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

Healthy Summer Learners: An explanatory mixed methods study and process evaluation

Healthy Summer Learners (HSL), a novel, 6-week summer program for 2-4th grade children from low-income families in the Southeastern United States, aimed to prevent accelerated summer BMI gain and academic learning loss by providing healthy meals and snacks, 15 min of nutrition education, 3 h of physical activity opportunities and 3.5 h of reading instruction daily. This three-armed pilot quasi-experimental study used a repeated measure within- and between-participant design to compare HSL, to an active comparator-21st Century Summer Learning Program (21 C), and no-treatment control. A mixed-methods process evaluation was employed to evaluate program implementation and provide insight for future program development. Though the program was well received, student attendance was lower than anticipated and full program fidelity was not achieved. During interviews, both parents and teachers noted that the bussing schedule was inconsistent, making attendance difficult for some families. These process evaluation findings may help explain why no statistically significant group-by-time interactions at 3- or 12-month follow up were found for the primary outcomes of zBMI or MAP reading score. Future iterations of HSL should seek to extend program hours, lengthen program duration, and explore ways to lower projected cost of attendance.

An overview of the Connect through PLAY trial to increase physical activity in underserved adolescents

BACKGROUND

The Connect through Positive Leisure Activities for Youth (Connect through PLAY) trial is a prospective, randomized controlled trial implemented within pre-existing afterschool programs (ASPs) comparing a staff-based social development physical activity (PA) program to a health curriculum active control. The efficacy trial aims to improve staff capacity for implementing effective physical activity (PA) programming within ASPs serving underserved youth (minority, low-income) through enhancing the influence of ASP staff as key change agents and addressing the social development needs of adolescents.

DESIGN AND SETTING

The 5-year cluster randomized trial will involve 30 ASPs that are randomized to either the Connect through PLAY intervention or the active health curriculum control.

INTERVENTION

The Connect through PLAY intervention employs a novel theoretical framework that targets three key social mechanisms for increased and sustained PA of staff and youth including youth-peer connections/friendships, group belonging, and staff-youth connections. All components of the intervention are designed to improve staff capacity for facilitating a PA context that supports these social mechanisms and increases the influence of ASP staff as positive PA role models and agents of change. Compared to control sites, ASPs receiving Connect through PLAY are expected to show greater improvements from baseline to post- and 6-month follow-up on youth PA, staff PA, and social mechanisms.

IMPLICATIONS

The results of the Connect through PLAY trial will demonstrate the efficacy of the intervention and will assist in developing a model of training, motivating, and empowering ASP staff to address social mechanisms that promote youth PA.

A multifaceted approach increased staff confidence to develop outside of school hours care as a health promoting setting

BACKGROUND

Outside-of-school-hours-care (OSHC) services are well positioned to influence the health behaviours of 489, 800 Australian children, and are an important setting for health promotion given the current rates of childhood overweight and obesity and associated health risks. OSHC Professionals are ideally placed to become positive influencers in this setting, although they may require training and support to confidently perform this role. This study piloted a multifaceted intervention strategy to increase OSHC Professional's confidence and competencies, to support a health promoting OSHC environment with a nutrition and physical activity focus.

METHODS

A mixed methods approach was used. Nineteen OSHC Professionals participated in the study, including a face-to-face workshop, supported by a closed Facebook group and website. Role adequacy (self-confidence) and legitimacy (professional responsibility) were measured pre and post workshop and evaluated using non-parametric statistics. Facebook interactions were monitored, and four participants undertook qualitative exit interviews to discuss their experiences with the intervention.

RESULTS

Pre-workshop 68% of participants had not received any OSHC-specific health promotion training. Post-workshop significant improvements in confidence about menu planning, accessing nutrition information, activities and recipes was observed (P < 0.05 for all). A significant improvement was observed in role support and role related training (P < 0.05). A high level of support and interaction was observed between participants on Facebook and the website was reported a useful repository of information.

CONCLUSIONS

Health promotion training, combined with positive social connections, shared learning experiences, and a website improved OSHC Professionals confidence and capacity to provide a health promoting OSHC environment. Health promotion professional development for OSHC professionals should be mandated as a minimum requirement, and such learning opportunities should be scaffolded with support available through social media interactions and website access.

Formative Process Evaluation of the "Connect" Physical Activity Feasibility Trial for Adolescents

Most interventions do not reach full implementation in real-world settings. Due to this issue, formative process evaluation during pilot programs can be especially useful to understand implementation strengths and areas for improvement so that full implementation can be reached in future iterations. This study demonstrated how a formative process evaluation of the Connect through Positive Leisure Activities for Youth (Connect) pilot informed course corrections for year 2 implementation. Connect is an intervention to promote a positive social motivational climate for physical activity (PA) in pre-existing after school programs. Connect ran 3 days a week for 8 weeks and had 2 components: a 30-minute “Get-to-Know-You” (GTKY) session and a 60-minute PA session. Formative evaluation was assessed using an observational tool and staff surveys. Changes in youth PA during program hours was assessed as a process outcome using the System for Observing Children’s Activity and Relationships during Play (SOCARP). All Connect essential elements were assessed with the observational tool including (a) social goal-oriented support; (b) collaborative, cooperative play; (c) equal treatment/access; and (d) an inclusive and engaging climate. Adequate dose was achieved on all items in all sessions. Although GTKY and PA sessions both reached high fidelity in promoting equal treatment and access, success in reaching fidelity varied for the 3 remaining essential elements. Post-intervention staff surveys indicated acceptability/adoptability of the Connect program and SOCARP observations indicated significant increases in PA from baseline to post-intervention. Changes for year 2 implementation based on the findings are discussed.

Intervention leads to improvements in the nutrient profile of snacks served in afterschool programs: a group randomized controlled trial

Widely adopted nutrition policies for afterschool programs (ASPs) focus on serving a fruit/vegetable daily and eliminating sugar-sweetened foods/beverages. The impact of these policies on the nutrient profile of snacks served is unclear. Evaluate changes in macro/micronutrient content of snacks served in ASPs. A 1-year group randomized controlled trial was conducted in 20 ASPs serving over 1700 elementary-age children. Intervention ASPs received a multistep adaptive framework intervention. Direct observation of snack served was collected and nutrient information determined using the USDA Nutrient Database, standardized to nutrients/100 kcal. By post-assessment, intervention ASPs reduced total kcal/snack served by 66 kcal (95CI -114 to -19 kcal) compared to control ASPs. Total fiber (+1.7 g/100 kcal), protein (+1.4 g/100 kcal), polyunsaturated fat (+1.2 g/100 kcal), phosphorous (+49.0 mg/100 kcal), potassium (+201.8 mg/100 kcal), and vitamin K (+21.5 μg/100 kcal) increased in intervention ASPs, while added sugars decreased (-5.0 g/100 kcal). Nutrition policies can lead to modest daily caloric reductions and improve select macro/micronutrients in snacks served. Long-term, these nutritional changes may contribute to healthy dietary habits.

Effects of a competency-based professional development training on children's physical activity and staff physical activity promotion in summer day camps

The YMCA of the USA serves more than nine million youth in its summer day camping programs nationwide. In spring 2011, the YMCA of Columbia, SC, with support from the University of South Carolina, adopted a competency-based staff-level training approach in an attempt to align staff behaviors with the YMCA of the USA new physical activity standards for summer camp programs. This chapter presents findings from a multiyear evaluation of a competency-based training approach using a single group design with preassessments and multiple postassessments. Training consisted of participatory exercises and video demonstrations. Data on staff physical activity promotion behaviors were collected using SOSPAN, an instrument that utilizes momentary time sampling to record instances of staff physical activity promotion behaviors consistent with physical activity standards. This chapter describes how a competency-based professional development training may be effective at increasing physical activity promoting and decreasing physical activity discouraging staff behaviors and related child activity levels.

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.

Good practice characteristics of diet and physical activity interventions and policies: an umbrella review

BACKGROUND

This umbrella review aimed at eliciting good practice characteristics of interventions and policies aiming at healthy diet, increasing physical activity, and lowering sedentary behaviors. Applying the World Health Organization's framework, we sought for 3 types of characteristics, reflecting: (1) main intervention/policy characteristics, referring to the design, targets, and participants, (2) monitoring and evaluation processes, and (3) implementation issues. This investigation was undertaken by the DEDPIAC Knowledge Hub (the Knowledge Hub on the DEterminants of DIet and Physical ACtivity), which is an action of the European Union's joint programming initiative.

METHODS

A systematic review of reviews and stakeholder documents was conducted. Data from 7 databases was analyzed (99 documents met inclusion criteria). Additionally, resources of 7 major stakeholders (e.g., World Health Organization) were systematically searched (10 documents met inclusion criteria). Overall, the review yielded 74 systematic reviews, 16 position review papers, and 19 stakeholders' documents. Across characteristics, 25% were supported by ≥ 4 systematic reviews. Further, 25% characteristics were supported by ≥ 3 stakeholders' documents. If identified characteristics were included in at least 4 systematic reviews or at least 3 stakeholders' documents, these good practice characteristics were classified as relevant.

RESULTS

We derived a list of 149 potential good practice characteristics, of which 53 were classified as relevant. The main characteristics of intervention/policy (n = 18) fell into 6 categories: the use of theory, participants, target behavior, content development/management, multidimensionality, practitioners/settings. Monitoring and evaluation characteristics (n = 18) were grouped into 6 categories: costs/funding, outcomes, evaluation of effects, time/effect size, reach, the evaluation of participation and generalizability, active components/underlying processes. Implementation characteristics (n = 17) were grouped into eight categories: participation processes, training for practitioners, the use/integration of existing resources, feasibility, maintenance/sustainability, implementation partnerships, implementation consistency/adaptation processes, transferability.

CONCLUSIONS

The use of the proposed list of 53 good practice characteristics may foster further development of health promotion sciences, as it would allow for identification of success vectors in the domains of main characteristics of interventions/policies, their implementation, evaluation and monitoring processes.

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.

Effects of a policy-level intervention on children's pedometer-determined physical activity: preliminary findings from Movin' Afterschool

OBJECTIVES

Although evidence supports the benefits of incorporating physical activity (PA) after school and standards for quality after-school programs (ASPs) include PA, evaluation of policies to increase PA after school is nonexistent. The purpose of this study was to examine the effect of an evidence-informed policy-level ASP intervention on youth pedometer-determined PA.

DESIGN

This study was a quasi-experimental community-based intervention (Movin' Afterschool), with a pre-/posttest design, without a control.

SETTING

Movin' Afterschool took place in the after-school setting.

PARTICIPANTS

Participants were children (5-12 years old) attending 1 of 12 ASPs in Nebraska during the fall and spring of 2010-2011.

INTERVENTION

Movin' Afterschool was an evidence-informed policy-level intervention.

MAIN OUTCOME MEASURES

Physical activity was measured using pedometers.

RESULTS

Children averaged 3145 steps per day at baseline and 3042 steps per day at postassessment. There were no effects of sex, body mass index percentile, age, or the interaction of these covariates on steps. Three ASPs experienced substantial declines in PA compared with the remaining 9 ASPs. Excluding these 3 sites, there was an average increase in steps per day in the remaining 9 sites. No significant contribution was observed with the covariates.

CONCLUSION

This was the first study to provide evidence for the initial effectiveness of a policy-level intervention on youth PA participation while attending an ASP despite the failed attempt by some ASPs to improve PA. Further research may help determine the following: (1) the amount of support necessary to help ASPs modify their planning to meet policies, and (2) strategies that should be emphasized during staff training to ensure that staff are able to implement PA policies.

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.

Staff's perceptions of the use of evidence-based physical activity promotion strategies for promoting girls' physical activity at afterschool programs: a qualitative study

There is a need to improve girls' physical activity (PA) in afterschool programs as girls' PA levels are consistently lower than boys'. An evidence-based professional development framework, the 5 Ms, has been effective in helping staff to improve PA in both girls and boys but further improvements in girls' PA are needed. Little is known about staff's perceptions of using PA promotion strategies to promote girls' PA. Therefore, the purpose of this study was to explore staff perceptions of the use of evidence-based PA promotion strategies for promoting PA in girls. Semi-structured interviews were conducted with staff from three community-based afterschool programs located within a school setting (n=18). Data were analyzed using the process of immersion/crystallization. A majority of staff had some knowledge of PA promotion strategies but few staff consistently utilized these strategies and a majority felt several strategies were unnecessary (i.e., having a PA policy). Newer staff reported depending on senior staff to promote PA in girls. Overall, findings suggest that staff's perceptions may impact their use of PA promotions strategies. The results of this study will contribute to the enhancement of an existing staff training framework (the 5 Ms) to improve girls' PA in afterschool programs.

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.

Is school community readiness related to physical activity before and after the Ready for Recess intervention?

The purpose of this study was to determine: (i) the effect of schools' baseline community readiness (CR) on youth physical activity (PA) at recess prior to the Ready for Recess intervention; (ii) if changes in PA due to the intervention were explained by baseline CR and (iii) if specific components of the intervention altered an association between baseline CR and changes in youth PA. Methods that were employed included: six informants from each of 17 schools participated in CR interviews at baseline (N = 101). CR scores were calculated based on the CR model's nine stages. Direct observation was used to measure PA. Poisson models evaluated the association between baseline CR and PA. Results were that seven schools were in denial, eight in vague awareness and two in pre-planning stages. CR marginally predicted pre-intervention PA. When compared with youth at schools in denial, youth at schools in vague awareness and pre-planning demonstrated significant increases in moderate/vigorous PA. Ready for Recess strengthened this association. This is the first study to demonstrate that school CR may explain changes in PA at recess after a school-based PA intervention. Low CR levels may contraindicate interventions. Efforts to increase school CR a priori may be critical to increasing PA among youth.

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.