A Culturally Appropriate School Wellness Initiative: Results of a 2-Year Pilot Intervention in 2 Jewish Schools

BACKGROUND: Despite the growing number of school-based interventions designed to reduce childhood obesity or otherwise promote health, no models or materials were found for Jewish schools. The current study describes an effort within a Jewish school system in Chicago to create, implement, and evaluate a school-based intervention tailored to the unique characteristics of Jewish religion, culture, and school structures. METHODS: Two schools (with approximately 600 students) were selected for the 2-year pilot study. The schools were required to form a wellness council, write a wellness policy, and implement policy changes or activities in 5 target areas (health education, physical education, school environment, family involvement, and staff wellness). Objectives were measured using pre- and postintervention surveys for students, as well as the School Health Index and other tools. RESULTS: Findings showed several significant increases in student knowledge, as well as an increase in the percentage of older students regularly meeting physical activity guidelines. Few changes in attitudes, other behaviors, or environmental factors were seen. CONCLUSIONS: Due to a strong partnership between researchers, schools, and community organizations, meaningful changes were made within the pilot schools. These changes were reflected in a limited number of improvements in student knowledge and activity levels. Future work is needed to determine how to bring about behavioral changes, how to increase the sustainability of all of the changes, and how to disseminate the model and products of this intervention to other day schools.     

Wellness Programs: A Remedy for Reducing Healthcare Costs

Offering wellness programs has become a popular method for preserving the health of employees in the hope of generating lower healthcare expenses and, in turn, higher profits. This article offers a cost/benefits analysis of providing wellness programs, to determine whether such programs could add value to a company. Recommendations follow for how to implement a successful wellness program with minimal initial costs should an analysis find that wellness initiatives would prove beneficial.     

Wellness in the Schools: A Lunch Intervention Increases Fruit and Vegetable Consumption

Wellness in the Schools (WITS) is a national non-profit organization partnering with public schools to provide healthy, scratch cooked, less processed meals (called an Alternative Menu), and active recess. This study examined the effects of WITS programming on school lunch consumption, including fruit and vegetable intake, in second and third grade students in New York City public schools serving a high proportion of students from low-income households. The intervention was evaluated with a quasi-experimental, controlled design with 14 elementary schools (7 that had initiated WITS programming in fall 2015 and were designated as intervention schools, and 7 matched Control schools). School lunch consumption was assessed by anonymous observation using the System of Observational Cafeteria Assessment of Foods Eaten (SOCAFE) tool in the fall of 2015 (Time 0, early intervention) and the spring of 2016 (Time 1) and 2017 (Time 2). There were no baseline data. Data were also collected on the types of entrées served in the months of October, January, and April during the two school years of the study. Across time points, and relative to students in the Control schools, students in WITS schools ate more fruits and vegetables (units = cups): Time 0: Control 0.18 vs. WITS 0.28; Time 1: Control 0.25 vs. WITS 0.31; and Time 2: Control 0.19 vs. WITS 0.27; p < 0.001. They also had more fruits and vegetables (cups) on their trays, which included more vegetables from the salad bar. However, students in the WITS schools ate fewer entrées (grain and protein) and drank less milk than students in the Control schools. Compared to the Control schools, WITS schools offered more homestyle entrées and fewer finger foods and sandwich entrees, i.e., less processed food. Students in WITS schools who received the Alternative menu and all of the WITS programming at all data collection time points selected and consumed more fruits and vegetables. Replication studies with randomized designs and true baseline data are needed to confirm these findings and to identify avenues for strengthening the effects of the program on other school lunch components.     

Food,Health, & Choices: Curriculum and Wellness Interventions to Decrease Childhood Obesity in Fifth-Graders

Objective

To evaluate Food, Health, & Choices, two 10-month interventions.

The strength of school wellness policies: one state's experience

BACKGROUND: This study examines the results of federal legislation on the content and quality of policies written in 2005-2006 by Utah school districts (n = 30). METHODS: Policies were gathered by phone call requests to school districts or obtained on district Web pages. Content was compared to requirements outlined in the Child Nutrition Reauthorization Act (CNRA) of 2004 and recommendations made by a state coalition of health and education agencies. The strength of the language was assessed (mandate vs recommendation), and characteristics of school districts that adopted strong policies were identified. RESULTS: The majority of Utah school districts (78%) complied with the federal guidelines, and a variety of state recommended nutrition and physical activity policy statements were included. The strength of the language used in the policies revealed that districts were more likely to mandate items already required by other entities or well established in the district. School districts with high participation in free- and reduced-price programs had significantly more mandatory policies (mean = 9.2) versus low (mean = 7.1) and medium enrollment (mean = 4.7). Urban school districts were more likely to indicate mandatory competitive food policies than rural and suburban (mean = 2.3 vs 0.93, 0.83). There were no differences in policy language between school districts based on race or size. CONCLUSIONS: Compliance with the CNRA may be a positive step toward improving the school nutrition and physical activity environment, but it does not ensure a comprehensive or powerful policy. Schools and community partners must continue to work together to strengthen wellness policies and programs.     

Student Involvement in Wellness Policies: A Study of Pennsylvania Local Education Agencies

ObjectiveExplore student-involvement goals in local wellness policies (LWPs) of local education agencies (LEAs) in Pennsylvania (PA) and investigate associations with LEA characteristics.DesignAn observational study that helped examine student-involvement goals.SettingPublic PA LEAs.ParticipantsLWPs submitted by 539 PA public LEAs.Main Outcome MeasuresSix student-involvement goals analyzed as dependent variables. Correlations between demographic and policy characteristics of LEAs and student-involvement goals were measured.AnalysisPolicies developed by LEAs were abstracted and analyzed. Logistic regression models were developed to analyze relationships between student-involvement goals and the demographic and policy characteristics of LEAs.ResultsMajority of LEAs included policy goals that address student involvement in an array of activities related to wellness policy, food service, and role modeling. Regression models showed that LEAs with comprehensive and strong policies were most likely to include student-involvement goals regardless of LEA location, enrollment, or socioeconomic status of students.Conclusions and ImplicationsStudent engagement in school nutrition policies has been shown to increase student acceptance in an array of health-related areas and is therefore promising in the area of obesity prevention. Comprehensiveness and rigor of LWPs were strongly correlated with the inclusion of student-involvement goals on LWPs. The upcoming reauthorization of the Child Nutrition programs in 2010 creates a good opportunity to address student involvement in LWPs.     

Active generations: an intergenerational approach to preventing childhood obesity

BACKGROUND: Over the last 3 decades, US obesity rates have increased dramatically as more children and more adults become obese. This study explores an innovative program, Active Generations, an intergenerational nutrition education and activity program implemented in out‐of‐school environments (after school and summer camps). It utilizes older adult volunteers to implement a version of the evidence‐based childhood obesity prevention program, Coordinated Approach to Child Health, in 8 US cities. METHODS: Approximately 760 children in third‐ to fifth‐grade participated in Active Generations, a 10‐lesson, intergenerational, childhood obesity prevention program. Children completed an age‐appropriate survey instrument, the Active Generations survey (AGS). The AGS is a valid and reliable, self‐administered, self‐report, paper‐and‐pencil survey designed to assess knowledge, attitudes, and behaviors. It was administered by trained volunteers on the first day and last day of the program. Constructs assessed included physical activity, nutrition, and media use. RESULTS: Students significantly increased their reported fruit and vegetable consumption post‐program. For example, the percentage of students reporting eating 3 or more servings of vegetables per day was 16% greater post‐program. Students were more likely to report reading food labels and greater confidence that they could participate in physical activity. They also significantly decreased their daily screen time. CONCLUSIONS: Active Generations is a promising childhood obesity prevention program.     

State Agency Support of Weight‐Related School Policy Implementation

BACKGROUND

In this study, we describe state agency strategies to support weight‐related policy implementation in schools, and examine the association among state support, obesity prevalence, and strength of state policies governing school nutrition and physical education.

METHODS

The 2012 School Health Policies and Practices Study describes prevalence of implementation support state agencies provided to schools/districts. Implementation support items were analyzed by weight‐related policy area (eg, advertising, wellness policy) and by type of support (eg, technical assistance). Results were summed to create a total weight‐related policy support score. Linear regression was used to examine associations between policy support and state youth obesity prevalence (2011‐2012 National Survey for Children's Health), overall and stratified by state policy strength (2012 Classification of Laws Associated with School Students).

RESULTS

States provided support most commonly for school meals and wellness policies (89% and 81%, respectively) and least often for after‐school PE (26%). Most states (80%) provided technical assistance. The total weight‐related policy support score had a significant positive association with state‐level youth overweight/obesity prevalence (p = .03).

CONCLUSION

State agencies appear to be responding to their youth obesity prevalence with technical support. Schools and state agencies should work in collaboration to provide a healthy school environment for all students.

     

Wisconsin School Wellness Policies after Federal Legislation Change: Understanding Key Mechanisms of Policy Improvement

BackgroundThe Final Rule of the Healthy Hunger Free Kids Act, published in 2016, required school districts participating in the federal Child Nutrition Programs to update their local wellness policies to reflect the more stringent requirements effective June 30, 2017.ObjectiveOur aim was to investigate whether Wisconsin school wellness policies (SWPs) were updated after the Final Rule, measure policy quality change, and describe mechanisms of successful policy change.DesignFrom 2016 through 2018, an explanatory sequential mixed-methods study examined change in SWP quality before and after the Final Rule was published. SWPs were collected in 2 waves reflecting policies written before and updated after the July 21, 2016 publication of the Final Rule. Semi-structured key-informant interviews were conducted with districts that demonstrated significant policy improvement.Participants/settingQuantitative analysis examined 442 Wisconsin school districts’ SWPs. Semi-structured interviews were conducted with 14 school districts that demonstrated significant change between waves.Main outcome measuresWellSAT 2.0 strength and comprehensiveness scores measured SWP quality among districts that updated their policies. Themes from interviews were identified using framework analysis.Statistical analysis performedFirst, we calculated the proportion of Wisconsin school districts participating in federal Child Nutrition Programs for which SWPs were obtained at both waves of policy collection (n = 192 districts, 43.4%). Among districts that updated SWPs in wave II, repeated-measure analysis of variance tests described policy quality and policy quality change, respectively.ResultsAmong the 192 districts that updated their SWPs, policy quality increased overall and for 5 of 6 domains. Nutrition education scores did not show significant change. Interviewees commonly cited wellness leadership, support and resources, and buy-in and culture change as key components of policy improvement.ConclusionsFewer than half of Wisconsin school districts updated their policies in the 10 months after the Final Rule was published. SWP from these districts showed policy quality improvement in most areas. Interviews with successful districts indicate the common need for empowered leaders and supportive environments to facilitate culture change around student wellness.     

Process Evaluation of a Policy,Systems, and Environmental Change Intervention in an Urban School District

Objective

To conduct a comprehensive process evaluation of a policy, systems, and environmental (PSE) change intervention.