Study to Evaluate the Health and Wellness Policies of the New Haven Public School District.

Not Applicable

Completed

• Conditions: Obesity; Chronic Diseases
• Interventions: Other: DISTRICT WELLNESS COMMITTEE; Other: NUTRITIONAL QUALITY OF FOODS AND BEVERAGES ON CAMPUS; Other: HEALTH PROMOTION AND MARKETING; Other: OPPORTUNITIES FOR PHYSICAL ACTIVITY

• Registration Number: NCT02043626
• Lead Sponsor: Yale University

Brief Summary

Our long-term objective is to reduce the rates and risk of childhood obesity via school-based nutrition and physical activity policies. Using a randomized design, we propose to monitor and evaluate how Connecticut's first-ranked District Wellness Policy, in the New Haven Public School district, is implemented and determine its impact on children's obesogenic behaviors, weight outcomes, and school performance. This study is designed to significantly advance empirical research on school wellness policies and to provide important evidence to guide future interventions in schools and communities - translating science to improved health of the public.

Detailed Description

Consistent with NIH priorities, our long-term objective is to reduce the rates and risk of childhood obesity via school-based nutrition and physical activity policies. We propose to monitor and evaluate how Connecticut's first-ranked School Wellness Policy, in the New Haven Public School district, is implemented and determine its impact on children's obesogenic behaviors, weight outcomes, and school performance. We will evaluate a strategy of implementation at 12 targeted schools using a randomized design. Focusing on targeted schools will enable a more rigorous evaluation of School Wellness Policy implementation, barriers/facilitators, and ultimately the behavioral and health impacts of school-based policies on childhood obesity. We propose a multi-level assessment of factors that may influence childhood obesity using the Ecological Model as a guiding framework.

Thus we propose a multi-sectoral, multi-level approach, focused on children, families, schools, and community. This ambitious project is possible because of the expertise and strong collaborative partnerships between The New Haven Public Schools and two Yale University research centers: The Rudd Center for Food Policy and Obesity and CARE: Community Alliance for Research and Engagement. Our partnership builds on Principles and Guidelines for Community-University Research Partnerships developed by a 12-member committee of community and university leaders and endorsed by Yale University and community partners in 2009.

This study is designed to significantly advance empirical research on school wellness policies: focused on implementation and measurable impact on student health. No matter how well written, a school wellness policy must be effectively implemented to achieve its potential impact. Further, students within schools represent only two components of a larger socio-ecological system that influences eating behavior, physical activity, and weight status. The federal mandate for school wellness policies requires districts to address many aspects of the school environment (e.g., nutrition education, nutrition standards for foods sold, and opportunities for physical activity). To maximize improvements, this type of multi-component policy is needed. However, this complexity makes it difficult to evaluate policy impact and draw conclusions about the causal relationships between specific policies and student health. With our team's unique strengths and these challenges in mind, we designed this research study with the following Specific Aims:

1. Track and evaluate a strategy of targeted implementation of a School Wellness Policy.

2. Identify factors that facilitate or impede implementation of The School Wellness Policy, including neighborhood, school, and student determinants; and

3. Evaluate the impact of implementation of The School Wellness Policy on obesogenic behaviors and health outcomes as well as school performance.

We will collaborate with the District to implement a subset of nutrition and physical activity policies in 12 schools using a randomized 2 x 2 research design. This will permit comparison of the potential unique and synergistic effects of these nutrition and physical activity policies on student behaviors and related health outcomes. We will follow a cohort of 5th grade students (N≈700) annually for four years to assess potential changes to student eating behaviors, physical activity levels, and BMI. We use a multi-method approach to collect data and examine predictors of these outcomes from across levels of the socio-ecological framework: student variables, family characteristics, school policies, and neighborhood features.

This multidisciplinary proposal is synchronous with specific research objectives articulated in Program Announcement (PA-10-052) School Nutrition and Physical Activity Policies, Obesogenic Behaviors and Weight Outcomes. As noted, few studies to date have examined the policy implementation process. We directly target the implementation and impact of health-related policies in schools, measuring obesogenic behaviors and BMI as primary outcomes. We have an active tracking system to monitor impact of policies, and we focus on minority populations traditionally vulnerable and underserved. As stated by NIH in this program announcement, policy-based approaches to combat obesity in schools exist; however, knowledge is lacking in key areas concerning the optimal policies, key implementation strategies for such policies, and the impact of these policies on important health and social outcomes. The proposed project will advance scientific knowledge and understanding in this arena and provide important evidence to guide future interventions in schools and communities translating science to improved health of the public.

Study Timeline

• Study Start: 2011-08
• Study First Submitted: 2014-01-20
• Study First Submitted QC: 2014-01-20
• Study First Posted: 2014-01-23
• Primary Completion: 2016-06
• Study Completion: 2016-06
• Status Verified: 2018-01
• Last Update Submitted: 2018-01-12
• Last Update Posted: 2018-01-17

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 796

Inclusion Criteria

• Student of the New Haven School District--State of Connecticut
• Enrolled in 12 eligible schools participating in study
• Child between the ages of 9 and 14 or in grades 5-8 as of the fall of 2011
• Primary Language of communication is English

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Exclusion Criteria

• Not enrolled in one of 12 participating schools
• Not in target grade (5-8) as of the fall 2011

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Nutrition and Physical Activity	HEALTH PROMOTION AND MARKETING	Students in 3 designated schools will receive nutrition education, nutrition standards for foods sold, and opportunities for physical activity.
Nutrition and Physical Activity	DISTRICT WELLNESS COMMITTEE	Students in 3 designated schools will receive nutrition education, nutrition standards for foods sold, and opportunities for physical activity.
Nutrition and Physical Activity	OPPORTUNITIES FOR PHYSICAL ACTIVITY	Students in 3 designated schools will receive nutrition education, nutrition standards for foods sold, and opportunities for physical activity.
Nutrition Only Interventions	NUTRITIONAL QUALITY OF FOODS AND BEVERAGES ON CAMPUS	Students in 3 designated study schools will receive multiple interventions regarding nutrition education and nutrition standards for foods sold.
Physical Activity Only	OPPORTUNITIES FOR PHYSICAL ACTIVITY	Students in 3 designated study schools will receive educational intervention and increased opportunities for physical activity.
Nutrition and Physical Activity	NUTRITIONAL QUALITY OF FOODS AND BEVERAGES ON CAMPUS	Students in 3 designated schools will receive nutrition education, nutrition standards for foods sold, and opportunities for physical activity.

Primary Outcome Measures

Name	Time	Method
Change in body mass index (BMI).	Baseline through Follow-up: Grades 5-6-7-8	Body weight and height to calculate BMI annually from baseline (grade 5) through follow-up (grade 8)

Secondary Outcome Measures

Name	Time	Method
Change in level of physical activity.	Baseline through Follow-up: Grades 5-6-7-8	Surveying of student physical activity habits and observation of student participation in class time or after school physical activity programs.
Mental Health	Baseline through Follow-up: Grades 5-6-7-8	Strengths and Difficulties Questionnaire screens child mental health problems, five subscales: emotional problems, hyperactivity, relationship, conduct and pro-social behavior.
Change in student nutritional habits (eating behaviors).	Baseline through Follow-up: Grades 5-6-7-8	Surveying student nutritional habits and close observation of nutritional habits (food consumed) in school.
Standardized test scores	Baseline through Follow-up: Grades 5-6-7-8	Standardized test scores, reading and mathematics

Trial Locations

Locations (1)

Yale University; 🇺🇸 New Haven, Connecticut, United States