Defining standards and policies for promoting physical activity in afterschool programs

Parent Preferences for Physical Activity in Before and After School Programs in Rural and Suburban Communities: A Discrete Choice Experiment

BACKGROUND

The purpose of this study was to examine and compare parent preferences of before and after school physical activity program components in rural and suburban elementary schools.

METHODS

A discrete choice experiment was conducted to measure parent preferences for components of before/after school programs. A total of 183 parents (age = 37.2 [8.2] y, 155 females) sampled from 15 elementary schools (K-6 grades) in the Western United States took part in the study, half of which were from a rural community (n = 93, 50.8%). Results from the discrete choice experiment were analyzed using hierarchic Bayesian methodology, which estimated utility scores and was used to calculate important scores for program components.

RESULTS

The specific goal of the before/after school program was the strongest determinant of parents' stated choice overall, followed by leaders, time of day, length, and main focus. Learning sports as the physical activity goal was the top-rated attribute. Subgroup analyses revealed discrepancies between suburban and rural parents and parents of boys and girls.

CONCLUSION

This study extends the application of discrete choice experiments to school-based programming, providing a unique way to design empirically based, stakeholder informed school programs, specifically within before and after school settings.

Evaluation of Afterschool Activity Programs' (ASAP) Effect on Children's Physical Activity, Physical Health, and Fundamental Movement Skills

Background

Physical literacy-focused afterschool activity programs (ASAPs) can be an effective strategy to improve children’s health-related parameters. We sought to compare physical activity, body composition, aerobic capacity, and fundamental movement skills between physical literacy-focused ASAP and a standard recreational ASAP.

Method

A pre–post (6 months) comparison study was conducted in 5- to 12-year-old children in a physical literacy-focused ASAP (physical literacy group, n = 14) and children attending a standard recreational ASAP (comparison group, n = 15). Physical activity guideline adherence was assessed using accelerometry, body composition was analyzed using bioelectrical impedance, aerobic capacity was estimated using the Progressive Aerobic Cardiovascular Endurance Run test, and fundamental movement skills were evaluated using the Test of Gross Motor Development–2.

Results

There were no significant differences between groups at baseline. After 6 months, the physical literacy group exhibited a significant improvement in their total raw score for the Test of Gross Motor Development–2 (p = .016), which was likely due to improvements in object control skills (p = .024). The comparison group significantly increased body mass index (p = .001) and body fat (p = .009) over time. No significant between-group differences were found; however, there was a trend for improved aerobic capacity in the physical literacy group (d = 0.58).

Conclusions

Engagement in the physical literacy-focused ASAP contributed to an attenuated increase in adiposity and an improvement in object control skills.

Impact of a year-round school calendar on children's BMI and fitness: Final outcomes from a natural experiment

BACKGROUND

Structure may mitigate children's accelerated summer BMI gain and cardiorespiratory-fitness (CRF) loss.

OBJECTIVES

Examine BMI and CRF change during school and summer for year-round and traditional calendar school children.

METHODS

Three schools (N = 2279, 1 year-round) participated in this natural experiment. Children's BMI z-score (zBMI) and CRF (PACER laps) were measured from 2017 to 2019 each May/August. Mixed effects regression estimated monthly zBMI and CRF change during school/summer. Secondary analyses examined differences by weight status and race. Spline regression models estimated zBMI and CRF growth from kindergarten-sixth grade.

RESULTS

Compared to traditional school, children attending a year-round school gained more zBMI (difference = 0.015; 95CI = 0.002, 0.028) during school, and less zBMI (difference = -0.029; 95CI = -0.041, -0.018), and more CRF (difference = 0.834; 95CI = 0.575, 1.093) monthly during summer. Differences by weight status and race were observed during summer and school. Growth models demonstrated that the magnitude of overall zBMI and CRF change from kindergarten-sixth grade was similar for year-round or traditional school children.

CONCLUSIONS

Contrary to traditional school children zBMI increased during the traditional 9-month school calendar and zBMI decreased during the traditional summer vacation for year-round school children. Structured summer programming may mitigate accelerated summer BMI gain and CRF loss especially for overweight or obese, and/or Black children.

COVID-19 Leads to Accelerated Increases in Children's BMI z-Score Gain: An Interrupted Time-Series Study

INTRODUCTION

The COVID-19 pandemic may have negatively impacted children's weight status owing to the closure of schools, increased food insecurity and reliance on ultraprocessed foods, and reduced opportunities for outdoor activity.

METHODS

In this interrupted time-series study, height and weight were collected from children (n=1,770 children, mean age=8.7 years, 55.3% male, 64.6% Black) and were transformed into BMI z-score in each August/September from 2017 to 2020. Mixed-effects linear regression estimated yearly BMI z-score change before the COVID-19 pandemic year (i.e., 2017-2019) and during the COVID-19 pandemic year (i.e., 2019-2020). Subgroup analyses by sex, race (i.e., Black, White, other race), weight status (overweight or obese and normal weight), and grade (i.e., lower=kindergarten-2nd grade and upper=3rd-6th grade) were conducted.

RESULTS

Before the COVID-19 pandemic, children's yearly BMI z-score change was +0.03 (95% CI= -0.10, 0.15). Change during the COVID-19 pandemic was +0.34 (95% CI=0.21, 0.47), an acceleration in BMI z-score change of +0.31 (95% CI=0.19, 0.44). For girls and boys, BMI z-score change accelerated by +0.33 (95% CI=0.16, 0.50) and +0.29 (95% CI=0.12, 0.46), respectively, during the pandemic year. Acceleration in BMI z-score change during the pandemic year was observed for children who were Black (+0.41, 95% CI=0.21, 0.61) and White (+0.22, 95% CI=0.06, 0.39). For children classified as normal weight, BMI z-score change accelerated by +0.58 (95% CI=0.40, 0.76). Yearly BMI z-score change accelerated for lower elementary/primary (+0.23, 95% CI=0.08, 0.37) and upper elementary/primary (+0.42, 95% CI=0.42, 0.63) children.

CONCLUSIONS

If similar BMI z-score accelerations occurred for children across the world, public health interventions to address this rapid unhealthy BMI gain will be urgently needed.

How Youth of Color Create Communities of Hope: Connecting Advocacy, Activity, and Neighborhood Change

The primary aim of this paper was to assess the association of after-school club characteristics with changes in physical activity, nutrition, and attitudes in students of color after participating in the “YEAH!” Advocacy-based Physical Activity Program. We examine the strengths of school-based vs. non-school based programs in promoting feelings of self-efficacy and empowerment among students learning to become more physically active—and importantly, also test the strength of how programs that are more connected (to community-based partners) may contribute to students’ optimism around policy and public health as it directly affects them. This study examined differences in the youth advocacy training impact across four after-school club types: school-based with community partnerships, school-based without partnerships, non-school-based with community partners, and non-school-based clubs without partnerships. We measured improvements in youth’s “optimism for change”, “assertiveness” and “decision-making” as related to after school activities and found that non-school-based programs with community partners showed highest positive impact.

Obesity: Epidemiology, Pathophysiology, and Therapeutics

Obesity is a complex multifactorial disease that accumulated excess body fat leads to negative effects on health. Obesity continues to accelerate resulting in an unprecedented epidemic that shows no significant signs of slowing down any time soon. Raised body mass index (BMI) is a risk factor for noncommunicable diseases such as diabetes, cardiovascular diseases, and musculoskeletal disorders, resulting in dramatic decrease of life quality and expectancy. The main cause of obesity is long-term energy imbalance between consumed calories and expended calories. Here, we explore the biological mechanisms of obesity with the aim of providing actionable treatment strategies to achieve a healthy body weight from nature to nurture. This review summarizes the global trends in obesity with a special focus on the pathogenesis of obesity from genetic factors to epigenetic factors, from social environmental factors to microenvironment factors. Against this background, we discuss several possible intervention strategies to minimize BMI.

A scoping review of physical activity and screen time guidelines for use in Outside School Hours Care

BACKGROUND

Globally, millions of children attend Outside School Hours Care. Children's activity in this setting is critical to meeting daily physical activity recommendations. Guidelines are evidence-based statements intended to optimise practice. This study aimed to identify guidelines used in Outside School Hours Care for physical activity and screen time and summarise their content and methods of development.

METHODS

Outside School Hours Care guidelines for children aged 5 to 12 years were identified by systematically searching Medline, Emcare, Embase, Scopus, ERIC, Sportsdiscus, TROVE, ProQuest, UpToDate, NICE, SIGN and Google in accordance with PRISMA-ScR guidelines. The search was conducted in March 2019 and results screened independently by two authors. Data were synthesized narratively.

RESULTS

Nine guideline documents were identified from grey literature only (n = 8 USA, n = 1 Canada). The included guidelines focused predominantly on the after school care period (n = 9 vs n = 2 for the before school period). All had recommendations for physical activity, whilst 7 included screen time recommendations. There was considerable variability across the physical activity and screen time recommendations, though taken together, they recommended 30-60 min of moderate- to- vigorous physical activity and less than 60 min of recreational screen time per session. All guidelines were developed by expert/stakeholder panels, but none followed rigorous guideline development methods.

CONCLUSIONS

Limited published guidelines for physical activity and screen time in Outside School Hours Care exist. There is a variation in duration and intensity of physical activity recommended, whilst screen time recommendations are more consistent. Guidelines designed with rigorous tools and for other world regions are warranted.

The application of mHealth to monitor implementation of best practices to support healthy eating and physical activity in afterschool programs

BACKGROUND

Childhood obesity continues to be a global epidemic and many child-based settings (e.g. school, afterschool programs) have great potential to make a positive impact on children's health behaviors. Innovative and time-sensitive methods of gathering health behavior information for the purpose of evaluation and strategically deploying support are needed in these settings.

PURPOSE

The aim is to (1) demonstrate the feasibility of mobile health (mHealth) for monitoring implementation of healthy eating and physical activity (HEPA) standards and, (2) illustrate the utility of mHealth for identifying areas where support is needed, within the afterschool setting.

METHODS

Site leaders (N = 175) of afterschool programs (ASPs) were invited to complete an online observation checklist via a mobile web app (Healthy Eating and Physical Activity Mobile, HEPAm) once per week during ASP operating hours. Auto-generated weekly text reminders were sent to site leaders' mobile devices during spring and fall 2015 and 2016 and spring 2017 school semesters. Data from HEPAm was separated into HEPA variables, and expressed as a percent of checklists where an item was present. A higher percentage for a given item would indicate an afterschool has higher compliance with current HEPA standards.

RESULTS

A total of 141 site leaders of ASPs completed 13,960 HEPAm checklists. The average number of checklists completed per ASP was 43 (range 1-220) for healthy eating and 50 (range 1-230) for physical activity. For healthy eating, the most common challenge for ASPs was 'Staff educating children about healthy eating', and for physical activity checklists, 'Girls only physical activity is provided at ASP'.

CONCLUSION

HEPAm was widely used and provided valuable information that can be used to strategically deploy HEPA support to ASPs. This study gives confidence to the adoption of mHealth strategies as a means for public health practitioners to monitor compliance of an initiative or intervention.

The potential of a year-round school calendar for maintaining children's weight status and fitness: Preliminary outcomes from a natural experiment

Purpose

To evaluate the potential of a year-round school calendar (180-day school year distributed across 12 months) as an intervention compared to a traditional school calendar (180-day school year distributed across 9 months) for mitigating children's weight gain and fitness loss via a natural experiment.

Methods

Height, weight, and cardiorespiratory fitness (CRF) (i.e., Fitnessgram Progressive Aerobic Cardiovascular Endurance Run) were measured in children (5-12 years old) in 3 schools (2 traditional, 1 year-round, n = 990 students, age = 8.6 ± 2.4 years, 53.1% male, 68.9% African American) from 1 school district. Structure (represented by the presence of a school day) was the independent variable. Changes in body mass index (BMI), age- and sex-specific BMI z-scores (zBMI), BMI percentile, percent of overweight or obese children, and CRF (Progressive Aerobic Cardiovascular Endurance Run laps completed) were assessed for summer 2017 (May-August 2017), school year 2017/2018 (August 2017-May 2018), and summer 2018 (May-August 2018). Primary analyses examined the overall change in weight and CRF from summer 2017 until summer 2018 via multilevel mixed effects regression, with group (traditional vs. year-round calendar), time, and a group-by-time interaction as the independent variables. Secondary regression analyses estimated differences in change within and between groups during each time period, separately.

Results

Year-round students gained less BMI (difference in ∆ = -0.44, 95% confidence interval (CI): -0.67 to -0.03) and less CRF (difference in ∆ = -1.92, 95%CI: -3.56 to -0.28) than students attending a traditional school overall. Compared with traditional students, during both summers, year-round students gained less BMI (summer 2017 difference in ∆ = -0.15, 95%CI: -0.21 to -0.08; summer 2018 difference in ∆ = -0.16, 95%CI: -0.24 to -0.07) and zBMI (summer 2017 difference in ∆ = -0.032, 95%CI: -0.050 to -0.010; summer 2018 difference in ∆ = -0.033, 95%CI: -0.056 to -0.009), and increased CRF (summer 2017 difference in ∆ = 0.40, 95%CI: 0.02-0.85; summer 2018 difference in ∆ = 0.23, 95%CI: -0.25 to 0.74). However, the opposite was observed for the school year, with traditional students gaining less BMI and zBMI and increasing CRF compared with year-round students (difference in BMI ∆ = 0.05, 95%CI: 0.03-0.07; difference in zBMI ∆ = 0.012, 95%CI: 0.005-0.019; difference in Progressive Aerobic Cardiovascular Endurance Run laps ∆ = -0.43, 95%CI: -0.58 to -0.28).

Conclusion

The year-round school calendar had a small beneficial impact on children's weight status but not CRF. It is unclear if this benefit to children's weight would be maintained because gains made in the summer were largely erased during the school year. Trajectories of weight and CRF gain/loss were consistent with the structured days hypothesis.

Physical Activity for Disabled Youth: Hidden Parental Labor

Locating suitable, inclusive community physical activity programs for disabled children can be challenging for parents. The aim of this study was to uncover everyday hidden labor experienced by parents, as they sought inclusive physical activity opportunities for their children. Focus group interviews with eight families of youth aged 13-19 years were completed using an interpretative phenomenological case study research approach. Four themes, interpreted through the framework of relational ethics, captured their experiences: (a) inclusion is immensely effortful; (b) judged by their impairments, not their possibilities; (c) ongoing education needed to open doors and sustain participation; and (d) the guilt of staying home. Reliance on hidden parental labor highlighted an exclusion agenda in community, accentuated by ableist belief systems.

Physical Activity and Energy Expenditure During an After-School Running Club: Laps Versus Game Play

BACKGROUND

After-school programs (ASPs) have the potential to contribute to student physical activity (PA), but there is limited empirical evidence to guide program development and implementation.

METHODS

We used pedometry to assess the overall effectiveness of an elementary school ASP running program relative to national and state PA recommendations and to compare 2 different formats (laps vs games) on PA and energy expenditure.

RESULTS

Both running laps and running games contributed substantially to PA accrual and energy expenditure (overall 24.2 minutes of PA and 52.6 kcal during sessions averaging 37 minutes), but the formats provided different outcomes relative to PA intensity and energy expenditure. Overall PA% was higher on lap days, but MVPA% (moderate-to-vigorous PA) was higher on game days. Only game days met the stipulation that ASPs provide activities at an intensity in which MVPA% of PA ≥ 50%.

CONCLUSIONS

Both running laps and running games in an ASP can contribute to PA accrual. ASP providers should weigh the demands and outcomes of program activities, and especially consider the quality of activities, students' feelings about them, and the implementation demands on instructors.

Economic evaluation of a group randomized controlled trial on healthy eating and physical activity in afterschool programs

Limited information is available on the cost-effectiveness of interventions to achieve healthy eating and physical activity policies in afterschool programs (ASPs). The objective of this study is to present the costs associated with a comprehensive intervention in ASPs. Intervention delivery inputs (IDIs) associated with a group randomized delayed treatment controlled trial involving 20 ASPs serving >1700 children (5-12yrs) were catalogued prospectively across 2-years (2014-2015). IDIs, analyzed 2015, were expressed as increases in per-child per-week enrollment fees based on a 34-week school year in US$. Total IDIs for year-1 were $15,058 (+$0.58/child/week enrollment fee). In year-2, total costs were $13,828 (+$0.52/child/week) for the delayed group and $7916 (+$0.30/child/week) for the immediate group, respectively. Site leader and staff hourly wages represented 11-17% and 45-46% of initial training costs; travel and trainer wages represented 31-42% and 50-58% of booster costs. Overall, a 1% increase in boys and girls, separately, accumulating 30 mins/d of moderate-to-vigorous physical activity ranged from $0.05 to $0.26/child/week, while a one-day increase in serving a fruit/vegetable or water, or not serving sugar-added foods/beverages ranged from $0.16 to $0.87/child/week. Costs associated with implementing the intervention were minimal. Additional efforts to reduce costs and improve intervention effectiveness are necessary.

A Scoping Review of Inclusive Out-of-School Time Physical Activity Programs for Children and Youth With Physical Disabilities

The objective of this study was to comprehensively evaluate inclusive out-of-school time physical activity programs for children/youth with physical disabilities. A search of the published literature was conducted and augmented by international expertise. A quality appraisal was conducted; only studies with quality ratings ≥60% informed our best practice recommendations. Seventeen studies were included using qualitative (n = 9), quantitative (n = 5), or mixed (n = 3) designs. Programs had a diversity of age groups, group sizes, and durations. Most programs were recreational level, involving both genders. Rehabilitation staff were the most common leaders. Outcomes focused on social skills/relationships, physical skill development, and psychological well-being, with overall positive effects shown in these areas. The best practice recommendations are consistent with an abilities-based approach emphasizing common group goals and interests; cooperative activities; mastery-oriented, individualized instruction; and developmentally appropriate, challenging activities. Results indicate that inclusive out-of-school time physical activity programs are important for positive psychosocial and physical skill development of children/youth with physical disabilities.

First year physical activity findings from turn up the HEAT (Healthy Eating and Activity Time) in summer day camps

BACKGROUND

Summer day camps (SDCs) serve 14 million children yearly in the U.S. and aim to provide participating children with 60 minutes of moderate-to-vigorous physical activity (MVPA). This study evaluated an intervention designed to increase the percent of children meeting this MVPA guideline.

DESIGN

Two-group, pre-post quasi-experimental.

SETTING/PARTICIPANTS

Twenty SDCs serving 1,830 children aged 5-12 years were assigned to MVPA intervention (n = 10) or healthy eating attention control (n = 10).

INTERVENTION

The STEPs (Strategies to Enhance Practice) intervention is a capacity-building approach grounded in the Theory of Expanded, Extended and Enhanced Opportunities. Camp leaders and staff receive training to expand (e.g., introduction of activity breaks/active field trips), extend (e.g., schedule minimum of 3 hours/day for PA opportunities), and enhance (e.g., maximize MVPA children accumulate during schedule activity) activity opportunities. Camps in the comparison condition received support for improving the types of foods/beverages served.

MAIN OUTCOME MEASURES

Percent of children accumulating the 60min/d MVPA guideline at baseline (summer 2015) and post-test (summer 2016) measured via wrist-accelerometry.

RESULTS

Multilevel logistic regression conducted fall 2016 indicated boys and girls attending intervention SDCs were 2.04 (95CI = 1.10,3.78) and 3.84 (95CI = 2.02,7.33) times more likely to meet the 60min/d guideline compared to boys and girls attending control SDCs, respectively. This corresponded to increases of +10.6% (78-89%) and +12.6% (69-82%) in the percentage of boys and girls meeting the guideline in intervention SDCs, respectively. Boys in comparison SDCs increased by +1.6% (81-83%) and girls decreased by -5.5% (76-71%). Process data indicated intervention SDCs successfully extended and enhanced PA opportunities, but were unable to expand PA opportunities, compared to control SDCs.

CONCLUSIONS

Although substantial proportions of children met the MVPA guideline at baseline, no SDCs ensured all children met the guideline. This intervention demonstrated that, with support, SDCs can help all children in attendance to accumulate their daily recommended 60min MVPA.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02161809.

Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood

Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives, we simulate the national implementation, impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school, afterschool and childcare settings. In 2016, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015-2025 including changes in mean MET-hours/day, intervention reach and cost per person, cost per MET-hour change, ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.14. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity, including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas.

Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs

BACKGROUND

The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness.

AIMS

(1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards.

METHOD

HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework ( Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately.

RESULTS

Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p ≤ .001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p ≤ .01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64).

CONCLUSIONS

Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

Physical activity outcomes in afterschool programs: A group randomized controlled trial

INTRODUCTION

Afterschool programs (ASPs) across the US are working towards achieving the standard of all children accumulating 30min of moderate-to-vigorous physical activity (MVPA) during program time. This study describes the two-year impact of an intervention designed to assist ASPs meeting the 30min/day MVPA standard.

METHODS

Using a two-year delayed treatment, group randomized controlled trial, 20 ASPs serving ~1700 children/year (6-12yrs) were randomized to either an immediate (n=10, baseline-2013 and 2yrs intervention fall-2013-to-spring-2015) or delayed group (n=10, baseline 2013-2014 and 1yr intervention fall-2014-to-spring-2015). The intervention, Strategies-To-Enhance-Practice (STEPs), focused on programming MVPA in the daily schedule, training of staff and leaders, and ongoing technical support/assistance. Accelerometry-derived proportion of children meeting the 30min/day MVPA standard was measured in the spring of each year. Mixed model logistic regressions were used to examine the change in the odds of achieving the MVPA standard. Analyses were conducted in 2015. Data were collected in one southeastern US state.

RESULTS

Immediate boys (n=677) and delayed girls (n=658) increased the percent achieving 30min MVPA/day from 35.9% to 47.0% (odds ratio [OR]=1.88, 95% CI 1.18-3.00) and 13.1% to 19.1% (OR=1.42, 95% CI 1.03-1.96). Immediate girls (n=613) and delayed boys (n=687) exhibited a nonsignificant increase from 19.1% to 21.6% (OR=1.20, 95% CI 0.84-1.72) and 29.0% to 31.3% (OR=1.13, 95%CI 0.80-1.58).

CONCLUSIONS

STEPs can have an impact on children's MVPA and time spent sedentary, yet was unable to fully achieve the goal of all children accumulating 30minMVPA/day. Additional efforts are need to identify strategies ASPs can use to meet this important public health standard.

Process Evaluation of Making HEPA Policy Practice: A Group Randomized Trial

This study examines the link between implementation of Strategies to Enhance Practice (STEPs) and outcomes. Twenty after-school programs (ASPs) participated in an intervention to increase children's accumulation of 30 minutes/day of moderate to vigorous physical activity (MVPA) and quality of snacks served during program time. Outcomes were measured via accelerometer (MVPA) and direct observation (snacks). STEPs implementation data were collected via document review and direct observation. Based on implementation data, ASPs were divided into high/low implementers. Differences between high/low implementers' change in percentage of boys accumulating 30 minutes/day of MVPA were observed. There was no difference between high/low implementers for girls. Days fruits and/or vegetables and water were served increased in the high/low implementation groups, while desserts and sugar-sweetened beverages decreased. Effect sizes (ES) for the difference in changes between the high and low group ranged from low (ES = 0.16) to high (ES = 0.97). Higher levels of implementation led to increased MVPA for boys, whereas girls MVPA benefited from the intervention regardless of high/low implementation. ESs of the difference between high/low implementers indicate that increased implementation of STEPs increases days healthier snacks are served. Programs in the high-implementation group implemented a variety of STEPs strategies, suggesting local adoption/adaptation is key to implementation.

Strategies to Increase After-School Program Staff Skills to Promote Healthy Eating and Physical Activity

Standards targeting children's healthy eating and physical activity (HEPA) in after-school programs call for staff to display or refrain from HEPA-promoting or -discouraging behaviors that are linked to children's HEPA. This study evaluated strategies to align staff behaviors with HEPA Standards. Staff at four after-school programs serving approximately 500 children participated in professional development training from January 2012 to May 2013. Site leaders also attended workshops and received technical support during the same time frame. Changes in staff behaviors were evaluated using the System for Observing Staff Promotion of Activity and Nutrition in a pre- (fall 2011) multiple-post (spring 2012, fall 2012, and spring 2013), no-control group study design. A total of 8,949 scans were completed across the four measurement periods. Of the 19 behaviors measured, 14 changed in the appropriate direction. For example, staff engaging in physical activity with children increased from 27% to 40% of scans and staff eating unhealthy foods decreased from 56% to 14% of days. Ongoing training and technical assistance can have a measureable impact on staff behaviors linked to child-level HEPA outcomes. Future research should explore the feasibility of disseminating ongoing trainings to after-school program staff on a large scale.

Making healthy eating and physical activity policy practice: process evaluation of a group randomized controlled intervention in afterschool programs

This study describes the link between level of implementation and outcomes from an intervention to increase afterschool programs' (ASPs) achievement of healthy eating and physical activity (HE-PA) Standards. Ten intervention ASPs implemented the Strategies-To-Enhance-Practice (STEPs), a multi-component, adaptive intervention framework identifying factors essential to meeting HE-PA Standards, while 10 control ASPs continued routine practice. All programs, intervention and control, were assigned a STEPs for HE-PA index score based on implementation. Mixed-effects linear regressions showed high implementation ASPs had the greatest percentage of boys and girls achieving 30 min of moderate-to-vigorous physical activity (47.3 and 29.3%), followed by low implementation ASPs (41.3 and 25.0%), and control ASPs (34.8 and 18.5%). For healthy eating, high/low implementation programs served fruits and vegetables an equivalent number of days, but more days than control programs (74.0 and 79.1% of days versus 14.2%). A similar pattern emerged for the percent of days sugar-sweetened foods and beverages were served, with high and low implementation programs serving sugar-sweetened foods (8.0 and 8.4% of days versus 52.2%), and beverages (8.7 and 2.9% of days versus 34.7%) equivalently, but less often than control programs. Differences in characteristics and implementation of STEPs for HE-PA between high/low implementers were also identified.

A comprehensive professional development training's effect on afterschool program staff behaviors to promote healthy eating and physical activity

OBJECTIVE

Evaluate a comprehensive intervention designed to support staff and program leaders in the implementation of the YMCA of USA healthy eating and physical activity (HEPA) standards for their afterschool programs (3-6 pm).

DESIGN

Pre- (fall 2011) and postassessment (spring 2012) no-control group.

SETTING/PARTICIPANTS

Four large-scale YMCA afterschool programs serving approximately 500 children.

INTERVENTION

Professional development training founded on the 5Ms (ie, Mission, Model, Manage, Monitor, and Maximize) and LET US Play principles (ie, Lines, Elimination, Team size, Uninvolved staff/kids, and Space, equipment, and rules), on-site booster training sessions, workshops, and ongoing technical support for staff and program leaders from January to May 2012.

MAIN OUTCOME MEASURES

System for Observing Staff Promotion of Activity and Nutrition.

ANALYSIS

Multilevel mixed-effects linear (ie, staff behaviors expressed as a percentage of the number of scans observed) and logistic regression.

RESULTS

A total of 5328 System for Observing Staff Promotion of Activity and Nutrition scans were completed over the 2 measurement periods. Of the 20 staff behaviors identified in HEPA standards and measured in this study, 17 increased or decreased in the appropriate direction. For example, the proportion staff engaged in physical activity with children increased from 26.6% to 37% and the proportion of staff eating unhealthy foods decreased from 42.1% to 4.5%.

CONCLUSIONS

Comprehensive professional development training, founded on the 5Ms and LET US Play principles, and ongoing technical assistance can have a sizable impact on key staff behaviors identified by HEPA standards for afterschool programs.

Making policy practice in afterschool programs: a randomized controlled trial on physical activity changes

INTRODUCTION

In the U.S., afterschool programs are asked to promote moderate to vigorous physical activity. One policy that has considerable public health importance is California's afterschool physical activity guidelines that indicate all children attending an afterschool program accumulate 30 minutes each day the program is operating. Few effective strategies exist for afterschool programs to meet this policy goal. The purpose of this study was to evaluate a multistep adaptive intervention designed to assist afterschool programs in meeting the 30-minute/day moderate to vigorous physical activity policy goal.

DESIGN

A 1-year group randomized controlled trial with baseline (spring 2013) and post-assessment (spring 2014). Data were analyzed 2014.

SETTING/PARTICIPANTS

Twenty afterschool programs, serving >1,700 children (aged 6-12 years), randomized to either an intervention (n=10) or control (n=10) group.

INTERVENTION

The employed framework, Strategies To Enhance Practice, focused on intentional programming of physical activity opportunities in each afterschool program's daily schedule and included professional development training to establish core physical activity competencies of staff and afterschool program leaders with ongoing technical assistance.

MAIN OUTCOME MEASURES

The primary outcome was accelerometry-derived proportion of children meeting the 30-minute/day moderate to vigorous physical activity policy.

RESULTS

Children attending intervention afterschool programs had an OR of 2.37 (95% CI=1.58, 3.54) to achieve the physical activity policy at post-assessment compared to control afterschool programs. Sex-specific models indicated that the percentage of intervention girls and boys achieving the physical activity policy increased from 16.7% to 21.4% (OR=2.85, 95% CI=1.43, 5.68) and 34.2% to 41.6% (OR=2.26, 95% CI=1.35, 3.80), respectively. At post-assessment, six intervention afterschool programs increased the proportion of boys achieving the physical activity policy to ≥45% compared to one control afterschool program, whereas three intervention afterschool programs increased the proportion of girls achieving physical activity policy to ≥30% compared to no control afterschool programs.

CONCLUSIONS

The Strategies To Enhance Practice intervention can make meaningful changes in the proportion of children meeting the moderate to vigorous physical activity policy within one school year. Additional efforts are required to enhance the impact of the intervention.

Physical activity opportunities in afterschool programs

Afterschool programs (ASPs) have potential to provide children moderate to vigorous physical activity (MVPA). The availability and types (e.g., free play or organized activities) of physical activity opportunities, their structure (e.g., presence of lines, elimination games), and staff behaviors (e.g., encouragement, engaged) can influence children's MVPA. This study explored these factors in 20 ASPs serving over 1,700 elementary-age children. The occurrence, types, and structure of physical activity opportunities, and staff behaviors were collected via the SOSPAN (System for Observing Staff Promotion of Physical Activity and Nutrition). A total of 4,660 SOSPAN scans were completed across 63 complete program days (1,733 during physical activity opportunities). Physical activity opportunities were observed on 60 program days across all 20 sites, with 73% of those opportunities classified as free play. ASPs scheduled an average of 66.3 minutes (range 15-150 minutes) of physical activity opportunities daily. Games played included basketball, tag, soccer, and football. Staff rarely engaged in physical activity promotion behaviors, and the structure of organized games discouraged MVPA. For example, staff verbally promoted physical activity in just 6.1% of scans, while organized games were more likely to involve lines and elimination. Professional development training may enhance staffs' physical activity promotion and the structure of activity opportunities.

Promoting physical activity in Out-of-School-Time programs: we built the bridge--can we walk over it?

This commentary describes physical activity standards for Out-of-School Time programs and argues that their widespread adoption presents important opportunities for research on their implementation and impact.

Association of environment and policy characteristics on children's moderate-to-vigorous physical activity and time spent sedentary in afterschool programs

BACKGROUND

Afterschool programs are an important setting in which to promote children's physical activity. This study examines the association of environmental and policy characteristics on the moderate-to-vigorous physical activity and sedentary behavior of children attending afterschool programs.

METHODS

A total of 1302 children attending 20 afterschool programs across South Carolina wore accelerometers (ActiGraph GT3X+) for up to 4non-consecutive days. Policy-level characteristics were evaluated using the Healthy Afterschool Program Index-Physical Activity scale. Physical activity space was measured using a measuring wheel (indoor, ft(2)) and Geographical Information Systems software (outdoor, acres). The structure (free-play or organized) of activity opportunities was evaluated via direct observation. Time spent in moderate-to-vigorous physical activity and sedentary, both indoors and outdoors, was estimated using accelerometry.

RESULTS

For every 5000 ft(2) of utilized indoor activity space an additional 2.4 and 3.3 min/day of sedentary behavior was observed among boys and girls, respectively. A higher ratio of free-play to organized play was associated with higher indoor sedentary behavior among boys and girls (3.9 min/day and 10.0 min/day, respectively). For every 1 acre of outdoor activity space used, an additional 2.7 min/day of moderate-to-vigorous physical activity was observed for boys. A higher free-play to organized play ratio was associated with higher outdoor moderate-to-vigorous physical activity for boys and girls (4.4 and 3.4 min/day increase, respectively). Policy characteristics were unrelated to moderate-to-vigorous physical activity levels and time spent sedentary.

CONCLUSION

Findings indicate that policies and size of activity space had limited influence on moderate-to-vigorous physical activity and sedentary behavior, suggesting that a programmatic structure may be a more effective option to improve moderate-to-vigorous physical activity levels of children attending afterschool programs.

Wasting Our Time? Allocated Versus Accumulated Physical Activity in Afterschool Programs

BACKGROUND

Afterschool programs (ASPs) can provide opportunities for children to accumulate moderate-to-vigorous physical activity (MVPA). The optimal amount of time ASPs should allocate for physical activity (PA) on a daily basis to ensure children achieve policy-stated PA recommendations remains unknown.

METHODS

Children (n = 1248, 5 to 12 years) attending 20 ASPs wore accelerometers up to 4 nonconsecutive week days for the duration of the ASPs during spring 2013 (February-April). Daily schedules were obtained from each ASP.

RESULTS

Across 20 ASPs, 3 programs allocated ≤ 30min, 5 approximately 45 min, 4 60 min, 4 75 min, and 4 ≥ 105 min for PA opportunities daily (min·d-1). Children accumulated the highest levels of MVPA in ASPs that allocated ≥ 60 min·d-1 for PA opportunities (24.8-25.1 min·d-1 for boys and 17.1-19.4 min·d-1 for girls) versus ASPs allocating ≤ 45 min·d-1 for PA opportunities (19.7 min·d-1 and 15.6 min·d-1 for boys and girls, respectively). There were no differences in the amount of MVPA accumulated by children among ASPs that allocated 60 min·d-1 (24.8 min·d-1 for boys and 17.1 min·d-1 for girls), 75 min·d-1 (25.1 min·d-1 for boys and 19.4 min·d-1 for girls) or ≥ 105 min·d-1 (23.8 min·d-1 for boys and 17.8 min·d-1 for girls). Across ASPs, 26% of children (31% for boys and 14% for girls) met the recommended 30 minutes of MVPA.

CONCLUSIONS

Allocating more than 1 hour of PA opportunities is not associated with an increase in MVPA during ASPs. Allocating 60 min·d-1, in conjunction with enhancing PA opportunities, can potentially serve to maximize children's accumulation of MVPA during ASPs.

Improving nutrition and physical activity policies in afterschool programs: results from a group-randomized controlled trial

OBJECTIVE

Afterschool programs can be health-promoting environments for children. Written policies positively influence nutrition and physical activity (PA) environments, but effective strategies for building staff capacity to write such policies have not been evaluated. This study measures the comprehensiveness of written nutrition, PA, and screen time policies in afterschool programs and assesses impact of the Out of School Nutrition and Physical Activity (OSNAP) intervention on key policies.

METHODS

Twenty afterschool programs in Boston, MA participated in a group-randomized, controlled trial from September 2010 to June 2011. Intervention program staff attended learning collaboratives focused on practice and policy change. The Out-of-School Time (OST) Policy Assessment Index evaluated written policies. Inter-rater reliability and construct validity of the measure and impact of the intervention on written policies were assessed.

RESULTS

The measure demonstrated moderate to excellent inter-rater reliability (Spearman's r=0.53 to 0.97) and construct validity. OSNAP was associated with significant increases in standards-based policy statements surrounding snacks (+2.6, p=0.003), beverages (+2.3, p=0.008), screen time (+0.8, p=0.046), family communication (+2.2, p=0.002), and a summary index of OSNAP goals (+3.3, p=0.02).

CONCLUSIONS

OSNAP demonstrated success in building staff capacity to write health-promoting policy statements. Future research should focus on determining policy change impact on practices.

Process evaluation of an intervention to increase child activity levels in afterschool programs

BACKGROUND

Identifying effective strategies in Afterschool programs (ASPs) to increase children's moderate-to-vigorous physical activity (MVPA) in the ASP setting is crucial. This study describes the process evaluation outcomes from an intervention to reduce child sedentary time and increase MVPA in ASPs.

METHODS

Four ASPs participated in a quasi-experimental single-group pre-post study targeting child sedentary time and MVPA. The strategies implemented to help ASPs meet Physical Activity Standards consisted of detailed schedules, professional development trainings, on-site booster sessions, and technical assistance. Process evaluation related to staff behaviors was collected via systematic observation to identify the interventions impact on the physical and social environment of the ASP. Random-effects regression models examined the impact of the intervention on boys/girls observed sedentary behavior, MVPA, and changes in staff behaviors.

RESULTS

Increases in MVPA and reductions in sedentary behavior were observed during enrichment, academics, organized and free-play physical activities (PA). Corresponding changes in staff behaviors were observed during these ASP contexts. For example, staff reduced child idle-time during organized PA (38.9-1.8%) and provided energizers more often during enrichment (0.2-11.5%).

CONCLUSIONS

This study identified changes in staff behavior during ASP contexts that led to increases in child MVPA and decreases in child sedentary behavior.

Making healthy eating and physical activity policy practice: the design and overview of a group randomized controlled trial in afterschool programs

National and state organizations have developed policies calling upon afterschool programs (ASPs, 3-6 pm) to serve a fruit or vegetable (FV) each day for snack, while eliminating foods and beverages high in added-sugars, and to ensure children accumulate a minimum of 30 min/d of moderate-to-vigorous physical activity (MVPA). Few efficacious and cost-effective strategies exist to assist ASP providers in achieving these important public health goals. This paper reports on the design and conceptual framework of Making Healthy Eating and Physical Activity (HEPA) Policy Practice in ASPs, a 3-year group randomized controlled trial testing the effectiveness of strategies designed to improve snacks served and increase MVPA in children attending community-based ASPs. Twenty ASPs, serving over 1800 children (6-12 years) will be enrolled and match-paired based on enrollment size, average daily min/d MVPA, and days/week FV served, with ASPs randomized after baseline data collection to immediate intervention or a 1-year delayed group. The framework employed, STEPs (Strategies To Enhance Practice), focuses on intentional programming of HEPA in each ASPs' daily schedule, and includes a grocery store partnership to reduce price barriers to purchasing FV, professional development training to promote physical activity to develop core physical activity competencies, as well as ongoing technical support/assistance. Primary outcome measures include children's accelerometry-derived MVPA and time spend sedentary while attending an ASP, direct observation of staff HEPA promoting and inhibiting behaviors, types of snacks served, and child consumption of snacks, as well as, cost of snacks via receipts and detailed accounting of intervention delivery costs to estimate cost-effectiveness.

From policy to practice: strategies to meet physical activity standards in YMCA afterschool programs

BACKGROUND

In 2011, the U.S. Young Men's Christian Association (YMCA) adopted activity standards recommending that afterschool programs (ASPs) ensure all children engage in a minimum of 30 minutes of moderate to vigorous physical activity (MVPA) daily during the ASP. ASPs decide how to accomplish this standard, for which few effective strategies exist.

PURPOSE

To evaluate strategies designed to help ASPs meet the MVPA standard.

DESIGN

Single group intervention with pretest and three follow-up measures repeated-cross-sectional design with a subsample cohort.

SETTING/PARTICIPANTS

Four large-scale YMCA ASPs, serving approximately 500 children each day.

INTERVENTION

Community-based participatory development of strategies focused on modification of program schedules, professional development training, and weekly checklists to evaluate activity opportunities.

MAIN OUTCOME MEASURES

Accelerometry-derived MVPA classified as meet or fail-to-meet the 30 minutes' MVPA/day standard collected over a minimum of 4 nonconsecutive days at baseline (fall 2011) and three follow-up assessments (spring 2012, fall 2012, spring 2013). Random intercept logistic regression models evaluated the probability of meeting the standard for boys and girls, separately (analyzed summer 2013).

RESULTS

A total of 895 children (aged 5-12 years, 48.4% girls) representing 3654 daily measures were collected across the four assessments. The percentage of girls and boys meeting the MVPA standard at baseline was 13.3% and 28.0%, respectively. By spring 2013, this increased to 29.3% and 49.6%. These changes represented an increase in the odds of meeting the 30 minutes' MVPA/day standard by 1.5 (95% CI=1.1, 2.0) and 2.4 (95% CI=1.2, 4.8) for girls and boys, respectively.

CONCLUSIONS

The strategies developed herein represent an effective approach to enhancing current practice within YMCA ASPs to achieve existing MVPA standards. Additional work is necessary to evaluate the scalability of the strategies in a larger sample of ASPs.

How physically active are children attending summer day camps?

BACKGROUND

Summer day camps (SDC) represent one of the largest settings, outside the academic school year, where children can engage in safe, enjoyable physical activity (PA). Yet, little is known about this setting and how active children are while attending.

METHODS

System for Observing Play and Leisure Activity in Youth was used to categorize PA of boys/girls as Sedentary/Walking/Vigorous across multiple days (8 AM to 6 PM) in 4 large-scale community-based SDCs. Contextual characteristics of type of activity, activity management, equipment, and in/outdoors were collected simultaneously. Mixed-model regression analyses examined associations between PA categories and contextual characteristics.

RESULTS

A total of 4649 scans of 2462 children were made across 27 days in the SDCs. Physical activity opportunities represented 38% of the daily schedule. Overall, 74%-79%, 13%-16%, and 7%-9% of children were observed Sedentary, Walking, or Vigorous during the SDC, and this changed to 62%-67%, 18%-19%, and 15%-18% observed Sedentary, Walking, or Vigorous during PA opportunities. Water-based PA, equipment, and free-play were related to increased PA. Children waiting-in-line for turns, staff instructing, and organized PA were related to increased sedentary.

CONCLUSIONS

These findings provide evidence of modifiable characteristics of SDCs associated with PA. Improving staff skills related to facilitating active environments is a viable avenue to increase PA accumulated within SDCs.

The role of schools in children's physical activity participation: staff perceptions

The school setting provides a promising environment to increase children's physical activity (PA), however, staff often impact the success of PA within schools. The purpose of this article was to describe the knowledge of elementary school staff related to PA and their perception of the importance of the school environment being conducive to PA prior to the implementation of a recess intervention. Qualitative focus groups were conducted in 12 elementary schools in the Midwest. Grounded theory was used to explore participants' knowledge and perceptions. Participants felt PA was important but believed several factors impacted children's ability to be more active: (i) lack of time due to increasing academic demands, (ii) peer pressure (especially in girls) not to be active and (iii) lack of space and equipment. When discussing recess, staff felt that their encouragement of or active participation in PA with children resulted in more activity. Furthermore, even though participants were aware of PA benefits, they noticed eliminating recess was often used as a punishment for misbehavior. School-based PA promotion and PA opportunities hold great promise for increasing PA in children. However, to maximize these efforts school polices related to training staff about PA are needed.

Development of healthy eating and physical activity quality standards for out-of-school time programs

BACKGROUND

Out-of-school time (OST) programs serve over 8 million children per year and have ample opportunity to promote health through menu and physical activity choices. Until recently, however, the field has lacked a comprehensive set of operationalizable standards for healthy eating and physical activity. The National AfterSchool Association adopted voluntary healthy eating and physical activity quality standards (HEPAQS) in April, 2011.

METHODS

We describe the development of HEPAQS. This work reflects a social ecological model for changing children's eating and activity behaviors through program-level interventions. The standards were developed using a national, mixed-methods needs assessment, review of existing standards and expert recommendations, and a participatory process of discussion, review, and consensus engaging 19 influential service and policy organizations and agencies in the Healthy Out-of-School Time (HOST) coalition, which we convened in 2009.

RESULTS

The HOST coalition approved a final version of the HEPAQS in January, 2011. The 11 standards address content, curriculum selection, staff training, program support, and environmental support for healthy eating and physical activity. In April, 2011, the HEPAQS were adopted by the National AfterSchool Association, and have subsequently been widely disseminated. Extensive adoption and implementation efforts are underway.

CONCLUSIONS

The availability of a comprehensive set of standards for healthy eating and physical activity in OST provides practical information to help community-based youth-serving organizations participate in obesity and chronic disease prevention. A working awareness of their content will be useful to scientists undertaking health promotion studies in the out-of-school time setting.

Impact of Policy Environment Characteristics on Physical Activity and Sedentary Behaviors of Children Attending Afterschool Programs

State and national organizations recently developed policies focused on increasing physical activity (PA) in afterschool programs (ASPs). These policies emphasize “activity friendly” environment characteristics that, when present, should lead to higher levels of PA and reduce the amount of time children spend sedentary during an ASP. Currently, little is known about the impact of existing PA policies on children’s PA and sedentary behaviors in ASPs. A sample of 18 community-based ASPs serving 1,241 children (5-12 years) were audited for environment features outlined in existing PA policies (i.e., presence of a written policy to promote PA, collecting child feedback, staff training to promote PA and the quality of that training, holding parent workshops, use of PA curricula, evaluating PA, allocating time in the schedule for PA opportunities, and providing activities that appeal to both boys and girls). Children’s PA and sedentary behavior were measured via accelerometry. Unexpectedly, the presence of a written policy, collecting child feedback, and receiving 1 to 4 hours of staff training for PA was associated with an increase in time spent sedentary and a decrease in PA. Conversely, allocating 50% or more time in an ASP schedule for PA and providing activities that appealed to boys and girls was associated with a decrease of time spent sedentary and an increase in PA. The present state of practice in ASPs suggests that policy environment characteristics are largely unrelated to the amount of PA children accumulate while attending ASPs.

Translating policies into practice: a framework to prevent childhood obesity in afterschool programs

Afterschool programs (3-6 p.m.) are positioned to play a critical role in combating childhood obesity. To this end, state and national organizations have developed policies related to promoting physical activity and guiding the nutritional quality of snacks served in afterschool programs. No conceptual frameworks, however, are available that describe the process of how afterschool programs will translate such policies into daily practice to reach eventual outcomes. Drawing from complex systems theory, this article describes the development of a framework that identifies critical modifiable levers within afterschool programs that can be altered and/or strengthened to reach policy goals. These include the policy environment at the national, state, and local levels; individual site, afterschool program leader, staff, and child characteristics; and existing outside organizational partnerships. Use of this framework and recognition of its constituent elements have the potential to lead to the successful and sustainable adoption and implementation of physical activity and nutrition policies in afterschool programs nationwide.

The healthy afterschool activity and nutrition documentation instrument

BACKGROUND

Policies call on afterschool programs to improve the physical activity and nutrition habits of youth attending. No tool exists to assess the extent to which the afterschool program environment meets physical activity and nutrition policies.

PURPOSE

To describe the development of the Healthy Afterschool Activity and Nutrition Documentation (HAAND) instrument, which consists of two subscales: Healthy Afterschool Program Index for Physical Activity (HAPI-PA) and the HAPI-Nutrition (HAPI-N).

METHODS

Thirty-nine afterschool programs took part in the HAAND evaluation during fall/spring 2010-2011. Inter-rater reliability data were collected at 20 afterschool programs during a single site visit via direct observation, personal interview, and written document review. Validity of the HAPI-PA was established by comparing HAPI-PA scores to pedometer steps collected in a subsample of 934 children attending 25 of the afterschool programs. Validity of the HAPI-N scores was compared against the mean number of times/week that fruits and vegetables (FV) and whole grains were served in the program.

RESULTS

Data were analyzed in June/July 2011. Inter-rater percent agreement was 85%-100% across all items. Increased pedometer steps were associated with the presence of a written policy related to physical activity, amount/quality of staff training, use of a physical activity curriculum, and offering activities that appeal to both genders. Higher servings of FV and whole grains per week were associated with the presence of a written policy regarding the nutritional quality of snacks.

CONCLUSIONS

The HAAND instrument is a reliable and valid measurement tool that can be used to assess the physical activity and nutritional environment of afterschool programs.

The distribution of physical activity in an after-school friendship network

OBJECTIVE

To examine whether a child's friendship network in an afterschool program influences his/her physical activity.

METHODS

Three waves of data were collected from school-aged children participating in aftercare (n = 81; mean [SD] age, 7.96 [1.74] years; 40% African American, 39% white, and 19% Latino) a name generator survey was used to map each child's social network, and accelerometers were used to measure physical activity. We applied stochastic actor-based modeling for social networks and behavior.

RESULTS

Children did not form or dissolve friendships based on physical activity levels, but existing friendships heavily influenced children's level of physical activity. The strongest influence on the amount of time children spent in moderate-to-vigorous activity in the afterschool hours was the activity level of their immediate friends. Children consistently made adjustments to their activity levels of 10% or more to emulate the activity levels of their peers (odds ratio [OR] = 6.89, P < .01). Age (OR = 0.92, P < .10) and obesity status (OR = 0.66, P < .10) had marginally significant and relatively small direct effects on the activity. Gender had no direct effect on activity.

CONCLUSIONS

These results suggest that friendship ties play a critical role in setting physical activity patterns in children as young as 5 to 12 years. Children's activity levels can be increased, decreased, or stabilized depending on the activity level of their immediate social network during a 12-week afterschool program. Network-based interventions hold the potential to produce clinically significant changes to children's physical activity.

A conceptual model for training after-school program staffers to promote physical activity and nutrition

BACKGROUND

After-school programs (ASPs, 3 pm to 6 pm) have been called upon to increase the amount of daily physical activity children accumulate and improve the nutritional quality of the snacks served. To this end, state and national physical activity and nutrition (PAaN) policies have been proposed. Frontline staff who directly interact with children on a daily basis are charged with the responsibility to meet policy goals. Without appropriate skills, staffers' ability to achieve such goals is limited. The gap between policies and improvements in PAaN must be bridged through professional development training. This article describes the development of an ASP staff professional development training program.

METHODS

A systematic review was performed to identify relevant theoretical perspectives, empirical evidence, and recommended best practices relating to promoting PAaN of children.

RESULTS

A comprehensive professional development framework was developed that incorporated the key elements identified from the review. These elements were distilled into 5 primary categories and conceptually referred to as the 5 Ms: mission-clearly defined policy/standards for PAaN; motivate-providing choices, developmentally appropriate activities, feedback, and encouragement; manage-structuring and managing the environment for safety, routines, and discipline; monitor-ongoing evaluation of PAaN; and maximize-incorporating all former Ms.

CONCLUSIONS

The application of this training framework should lead to improved implementation and eventual achievement of policy goals for PAaN in ASPs. These competencies need to be developed in all ASPs if widespread improvements in PAaN within the ASP setting are to be realized.

Physical activity of children attending afterschool programs: research- and practice-based implications

BACKGROUND

Afterschool programs (3PM-6PM; ASPs) are positioned to play a vital role in the improvement of children's daily physical activity. Recent guidelines specify that children should accumulate 4600 steps per day while attending an ASP. The extent to which ASPs currently meet this goal and how many steps per day children naturally accumulate within the ASP setting is unknown.

PURPOSE

The purpose of this study was to describe the pedometer-determined physical activity of a large sample of children attending a diverse range of ASPs and evaluate the extent to which ASPs are meeting current physical activity guidelines.

METHODS

Children (N=934, 51% girls, average 8.2 years; range 4-14 years) enrolled across 25 ASPs wore Walk4Life MVPa pedometers (number of steps accumulated, time spent active [hours:minutes:seconds]) up to 4 days. Data were collected in fall/spring 2010-2011 and analyzed in summer 2011.

RESULTS

On average, children attended ASPs for 125 minutes per day, accumulated 2944 steps per day, and spent approximately 26.6 minutes per day in physical activity. Only 16.5% of the 1819 daily observations met the 4600 steps per day guideline. No differences in steps per day, minutes per day in physical activity, or demographics were observed among children measured a single day versus 2, 3, or 4 days. Based on current practice, children would need to spend approximately 3.4 hours per day at an ASP to reach 4600 steps per day.

CONCLUSIONS

Activity levels in ASPs are well below recommendations. Substantial effort is needed to identify strategies ASPs can employ to ensure children are sufficiently active.

Enhancing the Translation of Physical Activity Interventions in Afterschool Programs

Afterschool programs (3-6 pm, ASPs) represent a promising approach to promote physical activity (PA) and are positioned to make a substantial contribution to children’s overall daily PA. This article synthesizes both descriptive and intervention focused efforts aimed at describing/increasing PA within the ASP setting and outlines future directions for research. ASPs provide anywhere from 8 to 24 minutes of moderate-to-vigorous PA daily, with children accumulating between 2600 and 3200 steps per day. State and national organizations have developed policies related to PA in ASPs, but the limited available evidence indicates that ASPs are far from meeting PA policy goals. A total of 17 ASP PA intervention studies have been conducted, more than half (9/17) within ASPs that were initiated and developed by researchers. Based on the review of evidence, key strategies to increase PA include high-quality professional development training, allocating time in the ASP schedule for children to engage in sufficient amounts of PA, and tailoring the intervention to local conditions. Future directions should focus on evaluating these key strategies, conducting descriptive studies of common ASP characteristics nationally and their influence on children’s PA, evaluation/refinement of existing ASP PA curricula, cost-effectiveness of interventions, and identification of feasible PA policy goals.

Nutritional policies and standards for snacks served in after-school programmes: a review

OBJECTIVE

To review and synthesize existing national and state organizations' policies related to the nutritional quality of snacks served in after-school programmes (ASP; 15.00-18.00 hours) in the USA.

DESIGN

Systematic review of websites and corresponding documentation describing national and state-level ASP organizations' policies, standards, guidelines and/or recommendations for the nutritional quality of snacks served within the ASP setting.

SETTING

ASP can play a critical role in a child's daily dietary intake. State and national organizations have developed policies to assist ASP in selecting nutritionally appropriate snacks, yet no widely accepted standards exist. By reviewing the extent of existing policies, recommendations for uniform policies can be made.

SUBJECTS

Policy documentation.

RESULTS

A total of seventeen organizations representing five unique snack policies comprised of thirteen different food items were identified. The most widely recognized snack policy, which the majority of state and national ASP organizations endorsed and upon which other snack policies were modelled, was the US Department of Agriculture reimbursement programmes. Consistently, policies endorsed serving fruits/vegetables, whole grains and milk/dairy products, and limiting foods high in fats/sugar/energy (calories). Two policies focused predominantly on total energy and macronutrient composition of snacks, a single policy suggested limits on sugar-sweetened beverages, and three endorsed serving water daily. A proposed set of general guidelines for ASP was developed based on uniformity in recommendations across policies.

CONCLUSIONS

The proposed set of nutritional guidelines will assist policy makers and ASP providers in selecting and serving nutritionally appropriate snacks that contribute to a child's overall healthful daily dietary intake.

Evaluation of policies to promote physical activity in afterschool programs: are we meeting current benchmarks?

BACKGROUND

Policies now recommend afterschool programs (ASP, 3-6 pm) provide children a minimum amount of physical activity daily. We examined the extent to which children attending ASPs meet existing national and state-level policies that specify expected levels of physical activity (PA).

METHODS

Accelerometer-derived physical activity (light and moderate-to-vigorous, MVPA) of 253 children (5-13 years) was compared to policies that recommend varying amounts of PA children should achieve during an ASP.

RESULTS

The proportion of children achieving a policy ranged from 0.0% (California 60 min MVPA and North Carolina 20% of daily program time devoted to MVPA), 1.2% (California 30 min MVPA), to 48.2% (National Afterschool Association 30 min light plus MVPA). Random effects logistic models indicated boys (odds ratio [OR] range 2.0 to 6.27) and children from a minority background (Black/Hispanic, OR range 1.87 to 3.98) were more likely to achieve a recommended level of physical activity, in comparison to girls and White children. Neither age nor BMI were related to achieving a policy.

CONCLUSIONS

The PA of children attending ASP falls below policy recommended levels; however, these policies were developed in absence of data on expected PA levels during ASPs. Thus, concerted effort towards building a stronger ASP evidence-base for policy refinement is required.