Hager Erin R, Rubio Diana S, Eidel G Stewart, Penniston Erin S, Lopes Megan, Saksvig Brit I, Fox Renee E, Black Maureen M
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.
Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, 737 West Lombard Street, Room 163, Baltimore, MD 21201.
J Sch Health. 2016 Oct;86(10):742-50. doi: 10.1111/josh.12430.
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.
学校系统中要求制定书面的地方健康政策（LWPs），以增加健康饮食/活动的机会。LWPs的有效性依赖于学校层面的实施。我们研究了与学校层面LWPs实施相关的因素。假设的关联包括系统对学校层面实施的支持以及拥有学校层面的健康团队/学校健康委员会（SHC），在无入学差异的学校（多数为非裔美国人/西班牙裔或低收入学生）中关联更强。
进行了在线调查：24个系统（支持情况），1349所学校（LWPs实施情况、感知到的系统支持、SHC）。该州提供了学校人口统计数据。分析包括多水平多项逻辑回归。
回复率为100%（系统）/55.2%（学校）。在学校中，44.0%有SHC，22.6%多数（≥75%）为非裔美国人/西班牙裔学生，25.5%多数（≥75%）为低收入（接受免费/减价餐）。LWPs实施情况（17项）分类为无 = 36.3%，低（1 - 5项） = 36.3%，高（6项及以上） = 27.4%。在调整模型中，在感知到系统支持的学校中观察到LWPs实施的可能性更大（高与无相比相对风险率，RRR = 1.63，CI：1.49，1.78；低与无相比RRR = 1.26，CI：1.18，1.36）以及有SHC的学校（高与无相比RRR = 6.8，CI：4.07，11.37；低与无相比RRR = 2.24，CI：1.48，3.39）。入学差异并未调节这些关联（p >.05）。
感知到系统支持且有SHC的学校实施LWPs的可能性更大，入学差异无调节作用。SHC/支持可能克服与差异相关的LWPs实施障碍。
