Overweight among children is growing at an alarming rate. Nearly twice as many children and three times as many teens are overweight today compared to 1980 (Ogden, 2002). According to the NHANES, 16% of all children and teenagers are overweight with Mexican-American and Black children at the highest prevalence (Hedley et al., 2004). If children at risk for overweight are included, the statistics are more grim. Nearly one in three children (31%) in the US is overweight or at risk of overweight. The highest prevalence is among Mexican-American boys, age 6-11, at 44%. In addition to racial and ethnic disparities, there is also evidence that non-Hispanic white children from lower-income families are more likely to be overweight compared to children from higher income families (Troiano, et al., 1998).
While researchers attempt to identify and isolate factors that are contributing to the epidemic of overweight and obesity, there is widespread agreement that multiple, inter-related environmental factors are involved (Hill et al., 2003). In regards to children, there has been focus on the impact of social (e.g., family mealtimes), technological (e.g., media and marketing) and economic (e.g., food systems) changes on physical activity and dietary behaviors (IOM, 2005). As policy makers and health professionals search for solutions, schools have emerged as an environment that may be effectively used to promote more healthful behaviors and reduce risk of overweight among children (USDHHS, 2001). There are many opportunities within the school environment to impact energy balance – both directly and indirectly. Direct influences include the quality and quantity of foods and beverages available at school (i.e., school meals and competitive foods) and physical activity (i.e., recess and physical education). These factors are important since children, on average, obtain approximately one-third of their daily energy intake from school lunch and should expend approximately 50% of their total daily expenditure while at school (IOM, 2005). There are indirect influences as well including health education, social norms, role models and marketing. All of these influences may be increasingly important as a recent review of time use shows that children are spending more time at school (Sturm, 2005). Several promising approaches have been used to modify the school environment including changes to the curriculum, school meals, and to competitive foods (e.g., Hoelscher et al., 2003; Murphy et al., 2002; French et al., 2004).
Recognition about the role of environment on health behaviors, in combination with political and public concern about obesity, has contributed to an intense focus on school practices that relate to nutrition and physical activity. The issue of competitive foods in particular, has served as a catalyst for the development of local, state and federal policies designed to create a more healthful school environment (US Government Accounting Office, 2004; CDC, 2005). Related efforts in Nevada began several years when the PI completed the Washoe County School District (WCSD) Food and Beverage Study documenting the accessibility and nutritional quality of competitive foods (Bonine et al., 2003). As a result of this study, the school district trustees tentatively approved a competitive food policy pending the outcome of a year-long pilot study in six schools (draft policy available at http://www.washoe.k12.nv.us/district/policies/pdfs/foodpolicy.pdf). While this local work was on-going, the Nevada Department of Education organized the Nutrition Advisory Committee (of which the PI was a member) to draft a model school nutrition policy. Over a two-year time period, the policy was drafted, reviewed and revised. In June 2005, the policy was approved by the Nevada State Board of Education (available at http://www.doe.nv.gov/edteam/ndeoffices/schoolhealth/wellness.html). Lastly, with the enactment of Public Law 108-265, all local education agencies that participate in the National School Lunch Program must establish a local school wellness policy.
As a consequence of these individual and collective activities, the WCSD Board of Trustees are expected to approve a School Wellness Policy during the Spring 2006 (per federal law and state policy, a local policy has to be in place prior to July, 2006). The policy, as currently written, addresses a) marketing, nutrition standards and portion sizes of competitive foods; b) timing and length of lunch; c) scheduling of recess and physical activity; and d) revenues and accounting. In addition, each school will be required to have personnel in place to implement and monitor the policy. In the long-term, it will be extremely important to evaluate the effectiveness of these and other school policies on children’s health outcomes. However, the efficacy of any policy is predicated on the degree to which the policy is implemented. According to McGraw et al., (2000), implementation research may be used to develop benchmarks, to provide accountability and to explain program effects.
The purpose of this research, therefore, is to study the implementation of the WCSD Wellness Policy. While studies on nutrition policy implementation are limited (Gittelsohn et al., 2003; McKenna, 2003; Cho & Nadow, 2004), such efforts are likely to emerge as important due to the numerous school nutrition policies that will be adopted shortly due to the federal law cited above.
In addition to the involvement in the policy development at the local and state level, the PI has also completed two statewide surveys of elementary and middle school employees on school environment issues (Benedict and Snow, 2004; Benedict and Snow, 2005). This research has provided new findings on the school employees’ perceptions of the school environment; characteristics of schools that may need additional support to achieve positive change; school norms related to nutrition and physical activity; and the perceived roles of school employees as policy advocates, educators, role models and decision-makers in relation to promoting student health.