RESEARCH Perspectives in Practice
Statewide Assessment of Local Wellness Policies in Pennsylvania Public School Districts CLAUDIA PROBART, PhD, RD; ELAINE MCDONNELL, MS, RD; J. ELAINE WEIRICH, MEd; LISA SCHILLING, MS; VONDA FEKETE, MS, RD
ABSTRACT With the passage of the Child Nutrition and Women, Infants, and Children Reauthorization Act of 2004, schools that sponsor school meals programs are required to establish local wellness policies to address childhood obesity. Little is known about how school districts will respond to this mandate, the nature of local wellness policies, and their compliance with this mandate. The objectives of this cross-sectional descriptive study, conducted in early 2007, were to assess local wellness policies established by Pennsylvania public school districts, compare these policies to local wellness policy mandate requirements, and provide information about local wellness policy development and implementation. Local wellness policies were collected from all Pennsylvania public school districts that sponsor school meals programs (N⫽499). School district representatives also completed and submitted a local wellness policy checklist, providing information about local wellness policy development and implementation. Policy goal data were abstracted and entered into a Microsoft Access database along with local wellness policy data. Frequencies were calculated. All required public school districts (N⫽499) submitted local wellness policies. Most school district local wellness policies (85.6%-100%) met each mandate requirement (eg, included goals for nutrition education, physical activity, etc.). The most common policy goals were general and may be difficult to measure, suggesting school staff may need assistance developing action plans and measuring policy implementation. Most respondents identified the superintendent (n⫽377; 75.6%) and school foodservice director (n⫽301; 60.3%) as responsible for ensuring local
C. Probart is an associate professor, E. McDonnell is a project coordinator, and J. E. Weirich is a project manager, Department of Nutritional Sciences, Penn State University, University Park, PA. L. Schilling is associate director, Chartwell Education Group LLC, Centreville, VA. V. Fekete is state director of child nutrition programs, Division of Food and Nutrition, Pennsylvania Department of Education, Harrisburg. Address correspondence to: Elaine McDonnell, MS, RD, Department of Nutritional Sciences, Penn State University, 5 Henderson Bldg, University Park, PA 16802. E-mail:
[email protected] Manuscript accepted: January 7, 2008. Copyright © 2008 by the American Dietetic Association. 0002-8223/08/10809-0009$34.00/0 doi: 10.1016/j.jada.2008.06.429
© 2008 by the American Dietetic Association
wellness policy implementation. Questions remain about feasibility of these district-level personnel to ensure policy implementation at the school level. The ability of local wellness policies to impact childhood obesity will depend on efforts at both the school and district levels to implement and enforce local wellness policies. J Am Diet Assoc. 2008;108:1497-1502.
T
he establishment of school wellness policies to address childhood obesity has long been recommended by government agencies and educators (1-3). This recommendation became a mandate with the passage of the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004 (Public Law 108-265). This law required each local education agency that sponsors a school meal program(s) to establish a local wellness policy by July 1, 2006 to address childhood obesity. These policies were required to include goals for nutrition education, physical activity, and other school-based activities designed to promote student wellness; include nutrition guidelines for all foods available on the school campus during the school day; provide an assurance that guidelines for reimbursable meals meet US Department of Agriculture regulations; establish a plan for measuring policy implementation, including designation of one or more people responsible for ensuring that the school meets the local wellness policy; and involve parents, students, representatives of the school food authority, school administrators, and the public in the development of the local wellness policy. Research conducted prior to the passage of this Act indicated that few school districts had wellness policies in place (4-8). In particular, comprehensive policies and policies addressing nutrition guidelines for competitive foods were lacking (4,7). A 2003 survey of Pennsylvania school foodservice directors found that only 18% reported existence and enforcement of policies related to setting nutritional standards for a la carte foods in their high schools. Even fewer (5% to 12%; varied by competitive food venue) school foodservice directors reported existence of policies setting nutrition standards for foods offered through other competitive food venues such as vending machines and student stores (7). Differences were found between school foodservice directors’ and principals’ perceptions of existence and enforcement of policies related to competitive foods. Research also suggested lack of involvement of school foodservice directors in policy development and possible weaknesses in communication about and enforcement of policies (6,7). Work conducted since passage of the local wellness policy mandate suggests concerns about local wellness
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policy implementation related to cost, time, stakeholder buy-in, and enforcement (9,10). The School Nutrition Association and Action for Healthy Kids have reported on analyses of local wellness policies from 100 to 256 school districts from several states, documenting the number of districts that meet the minimum requirements of the law, the number that include key wellness goals (eg, recess requirement, staff qualifications), and competitive food venues covered by the districts’ nutrition guidelines (11,12). A Virginia report provides information about steps and procedures taken by school districts in that state to prepare for establishment of local wellness policies and districts’ proposed goals (13). Specific areas of concern noted in these reports include the omission of nutrition guidelines for foods offered as fundraisers; during classroom parties; and as rewards, and weaknesses in plans for policy evaluation (11-13). As of fall 2007, no reports have been found describing public school districts’ responses to the 2004 legislation related to the local wellness policy development process, individuals identified as responsible for overseeing policy implementation, and policy goals identified by school districts on a statewide basis. This report is an examination of Pennsylvania public school district local wellness policies and provides information about the local wellness policy development process, specific goals identified, and compliance with the local wellness policy mandate. PENNSYLVANIA-SPECIFIC RESOURCES The Pennsylvania School Boards Association, in collaboration with the Pennsylvania Department of Education, developed a local wellness policy template and made it available to local education agencies to assist in local wellness policy development (14). This template included multiple goals within each required local wellness policy component. The local education agency personnel had the option to use all or selected goals from the template, modify goals, use other templates, or develop their own goals. The Pennsylvania Department of Education developed voluntary state nutrition standards for competitive foods (15). A 27-item Local Wellness Policy Checklist was also developed by the Pennsylvania Department of Education (16). The Local Wellness Policy Checklist contained 14 questions to be completed by a representative of each local education agency and included questions about the local wellness policy development process, individual(s) responsible for ensuring the local wellness policy is implemented, and nutrition guidelines for competitive foods the local education agency policy development team has chosen to implement. The mandatory Local Wellness Policy Checklists were to be signed by the person with lead responsibility for local wellness policy implementation and the district superintendent. Upon receipt of each local wellness policy and Local Wellness Policy Checklist by Pennsylvania Department of Education, copies were made and sent to the research group. Public school districts represent the majority of local education agencies in Pennsylvania (n⫽499). They are a homogenous group in terms of structure, governance, and requirements to meet state standards. Based on these factors, as well as their similarities to public school districts in other states, this report focuses on data collected from all Pennsylva-
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nia public school districts that sponsor school meals programs. This project was approved by the Institutional Review Board of The Pennsylvania State University. Policy Data Abstraction This is a cross-sectional descriptive study abstracting Pennsylvania public school district local wellness policies. Upon initial review of school districts’ policies, a decision was made to use the Pennsylvania School Boards Association template as the basis for a policy abstraction tool because it was recommended to local education agencies by Pennsylvania Department of Education and used by most school districts (n⫽480 [96.2%]). A table was set up listing each of the goals from the Pennsylvania School Boards Association template using Microsoft Office Access (2003, Microsoft Corp, Redmond, WA). Each policy was reviewed against this template and the presence or absence of each template goal for each policy was recorded in the table. Another Microsoft Access table was set up to compile data from the Local Wellness Policy Checklists. Five research assistants were trained in aspects of the local wellness policy and an abstraction system to designate local wellness policy goals’ correspondence to the goals in the Pennsylvania School Boards Association template. One research assistant served as the primary abstractor. At five time points throughout the process, another research assistant abstracted seven to 12 randomly selected policies. Their results were compared to those of the primary abstractor. The research team met to discuss discrepancies, decide on the correct abstraction, and document decisions. Corrections were made to previously abstracted policies based on these decisions when needed. One research assistant took primary responsibility for entry of data from the Local Wellness Policy Checklist. Two other research assistants were responsible for inspecting the accuracy of this data entry by comparing printouts of completed data entry forms for 30 Local Wellness Policy Checklists with the actual Local Wellness Policy Checklists. The accuracy rate was determined to be 99.7%. Upon completion of data entry for both policy goals and Local Wellness Policy Checklists, data clean-up procedures were instituted to identify and correct data anomalies before analyses were conducted. Frequencies were calculated using Microsoft Access. RESULTS Local Wellness Policy Development The majority of Local Wellness Policy Checklist respondents (n⫽432; 86.6%) indicated that they conducted an assessment of the school environment prior to developing the local wellness policy. The most commonly used assessment forms were Keystone Healthy Zone (n⫽309; 61.9%), an on-line assessment form developed by Pennsylvania Advocates for Nutrition and Activity, and the Centers for Disease Control and Prevention’s School Health Index (n⫽90; 18%). Fewer school districts indicated using the US Department of Agriculture’s School Improvement Checklist (n⫽49; 9.8%) and “other” assessment forms (n⫽79; 15.8%). Groups who were represented on the local wellness policy development team in each school district are rep-
Table 1. Groups who participated in local wellness policy development in each Pennsylvania public school district (N⫽499) Group
n
%
School administrator(s) School food authority Parents School board representative(s) Students Public representative(s) Teachers Nurses Other
497 492 485 466 444 429 139 135 105
99.6 98.6 97.2 93.4 89.0 86.0 27.9 27.1 21.1
resented in Table 1. According to the local wellness policy mandate, the first six of these groups (administrators through public) were required to be represented. Slightly more than three-quarters (n⫽380; 76.2%) of school districts indicated that each of these groups was represented. Local Wellness Policy Compliance and Content As a result of the local wellness policy mandate, 100% (n⫽499) of Pennsylvania public school districts that sponsor school meals programs have established local wellness policies. Other than the team membership requirement discussed here, almost all school districts (85.6% to 100%) met each of the other requirements of the local wellness policy mandate as represented in Table 2. The requirement met by the fewest number of school districts was establishment of a plan for measuring local wellness policy implementation. Policy goal areas addressed by Pennsylvania public school districts related to nutrition education, physical activity, physical education, and other school-based wellness activities are presented in Table 3. The top selected goals in each category were general; the least selected were more specific. Goals extending the content outside of the classroom were also least selected. Although goals related to physical education were not required by the local wellness policy mandate, these goals are presented because a large number of school districts included them. The majority of Local Wellness Policy Checklist respondents (n⫽299; 59.9%) indicated they implemented the nutrition standards for competitive foods developed by the Pennsylvania Department of Education without modification. These standards provide guidelines for foods and beverages offered as a la carte items, in vending machines, in school stores, as fundraisers, at classroom parties/celebrations, as rewards, brought from home, and in faculty lounges. Approximately one third (n⫽164; 32.9%) indicated they used the Pennsylvania Department of Education nutrition standards with “minor” modifications. Forty school districts (8.0%) indicated they implemented substantially modified versions of the Pennsylvania Department of Education standards or they developed their own. (Total number of schools districts adds up to ⬎499 because respondents could check more than one response, possibly indicating plans to imple-
ment different versions of the standards in different grade levels.) Local Wellness Policy Implementation Most respondents (n⫽377; 75.6%) indicated the superintendent has lead responsibility for ensuring that the local wellness policy is implemented. This response was followed by school foodservice directors (n⫽301; 60.3%). Smaller percentages of respondents selected school nurse (n⫽171; 34.3%), assistant superintendent (n⫽128; 25.7%), principal/assistant principal (n⫽128; 19.8%), teacher (n⫽90; 18.0%), business manager (n⫽84; 16.6%), and curriculum coordinator (n⫽78; 15.6%). DISCUSSION The Child Nutrition and WIC Reauthorization Act of 2004 included a requirement for all local education agencies to establish local wellness policies focused on reducing childhood obesity. This report is an examination of local wellness policies submitted by Pennsylvania public school districts sponsoring school meals programs, including the development process, key players involved, specific goals identified, compliance with the local wellness policy mandate, and lead people responsible for implementation. Limitations of this study include the fact that it involves only Pennsylvania public school districts and, therefore, results and conclusions may not be generalizable beyond this audience. These data reflect a onetime assessment. Although earlier research found the existence of few school nutrition policies, now all Pennsylvania school districts that sponsor school meals programs have policies in place (4-8). In a 2003 survey, only 18% of Pennsylvania school foodservice directors indicated the existence of a policy at their high school related to the nutritional quality of a la carte foods (7). Policies related to nutrition standards for other sources of competitive foods were even less common (7). In their examination of local wellness policies, the School Nutrition Association found some weaknesses in the reach of school districts’ nutrition guidelines (11). Thirty-one percent to 45% of school districts omitted nutrition guidelines for foods offered as fundraisers, during classroom parties, or as rewards in the classroom. In the current study, virtually all (99.8%) Pennsylvania public school districts included nutrition guidelines for competitive foods in their local wellness policies, with 92% of them using the voluntary Pennsylvania Department of Education nutrition guidelines for competitive foods, with no or only minor modifications. These guidelines cover all of the venues mentioned here. This finding suggests a reliance on state nutrition guidelines and provides opportunities for school foodservice personnel to work together with the food industry to develop and test new foods that meet the guidelines and are acceptable to students. An earlier report about local wellness policy development in Virginia indicated that only 34.1% of school districts included the required people on their policy development team, compared to ⬎75% in the current study (13). The required groups that were least represented in the current study were students and members of the
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Table 2. Pennsylvania public school districts meeting each local wellness policy requirement (N⫽499) School Districts Meeting the Requirement
Requirements for the local wellness policy as mandated by The Child Nutrition and WIC Reauthorization Act of 2004
n
%
Include at least one goal for nutrition education Include at least one goal for physical activity Include at least one goal for other school-based activities designed to promote student wellness Include nutrition guidelines for all foods available on the school campus during the school day Provide an assurance that reimbursable meals meet US Department of Agriculture regulations Establish a plan for measuring implementation of the local wellness policy Designate one or more person responsible for ensuring that the school meets the local wellness policy
499 498 499 498 494 427 499
100 99.8 100 99.8 99.0 85.6 100
public. Lack of involvement of these groups may impact the ability of school districts to gain support and buy-in for policy goals. However, while these were the least represented of the required groups, students and the public were still represented on the large majority of policy development teams. Other than the team membership requirement, each of the requirements of the local wellness policy presented in Table 2 was met by almost all (85.6% to 100%) of Pennsylvania public school districts. In their analysis of 256 local wellness policies from several states, Action for Healthy Kids also reported high levels of compliance with these requirements, although not as high as in the current study (12). Several Pennsylvania-based organizations and associations offered training on local wellness policies and/or provided information on local wellness policy requirements in newsletters and mailings. The Pennsylvania Department of Education presented a mandatory training session for all National School Lunch Program sponsors on the Child Nutrition and WIC Reauthorization Act of 2004, including the local wellness policy requirement. These training opportunities, promotional efforts, and availability of resources to aid in policy development, coupled with state-level collection and review of local wellness policies may account for the high number of school districts meeting local wellness policy requirements. Previous research has suggested weaknesses in the area of local wellness policy measurement and evaluation and has documented school districts’ need for assistance in these areas (12,13). The findings in the current study are in line with these previous findings and suggest a need for assistance in developing and implementing plans for local wellness policy measurement and evaluation. While 100% of school districts established local wellness policies as required and most met the specific requirements, some school districts included qualifiers in their policy language to suggest ambiguity in their commitment to certain goals. For example, some policies stated that a goal is “recommended” or that they will “strive to comply.” The rigor of the policy statements included with local wellness policies is an area in need of further research. While the Child Nutrition and WIC Reauthorization Act of 2004 required that school districts develop policies
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that include goals in specific areas (eg, nutrition education), it did not mandate specific goals in these areas. The most commonly chosen goals in the current report were fairly broad and general and the least often chosen goals were more specific and measurable. This may reflect school districts’ discomfort with committing to specific goals because of concerns that they may not be able to achieve those goals or a philosophy that policy goals should be broad and general, with the specific details described in Administrative Guidelines. Detailed procedures or Administrative Guidelines will be necessary for school districts to measure policy implementation and evaluate effectiveness of the local wellness policies. Standardized forms for assessment and reporting may aid schools in these processes. Among the least-often selected nutrition education goals are goals that extend nutrition education beyond the classroom environment to engage families, provide opportunities for community nutrition projects, and link with school foodservice. These goals represent strategies for reinforcing classroom nutrition education and providing opportunities for skill-building related to nutrition that have been recommended by US Department of Agriculture’s Team Nutrition program (17). Schools may benefit from examples of successful strategies for extending nutrition education beyond the classroom to connect with the cafeteria and the community. Integrating nutrition education into other subject areas has been advocated as a strategy for providing nutrition education, given the limited time available within the school day (2). The current finding that 59.3% of school districts included a goal related to integrating nutrition into other subject areas is in line with findings from an earlier report (12). In the current study, many of the “other school-based activities” goals relate to school meals with the top three goals in this area addressing the school meal environment and time allocated for school meals. This may be reflective of the fact that almost all of the school districts (98.6%) indicated that a representative of the school food authority was on the policy development team. Previous local wellness policy research has shown that 41% to 58.7% of school districts’ policies addressed professional development for staff responsible for providing nutrition education (12,13). Findings in the current study are in line with these earlier findings. These previous and
Table 3. Local wellness policy goal areas addressed by Pennsylvania public school districts (N⫽499)
Table 3. Local wellness policy goal areas addressed by Pennsylvania public school districts (N⫽499) (continued)
Goal area
Goal area
n
%
Time to eat school meals Access to handwashing Availability of drinking water Availability of nutrition content of school meals Nutrition qualifications of school foodservice administrator(s) Training for staff about local wellness policy Communication about diet and physical activity with parents Professional development for district nutrition staff Appropriate scheduling of meal periods Limits access to foodservice operation Encourage positive role-modeling Consideration of local wellness policy goals in school activities Safe routes to school Utilization of funding to enhance student wellness Fundraising projects supportive of student wellness Involve of parents/guardians in menu selections Addresses use of food as reward or punishment
355 347 338 337
71.1 69.5 67.7 67.5
310 308
62.1 61.7
307 304 297 288 287
61.5 60.9 59.5 57.7 57.5
286 283 281
57.3 56.7 56.3
241 226 223
48.3 45.3 44.7
Nutrition education Align with state curriculum regulations and academic standards Teach, encourage, and support healthy eating Age appropriate lessons Consistent nutrition messages Knowledge and skills to lead healthful lives Link with physical activity Integrate into other subjects Professional development for staff Engage and involve families Opportunities for community nutrition projects for students Behavior-focused curriculum Link with school foodservice Physical activity Developmentally appropriate Age-appropriate activities Environment encourages safe and enjoyable activity Access to facilities outside school hours Partner with parents and community to institute physical activity programs Addresses use of physical activity as punishment Classroom physical activity breaks for elementary students Provide physical activity through after-school programs Discourages extended periods of student inactivity Contribute to effort to provide students with 60 minutes of daily physical activity, including outside of school Daily physical activity to achieve health, wellness, fitness, and performance benefits Physical education (PE) Quality PE to promote lifelong physical activity Taught by certified health/PE teachers Alignment with state curriculum regulations and academic standards Safe and adequate equipment, facilities, and resources Provide means for students to learn, practice and be assessed on skills and knowledge for lifelong physical activity Professional development for PE staff Addresses level of physical activity during PE Provide skills, knowledge, and confidence Varied and comprehensive curriculum Planned instruction to meet proficient level for academic standards Require local assessment system Address teacher-to-student ratio Other school-based wellness activities Clean and safe meal environment Space for eating and serving school meals
n
%
435 427 329 315 314 299 296 275 250
87.2 85.6 65.9 63.1 62.9 59.9 59.3 55.1 50.1
233 193 165
46.7 38.7 33.1
373 366
74.7 73.3
337 295
67.5 59.1
276 270
55.3 54.1
228
45.7
206
41.3
186
37.3
218
43.7
201
40.3
387 367
77.6 73.5
375
75.2
346
69.3
298 282 329 252 218
59.7 56.5 65.9 50.5 43.7
222 168 156
44.5 33.7 31.3
398 79.8 372 74.5 (continued)
current findings suggest room for improvement and suggest opportunities for professional organizations to provide continuing education related to school-based nutrition education strategies. In previous research, school foodservice directors expressed discomfort with being identified as responsible for local wellness policy enforcement because of the reach of the local wellness policies into a variety of areas in the school environment unrelated to the school meals programs and the time required to monitor compliance with the local wellness policies (9). In the current study, school district representatives most often identified superintendents as having lead responsibility for policy implementation, followed by school foodservice directors. Although support and leadership from the superintendent is important, it is questionable whether a district-level administrator can feasibly oversee the day-to-day implementation of and compliance with the local wellness policy at the school level. In addition, while it is appropriate for the school foodservice director to oversee policy implementation related to school meals, it is doubtful that he or she would have the time or authority to oversee implementation of other policy areas. School district personnel may need to consider identification of school level personnel to oversee policy implementation, division of oversight responsibilities, and/or identification of district wellness coordinators to oversee implementation of local wellness policies. CONCLUSIONS In the current study, all required public school districts in Pennsylvania established a local wellness policy, and the majority met the specific requirements of the local wellness policy mandate. Considering that research in 2003
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documented that few school nutrition policies existed in Pennsylvania public high schools, current findings suggest the effectiveness of the combination of federal legislation, state-level oversight, and availability of resources to impact policy change at the local level (7). Applications suggested for the following sectors include: Applications for Policy-Makers ●
●
●
A federal mandate, coupled with state review and enforcement, was very successful in prompting Pennsylvania school districts to establish local wellness policies related to reducing childhood obesity. Because school district staff relied heavily on centrally developed resources to meet the mandate requirements, additional resources should be developed to assist school district staff in development of implementation plans. Implementation and enforcement of the local wellness policy will require delegation of both authority and responsibilities or appointment of a dedicated and qualified individual to coordinate this process, as well as the establishment of a plan for communicating implementation and enforcement plans.
Applications for Researchers ●
●
●
The rigor of the policy statements included in local wellness policies is an area in need of additional analysis. The extents to which policy goals are implemented and barriers associated with implementation are areas in need of follow-up research. The success of local wellness policies to change school environments, student behavior, and ultimately, rates of childhood obesity should be documented.
Applications for Food and Nutrition Professionals ●
●
●
Local wellness policies provide an opportunity for food and nutrition professionals to become involved in prevention of childhood obesity. Food and nutrition professionals should learn about the local wellness policy in their local school districts and become members of school districts’ wellness committees. Food and nutrition professionals can play a role in offering professional services to assist implementation of existing local wellness policies as well as working within school districts to adopt additional nutrition goals in subsequent revisions of local wellness policies. Areas in particular need of professional assistance are those identified in this report as being least likely to be adopted. These include behavioral approaches and approaches that extend the nutrition education beyond the classroom, important goals to solve the problem of childhood obesity. Food and nutrition professionals can become involved in local wellness policies success by assisting in development of tools and strategies to measure local wellness policy implementation and effectiveness.
Funding for this project was provided by both the US Department of Agriculture administered through the
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Pennsylvania Department of Education, Division of Food and Nutrition and the Robert Wood Johnson Foundation, Healthy Eating Research program. References 1. US Department of Agriculture, Food and Nutrition Service. Healthy school nutrition environment Web site. http://www.fns.usda.gov/tn/ Healthy/hsne.html. Accessed December 18, 2007. 2. Centers for Disease Control and Prevention. Guidelines for school health programs to promote lifelong healthy eating. Morb Mortal Wkly Rep. 1996;45:1-37. MMWR Web site. http://www.cdc.gov/mmwr/preview/ mmwrhtml/00042446.htm. Published September 19, 1998. Accessed December 18, 2007. 3. Bogden J. Fit, Healthy, and Ready to Learn: A School Health Policy Guide. Alexandria, VA: National Association of State Boards of Education; 2000. 4. Barratt RD, Cross NA, Mattfeldt-Beman MK, Katz BM. School policies that promote healthy eating: A survey of foodservice directors in North Carolina public schools. J Child Nutr Manage. [serial online]. 2004;1: Spring 2004. http://docs.schoolnutrition.org/newsroom/jcnm/ 04spring/barratt/. Accessed December 18, 2007. 5. French SA, Story M, Fulkerson JA. School food policies and practices: A state-wide survey of secondary school principals. J Am Diet Assoc. 2002;102:1785-1789. 6. French SA, Story M, Fulkerson JA, Gerlach AF. Food environment in secondary schools: A la carte, vending machines, and food policies and practices. Am J Public Health. 2003;93:1161-1167. 7. McDonnell E, Probart CK, Weirich JE, Hartman T, Bailey-Davis L. School competitive food policies: Perceptions of Pennsylvania public high school foodservice directors and principals. J Am Diet Assoc. 2006;106:271-276. 8. Wechsler H, Brener ND, Kuester S, Miller C. Food service and foods and beverages available at school: Results from the School Health Policies and Programs Study 2000. J Sch Health. 2001;71:313-324. 9. McDonnell E, Probart CK, Weirich, JE. School foodservice directors perceptions and concerns about local wellness policy development, implementation, and enforcement. J Child Nutr Manage. [serial online]. 2006;1: http://docs.schoolnutrition.org/newsroom/jcnm/06spring/mcdonnell/ index.asp. Accessed December 18, 2007. 10. Probart CK, Snow-Telfer H, McDonnell E. Use of stakeholder theory to examine groups salient in decisions related to a la carte offerings. J Child Nutr Manage. [serial online]. 2006;2. http://docs.schoolnutrition.org/newsroom/jcnm/06fall/probart/index.asp. Accessed December 18, 2007. 11. School Nutrition Association. A foundation for the future II: Analysis of local wellness policies from 140 school districts in 49 states. http://www.asfsa.org/uploadedFiles/SchoolNutrition.org/News_&_ Publications/School_Foodservice_News/New_Folder/Regional%20 LWP%20Report.pdf. Published December 2006. Accessed December 18, 2007. 12. Howley N. Local wellness policies: A national snapshot. Presented at Wellness and Academic Success: From Policy to Action conference, State College, PA, April 30-May 1, 2007. 13. Serrano E, Kowakeska A, Hosig K, Fuller C, Fellin L, Wigand V. Status and goals of local school wellness policies in Virginia: A response to the Child Nutrition and WIC Reauthorization Act of 2004. J Nutr Educ Behav. 2007;39:95-100. 14. Pennsylvania School Boards Association. PSBA Local Wellness Policy Template. Pennsylvania Department of Education: Pennsylvania School Boards Association (PSBA) Resources Web site. http://www. pde.state.pa.us/food_nutrition/cwp/view.asp?a⫽5&q⫽119997. Accessed July 14, 2008. 15. Pennsylvania Department of Education, Division of Food and Nutrition. Nutrition Standards for Competitive Foods in Pennsylvania Schools. School Nutrition Incentive Program Web Site. http://www.pde.state. pa.us/food_nutrition/cwp/view.asp?Q⫽125996&A⫽5. Published July 27, 2007. Accessed December 18, 2007. 16. Pennsylvania Department of Education, Division of Food and Nutrition. Local Wellness Policy Checklist. Local Wellness Policy Web site. http:// www.pde.state.pa.us/food_nutrition/cwp/view.asp?Q⫽117239&A⫽5. Accessed December 18, 2007. 17. United States Department of Agriculture, Food and Nutrition Service. Team Nutrition Web Site. http://www.fns.usda.gov/tn/. Accessed December 18, 2007.
