Analysis of Washington State School District Nutrition and Fitness Policies Janice Kao MPH Candidate...

Analysis of Washington State School District Nutrition and Fitness Policies

Janice KaoMPH Candidate

Thesis PresentationAugust 8, 2006

University of WashingtonInterdisciplinary Graduate Program in Nutritional Sciences

Overview of Presentation General background and statistics on overweight

in youth Context for a policy analysis study in WA Background on school-based policies Study Aims Methods Results and Discussion Limitations Implications for future research Conclusions

Youth Overweight: Prevalence Nearly one-third of youth aged 6-19 years are

overweight or at risk of overweight. (1,2) 2004 WA HYS results for 8th, 10th, 12th graders show

similar numbers (3)

Trajectory over past 20 years (4,5): Numbers have tripled in adolescents, and Doubled in children

Youth Overweight: Consequences Long-term

Increased likelihood of obesity as adults (2,6-8) Higher risk of hypertension, diabetes, high cholesterol, asthma,

joint problems, mortality (9-12)

Short-term Higher incidence of type 2 diabetes and having cardiovascular risk

factors as children (7,13) Development of social and psychological problems (14,15)

Economic Costs of treating obesity-related illness are enormous (16) Annual hospital costs for youth: $127 M (17)

Youth Overweight: Causes

Trends in society: Sedentary lifestyles (18) Increased access to fast food, pre-packaged food, and

larger portion sizes (19)

School environment is not immune Access to competitive foods through VMs, school stores,

special sales, a la carte sales (20-24) Less than 10% of schools require daily PE (25)

Youth Overweight: Solutions

Need cost-effective, preventive strategies Need to establish healthy behaviors during childhood

Need comprehensive, policy-level efforts to effect change (26-27)

Schools are an important place to start (26-30)

Context for Study

State-level: Senate Bill 5436 requires school districts to develop a nutrition and physical fitness policy by August 2005

National-level: Child Nutrition and WIC Reauthorization Act of 2004 requires wellness policies by July 2006

Context For Study

SB 5436 does not require anything specific about policy content, though federal Child Nutrition Act does

Sample policy and procedures were provided, but districts expected to create their own individualized policies (31)

Variation is expected - There are 296 school districts in WA

School-Based Policies and Programs: What’s in Place Now?

National initiatives to improve school health Coordinated School Health Program (32-34) USDA Fruit and Vegetable Program (35) Steps to A Healthier US Initiatives (36,37)

School Health Profile for Washington (38) 55% of schools have health advisory committees 64% of schools offer intramural activities 18% prohibit students from buying snack foods from

VMs, student stores, etc. during lunch time

Findings from SHPPS 2000 for WA (39)

IN PLACE

Teach and test on health topics, such as nutrition and dietary behavior, and PA and fitness

Follow PE stds or guidelines

Adopted PE goals and objectives

New PE teachers must have training

NOT IN PLACE Regularly scheduled recess PE skill or fitness tests Specific student-to-teacher

ratios in PE Prohibition of junk food in VMs,

a la carte Prohibition of use of food as

reward Requires certification for FS

coordinators and managers Any faculty/staff health

promotion

School-Based Policies: Recommendations for Success

Findings from policy implementation in other states or nations: Barriers (20,40-43) Contributions (44-47)

Suggestions for best practices (48,49): Stakeholder buy-in and formation of advisory

committee Implementation plans that include evaluation, funding,

and target dates

Study Aims

1. What is the content of these policies?

2. Is content associated with school district characteristics?

Findings can help to direct technical assistance and training efforts needed currently and to evaluate policy impact in the future

Methods: Development and District Recruitment

Collaboration with school policy database workgroup: Requested and posted school district

policies October 2005 – January 2006

Helped determine what variables to use and how to code policy content areas

Helped with data requests for school district characteristics variables

Methods: Measurements

Policy content components

Similarity to sample Inclusion of procedures Inclusion of

implementation plans Meets fed wellness

policy reqs Meets all 5 policy

content areas (Handout) Specific content areas

and components

School district characteristics

Demographics: location; size; race/ethnicity, bilingual, eligible for F/R price meals enrollments

Academic indicators: pass rates for WASL standards, annual dropout rates

Environmental factors: active PTA, county obesity rate, federal grant recipient

Methods: Procedures

Policies downloaded from Healthy Schools website Coded according to coding scheme

(Handout) Corresponding districts’

characteristics entered Several of these variables were

“transformed” to match unit of measurement

Methods: Statistical Analysis

To describe content, used descriptive frequencies

To determine associations, used independent t-tests, chi-square tests, and Somers’ d tests

Inter-rater reliability tested for policy content coding on a sample of policies

Presentation of Results

1. Description of districts submitting materials

2. Results follow study aims1. Content

2. Relationships

3. Discuss simultaneously

Study School Districts: Location and Size

District Characteristic N (%)

Location by County

Urban 64 (53.3)

Mixed Urban 0

Large Town 20 (16.7)

Small Town/Rural 22 (18.3)

Mixed Rural 14 (11.7)

Size

Large (>2000 students enrolled) 64 (53.3)

Small (≤ 2000 students enrolled) 56 (46.7)

Aim 1: Similarity to WSSDA Sample Policy

Policy Content Component N (%)

Similarity to sample policies (N=120)Similar 91 (75.8)

Not Similar 29 (24.2)

Aim 1: Indices of Policy Quality


Included procedures (N=120) 75 (62.5)

Includes plans for implementation and/or phase-in (N=120)

27 (22.5)

Meets federal wellness policy requirements (N=107)

40 (37.4)

Meets all five policy content areas (N=107) 50 (46.7)

Aim 1: Specific Components By Policy Content Area

Area 1: Setting nutrition education goals (N=114)

District’s materials address:

a. Classroom teaching 98 (86.0)

b. Education, marketing, and promotions outside classroom links with school

69 (60.5)

c. Teacher training 46 (40.4)


Area 2: Setting physical activity goals (N=107)District’s materials address:b. PE (time, frequency, and/or intensity) 86 (80.4)c. PE (teacher-to-student ratio) 42 (39.3)d. PE (standards/req based) 46 (43.0)e. PE (staff training/certification) 47 (43.9)f. PA outside of PE 6 (5.6)g. Recess to promote PA 82 (76.6)h. Walking or biking to school to promote PA

38 (35.5)



Area 3: Establishing nutrition standards (N=120)District’s materials address:a. Nutritional value of foods and beverages 115 (95.8)b. Portion size 30 (25.0)c. A la carte, vending, student stores, concession

stands96 (80.0)

d. After-school programs, field trips, school events 27 (22.5)e. Parties, celebrations, meeting 27 (22.5)f. Food rewards 64 (53.3)g. Food-related fundraising 92 (76.7)h. Food or beverage contracts 81 (67.5)i. Qualifications of foodservice staff 6 (5.0)



Area 4: Setting goals for other activities promoting student wellness (N=120)

District’s materials address:a. Access to school nutrition programs 102 (85.0)b. Time and scheduling for meals 53 (44.2)c. Surroundings for eating 53 (44.2)d. Marketing of food and/or beverages 53 (44.2)e. Sustainable food practices 15 (12.5)f. Access to facilities for PA after school-hours (N=108) 71 (65.7)g. After-school programs (N=108) 74 (68.5)h. Coordinated school health approach 0i. School health councils 54 (45.0)j. Community/family involvement 59 (49.2)k. Staff wellness 7 (5.8)



Area 5: Setting Goals for Measurement and Evaluation (N=120)

District’s materials address:

a. Funding support for policy 3 (2.5)

b. Monitoring and evaluation 68 (56.7)



Aim 1: Composite Scores for Each Policy Content Area

Area 1: Setting nutrition education goals (N=114)

Submitted materials:Exceed the area 74 (64.9)

Meet the area 25 (21.9)Do not meet the area 15 (13.2)

Area 2: Setting physical activity goals (N=107)



Area 3: Establishing nutrition standards (N=120)



Area 4: Setting goals for other activities (N=108)

Submitted materials:

Exceed the area 54 (50.0)Meet the area 34 (31.5)

Do not meet the area 20 (18.5)Area 5: Setting Goals for

Measurement and Evaluation (N=120)

Submitted materials:

Exceed the area 2 (1.7)Meet the area 67 (55.8)

Do not meet the area 51 (42.5)

Policy Content Score N (%) Policy Content Score N (%)

Aim 1: Policy Content Summary Most districts submitted policies similar to the

WSSDA sample policy Many districts submitted procedures, but few

submitted implementation plans Almost two-thirds are not meeting the federal

wellness policy requirement Only half meet all 5 AFHK content areas, though

most meet Areas 1-4, individually Policy content components that were not included

in the WSSDA sample policy and procedures are included in fewer school districts’ materials

Recap of School District Characteristics Variables

School district characteristics

Demographics: location; size; race/ethnicity, bilingual, eligible for F/R price meals enrollments

Academic indicators: pass rates for WASL standards, annual dropout rates

Environmental factors: active PTA, county obesity rate, federal grant recipient

Aim 2: RelationshipsSimilarity to WSSDA Sample Policy

Characteristics of districts associated with submitting non-similar policies: Categorical: Size** (large), having a PTA*,

participating in a federal nutrition grant* Continuous: lower % enrollment for F/R price

meals*, higher WASL pass rates for 4th*, 7th*, 10th* grade students, lower county obesity rates

* = p-value <.05, ** = p-value <.01

Aim 2: RelationshipsIndices of Policy Quality

Characteristics of districts associated with:

Inclusion of procedures higher % enrollment for F/R price meals*, lower WASL

pass rates for 7th** graders

Inclusion of implementation plans Size* (large), having a PTA*, grant recipient*, higher

WASL pass rates for 4th* graders

* = p-value <.05, ** = p-value <.01

Aim 2: RelationshipsIndices of Policy Quality

Characteristics of districts associated with:

Meeting federal wellness policy requirements Location** (large and small towns, rural areas), size**

(small), no PTA*, higher % enrollment for F/R price meals*

Meeting the 5 AFHK policy content areas Location** (large and small towns, rural areas), size*

(small), higher % enrollment for F/R price meals*, lower WASL pass rates for 7th** graders

* = p-value <.05, ** = p-value <.01

Aim 2: RelationshipsIndividual Policy Content Areas

Total WASL Significant negative association with

meeting Area 1: Nutrition Education Trend for negative association with Area

2: Physical Education Location

Urban school districts met Areas 2, 4, 5 significantly less frequently than expected

Aim 2: Relationships“Rare” Policy Content Components

Recap: (2f) PA outside of PE (3b) Portion size (3d) Foods/beverages allowed after school (3e) Food/beverages at parties/celebrations (3i) Qualifications of food service staff (4e) Sustainable food practices (4k) Staff wellness (5a) Funding support for policy

Aim 2: Relationships“Rare” Policy Content Components

District characteristic 3b 3d 3e

Size (large) *** * **

Active PTA ** ** ***

Grant recipient ** - ***

* = p-value <.05, ** = p-value <.01, *** = p-value <.001

For 3i, 4e, 4k:• Grant recipient districts also include 3i, 4e, and

4k more frequently than expected (p-value <.05)– Steps program participants associated with 3i– USDA program participants associated with 4e, 4k

Aim 2: Relationships

Summary• Similar district characteristics associated with:

– including procedures, meeting federal requirements, and meeting AFHK areas

– Including implementation plans and submitting non-similar policies

• Districts that are large, have active PTAs, and are grant recipients, more frequently meet components not included in WSSDA sample

• Non-urban districts more frequently meet some indices of policy quality and individual AFHK policy content areas

• Districts with high WASL pass rates associated with non-similarity, implementation plans, and not meeting Areas 1&2

• Other district characteristics: race/ethnicity, bilingual, dropout rates, obesity rates unable to distinguish any pattern

Limitations

Convenience sample Methodology has not been validated Variable selection limited by study

feasibility Policy content scoring limited to AFHK tool Lack of specificity in content analysis

Implications

Technical assistance and training efforts should be directed towards helping school districts with: Planning for implementation and how to best

phase-in different elements of their policy Identifying sources for funding How to monitor, evaluate, and enforce their

policies

Implications More research is needed to explore some of

the relationships found in this study

Questions/issues to consider: Comprehensive versus individualized policies Stakeholder involvement in policy development

Findings about having PTAs and grant teams Perceived barriers and effects on policy

WASL testing, % eligibility for F/R price meals District characteristics

Different results with state-wide sample Consider including political climate (East vs. West)

Conclusions

Less variation than expected Many school districts have gone above and

beyond what’s required by SB 5436 Training and assistance in implementation

could be beneficial Future research should include in-depth

qualitative content analysis and key informant interviews with school districts

Thank you Donna, Louise, Glen for guidance and

support; Krista for advice on statistical analysis

Molly and the school policy database workgroup for helping me develop the methodology and providing data

WA State school districts for sending in their policies

Questions?

References

Please see attached.

Analysis of Washington State School District Nutrition and Fitness Policies Janice Kao MPH Candidate...

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