An Examination of Nutrition Policies, Practices, and Environments in Georgia SNAP-Ed Elementary Schools Using a Socio-Ecological Framework Open Access

Guglielmo, Dana (2016)

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Background: Despite the importance of a nutritious diet for children to be healthy, perform better in school, and prevent obesity and chronic disease, children nationwide have energy-dense, nutrient-poor diets and childhood obesity rates have increased significantly over the past few decades. Evidence documents that elementary schools play a salient role in shaping childhood nutrition habits.

Methods: The HealthMPowers School Setting Nutrition Survey assessed current nutrition policies, practices, and environments in 85 Georgia elementary schools that were funded by the US Department of Agriculture's Supplementary Nutrition Assistance Program Education (SNAP-Ed) grant during the 2015-2016 school year. Differences in survey responses were assessed across school-level variables of the socio-ecological model. Fisher's exact and Rao-Scott chi-square tests were performed to assess differences by geography and "cohort year" (number of years working with HealthMPowers); logistic regression tests were performed to assess differences by free and reduced-price lunch eligibility (FRL) and race/ethnicity.

Results: During the past school year, all schools offered fresh fruits and vegetables daily, and the majority followed their district's wellness policy or their own, offered students nutrition education, participated in farm-to-school programs, and used Georgia-grown products daily in school lunch programs. Fewer schools provided non-food celebration and fundraising ideas and limited sugar-sweetened items in the classroom. Schools classified as "rural/town" were the least likely to use food in their classrooms (i.e., as a reward or incentive or in classroom lessons) (p<0.05) and schools in cohort years 3-5 reported having the fewest competitive venues (i.e., a la carte, school stores, or snack carts) (p<0.05). The odds of purchasing fruits and vegetables from Georgia growers increased with higher FRL (OR: 1.15; 95% CI: 1.06, 1.25).

Conclusions: Although Georgia schools are excelling in the areas of wellness policies and student nutrition education, there is room for improvement in classroom policies/practices and parental involvement. There is a need for evidence-based interventions including increased nutrition education and greater access to resources including training and nutrition programs.

Key words: nutrition, obesity, elementary, school, policy, wellness, SNAP-Ed

Table of Contents

Chapter I. Introduction (1)
A. Problem Overview (1)
B. Role of Schools in Childhood Nutrition and Obesity (2)
C. Federal Legislation (4)
i. Impact of Legislation on School Nutrition Environments (5)
i. Barriers to School Wellness Policy Implementation (7)
ii. Healthy, Hunger-Free Kids Act and SNAP-Ed (8)
D. HealthMPowers (9)
i. Resources Provided to Schools (9)
ii. HealthMPowers School Setting Nutrition Survey (10)
E. Theoretical Framework (11)
F. Study Objectives (12)
Chapter II. Literature Review (13)
A. Introduction (13)
B. Basis for Survey Instrument (13)
i. Bridging the Gap: Food and Fitness Surveys (14)
ii. Other Sources Reviewed (14)
C. Related Studies (15)
D. Rationale for Study (16)
i. School Wellness Policies and Committees (17)
ii. Geography (18)
iii. FRL (18)
iv. Race/Ethnicity (19)
v. Cohort Year (20)
E. Summary (21)
Chapter III. Methods (22)
A. Instrument Design (22)
B. Participants (23)
C. Data Collection (24)
D. Data Measures (24)
i. Demographic Data (24)
ii. Nutrition Policies, Practices, and Environments Data (25)
E. Data Analysis (27)
Chapter IV. Results (29)
A. Overall Results (29)
B. Differences in Responses Across School-Level Factors (31)
Chapter V. Discussion (35)
A. Key Findings (35)
B. Recommendations for Schools (37)
C. Strengths and Limitations of Study (37)
D. Future Directions (39)
E. Conclusion (41)
References (43)
Appendix A. HealthMPowers School Setting Nutrition Survey (53)
Appendix B. Survey Questions and Sources (76)
Appendix C. Response Rate Flowchart (93)
Appendix D. Complete Survey Results (94)

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