HSA 2011 & 2012:
Implementation and Impact
2013 Healthy School Act Conference
Anastasia Snelling, Ph.D., R.D.
Sarah Irvine Belson, Ph.D.
DC HSA Evaluation; Snelling & Belson; 2013
Agenda
• HSA overview and vision
• Data and instruments used for analysis
• Descriptive Results
– All schools; 2011 & 2012 school year
– level of schools {elementary or middle}
– DC Public Schools and DC Public Charter Schools
• Composite Score
– Methodology
– What are the scores telling us about school health?
• Relationship between school health and other variables:
– Percent of free and reduced lunch
– academic achievement
DC HSA Evaluation; Snelling & Belson; 2013
The Vision
• School health policies are being established and
implemented to respond to childhood obesity rates.
• DC is a leader in passing the DC Healthy Schools Act.
• Full implementation and critical evaluation and
research will allow the Act to reach its intended results
to reduce childhood obesity, thereby improving
students’ health status and allowing them to achieve
academic success.
“It is easier to build strong children then
to mend broken adults.”
DC HSA Evaluation; Snelling & Belson; 2013
District of Columbia Healthy Schools Act
School Nutrition,
Physical, and Health
Education






Farm-to-School Program


Wellness Policy and
Health Profiles


Encourage schools to serve a vegetarian option each week
Require schools to serve a different vegetable and fruit daily
Require schools to serve 1% milk
Require schools to have only healthy foods in vending machines,
for fundraising and for prizes
Require students in grades K-5 to have at least 150 minutes per
week of physical education
Require students in grades 6-8 to have at least 225 minutes per
week of physical education
Encourage a preference for unprocessed foods grown in DC,
Delaware, Maryland, North Carolina, New Jersey, Pennsylvania,
Virginia, and West Virginia
Provide grants to establish curriculum-coordinated school garden
programs
Require schools to annually assess and report on student
achievement according to health and physical education standards
Require schools to develop a school health environment profile
detailing health, nutrition, physical education programs and
wellness policies
DC HSA Evaluation; Snelling & Belson; 2013
Data and Instruments
Instrument Collection
Date
School Health Profiles
Every February
beginning in 2011
CAS-HEALTH
Full implementation:
2012
Fitness Gram
Every Spring
DC Comprehensive
Assessment System
(CAS)
Every Spring
Assessment and
Accountability Report
Ongoing
Description
Sample Variable
Describes the school health environment.
Minutes of physical education
Contains 6 sections on health services,
Minutes of health education
instruction on health and physical education, Existence of a School garden
nutrition programs, gardens, posting the
information to the parents.
Assessment of health education knowledge
for 5, 8, 10 grades. The survey is a multiple
choice survey developed by DCPS and OSSE.
An assessment of aerobic capacity, muscular
strength and endurance, flexibility, and
height and weight.
This data is collected by DCPS and submitted
to OSSE.
Academic Student Achievement in reading,
writing, math and science test scores
Test score for each grade level
at each school.
Student demographics (gender, age, grade,
race, free and reduced price lunch status)
Student enrollment data
Number of students eligible
for free or reduced lunch
DC HSA Evaluation; Snelling & Belson; 2013
Score of aerobic capacity
Score of muscular strength
Body mass index
Percent students passing the
comprehensive assessment
exam
Descriptive Results
School Level
Year
Public & Charter
DC HSA Evaluation; Snelling & Belson; 2013
Health Education Standards
2011 & 2012
DC Public and Charter Schools
Answered YES,
Health Education is
based on DC standards
2011
2012
DCPS
Charter
85% (n =117)
80% (n=89)
86% (n=113)
71% (n=93)
DC HSA Evaluation; Snelling & Belson; 2013
Health Education Minutes
Elementary Schools:
DC Public and Charter Schools 2011-2012
2011 Elementary School
(all grade levels)
DCPS (n = 393)
Charter (n = 182)
Mean
36.2
31.4
25th percentile
20.0
15.0
50th percentile
42.5
20.7
75th percentile
45.0
49.2
DCPS (n = 418)
Charter (n = 213)
Mean
33.1
28.9
25th percentile
15.0
12.5
50th percentile
38.3
22.1
75th percentile
45.0
41.7
2012 Elementary School
(all grade levels)
Excluding grades with more than 125 min/week of health education within any grade
DC HSA Evaluation; Snelling & Belson; 2013
Health Education Minutes
in Middle Schools:
DC Public and Charter Schools 2011-2012
2011 Middle School
(all grades levels)
DCPS (n = 78)
Charter (n = 74)
Mean
56.6
37.9
25th percentile
40.0
15.0
50th percentile
45.0
42.7
75th percentile
80.0
60.0
DCPS (n = 74)
Charter (n = 94)
Mean
54.4
39.6
25th percentile
29.7
15.0
50th percentile
45.0
30.0
75th percentile
74.2
55.8
2012 Middle School
(all grade levels)
Excluding grades with more than 125 min/week of health education within any grade
DC HSA Evaluation; Snelling & Belson; 2013
Health & Physical Education Scores
DC CAS Health
Comm &
Safety
emotional skills
hlth
Human
body &
personal
hlth
Disease
Prevent.
Nutr
Alcohol, Healthy
Tobacco, decision
& other making
drugs
Physical
ed
5th
grade
77%
66%
44%1
66%1
70%
52%
59%
63%
8th
grade
76%
68%
58%1
70%
50%
64%
70%
51%
1includes items which parents may opt students out of.
DC HSA Evaluation; Snelling & Belson; 2013
Physical Education Standards
2011 & 2012
DCPS and Charter Schools
Answered “YES”
Physical Education is based
on DC standards
2011
DCPS
Charter
98% (n =117)
87% (n=89)
2012
93% (n=113)
78% (n=93)
DC HSA Evaluation; Snelling & Belson; 2013
Physical Education Minutes
in Elementary Schools:
DC Public and Charter Schools 2011-2012
2011 Elementary School
(all grades levels)
DCPS (n = 481)
Charter (n = 354)
Mean
53.6
89.3
25th percentile
45.0
45.0
50th percentile
45.0
58.8
75th percentile
50.4
125.0
DCPS (n = 485)
Charter (n = 266)
Mean
57.3
63.8
25th percentile
44.2
39.2
50th percentile
45.0
56.4
75th percentile
56.3
85.3
2012 Elementary School
(all grade levels)
Excluding grades with more than 225 min/week (grades K-5) of physical education
within any grade in 2011. There were no outliers in 2012.
DC HSA Evaluation; Snelling & Belson; 2013
Physical Education Minutes
in Middle Schools:
DC Public and Charter Schools 2011-2012
2011 Middle School
(all grade levels)
DCPS (n = 103)
Charter (n = 111)
Mean
103.6
110.7
25th percentile
45.0
45.0
50th percentile
72.5
92.7
75th percentile
128.3
163.7
DCPS (n = 103)
Charter (n = 129)
Mean
111.9
103.3
25th percentile
45.0
48.3
50th percentile
103.3
79.8
2012 Middle School
(all grade levels)
75th percentile
173.3
141.7
Excluding grades with more than 300 min/week (grades 6-8) of physical education
within any grade for 2011. There were no outliers for 2012.
DC HSA Evaluation; Snelling & Belson; 2013
School Nutrition
2012
DC Public and Charter Schools
2012
Number of schools
Public
Charter
Total
108
98
206
93%
98%
96%
97%
94%
98%
71%
77%
74%
90%
99%
98%
94%
96%
98%
92%
98%
98%
100%
97%
99%
LUNCH MENU COMPONENTS
A different vegetable every day of the week
Dark green and/or orange vegetables at
least three times a week?
Cooked dry beans or peas at least once a
week?
A different fruit every day of the week?
Fresh fruit at least twice a week?
A whole grain food serving every day of the
week?
Milk each day?
DC HSA Evaluation; Snelling & Belson; 2013
Schools Reporting on a
Local Wellness Policy and a Wellness Council
LW Policy
2012
DCPS (n=113)
50%*
Charter (n=93)
84%*
Wellness Council
2012
DCPS (n=113)
27%*
Charter (n=93)
40%*
* Significant difference between DCPS and Charter Schools
DC HSA Evaluation; Snelling & Belson; 2013
Prevalence of School Gardens
2011 & 2012
DCPS and Charter Schools
Answered “YES”
Have a school garden
2011*
2012*
DCPS
Charter
38% (n =117)
22% (n=89)
41% (n=113)
26% (n=93)
* Significant difference between DCPS and Charter Schools in 2011 and in 2012
DC HSA Evaluation; Snelling & Belson; 2013
Promoting Additional Physical Activity
2011 & 2012
DCPS and Charter Schools
AFTER SCHOOL
ACTIVITIES
2011
DCPS
Charter
87% (n =117)
80% (n=89)
2012
88% (n=113)*
76% (n=93)*
* Significant difference between DCPS and Charter for 2012
ATHLETIC PROGRAMS
DCPS
Charter
2011
75% (n =117)*
62% (n=89)*
2012
70% (n=113)
68% (n=93)
* Significant difference between DCPS and Charter for 2011
DC HSA Evaluation; Snelling & Belson; 2013
Schools Working with Outside Partners:
Physical and Health Education
Partner with
Outside Programs
2012
DCPS (n=113)
Charter (n=93)
40%
45%
DC HSA Evaluation; Snelling & Belson; 2013
Most Frequent Partners
• Alliance for Healthier
Generation
• BOKs Program
• Children’s National
Medical Center
• City Year
• DC Scores
• DC Eat Smart Move
More Program
• Playworks
• Revolution Foods
• Department of Health &
Mental Health
Over 100 different programs/partners were listed
DC HSA Evaluation; Snelling & Belson; 2013
Composite Score
DC HSA Evaluation; Snelling & Belson; 2013
Composite Score Methodology
• Based on previous research 1-5
• Composite score is an indicator of the strength
of the school environment’s health
• Assigned scores to the key provisions
• Many of the scores were either yes (1) or no
(0)
• Five variables were given a “sliding” score
• Maximum score : 35
DC HSA Evaluation; Snelling & Belson; 2013
Composite Score Development:
Five Components Based on HSA
Environment
3%
Health and
Wellness
14%
School Nutrition
20%
Farm-to-School
Program
6%
Physical and
Health Education
57%
DC HSA Evaluation; Snelling & Belson; 2013
0
5
10
15
20
HSA Composite Scores for
DCPS and DC Charter School
5
10
15
20
Composite Score
25
DC HSA Evaluation; Snelling & Belson; 2013
30
Distribution of Composite Scores for Public and Charter Schools
Charter
Public
5
10
15
20
25
Composite Scores
DC HSA Evaluation; Snelling & Belson; 2013
30
Grants and Awards
• Grants
– PAY Grants
– School Garden Grants
• Healthier US School Challenge
–
–
–
–
Voluntary award
Follows the 2010 Dietary Guidelines
Includes time for physical and health education
Four levels: bronze, silver, gold, and gold with
distinction
DC HSA Evaluation; Snelling & Belson; 2013
Rankings of Schools
Based on the Composite Score
27
25.8
26
25
24
Mean
Composite Score 23
22
23.4
22
22.4
21
20
Mean Score for all
Schools
1 (n=63)
2 (n=5)
Number of Awards Received
DC HSA Evaluation; Snelling & Belson; 2013
3 (n=2)
US Healthier School
Challenge Award
27
26
25
Mean
24
Composite
23
Score
22
21
20
Bronze (n=7)
Silver (n=28)
DC HSA Evaluation; Snelling & Belson; 2013
Gold (n=5)
Provisions where schools are
succeeding
• School nutrition offerings
•
•
•
•
Different daily vegetable offered
Different daily fruit offered
Offering fresh fruit at least twice per week.
Offering a dark green or orange vegetable at least once
per week.
• OSSE physical and health education standards are
being used.
• Some students are required to take physical and
health education.
DC HSA Evaluation; Snelling & Belson; 2013
Provisions where schools need
additional resources and/or support
• Number of teachers: physical education and
health education
• Minutes of health and physical education
• Farm-to-School education programs
• School gardens
• Local foods
• Communicating policy
• Having a wellness council
DC HSA Evaluation; Snelling & Belson; 2013
Relationship between Composite
Scores and Academic Scores &
Percent Free/Reduced Lunch
DC HSA Evaluation; Snelling & Belson; 2013
30
25
20
15
10
5
Composite Score
Composite Scores and Free and Reduced Price Lunch
0
20
40
60
Percent of Free or Reduced Price Lunch
DC HSA Evaluation; Snelling & Belson; 2013
80
100
20
15
10
5
Composite Score
25
30
Composite Scores and CAS Reading
0
20
40
60
CAS Reading Percent Proficient
DC HSA Evaluation; Snelling & Belson; 2013
80
100
20
15
10
5
Composite Score
25
30
Composite Scores and CAS Math
0
20
40
60
CAS Math Percent Proficient
DC HSA Evaluation; Snelling & Belson; 2013
80
100
YRBS Results
• Variables:
– Food Choices
– Self-report grades
1) A, B, C, D, F
– Physical Activity
1) days with 60 minutes of
physical activity in the past
week
2) average of hours of TV
watched in a day
3) average hours playing
video games
4) number of days in PE at
school
1) [drink] 100% fruit juices
2) fruit
3) green salad
4) potatoes
5) carrots
6) other vegetable
7) [drink] a can, bottle, or
glass of soda
8) Fast food consumption
DC HSA Evaluation; Snelling & Belson; 2013
Mean values of physical activity variables
over levels of self-reported grades
DC HSA Evaluation; Snelling & Belson; 2013
Mean values of food consumption variables over
levels of self-reported grades
DC HSA Evaluation; Snelling & Belson; 2013
Limitations & Opportunities
•
•
•
•
Limitations
Self-report data
School-level data
Data collection takes time
and funding
Validity and reliability of the
instruments
•
•
•
•
Opportunities
Build a Longitudinal
relational data set
Design targeted
programming to
increase the health of
children in DC
Build healthy students
Model example for
other urban areas
DC HSA Evaluation; Snelling & Belson; 2013
Closing Remarks
• Continued monitoring of the HSA is critically important
• Additional resources need to be available in the
schools to reach the minutes of health and physical
education
• Communicate the Wellness Policies to Principals and
School Staff
• Encourage schools to apply for grants and awards
• Composite scores & academics (math) shows us the
relationship between health and academics
• Missing is student-level data especially on health status
DC HSA Evaluation; Snelling & Belson; 2013
Questions for Lunch Discussion
• Identify an interesting result
• Identify a research question to answer
• Describe additional data that can be incorporated
• Suggest recommendations for OSSE, DCPS, DC
Charter Schools, and the Commission
DC HSA Evaluation; Snelling & Belson; 2013
References
1.
2.
3.
4.
5.
Brener ND, Chriqui JF, Terrence P et al. Establishing a baseline measure
of school wellness-related polices implemented in a nationally
representative sample of school districts. J Am Diet Assoc 2011;111:894901.
Budd EL, Schwartz C, Yount BW, Haire-Joshu D. Factors influencing the
implementation of school wellness policies in the United States, 2009.
Preventing Chronic Disease, 2012, volume 9.
Lyn R, O’Meara S, Hepburn VA, Potter A. Statewide evaluation of local
wellness policies in Georgia: An examination of policy compliance, policy
strength, and associated factors. J Nutr Educ Behav 2012;44(60:513-519)
Schwartz MB, Lund AE, Grow M et al. A comprehensive coding system to
measure the quality of school wellness policies. J Am Diet Assoc
2009;109:1256-1262.
Turner L, Chaloupka FJ. Slow progress in changing the school food
environment: Nationally Representative Results from Public and Private
Elementary Schools. J Acad Nutr Diet 2012;112:1380-1389.
DC HSA Evaluation; Snelling & Belson; 2013
Thank You
DC HSA Evaluation; Snelling & Belson; 2013