The Role of Programs and Policies in Shaping
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2018
The Role of Programs and Policies in Shaping the Observed School Nutrition Environment and Rural Childhood Obesity Shadai Martin South Dakota State University
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THE ROLE OF PROGRAMS AND POLICIES IN SHAPING THE OBSERVED
SCHOOL NUTRITION ENVIRONMENT AND RURAL CHILDHOOD OBESITY
BY
SHADAI S. MARTIN
A dissertation submitted in partial fulfillment of the requirements for the
Doctor of Philosophy
Major in Nutrition and Exercise Science
South Dakota State University
2018
iii
This dissertation is dedicated to my parents. Thank you for the many years of
support, encouragement and guidance. Thank you for loving me more than I loved myself
some days and helping me to realize that my life is worth it, and I do deserve good things
in life. There were many days where all I could think about was packing up and going
home but you would always know the right words to say to keep me going. Although it
has been 1 year and 4 months since I have last seen you all, thank you for calling me
every single day, sometimes a few times in a day to make sure I was still going and
letting me know I was one day closer. Mom, I value your wisdom and I hope to be half
the woman you are one day. I love you with all my heart; thank you for never giving up
on me and loving me unconditionally. Our best is yet to come!
iv
ACKNOWLEDGEMENTS
I would like to thank the members of my committee for the time they have
spent ensuring my academic success; I appreciate your flexibility, time and support. I
would like to thank my advisor, Dr. Lacey McCormack, for your role as my supervisor
and mentor and for accepting me as a student half way through the program. I am grateful
to have had the opportunity to work with you. I have grown personally and professionally
being under your tutelage; I still have quite a bit of growing and maturing to do but I have
come along way. Thank you for everything!
v
TABLE OF CONTENT
ABBREVIATIONS …………………………………………………………… vii
LIST OF FIGURES …………………………………………………………… viii
LIST OF TABLES ……………………………………………………………. ix
ABSTRACT……………………………………………………………………. x
CHAPTER 1: Introduction………………………………………………………1
Importance of the Nutrition Environment……………………………………… 2
Importance of School Meals…………………………………………………….4
Importance of School Wellness Policies ……………………………………….7
Importance of Researching Rural vs. Non-Rural ………………………………8
Specific Aims……………………………………………………………………9
References ………………………………………………………………………11
CHAPTER 2: The Association Between Free & Reduced School Lunch
Participation and Rural Obesity ………………………………………………. 17
Abstract ………………………………………………………………………. 18
Introduction…………………………………………………………………….20
Methods ………………………………………………………………………. 23
Results …………………………………………………………………………24
Discussion ……………………………………………………………………. 24
References ……………………………………………………………………. 28
CHAPTER 3: The Association Between Strength and Comprehensive Wellness Policy
Scores and the Nutrition Environment …………………………………………37
vi
Abstract ………………………………………………………………………. 38
Introduction…………………………………………………………………… 39
Methods ………………………………………………………………………. 41
Results …………………………………………………………………………43
Discussion ……………………………………………………………………. 44
References………………………………………………………………………48
CHAPTER 4: Association between More Comprehensive and Stronger School Nutrition
Wellness Policy Scores and Nutrition Policy Implementation…………………56
Abstract …………………………………………………………………………57
Introduction……………………………………………………………………..58
Methods …………………………………………………………………………59
Results ………………………………………………………………………….62
Discussion ………………………………………………………………………62
References……………………………………………………………………… 67
Chapter 5………………………………………………………………………..74
vii
ABBREVIATIONS
BMI-body mass index
HHFKA – Healthy Hungry- Free Kids Act
LEA – Local Education Agencies
NSLP- national school lunch program
RUC codes- Rural-Urban Continuum Codes
SPAN-ET – School Physical Activity and Nutrition Environment
SWP- school wellness policy
USDA- United States Department of Agriculture
Well SAT – Wellness School Assessment Tool
viii
LIST OF TABLES
Table 2.1 BMI definitions ……………………………………………… 34
Table 2.2 RUC code definitions…………………………………………. 35
Table 2.3 RUC code groups …………….……………………………… 37
Table 3.1 Well SAT and SPAN-ET (physical)…………………………. 53
Table 3.2 Well SAT and SPAN-ET (situational)………………………. 54
Table 3.3 Well SAT and SPAN-ET (policy)……………………………. 55
Table 3.4 Total SPAN-ET and Well SAT………………………………. 56
Table 4.1 SPAN-ET Criteria…….………………………………………. 72
Table 4.2 SPAN-ET and Well SAT correlations………………………… 74
ix
ABSTRACT
THE ROLE OF PROGRAMS AND POLICIES IN SHAPING THE OBSERVED
SCHOOL NUTRITION ENVIRONMENT AND RURAL CHILDHOOD OBESITY
SHADAI MARTIN
2018
Childhood obesity is an ongoing public health concern that impacts many children
in the United States. Research has shown that the prevalence of childhood obesity is
higher in rural populations compared to non-rural populations. This may be attributable
to differences in the school nutrition environment, particularly school meals and school
wellness policy implementation. In order to design effective intervention targeted at
weight management and obesity reduction, information regarding the school nutrition
environment must be known. Therefore, the purpose of this research was to examine the
school nutrition environment, particularly school lunch participation and weight
outcomes between metro, non-metro and rural counties. Additionally, strength and
comprehensiveness of nutrition wellness policies and its association with the nutrition
environment along with nutrition policy implementation were examined. Rural
populations are understudied and differ from their metro and non-metro counterparts in
terms of sociodemographic factors and access to food.
The following analyses utilize school meals participation data from the Annie E. Carsey
Foundation, SPAN-ET tool from the Oregon State University extension services and
WellSAT tool from UCONN Rudd Center. School lunch participation by county
ruralness was examined to determine if meal participation was associated with weight
outcomes. Strength and comprehensiveness of school nutrition wellness policies and the
x
observed physical, situational and policy nutrition environment were examined and
finally SPAN-ET and WellSAT scores were examined to assess whether more
comprehensive and stronger policies equate to…
