Wellness Policy Implementation Research Articles

The Role of Wellness Teams in Promoting Health and Wellness Implementation Strategies in Elementary Schools in Chicago.

Strategies used by wellness teams (WTs) to foster local wellness policy (LWP) implementation have been documented, yet there remains a need to better understand how WTs respond to district-level LWP requirements, particularly when bundled with additional health-related policies. This study's goal was to explore how WTs implement Healthy Chicago Public School (CPS), a district-led initiative focused on both LWP and other health policy implementation in the CPS district, one of the most diverse in the nation. Eleven discussion groups were conducted with WTs in CPS. Discussions were recorded, transcribed, and thematically coded. Six overarching strategies used by WTs in working to achieve Healthy CPS include: (1) using district guides and resources to support planning, progress monitoring, and reporting; (2) under the leadership of wellness champions, as required by the district, facilitating engagement among staff, students, and/or families; (3) taking district guidance and adapting and integrating it into their schools' existing structures, curricula, and practices, often taking a holistic approach; (4) fostering linkages in the communities surrounding their schools to supplement internal school capacities; and (5) stewarding resources, time, and staff for sustainability. Strategies for LWP implementation by WTs in urban and diverse schools include planning for staff turnover, integrating health and wellness into existing curricula and structures, and leveraging relationships with the local community. WTs can play a critical role in supporting schools in diverse, urban districts to implement district-level LWP and the plethora of related policies that schools are subject to at the federal, state, and district levels.

A strategic approach to employees’ well-being: study assessing the relationship between holistic wellness, job satisfaction emotions, and productivity

Employee holistic well-being is attracting more interest and consideration from businesses as the employers started realizing the gains and impact this implementation of holistic wellness policies for workers in the workplace can have on the business. This study aims to analyze the impact of the holistic wellness of employees on their job satisfaction and work productivity. This paper aims to assess the approaches adopted by organizations towards employees’ holistic wellness and how it contributes to their job satisfaction and quality of work. The study aims to identify current employee well-being in organizations, employee wellness dimensions being covered through workplace wellness programs, and analyze the relationship between employees’ holistic well-being and work productivity, job satisfaction, and organization performance. The approach of the study includes a quantitative survey, qualitative interviews, and empirical evidence. Primary research is done at the organizational level using structured interviews with HR leads and employees. Secondary research is done by reviewing existing literature to explore industry best practices in holistic well-being. The deductive approach has been used to explain explanations and arguments backed by empirical observations in organizations and relevant theoretical concepts. The findings from the study will help the organizations who are in the process of streamlining and structuring the employee wellness programs to understand the link between employees’ holistic wellness and their productivity and job satisfaction and use these findings to increase job satisfaction and productivity of the employees. The data gathered not only from quantitative surveys and qualitative interviews but also through empirical observations. These findings can provide valuable pointers for human resource managers in other organizations.

Environmental Constructs Associated with School Readiness to Implement Wellness Initiatives

Objective: In this study, we examined school and environmental factors associated with readiness to implement school-based wellness initiatives. Methods: We used an exploratory mixed methods design to assess facilitators and barriers to school wellness policy implementation. We conducted school site visits in 8 K-12 schools in one midwestern school district. We collected quantitative and qualitative data to measure school wellness environments and readiness for change. We used a one-way ANOVA to examine associations between readiness for change and school wellness environments. We analyzed qualitative data inductively; school- and district-level themes emerged. Results: One-way ANOVA results revealed schools in the high readiness (HR) group reported more active school wellness teams than those in the low readiness (LR) group (F(1,6) = 8.442, p = .03). Qualitative data indicated that establishing local school wellness committees was an area of growth needed for all schools. Areas of need in HR schools included enhancing school wellness policy communication, leadership, and staff wellness initiatives. Areas of need in LR schools focused on providing more physical activity and wellness opportunities for students. Conclusion: Readiness for change is a promising metric that could associate with more physical activity opportunities, better wellness team function, and perhaps, wellness policy implementation.

The Role of Technical Assistance in School Wellness Policy Enhancement.

School settings offer an opportunity to impact student health and wellness. Quality wellness policies are important in establishing strong wellness environments, but current resources to support policy development, maintenance, and dissemination are lacking. The Building Healthy Schools Program aimed to develop capacity of school districts to improve the strength and comprehensiveness of wellness policies and sustain these activities. Fifteen school districts in Pennsylvania participated in a program to facilitate the improvement of district wellness policies and practices. Program staff provided technical assistance to evaluate wellness policies before and after program implementation. Professional development and tailored training was provided for school personnel to create sustainability. Statistical analysis was performed to evaluate policy improvement. Thirteen of the 15 participating districts completed a policy revision. Median strength (p=.001) and comprehensiveness (p=.002) scores improved from baseline to post-program and there were significant improvements in most assessment sub-sections. Some districts were hesitant to make strong language improvements due to their limited capacity (ie, staff) for implementation. Champions (n=13; 87%) reported confidence to revise wellness policy language independently in the future. Technical assistance provided to districts facilitated significant improvements to wellness policy language, especially in the implementation, evaluation, and communication; critical components for policy impact on school wellness environments. In addition, participant feedback suggested an ability to sustain activities in the future. Both external (ie, technical assistance) and internal resources are needed to facilitate school districts' ongoing wellness policy improvement and implementation, including improved model wellness policy language and enforcement within schools, respectively.

Disparities in Local Wellness Policies Implementation Across Maryland Schools.

School-level implementation of district-level local wellness policies (LWPs) is needed to create school environments that promote nutrition and physical activity (PA). Disparities in classroom-specific LWPs implementation were examined. An administrator survey (N=756 schools; 24/24 districts) included 6 classrooms LWP best-practice items (fully/not fully implemented: restricting food celebrations or rewards, incorporating PA breaks or integrating PA in curricula, restricting withholding or using PA as punishment). A sum score (alpha=.71; elementary and middle/high examined separately) was used to examine associations with student body income (free-and-reduced priced meals (FARMS): ≤40%, 41-75%, ≥75%), race/ethnicity, and school location (rural/urban/suburban), accounting for district-level clustering, with moderation examined. Classroom implementation scores were: elementary=3.1 ± 1.8 (range: 0-6/6 items) and middle/high=2.3 ± 1.6 (range:0-5/5 items). Among elementary and middle/high schools, 65% and 55% had >40% FARMS, 39% and 46% had ≥50% white student body, and 24% and 23% were urban, respectively. Elementary schools with >40% of FARMS-eligible students and middle/high schools with <25% white students reported implementing fewer items. Location was not associated with classroom practices nor was moderation observed. Disparities in classroom-specific LWP best practices implementation were observed by income and race/ethnicity. Tailored support may be needed to improve classroom LWP implementation in schools serving low-income students.

State Wellness Policy Requirement Laws Matter for District Wellness Policy Comprehensiveness and Wellness Policy Implementation in the United States.

Beginning with the school year 2006–2007, U.S. school districts participating in the federal Child Nutrition Programs were required to adopt and implement a local wellness policy (LWP) that included goals and/or standards for nutrition education, school meals, other foods sold or served in schools, and physical activity. A primary challenge with LWPs has been inconsistent implementation. This study examined whether state wellness policy requirement laws and district LWP comprehensiveness influence district level implementation, using law/policy data from the National Wellness Policy Study and school food authority (SFA)-reported district LWP implementation from the School Nutrition and Meal Cost Study. Generalized linear and structural equation models were used, controlling for SFA and district characteristics. SFAs in states with wellness policy requirement laws (vs. those in states without) reported implementing significantly more practices (59.56% vs. 44.57%, p < 0.01). State wellness policy requirement laws were associated with district LWP comprehensiveness (coeff.: 0.463; 95% CI: 0.123, 0.803) and district-level implementation (coeff.: 1.392; 95% CI: 0.299, 2.485). District LWP comprehensiveness was associated with district implementation (coeff.: 0.562; 95% CI: 0.072, 1.053), but did not mediate the state law–district implementation relationship. This study highlights the important role that state laws and district LWPs can play in facilitating wellness policy implementation.

Can Monitoring Make It Happen? An Assessment of How Reporting, Monitoring, and Evaluation Can Support Local Wellness Policy Implementation in US Schools.

US school districts participating in federal child nutrition programs are required to develop a local wellness policy (LWP). Each district is allowed flexibility in policy development, including the approaches used for policy reporting, monitoring, and evaluation (RME). The aim of this convergent mixed-methods study was to quantitatively examine RME provisions in policies among a nationally representative sample of districts in the 2014–2015 school year in order to examine whether policies were associated with RME practices in those districts, and to qualitatively examine perceived challenges to RME practices. Data were compiled through the School Nutrition and Meal Cost Study and the National Wellness Policy Study. In multivariable regression models accounting for demographics, survey respondents were significantly more likely to report that their district had informed the public about LWP content and implementation, if there was a relevant policy provision in place. Having a strong policy (as compared to no policy) requiring evaluation was associated with reports that the district had indeed evaluated implementation. Having definitive/required provisions in policies was significantly associated with actual use of RME practices. RME activities are an important part of policy implementation, and these results show that policy provisions addressing RME activities must be written with strong language to require compliance. In interviews with 39 superintendents, many reported that RME activities are challenging, including difficulty determining how to monitor and show impact of their district’s wellness initiatives. Furthermore, the qualitative results highlighted the need for vetted tools that are freely available, widely used, and feasible for districts to use in assessing their progress toward meeting the goals in their LWPs.

Every School Healthy: An Urban School Case Study.

ABSTRACTBACKGROUNDIn this case study, multiple participants in a large urban school district used the Whole School, Whole Community, Whole Child (WSCC) model to guide development of a district wellness policy. The model's health education component is highlighted, focusing on concerns for special needs students and ones speaking English as a New Language (ENL).METHODSOrganizational structure was developed around the WSCC model and district wellness policy implementation through coordination, collaboration, and communication (3Cs) of programs, policies, and processes/practices (3Ps).RESULTSThe WSCC approach guided the creation of a district wellness policy that influenced programming for students with special needs and required Youth Risk Behavior Survey (YRBS) data collection. Using YRBS and School Health Index (SHI) data in planning sexual health education illustrated improvements over time. Formation of the School Health and Wellness Collaborative under WSCC improved family engagement in sexual health education programs and practices. Relationships were established with community partners to impact student's sexual risk behaviors. Finally, the district co‐created and implemented an evidenced‐based sexual health curriculum, modifying it for special education and ENL students.CONCLUSIONSThe WSCC approach is system changing. It takes time to develop the relationships vital to improve the 3Cs and 3Ps. Success is enhanced with a district wellness coordinator, the right people at the table, valid health data, and administrative and board support.

Dimensions of School Food Environments and Their Association with Anthropometric and Dietary Outcomes in Children: The Healthy Communities Study

Abstract Objectives While it has been recommended that schools be the hub of efforts to improve child nutrition, research describing dimensions of U.S. school nutrition environments is limited. This study used exploratory factor analysis to estimate dimensions of school nutrition environments and examined their association with child anthropometric and dietary measures. Methods Cross-sectional analyses of 386 U.S. elementary and middle schools and 4635 children from the national Healthy Communities Study (2013–2015) was conducted. Three complementary instruments to assess the school nutrition environment were used to create 34 variables. Data were collected by observation and surveys. Factor analysis was done with orthogonal rotation. Mixed-effects regression models examined the multivariate-adjusted associations of dimensions of school nutrition environments with child anthropometric and dietary measures accounting for community and school variation. Results Six dimensions of school nutrition environments were derived: 1) nutrition education; 2) fruit and vegetable availability; 3) dining environment, including size and crowding; 4) school meal quality, including compliance with competitive food standards, amount of whole grains, and high fat foods; 5) school participation in state and federal nutrition programs; and 6) self-reported implementation of school wellness policies. Higher school meal quality was associated with lower added sugars intake (ß = –0.94, P &amp;lt; 0.01), better dining environment was associated with higher body mass index z scores (ß = 0.04, P = 0.03), and higher implementation of school wellness policies was associated with higher waist circumference (ß = 0.54, P &amp;lt; 0.01). Conclusions Schools serving meals of higher nutritional quality had children with lower added sugars intake. Associations between dining environment and BMI-z; and implementation of school wellness policies and waist circumference were counterintuitive and may be due to school selection or the inability of cross-sectional data to capture relationships with longer-term health outcomes. More efforts are needed to identify school nutrition environments that have the greatest impact on child diet and adiposity outcomes. Funding Sources National Heart, Lung, and Blood Institute #K01HL131630.

\u201cBridging, brokering, and buffering\u201d: a theoretical exploration of school leaders\u2019 engagement with local school wellness policy implementation

BackgroundThe Healthy, Hunger-Free Kids Act of 2010 (P.L. 111-296) prompted the expansion of federal requirements for local school wellness policies, which aim to improve health promoting practices across school districts in the USA. This qualitative study examined how school district superintendents—as key school leaders who are often listed as the district accountability figure for wellness policies applicable to kindergarten through 12th grade—engaged with wellness policy implementation. The inquiry was guided by evidence-informed implementation and leadership frameworks, including the Consolidated Framework for Implementation Research (CFIR) and “bridging, buffering, and brokering” strategies from education leadership theory.MethodsWe conducted focus groups and interviews with superintendents (n = 39) from 23 states. Interviews were recorded and professionally transcribed; transcripts were team-coded in Atlas.ti v8 using an iteratively revised coding guide that was informed by CFIR, pilot testing, and during weekly analyst meetings. Principles of constant comparative analysis were employed to develop themes.ResultsMost superintendents’ reported positive perspectives and personal motivations to engage with wellness policy implementation. Within the CFIR process domain, superintendents demonstrated adaptive leadership traits and employed a combination of “bridging, buffering, and brokering” strategies to lead implementation activities. Rather than focus on personal traits, an emphasis on specific strategies highlights actions that may be applied.ConclusionsThe findings offer practical strategies to support superintendents with implementation, as well as a formative contribution to the dearth of theoretical frameworks in school wellness literature, particularly by advancing the specific understanding of leadership roles within a broader implementation framework. The application of education theory allowed for a deeper inquiry into the potential ways that leaders’ strategies and engagement influences implementation more broadly.

"On a Positive Path": School Superintendents' Perceptions of and Experiences With Local School Wellness Policy Implementation and Evaluation.

Renewed federal requirements for local school wellness policies highlighted the continued importance of supporting school districts as they implement and evaluate wellness initiatives. Superintendents-as school district leaders-play a critical role in wellness policy implementation and evaluation; however, to our knowledge, no studies examine their perspectives or experiences with the most recent federal rule or wellness initiatives more broadly. This study qualitatively examined superintendents' perspectives, experiences, and recommendations with wellness policy implementation and evaluation. Focus groups (n = 39) and follow-up interviews (n = 14 of the focus group participants) were conducted with superintendents from March to July 2017. Coders organized and coded transcript data using Atlas.ti, Version 8 to facilitate thematic analysis. Superintendents had overall positive perceptions of wellness policies and reported that implementation improved over time. Most described wellness approaches beyond typical wellness policy domains, including social-emotional learning and staff wellness. Evaluation of wellness policies was noted to be a challenge, and superintendents requested more tools and resources, as well as opportunities to learn from "best practices." Increased local and state accountability were recommended to facilitate motivation for other superintendents to engage with wellness. This study adds to the literature on a critical stakeholder in the school wellness field. Advocates and technical assistance providers can apply superintendents' recommendations to engage more district leaders in these initiatives.

NP17 Approaches to Enhancing Wellness Policy Implementation in Schools to Prevent Obesity: Implementation/Plans for Dissemination

Objective “Wellness Champions for Change” (WCC) aims to create health-promoting school environments by training teachers and student leaders (5th or 8th graders) to promote Local Wellness Policy (LWP) implementation. LWPs are school district documents outlining food/physical activity (PA) policies. This abstract describes data collection/intervention implementation at the mid-point of the funding period and plans for dissemination. Description Twenty-one schools (12 elementary/9 middle) serving low-income families in three school districts and 572 students (evaluation cohort) were recruited in grades 3/4 or 6/7 to be followed for 2 years. Schools were block randomized to: WCC-teachers+student leaders, WCC-teachers only, control. Student-level impact is assessed via measures of height/weight (BMI-for-age calculated), PA (accelerometry), and diet (Perceptions of Diet at School screener). Implementation of teacher/student leader curricula is tracked through attendance/activity logs, fidelity checklists, and participant interviews. Local, state, and national dissemination planning is led by a partnership of extension agents, state department of education representatives, eXtension COP members, and WCC wellness specialists/investigators. Evaluation Students were 43% male, 56.5% in elementary school, 45.8% overweight/obese, and averaged 15 minutes/day of moderate-vigorous PA at school (30 minutes/day overall). Most lunches were from the school cafeteria (50%) or home (34%). During lunch, 60% reported consuming a fruit and 37% a vegetable. Six schools completed the intervention year and are in a sustainability-planning year. Of these, all WCC-teachers schools (n = 4) attended training, three built active wellness teams, two focused on PA opportunities and two on promoting school meals/smart snacks. Student leaders (n = 2 schools) focused on included advocating for PA time/promoting healthy eating through social marketing. Fifteen schools are in the intervention year with implementation tracking ongoing. Conclusion and Implications At the mid-point of a five-year project, schools and students within three districts have been recruited/evaluated, with intervention implementation ongoing. Two additional districts will participate in future years. Dissemination plans include train-the-trainer modules, an online professional credit course for teachers, and distributing the manualized student leader curricula to schools with active teacher wellness teams. Funding 2016-68001-24927.

School Health Policy Implementation: Facilitators and Challenges.

Schools are uniquely positioned to impact student health and academic outcomes through health and wellness policies. The purpose of this study was to describe factors influencing implementation of school health and wellness policies, specifically those focused on physical activity and nutrition. In-depth, stakeholder interviews were conducted with key informants at eight Chicago Public Schools (K-eighth grade). Data were analyzed using summative content analysis. Two themes were identified, facilitators and challenges to policy implementation. Facilitators included district support and motivation (internal and external). Challenges included limited school nurse availability, breaking tradition and budget. The external community and wellness team composition fell within both themes. Specific strategies are suggested to build upon policy implementation facilitators and overcome challenges. While school nurses play an integral role in student health and wellness, further research is needed to understand school nurse impact on student health and academic outcomes through school health policy.

Wellness Committee Status and Local Wellness Policy Implementation Over Time

Local Wellness Policies are school-district documents containing guidelines for schools to promote nutrition/physical activity. In cross-sectional studies, schools with wellness committees are more likely to implement Local Wellness Policies. This prospective cohort study examines associations between wellness committee status over time and change in Local Wellness Policy implementation using a biennial, statewide survey. School administrators completed surveys following the 2012-2013 (Wave I) and 2014-2015 (Wave II) school years, including a 17-item Local Wellness Policy implementation scale. Four wellness committee status categories included established (both Waves, 35%); new (Wave II only, 22%); discontinued (Wave I only, 13%); and never (neither Wave, 30%). Linear mixed models conducted in 2017-2018 compared LWP implementation change across status groups, accounting for clustering and school characteristics. Of 1,333 schools, 701 had Wave I data (53%); 748 Wave II (56%); and 441 both (33%). Schools were 69% elementary, 56% suburban, and 35% and 28% had majority (≥75%) African American/Hispanic or low-income student body, respectively. At Wave I, schools with wellness committees (established/discontinued groups) had higher Local Wellness Policy implementation (mean=32.0, SD=11.5, and mean=28.3, SD=11.4, respectively) compared with schools without committees (never/new: mean=15.4, SD=10.7 and mean=17.6, SD=11.4, respectively, F=64.9, p≤0.001). Over time, never and established groups maintained low and high Local Wellness Policy implementation, respectively. Compared with never, new committees increased implementation by 9.9 points (SE=1.8, p<0.001), and discontinued committees decreased by 11.2 (SE=2.1, p<0.001). Forming and maintaining wellness committees encourages Local Wellness Policy implementation and should be a recommended strategy for school wellness promotion.

“Wellness Champions for Change,” a multi-level intervention to improve school-level implementation of local wellness policies: Study protocol for a cluster randomized trial

Schools are a recommended place for childhood obesity prevention. Local Wellness Policies (LWPs) establish guidelines for schools to provide opportunities for students to access nutritious foods and be physically active. Little is known about the impact of LWPs, when implemented, on students' behavior and body mass index (BMI). The Wellness Champions for Change trial assesses the student-level impact of providing theory-based training and technical assistance to help schools implement LWPs. This 3-arm, cluster randomized controlled trial will take place in 30 low- or middle-income schools (15 elementary and 15 middle) in five Maryland school districts. Ten schools will receive both Wellness Champions for Change (WCC), which involves training teacher-led wellness teams, and Wellness Champions for Change-Student (WCC-S), which engages students as wellness team members. Ten schools will receive WCC only, and ten control schools will receive a delayed intervention. The RE-AIM framework will guide evaluation. Student Effectiveness measures will include BMI z-scores, self-reported diet patterns, and objectively-measured physical activity. The sample size (1080 students across 30 schools, followed for 2.5 years) will enable power (>0.8) to detect BMI z-score differences. A three-level linear mixed model that accounts for clustering will be used to assess Effectiveness. A mixed methods approach will assess school- and district-level Reach, Adoption, and Implementation. If effective, this approach will represent a sustainable, multi-level, school-based strategy to prevent childhood obesity. The evaluation framework will allow for the description of factors necessary to broadly disseminate this approach for obesity prevention on a large scale.

Pilot-Testing an Intervention to Enhance Wellness Policy Implementation in Schools: Wellness Champions for Change

ObjectiveTo develop and pilot-test Wellness Champions for Change (WCC) to enhance local wellness policy (LWP) implementation by forming wellness teams. DesignRandomized, controlled school-level pilot study. SettingFive Maryland school districts. ParticipantsA total of 63 elementary, middle, or high schools. Intervention(s)Developed from stakeholder interviews, focus groups, and existing programs. Schools were randomized within district to (1) WCC training (6-hour, single-day teacher training), (2) WCC training plus technical assistance (TA), or (3) delayed training (control). Main Outcome Measure(s)Online teacher/administrator survey pre-post (spring, 1 year apart) that examined the direct effect of the intervention on active wellness team formation (postintervention, 8-item sum score) and LWP implementation (29 items, not implemented to fully implemented)/indirect effect of intervention on LWP implementation via active wellness team formation. AnalysisAdjusted linear or logistic regression and mediation modeling. ResultsPostintervention, WCC plus TA and WCC had more active wellness teams (vs control, β = 1.49, P = .02 and β = 1.42, P = .03, respectively). No direct effect of intervention on LWP implementation was found. Formation of active wellness teams mediated the association between both WCC plus TA and WCC and LWP implementation (WCC plus TA confidence interval [CI], 1.22–16.25; WCC CI, 10.98–15.61 [CI was significant without 0]). Conclusions and ImplicationsThe WCC intervention approaches indirectly affected LWP implementation through the formation of active wellness teams. These results support building and school-level wellness teams.

School Wellness Committees Are Associated With Lower Body Mass Index Z-Scores and Improved Dietary Intakes in US Children: The Healthy Communities Study.

Our objective was to examine the association between school wellness committees and implementation of nutrition wellness policies and children's weight status and obesity-related dietary outcomes. A cross-sectional study was conducted of 4790 children aged 4-15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z-score [BMIz]) and nutrition measures, adjusting for child and community-level covariates. Children had lower BMI z-scores (-0.11, 95% confidence interval [CI]: -0.19, -0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02-0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy-dense foods (p = .0004), lower sugar intake from sugar-sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district. A more active wellness committee was associated with lower BMI z-scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity.

NP8 - Approaches to Enhancing Wellness Policy Implementation in Schools to Prevent Obesity: Implementation

NP8 - Approaches to Enhancing Wellness Policy Implementation in Schools to Prevent Obesity: Implementation

Like Peas and Carrots: Combining Wellness Policy Implementation With Classroom Education for Obesity Prevention in the Childcare Setting.

We evaluated an intervention combining policy training and technical assistance for childcare teachers with a nutrition education curriculum to improve (1) the knowledge and self-efficacy of childcare teachers in implementing obesity prevention policies and practices, (2) the quantity and quality of nutrition and physical activity education, and (3) the childcare wellness environment. Thirteen teachers and 8 administrators (2 of whom were also teachers) from 8 childcare programs in Clarke County, Georgia, participated in the Healthy Child Care Georgia intervention during June-October 2015. The intervention included (1) training and technical assistance on obesity prevention policies, systems, and practices and (2) direct education by teachers using the Eat Healthy, Be Active curriculum. We assessed changes in program wellness policy adoption and teacher knowledge and self-efficacy from pre- to post-intervention through self-report questionnaires, interviews, and focus groups. Teachers' knowledge scores (maximum score = 100) rose significantly from a mean (SD) pre-intervention of 67.1 (14.6) to post-intervention of 83.2 (14.3) ( P < .001). The mean score for "teaching nutrition and activity to children" (maximum score = 105) rose significantly from 86.9 (8.2) to 93.5 (5.2) ( P = .011) and for "modeling and supporting children" (maximum score = 63) from 55.8 (5.1) to 59.5 (4.5) ( P = .015). The mean (SD) scores for breastfeeding and infant feeding policy/practice adoption (maximum score = 6) increased significantly from 2.5 (1.8) to 3.7 (1.9) ( P = .043) and for nutrition education policy/practice adoption (maximum score = 4) from 2.0 (1.3) to 3.3 (1.4) ( P = .019). The combined approach enhanced classroom nutrition education and improved the adoption of best practices. Future studies should examine the effects of using a combined approach to promote nutrition and physical activity policies and practices in the early care and education setting.

Approaches to Enhancing Wellness Policy Implementation in Schools to Prevent Obesity: Protocol and Measures Development

To describe development of key outcome measures for a 5-year NIFA/USDA school-based obesity prevention study and protocol for Wellness Champions for Change-Students (WCC-S), a 5th and 8th grade student leadership/advocacy/health literacy training wherein students promote Local Wellness Policy implementation (school system documents outlining food/physical activity/health education policies) to create a health-promoting school environment. Three key outcome measures were developed for students: in-school food access and consumption survey, school wellness policies and practices perceptions survey, and real-time healthy eating/physical activity access/accessibility via ecological momentary assessment (EMA). WCC-S intervention protocol was developed through focus groups with 5th, 7th, and 8th graders, stakeholder interviews, and compilation of evidence-based content and materials. Measures were developed and/or modified from existing instruments. To assess wording, comprehension, and timing, cognitive pre-testing was conducted with 3rd (n=4), 6th (n=4), and 9th (n=3) grade students. To assess feasibility, reliability, and validity, a separate cohort of 3rd (n=20), 6th (n=20), and 9th (n=20) grade students participated in a 2-week validation study. Surveys were administered twice, one week apart, to evaluate reliability. The EMA questionnaire was administered via smartphone, after school, over five days to evaluate feasibility. The in-school food access and consumption survey was validated against daily report over a 5-day period, using a smartphone survey. Data analysis is in process. WCC-S will be evaluated for feasibility and acceptance through pilot-tested with 5th and 8th graders in an elementary school and during a summer camp during spring/summer 2017. The first year of a 5-year project included the systematic development of intervention measures and protocols, which will be incorporated into the randomized trial.