Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA.
Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA.
Nutrients. 2021 Jan 9;13(1):188. doi: 10.3390/nu13010188.
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%, < 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.
从 2006-2007 学年开始，参与联邦儿童营养计划的美国学区被要求采用并实施一项地方健康政策（LWP），其中包括营养教育、学校膳食、学校销售或提供的其他食品以及体育活动的目标和/或标准。LWP 的一个主要挑战是实施不一致。本研究使用全国健康政策研究中的法律/政策数据和学校营养和膳食成本研究中学校食品管理局（SFA）报告的地区 LWP 实施情况，检查州健康政策要求法律和地区 LWP 全面性是否会影响地区一级的实施情况，控制 SFA 和地区特征。使用广义线性和结构方程模型。与没有健康政策要求法律的州（与有健康政策要求法律的州相比）相比，SFA 报告实施的实践更多（59.56% 对 44.57%，<0.01）。州健康政策要求法律与地区 LWP 全面性（系数：0.463；95%CI：0.123，0.803）和地区一级的实施情况（系数：1.392；95%CI：0.299，2.485）相关。地区 LWP 全面性与地区实施情况相关（系数：0.562；95%CI：0.072，1.053），但不调节州法律与地区实施情况的关系。本研究强调了州法律和地区 LWP 可以在促进健康政策实施方面发挥的重要作用。
