Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities.
Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students).



Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression.



Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05).



Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Room 163, Baltimore, MD 21201. ehager@peds.umaryland.edu.
Erin R
ER
Hager
Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, 737 West Lombard Street, Room 163, Baltimore, MD 21201. drubio@peds.umaryland.edu.
Diana S
DS
Rubio
Professional Development and Technical Assistance, Maryland State Department of Education, Office of School & Community Nutrition Programs, Baltimore, MD 21201. stewart.eidel@maryland.gov.
G Stewart
GS
Eidel
Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201. erin.penniston@maryland.gov.
Erin S
ES
Penniston
Maryland State Department of Education, Professional Development and Technical Assistance Section, Office of School and Community Nutrition Programs/Office for School Effectiveness, Baltimore, MD 21201. megan.sweatlopes@maryland.gov.
Megan
M
Lopes
Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742. bsaksvig@umd.edu.
Brit I
BI
Saksvig
Division of Quality & Health Outcomes (DQHO), Center for Medicare and Medicaid Services, CMCS/CAHPG, 7500 Security Blvd, Baltimore, MD 21244. Renee.Fox@cms.hhs.gov.
Renee E
RE
Fox
Division of Growth and Nutrition, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 737 West Lombard Street, Room 161, Baltimore, MD 21201. mblack@peds.umaryland.edu.
Maureen M
MM
Black
D004032:Diet; D004777:Environment; D015444:Exercise; D015438:Health Behavior; D006291:Health Policy; D006293:Health Promotion / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D010809:Physical Fitness; D012574:Schools / Q000458:organization & administration* / Q000592:standards; D012959:Socioeconomic Factors
health policy; nutrition and diet; physical fitness and sport