| Policy makers, concerned about adolescent obesity, often consider limiting foods and beverages are high in fat and/or sugar and low in essential nutrients in schools (so-called Foods of Minimal Nutritional Value - FMNV).;Decisions made locally by schools about whether to limit FMNV restrictions result from complex processes involving multiple actors responding to social, political and economic concerns. This dissertation examines contextual factors that influence local schools' decisions related to regulation of FMNV and seeks to understand factors associated with healthy food policies in schools.;A two stage methodology was employed. First, a telephone survey gathered data describing the current status of FMNV in Massachusetts public high schools. Second, five schools were selected from the survey sample to participate in a comparative case study. Data regarding contextual factors that impacted the food environment were gathered from key stakeholders, site observations, and document review. Using a resource dependency model (External Control of Organizations) and Stakeholder Analysis as analytic constructs, relevant factors and patterns in decision making processes and environmental outcomes are identified and analyzed.;Eight environmental factors are analyzed for their importance in schools' decisions: (1) revenue and budget, (2) information and knowledge, (3) statutes and regulations, (4) values and beliefs, (5) media and public awareness, (6) social actors and power, (7) school culture, and (8) family and community culture. All of these factors affect decision outcomes, but there are no specific patterns of influence in school food environments. Instead, since schools are unique, contextual factors have varying impact, influencing food improvements in some schools, but not others. The overall effect of contextual factors is cumulative; that is, as additional factors favor a healthy environment, policies are more likely to limit FMNV.;The study concludes that there are multiple pathways to create healthy school food policies and promote wellness. Sustainable improvements in the school food environment will best result from attention to each schools unique context. Policies and laws supporting individualized approaches, gradual change, and a positive frame for change are critical. School-based initiatives are also more likely to be successful if they work within the larger environment of families and communities. Additionally, adequate funding is a key factor in allowing schools decrease FMNV. |
