A Statewide Movement to Promote the Adoption of Tobacco‐Free School Policies*

BACKGROUND: Since most tobacco users become addicted to nicotine as teenagers, prevention efforts for youth remain central to comprehensive prevention programs. National and state efforts that encourage adoption and enforcement of comprehensive tobacco‐free school (TFS) policies can lead to significant reductions of youth tobacco use. In 2003, North Carolina (NC) Health and Wellness Trust Fund grantees began to focus statewide on the adoption of and compliance with TFS policies in NC schools. This study examined 46 NC districts that passed TFS policies between 2003 and early August of 2005 to see what factors were important in policy passage in order to support the continued promotion of TFS policy adoption across the state. METHODS: Detailed interviews were conducted with 118 key informants who were intimately involved with passage of their school districts’ TFS policies, and results were coded and analyzed for common themes. RESULTS: The study found several strategies key to adoption of TFS policies: effective leadership from organizations and individuals in positions of influence, grassroots organizing from community coalitions and youth groups, and communication strategies that optimally position policy adoption and compliance. CONCLUSION: States that have not yet achieved TFS policy adoption can focus on leadership development, grassroots organizing, and improved communication to advance their advocacy efforts.     

Passage of 100% tobacco-free school policies in 14 North Carolina school districts

Though comprehensive tobacco-free school policies constitute an important component of state tobacco control efforts, little research exists about their adoption process. In the past two years, efforts occurred in North Carolina to increase the number of school districts adopting 100% tobacco-free school policies. As part of the North Carolina Youth Empowerment Study (NC-YES), researchers developed a school tobacco policy interview guide to conduct interviews with 40 key people (e.g., school board member, principal, etc.) in each of 14 school districts that adopted a 100% tobacco-free school policy by the end of 2001. Results showed seven districts adopted their school policy in the past two years. Seven themes emerged: 1) Catalysts: Local adult and youth "champions" facilitated policy change; 2) Process of Adoption: Most school policies were adopted with an administrator or other adult initiating the change, but youth involvement increased in recent years; 3) Methods of Adoption: Advocates personalized health concerns by focusing on children and role modeling by adults; 4) Political Leadership: Governors of North Carolina, through letters to school districts and a policy summit, played an important role in stimulating policy change; 5) Barriers to Adoption: Concerns expressed before policy adoption, about teacher attrition or inability to enforce the policy, did not occur as feared; 6) Enforcement Issues: A key to policy enforcement involved being consistent, supportive, and firm; and 7) Economics of Tobacco Farming/Manufacturing: Though a local tobacco economy did little to influence policy adoption, districts that adopted policies were not located in counties with heavy tobacco production. Public health advocates may use this information to encourage school districts to adopt 100% tobacco-free school policies.     

Promoting healthy vision in students: progress and challenges in policy, programs, and research

Background:  An estimated 1 in 5 American children has a vision problem. Children living in poor urban environments have twice the normal rate of vision problems. Uncorrected vision problems can worsen over time and result in permanent vision loss. Early detection and treatment of vision problems is therefore essential in optimizing children's health and development. Federal-, state-, and school-based prevention efforts continue to evolve to identify and serve children with vision problems.
Methods:  Review of current literature on (1) major vision problems among children, (2) unique problems faced by low-income children with poor vision, and (3) the rise in health policy and program efforts to support the goal of healthy vision for each child. The preliminary relationship established between vision and academic performance is also discussed.
Results:  Low-income children have a disproportionate amount of vision problems and face several barriers to acquiring vision care. Varied actions among states include legislation requiring screening and follow-up before entry into elementary school.
Conclusions:  States and schools can take concrete steps to increase the number of children identified and treated for vision problems. Health policy and programs should also address common barriers to children receiving and wearing their glasses at home and in the classroom. Further research is necessary to assess the relationship between children's vision and educational outcomes. To the extent that vision is associated with academic success, policies and programs can be shaped to address the achievement gap that exists among our nation's youth and to support the goal of healthy vision for each child.     

The North Carolina Youth Empowerment Study (NCYES): a participatory research study examining the impact of youth empowerment for tobacco use prevention.

This article describes the North Carolina Youth Empowerment Study (NC YES), a 3-year participatory evaluation of youth programs addressing tobacco use prevention. The study goals of NC YES were to (1) convene an advisory board comprised of lay youths and adults in a participatory research process, (2) document the characteristics of youth programs for tobacco use prevention and control in North Carolina, and (3) track the role of youth involvement in initiating and implementing 100% tobacco-free policies in local school districts. The NC YES Statewide Advisory Board helped guide the evaluation process, reviewed study protocols and data collection instruments, and helped interpret preliminary findings. Both quantitative and qualitative methods(e.g., telephone interviews and written questionnaires) were used to gather data from youth and adult leaders to achieve these aims. Lessons learned about the process of conducting participatory evaluation approaches and summary findings about the role of youths in policy advocacy efforts are presented.     

Evaluating the Strength of School Tobacco Policies: The Development of a Practical Rating System

BACKGROUND: School tobacco control policies vary widely in their strength, extensiveness, and enforcement. Currently, no standardized method exists to assess the comprehensiveness of school tobacco policies. The purpose of this study was to develop a new practical rating system for school tobacco policies, assess its reliability, and present preliminary validation data.
METHODS: This study presents the systematic development of a rating system to assess the strength of school tobacco policies. Based on the empirical literature and the expertise of an advisory panel consisting of educational leaders and tobacco control advocates and practitioners, a "gold standard" school tobacco policy was developed and guided the content of the 40-point rating system. The 4 domains of the School Tobacco Policy Index were: Tobacco-free environment (14 points), Enforcement (12 points), Prevention and treatment services (6 points), and Policy organization (8 points).
RESULTS: The Index was pilot-tested using 95 Missouri public school district tobacco policies and proved to be highly reliable among coders. The evaluated policies varied greatly between school districts, with the lowest total policy score of φ and the highest score of 21. School district policy scores were significantly related to a number of county-level tobacco policy characteristics, including support for a tobacco excise tax increase.
CONCLUSIONS: The Index is a user-friendly, practical tool for tobacco control professionals and educators, providing them with the ability to easily evaluate their own school policies. Their evaluation efforts will be useful in strengthening existing policies and developing new comprehensive policies to protect the health of students, staff, administrators, and visitors.     

Transparency and oversight in local wellness policies

BACKGROUND: Advocates have called for increased wellness policy transparency and oversight through the use of health advisory councils. This study examines (1) wellness policy transparency, (2) advisory council requirements, (3) factors associated with each, and (4) whether transparency or advisory council requirements are indicative of a stronger policy addressing nutrition and physical activity. METHODS: Policies for school year 2007–2008 were obtained from a nationally representative sample of 641 districts and analyzed for their applicability to elementary, middle, and high school levels. Main outcome measures included (1) policy transparency (online availability), (2) advisory council requirements, and (3) overall policy strength. T‐tests assessed variability in policy strength by transparency and advisory council requirements. Multivariate logistic and linear regression analyses controlled for district size, socioeconomic status, race/ethnicity, region, and locale; models of advisory council/policy strength relationships also controlled for state advisory council requirements. RESULTS: More than 41% of districts posted wellness policies online and more than 43% required advisory councils. Transparency was less likely in small‐/medium‐sized and non‐southern districts; and, for elementary school policies, most common in majority Hispanic districts. Advisory council requirements were less likely in small‐/medium‐sized districts for middle/high school policies and more likely in majority Hispanic districts for elementary school policies. After adjusting for all covariates, transparency was not associated with policy strength, but advisory council requirements significantly predicted policy strength. CONCLUSIONS: Transparency may facilitate awareness, but it does not mean that wellness policies will be stronger; however, advisory council requirements may be a marker for stronger policies.     

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

BACKGROUND: In 2006, all local education agencies in the United States participating in federal school meal programs were required to establish school wellness policies. This study documented the strength and comprehensiveness of 1 state's written district policies using a coding tool, and tested whether these traits predicted school‐level implementation and practices. METHODS: School wellness policies from 151 Connecticut districts were evaluated. School principal surveys were collected before and after the writing and expected implementation of wellness policies. Sociodemographic variables were assessed for each district, including enrollment, population density, political climate, racial composition, and socioeconomic status. Changes in school‐level policy implementation before and after the federal wellness policy mandate were compared across districts by wellness policy strength; policies were compared based on district‐level demographics. RESULTS: Statewide, more complete implementation of nutrition and physical activity policies at the school level was reported after adoption of written policies. Districts with stronger, more comprehensive policies were more successful in implementing them at the school level. Some sociodemographic characteristics predicted the strength of wellness policies. CONCLUSIONS: Written school wellness policies have the potential to promote significant improvements in the school environment. Future regulation of school wellness policies should focus on the importance of writing strong and comprehensive policies.     

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

BACKGROUND: This study evaluated wellness policies created by Alabama public school districts and progress made in the implementation of Alabama State Department of Education (ALSDE) school food and nutrition mandates. METHODS: Wellness policies from Alabama public school districts were compared to minimum requirements under the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004. Additionally, data were analyzed from a survey of school district superintendents regarding compliance with ALSDE mandates. Districts were graded based on the percentage of 7 components addressed in wellness policies, and on the percentage of ALSDE mandates implemented. RESULTS: The majority of school districts (71%) were in compliance with all federal wellness policy requirements. An average 6.4 components were addressed, for a mean score of 92%. Mean implementation of ALSDE mandates was 79%; only 7% of districts indicated implementing all of the mandates. No significant differences were found in federal wellness policy or ALSDE mandate compliance scores based on district type, enrollment, percentage of students eligible for free and reduced‐price meals, use of an environmental assessment survey, and use of wellness committee and a nutrition professional during policy development. CONCLUSIONS: The majority of Alabama school districts created school wellness policies with appropriate content. This does not, however, guarantee effective policies. School districts have not done as well implementing ALSDE mandates, demonstrating delay between policy creation and implementation. Future research is needed regarding progress the school districts make in the implementation of school health policy and on factors influencing that progress.     

Antitobacco Media Awareness of Rural Youth Compared to Suburban and Urban Youth in Indiana

PURPOSE: This study examined the awareness and impact of antitobacco media messages among rural, suburban, and urban youth. METHOD: Self-administered questionnaires were received from 1,622, 1,059, and 1,177 middle school (sixth, seventh, and eighth grade) students in rural, suburban, and urban locations, respectively. Logistic regression compared media awareness and impact among the groups, controlling for grade, gender, race, and smoking behavior. RESULTS: Compared to rural youth, suburban youth were more likely to recall media messages about the dangerous health effects of tobacco use (odds ratio [OR] = 1.94) and have their personal choice to use tobacco affected by the messages (OR = 1.85). Suburban and urban youth more often recalled antitobacco messages (OR = 2.00 and 2.15), reported that the messages made them think about the dangers of tobacco use (OR = 2.02 and 1.47), believed that these ads prevent youth from initiating tobacco use (OR = 3.21 and 1.46) and stop youth from using tobacco (OR = 2.25 and 1.47), and recalled seeing specific campaign television ads (OR = 3.72 and 3.57). Urban youth were more likely to recall specific campaign messages on the radio (OR = 1.58). Neither suburban nor urban youth differed from the rural youth on whether the campaign-specific radio and television ads made them think about not using tobacco. CONCLUSIONS: The results support the need for targeting antitobacco media announcements to youth, based on their residence.     

The Relationship Between School Policies and Youth Tobacco Use*

BACKGROUND: The school setting is frequently used both to educate youth about risks involved in tobacco use and to implement tobacco prevention and cessation programs. Given that school‐based programs have resulted in limited success, it is necessary to identify other setting‐level intervention strategies. School tobacco policies represent a type of universal intervention that might have some promise for preventing or reducing tobacco use. METHODS: Hierarchical linear modeling was used to assess whether school tobacco policies were related to observations of tobacco use and current smoking among 16,561 seventh through twelfth graders attending 40 middle and high schools in Illinois. RESULTS: Results indicated that the enforcement of school tobacco policies, but not the comprehensiveness of those policies, was associated with fewer observations of tobacco use by minors on school grounds as well as lower rates of current smoking among students. CONCLUSIONS: The school setting is a key system to impact youth tobacco use. Findings underscore the need to train school personnel to enforce school tobacco policy.     

Comparison of indoor air quality management strategies between the school and district levels in New York State

BACKGROUND: Good school indoor air quality (IAQ) can affect the health and functioning of school occupants. Thus, it is important to assess the degree to which schools and districts employ strategies to ensure good IAQ management. We examined and compared the patterns of IAQ management strategies between public elementary schools and their school districts in New York State. METHODS: District‐level information obtained from surveys of district facilities managers in 326 districts was described and stratified by district size and socioeconomic status. School‐level information obtained from surveys of head custodians in 770 elementary schools was then compared with the district‐level information in 241 districts. RESULTS: About 47% of participating school districts reported having a district‐wide IAQ program, with a large range in the prevalence of specific IAQ management strategies. Airing out newly painted areas was the most commonly reported (92%) and having a classroom animal policy was the least commonly reported (29%). Larger districts and districts with a district‐wide IAQ program were more likely to report certain IAQ strategies than other districts. Elementary schools and their districts were most likely to report airing out newly painted areas (76%). The most common area of disagreement was construction after hours (50%). The top strategy not reported at either level was having an IAQ coordinator (53%). CONCLUSIONS: Many school districts lack key IAQ management strategies, and differences exist between district‐level policy and school‐level practice. Districts and schools should work together to formalize and expand existing IAQ policies and inform stakeholders about these strategies.     

Healthy and safe school environment, Part II, Physical school environment: results from the School Health Policies and Programs Study 2006

BACKGROUND: As society continues to focus on the importance of academic achievement, the physical environment of schools should be addressed as 1 of the critical factors that influence academic outcomes. The School Health Policies and Programs Study (SHPPS) 2006 provides, for the first time, a comprehensive look at the extent to which schools have health-promoting physical school environment policies and programs. METHODS: The Centers for Disease Control and Prevention conducts the SHPPS every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states and the District of Columbia and among a nationally representative sample of school districts (n=424). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=992). RESULTS: One third (35.4%) of districts and 51.4% of schools had an indoor air quality management program; 35.3% of districts had a school bus engine-idling reduction program; most districts and schools had a policy or plan for how to use, label, store, dispose of, and reduce the use of hazardous materials; 24.5% of states required districts or schools to follow an integrated pest management program; and 13.4% of districts had a policy to include green design when building new school buildings or renovating existing buildings. CONCLUSIONS: SHPPS 2006 results can guide education and health agency actions in developing and implementing evidence-based tools, policies, programs, and interventions to ensure a safe and healthy physical school environment.     

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.     

Integrated Community Policy Uptake Model: responding to select Manitoba and Saskatchewan rural women's experiences of health reform/renewal

Objective:  To explore the impacts and implications of health reform/renewal for rural women in Saskatchewan and Manitoba, Canada.
Design:  The study was a multiple case study approach using mixed methods of focus groups, individual interviews, and trends/utilization analysis.
Setting:  Three rural communities – two in Saskatchewan; one in Manitoba.
Participants:  Rural women; non-health providers.
Interventions:  None.
Outcome Measures:  None.
Results:  This paper presents a four phase Integrated Community Policy Uptake Model which is derived from the experiences of rural women during the operationalizing of health reform policy. The model depicts a four phase integration of the health reform or renewal policy; specifically, 'Taking In', 'Taking On', 'Taking Over', and 'Taking Beyond'. The Integrated Community Policy Uptake Model is firmly rooted in the perceptions and opinions of rural women, and is informed by their understanding of health policy.
Conclusion:  The involvement of rural women in the policy process is necessary. The model proposed potentially encourages women to become more directly engaged in future health policy making and planning. There is also significant potential for this model to inform decision makers of the perceptions, needs, and solutions offered by stakeholders such as rural women.     

School wellness policies: perceptions, barriers, and needs among school leaders and wellness advocates

BACKGROUND: School wellness policies are a key component to the prevention of adolescent obesity. This national research study sought to understand the wellness environment in school districts across the country and to identify challenges districts face and needs they have in order to effectively implement, monitor, and evaluate school wellness policies. The study determined (1) perceptions, barriers, and opportunities regarding the development, implementation, and monitoring/evaluation of school wellness policies among school board members, state school boards association leaders, state public health nutrition directors, and school wellness advocates; (2) the readiness and capacity of survey groups to address nutrition and physical activity policies; (3) the extent to which survey groups collaborate; and (4) the acceptability of wellness tools. METHODS: In 2006, over 2900 individuals participated in online surveys, focus groups, and key informant interviews. School board members represented 1296 school districts across the nation. RESULTS: School board members expressed the highest level of confidence among all survey groups that their district has the capacity to develop, implement, and monitor/ evaluate the wellness policy. The disparities among groups are most notable with regard to perceptions of district capacity to monitor/evaluate the policy. School board members are interested in school wellness policy tools and trainings. CONCLUSIONS: There is an opportunity for state school boards associations, state public health nutrition directors, and school wellness advocates to build their own capacity to provide training and resources to districts on wellness issues, particularly physical education/activity, school-based wellness initiatives, and strategies for implementing and monitoring/evaluating wellness policies.     

Implementation of school policies to prevent youth tobacco use in Alabama

BACKGROUND: Public health professionals must monitor the effectiveness of school policies and programs to prevent youth initiation, promote quitting, and eliminate secondhand smoke. This analysis of school tobacco policies was preliminary to release of a state tobacco prevention and control plan for 2010‐2015. METHODS: University health educators collaborated with the state health agency to review policies of 33 school systems in 5 Metropolitan Statistical Areas and 9 public health areas. Authors developed a systematic approach of 8 steps useful to rate implementation of school tobacco control and prevention policies and discuss implications for health education program planning. RESULTS: Thirty school policies prohibited possession and use of tobacco by students, faculty and campus visitors, and 26 of 33 specified disciplinary measures following violations. Only 4 public education agencies included 3 of the 6 elements of a model tobacco prevention and control policy as suggested by the state public health agency. None featured all 6 elements. None specified establishing school‐community partnerships for tobacco prevention and control. CONCLUSIONS: Preparing smoke‐free youth requires implementing and evaluating tobacco education in grades K‐12 including use of model guidelines from federal agencies and professional organizations. Determining the focus of existing school tobacco policies is an initial step to encourage adoption of comprehensive policies to reduce youth use of tobacco. Youth health advocates may act together with school administrators and legislators to strengthen policies to be consistent with model guidelines for tobacco prevention and control.     

Responses to Positive Results From Suspicionless Random Drug Tests in US Public School Districts

Background:  Little is known about the context in which school-based suspicionless random drug testing (SRDT) occurs. The primary purpose of the current study was to describe school districts' responses to students' first positive result in districts with SRDT programs.
Methods:  Data were collected in spring 2005 from 1612 drug prevention coordinators in a nationally representative sample of 1922 school districts (83.9% response rate), of which 205 districts reported SRDT in high school grades.
Results:  Respondents reported an array of consequences for students with an initial positive SRDT, including requiring parents or guardians to meet with school officials (88.4%) and requiring students to participate in an education, counseling, or treatment program (60.8%). However, some districts also reported consequences contraindicated by federal advisory guides, such as notifying law enforcement officials (45.1%) and suspending the student from an athletic team (65.0%) or from school (31.0%). Some respondents may have conflated their districts' responses to for cause and random tests. Districts generally had available key services for students testing positive, including professional counseling for substance use problems (87.3%) and referrals to counseling services (91.9%).
Conclusions:  More understanding is needed of schools' responses to students who test positive following the administration of SRDT, available advisory guides concerning best practices should be more effectively disseminated, and appropriate training and technical assistance should be available to schools with SRDTs.     

Environmental justice at school: understanding research, policy, and practice to improve our children's health

BACKGROUND: No overarching federal agencies or policies are responsible for ensuring environmental health at schools in the United States, potentially allowing many inequities for low‐income and minority communities to persist. This article examines emergent research, policy, and practice‐based efforts that may be used to identify and address environmental justice at school. METHODS: A brief literature review was conducted to understand (1) major mental, behavioral, and physical outcomes associated with environmental risk for school‐aged children and (2) current research methods for assessing these relationships. Documents prepared by government agencies, school districts, and advocacy groups were also collected and synthesized to improve understanding of the state of planning and policies for maintaining or improving school environments. RESULTS: Environmental risk can manifest in diverse ways such as mold, poor air quality, poor community design, or contaminated playgrounds. Deeply rooted in national and state structures of school funding and planning, such risks can lead to outcomes including respiratory illness, poor performance in school, and reduced levels of physical activity. With growing attention to these concerns, methods for measuring environmental risks and underlying disparities have advanced tremendously in the last few decades, yet development of innovative research approaches may be necessary to further advance and evaluate appropriate interventions. CONCLUSIONS: Environmental injustice is generally unacknowledged during decision‐making in US school districts. Continued dialogue reflective of translatable science is necessary to support school districts with limited funding in ensuring safe, healthy environments for learning.     

Association and diffusion of nutrition and physical activity policies on the state and district level

BACKGROUND: School district wellness policies designed to reduce obesity and promote student health and well‐being often lack specific requirements or any mandate that schools comply with the policy. Researchers, educators, and policymakers have called for states to take an active role in shaping district policies. The objective of this study was to determine if states with strong school‐based nutrition and physical activity (PA)‐related policies have stronger district wellness policies, and explore the direction of policy diffusion between states and districts. METHODS: State policies and nationally representative samples of district policies for the 2006–2007 and 2008–2009 school years were obtained across 5 domains—competitive foods, school meals, nutrition education, physical education (PE), and PA—and were classified as “strong” or “weak,” based on policy language, in each grade level (elementary, middle, high). Linear models estimated the cross‐sectional and longitudinal associations between state and district policies. RESULTS: In 2006–2007 and 2008–2009, district elementary school competitive food policies were stronger in states with strong policies. For policies governing competitive foods in high schools and school meals at all grade levels, mean district policy strength increased from 2006–2007 to 2008–2009 in states with strong 2006–2007 policies. States that strengthened their PE policies from 2006–2007 to 2008–2009 saw an increase in mean district PE policy strength. Across all domains, states that had weak 2006–2007 policies and made no changes saw little increase in district policy strength. CONCLUSION: District competitive food, school meal, and PE policies are stronger in states that have developed strong policies in these domains.     

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.