School Employee Wellness: Understanding Health Behaviors and Identifying Opportunities for Student and Staff Health Promotion
Despite the growth of workplace wellness nationwide, schools lag behind other employers
in the promotion of employee health and the provision of employee wellness programming.
School employees, however, serve as role models for students, and are called upon to
deliver student health-related programs, including physical activity (PA) programs.
Employee wellness can increa... read morese productivity, boost morale, save money, and, in the
school setting, potentially enhance student program implementation and academic success.
However, evidence suggests poor health among school employees. The primary objectives of
this research were to provide evidence to support the need for and value of school
employee wellness, particularly in underserved school districts, and to inform employee
wellness efforts in the school setting. METHODS: Employees were recruited from
lower-income Massachusetts schools participating in the Fueling Learning Through
Exercise (FLEX) Study, a group randomized-controlled trial evaluating two school-based
PA programs. Focus groups were conducted to identify barriers and facilitators to
healthy behaviors. Employees participated in Wellness Assessments, including measured
height, weight, and lipids [total (TC), high-density lipoprotein-cholesterol (HDL-C),
low-density lipoprotein-cholesterol (LDL-C)]. Surveys were used to collect demographic,
perceived stress, PA and 24-hour food intake data. Linear regression was used to examine
the relationship among health behaviors (PA and diet), stress and cardiometabolic
health. An interaction between stress and health behaviors was explored. Lastly,
intervention implementation, PA environment (PAE) scores, student demographics and
objectively measured student school-time moderate-to-vigorous physical activity (MVPA)
were collected from FLEX. Linear regression was used to examine the relationship between
employee MVPA and (1) intervention implementation, accounting for stress, and (2)
student school-time MVPA. The impact of the PAE on the relationship between employee
MVPA and intervention implementation was explored. RESULTS: Findings from the focus
groups (10 sessions, N=62) highlighted the importance of an organizational culture of
wellness. Barriers included High Stress, Demanding Job, Lack of Wellness Culture, and
Unhealthy Food. Facilitators included a Desire to Adopt Healthy Behaviors and Role
Model, Sufficient Health Knowledge, and a Strong Social Network. Seventy-four employees
(66% teachers) participated in Wellness Assessments. Overweight/obesity, high TC and
LDL-C were observed in 47% (mean BMI: 25.6 kg/m2), 4%, and 34%, respectively, and MVPA
was low (median: 17 min/day). Significant positive associations were identified between
MVPA and cardiometabolic health. The relationship between MVPA and BMI was modified by
stress (p-for-interaction=0.001), with higher levels of stress associated with a
diminished protective association between MVPA and BMI. Higher stress was also
associated with lower implementation (p<0.0001). Contrary to our hypothesis, higher
employee MVPA was associated with lower student school-time MVPA (p=0.0002) and lower
implementation (p<0.0001), with a stronger negative relationship in schools with
higher PAE scores (p-for-interaction <0.0001). CONCLUSION: Our findings demonstrate
physical inactivity and high stress among school employees, and suggest that this
population would be receptive to wellness programming if barriers were minimized.
Promising approaches to employee health promotion include wellness champions,
accountability, and convenience. Observed relationships between employee PA and both
implementation and student PA, which were contrary to our hypotheses, warrant further
investigation as our analysis was limited by school-level employee PA data. Future
studies should measure individual-level PA of teachers and champions delivering
programming. This work provides a foundation for future research examining the impact of
school employee wellness on both employee and student health, as well as on the
implementation of school-based student PA
Thesis (Ph.D.)--Tufts University, 2018.
Submitted to the Dept. of Biochemical and Molecular Nutrition.
Advisor: Jennifer Sacheck.
Committee: Kenneth Chui, Christina Economos, Alice Lichtenstein, and Stella Volpe.
Keywords: Nutrition, and Health education.read less