Theoretical Framework. The socio-ecological model (SEM) is a framework that can help explain the interaction of people with their environments as compared among various multilevel factors (Figure 1).45 In the context of this study, there is evidence indicating that the SEM is appropriate for investigating eating behaviors and physical acitivity,17,45-47 as the framework has been used to explain how multilevel factors influence eating and physical activity behaviors and resulting health outcomes.5 Previous research has employed the SEM or similar ecological models to investigate related topics such as food environments and eating behaviors,45,47 nutrition education and social marketing in low-income populations,46 and promoting healthy eating in schools.17 Additionally, some studies have explored the connection between school food environments and policies and various geographical, socioeconomic, and cultural factors while not explicitly employing the SEM or similar model.12,48,49 However, current literature is lacking specifically in the area of examining food environments in general from an ecological perspective,45 and no studies to date have utilized the SEM to investigate school-level factors influencing school nutrition policies, practices, and environments with a specific emphasis on low-income Georgia elementary schools. The current study aims to fill in this gap by examining school nutrition policies, practices, and environments in this understudied population from a socio-ecological perspective. Of particular interest in this study are school-level factors, which include geography, FRL, race/ethnicity (measured by percent Caucasian), and cohort year. The study is based on the SEM while acknowledging that there are numerous other factors that may influence nutrition policies, practices, and environments that are not explicitly examined in this study.
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