Policy Legislation And Nutrition: What Works to Improve School Health

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Policy Legislation And Nutrition What Works to
Improve School Health?
Donna B. Johnson, RD, PhDAssociate Professor,
Nutritional SciencesAssociate Director, Center
for Public Health NutritionUniversity of
Washington
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PLAN Investigators Staff

• Donna B Johnson, RD, PhD
• Vic Colman, JD
• Anne E Lund, RD, MPH
• Barb Bruemmer, RD, PhD
• Cori Mar, PhD
• Carina Evens, RD, PhD
• Mollie Greves Grow, MD, MPH
• Bob Lutz, MD, MPH
• Amy Lutz, MAT

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PLAN Advisory Committee

• Ruth Abad, Healthy Communities Specialist, WA
  Department of Health
• Patti Ensor, School Board Member, Davenport
• David Gee, PhD, Professor of Food Science
  Nutrition, Central Washington University,
  District wellness committee member
• Ann Lanning, WA State PTA, Bellevue
• Gaye Lynn MacDonald, School Food Service
  Consultant, Formerly Bellingham Food Service
  Director
• Jim Russo, PhD, Associate Professor Biochemistry,
  Biophysics,  Molecular Biology, Whitman College,
  District wellness committee member
• Debbie Webber, School Food Service Director,
  Everett
• Doug Wordell, Spokane Food Service Director,
  Spokane

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Policy Legislation And Nutrition (PLAN) Study
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64 Study Schools in 28 Districts
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PLAN School Characteristics
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PLAN School Characteristics Students
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Policy Development
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Survey of Policy Development Strategies
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Survey of Policy Development Strategies
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Survey of Policy Development Strategies
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Survey of Policy Development Strategies
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Resources districts used extensively during
policy development (n28)
Percent of districts that used the tool
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Resources Used for Policy Development

• Planning Assessment Tools
• Action for Healthy Kids, 18
• CDCs School Health Index, 7
• USDAs Changing the Scene, 3
• Sample Policies
• WSSDA, 61
• Other districts policies, 57
• Training and Consultation
• Childrens Alliance, 3

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Major Barriers to Policy Development (n28)
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Policy quality not associated with these
developmental strategies

• Use of planning tools
• Training or consultation from outside the
  district or community
• Internal funding
• External funding
• Sample policy
• Community forum
• Wellness committee
• Total score

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Agreement within each district varied
Agreement score within districts
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Concerns

• Almost all Districts
• Threat of decreased revenue
• Confusion about nutrition standards foods
  allowed
• Complaints from students
• Most Districts
• Product availability
• Existing vending or pouring contracts
• Burden of unfunded mandate
• About Half the Districts
• Vending company compliance
• Complaints from parents
• Complaints from food service workers

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Policy Quality
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How to Abstract School Nutrition Physical
Activity Policies
Step 1 Review 96 items in code book
Step 2 Read district policy
Washington Valley School District Policy
2124 Instruction Health and Fitness Policy All
students in grades one through eight are required
to complete an average of one hundred
instructional minutes per week of physical
education. This includes instruction and practice
in basic movement and fine motor skills,
progressive physical fitness, and wellness
activities through age-appropriate activities.
All high school students are required to complete
two credits of health and fitness. The District
encourages all high schools to offer a variety of
health and fitness classes for each grade in the
high school.
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How to Abstract School Nutrition Physical
Activity Policies
Step 3 Compare strength of statements in
district policy to examples in code book, decide
if statement scores as a 0,1, or 2
Step 4 Mark score on score sheet
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Strength of WA Wellness Policies
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Quality of competitive food policy NOT associated
Percent Free Reduced Meal Eligible

•  
• N93

Competitive Foods Policy Score (33-37)
Percent Free/Reduced Meal by school
Pearson Correlation -0.079, not significant
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Quality of competitive food policy NOT associated
with percent white students
  N93
Competitive Foods Policy Score (33-37)
Percent White

• Pearson Correlation -0.113, not significant

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Quality of PE policy NOT associated with percent
Free Reduced Meal Eligible
  N93
PE Policy Score (52-68)
Percent Free/Reduced Meal by school
Pearson Correlation 0.38, not significant
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Quality of PE policy NOT associated with percent
white students
  N93
PE Policy Score (52-68)
Percent White
Pearson Correlation 0.004, not significant
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Highlights of District Policies (n93)

• Federal Requirements
• Almost all included nutrition education USDA
  school meal requirements
• Evaluation
• Very strong in 12 districts
• 0 in 32 districts
• Physical Activity
• Over ½ specified recess for K-6
• Almost no policies for safe and active routes to
  school
• Nutrition
• 1/3 specified fat requirements
• 1/5 specified sugar limits

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Strength of WSSDA Sample Policy
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Student Consumption of Snacks and Beverages
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Categories of foods found in schools aligned with
student questionnaire
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Categories of beverages found in schools aligned
with student questionnaire
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Mean Student Consumption per Week (n9,000)
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Mean Student Consumption per Week (n9,000)
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Unhealthy Snack Consumption by School
Number of schools
Mean Weekly Student Consumption of Unhealthy
Snacks at School
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Sugar Sweetened Beverage Consumption by School
Number of Schools
Mean Weekly Student Consumption of Unhealthy
Snacks at School
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In schools with higher meal participation,
students drink more milk
Number of times milk consumed at school per week
Percent School Meal Participation
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Student Consumption of Unhealthy Snacks in
Schools With and Without Snacks for Sale
P for difference 0.53
Mean intake per week of unhealthy snacks
Schools without snacks
Schools with snacks
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Competitive Foods in the School Environment
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Entering Items in Food BEAMS
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Access to Sugar Sweetened Beverages in Schools
(n64)
Other Beverages with Sugar are defined as
non-soda beverages that contain any grams of
added sugar including sweetened juice drink,
carbonated sweetened juice drink, sports drink,
sweetened coffee, sweetened tea drink, hot
chocolate and sweetened water drink
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IOM Standard 1 Snacks, foods, and beverages meet
the following criteria for dietary fat per
portion as packaged

• No more than 35 percent of total calories from
  fat
• Less than 10 percent of total calories from
  saturated fats
• Zero trans fat

IOM Report available at http//www.iom.edu/CMS/37
88/30181/42502.aspx
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Standard 2 Snacks, foods, and beverages provide
no more than 35 percent of calories from total
sugars per portion as packaged

• Exceptions include
• 100 fruits and fruit juices in all forms without
  added sugars
• 100 vegetables and vegetable juices without
  added sugars
• Unflavored nonfat and low-fat milk and yogurt
• Flavored nonfat and low-fat milk with no more
  than 22 grams of total sugars per 8-ounce serving
• Flavored nonfat and low-fat yogurt with no more
  than 30 grams of total sugars per 8-ounce serving

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IOM Standard 3 Snack items are 200 calories or
less per portion as packaged and á la carte
entrée items do not exceed calorie limits on
comparable NSLP items
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IOM Standard 4 Snack items meet a sodium content
limit of 200 mg or less per portion as packaged
or 480 mg or less per entrée portion as served
for á la carte
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IOM Standard 5 Beverages containing nonnutritive
sweeteners are only allowed in high schools after
the end of the school day
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IOM Standard 6 Foods and beverages are caffeine
free, with the exception of trace amounts of
naturally occurring caffeine-related substances
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Unhealthy Snack per IOM

• Defined as any item that does NOT meet the IOM
  Tier 1 Standards
• lt 200 Kcal per item as packaged
• lt 35 Kcal from fat
• lt 10 Kcal from saturated fat
• 0 Trans fat per item as packaged
• lt 35 Kcal from sugar
• lt 200 mg Sodium per item as packaged

Yogurt may have lt 30 grams sugar per 8 oz
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Proportion of foods that meet IOM guidelines
Low Fat or Non Fat Chips
Regular Fat Chips
Candy
Other Salty Snacks
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Proportion of foods that meet IOM guidelines
Cookies Brownies
Doughnuts Pop tarts
Regular Ice Cream Treats
Low or Non Fat Frozen Treats
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Healthy foods cost more per calorie
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Can you find the items that meet the IOMs
definition of a healthy snacks?

• Miss Vickie's jalapeño potato chips
• Sunchips french onion
• Lay's Original baked chips
• Oberto hickory beef jerky
• Kellogg's yogo's bits strawberry slam
• Tree Top Flat Fruit, 100 fruit snacks
• Grandma's chocolate chip cookies
• General Mills cinnamon toast crunch milk 'n
  cereal bar
• General Mills cinnamon toast crunch cereal
• Snickers
• Kellogg's blueberry-frosted pop tarts
• Quaker Chewy cereal bar 90 calories, chocolate
  chunk

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Healthy snacks

• Miss Vickie's jalapeño potato chips
• Sunchips french onion
• Lay's Original baked chips
• Oberto hickory beef jerky
• Kellogg's yogo's bits strawberry slam
• Tree Top Flat Fruit, 100 fruit snacks
• Grandma's chocolate chip cookies
• General Mills cinnamon toast crunch milk 'n
  cereal bar
• General Mills cinnamon toast crunch cereal
• Snickers
• Kellogg's blueberry-frosted pop tarts
• Quaker Chewy cereal bar 90 calories, chocolate
  chunk

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Proportion of foods that meet SB 5093 guidelines
Low Fat or Non Fat Chips
Regular Fat Chips
Other Salty Snacks
Candy
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Proportion of foods that meet SB 5093 guidelines
Cookies Brownies
Doughnuts Pop tarts
Regular Ice Cream Treats
Low or Non Fat Frozen Treats
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Percent of items meeting standards
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Policies The Foods and Beverages Found in School
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Sugar Sweetened Beverage Policy Indicators (n28)
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School policy score versus sugar sweetened
beverage (SSB) exposure For each policy score,
the same symbol indicates schools from same
district.
Exposure (slots SSB/enrollment x 1000)
SSB Policy Score
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Quality of Snack Guideline Policy Statements
(n28)
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No relationship between unhealthy snacks in
schools and the snack policy
Exposure (slots unhealthy snacks/enrollment x
1000)
Competitive Food Policy Score (q 33-37)
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White students have lower consumption of
unhealthy snacks (plt.001)
Mean weekly intake at school
6.7
10.2
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Females have lower consumption than males (p
.001)
Mean weekly intake at school
6.8
8.2
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Students who are not eligible for FRPM have lower
consumption of unhealthy snacks (plt.002)
Mean weekly intake at school
8.3
6.9
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Exposure to Foods and Beverages at School
Student Consumption
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SSB exposure at school versus percent of students
drinking any SSB at school
Percent of students drinking SSB
Exposure (slots SSB/enrollment 1000)
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Unhealthy snack exposure at school versus percent
of students eating any unhealthy snacks at school
Percent of students eating unhealthy snacks
Exposure (slots unhealthy snacks/enrollment
1000)
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Perspectives of Physical Education (PE) Teachers
on PE Practices and Policies

• H. Mollie Greves Grow, MD MPH
• University of Washington Dept. of Pediatrics
• Seattle Childrens Hospital Center for Child
  Health Behavior and Development

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State National Physical Activity (PA) Policy
Legislation

• WA SB 5436 Requirement
• All district write PA policy
• (previous requirement often quoted in policies
  grades 1-8, 100 min/wk PE)
• WA SB 5093 Goal
• Grades 1-8, 225 minute/week
• Federal Requirement
• District include PA goals in Wellness Policy

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Methodology

• One PE teacher per school, 20 minute phone survey
• Survey based on state and national standards
• Questions on
• Current PE PA practices
• Changes since the policies
• Barriers to implementation

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Standards used for comparison

• Washington State legislative and curriculum
  standards for PE (EALRS)
• National Association for Sport and Physical
  Education (NASPE)
• National Alliance for Nutrition and Activity
  (NANA)

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PE PA Environments Reported by WA Middle School
PE Teacher

• (n64)
• 64 interviews complete, one PE teacher declined
• 15 offered daily PE, HP 2010 goal
• 56 offered 100 min/wk, WA standard
• 39 reported curriculum met EALRs
• But only 19 reported students develop individual
  fitness plans

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Schools meeting NASPE Guidelines
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Schools meeting NANA Guidelines
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Barriers to PA Policy Implementation
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Changes since PA policy
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PE conclusions

• None of the schools met all national
  recommendations
• PE teachers needed more resources, especially
  space, to meet the policies

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Key Findings

• The quality of school nutrition and physical
  activity policies in WA State varies from
  district to district
• Many of Washingtons middle school students have
  diets that are high in energy-dense/low nutrient
  foods
• A considerable number of energy-dense/low
  nutrient foods are consumed at school
• Strong school policies are associated with better
  diets
• Few middle schools in WA State meet
  recommendations for physical activity and
  physical education

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SB 5093 Text
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SB 5093 Text
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Extra pictures