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Background: Early care and education settings (ECE) are potential venues for young children to develop healthy lifestyle habits. The study assesses training needs and associations with relevant practices of licensed ECE providers across Minnesota and Wisconsin. Methods: A random sample of 823 providers completed a 97-item survey assessing nutrition and physical activity (PA) practices and training needs. Logistic regression, adjusted for program type (center- and family home-based), and location (urban/rural) examined associations between the top 3 selected training needs and provider practices. Results: Top training needs: (1) ways to effectively engage parents about healthy eating and PA, (2) low-cost ways to serve healthy foods, and (3) fun and easy nutrition education curricula. Providers who reported being not happy/somewhat happy vs happy/very happy with parent communication were more likely to need training to engage parents. Among providers who prepared food on-site, shopping at Farmer's Market had lower odds of needing training for serving healthy meals on a budget. Not having completed nutrition training in the past year providers were more likely to need training for fun and easy nutrition education curricula. Conclusions: Providers need additional training to improve communication with parents, healthy food shopping practices, and nutrition-related games.

Background: Breakfast consumption often decreases as youth get older. The School Breakfast Program (SBP) provides an opportunity to intervene and increase breakfast consumption, especially among high school students. Methods: Project breakFAST implemented an expanded breakfast service at 12 high schools. In this longitudinal evaluation, school administrators provided SBP participation and demographic data on all ninth and 10th graders for two full consecutive school years. Students screened for eating breakfast <3 times/week were randomly selected to participate in the cohort study. The cohort completed a survey on perceived barriers, benefits, and breakfast habits. Results: At baseline, all 12 schools had only traditional before school cafeteria SBP service. Mean participation was 16.3% and ranged from 7.9 to 38.1%. After the intervention, there was an increase in participation to 25.7% (p = 0.004) ranging from 14.1 to 47.5%. There was no change in breakfast participation before school (13.3%, p = 0.06). Students who traveled to school by car, bike, or walking at baseline were 4.5% less likely to participate in second chance breakfast at follow-up than those who took the bus to school (p = 0.006). Conclusion: Second chance breakfast is an option for increasing high school breakfast participation, especially for those riding the bus.

Background: Adolescents frequently miss breakfast which may impact cognitive, academic, and health outcomes. This analysis describes the effect of a trial to assess school level changes to increase breakfast consumption on grade point average (GPA). Methods: Sixteen rural Minnesota high schools were randomized to a policy and environmental change intervention or delayed intervention (control) group. Baseline screening identified, randomly selected and enrolled 9th and 10th grade students who eat breakfast =3 times per school week for assessment. Mean unweighted GPA was provided by 13 schools for 636 students. Student-level and administrative data were used for sociodemographic and free or reduced-price meals (FRPM). Linear mixed models and latent class analysis (LCA) were used to assess change in GPA. Results: Students were 54% female, 76% white, and 34% received FRPM. Unweighted cumulative GPA mean = 2.82 (0.78) at baseline. There was no significant intervention effect on GPA postintervention or 1-year follow-up. LCA revealed two classes: "higher" (N = 495) and "lower" (N = 141) resource. There was an intervention effect among low-resource students from baseline to 1-year post only among the control condition (delayed intervention). Conclusions: In combination with the full study results, increasing breakfast consumption may have an impact particularly for low resource students.

Licensed child care providers, and the early care and education settings in which they operate, are uniquely situated to influence children's healthy eating and physical activity through practices, attitudes, and supportive physical and social environments. However, preliminary research indicates that child-, family-, and provider-level characteristics affect adherence to best practices across early care and education settings. The current article used survey data (n = 618) to characterize differences in child care providers' adherence to nutrition, physical activity, and mealtime best practices, based on child-, family- and provider-level characteristics, and to describe secular trends in adherence to nutrition and physical activity best practices between 2010 and 2016. Results indicate that differences exist across certain characteristics, including child race/ethnicity, family's use of child care assistance, language spoken at home, and provider educational attainment; however, it is notable that in most cases providers serving children of minority race and children in low-income families have a higher rate of compliance with the nutrition and physical activity best practices studied. Additionally, the comparison of adherence to best practices from 2010 to 2016 suggests that, while there was an increase in mean adherence from 2010 to 2016, overall trends in adherence across child-, family- and provider-level characteristics have been consistent across time. Public health professionals should continue to advocate for opportunities for providers to learn how to best incorporate best practices within their setting (e.g., education and training opportunities) as well as for the development and adoption of systems-level changes (e.g., expansion of food assistance programs) to reduce barriers to adherence to best practices.

University of Minnesota (UMN) Extension has assisted schools in making policy, systems, and environmental (PSE) changes to improve the school food environment. UMN Extension's involvement in the Project breakFAST program demonstrates how Extension can provide training and technical assistance to support school staff in making PSE changes that improve teens' access to school breakfast. Intervention schools increased participation in school breakfast by 56%, whereas comparison schools increased participation by only 7%. Background on and details of the project will be useful to others in Extension interested in assisting schools in implementing PSE changes.

Background: In this study, we describe state agency strategies to support weight-related policy implementation in schools, and examine the association among state support, obesity prevalence, and strength of state policies governing school nutrition and physical education. Methods: The 2012 School Health Policies and Practices Study describes prevalence of implementation support state agencies provided to schools/districts. Implementation support items were analyzed by weight-related policy area (e.g., advertising, wellness policy) and by type of support (e.g., technical assistance). Results were summed to create a total weight-related policy support score. Linear regression was used to examine associations between policy support and state youth obesity prevalence (2011-2012 National Survey for Children's Health), overall and stratified by state policy strength (2012 Classification of Laws Associated with School Students). Results: States provided support most commonly for school meals and wellness policies (89% and 81%, respectively) and least often for after-school PE (26%). Most states (80%) provided technical assistance. The total weight-related policy support score had a significant positive association with state-level youth overweight/obesity prevalence (p = 0.03). Conclusions: State agencies appear to be responding to their youth obesity prevalence with technical support. Schools and state agencies should work in collaboration to provide a healthy school environment for all students.

Background: The purpose is to determine if altering school breakfast policies and the school breakfast environment will positively impact adolescent beliefs of the barriers and benefits of eating breakfast. Methods: There were 904 adolescents from 16 rural high schools, Minnesota, in the BreakFAST Study who reported eating breakfast fewer than 4 times per week at baseline. Schools were randomized to intervention (N = 8 schools) or delayed intervention (N = 8) condition. The intervention lasted 1 school year. Students completed an online survey of beliefs of barriers and benefits to eating breakfast at baseline and follow-up. Summative scales were created. Bivariate and multivariate linear regression, accounting for clustering by school, was performed using SAS. Sex interaction was tested. Models tested the effect of the intervention on change in summative scales from baseline to follow-up. Results: Participants were 54% female, 69.1% white, 36.6% eligible for free or reduced-price meals (FRM) and 13.1% of families received public assistance. The change in reported barriers was significantly different in intervention versus control schools (Net difference = 1.0, p = 0.03). There was no intervention effect of perceived benefits. Conclusions: A school-based policy and environmental change intervention can successfully reduce perceived barriers to eating school breakfast.

Background: Little is known about adolescents' food purchasing behaviors in rural areas. This study examined whether purchasing food at stores/restaurants around schools was related to adolescents' participation in school breakfast programs and overall diet in rural Minnesota. Methods: Breakfast-skippers enrolled in a group-randomized intervention in 2014 to 2015 (N = 404 from 8 schools) completed 24-hour dietary recalls and pre/post surveys assessing food establishment purchase frequency. Healthy Eating Index Scores (HEI-2010) were calculated for each student. Student-level school breakfast participation (SBP) was obtained from school food service records. Mixed-effects regression models estimated: (1) whether SBP was associated with store/restaurant use at baseline, (2) whether an increase in SBP was associated with a decrease in store/restaurant use, and (3) whether stores/restaurant use was associated with HEI-2010 scores at baseline. Results: Students with increased SBP were more likely to decrease fast-food restaurant purchases on the way home from school (OR 1.017, 95% CI 1.005, 1.029), but were less likely to decrease purchases at food stores for breakfast (OR 0.979, 95% CI 0.959, 0.999). Food establishment use was associated with lower HEI-2010 dairy component scores (p = 0.017). Conclusions: Increasing participation in school breakfast may result in modest changes in purchases at food establishments.

Background: Long-term evaluation studies reveal that high-quality early care and education (ECE) programs that include a lifestyle component predict later adult health outcomes. The purpose of this article is to characterize the nutrition and physical activity (PA) practices, including implementation difficulty and barriers, of licensed center- and family home-based ECE programs serving 2- to 5-year-old children in Minnesota (MN) and Wisconsin (WI). Method: A stratified random sampling procedure was used to select representative cross sections of licensed ECE providers in MN and WI. A total of 2,000 providers (1,000 center-based, 1,000 family home-based) were randomly selected and invited to respond to a 97-item survey with questions representing (1) nutrition and PA practices, (2) barriers to meeting nutrition and PA best practices, and (3) written and implemented nutrition and PA policies. Summated scales were constructed for nutrition-related (range 0-15; Cronbach's a = 0.86) and for PA-related best practices (range 0-10; Cronbach's a = 0.82). Results: A total of 823 providers returned surveys between August 2010 and March 2011, resulting in a 44% bistate participation rate. Across all programs an average (SD) of 7.0 (4.1) nutrition best practices were already implemented. Center-based providers reported on average 0.8 additional nutrition best practice (7.4 vs. 6.6, p = 0.01). Across all programs an average (SD) of 5.2 (3.1) PA best practices were already implemented. Center-based providers reported on average one more PA best practice (5.3 vs. 4.3, p < 0.01). The cost of healthy food and the weather were identified as barriers by 80% of providers, regardless of program type.

Background: We examined whether there are differences in the presence of supports for student wellness promotion (1) between schools in city, suburban and rural locations and, (2) among rural schools, according to distance from a metropolitan center. Methods: The analysis was conducted in a sample of 309 secondary schools using 2012 Minnesota School Health Profiles surveys and National Center for Educational Statistics Common Core Data. Scores for overall support addressed school health improvement coordination (range: 0-29), collaboration on health education activities (range: 0-5), and teachers' professional preparation (range: 0-7). Results: Mean overall scores for health improvement coordination (10.5 ± 7.3), collaboration on health education activities (3.0 ± 1.5) and professional preparation (4.0 ± 1.9) indicated supports are lacking in schools across city, suburban, and rural locations. Comparison of overall scores did not identify disparities; however, weaknesses and strengths of particular relevance for rural schools were identified in examining specific aspects of support. For example, the proportion of rural schools having a written school improvement plan was 54.8% compared to 84.6% of city schools and 64.3% of suburban schools (p = 0.01). Conclusions: Tailored training and technical assistance are needed to better support schools in implementing recommended wellness policies and practices.

Background: This study examines school strategies to educate parents over time about physical activity and nutrition and how those strategies are related to adolescent health behaviors. Methods: Data from the Minnesota School Health Profiles Lead Health Education Teacher survey (2008-2012) and the Minnesota Student Survey (MSS, 2013) included provisions for parent education about physical activity and nutrition and student physical activity and dietary intake behaviors. Analyses were performed using SAS, version 9.3. A generalized estimating equation (GEE) was used to examine changes over time in school policies. Adjusted linear regression models examined cross-sectional association between school policies (2012) and school-level mean student outcomes (2013). Results: Parent education about physical activity and nutrition was constant over time, with the exception of a decrease in physical activity education in schools with low minority enrollment. There was a positive relationship between schools offering physical activity education for parents and the number of days a student meets physical activity and water consumption recommendations. There was no relationship between strategies for nutrition education and dietary intake. Conclusions: School providing strategies for parent engagement around student physical activity and nutrition may increase parent engagement overall and improve adolescent and school-related outcomes.

Background: Food-insecure (FIS) adolescents struggle in school and with health and mental health more often than food-secure (FS) adolescents. Rural communities experience important disparities in health, but little is known about rural FIS adolescents. This study aims to describe select characteristics of rural adolescents by food-security status. Methods: Baseline analysis using data from a randomized trial to increase school breakfast participation (SBP) in rural Minnesota high schools. Students completed a survey regarding food security, characteristics, and home and school environments. Schools provided academic data and staff measured height and weight. Food security was dichotomized as FS vs FIS. Bivariate analysis, multivariate linear/logistic regression, and testing for interaction of food security and sex were performed. Results: Food-insecure adolescents reported poorer health, less exercise, had lower grades, and higher SBP (p < 0.01). Food-insecure adolescents reported marginally fewer barriers (p = 0.06) and more benefits of breakfast (p = 0.05). All associations except reported benefits remained significant after adjustment. Interactions were identified with girls' grade point average and with boys' caloric and added sugar intake. Conclusions: Negative associations among food insecurity and positive youth development are identified in our sample. Policy and environmental strategies should address the complexities of these associations, including exploration of the role of school meals.

Weight-related outcomes were examined among high school students in Minnesota public school districts according to the quality of district wellness policies. Wellness policy strength and comprehensiveness were scored using the Wellness School Assessment Tool (WellSAT) for 325 Minnesota public school districts in 2013. The associations between WellSAT scores and district-level means of high school student responses to a statewide survey of health behaviors were examined in this ecologic study. WellSAT Total Strength and Total Comprehensiveness scores were positively associated with both student mean Body Mass Index (BMI) percentile (Strength: P = 0.018, Comprehensiveness: P = 0.031) and mean percent overweight or obese (Strength: P = 0.008, Comprehensiveness: P = 0.026), but only in districts with >50% of students eligible for Free or Reduced-Price Lunches (FRPLs), or "high FRPL districts". WellSAT Physical Education and Physical Activity subscale scores were also positively associated with the mean days per week students engaged in physical activity for = 60 min in high FRPL districts (Strength: P = 0.008, Comprehensiveness: P = 0.003) and in low FRPL districts (<35% eligible) for Strength score: (P = 0.027). In medium FRPL districts (35-50% eligible), Nutrition Education and Wellness Promotion Strength and Comprehensiveness subscale scores were positively associated with, respectively, daily servings of vegetables (P = 0.037) and fruit (P = 0.027); and WellSAT Total scores were positively associated with daily vegetable servings (Strength: P = 0.037, Comprehensiveness: P = 0.012). Administrators of economically disadvantaged school districts with a higher percentage of overweight students may be recognizing the need for stronger wellness policies and the specific importance of implementing policies pertaining to physical activity as a means to improve student health.

Background: Although there are several evidence-based recommendations directed at improving nutrition and physical activity standards in schools, these guidelines have not been uniformly adopted throughout the United States. Consequently, research is needed to identify facilitators promoting schools to implement these recommendations. Therefore, this study analyzed the 2008 School Health Profiles Principal Survey (Profiles) to explore the role of family and community involvement in school nutrition and physical activity standards. Methods: Survey data on nutrition and physical activity policies, as well as family and community involvement, were available for 28 states, representing 6732 secondary schools. One-factor analysis of variance (ANOVA), 2-sample t-tests, Pearson's chi-square tests, and multiple logistic and linear regression models were employed in this analysis. Results: Family and community involvement were associated with schools more frequently utilizing healthy eating strategies and offering students healthier food options. Further, involvement was associated with greater support for physical education staff and more intramural sports opportunities for students. Conclusions: Though family and community involvement have the potential to have a positive influence on school nutrition and physical activity policies and practices, involvement remains low in schools. Increased efforts are needed to encourage collaboration among schools, families, and communities to ensure the highest health standards for all students.

Objectives and Participants: The purpose of this article is to describe weight indicators and weight-related behaviors of students enrolled in 2-year colleges, including sex differences. Methods: During Fall 2011 and Spring 2012, 441 students from 3 Minnesota community colleges enrolled in the Choosing Healthy Options in College Environments and Settings (CHOICES) Study and completed baseline assessments. Participants completed a baseline survey evaluating eating and activity patterns, sleep, and stress and measures of height, weight, waist circumference, and body fat. Results: Participants were primarily female (68%), white (73%), with a mean age of 22.8 years, and 66.2% reporting an annual income < $12,000. Almost half (47%) were overweight or obese. Young males appeared to engage the most in risky health behaviors and had higher levels of overweight or obesity, compared with young females. Conclusions: Findings confirm the need for innovative interventions targeting this understudied and underserved young adult population.

Background: The purpose of this study was to describe promotions for unhealthy and healthy foods and beverages within Minnesota secondary schools from 2008 to 2012, and to examine associations with school-level coordination of environmental improvements and students' dietary behaviors. Methods: The Minnesota School Health Profiles and Minnesota Student Survey data were used along with National Center for Education Statistics data to conduct analyses accounting for school-level demographics. Result: There was no significant improvement over time in the proportion of schools that banned advertising for unhealthy products in school buildings, on school grounds, on buses, or in publications. Whereas more than two thirds of schools had implemented strategies focused on the promotion of fruits/vegetables by 2012, only 37% labeled healthful foods with appealing names and just 17% used price incentives to encourage healthy choices. The number of stakeholders representing different roles on school health councils was positively correlated with implementation of healthy food and beverage promotion strategies. Little evidence was found to support an influence of in-school advertising bans or promotions on students' diets. Conclusions: Policy changes are needed to protect students from food and beverage advertising and additional opportunities exist to reduce disparities in the selection of healthy options at school.

Background: This study tested the feasibility and acceptability of adding a reimbursable snack that meets the Institute of Medicine nutrition recommendations to an afterschool homework program for middle school students. Methods: Snack menu was developed and administered to students attending an afterschool homework program over 12 weeks. In spring 2009, two cross-sections of middle school students completed study measures, including snack preferences. Key school personnel completed follow-up interviews assessing program feasibility. Results: Survey evaluations from 110 students at baseline and 113 at posttest suggested improved preferences for healthy snacks. Teacher supervisors (n = 3) and the assistant principal rated the pilot project as feasible and beneficial, whereas school food service (n = 3) rated the program unsustainable because of administration logistics and costs. Conclusions: The addition of healthy snacks to afterschool programs was liked by students and teachers. However, policies that support simpler accountability procedures may be needed for school-based afterschool snack programs to be sustainable. (Contains 2 tables.)

Background: This study examines the results of federal legislation on the content and quality of policies written in 2005-2006 by Utah school districts (n = 30). Methods: Policies were gathered by phone call requests to school districts or obtained on district Web pages. Content was compared to requirements outlined in the Child Nutrition Reauthorization Act (CNRA) of 2004 and recommendations made by a state coalition of health and education agencies. The strength of the language was assessed (mandate vs recommendation), and characteristics of school districts that adopted strong policies were identified. Results: The majority of Utah school districts (78%) complied with the federal guidelines, and a variety of state recommended nutrition and physical activity policy statements were included. The strength of the language used in the policies revealed that districts were more likely to mandate items already required by other entities or well established in the district. School districts with high participation in free- and reduced-price programs had significantly more mandatory policies (mean = 9.2) versus low (mean = 7.1) and medium enrollment (mean = 4.7). Urban school districts were more likely to indicate mandatory competitive food policies than rural and suburban (mean = 2.3 vs 0.93, 0.83). There were no differences in policy language between school districts based on race or size. Conclusions: Compliance with the CNRA may be a positive step toward improving the school nutrition and physical activity environment, but it does not ensure a comprehensive or powerful policy. Schools and community partners must continue to work together to strengthen wellness policies and programs. (Contains 3 tables.)

Objective: To identify regional, organizational, and personal characteristics that predict awareness and adoption of a dietary curriculum training and CD among educators. Methods: A cross-sectional study of educators (n=675) representing 48 states report program awareness and factors that influenced adoption. Results: Among those surveyed, 354 educators were aware (52%) of the CD and 192 educators adopted it (54%). Adopters were nearly 8 times more likely to identify training time and nearly 7 times more likely to identify CD training method as influencing adoption. Conclusion: Although regional and organizational characteristics are predictors of awareness, these variables were less likely to predict adoption of such programs.

Background: Two Healthy People 2020 goals are to increase physical activity (PA) and to reduce disparities in PA. We explored whether PA at the school level changed over time in Minnesota schools and whether differences existed by demographic and socioeconomic factors. Methods: We examine self-reported PA (n = 276,089 students; N = 276 schools) for 2001-2010 from the Minnesota Student Survey linked to school demographic data from the National Center for Education Statistics and the Rural-Urban Commuting Area Codes. We conducted analyses at the school level using multivariable linear regression with cluster-robust recommendation errors. Results: Overall, students who met PA recommendations increased from 59.8% in 2001 to 66.3% in 2010 (P < .001). Large gains in PA occurred at schools with fewer racial/ethnic minority students (0%-60.1% in 2001 to 67.5% in 2010, P < .001), whereas gains in PA were comparatively small at schools with a high proportion of racial/ethnic minority students in 2001 (30%-59.2% in 2001 to 62.7% in 2010). Conclusions: We found increasing inequalities in school-level PA by racial/ethnic characteristics of their schools and communities among secondary school students. Future research should monitor patterns of PA over time and explore mechanisms for patterns of inequality. [ABSTRACT FROM AUTHOR]