Awareness and Knowledge of School Wellness Committees is Low Among Rural K-12 Teachers and Staff

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Systems thinking was used to guide explorations of school wellness by examining multiple components of school systems. Design: Cross-sectional, observational study. An online survey was administered to examine understanding of school wellness policies and committees, including duties and who should promote school wellness in rural schools. Setting: Seven rural school districts in a single Midwestern state Participants: Teachers and staff members in rural schools Results Among 167 teachers and staff members, only 34.1% were aware of their wellness committee. Age (p = 0.01), the number of years at their current school (p = 0.02), higher education (compared to lower, p = 0.02), and the number of years teaching (teachers only, p < 0.01) were all positively associated with awareness of wellness committees. School nurses, health-related teachers, and food service staff were noted as frequent members of wellness committees and were preferred for potentially serving as wellness promoters in schools. Conclusions General wellness committee awareness is low, and efforts to enhance awareness may be needed in rural schools. Multiple school systems can be targeted to promote wellness, including health-related curricula, school nursing and food service staff. wellness wellness policy wellness committee K-12 teachers rural staff systems thinking INTRODUCTION Children who attend public schools spend a large portion of their day there, and schools can significantly affect child wellness[ 1 ]. Wellness in schools embodies a conscious effort to employ healthy habits for optimal health [ 2 ]. In rural areas, schools and communities face unique obstacles to wellness such as inadequate broadband connectivity, lack of access to parks to engage in physical activity, and funding needs to initiate wellness programs [ 3 ]. Rural researchers are also challenged to locate studies presenting only rural data, exacerbating difficulties when attempting to examine wellness issues [ 4 ]. Studies focused on rural populations reveal inconsistency in school wellness policy implementation [ 5 ], indicating the need for further study in this area. While the etiology of childhood and adolescent obesity is multifactorial, excessive caloric consumption and lack of physical activity are well-known, modifiable factors [ 6 ]. These are factors that fall under the tenets of health promotion practice (HPP) [ 7 ]. Through the lens of modern HPP, schools in general, and rural schools in specific, offer a unique opportunity to contribute to childhood wellness. Purpose Rural teachers and staff awareness and knowledge regarding their school wellness committees (SWC) is not well studied. The aims of this study were therefore to: 1) describe rural teachers and staff members’ knowledge and awareness of and factors associated with their SWC in a single Midwestern state; and 2) examine who should serve as wellness champions for rural schools. METHODS Design, Setting, and Sample This descriptive, cross-sectional study used an online survey to collect data from rural areas (no city in a county with a population > 50,000) [ 8 ]. This study was reviewed and approved by the Institutional Review Board at (masked for review) (#masked for review), and was carried out according to the relevant guidelines of the Declaration of Helsinki. School superintendents were emailed and called in April-May, 2022 to obtain permission for teachers and staff participation. Upon receipt of written approval from superintendents, survey links were forwarded by the superintendents to their teachers and staff. Informed consent was obtained electronically prior to survey commencement. All human subjects provided consent before participating in the study. Participants who completed the survey were provided a $ 20 electronic gift card to a national retailer. Measures General Systems Theory (GST) guided this study. This approach focuses on understanding how different components affect a larger, global system [ 9 ]. Breaking down the whole to its basic elements is essential for organizations like school districts to undertake when: 1) identifying resources, 2) problem-solving issues, 3) setting goals and, 4) enforcing compliance of mandates. 9 Thus, we examined what components affect structuring of rural SWCs from the teachers’ and staff members’ perspectives. Data analyzed here included 7 questions on school wellness, developed by the study team and pretested with school superintendents to ensure face validity. The questions incorporate different systems in a school and school district (e.g., teachers, food service staff, and administration). Questions included: awareness of SWCs (yes, no, don’t know); who serves on the wellness committee (select all that apply with 14 response options); how frequently the committee meets (7 options ranging from once per week to once per year); what duties the committee does (select all that apply with 10 response options); who is the best person to serve as a wellness champion of school wellness (choose up to 3 among 13 options); of those top 3, who is the best option (open-ended response). Participants responding “no” or “don’t know” to the question on awareness of the SWC did not receive questions on details of the wellness committee. Analysis The survey was administered using Research Electronic Data Capture (REDCap) [ 10 ]. Analyses were conducted via SPSS software (V. 27, IBM Corp., Armonk, NY). Descriptive statistics were examined as frequencies and percentages for categorical variables and means/standard deviations (SD) or medians/interquartile range for continuous variables. Shapiro-Wilk normality tests indicated non-normal distributions and thus non-parametric statistics (Chi-square and Kruskal-Wallis tests) were used in significance testing. Missing data were managed using pairwise deletion. RESULTS Seven of 33 invited rural school districts in a single state in the midwestern United States participated in the study, representing a 21.2% participation rate. Across these 7 districts were a total of 26 schools and approximately 830 teachers. We were unable to determine total number of staff members among the school districts. A total of 167 teachers and staff comprise the study sample. Post-hoc power analyses yielded an expected power of 0.79 at an alpha level of 0.05 for 167 participants. Mean age was 38.4 years old (SD = ± 10.9; Table 1 ). Most participants were female (n = 144, 86.2%) and White/Caucasian (n = 162, 97.0%). The majority were teachers (n = 151), representing an 18.2% response rate for teachers only. The survey was pretested in other school districts and took approximately 5 minutes to complete. Table 1 Demographic characteristics of rural teachers and staff members (n = 167) Variable and Categories N,% or Mean, SD Age Mean Age (Range: 19–74) 38.4 (10.9) Gender Male 23 (13.8%) Female 144 (86.2%) Education Bachelor’s 68 (41.0%) Master’s 94 (56.6%) Doctoral 4 (2.4%) Race/Ethnicity White/Caucasian 162 (78.6%) Black/African American 1 (0.5%) Hispanic 1 (0.5%) Asian 2 (1.0%) American Indian/ Alaskan Native 1 (0.5%) Native Hawaiian/ Pacific Islander 1 (0.5%) Other/ Prefer Not to Answer 1 (0.5%) School Level Elementary 101 (60.1%) Middle 26 (15.5%) High 41 (24.4%) Income Less than $ 35,000 10 (6.1%) $ 35,000 to Less than $ 50,000 39 (23.6%) $ 50,000 to Less than $ 75,000 37 (22.4%) $ 75,000 or More 74 (44.8%) Do Not Know/ Prefer Not to Answer 5 (3.0%) Years of Teaching Mean Years (Range: 0–42) 11.0 (8.3) Years at Current School Mean Years (Range: 0–41) 7.41 (6.7) Awareness of School Wellness Committee When asked if they had a SWC, 43 (34.1%) reported yes, 33 (26.2%) reported no, and 50 (39.7%) reported “do not know”. When examining associations between awareness of SWCs and continuous variables, certain patterns emerged. Age (p = 0.01), years at their current school (p = 0.02), and years teaching (teachers only, p < 0.01) all showed positive associations with awareness of the SWC (Table 2 ). Table 2 Associations^ among awareness of school wellness committees and continuous sociodemographic characteristics of rural teachers and staff Yes (mean, SD) No (mean, SD) Don’t know (mean, SD) P-value Age (n = 126) 42.4 (11.7) 34.6 (9.5) 38.0 (10.5) 0.01 BMI (n = 122) 31.9 (10.7) 30.6 (7.1) 29.9 (6.7) 0.85 Nutrition literacy (n = 126) 46.5 (5.8) 4.6 (8.2) 46.5 (7.2) 0.38 Nutrition knowledge (n = 126) 14.5 (2.7) 14.3 (3.2) 14.3 (3.2) 0.97 Years in school (n = 126) 10.2 (8.5) 5.8 (3.9) 6.7 (6.6) 0.02 Years teaching* (n = 115) 14.8 (9.3) 8.2 (6.5) 9.4 (8.4) < 0.01 ^using Kruskal-Wallis tests *only teachers received this question Knowledge of School Wellness Committee The following results apply only to those who were aware of their SWC. Regarding whom serves on the SWC, the most frequent responses were school nurses (n = 25, 58%), general teachers (n = 24, 56%), food service staff (n = 12, 28%), and principal(s) (n = 11, 26%). In terms of wellness committee meeting frequency, most reported they did not know how frequently the committees meets (n = 30, 70%). Once per month was the most frequent category reported for SWC meeting frequency (n = 6, 14%). Most teachers and staff did not know the specific duties (n = 17, 40%) of the SWC. The most frequent responses of SWC duties included planning and implementing wellness programs for students and staff (n = 17, 40%), promoting parent, community, and professional involvement in developing a healthier school environment (n = 14, 33%), and assisting with policy development or revision to support a healthy school environment (n = 11, 26%) (Table 3 ). Table 3 Knowledge of Wellness Committee among the teachers and staff (n = 43) who reported being aware of the committee Variable and Categories N, % Those Serving on Wellness Committee School nurse 25 (58%) Teachers (general) 24 (56%) Food service staff 12 (28%) Do not know 12 (28%) Principal(s) 11 (26%) Superintendent 5 (12%) County health official 5 (12%) Teachers (health-related) 4 (9%) Relevant Community Member 4 (9%) School Board Member 3 (7%) Parents 2 (5%) Student(s) 1 (2%) Other 1 (2%) Member(s) of the public 0 Individual who would best serve as school wellness champion School Nurse 94 (56.3%) Food Service Staff 80 (47.9%) Teachers (Health-Related) 51 (30.5%) Teachers (General) 50 (29.9%) Local Wellness Committee Coordinator 49 (29.3%) County Health Officials 27 (16.2%) Relevant Community Member 18 (10.8%) Principal(s) 17 10.2%) Parents 10 (6.0%) Member(s) of Public 8 (4.8%) Superintendent 5 (3.0%) School Board Member 2 (1.2%) Other 1 (0.06%) Frequency of Wellness Committee Meeting Once Per Week 0 Once Per Month 6 (14%) Once Per Quarter 5 (12%) Once Per Semester 0 Oncer Per School Year 2 (5%) Do Not Know 30 (70%) Other 0 Duties of Wellness Committee Plan and Implement Wellness Programs for Students and Staff 17 (40%) Do Not Know 17 (40%) Promote Parent, Community, and Professional Involvement 14 (33%) Assist with Policy Development or Revision 11 (26%) Evaluate Wellness Program and Policy Efforts 8 (19%) Provide Feedback to District on Local Wellness Program 5 (12%) Measure School Compliance with Local Wellness Policy 4 (9%) Report Content and Implementation to Public 2 (5%) Tap into Funding and Leverages Resources for Students and Staff 1 (2%) Other 0 Best Individual to Serve as School Wellness Champion Among all participants, regarding whom would best serve as a school wellness champion or enforcer of school wellness policy; the most frequently reported responses were school nurses (94, 56.3%), followed by food service staff (80, 47.9%), and health-related teachers (51, 30.5%). DISCUSSION This study examined awareness and knowledge of SWC’s, and who would best serve as a school wellness champion among rural teachers and staff in a single Midwestern state. This information is vital given health disparities are more prominent in rural communities across the globe [ 4 ]. Findings offer support for using GST to assess wellness in schools given that different school systems, including teachers, administrators, school nurses, and food service staff were all noted as important pieces of school wellness. Participant demographics for this study are consistent with other rural school districts [ 11 ]. This sample included 60.1% who participated from elementary schools. We were unable to locate national data that present what school level (elementary, middle, or high school) had the greatest number of established SWCs, or whether a disparity exists between rural, urban and suburban SWCs. Awareness Findings from our study indicate participants had a low awareness regarding the existence of SWCs at their schools/school districts. Teachers and staff who were older, with more years in their school or more teaching experience, were more likely to be aware of SWCs compared to those younger, with fewer years at their school, or with less teaching experience. Although local education agencies are directed to have SWCs in place with at least three members and which meet a minimum of four times per school year [ 12 ], it is challenging to locate information regarding specific SWCs. Schools have expanded efforts to improve student nutritional behaviors and wellness promotion over recent years [ 13 ], yet teachers and staff members’ awareness of SWCs in our study needs improvement. Due to the dearth of information regarding SWCs, we were unable to compare this with other studies from the rural sector. Nonetheless, others have noted that local wellness committee coordinator efforts are associated with increased awareness of health and wellness in schools and school districts [ 14 ]. Perhaps rural school districts with existing local wellness coordinators could be recruited in future studies to assist with wellness activities. Knowledge Interestingly, over one-fourth of the participants were unaware of the frequency of wellness committee meetings. For SWCs to be effective and engaged, it is recommended that committees meet ≥ four times during the school year, where structured agendas assume a systematic approach and detail targeted action steps and how to achieve them. School wellness duties should include nutrition and physical education activities; involve parents, school health professionals, school district personnel, students, and the public; designate a wellness policy compliance official and assess school wellness policy compliance [ 15 ]. Based on study findings, work is needed to increase awareness of rural SWCs, particularly regarding when they meet and how frequently. Wellness Champion Nurses, food service staff, and health-related teachers were noted as the preferred roles to serve as school wellness champions. Supporting our findings, participants in Cygan et al.’s study [ 16 ] articulated the need for school nurses to support and facilitate wellness policy implementation. In addition, local wellness coordinators were also frequently noted for serving as a wellness champion. Others have discussed how they are critical to school wellness efforts[ 14 ]. Participants ranked the need for public involvement quite low despite recommendations illustrating the need to engage the public in wellness work [ 12 , 15 – 16 ]. Superintendents ranked low for serving as wellness champions, despite their unique and potential role as authoritative stakeholders for wellness policy evaluations [ 17 ]. Superintendents face challenges that may not be readily apparent to public health practitioners. Issues such as social-emotional learning, staff wellness integration, assistance from community partners and governmental accountability must be considered [ 18 ]. Strengths and Limitations This was the first study to examine teacher and staff perceptions from multiple rural school districts concerning their SWC’s existence and structures, using a systems theory approach. Results provided insight as to who rural teachers and staff members felt would best serve as school wellness champions from a broad reach of rural schools in a single state in the midwestern United States. This study also included several limitations. Data were cross-sectional, which prohibits causal inferences across subgroups. While we obtained a sample of teachers and staff members from 7 rural school districts, the homogeneity of their sociodemographic characteristics’ limits generalizability to other regions and urbanicity types. Lastly, these data are self-reported and may be subject to recall and/or social desirability bias. Implications for Practice Rural areas are more likely to encounter obstacles associated with technology and a lack of resources to facilitate and promote student wellness. These issues make the rural school setting an appropriate environment to address wellness, as HPP can target specific behavioral and environmental health issues of interest. While health education may be an important pedagogical attribute of HPP, education alone without communication, research, and systemic change is not effective [ 3 ]. Although providing access to health-promoting programs and activities does not guarantee health, it does provide the impetus to promote student wellness and academic achievement [ 19 ]. More research is needed to examine HPP strategies that promote wellness in the K-12 student population. Conclusion Using a systems-thinking approach, we found that rural teachers and staff had low awareness of their SWCs. This systemic issue occurs across rural school districts and is a critical concern that needs to be addressed. Increasing awareness of SWCs among all teachers and staff members of rural school districts is a logical place to begin intervention efforts so that compliance with federal and state mandates can be achieved, and to strive toward advancing HPP across the age continuum. Identifying who should serve as wellness champion for schools provided a starting point for future rural SWC’s. Given the multiple responses on wellness champions, perhaps this should be a consorted team-effort, utilizing faculty, staff, and the community to foster wellness in school systems. Declarations Ethics approval and Consent to participate The study protocol underwent a thorough review by an Institutional Review Board. It was approved by the Institutional Review Board at University of Missouri-Kansas City, review number 393009. All human subjects provided consent before participating in the study, and the study was deemed minimal risk with a waiver of documentation of consent. The study as carried out according to the relevant guidelines of the Declaration of Helsinki. Consent for publication Not applicable. Author Contribution MC was involved in study design, oversaw data collection, contributor of manuscript content, supervised and conducted statistical analyses and contributed primary content and edits to the manuscript; NJM was involved in study design, and contributed content and edits to the manuscript; and PE was involved in study design and contributed content and edits to the manuscript. Acknowledgement The authors would like to acknowledge the efforts of Dr. Anita Skarbek, PhD, RN and student assistant Jennifer Spies, MSN in drafting this manuscript and assisting with data analyses Data Availability The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. References Rattermann MJ, Angelov A, Reddicks T, Monk J. Advancing health equity by addressing social determinants of health: Using health data to improve educational outcomes (2021). 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Pew Res Cent. https://tinyurl.com/y4zza3n8 Key JD, Head KC, Piwinski S, Morella K, Martin CT, Melvin CL. Development of an innovative and unique comprehensive school health initiative involving community health care professionals. J School Health. 2021;91(11):870–5. https://doi.org/10.1111/josh.13081 . Boehm R, Schwartz MB, Lowenfels A, Brissette I, Pattson MJ, Ren J. The relationship between written district policies and school practices among high-need districts in New York State. J School Health. 2020;90(6):465–73. https://doi.org/10.1111/josh.12896 . Westrich L, Sanchez M, Strobel K. Coordinated school health and the contribution of a district wellness coordinator. J School Health. 2015;85(4):260–6. https://doi.org/10.1111/josh.12240 . Alliance for a Healthier Generation. (2013). School wellness committee toolkit . https://tinyurl.com/bde85tzh Cygan H, Tribbia C, Tully J. School health policy implementation: Facilitators and challenges. J School Nurs. 2020;36(5):330–8. https://doi.org/10.1177/1059840519846089 . Asada Y, Turner L, Schwartz M, Chriqui JF. Bridging, brokering, and buffering: a theoretical exploration of school leaders’ engagement with local school wellness policy implementation. Implement Sci Commun. 2020;1(1):1–11. https://doi.org/10.1186/s43058-020-00029-1 . Asada Y, Hughes A, Chriqui JF. (2020). On a positive path: School superintendents’ perceptions of and experiences with local school wellness policy implementation and evaluation. Kelley B, Silva-Padrón G. (2023). Addressing health disparities through school-based health services. Policy Brief. Education Commission of the States ; https://eric.ed.gov/?id=ED626748 Additional Declarations No competing interests reported. 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Wellness in schools embodies a conscious effort to employ healthy habits for optimal health [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In rural areas, schools and communities face unique obstacles to wellness such as inadequate broadband connectivity, lack of access to parks to engage in physical activity, and funding needs to initiate wellness programs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Rural researchers are also challenged to locate studies presenting \u003cem\u003eonly\u003c/em\u003e rural data, exacerbating difficulties when attempting to examine wellness issues [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Studies focused on rural populations reveal inconsistency in school wellness policy implementation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], indicating the need for further study in this area.\u003c/p\u003e\u003cp\u003eWhile the etiology of childhood and adolescent obesity is multifactorial, excessive caloric consumption and lack of physical activity are well-known, modifiable factors [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These are factors that fall under the tenets of health promotion practice (HPP) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Through the lens of modern HPP, schools in general, and rural schools in specific, offer a unique opportunity to contribute to childhood wellness.\u003c/p\u003e\n\u003ch3\u003ePurpose\u003c/h3\u003e\n\u003cp\u003eRural teachers and staff awareness and knowledge regarding their school wellness committees (SWC) is not well studied. The aims of this study were therefore to: 1) describe rural teachers and staff members’ knowledge and awareness of and factors associated with their SWC in a single Midwestern state; and 2) examine who should serve as wellness champions for rural schools.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"METHODS","content":"\u003ch2\u003eDesign, Setting, and Sample\u003c/h2\u003e\u003cp\u003eThis descriptive, cross-sectional study used an online survey to collect data from rural areas (no city in a county with a population \u0026gt; 50,000) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This study was reviewed and approved by the Institutional Review Board at (masked for review) (#masked for review), and was carried out according to the relevant guidelines of the Declaration of Helsinki. School superintendents were emailed and called in April-May, 2022 to obtain permission for teachers and staff participation. Upon receipt of written approval from superintendents, survey links were forwarded by the superintendents to their teachers and staff. Informed consent was obtained electronically prior to survey commencement. All human subjects provided consent before participating in the study. Participants who completed the survey were provided a \u003cspan\u003e$\u003c/span\u003e20 electronic gift card to a national retailer.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eGeneral Systems Theory (GST) guided this study. This approach focuses on understanding how different components affect a larger, global system [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Breaking down the whole to its basic elements is essential for organizations like school districts to undertake when: 1) identifying resources, 2) problem-solving issues, 3) setting goals and, 4) enforcing compliance of mandates.\u003csup\u003e9\u003c/sup\u003e Thus, we examined what components affect structuring of rural SWCs from the teachers\u0026rsquo; and staff members\u0026rsquo; perspectives.\u003c/p\u003e\u003cp\u003eData analyzed here included 7 questions on school wellness, developed by the study team and pretested with school superintendents to ensure face validity. The questions incorporate different systems in a school and school district (e.g., teachers, food service staff, and administration). Questions included: awareness of SWCs (yes, no, don\u0026rsquo;t know); who serves on the wellness committee (select all that apply with 14 response options); how frequently the committee meets (7 options ranging from once per week to once per year); what duties the committee does (select all that apply with 10 response options); who is the best person to serve as a wellness champion of school wellness (choose up to 3 among 13 options); of those top 3, who is the best option (open-ended response). Participants responding \u0026ldquo;no\u0026rdquo; or \u0026ldquo;don\u0026rsquo;t know\u0026rdquo; to the question on awareness of the SWC did not receive questions on details of the wellness committee.\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eThe survey was administered using Research Electronic Data Capture (REDCap) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Analyses were conducted via SPSS software (V. 27, IBM Corp., Armonk, NY). Descriptive statistics were examined as frequencies and percentages for categorical variables and means/standard deviations (SD) or medians/interquartile range for continuous variables. Shapiro-Wilk normality tests indicated non-normal distributions and thus non-parametric statistics (Chi-square and Kruskal-Wallis tests) were used in significance testing. Missing data were managed using pairwise deletion.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eSeven of 33 invited rural school districts in a single state in the midwestern United States participated in the study, representing a 21.2% participation rate. Across these 7 districts were a total of 26 schools and approximately 830 teachers. We were unable to determine total number of staff members among the school districts. A total of 167 teachers and staff comprise the study sample. Post-hoc power analyses yielded an expected power of 0.79 at an alpha level of 0.05 for 167 participants. Mean age was 38.4 years old (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most participants were female (n\u0026thinsp;=\u0026thinsp;144, 86.2%) and White/Caucasian (n\u0026thinsp;=\u0026thinsp;162, 97.0%). The majority were teachers (n\u0026thinsp;=\u0026thinsp;151), representing an 18.2% response rate for teachers only. The survey was pretested in other school districts and took approximately 5 minutes to complete.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of rural teachers and staff members (n\u0026thinsp;=\u0026thinsp;167)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable and Categories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN,% or Mean, SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean Age (Range: 19\u0026ndash;74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38.4 (10.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23 (13.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e144 (86.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68 (41.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94 (56.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctoral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eRace/Ethnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhite/Caucasian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e162 (78.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBlack/African American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAsian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAmerican Indian/ Alaskan Native\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNative Hawaiian/ Pacific Islander\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther/ Prefer Not to Answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSchool Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101 (60.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26 (15.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41 (24.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eIncome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than \u003cspan\u003e$\u003c/span\u003e35,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (6.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35,000 to Less than \u003cspan\u003e$\u003c/span\u003e50,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39 (23.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50,000 to Less than \u003cspan\u003e$\u003c/span\u003e75,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37 (22.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e75,000 or More\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74 (44.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo Not Know/ Prefer Not to Answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (3.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of Teaching\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean Years (Range: 0\u0026ndash;42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.0 (8.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears at Current School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean Years (Range: 0\u0026ndash;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.41 (6.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eAwareness of School Wellness Committee\u003c/h2\u003e\u003cp\u003eWhen asked if they had a SWC, 43 (34.1%) reported yes, 33 (26.2%) reported no, and 50 (39.7%) reported \u0026ldquo;do not know\u0026rdquo;. When examining associations between awareness of SWCs and continuous variables, certain patterns emerged. Age (p\u0026thinsp;=\u0026thinsp;0.01), years at their current school (p\u0026thinsp;=\u0026thinsp;0.02), and years teaching (teachers only, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) all showed positive associations with awareness of the SWC (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociations^ among awareness of school wellness committees and continuous sociodemographic characteristics of rural teachers and staff\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes (mean, SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo (mean, SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDon\u0026rsquo;t know (mean, SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42.4 (11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.6 (9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38.0 (10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31.9 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30.6 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.9 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition literacy (n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46.5 (5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.6 (8.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46.5 (7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition knowledge (n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.5 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.3 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.3 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears in school (n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.2 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.8 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.7 (6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears teaching* (n\u0026thinsp;=\u0026thinsp;115)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.8 (9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.2 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.4 (8.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e^using Kruskal-Wallis tests\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*only teachers received this question\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eKnowledge of School Wellness Committee\u003c/h3\u003e\n\u003cp\u003eThe following results apply only to those who were aware of their SWC. Regarding whom serves on the SWC, the most frequent responses were school nurses (n\u0026thinsp;=\u0026thinsp;25, 58%), general teachers (n\u0026thinsp;=\u0026thinsp;24, 56%), food service staff (n\u0026thinsp;=\u0026thinsp;12, 28%), and principal(s) (n\u0026thinsp;=\u0026thinsp;11, 26%). In terms of wellness committee meeting frequency, most reported they did not know how frequently the committees meets (n\u0026thinsp;=\u0026thinsp;30, 70%). Once per month was the most frequent category reported for SWC meeting frequency (n\u0026thinsp;=\u0026thinsp;6, 14%).\u003c/p\u003e\u003cp\u003eMost teachers and staff did not know the specific duties (n\u0026thinsp;=\u0026thinsp;17, 40%) of the SWC. The most frequent responses of SWC duties included planning and implementing wellness programs for students and staff (n\u0026thinsp;=\u0026thinsp;17, 40%), promoting parent, community, and professional involvement in developing a healthier school environment (n\u0026thinsp;=\u0026thinsp;14, 33%), and assisting with policy development or revision to support a healthy school environment (n\u0026thinsp;=\u0026thinsp;11, 26%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKnowledge of Wellness Committee among the teachers and staff (n\u0026thinsp;=\u0026thinsp;43) who reported being aware of the committee\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable and Categories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN, %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"13\" rowspan=\"14\"\u003e\u003cp\u003eThose Serving on Wellness Committee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchool nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (58%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeachers (general)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (56%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFood service staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (28%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo not know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (28%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrincipal(s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (26%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuperintendent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCounty health official\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeachers (health-related)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRelevant Community Member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchool Board Member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudent(s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMember(s) of the public\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e\u003cp\u003eIndividual who would best serve as school wellness champion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchool Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 (56.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFood Service Staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (47.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeachers (Health-Related)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (30.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeachers (General)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (29.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLocal Wellness Committee Coordinator\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49 (29.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCounty Health Officials\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (16.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRelevant Community Member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (10.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrincipal(s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 10.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (6.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMember(s) of Public\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (4.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuperintendent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchool Board Member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.06%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eFrequency of Wellness Committee Meeting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnce Per Week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnce Per Month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnce Per Quarter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnce Per Semester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOncer Per School Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo Not Know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (70%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e\u003cp\u003eDuties of Wellness Committee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePlan and Implement Wellness Programs for Students and Staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (40%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo Not Know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (40%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePromote Parent, Community, and Professional Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (33%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssist with Policy Development or Revision\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (26%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEvaluate Wellness Program and Policy Efforts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (19%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProvide Feedback to District on Local Wellness Program\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMeasure School Compliance with Local Wellness Policy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReport Content and Implementation to Public\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTap into Funding and Leverages Resources for Students and Staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eBest Individual to Serve as School Wellness Champion\u003c/h3\u003e\n\u003cp\u003eAmong all participants, regarding whom would best serve as a school wellness champion or enforcer of school wellness policy; the most frequently reported responses were school nurses (94, 56.3%), followed by food service staff (80, 47.9%), and health-related teachers (51, 30.5%).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study examined awareness and knowledge of SWC\u0026rsquo;s, and who would best serve as a school wellness champion among rural teachers and staff in a single Midwestern state. This information is vital given health disparities are more prominent in rural communities across the globe [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Findings offer support for using GST to assess wellness in schools given that different school systems, including teachers, administrators, school nurses, and food service staff were all noted as important pieces of school wellness.\u003c/p\u003e\u003cp\u003eParticipant demographics for this study are consistent with other rural school districts [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This sample included 60.1% who participated from elementary schools. We were unable to locate national data that present what school level (elementary, middle, or high school) had the greatest number of established SWCs, or whether a disparity exists between rural, urban and suburban SWCs.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eAwareness\u003c/h2\u003e\u003cp\u003eFindings from our study indicate participants had a low awareness regarding the existence of SWCs at their schools/school districts. Teachers and staff who were older, with more years in their school or more teaching experience, were more likely to be aware of SWCs compared to those younger, with fewer years at their school, or with less teaching experience. Although local education agencies are directed to have SWCs in place with at least three members and which meet a minimum of four times per school year [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], it is challenging to locate information regarding specific SWCs. Schools have expanded efforts to improve student nutritional behaviors and wellness promotion over recent years [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], yet teachers and staff members\u0026rsquo; awareness of SWCs in our study needs improvement. Due to the dearth of information regarding SWCs, we were unable to compare this with other studies from the rural sector. Nonetheless, others have noted that local wellness committee coordinator efforts are associated with increased awareness of health and wellness in schools and school districts [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Perhaps rural school districts with existing local wellness coordinators could be recruited in future studies to assist with wellness activities.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge\u003c/h2\u003e\u003cp\u003eInterestingly, over one-fourth of the participants were unaware of the frequency of wellness committee meetings. For SWCs to be effective and engaged, it is recommended that committees meet\u0026thinsp;\u0026ge;\u0026thinsp;four times during the school year, where structured agendas assume a systematic approach and detail targeted action steps and how to achieve them. School wellness duties should include nutrition and physical education activities; involve parents, school health professionals, school district personnel, students, and the public; designate a wellness policy compliance official and assess school wellness policy compliance [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Based on study findings, work is needed to increase awareness of rural SWCs, particularly regarding when they meet and how frequently.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eWellness Champion\u003c/h2\u003e\u003cp\u003eNurses, food service staff, and health-related teachers were noted as the preferred roles to serve as school wellness champions. Supporting our findings, participants in Cygan et al.\u0026rsquo;s study [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] articulated the need for school nurses to support and facilitate wellness policy implementation. In addition, local wellness coordinators were also frequently noted for serving as a wellness champion. Others have discussed how they are critical to school wellness efforts[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eParticipants ranked the need for public involvement quite low despite recommendations illustrating the need to engage the public in wellness work [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Superintendents ranked low for serving as wellness champions, despite their unique and potential role as authoritative stakeholders for wellness policy evaluations [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Superintendents face challenges that may not be readily apparent to public health practitioners. Issues such as social-emotional learning, staff wellness integration, assistance from community partners and governmental accountability must be considered [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eThis was the first study to examine teacher and staff perceptions from multiple rural school districts concerning their SWC\u0026rsquo;s existence and structures, using a systems theory approach. Results provided insight as to who rural teachers and staff members felt would best serve as school wellness champions from a broad reach of rural schools in a single state in the midwestern United States. This study also included several limitations. Data were cross-sectional, which prohibits causal inferences across subgroups. While we obtained a sample of teachers and staff members from 7 rural school districts, the homogeneity of their sociodemographic characteristics\u0026rsquo; limits generalizability to other regions and urbanicity types. Lastly, these data are self-reported and may be subject to recall and/or social desirability bias.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eImplications for Practice\u003c/h2\u003e\u003cp\u003eRural areas are more likely to encounter obstacles associated with technology and a lack of resources to facilitate and promote student wellness. These issues make the rural school setting an appropriate environment to address wellness, as HPP can target specific behavioral and environmental health issues of interest. While health education may be an important pedagogical attribute of HPP, education alone without communication, research, and systemic change is not effective [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although providing access to health-promoting programs and activities does not guarantee health, it does provide the impetus to promote student wellness and academic achievement [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. More research is needed to examine HPP strategies that promote wellness in the K-12 student population.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUsing a systems-thinking approach, we found that rural teachers and staff had low awareness of their SWCs. This systemic issue occurs across rural school districts and is a critical concern that needs to be addressed. Increasing awareness of SWCs among all teachers and staff members of rural school districts is a logical place to begin intervention efforts so that compliance with federal and state mandates can be achieved, and to strive toward advancing HPP across the age continuum. Identifying who should serve as wellness champion for schools provided a starting point for future rural SWC\u0026rsquo;s. Given the multiple responses on wellness champions, perhaps this should be a consorted team-effort, utilizing faculty, staff, and the community to foster wellness in school systems.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and Consent to participate\u003c/strong\u003e\u003cp\u003e The study protocol underwent a thorough review by an Institutional Review Board. It was approved by the Institutional Review Board at University of Missouri-Kansas City, review number 393009. All human subjects provided consent before participating in the study, and the study was deemed minimal risk with a waiver of documentation of consent. The study as carried out according to the relevant guidelines of the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMC was involved in study design, oversaw data collection, contributor of manuscript content, supervised and conducted statistical analyses and contributed primary content and edits to the manuscript; NJM was involved in study design, and contributed content and edits to the manuscript; and PE was involved in study design and contributed content and edits to the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to acknowledge the efforts of Dr. Anita Skarbek, PhD, RN and student assistant Jennifer Spies, MSN in drafting this manuscript and assisting with data analyses\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRattermann MJ, Angelov A, Reddicks T, Monk J. 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On a positive path: School superintendents\u0026rsquo; perceptions of and experiences with local school wellness policy implementation and evaluation.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKelley B, Silva-Padr\u0026oacute;n G. (2023). Addressing health disparities through school-based health services. Policy \u003cem\u003eBrief. Education Commission of the States\u003c/em\u003e; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://eric.ed.gov/?id=ED626748\u003c/span\u003e\u003cspan address=\"https://eric.ed.gov/?id=ED626748\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"wellness, wellness policy, wellness committee, K-12, teachers, rural, staff, systems thinking","lastPublishedDoi":"10.21203/rs.3.rs-7794001/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7794001/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo better understand awareness and knowledge of rural schoolteachers and staff regarding their wellness committees. Systems thinking was used to guide explorations of school wellness by examining multiple components of school systems.\u003c/p\u003e\u003ch2\u003eDesign:\u003c/h2\u003e\u003cp\u003eCross-sectional, observational study. An online survey was administered to examine understanding of school wellness policies and committees, including duties and who should promote school wellness in rural schools.\u003c/p\u003e\u003ch2\u003eSetting:\u003c/h2\u003e\u003cp\u003eSeven rural school districts in a single Midwestern state\u003c/p\u003e\u003ch2\u003eParticipants:\u003c/h2\u003e\u003cp\u003eTeachers and staff members in rural schools\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong 167 teachers and staff members, only 34.1% were aware of their wellness committee. Age (p\u0026thinsp;=\u0026thinsp;0.01), the number of years at their current school (p\u0026thinsp;=\u0026thinsp;0.02), higher education (compared to lower, p\u0026thinsp;=\u0026thinsp;0.02), and the number of years teaching (teachers only, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) were all positively associated with awareness of wellness committees. School nurses, health-related teachers, and food service staff were noted as frequent members of wellness committees and were preferred for potentially serving as wellness promoters in schools.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eGeneral wellness committee awareness is low, and efforts to enhance awareness may be needed in rural schools. Multiple school systems can be targeted to promote wellness, including health-related curricula, school nursing and food service staff.\u003c/p\u003e","manuscriptTitle":"Awareness and Knowledge of School Wellness Committees is Low Among Rural K-12 Teachers and Staff","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 16:33:48","doi":"10.21203/rs.3.rs-7794001/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a3e99354-962f-455b-a43a-d3fc223e7cc3","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-05T04:24:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 16:33:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7794001","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7794001","identity":"rs-7794001","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}