items were coded 0 if there was no mention of the component in the policy. A score of 1 was given to an item if the policy mentioned the component vaguely, and an item received a 2 if the component was addressed with specifıc strategies. The policies were coded independently by three researchers—two junior researchers and one senior researcher. The inter-rater reliability25 of the researchers for the current study was strong (␬⫽0.72).

Participants

Policy Strength and Comprehensiveness

The purpose of this pilot study was to determine the degree to which third-party school wellness policy templates either improve or reduce policy quality. To achieve this purpose, an equal number of school wellness policies were selected in the Commonwealth of Virginia that were either developed locally or used the third-party template and compared the strength and comprehensiveness of the wellness policies that resulted.

A policy’s strength reflected the degree to which a policy included Each local educational agency throughout Virginia was identifıed detailed implementation information including specifıc strategies for possible participation in the current study using the National for each policy component based on the equations below.24 To Center for Education Statistics23 in 2010 after receiving approval calculate the strength score of a school wellness policy across a from Virginia Tech’s IRB. School districts were excluded if they specifıc policy subgroup, researchers counted the number of items were a charter school, a regional educational agency, or a state scored as 2 and divided that count by the total number of items in educational agency (as designated by the National Center for Eduthe policy subgroup. The Total Strength Score was the average of the cational Statistics). seven policy strength subgroups for each school wellness policy. From the resulting 130 districts, each district wellness policy was The policy subgroup scores along with the Total Strength Score obtained and classifıed either as a locally developed policy or as a could range from 0 (weakest) to 1 (strongest). A policy’s comprepolicy influenced or provided by the Virginia School Boards Assohensiveness reflected the breadth of the policy across a particular ciation (VSBA). To be categorized as VSBA policy, the following subgroup.24 To calculate the comprehensiveness of conditions had to be met: (1) the policy used the a school wellness policy across a specifıc policy Policy File Code “JHCF”—a code provided in subgroup, researchers counted the number of subthe policy organization VSBA template providSee group items coded as 1 or 2 and divided that count ed; (2) the introduction to the policy contained related by the total number of items in the subgroup. The the following verbatim language “the XX School Commentary by Total Comprehensiveness Score was the average of Board recognizes the relationship between stuall the policy comprehensive subgroups for each Maddock in this dent health and learning. The school division school wellness policy. The policy subgroup along issue. desires to provide a comprehensive program that with the Total Comprehensiveness Scores could addresses nutrition education, physical activity, range from 0 (least comprehensive) to 1 (most nutrition guidelines and other school activities”; comprehensive). and (3) the policy was organized in the same manner as the VSBA template. Compliance with Federal Requirements Once eligible policies were identifıed for each of the VSBA and non-VSBA conditions, ten policies were randomly selected from each Compliance was determined by counting the presence of six spepool of policies. The decision to randomly select ten policies for each cifıc items that reflected the fıve federal requirements to indicate if condition was based on the resources available for coding the policies a school wellness policy was addressed: (1) nutrition education; in a timely manner rather than on an a priori sample size calculation. (2) USDA meals; (3) competitive foods; (4) physical activity goals; This pragmatic approach was used to provide initial data to determine (5) communication and promotion of the policy with parents and if there were trends in the strength and comprehension of policies surrounding community; and (6) implementation plans.23 Theredeveloped using the template when compared to those that did not. fore, any school wellness policy that received a coding of 1 or 2 on The number of policies was selected to allow for the power necessary to each of these items would be considered compliant. detect a large effect with a probability of p⬍0.05.

Statistical Analyses Policy Coding Researchers used a previously validated24 version of the Wellness School Assessment Tool (WellSat) to determine the strength and comprehensiveness of each district’s school wellness policies. This tool, developed by The Yale Rudd Center for Food Policy and Obesity, has been used in a previous research study to evaluate the strength and comprehensiveness of school wellness policies to systematically evaluate each school district’s efforts to improve access to healthful foods and regular physical activity in the following seven subgroups: (1) nutrition education; (2) federal standards for the U.S. Department of Agriculture (USDA) child nutrition programs and school meals; (3) nutrition standards for competitive September 2012

Researchers used SPSS, version 18, for all statistical analyses. Independent t-tests were used to compare school wellness policy subcategories and overall strength and comprehensiveness scores according to different policy types. Finally, standardized effect sizes were calculated to document the magnitude of any differences that emerged.

Results One hundred eleven of 130 wellness policies were publically available via a school district’s website. Of those 111 policies, 78% were influenced and/or provided by the VSBA, and 22% were developed locally. Table 1 shows selected descrip-

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306

Table 1. Sample characteristics, n (%) Characteristic

Present study

Virginia

3 (15)

15 (11.3)

DISTRICT TYPE Urban VSBA

1

Non-VSBA

2

Suburban

6 (30)

VSBA

1

Non-VSBA

5

Rural

11 (55)

VSBA

8

Non-VSBA

3

19 (14.3)

9 (45)

VSBA

7

Non-VSBA

2

⬎5000

11 (55)

VSBA

3

Non-VSBA

8

Federal component

13 (60)

VSBA

5

Non-VSBA

8

40–100

7 (40)

VSBA

5

Non-VSBA

2

%

Nutrition education goals

82 (63.1)

Overall

91.3

VSBA

92.3

Local

90.0

USDA meals*

48 (36.9)

Overall

69.6

VSBA

46.2

Local

100.0

Competitive foods

ELIGIBLE FOR FREE AND REDUCED-PRICE MEALS (%) 0–39.9

Table 2. Compliance of sample population to federal wellness policy requirements, % of goals addressed

98 (74.2)

ENROLLMENT 0–4999

oped policies (Table 3). Locally developed school wellness policies were stronger, t(2, 21)⫽ ⫺1.82, p⬍0.05, and more comprehensive, t(2, 21)⫽ ⫺2.5, p⬍0.05, than those influenced or provided by the VSBA. Standardized effect sizes documented that the differences between locally developed school wellness policies were large for both comprehensiveness and strength (d⫽0.90 and 1.43, respectively; Table 3).

55 (42.3)

Overall

86.9

VSBA

92.3

Local

80.0

Physical activity goals 75 (57.7)

Overall

95.6

VSBA

100.0

Local

90.0

Communication and promotion* Note: Virginia shows the total population of school districts across categories. VSBA, Virginia School Boards Association

tive information of the sample of randomly selected school districts compared to all districts in Virginia. Overall, only 17% of school wellness policies met all federal requirements (Table 2). On average, locally developed policies met fıve of six federal requirements, whereas VSBA policies met four of six, t(2, 21)⫽2.161, p⬍0.05. Also, non-VSBA policies were more likely to meet federal guidelines for communication and promotion (chi-squared⫽7.304, p⬍0.05) and USDA meals (chisquared⫽7.740 p⬍0.05). In terms of strength, the school wellness policies of both samples were extremely weak (M⫽0.16⫾0.13) and mildly comprehensive (M⫽0.37⫾0.16). For overall strength and comprehensiveness, there was a difference between local educational agencies that adopted the VSBA-form policy and those that adopted locally devel-

Overall

30.4

VSBA

7.6

Local

60.0

Implementation Overall

86.9

VSBA

84.6

Local

90.0

Met all federal guidelines17 Overall

17.4

VSBA

0.0

Local

17.4

Source: Child Nutrition and WIC Reauthorization Act of 2004. Public L. No. 108 –265. § 204 (2004)17 *␹2 analysis showed significant differences, p⬍0.05. USDA, U.S. Department of Agriculture; VSBA, Virginia School Boards Association; WIC, U.S. Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children

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Smith et al / Am J Prev Med 2012;43(3):304 –308

Table 3. Descriptive statistics for policy subgroups for VSBA and locally developed school wellness policies M (SD)

307

Table 3. (continued)

Effect size

M (SD)

Effect size 1.07*

NUTRITION EDUCATION

VSBA

0.163 (0.134)

Comprehensive score

Local

0.347 (0.210)

VSBA

0.407 (0.147)

Local

0.419 (0.242)

0.06

Strength score VSBA

0.154 (0.092)

Local

0.220 (0.201)

0.48

Strength score VSBA

0.016 (0.033)

Local

0.122 (0.125)

EVALUATION Comprehensive score

USDA MEALS

VSBA

0.465 (0.268)

Comprehensive score

Local

0.564 (0.223)

VSBA

0.349 (0.148)

Local

0.479 (0.275)

0.65

Strength score VSBA

0.140 (0.111)

Local

0.222 (0.206)

0.50

VSBA

0.099 (0.261)

Local

0.333 (0.314)

Comprehensive score 0.308 (0.109)

Comprehensive score

Local

0.431 (0.183)

Local

0.300 (0.220)

0.65

Strength score VSBA

0.044 (0.038)

Local

0.159 (0.212)

0.90

PHYSICAL EDUCATION

0.90*

Strength score VSBA

0.091 (0.048)

Local

0.226 (0.159)

1.43*

*Bold indicates that independent t-tests showed significant differences (p⬍0.05) between the groups VSBA, Virginia School Boards Association

Discussion

Comprehensive score VSBA

0.097 (0.168)

Local

0.361 (0.261)

1.26*

Strength score VSBA

0.027 (0.046)

Local

0.172 (0.204)

1.22*

PHYSICAL ACTIVITY Comprehensive score VSBA

0.500 (0.194)

Local

0.550 (0.279)

0.21

Strength score VSBA

0.160 (0.096)

Local

0.350 (0.236)

1.17*

COMMUNICATION AND PROMOTION Comprehensive score (continued)

September 2012

0.82*

TOTAL

VSBA

0.180 (0.149)

0.41

Strength score

COMPETITIVE FOODS

VSBA

1.34*

School wellness policies’ strength and comprehensiveness may be affected negatively when a school district adopts a third-party wellness policy. Policy strength appears to be most affected, as suggested by the magnitude of effect sizes between the locally developed and VSBA wellness policies. This may be the result of a district’s adoption of vague components included within the template that lack specifıc strategies to address certain policy components within a given school district. For example, one district addressed Communication and Promotion with “[o]utreach strategies to encourage families to reinforce and support healthy eating and physical activity are in place.”26 Although “outreach strategies” are mentioned, the policy fails to delineate specifıc approaches to reinforce the healthy eating and physical activity habits in the familial environment. The absences of specifıc strategies may further reveal potential problems in the policy implementation and evaluation processes, which are ripe areas for future research. Locally developed school wellness policies also outperformed the VSBA policies in the measure of comprehensive-

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Smith et al / Am J Prev Med 2012;43(3):304 –308

ness, or the breadth of addressing policy components in each policy subgroup. Most notably, the largest and most signifıcant gap between local and VSBA policies occurred within the Physical Education and Communication and Promotion subgroups. In contrast to the VSBA policies, many of the locally developed policies had specifıc policies outlining their physical education requirements and/or curriculum. For example, one district included stipulations that funding for physical education be included in the school district budget along with time requirements for moderate to vigorous physical activity.27 However, a local education agency that adopted a VSBA wellness policy devoted only two lines to its physical education program, saying that students will “participate in a physical education program.”28

Limitations The current study includes a number of limitations. First, all school wellness policies in the commonwealth were not evaluated; however, policies were selected randomly to aid in collecting a representative sample. Second, although analyses show that the VSBA template led to weaker policies, it is possible that this template was intended to be tailored or used as part of a policy development training process. Third, written documents were only assessed, and researchers did not evaluate the associated school environments to determine the degree of policy implementation.

Conclusion Overall, this study showcases the weak policy environment regarding student wellness in public schools throughout Virginia, and these fındings suggest that simple templates for school wellness policies are not the answer. Rather, local engagement in the creation of these policies may be most important. Further research to determine the reasons for this seems warranted. This research was funded, in part, by the Hepler Summer Research Grant at Virginia Tech. No fınancial disclosures were reported by the authors of this paper.

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