Urban-Rural Differences in School Districts' Local Wellness Policies and Policy Implementation Environments.

Higher rates of obesity in rural compared to urban districts suggest environmental differences that affect student health. This study examined urban-rural differences in districts' local wellness policies (LWPs) and LWP implementation environments. Cross-sectional data from two assessments in Texas were analyzed. In assessment one, each district's LWP was reviewed to see if 16 goals were included. In assessment two, an audit was conducted to identify the presence of a wellness plan (a document with recommendations for implementing LWPs), triennial LWP assessment, and school health advisory councils (SHACs) on the district website. Rural districts' LWPs had a smaller number of total goals (B = -2.281, p = 0.014), nutrition education goals (B = -0.654, p = 0.005), and other school-based activity goals (B = -0.675, p = 0.001) in their LWPs, compared to urban districts. Rural districts also had lower odds of having a wellness plan (OR = 0.520, 95% CI = 0.288-0.939), p = 0.030) and a SHAC (OR = 0.201, 95% CI = 0.113-0.357, p < 0.001) to support LWP implementation, compared to urban districts. More resources may be needed to create effective SHACs that can help develop and implement LWPs in rural areas. Important urban-rural differences exist in Texas LWPs and LWP implementation environments.