Policy, System, and Environmental Approaches in the High School Setting Affect Student Eating Outcomes

Abstract

To explore associations between policy, system, and environmental (PSE) approaches and changes in eating behaviors among low-income high school students in California. To test a newly-developed scale to measure PSEs in high school settings. In 2012-2013, five school districts implemented PSE approaches, which varied by type and number by school site. Concurrently, participating schools implemented a standardized nutrition education intervention. Using a pre-post design, districts collected food consumption outcome data from students (n=1,505) using a standardized questionnaire. Investigators used ANOVAs to analyze a 21-item instrument identifying the frequency of specific PSEs in each district in conjunction with its pre-post data. The PSE scale was adapted from various sources including CDC's School Health Profiles, a system of surveys assessing school health policies and practices. Examples of PSE approaches were the availability of healthy foods offered at lower price points, partnerships with nearby stores, self-serve salad bars, and healthy food celebrations. The five districts reported having 9, 12, 13, 14, and 16 of the 21 possible PSE approaches. Group comparisons by ANOVA revealed that the district implementing 16 PSE approaches compared with 14 or fewer showed better self-reported behavioral outcomes for dairy, cereal, water, fruit, vegetable, and 100% juice consumption (all p<0.001). Results suggest that a threshold effect rather than a linear relationship exists when implementing multiple PSEs aimed at low-income high school students. These findings support the importance of utilizing PSE approaches in a setting that serves a population with more autonomy to make their own food-related decisions than younger children.