Evidence-based policies on school nutrition and physical education: Associations with state-level collaboration, obesity, and socio-economic indicators

- Obesity-related state policies were not associated with cross-sector collaboration.
- Nutrition policies were more common in socioeconomically disadvantaged states.
- Higher childhood obesity rates were positively associated with nutrition policies.
- Most significant associations were found for elementary school policies.

Despite calls for more cross-sector collaboration on obesity prevention, little is known about the role of collaborative partnerships, or groups of organizations from different sectors working together toward a shared goal, in state policy activities. This study examined associations between competitive food/beverage and physical education policies and state-level collaboration and state characteristics (obesity, socioeconomic indicators, public health funding levels) for all 50 states and the District of Columbia, USA, in 2012. We examined cross-sectional associations between evidence-based competitive food/beverage and physical education policies from the Classification of Laws Associated with School Students and state characteristics from the School Health Policies and Practices Study and other national data sources using prevalence ratios and generalized linear models. Analyses were conducted in 2016. Cross-sector collaboration (i.e., state staff reports of working together on school nutrition or physical education activities) between state-level nutrition and physical education staff and ten types of organizations was not significantly associated with having state policies. Childhood obesity (RR = 1.78, 95% CI[1.11,2.85]), high-school non-completion (RR = 2.35, 95% CI[1.36,4.06]), poverty (RR = 1.89, 95% CI[1.16,3.09]) and proportion non-white or Hispanic residents (RR = 1.75, 95% CI[1.07, 2.85]) were positively associated with the presence of elementary school competitive food/beverage policies. Fewer indicators were associated with policies for middle and high schools. The large investment of time and resources required for cross-sector collaboration demands greater research evidence on how to structure and manage collaborative partnerships for the greatest impact.