Erin R Hager1, Diana S Rubio2, G Stewart Eidel3, Erin S Penniston4, Megan Lopes5, Brit I Saksvig6, Renee E Fox7, Maureen M Black8. 1. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Room 163, Baltimore, MD 21201. ehager@peds.umaryland.edu. 2. Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, 737 West Lombard Street, Room 163, Baltimore, MD 21201. drubio@peds.umaryland.edu. 3. Professional Development and Technical Assistance, Maryland State Department of Education, Office of School & Community Nutrition Programs, Baltimore, MD 21201. stewart.eidel@maryland.gov. 4. Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201. erin.penniston@maryland.gov. 5. Maryland State Department of Education, Professional Development and Technical Assistance Section, Office of School and Community Nutrition Programs/Office for School Effectiveness, Baltimore, MD 21201. megan.sweatlopes@maryland.gov. 6. Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742. bsaksvig@umd.edu. 7. Division of Quality & Health Outcomes (DQHO), Center for Medicare and Medicaid Services, CMCS/CAHPG, 7500 Security Blvd, Baltimore, MD 21244. Renee.Fox@cms.hhs.gov. 8. Division of Growth and Nutrition, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 737 West Lombard Street, Room 161, Baltimore, MD 21201. mblack@peds.umaryland.edu.
Abstract
BACKGROUND: Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students). METHODS: Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. RESULTS: Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05). CONCLUSIONS: Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities.
BACKGROUND: Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students). METHODS: Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. RESULTS: Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05). CONCLUSIONS: Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities.
Authors: Hannah G Lane; Rachel Deitch; Yan Wang; Maureen M Black; Genevieve F Dunton; Linda Aldoory; Lindsey Turner; Elizabeth A Parker; Shauna C Henley; Brit Saksvig; Hee-Jung Song; Erin R Hager Journal: Contemp Clin Trials Date: 2018-10-18 Impact factor: 2.226
Authors: Brittany R Schuler; Brit I Saksvig; Joy Nduka; Susannah Beckerman; Lea Jaspers; Maureen M Black; Erin R Hager Journal: Health Promot Pract Date: 2018-01-18
Authors: Jennifer Leeman; Jean L Wiecha; Maihan Vu; Jonathan L Blitstein; Sallie Allgood; Sarah Lee; Caitlin Merlo Journal: Implement Sci Date: 2018-03-20 Impact factor: 7.327
Authors: Tanya M Horacek; Marlei Simon; Elif Dede Yildirim; Adrienne A White; Karla P Shelnutt; Kristin Riggsbee; Melissa D Olfert; Jesse Stabile Morrell; Anne E Mathews; Wenjun Zhou; Tandalayo Kidd; Kendra Kattelmann; Geoffrey Greene; Lisa Franzen-Castle; Sarah Colby; Carol Byrd-Bredbenner; Onikia Brown Journal: Int J Environ Res Public Health Date: 2019-03-04 Impact factor: 3.390