Decision making in Massachusetts public high schools: Contextual factors that influence restrictions of foods of minimal nutritional value

Background: Foods of Minimal Nutritional Value (FMNV) in public schools may contribute to child and adolescent obesity. Many Massachusetts public schools have decreased the amount of FMNV available to students, but much still remains. Although the Wellness Policy took effect in 2006, local districts and schools continue to make their own decisions about food restrictions. Purpose: Understanding contextual factors that influence decisions related to FMNV, is critical to inform future policy. This study examines environmental and organizational factors that influence decisions around restricting FMNV outside of school meal programs. Methods: A survey of 100 schools in Massachusetts and an in-depth case study analysis of 5 school districts were conducted. Results: FMNV were available in most schools, with some notable restrictions compared to literature from 5 to 10 years ago. Power structures and decision processes related to food environments varied widely among schools and districts. Organizational decisions were shaped largely by environmental context. These included control of budget and revenue streams, stakeholders' beliefs and values, school, family and community culture as well as statutory requirements and organizational hierarchy. Policy Implications: Policies that promote change, provide broad guidelines and support, increase public awareness and allow for variation at local levels may be more effective than mandates that impose strict nutrition standards.