title: District wellness policies and school-level practices in Minnesota, USA.
abstract: OBJECTIVE
  To compare the strength of district wellness policies with corresponding school-level practices reported by principals and teachers.
  
  
  METHODS
  District-level wellness policy data were collected from school district websites and, if not available online, by requests made to district administrators in the autumn of 2013. The strength of district policies was scored using the Wellness School Assessment Tool. School-level data were drawn from the 2012 Minnesota School Health Profiles principal and teacher surveys and the National Center for Education Statistics Common Core Data. Generalized estimating equations which accounted for school-level demographics and the nesting of up to two schools within some districts were used to examine ten district policy items and fourteen school-level practices of relevance to nutrition standards, nutrition education and wellness promotion, and physical activity promotion.
  
  
  METHODS
  State-wide sample of 180 districts and 212 public schools in Minnesota, USA.
  
  
  RESULTS
  The mean number of energy-dense, nutrient-poor snack foods and beverages available for students to purchase at school was inversely related to the strength of district wellness policies regulating vending machines and school stores (P=0·01). The proportion of schools having a joint use agreement for shared use of physical activity facilities was inversely related to the strength of district policies addressing community use of school facilities (P=0·03). No associations were found between the strength of other district policies and school-level practices.
  
  
  CONCLUSIONS
  Nutrition educators and other health professionals should assist schools in periodically assessing their wellness practices to ensure compliance with district wellness policies and environments supportive of healthy behaviours.
authors.affiliation: 1Division of Epidemiology and Community Health,School of Public Health,University of Minnesota,Suite 300,1300 South Second Street,Minneapolis,MN 55454,USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Larson
authors.affiliation: 2Biostatistical Design and Analysis Center,Clinical and Translational Science Institute,University of Minnesota,Minneapolis,MN,USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Davey
authors.affiliation: 3Department of Family Medicine & Community Health,Program in Health Disparities Research,University of Minnesota,Minneapolis,MN,USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Hoffman
authors.affiliation: 4School of Nursing,University of Minnesota,Minneapolis,MN,USA.
authors.forename: Martha Y
authors.initials: MY
authors.lastname: Kubik
authors.affiliation: 3Department of Family Medicine & Community Health,Program in Health Disparities Research,University of Minnesota,Minneapolis,MN,USA.
authors.forename: Marilyn S
authors.initials: MS
authors.lastname: Nanney
mesh_terms: D000293:Adolescent; D001628:Beverages; D002648:Child; D060766:Drinking Water; D005522:Food Services / Q000592:standards*; D005638:Fruit; D015438:Health Behavior; D006266:Health Education; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006293:Health Promotion; D006801:Humans; D008910:Minnesota; D009043:Motor Activity; D018673:Nutrition Policy / Q000331:legislation & jurisprudence*; D009765:Obesity / Q000517:prevention & control; D012572:School Health Services / Q000592:standards; D012574:Schools / Q000592:standards*; D062410:Snacks; D013334:Students; D014675:Vegetables
chemical_list: D060766:Drinking Water
keywords: Competitive foods; District wellness policies; Nutrition education; Physical activity; Secondary schools