Using Diffusion of Innovations (DOI) in Organizations as a theoretical framework, this dissertation analyzed the diffusion process of the federally mandated School Wellness Policy (SWP) in three separate studies. Beginning with a content analysis of the SWP mandate's legislative history using the constant comparative method, the first manuscript evaluated the policy Initiation process to provide context for the creation of the original mandate. Next, the researcher conducted a systematic literature review to organize and analyze the current literature on SWP implementation. The third manuscript presented a qualitative case study of one local school district's experience implementing the School Wellness Policy. Interviewing school personnel such as teachers, school nurses, PE teachers, and cafeteria mangers provided key insight to processes involved in policy implementation at the local level. Three key findings emerged from the study: 1) a lack of research on the clarifying stage of the policy diffusion process, 2) the limitation of policy alone in addressing child obesity, and 3) an opportunity for health promotion researchers to engage in policy research. This study is unique because it analyzed the complete diffusion process of the SWP policy, beginning with policy decision making by legislators on the federal level and ending with policy implementation efforts by school district personnel on the local level. Public attention to the child obesity epidemic has grown significantly in the last decade. However, increased awareness is not necessarily indicative of change or improvement of the problem. In the case of the School Wellness Policy (SWP), the federal government attempted to mandate change in the school environment as a way of combating the child obesity epidemic. Although public policy can be effectively used to facilitate change, policy alone is incapable of solving problems as vast and complex as the child obesity epidemic. The SWP has resulted in changes to the school environment; but, this study showed that a societal shift (change across all private and public sectors) is necessary for long term success in combating child obesity.

In 2010, approximately two-thirds of adults and one-fifth of the adolescent population in the United States were considered either overweight or obese, resulting in the United States having the highest per capita obesity rate among all OECD countries. A considerable body of literature regarding health behavior, health outcomes, and public policy exists on what the Centers for Disease Control and Prevention considers an obesity epidemic. In response to the growing problem of childhood obesity, the Child Nutrition and WIC Reauthorization Act of 2004 (CNRA), which required that schools participating in the National School Lunch Program and/or School Breakfast Program have wellness policies on file, was passed. The purpose of this research is to provide additional insight into the origin of the geographic variation in adolescent obesity rates between the U.S. states. Previous research has looked at differences in built environments, maternal employment, food prices, agriculture policies, and technology factors in an effort to explain the variation in adolescent obesity prevalence. This dissertation contributes to the literature by examining the hypothesis that state-level school wellness policies also played a role in determining the rates of childhood obesity. Using School Health Policies and Practices Study (SHPPS) surveys from 2000 – 2012, I derived a state-level school wellness policy measure. This, together with Youth Risk Behavior Surveillance survey data on adolescent BMI was used to measure the effect of the wellness policy mandate on adolescent obesity prevalence. Several models were applied to first demonstrate that the state of residence for an adolescent is indeed related to BMI trends and then to investigate various determinants of adolescent obesity including the primary variable of interest, state school wellness policies. The results of this research provide evidence of a statistically significant, although very small positive effect of school wellness policies on adolescent BMI that is contrary to my hypothesis. Dominance analysis showed that of the four wellness policy factors considered in the principal component composition of the wellness policy measure, policy components that met state requirements rather than those meeting health screen criteria, state recommendations, and national standards were most important in explaining the overall variance of the regression model. Interestingly, the public school attendance rate itself was also associated with a substantial decrease in adolescent BMI. Understanding the determinants of adolescent obesity and how to effect change in the rising trend is a national concern. Obese adolescents are at significant risk of becoming obese adults and previous research has already shown the high economic costs associated with adult obesity and its comorbidities. Policies implemented in school, where adolescents consume a considerable portion of their daily calories and participate in physical activity, can help to build healthy habits that have the potential to lower the probability of an adolescent becoming an obese adult. Over time, a healthier adult population may result in lower economic costs associated with medical care and lost productivity.

Previous studies have identified the barriers foodservice directors encounter when developing and implementing nutrition policies (40- 44). However, no research has compared Local School Wellness Policy (LSWP) goals to the priorities of foodservice workers after implementation. This study used observations, surveys, and interviews to determine strengths and weaknesses of Harrisburg Middle School's LSWP and compare them to priorities of that school's foodservice workers in providing healthy meals. Although nutrition policies exist and were considered an important priority among school foodservice workers, enforcement was lacking due to priorities of maintaining a clean and organized lunchroom. Attention to school wellness was indicated at Harrisburg Middle School by the lack of competitive foods and beverages available to students, however healthy menu items and variety in food selections were lacking. These findings are important when approaching school foodservice workers about improving nutrition standards within their lunchroom. In order to bridge the gap between nutrition professionals and school foodservice workers regarding changes in the lunchroom, suggestions should be made with respect to their priorities, such as keeping their lunchroom clean and efficient.

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