Evaluating equity in participation within a comprehensive school based wellness initiative amongst schools from different resource settings

ABSTRACT

Purpose of Study It is well documented that the school environment can foster students' health through modification of social, nutritional, and physical activity factors. Schools often employed wellness programs prior to the COVID-19 pandemic to comprehensively address these different factors. However, one factor predicted to have negative health impacts on children during the pandemic involved schools shutting down and transitioning to virtual learning. Schools from lower resource settings like Title 1 schools likely experienced challenges addressing these health impacts during the pandemic through wellness programs, such as lack of access to technology and challenges within the home setting. The purpose of this study is to examine participation in an academic medical center supported K-12 school-based wellness initiative amongst schools from different resource settings during the COVID-19 pandemic. Methods Used This was a retrospective cohort study of 68 schools within the longest participating county school district during the school years of 2017 + 2018, 2019, and 2020 respectively, with schools being separated by Title 1 status (Title 1 n = 36, non-Title 1 n = 32). The mean percentage of points earned on the wellness initiative's School Wellness Checklist was stratified by Title 1 status and compared utilizing two-sample T-tests between the study years. As well, within each study year, points earned on the checklist were compared between Title 1 and non- Title 1 schools utilizing two-sample T-tests. The change in number of participating Title 1 schools across the study years was analyzed using the Cochrane-Armitage Trend Test. Summary of Results: Non-Title 1 schools decreased significantly more in mean percent of earned checklist points from pre-pandemic to the 2020 pandemic study year compared to Title 1 Schools during that same period (mean decreas -1.24% non-Title 1, mean increase 0.796% Title 1, p = 0.0018). Non-Title 1 schools implemented checklist items significantly more compared to Title 1 schools during all study years except for the 2020 pandemic study year (p < 0.05). The number of participating Title 1 schools did not significantly change across the study years (p < 0.05). Conclusion(s) These results demonstrate the resiliency of schools from lower resource settings to equitably participate in this wellness initiative despite the challenges faced during the pandemic. Non-Title 1 schools demonstrated significantly higher performance within the initiative prior to the pandemic, but significantly declined as the pandemic was in full effect. In contrast, Title 1 schools sustained participation in the wellness initiative across all study years and performed similarly to non-Title 1 schools during the pandemic study year. This study supports how schools from different resource settings can equitably utilize this comprehensive school wellness initiative as a framework for their wellness programs, even during challenging times such as the COVID-19 Pandemic. Copyright © 2023 Southern Society for Clinical Investigation.