Measuring the school nutrition and physical activity (SNPA) environment - a case for assessing school resources and readiness for changing the context to address child obesity

Elementary schools are key sites for delivering nutrition and physical activity education and promoting healthy behaviors. Most school-based programs model outcomes at the level of the individual and evaluate impacts at the level of changes in students' abilities and behaviors. A public health approach to promoting healthy habits focuses efforts on changing the context of the behavioral environmental to make healthy options the default choice. Purpose: The School Nutrition and Physical Activity (SNPA) tool was developed to fill a gap in our understanding of the interplay between characteristics of students and schools, and that effect on students' nutrition and physical activity choices as well as health (whole school BMI). Methodology: A descriptive case study approach at the school level was employed to pilot (n=3) and implement (n=6) the SNPA. The SNPA demonstrated strong inter-rater reliability when used by trained evaluators, sensitivity when assessing school resources and readiness to address the conditions, and efficacy for identifying environmental and policy characteristics needing improvement. Findings: Among 6 rural elementary schools, objectively measured overweight (36% vs.18%) and obesity (19% vs.15%) rates (grades K-5) were higher than Oregon (children age 2 < 5 years), respectively. SNPA assessments revealed that generally rural schools are poised to address the issue but planned efforts are not focused or evidence-based. Conclusions/Recommendations: SNPA assessments and reports can be leveraged to secure grant funding for school partners to improve SNPA environments, document school-level changes resulting from national, state, and/or district level policies, and evaluate school SNPA performance factors and practices.