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.

This study determined attitudes of kindergarten through fifth grade teachers about school nutrition environments, their perceived influence on school nutrition environments, and self-reported classroom behaviors. Specific objectives were to: (a) identify perceived factors that influence the school nutrition environment, according to teachers surveyed; (b) examine relationships between elementary school teacher attitudes about school nutrition environments and perceived influence on the environment; (c) examine relationships between elementary school teachers’ attitudes about school nutrition environments, and self-reported classroom behaviors; (d) examine relationships between perceived influence over the school nutrition environment and self-reported classroom behaviors; and, (e) examine relationships between teachers’ demographic characteristics and attitudes and perceived influence on school nutrition environments, and self-reported classroom behaviors. Research was conducted in a mid-size Florida school district including 501 participants from 23 elementary schools. The Teacher Survey on School Nutrition Environments instrument was developed and validated by the researcher. Teachers identified the Food and Nutrition Services department as having the greatest impact on school nutrition environments, followed by student lunches and snacks sent from home. Responses to open-ended questions identified parents as part of the problem in developing healthy school nutrition environments. The Food and Nutrition Services department and parents were identified as having primary responsibility for encouraging healthy food choices at school, followed by administration, then teachers. Teachers did not perceive opportunities to provide input or to impact the school nutrition environment beyond their classrooms. The greater self-efficacy the teachers possessed, the more they felt they influenced the nutrition environment, and the more likely they were to offer menu suggestions, to sit or eat with students, to discuss food-related topics, and to integrate nutrition into lessons. Similar results were noted for teachers with college coursework in nutrition and those who were more experienced teachers. Classroom teachers should be encouraged to become involved and to recognize their role in developing and maintaining a healthy school nutrition environment. Increased communication should occur between school nutrition programs and teachers. Local wellness policy development and implementation should emphasize teachers’ influence.

Background: This study analyzes local wellness policies of 176 Georgia public school systems. The purpose of the study was to analyze potential relationships between demographic characteristics of Georgia school systems and compliance with the Child Nutrition and WIC Reauthorization Act of 2004, as well as the strength of wellness policy goals in the areas of nutrition, physical activity, and other school-based activities. Methods: Demographic data from the Georgia Department of Education were used as independent variables. Compliance ratings and the strength of wellness policy goals were derived from an evaluation tool developed by a research team at Georgia State University’s Institute of Public Health as part of a project contracted by the Georgia Department of Education. Analysis was conducted using Pearson’s correlation (two-tailed), crosstabulation, and linear regression. Results: Statistically significant positive associations were found between academic performance and strength of overall wellness policy goals (p < .05), as well as goals in the areas of nutrition education and other school-based activities (p < .01). Economic status of the student population was found to be positively associated with the strength of nutrition education goals (p < .05). No statistically significant associations were identified between demographic characteristics of school systems and physical activity goals. No associations were identified between involving community stakeholders in wellness policy development and having more comprehensive wellness policy goals. Conclusions: This study found statistically significant evidence of districts with stronger academic performance having more comprehensive overall wellness policy goals and stronger goals specifically in the areas of nutrition education and other school-based activities goals. Findings should assist the Georgia Department of Education in allocating its limited resources to help school systems improve wellness in public schools throughout Georgia. Recommendations are made to strengthen federal and state policy regarding school wellness, to conduct more research regarding the influence of community involvement on school wellness, and to provide guidance to local school systems having less resources and lower student academic performance in order to ensure health disparities are not further exacerbated.

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.

Parents of elementary school children in the small, rural area of Unicoi County, TN were surveyed to determine their attitudes toward health, nutrition, and Unicoi County Schools' Wellness Policy. Elementary school classrooms were randomly chosen to receive surveys for the children's parents to return by mail. Data were compiled and analyzed using SPSS software. Over 99% of parents stated that nutrition education in schools was important, and 96% stated schools played an important role in their child's health. The assessment provided meaningful data and laid groundwork for future nutrition education programs. The research showed rural, lower-income parents are supportive of positive nutritional changes in schools.

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Scholars have validated both the damaging presence of police officer stress and separately, their increasing obese condition in the United States. Previous studies of police officers focus on stress or body weight, but not these variables conjointly. The purpose of this study was to inform policy creation by examining the problem of officer stress in relation to the calculated body mass index (BMI) values and to gain insight into stress outcomes. Lazarus and Folkman's stress-coping theory served as the research lens to examine if BMI would significantly contribute to the percent change of R2 variance accounted for in the predictive effect of self-reported organizational and operational stress in the past 6 months after controlling for age, gender, rank, marital status, shift work, and seniority. This quantitative research consisted of survey data that were collected from 132 volunteer officers using McCreary's Police Stress Questionnaires. Multiple regression analysis tested the predictive relationship between BMI and stress and regression model outputs illustrated no statistically significant relationship between officer stress and BMI; however, post hoc analyses found shift work to be a significant stress predictor (p = .01). Based on regression results and this body of research, social change implications include police administrators promoting policies and training which protects officers from the harmful effects of stress and BMI. Lessened stress can have a positive influence on the police and the entire public they serve.