Date post: | 27-Mar-2015 |
Category: |
Documents |
Upload: | ashley-weaver |
View: | 214 times |
Download: | 0 times |
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
Policy Content Component N (%)
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)
Policy Content Component N (%)
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)
Policy Content Component N (%)
Aim 1: Specific Components By Policy Content Area
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)
Policy Content Component N (%)
Aim 1: Specific Components By Policy Content Area
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)
Policy Content Component N (%)
Aim 1: Specific Components By Policy Content Area
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)
Policy Content Component N (%)
Aim 1: Specific Components By Policy Content Area
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)
Submitted materials:Exceed the area 36 (33.6)
Meet the area 45 (42.1)Do not meet the area 26 (24.3)
Area 3: Establishing nutrition standards (N=120)
Submitted materials:Exceed the area 62 (51.7)
Meet the area 38 (31.7)Do not meet the area 20 (16.7)
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.