Poster presentation for the American Public Health Association & Expo in Atlanta, GA Nov 2017: While a 2015 analysis of Massachusetts school wellness policies suggested opportunities to improve compliance with USDA requirements and recommendations, some data suggests that many best practices are already under adoption across the commonwealth. This study investigates whether wellness policies accurately reflect existing nutrition-related and physical education/physical activity (PE/PA) practices. School wellness policies submitted in 2014 and 2015 were scored using WellSAT 2.0 to review policy language and score for strength and comprehensiveness. Metrics were mapped to School Health Profiles (SHP) 2014 indicators by key terms and concepts. Statewide mean score of WellSAT 2.0 policy metrics were compared to percent implementing related activities as reported on SHP. While analyses of wellness policies sometime indicate poor inclusion of recommended nutrition and PE/PA standards, current practices among schools can actually reveal higher implementation rates. For example, while only 15% of policies reviewed require nutrition information for school meals be made available to students and parents, SHP data reveals that nearly 63% of schools are already making nutrition and caloric content of foods available. Similarly, while only half of reviewed polices require a written PE curriculum, SHP data indicates that 87% of schools are providing written curriculums to PE instructors. Preliminary results indicate misalignment of policy and practice on a number of nutrition-related and physical activity metrics. Findings suggest schools should be encouraged to better align their written policies with implementation practices. In addition, evaluators should assess both of these elements when determining which programmatic changes to recommend to school districts.

1. www.postersession.com
DO SCHOOL WELLNESS POLICIES REFLECT CURRENT NUTRITION
AND PE/PA PRACTICES IN MASSACHUSETTS SCHOOLS?
INTRODUCTION
METHODS
Meg Her, MPH1, Claire Santarelli, RD, CDE, LDN1, Tamara Calise, Dr.Ph, M.Ed2 and W.W. Sanouri Ursprung, PhD1,
(1) Massachusetts Department of Public Health, Boston, MA, (2) John Snow Inc. (JSI), Boston, MA
CONCLUSION
 1 in 5 school-aged children meet the definition of childhood obese (body
mass index (BMI) greater than or equal to 95th percentile for a child’s age).1
 Research shows that healthy behaviors, such as healthy eating and physical
activity, can reduce childhood obesity.2,3,4
 Local educational agencies (LEAs) with stronger and more comprehensive
wellness policies are more successful in implementing them in schools.5
 To address the growing childhood obesity rates, the Child Nutrition and
Women, Infants, and Children Reauthorization Act of 2004 required all LEAs
participating in the National School Lunch Program to create school wellness
policies that promote student health.
 The Healthy, Hunger-free Kids Act of 2010 was later passed and required
those policies to meet minimum standards developed by the US Department
of Agriculture (USDA).
 Massachusetts also passed the Act Relative to School Nutrition in 2010,
requiring competitive foods (foods sold “in competition” with the National
School Lunch Program) to meet standards developed by the Massachusetts
Department of Public Health (MDPH).
 Massachusetts school wellness policies were analyzed in 2015 and findings
show low compliance with USDA guidance. However, other data suggest
many best practices are in place. This study investigates whether MA school
wellness policies accurately reflect existing nutrition-related and physical
education/physical activity (PE/PA) practices according to School Health
Profiles (SHP).
Table 3: Percent Range of Massachusetts School Wellness Policy Scores and School
Health Profiles Principal Survey 2014 by Item Match to WellSAT 2.0 Goal Area Elements
SUMMARY OF RESULTS
 25% of WellSAT 2.0 elements were successfully matched to SHP 2014.
 MA school wellness policies overall scored 36.5% on comprehensiveness
and 18.4% on strength.
 SHP data suggest that, on average, more MA schools are meeting desired
goals than the policy review indicates. For example:
• 62.9% of schools report providing nutrition information for school meals to
students and parents, while 30.8% of reviewed policies state providing
that information.
• 87.3% of schools have a written PE curriculum for all grades K-12, while
just over half (54.5%) of reviewed polices state having one in place.
 School wellness policies do not align with current practices on a number of
nutrition-related and physical activity elements. Future research should seek
to understand these discrepancies (e.g., desire to keep generic wellness
policies, disconnect between implementers and policy “makers,” need to
refine specificity of existing tools, etc.).
 Many schools are already implementing best practices. LEAs should ensure
wellness policies accurately reflect these efforts in order to: 1) ensure
sustainable solutions to promoting student health while reducing childhood
obesity and 2) support local evaluation and national surveillance.
 To characterize the true level and quality of school wellness policies and
practices, and to inform future strategies, evaluators should consider using a
variety of data sources and tools.
Corresponding Author:
Meg Her, M.P.H., Epidemiologist
Office of Statistics & Evaluation
Massachusetts Department of Public Health
Meg.Her@state.ma.us
SAMPLE SELECTION
 In 2015, the Massachusetts Department of Elementary and Secondary
Education commissioned Jon Snow, Inc. (JSI) Healthy Communities to
review MA school wellness policies submitted in 2014 and 2015. JSI used
WellSAT 2.0 to score the policies on criteria of comprehensiveness and
strength.6 Data containing LEA name, grade-levels served, and WellSAT
2.0 scores were shared with MDPH.
 SHP is a reliable source of nationally representative data on local school
nutrition and PE/PA practices. SHP 2014 Principal Survey data was
selected for comparison to MA wellness policies.
ANALYSIS
Policy scoring
 WellSAT 2.0 tool is a 78-item instrument developed by researchers at the
Rudd Center for Food Policy and Obesity to measure the quality of school
wellness policies.
 Policies were scored in six goal areas: 1) nutrition education, 2) school
meal nutrition standards, 3) competitive foods, 4) physical education and
physical activity, 5) wellness promotion and marketing, and 6) evaluation.
 All elements within each WellSAT 2.0 goal area were coded based on
comprehensiveness and strength of language, where: 0 = no mention of the
topic, 1 = mention of the topic with weak language, and 2 = mention of the
topic with strong language. Overall scores and subscores were determined
by calculating a percentage from combinations of these codes.6
Policy & Practice Review
 WellSAT 2.0 elements were matched to relevant SHP 2014 Principal
Survey items based on key terms and concepts. Items that could not be
matched were not reviewed.
RESULTS
Table 2: WellSAT 2.0 Mean Scores for Massachusetts School Wellness Policies
DISCUSSION
REFERENCES
 MA school wellness policies, on average, score lower on
comprehensiveness than the national average (36.5% vs. 44.7%).7
However, Massachusetts policies may be doing better in a few goal areas:
Nutrition Education, School Meals Standards, and Competitive Foods.
 Because SHP was developed before WellSAT 2.0, it was not designed to
evaluate school wellness policies as outlined by WellSAT 2.0 and therefore
exact matches were not possible and statistical analyses not performed.
 While analyses of school wellness policies sometime indicate poor inclusion
of recommended nutrition and PE/PA standards, current practices among
schools can reveal higher implementation rates.
 These results are consistent with previous findings that school wellness
policies may misrepresent the true extent schools are implementing
recommendations and best practices.8,9
WellSAT 2.0 Goal Area Comprehesiveness Strength
Nutrition Education 3 out of 7 64.1 - 66.2 30.8 - 36.4 73.3 - 88.4
School Meals Standards 1 out of 14 30.8 16.2 62.9
Competitive Foods 6 out of 11 13.1 - 73.7 4.0 - 42.4 45.5 - 100.0
Physical Education/Physical Activity 5 out of 20 9.6 - 89.9 2.0 - 54.5 39.5 - 87.3
Wellness Promotion & Marketing 4 out of 15 22.2 - 42.4 5.1 - 23.2 43.8 - 89.8
Evaluation 0 out of 11 n/a n/a n/a
WellSAT 2.0
Percent Range (%)# of
Elements
Matched In Practice
SHP 2014
 Of the 216 observations included in the wellness policy dataset, 18 were not recognized as
LEAs and excluded. The remaining 198 policies represent 49.1% of MA school wellness
policies.
 For some WellSAT 2.0 items, SHP questions could address more than one WellSAT 2.0
element and were matched more than once. For matched pairs, WellSAT 2.0 policy scores or
score ranges were compared to SHP 2014 percentages.
 SAS 9.3 was utilized to generate review and descriptive statistics.
N Mean SD Mean SD
All schools 198 36.5 16.6 (0.0, 75.0) 18.4 12.0 (0.0, 54.5)
Grade levels unspecified 146 37.6 15.5 (0.0, 75.0) 19.1 11.2 (0.0, 54.5)
Grades K-8 a
29 29.6 19.8 (2.1, 70.5) 13.5 14.3 (0.0, 46.6)
Grades 6-12 b
14 38.5 17.6 (4.6, 64.6) 19.9 13.0 (0.9. 43.7)
a
Includes schools that specified serving students only in grades K-4, K-5, K-6, K-8, 5-8, and 6-8.
b
Includes schools that specified serving only students in grades 6-12, 7-12, 8-12, and 9-12.
Comprehensiveness Score Strength Score
Range Range
1. Ogden CL, Carroll MD, Fryar CD, & Flegal KM. (2015). Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. NCHS Data Brief. No. 219;
2. Speroni KG, Earley C, & Atherton M. (2007). Evaluating the Effectiveness of the Kids Living Fit Program: A Comparative Study. Journal of School Nursing.
3. da Silva LSM, Fisberg M, de Souza Pires MM, Nassar SM, & Sottovia CB. (2013). The effectiveness of a physical activity and nutrition education program in
the prevention of overweight in schoolchildren in Criciúma, Brazil. Journal of Clinical Nutrition. 67, 1200–1204.
4. Bishop J, Middendorf R, Babin T, & Tilson W. ASPE Research Brief: Child Obesity. (2005). US Department of Health & Human Services.
5. Schwartz MB, Henderson KE, Falbe J, Novak SA, Wharton C, Long M,…Fiore SS. (2012). Journal of School Health. 82(6).
6. Department of Elementary & Secondary Education & JSI Research & Training Institute, Inc. (2016) 2015 Massachusetts School Wellness Policy Review.
7. Piekarz E, Schermbeck R, Young SK, Leider J, Ziemann M, & Chriqui JF. (2016). School District Wellness Policies: Evaluating Progress & Potential for
Improving Children’s Health Eight Years after the Federal Mandate. Bridging the Gap.
8. Lucarelli JF, Alaimo K, Belansky ES, Mang E, Miles R, Kelleher DK,…Lui H. (2015). Little Association Between Wellness Policies and School-Reported
Nutrition Practices. Health Promotion Practice. 16(2) 193-201.
9. Brener ND, Chriqui JF, O’Toole TP, Schwartz, MB, McManus T. (2011). Establishing a Basline Measure of School Wellness-Related Policies Implemented in a
Nationally Representative Sample of School Districts. Journal of American Dietetic Association.111(6) 894-901.
Table 1: Excerpt of WellSAT 2.0 Elements with Scores Matched to School Health Profiles Principal
Survey 2014 Items with Percent Practicing in Schools
Comprehensive Strength
NEPE6: Nutrition education teaches
skills that are behavior-focused
64.1% 30.8%
Percentage of schools in which teachers taught the
following nutrition and dietary behavior topics in a
required course for students in any of the grandes 6-
12 during the current school year: a) benefits of
healthy eating, b) using food labels, c) balancing
food intake and physical activity, d) eating more
fruits, vegetables, and whole grains, e) choose
foods and snacks that are low in solid fat, and f)
preparing healthy meals and snacks.
73.3%-
88.4%
SM11: Nutrition information for
school meals (e.g., calories, saturated
fat, sodium, sugar) is available to
students and parents.
30.8% 16.2%
Percentage of schools that have done any of the
following during the current school year: provided
information to students or families on the nutrition
and caloric content of foods available.
62.9%
PEPA1: There is a written physical
education curriculum for grades K-12
89.9% 54.5%
Percentage of schools in which those who teach PE
are provided with a written PE curriculum.
87.3%
PEPA 14: District addresses before
and after school physical activity for
all K-12 students.
65.2% 32.3%
Percentage of schools that offer opportunities for
all students to participate in intramural sports
programs or physical activity clubs.
86.3%
PEPA 16: Addresses physical activity
breaks for all K-12 students. 20.7% 2.0%
Percentage of schools in which students participate
in PA breaks in classrooms during the school day
outside of PE.
39.5%
PEPA 20: Joint or shared-use
agreements for physical activity
participation at all schools.
19.2% 9.1%
Percentage of schools that have a join use
agreement for shared use of school or community
PA facilities.
67.2%
1. Nutrition Education
4. Physical Education and Physical Activity
WellSAT 2.0 Score
WellSAT 2.0 Element School Health Profiles Principal Survey Item In Practice
2. Standards for USDA Child Nutrition Programs and School Meals