R ESEARCH A RTICLE The Role of School Design in Shaping Healthy Eating-Related Attitudes, Practices, and Behaviors Among School Staff LEAH FRERICHS, PhD a JERI BRITTIN, PhD, MM, Allied ASID b LOREN INTOLUBBE-CHMIL, PhD c MATTHEW TROWBRIDGE, MD, MPH d DINA SORENSEN, M.ARCH, LEED AP e TERRY T.-K. HUANG, PhD, MPH, CPH f ABSTRACT BACKGROUND: Schools have increasing responsibility to address healthy eating, but physical barriers influence their ability to adopt and sustain recommended strategies. We took advantage of a natural experiment to investigate the role of the physical environment in shaping healthy eating attitudes and practices among school staff members. METHODS: A school district consolidated its elementary schools and incorporated architectural features to support healthy eating into a building renovation. Surveys along with structured, in-depth interviews were administered prior to and at 12 months postoccupancy. Paired t-tests and McNemar’s tests were used to analyze changes in survey indices and interview data were coded for themes. RESULTS: The school implemented new policies and programs, including staff wellness activities. There was a significant decrease in the percent of teachers with a high-fat diet (from 73.68% to 57.14%, p < .05). Many physical barriers were removed but new challenges emerged, and staff varied in their awareness and comfort with using the new healthy eating features. CONCLUSIONS: We found promising evidence that school architecture can support a school to address healthy eating. To enhance influence of the physical environment, more research is merited to test complementary strategies such as improving ownership of space and increasing self-efficacy to manage space. Keywords: diet; schools; environment design; teachers. Citation: Frerichs L, Brittin J, Intolubbe-Chmil L, Trowbridge M, Sorensen D, Huang TT-K. The role of school design in shaping healthy eating-related attitudes, practices, and behaviors among school staff. J Sch Health. 2016; 86: 11-22. Received on July 29, 2014 Accepted on May 8, 2015 S chools are a priority setting for childhood obesity prevention, 1 and there is increasing responsibility placed on them to address issues of healthy eating. Unfortunately, schools often face structural and phys- ical environment barriers to adopting recommended curricular and food service changes. 2-4 A transdisci- plinary team of architects and public health researchers developed the theory- and evidence-based Healthy Eating Design Guidelines for School Architecture that aim to address such barriers. 5 Yet, research is lacking regarding the role of the physical environment in shap- ing schools’ and their staff’s healthy eating attitudes, practices, and policies. Evidence from school-based healthy eating inter- ventions to address childhood obesity are inconclusive, 6 a Postdoctoral Research Associate, (leahf@unc.edu), University of North Carolina at Chapel Hill, Center for Health Equity Research, 323 MacNider Hall, CB 7240, Chapel Hill, NC 27599-7240. b Graduate Research Assistant, (jeri.brittin@unmc.edu), University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social and Behavioral Health, 984365 Nebraska Medical Center, Omaha, NE 68918-4365. c Director of International and Intercultural Engagement, (logic69@gmail.com), Johnson & Wales University, 8 Abbott Park Place, Providence, RI 02903. and issues of adoption and sustainability of healthy eating programming and practices remain present. 7 Most school-based healthy eating interventions focus on student outcomes; however, school staff are often central to adopting and implementing programs and practices. Policy approaches are promising, but while a high proportion of schools adopt wellness policies, subsequent implementation and enforcement are problematic. 8-11 School staff often note barriers, including lack of space and appropriate facilities, hinder their ability to implement healthy eating programs and practices. 2,3,12 For example, a national survey of school food service directors found that 88% required new equipment to help them meet the newly updated U.S. Department of Agriculture dietary Journal of School Health • January 2016, Vol. 86, No. 1 •  2015, American School Health Association • 11