title: The Role of School Design in Shaping Healthy Eating-Related Attitudes, Practices, and Behaviors Among School Staff.
abstract: BACKGROUND
  Schools have increasing responsibility to address healthy eating, but physical barriers influence their ability to adopt and sustain recommended strategies. We took advantage of a natural experiment to investigate the role of the physical environment in shaping healthy eating attitudes and practices among school staff members.
  
  
  METHODS
  A school district consolidated its elementary schools and incorporated architectural features to support healthy eating into a building renovation. Surveys along with structured, in-depth interviews were administered prior to and at 12 months postoccupancy. Paired t-tests and McNemar's tests were used to analyze changes in survey indices and interview data were coded for themes.
  
  
  RESULTS
  The school implemented new policies and programs, including staff wellness activities. There was a significant decrease in the percent of teachers with a high-fat diet (from 73.68% to 57.14%, p < .05). Many physical barriers were removed but new challenges emerged, and staff varied in their awareness and comfort with using the new healthy eating features.
  
  
  CONCLUSIONS
  We found promising evidence that school architecture can support a school to address healthy eating. To enhance influence of the physical environment, more research is merited to test complementary strategies such as improving ownership of space and increasing self-efficacy to manage space.
authors.affiliation: University of North Carolina at Chapel Hill, Center for Health Equity Research, 323 MacNider Hall, CB 7240, Chapel Hill, NC 27599-7240. leahf@unc.edu.
authors.forename: Leah
authors.initials: L
authors.lastname: Frerichs
authors.affiliation: University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social and Behavioral Health, 984365 Nebraska Medical Center, Omaha, NE 68918-4365. jeri.brittin@unmc.edu.
authors.forename: Jeri
authors.initials: J
authors.lastname: Brittin
authors.affiliation: Johnson & Wales University, 8 Abbott Park Place, Providence, RI 02903. logic69@gmail.com.
authors.forename: Loren
authors.initials: L
authors.lastname: Intolubbe-Chmil
authors.affiliation: School of Medicine, University of Virginia, PO Box 800699, Charlottesville, VA 22908. mtrowbridge@virginia.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Trowbridge
authors.affiliation: VMDO Architects, 200 East Market Street, Charlottesville, VA 22902. sorensen@vmdo.com.
authors.forename: Dina
authors.initials: D
authors.lastname: Sorensen
authors.affiliation: CUNY School of Public Health, 55 W. 125 Street, Room 803, New York, NY 10027. terry.huang@sph.cuny.edu.
authors.forename: Terry T-K
authors.initials: TT
authors.lastname: Huang
mesh_terms: D000328:Adult; D005160:Facility Design and Construction; D005178:Faculty; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012572:School Health Services; D012574:Schools
keywords: diet; environment design; schools; teachers