Family, Child, Adolescent Health (Includes Maternal & Child Health)
Disparities in Local Wellness Policies Implementation across Maryland Schools
(School of Medicine (UMB) Family and Community Medicine Faculty)
Feinberg, Termeh (UMB SOM Family & Community Medicine), Parker, Elizabeth (UMB SOM Family & Community Medicine), Lane, Hannah (UMB SOM Pediatrics), Rubio, Diana (UMB SOM Pediatrics), Wang, Yan (UMB SOM Pediatrics), Hager, Erin (UMB SOM Pediatrics)
Objectives: Local wellness policies (LWP) are mandated in school systems to promote a healthy environment, but school-level implementation influences LWP effectiveness. We examined disparities (geographic, racial/ethnic, and socio-economic) in the implementation of classroom-level LWP nutrition/physical activity (PA) best practices within a large, diverse state-wide sample of Maryland schools. Approach: School administrators (N=809; each (N=24) district represented) completed a comprehensive survey consisting of 29 LWP implementation items, including 6 items on classroom-level PA/nutrition-related best practices (i.e., restricting food celebrations or rewards, incorporating regular PA breaks and into curriculum, and restricting PA from being withheld or used or as punishment). A sum score was created (Cronbach’s alpha=0.75), and divided into quartiles as the dependent variable. Multilevel ordinal logistic regression models examined relationships between student body FARMS rate (proxy for income; 0-40%, 41-75%, >75%) and race/ethnicity (>75% African American/Hispanic, >75% White, other) and geographic location (urban, rural) to classroom-level LWP best practices, while controlling for school district as a random effect. Findings: There was a significant relationship between FARMS and classroom practices items after controlling for school type and race/ethnicity (p=.003). Schools with mid-range FARMS rates (41%-75% FARMS-eligible students) had a 47% reduced risk of lower classroom practices-quartile than schools with FARMS rates <40% (i.e. serving higher-income families) (AOR:0.53,CI: 0.37,0.76;p<.001). Classroom practices scores were not associated with race/ethnicity or geographic location. Conclusions: Disparities in administrator-reported classroom practices exist in schools with less FARMS-eligible students. Public Health Significance: Interventions examining implementation of classroom-related LWP best practices may be warranted in these at-risk schools.