We found significant increases in the percentage of middle and high schools reporting the presence of certain PAN policies and practices after the implementation of the Washington State PAN mandate. This is the first published study to present a longitudinal analysis of changes in PAN policies and practices in 1 state by using measures of PAN policies and practices in another state for comparison to control for secular trend.
In 2002, few schools in Washington State had restricted access to competitive foods or nutrition-related policies in place, although most schools did have healthy food options available. It is not surprising that restricted access to competitive foods and school food practices were areas for growth, even in absence of the Washington mandate. We were surprised, however, to find a substantial decline in the percentage of middle and high schools offering healthy food options. Because the Profiles questions about healthy food options focused on the availability of healthy foods in vending machines and school stores, these schools may have been eliminating these venues for food purchases rather than reducing the availability of healthier food types in vending machines or school stores. Another explanation for the decline may be changing perceptions of school principals about what constitutes a "healthy" option.
Because so many Washington State schools already had physical activity policies and practices in place before the statewide mandate, opportunity for growth in this area was limited. The only area that changed after the implementation of the law was an increase in the number of schools that were not allowing student exemptions from PE because of participation in school sports and other school or community activities. Rather than trying to fund new provisions and programs for physical activity, the elimination of exemptions from PE may have been a budget-neutral way for schools and districts to respond to the mandate.
Our study's findings of a significant increase in nutrition policies and practices and only small improvement in physical activity policies are consistent with a recent study of trends in state-level school nutrition and physical activity policy environments (14
). That study found that schools adopted more food service and nutrition policies than physical activity, education, or weight assessment policies. Similarly, a study of the effects of federal wellness legislation in school districts throughout the United States found that nutrition components were the most frequently implemented (10
). However, even in the presence of nutrition policies, improvements in school food environments are modest (15
), and foods of minimal nutritional value remain available (16
). In contrast to most nutrition policies, many physical activity policies have a direct effect on instruction time (eg, requiring more PE classes or longer classes), and this may be a barrier to school districts adopting such changes.
We saw very few differences in change associated with various school-level factors, such as urban/not urban setting, SES, and academic performance. This suggests that the effect of a policy mandate was similar among different school types.
Washington State did not allocate funding to support schools in implementing their PAN policies, nor was there meaningful quality assurance of adopted policies or clear punitive measures in place for school districts that failed to effectively implement a policy. Addition of any of these supportive measures might have resulted in different — perhaps greater — policy and practice improvements.
This study has several limitations. First, we did not see appreciable increases in physical activity policies and practices associated with the Washington State mandate. This may indicate that Profiles did not ask about the features of the model policy that were most emphasized and acted on by local school districts. A substantial portion of the language in the model policy described the amount of instructional time for physical education, which was not asked about in the Profiles questionnaire. Second, we examined the changes in school policies and practices only 1 year after the Washington statewide PAN mandate went into effect. Arguably, 1 year is too short a time for schools to mobilize their efforts for PAN-related policy changes. However, we did see changes in restricted access to competitive foods, nutrition policy, and reduced exemptions from PE relative to trend, which could confirm that PAN effected changes. Conversely, a federal wellness policy requirement similar to the Washington policy requirement was scheduled for implementation in both Washington and Oregon in the fall of 2006, and the Profiles survey was administered in spring of that year. Thus, some Oregon schools may have already responded to the federal requirement. If this was the case, our analysis of the Washington trends may have underestimated the real effect of the Washington mandate. Finally, this study describes the policy environment in the Pacific Northwest, which may differ in other regions.
Future studies should examine the relationship between state and federal laws and the quality of PAN policy implementation in schools and the association of PAN policy with youth PAN outcomes.
Our results suggest that a statewide mandate had a modest positive effect on PAN policies and practices in schools. Government policy is potentially an effective tool for addressing the childhood obesity epidemic through improvements in PAN environments in schools.