Study to Evaluate the Health and Wellness Policies of the New Haven Public School District.
Condition: Chronic Diseases; Obesity
MeSH terms: Obesity; Chronic Disease
Study type: Interventional

Summary: 
      Our long-term objective is to reduce the rates and risk of childhood obesity via school-based
      nutrition and physical activity policies. Using a randomized design, we propose to monitor
      and evaluate how Connecticut's first-ranked District Wellness Policy, in the New Haven Public
      School district, is implemented and determine its impact on children's obesogenic behaviors,
      weight outcomes, and school performance. This study is designed to significantly advance
      empirical research on school wellness policies and to provide important evidence to guide
      future interventions in schools and communities - translating science to improved health of
      the public.
    

Detailed description: 
      Consistent with NIH priorities, our long-term objective is to reduce the rates and risk of
      childhood obesity via school-based nutrition and physical activity policies. We propose to
      monitor and evaluate how Connecticut's first-ranked School Wellness Policy, in the New Haven
      Public School district, is implemented and determine its impact on children's obesogenic
      behaviors, weight outcomes, and school performance. We will evaluate a strategy of
      implementation at 12 targeted schools using a randomized design. Focusing on targeted schools
      will enable a more rigorous evaluation of School Wellness Policy implementation,
      barriers/facilitators, and ultimately the behavioral and health impacts of school-based
      policies on childhood obesity. We propose a multi-level assessment of factors that may
      influence childhood obesity using the Ecological Model as a guiding framework.

      Thus we propose a multi-sectoral, multi-level approach, focused on children, families,
      schools, and community. This ambitious project is possible because of the expertise and
      strong collaborative partnerships between The New Haven Public Schools and two Yale
      University research centers: The Rudd Center for Food Policy and Obesity and CARE: Community
      Alliance for Research and Engagement. Our partnership builds on Principles and Guidelines for
      Community-University Research Partnerships developed by a 12-member committee of community
      and university leaders and endorsed by Yale University and community partners in 2009.

      This study is designed to significantly advance empirical research on school wellness
      policies: focused on implementation and measurable impact on student health. No matter how
      well written, a school wellness policy must be effectively implemented to achieve its
      potential impact. Further, students within schools represent only two components of a larger
      socio-ecological system that influences eating behavior, physical activity, and weight
      status. The federal mandate for school wellness policies requires districts to address many
      aspects of the school environment (e.g., nutrition education, nutrition standards for foods
      sold, and opportunities for physical activity). To maximize improvements, this type of
      multi-component policy is needed. However, this complexity makes it difficult to evaluate
      policy impact and draw conclusions about the causal relationships between specific policies
      and student health. With our team's unique strengths and these challenges in mind, we
      designed this research study with the following Specific Aims:

        1. Track and evaluate a strategy of targeted implementation of a School Wellness Policy.

        2. Identify factors that facilitate or impede implementation of The School Wellness Policy,
           including neighborhood, school, and student determinants; and

        3. Evaluate the impact of implementation of The School Wellness Policy on obesogenic
           behaviors and health outcomes as well as school performance.

      We will collaborate with the District to implement a subset of nutrition and physical
      activity policies in 12 schools using a randomized 2 x 2 research design. This will permit
      comparison of the potential unique and synergistic effects of these nutrition and physical
      activity policies on student behaviors and related health outcomes. We will follow a cohort
      of 5th grade students (N≈700) annually for four years to assess potential changes to student
      eating behaviors, physical activity levels, and BMI. We use a multi-method approach to
      collect data and examine predictors of these outcomes from across levels of the
      socio-ecological framework: student variables, family characteristics, school policies, and
      neighborhood features.

      This multidisciplinary proposal is synchronous with specific research objectives articulated
      in Program Announcement (PA-10-052) School Nutrition and Physical Activity Policies,
      Obesogenic Behaviors and Weight Outcomes. As noted, few studies to date have examined the
      policy implementation process. We directly target the implementation and impact of
      health-related policies in schools, measuring obesogenic behaviors and BMI as primary
      outcomes. We have an active tracking system to monitor impact of policies, and we focus on
      minority populations traditionally vulnerable and underserved. As stated by NIH in this
      program announcement, policy-based approaches to combat obesity in schools exist; however,
      knowledge is lacking in key areas concerning the optimal policies, key implementation
      strategies for such policies, and the impact of these policies on important health and social
      outcomes. The proposed project will advance scientific knowledge and understanding in this
      arena and provide important evidence to guide future interventions in schools and communities
      translating science to improved health of the public.
    

Intervention name(s): DISTRICT WELLNESS COMMITTEE; NUTRITIONAL QUALITY OF FOODS AND BEVERAGES ON CAMPUS; HEALTH PROMOTION AND MARKETING; OPPORTUNITIES FOR PHYSICAL ACTIVITY
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Three Targeted Schools (N+PA) will expand the District's school based wellness initiative, PAW-Physical Activity and Wellness. With District support, PAW schools develop School Wellness Teams (SWTs) to identify school health priorities, implement and sustain health initiatives through school campaigns, promote healthy behavior, and support wellness policies. Results from a 3-year evaluation suggest significant and sustained positive impact on school health culture, student behavior, time-on-task, and increased physical activity among students.; Policy changes will focus on 6 target schools. District will expand nutrition education by integrating other opportunities to learn and practice healthy behaviors across disciplines. Farm-to-School programs will include school visits by farmers to teach students about agriculture, healthy foods and nutrition, coinciding with Farmer's Market Menu Days. Schools will receive four 45 minute nutrition workshops per year. Community educators will offer culturally appropriate, interactive nutrition workshops and cooking demonstrations. Cafeterias will receive youth friendly nutritional messaging, regular promotion of new menu foods, and a variety of monthly nutrition-focused activities. The goals are to: increase number of students who try new menu items regularly, increase acceptance of healthy foods, and improve nutrition literacy. Policy states schools will limit celebrations that involve food to no more than 1 per class/month: 6 schools will pilot alternatives to food for celebrations.; SWP addresses health promotion and marketing by limiting product marketing in schools, expanding nutrition education and broadening health communication with parents. In 3 targeted schools, we expand to include Staff Wellness Promotion. Adults in schools are trusted and influential role models for students; by increasing their positive health behaviors, students may be influenced to adopt similar behaviors. The District will work with the City's Employee Wellness Program to increase school staff participation.; District-wide policies include mandates for daily physical activity and PE and development of policies that prohibit withholding PE for punitive reasons. To further increase physical activity, the School Wellness Policy specifies expanding programs/activities that meet need, interest, and abilities of students. Exer-gaming consoles will be provided to 6 schools and will be integrated into 5th-8th grade PE classes and after-school programs. New and innovate gym equipment will be purchased for the 6 target schools for use in gym class and after school programming. Various pedometer and interactive programs encouraging physical activity in and outside of school are planned for the 6th grade.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: childhood nutrition; physical activity; school wellness; school health; nutritional policies; childhood obesity