1. Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Julie Metos No relationships to disclose

2. Are obesity prevention practices in high schools associated with school district wellness policies? Julie Metos James VanDerslice Elizabeth Joy Rebecca Utz Christine Porucznik Norman Waitzman American Public Health Association School Health Education and Services October 30, 2012

4. Percentage of Adolescents Who Were Obese, Grades 9-12, Utah and U.S., 1999, 2001, 2003, 2005, 2007, 2009, and 2011

5. Consequences of Obesity in Adolescence Hypertension Diabetes Asthma Joint problems Sleep apnea Liver abnormalities Depression Negative stereotyping Stigmatization Poor peer interaction Discrimination Fewer academic and employment opportunities

6. Research on School Wellness Policies Written Policy – 99% of school districts wrote a policy – Language is weak – Variety of policy components – Adolescents in school districts with mandated wellness policies may have lower BMI Implementation – Barriers: time, people, incentives, resources – Increased nutrition education – Fewer sugar sweetened beverages – No change in physical education or activity – No studies with BMI

7. Social, economic, behavioral and cultural factors influence adolescent BMI – Income – Education – Race – Ethnicity – Marital Status of Parents Adolescent obesity rates vary by community

8. Socioecologic Model (Institute of Medicine, 2005)

9. Gaps in the school literature Wellness Policy Mandate Federal level Written Wellness Policy School district level Wellness Policy Practices Implementation School level GAP IN LITERATURE Adolescent behaviors Individual level Adolescent BMI Individual level GAP IN LITERATURE

10. Methods – School Practices School Health Profiles- Centers for Disease Control and Prevention – School Characteristics Common Core of Data- U.S. Department of Education – School wellness policies Utah school districts – Compared high school practices 2004 and 2008

11. Questions: Principals  Can students purchase snack foods or beverages from one or more vending machines, school stores or canteens?  Can students purchase chocolate candy, other candy, SSB..)?  Has this school adopted a policy that celebrations will have fruits and/or vegetables?  Can students be exempt from required PE (for school sport, community sport, other class, school activity…)?  Does this school offer intramurals or physical activity clubs?  Does school have a wellness committee?

12. Questions: Teachers Did teachers…  teach ‘decrease sedentary activities like TV’?  teach ‘overcoming barriers to physical activity’?  teach ‘balance food intake with physical activity’?  teach ‘opportunities for physical activity in the community’?  teach ‘eat more fruits and vegetables’?  teach ‘preparing healthy meals and snacks’?  collaborate with food services staff?  collaborate with physical education teachers?  receive staff development on nutrition?  receive staff development on physical activity?

13. Methods – Characterized practices for each high school as: No in 2004 Yes in 2008 No in 2004 No in 2008 Yes in 2004 Yes in 2008 Yes in 2004 No in 2008 – Analyzed implementation by: school characteristics district wellness policy content nutrition, physical activity and collaboration/ training domains comparing high schools in same district

14. Results

15. Mean or % SD10%ile90%ile Race/ Ethnicity % Black 1.1 1.4 0.0 2.6 % Pacific Islander 1.0 2.0 1.3 % American Indian 5.3 1.7 0.2 7.7 % Asian 2.5 2.7 0.0 6.1 %Hispanic 10.6 1 1.4 1.7 2.6 %White 80.3 19.4 54.2 94.8 % Rural 36.9 NA 0.0 1.0 Free & Reduced Price Lunch (proportion eligible) 32.5 19.6 4.2 98.5 Student Enrollment 1010.9 741.7 116.0 1950.0 Characteristics of Utah High Schools, n=86 (79%).

16. Figure 1. Proportion of high school principals reporting school environment practices, 2004, 2006 and 2008, n=66.

17. Figure 2. Proportion of lead health education teachers reporting they teach nutrition topics in Utah high schools 2004, 2006 and 2008, n=57.

18. Figure 3. Proportion of lead health education teachers reporting they teach physical activity topics in Utah high schools 2004, 2006 and 2008, n=57.

19. Figure 4. Proportion of school staff reporting obesity related collaboration or training practices in 2004, 2006 and 2008, n=64 principals or 57 health teachers

20. School Characteristics and Wellness Practices The following were not associated with wellness practices: – Race and ethnicity of school population – School enrollment – Rurality – Proportion of students receiving free and reduced price meals – Mandated policy versus recommended policy – Practices in schools within the same district

21. Strengths and Limitations Strengths Adds to scarce literature Profiles allowed examination of practices pre and post CNRA without lag time Able to look at the same schools over multiple time periods Limitations Profiles survey inadequate for examining wellness policies No information on school cafeterias Principals may not be best source of competitive foods and PE practices Limited to one state

22. Summary Few changes in high school nutrition and physical activity practices post CNRA No associations of practices by: – School characteristics – School district wellness policy content – Schools in the same district In Utah: – Junk foods are available in >90% of high schools – 67% of high schools allow exemption from PE for at least one reason – Nutrition and PA concepts are consistently taught in the health classroom

23. Discussion Research Assess practices pre- and post CNRA 2010 – develop better tools for wellness policy implementation and evaluation – evaluate middle school practices Include built environment surrounding schools in analyses Strive to understand changes in health behaviors and outcomes resulting from wellness policies Public Health Application Policy is different than practice – In state policy – In federal policy Ensure quality nutrition and physical activity education in health classes Do a better job with obesity prevention in high schools – Competitive foods/ PE – Make guidelines specific – Work towards long-term sustainability

24. Logic Model Logic Model

25. Acknowledgements James VanDerslice, PhD Family and Preventive Medicine-Division of Public Health Elizabeth Joy, PhD, MD Family and Preventive Medicine-Division of Public Health Rebecca Utz, PhD Social and Behavioral Sciences-Department of Sociology Christine Porucznik, PhD Family and Preventive Medicine-Division of Public Health Norman Waitzman, PhD Social and Behavioral Sciences-Department of Economics