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

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.

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

Exclusion Criteria:

- Not enrolled in one of 12 participating schools

- Not in target grade (5-8) as of the fall 2011