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Two Years Later: Wellness Councils and Healthier Vending in a Cohort of Middle and High Schools

      Abstract

      Purpose

      To examine the association between school wellness council structure over 2 years and low-nutrient, energy-dense vending fare assessed as a food score (range: 0–7), following enactment of federal legislation.

      Methods

      Multivariate linear regression was used to examine 2006/2007 and 2008/2009 data among a cohort of middle (n = 16) and high (n = 38) schools located in a Midwest metropolitan area.

      Results

      Schools with district and school councils had a significantly lower mean food score (3.28) than schools with district-only (4.50) and no councils (4.99).

      Conclusions

      Wellness councils, particularly a structure that includes both a district and school council, may contribute to decreasing low-nutrient, energy-dense food/beverage availability in middle and high schools.

      Keywords

      The 2006/2007 school year found most U.S. schools responding to the Child Nutrition and WIC Reauthorization Act of 2004 that required school districts participating in the federal school meal program to establish policies that included nutrition guidelines for all foods/beverages offered at school and policy development involving key stakeholders, such as parents and school representatives [
      Child nutrition and WIC reauthorization act of 2004.
      ]. National data suggest that many schools and/or school districts use health/wellness councils to develop and disseminate nutrition policies [
      • Jones S.E.
      • Fisher C.J.
      • Greene B.Z.
      • et al.
      Healthy and safe school environment, part I: Results from the School Health Policies and Programs Study 2006.
      ].
      In middle and high schools, vending machines (VM) are a prevalent source of low-nutrient, energy-dense (LNED) foods/beverages and a policy target [
      • O'Toole T.P.
      • Anderson S.
      • Miller C.
      • Guthrie J.
      Nutrition services and foods and beverages available at school: Results from the School Health Policies and Programs Study 2006.
      ,
      • Johnson D.B.
      • Bruemmer B.
      • Lund A.E.
      • et al.
      Impact of school district sugar-sweetened beverage policies on student beverage exposure and consumption in middle schools.
      ]. Research conducted in 2006/2007 found that LNED vending fare was lower in middle and high schools reporting a district-only or district and school wellness council structure, with the latter offering the greatest benefit when compared with the schools without councils [
      • Kubik M.Y.
      • Lytle L.A.
      • Farbarkash K.
      School and district wellness councils and availability of low-nutrient, energy-dense vending fare in Minnesota middle and high schools.
      ]. However, because of the weaknesses with the federal legislation related to policy implementation and enforcement, there is concern about council sustainability and meaningful policy making over time [
      • Probart C.
      • McDonnell E.
      • Weirich J.E.
      • et al.
      Statewide assessment of local wellness policies in Pennsylvania public school districts.
      ,
      • Story M.
      • Kaphingst K.M.
      • Robinson-O'Brien R.
      • Glanz K.
      Creating healthy food and eating environments: Policy and environmental approaches.
      ,
      • Kubik M.Y.
      • Lytle L.A.
      • Farbarkash K.
      • et al.
      Food use in middle and high school fundraising: Does policy support healthy practice? Results from a survey of Minnesota school principals.
      ]. The aims of the current study were to assess the wellness council structure in 2006/2007 and 2008/2009 in a cohort of public middle and high schools and to examine the association between council structure at the two time points and availability of LNED vending fare in 2008/2009.

      Methods

      Data were collected as part of a longitudinal measurement study of youth to assess obesity-related factors, conducted in Minneapolis/St. Paul, MN [
      • Lytle L.A.
      Examining the etiology of childhood obesity: The IDEA Study.
      ]. Study recruitment and data collection details have been reported elsewhere [
      • Kubik M.Y.
      • Lytle L.A.
      • Farbarkash K.
      School and district wellness councils and availability of low-nutrient, energy-dense vending fare in Minnesota middle and high schools.
      ,
      • Lytle L.A.
      Examining the etiology of childhood obesity: The IDEA Study.
      ]. The sample for this study included 54 public middle (n = 16) and high (n = 38) schools that completed school-level data collection in 2006/2007 and 2008/2009. The University of Minnesota Human Subjects Research Committee approved the study.
      On both measurement occasions, a survey completed by the school principal/designee asked whether the school and school district had a health/wellness advisory council. A composite variable representing wellness council structure at both time points was created as follows: district and school councils at both time points; district-only council at one or both time points; and no council at one or both time points.
      In 2008/2009, trained study staff visited schools one day and directly observed and recorded package size and kilocalories and fat grams per package for all vending items. LNED foods/beverages, defined as snacks containing >3 g of fat/serving or >200 calories/serving and soft drinks (regular and diet), fruit drinks (not 100% fruit juice), sport drinks, and 2% or whole milk (plain or flavored), were grouped into seven categories (chocolate; other candy; baked goods not low-fat; salty snacks not low-fat; 2% or whole milk (plain or flavored); soda pop/fruit drinks; sports drinks) [
      • O'Toole T.P.
      • Anderson S.
      • Miller C.
      • Guthrie J.
      Nutrition services and foods and beverages available at school: Results from the School Health Policies and Programs Study 2006.
      ,
      • Kubik M.Y.
      • Lytle L.A.
      • Farbarkash K.
      School and district wellness councils and availability of low-nutrient, energy-dense vending fare in Minnesota middle and high schools.
      ]. A food score was calculated on the basis of number of categories (range: 0–7). Higher scores indicated more LNED foods/beverages. Schools without VM or VM offering only healthy items (water, 100% fruit juice) were scored as 0. Past research demonstrated a high correlation between the mean number of LNED food/beverage items and the food score [
      • Kubik M.Y.
      • Lytle L.A.
      • Farbarkash K.
      School and district wellness councils and availability of low-nutrient, energy-dense vending fare in Minnesota middle and high schools.
      ].
      At baseline (2006/2007), information on school-level characteristics was obtained from the Minnesota Department of Education Web site, supplemented by a school representative.
      A cross-sectional approach and multivariate linear regression, adjusted for school-level characteristics, were used to examine the association between the composite wellness council variable and the food score. Analyses were performed using SAS version 9.2 (SAS Institute, Cary, NC).

      Results

      Most schools were suburban (91%) and high schools (70%). Mean student enrollment was 1,566 (SD: 695), and 18% (SD: 14.5%) of the students reported free/reduced lunch participation. Among the selected schools, 12 (22%) had a school and district council at both time points. At one or both time points, 33 (61%) had a district-only council and 9 (17%) reported no council (Table 1). In 2008/2009, schools with a school and district council at both time points reported a greater variety of council participants and more frequent meetings than schools with a district-only council at one or both time points (Table 2).
      Table 1Wellness council structure over 2 school years in a cohort of Minnesota public middle (n = 16) and high schools (n = 38)
      2006/20072008/2009
      District-only councilSchool + District councilNo councilTotal
      District-only council199432
      School + District council512017
      No council0145
      Total2422854
      Table 2Characteristics of district and school wellness councils in a cohort of middle and high schools (N = 54),
      Nine schools reported no wellness council during one or both school years, 2006/2007 and 2008/2009.
      Minneapolis/St Paul, MN, 2008/2009
      Council characteristicsDistrict councils
      Defined as a school with only a district-level council during one or both school years, 2006/2007 and 2008/2009.
      (n = 33)
      School councils
      Defined as a school with a district and school council during both school years, 2006/2007 and 2008/2009.
      (n = 12)
      p
      Members
       Principals27%50%.17
       Parents21%33%.45
       Students9%42%.02
       School nurses36%42%.74
       Teachers42%92%<.01
       Food service staff36%50%.50
      Meeting frequency
       ≥monthly18%33%.42
      VM
      VM = vending machine.
      policy
       Yes70%58%.50
      a Nine schools reported no wellness council during one or both school years, 2006/2007 and 2008/2009.
      b Defined as a school with only a district-level council during one or both school years, 2006/2007 and 2008/2009.
      c Defined as a school with a district and school council during both school years, 2006/2007 and 2008/2009.
      d VM = vending machine.
      In adjusted multivariate analysis, having a wellness council structure at both time points was inversely associated with the food score: (β = −1.71 [district and school at both]; β = −.49 [district-only at one or both]; F-test = .07). High schools and suburban schools had higher scores than middle and urban schools (β = 2.13, p = .003; and β = 2.66, p = .04, respectively). In post hoc adjusted analysis, the mean food score for schools with both a district and school council was significantly lower as compared with schools with district-only (3.28 vs. 4.50; p = .05) or no council (3.28 vs. 4.99; p = .04) at one or both time points. The mean score for schools with district-only and no council structures at one or both time points was not significantly different (4.50 vs. 4.99; p = .48).

      Discussion

      This research contributes to the dearth of empirical evidence linking school policy to school-level food practice. Study findings indicate that 2 years postenactment of federal legislation, LNED foods/beverages remain common vending fare in middle and high schools. However, schools reporting a wellness council structure over 2 years that included both a school and district wellness council had significantly less LNED vending fare than schools with a district-only council or no council at one or both time points. Consistent with earlier research, the added benefit of a school council is likely due to involving a greater variety of stakeholders, particularly students and teachers, and more frequent meetings [
      • Jones S.E.
      • Fisher C.J.
      • Greene B.Z.
      • et al.
      Healthy and safe school environment, part I: Results from the School Health Policies and Programs Study 2006.
      ,
      • Kubik M.Y.
      • Lytle L.A.
      • Farbarkash K.
      School and district wellness councils and availability of low-nutrient, energy-dense vending fare in Minnesota middle and high schools.
      ], factors that foster improved policy oversight and enforcement at the school level. Stability of council structure over time may also be a factor.
      Study strengths include the examination of policy and practice in a school cohort over a 2-year period and the use of objective data to categorize food/beverages. However, the cohort was a small convenience sample of mostly suburban high schools in one Midwestern metropolitan area, thus limiting generalizability. The data collected on one day may not be representative of food/beverage availability throughout the school year.
      Wellness councils may be a sustainable and useful structure for developing and disseminating food policy that results in healthy food practice at the school level, particularly a structure that includes both a district and school council. Future research should replicate this study in a larger sample of more diverse schools and examine other prevalent food practices, such as the use of LNED foods/beverages as rewards/incentives and for school fundraising [
      • O'Toole T.P.
      • Anderson S.
      • Miller C.
      • Guthrie J.
      Nutrition services and foods and beverages available at school: Results from the School Health Policies and Programs Study 2006.
      ,
      • Kubik M.Y.
      • Lytle L.A.
      • Farbarkash K.
      • et al.
      Food use in middle and high school fundraising: Does policy support healthy practice? Results from a survey of Minnesota school principals.
      ], as well as the link between policy, practice, and weight outcomes among students.

      Acknowledgments

      This research was funded through a grant from the National Cancer Institutes as part of their Transdisciplinary Research in Energetics and Cancer Initiative, grant number U54CA116849 .

      References

      1. Child nutrition and WIC reauthorization act of 2004.
        (Retrieved August 10, 2010)
        • Jones S.E.
        • Fisher C.J.
        • Greene B.Z.
        • et al.
        Healthy and safe school environment, part I: Results from the School Health Policies and Programs Study 2006.
        J Sch Health. 2007; 77: 522-543
        • O'Toole T.P.
        • Anderson S.
        • Miller C.
        • Guthrie J.
        Nutrition services and foods and beverages available at school: Results from the School Health Policies and Programs Study 2006.
        J Sch Health. 2007; 77: 500-521
        • Johnson D.B.
        • Bruemmer B.
        • Lund A.E.
        • et al.
        Impact of school district sugar-sweetened beverage policies on student beverage exposure and consumption in middle schools.
        J Adolesc Health. 2009; 45: S30-S37
        • Kubik M.Y.
        • Lytle L.A.
        • Farbarkash K.
        School and district wellness councils and availability of low-nutrient, energy-dense vending fare in Minnesota middle and high schools.
        J Am Diet Assoc. 2011; 111: 150-155
        • Probart C.
        • McDonnell E.
        • Weirich J.E.
        • et al.
        Statewide assessment of local wellness policies in Pennsylvania public school districts.
        J Am Diet Assoc. 2008; 108: 1497-1502
        • Story M.
        • Kaphingst K.M.
        • Robinson-O'Brien R.
        • Glanz K.
        Creating healthy food and eating environments: Policy and environmental approaches.
        Annu Rev Public Health. 2008; 29: 1-6
        • Kubik M.Y.
        • Lytle L.A.
        • Farbarkash K.
        • et al.
        Food use in middle and high school fundraising: Does policy support healthy practice?.
        J Am Diet Assoc. 2009; 109: 1215-1219
        • Lytle L.A.
        Examining the etiology of childhood obesity: The IDEA Study.
        Am J Community Psychol. 2009; 44: 338-349