Children's Obesogenic Behaviors During Summer Versus School: A Within-Person Comparison

The Day-Level Association Between Child Care Attendance and 24-Hour Movement Behaviors in Preschool-Aged Children

BACKGROUND

Twenty-four hour movement behaviors (ie, physical activity [PA], screen time [ST], and sleep) are associated with children's health outcomes. Identifying day-level contextual factors, such as child care, that positively influence children's movement behaviors may help identify potential intervention targets, like improving access to child care programs. This study aimed to examine the between- and within-person effects of child care on preschoolers' 24-hour movement behaviors.

METHODS

Children (N = 74, 4.7 [0.9] y, 48.9% girls, 63.3% White) wore an Axivity AX3 accelerometer on their nondominant wrist 24 hours per day for 14 days to measure PA and sleep. Parents completed surveys each night about their child's ST and child care attendance that day. Linear mixed effects models predicted day-level 24-hour movement behaviors from hours spent in child care.

RESULTS

Children spent an average of 5.0 (2.9) hours per day in child care. For every additional hour of child care above their average, children had 0.3 hours (95% CI, -0.3 to -0.2) less ST that day. Between-person effects showed that compared with children who attended fewer overall hours of child care, children who attended more hours had less overall ST (B = -0.2 h; 95% CI, -0.4 to 0.0). Child care was not significantly associated with PA or sleep.

CONCLUSIONS

Child care attendance was not associated with 24-hour PA or sleep; however, it was associated with less ST. More research utilizing objective measures of ST and more robust measures of daily schedules or structure is necessary to better understand how existing infrastructure may influence preschool-aged children's 24-hour movement behaviors. In addition, future research should consider how access to child care may influence child care attendance.

Understanding Accelerated Summer Body Mass Index Gain by Tracking Changes in Children's Height, Weight, and Body Mass Index Throughout the Year

Background: Drivers of summer body mass index (BMI) gain in children remain unclear. The Circadian and Circannual Rhythm Model (CCRM) posits summer BMI gain is biologically driven, while the Structured Days Hypothesis (SDH) proposes it is driven by reduced structure. Objectives: Identify the mechanisms driving children's seasonal BMI gain through the CCRM and SDH. Methods: Children's (N = 147, mean age = 8.2 years) height and weight were measured monthly during the school year, and once in summer (July-August). BMI z-score (zBMI) was calculated using CDC growth charts. Behaviors were measured once per season. Mixed methods regression estimated monthly percent change in children's height (%HΔ), weight (%WΔ), and monthly zBMI for school year vs. summer vacation, seasonally, and during school months with no breaks vs. school months with a break ≥1 week. Results: School year vs. summer vacation analyses showed accelerations in children's %WΔ (Δ = 0.9, Standard Error (SE) = 0.1 vs. Δ = 1.4, SE = 0.1) and zBMI (Δ = -0.01, SE = 0.01 vs. Δ = 0.04, SE = 0.3) during summer vacation, but %HΔ remained relatively constant during summer vacation compared with school (Δ = 0.3, SE = 0.0 vs. Δ = 0.4, SE = 0.1). Seasonal analyses showed summer had the greatest %WΔ (Δ = 1.8, SE = 0.4) and zBMI change (Δ = 0.05, SE = 0.03) while %HΔ was relatively constant across seasons. Compared with school months without a break, months with a break showed higher %WΔ (Δ = 0.7, SE = 0.1 vs. Δ = 1.6, SE = 0.2) and zBMI change (Δ = -0.03, SE = 0.01 vs. Δ = 0.04, SE = 0.01), but %HΔ was constant (Δ = 0.4, SE = 0.0 vs. Δ = 0.3, SE = 0.1). Fluctuations in sleep timing and screen time may explain these changes. Conclusions: Evidence for both the CCRM and SDH was identified but the SDH may more fully explain BMI gain. Interventions targeting consistent sleep and reduced screen time during breaks from school may be warranted no matter the season.

Variations in Physical Activity and Screentime According to School Format During the COVID-19 Pandemic

BACKGROUND

Early studies indicate children's physical activity (PA) decreased during the pandemic but may vary by school format and season. We longitudinally assessed changes in PA and screentime (ST) behaviors throughout 1 year of the COVID-19 pandemic and according to changes in school format.

METHODS

Parents of children (5-18 years) completed a survey about school format, home characteristics, PA, and ST. Initial data were collected in November 2020 with follow-up in February, May, and August 2021. Physical activity and ST were compared by season and school format using a 4 (format) × 4 (season) repeated measures analysis of variance.

RESULTS

Children were active for at least 60 minutes/day less often in winter (2.4 ± 0.3 days; p < .001; n = 176) than in other seasons. Longitudinal analysis (n = 61) showed that PA was highest among students attending school fully in-person and lowest among students attending remotely, though school format differences were not significant. Non-school ST did not differ by season or school format.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

These results suggest that changes in school format influence students' lifestyle behaviors.

CONCLUSIONS

The impact on children's lifestyle behaviors should be considered in planning for safe, in-person operation of schools in the event of future pandemics or natural disasters.

Excessive weight gain among preschool children during the COVID-19 lockdown in China: a retrospective observational study

OBJECTIVES

We aimed to analyse weight change and risk factors associated with excessive weight gain in preschool children during the COVID-19-related lockdown in western China.

METHODS

A retrospective observational study of eight randomly selected kindergartens was conducted. Data was collected via online electronic questionnaires during the lockdown.

RESULTS

During the COVID-19 lockdown period, the incidence of overweight and obesity among preschool children involved in the study was 7.6 and 14.7 %, respectively. In addition, the incidence of obesity among children aged 3-4 years was 26.3 %, which was higher than that of other age groups. Children with excessive weight gain (weight gain ≥1.0 kg) spent more time on TV and video viewing during lockdown than children with normal gain. Among children with excessive weight gain, weight before lockdown and fathers' BMI were higher than those of children with normal weight gain. Heavier weight before lockdown (OR 1.044, p<0.05), higher father's BMI (OR 1.022, p<0.05), fresh fruit consumption during lockdown (frequently, ≥5 times/week) (OR 5.946, p<0.05), and long touch-screen device time during lockdown (OR 1.259, p<0.05) were found to be risk factors significantly associated with excessive weight gain. Living space (80-100 m2, OR=0.499, p<0.05; 100-150 m2, OR=0.467, 95 % CI 0.26, 0.83) and good mental behavior during the lockdown (OR=0.056, p<0.05) were found to be significant protective factors against excessive weight gain.

CONCLUSIONS

There was a clear trend in excessive weight gain among preschool children during the COVID-19 lockdown, especially those who had already had heavier weight before the pandemic. The obesity-promoting environment resulting from the COVID-19 pandemic may lead to a further serious exacerbation of the childhood obesity pandemic. Therefore, child health care providers must pay close attention to this and implement effective preventive measures in a timely manner.

Children's activity and diet behaviours in the summer holidays versus school year

BACKGROUND

Evidence shows children gain more weight during the summer holidays versus the school year.

OBJECTIVES

To examine within-child differences in activity and diet behaviours during the summer holidays versus the school year.

METHODS

Children (mean age 9.4 years; 37% male) wore accelerometers (GENEActiv; n = 133), reported activities (Multimedia Activity Recall for Children and Adolescents; n = 133) and parents reported child diet (n = 133) at five timepoints over 2 years capturing school and summer holiday values. Mixed-effects models were used to compare school and summer holiday behaviours.

RESULTS

Children spent less time in moderate- to vigorous-physical activity (-12 min/day; p = 0.001) and sleep (-12 min/day; p < 0.001) and more time sedentary (+27 min/day; p < 0.001) during summer holidays versus the school year. Screentime (+70 min/day; p < 0.001), domestic/social activities (+43 min/day; p = <0.001), self-care (+24 min/day; p < 0.001), passive transport (+22 min/day; p = 0.001) and quiet time (+16 min/day; p = 0.012) were higher during the summer holidays, compensating for less time in school-related activities (-164 min/day; p < 0.001). Diet quality was lower (-4 points; p < 0.001) and children consumed fewer serves of fruit (-0.4 serves; p < 0.001) during the summer holidays versus the school year.

CONCLUSIONS

Children are displaying poorer activity and diet behaviours during the summer holidays, which may contribute to accelerated weight gain over the holiday period.

Examination of parent-reported differences in children's daily screen use, sleep, and sleep hygiene behaviors during the school year and summer and their association with BMI

OBJECTIVE

The current study examined school-summer differences in children's sleep patterns and sleep hygiene. Cross-sectional relationships with children's sleep, sleep hygiene, and weight status were explored during the school year and summer.

METHODS

Children (5-8 years) and their parents (n = 197 dyads) were recruited from 4 schools in southeastern Texas and via Facebook. Parents reported children's school year and summer sleep, sleep hygiene, and screen media use. Children's body mass index (BMI) was objectively assessed at the beginning and end of the summer. Associations between children's sleep hygiene and screen media use, sleep duration, and weight status were explored.

RESULTS

Children's sleep midpoint was earlier during the school year (1:54 AM ± 0.03) than in the summer (2:06 AM ± 0.03; t = 4.07, p < .0001). During summer, children increased their screen media use by 38 minutes (t = 2.32, p = .023) and decreased their caffeine intake from 7.43 to 7.0 (with scores ranging from 3 to 15; t = 2.83, p = .006). Greater sleep-inhibiting (β = 0.40, p = .011) and fewer sleep-promoting (β = -0.28, p = .049) behaviors during the school year were associated with having a higher BMI. There were no associations among sleep patterns, sleep hygiene and BMI during summer.

CONCLUSIONS

More positive school year sleep hygiene behaviors were supportive of having a healthier weight status. Changes in these behaviors during the summer did not portend worse weight outcomes. Supporting families in the establishment of sleep-promoting behaviors, particularly during the school year may help address the child obesity epidemic.

Seasonal variability in body mass index change among children enrolled in the Pediatric Obesity Weight Evaluation Registry: A step in the right direction

BACKGROUND

Research has shown children disproportionately gain excess weight over the summer months (vs. school months), with stronger effects for children with obesity. However, the question has not been investigated among children receiving care in paediatric weight management (PWM) programs.

OBJECTIVE

To test for seasonal variability in weight change among youth with obesity in PWM care enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER).

METHOD

Longitudinal evaluation of a prospective cohort from 2014 to 2019 among youth in 31 PWM programs. Change in percentage of the 95th percentile for BMI (%BMIp95) was compared by quarter.

RESULTS

Participants (N = 6816) were primarily ages 6-11 (48%), female (54%), 40% non-Hispanic White, 26% Hispanic and 17% Black, and 73% had severe obesity. Children were enrolled on average 424.9 ± 401.5 days. Participants reduced their %BMIp95 every season, but compared with Quarter 3 (July-September), reductions were significantly greater in Q1 (Jan-March, b = -0.27, 95%CI -0.46, -0.09), Q2 (April-June, b = -0.21, CI -0.40, -0.03), and Q4 (October-December, b = -0.44, CI -0.63, -0.26).

CONCLUSION AND RELEVANCE

Across 31 clinics nationwide, children reduced their %BMIp95 every season, but reductions were significantly smaller during the summer quarter. While PWM successfully mitigated excess weight gain during every period, summer remains a high-priority time.

Interpersonal and Environmental Protective Factors and Their Associations With Children's Weight Status

Both external structure (ie, participating in extracurricular activities) and family factors (ie, parental emotional support) have separately been linked with children's physical health and well-being, however, their combined effects are less well known. The current study examined the longitudinal associations between participating in structured out-of-school activities and parent reports of warmth/emotional support with children's weight status (ie, zBMI) over time. Utilizing longitudinal data from the United States-based Early Childhood Longitudinal Study, Kindergarten Class of 2010 to 2011 (ECLS-K:2011), we employed a confirmatory factor analysis (CFA) and a latent variable cross-lagged path analysis to examine if emotional supportiveness and participation in structured activities predicted lower zBMI over the course of 1 year. The final sample included 18 135 participants. Mean age of the participants was 8.12 years (±0.38 years), and 51% of children were male. Mean zBMI was 0.54 (±1.12). Structure at baseline predicted increased zBMI in year 2 (β = .03, P = .02) but did not predict parent emotional supportiveness at year 2 (β = -.05, P = .09). Parent emotional supportiveness at baseline predicted greater zBMI at year 2 (β = .02, P = <.01) but did not predict structure at year 2 (β = .02, P = .39). zBMI at baseline did not predict structure (β = .02, P = .25) or parent emotional supportiveness at year 2 (β = -.01, P = .55). Our findings were inconsistent with our hypothesis with regard to directionality. Continued refinement about the role of internal structure (ie, family, and parenting practices) may inform public health prevention strategies to support the well-being of children and families.

Maintaining School Foodservice Operations in Ohio during COVID-19: “This [Was] Not the Time to Sit Back and Watch”

The COVID-19-related lockdowns led to school closures across the United States, cutting off critical resources for nutritious food. Foodservice employees emerged as frontline workers; understanding their experiences is critical to generate innovations for program operations and viability. The purpose of this cross-sectional study was to characterize COVID-19-related foodservice adaptations for summer and school year meal provision. Public school district foodservice administrators across Ohio were surveyed in December 2020. Questions related to meal provision before, during, and after COVID-19-related school closures. Results indicate the majority of districts continued providing meals upon their closure in Spring 2020 (n = 182, 87.1%); fewer did so in Summer (n = 88, 42.1%) and Fall (n = 32, 15.3%). In Spring and Summer, most districts that offered meals functioned as ‘open sites’ (67.0% and 87.5%, respectively), not limiting food receipt to district-affiliated students. Most districts employed a pick-up system for food distribution (76–84% across seasons), though some used a combination of approaches or changed their approach within-season. Qualitatively, districts reported both “successes” (e.g., supporting students) and “challenges” (e.g., supply chain). Despite being ill-prepared, districts responded quickly and flexibly to demands of the pandemic. This analysis provides insight for future practice (e.g., establishing community partnerships) and policy (e.g., bolstering local food systems).

Estimates of the Nutritional Impact of Non-Participation in the National School Lunch Program during COVID-19 School Closures

The COVID-19 pandemic resulted in widespread school closures, reducing access to school meals for millions of students previously participating in the US Department of Agriculture (USDA) National School Lunch Program (NSLP). School-prepared meals are, on average, more nutritious than home-prepared meals. In the absence of recent data measuring changes in children's diets during the pandemic, this article aims to provide conservative, back-of-the-envelope estimates of the nutritional impacts of the pandemic for school-aged children in the United States. We used administrative data from the USDA on the number of NSLP lunches served in 2019 and 2020 and nationally representative data from the USDA School Nutrition and Meal Cost Study on the quality of school-prepared and home-prepared lunches. We estimate changes in lunchtime calories and nutrients consumed by NSLP participants from March to November 2020, compared to the same months in 2019. We estimate that an NSLP participant receiving no school meals would increase their caloric consumption by 640 calories per week and reduce their consumption of nutrients such as calcium and vitamin D. Because 27 to 78 million fewer lunches were served per week in March-November 2020 compared to the previous year, nationally, students may have consumed 3 to 10 billion additional calories per week. As students return to school, it is vital to increase school meal participation and update nutrition policies to address potentially widening nutrition disparities.

Examining adolescents' obesogenic behaviors on structured days: a systematic review and meta-analysis

BACKGROUND

The structured days hypothesis posits that 'structured days' (i.e., days with pre-planned, segmented, and adult-supervised environments) reduce youth obesogenic behaviors. Structured days may be especially important for adolescents', as adolescence (12-19 years) is a period of developmental milestones and increased autonomy. Therefore, the objective of this systematic review and meta-analysis is to evaluate the relationship between structured days and adolescents' obesogenic behaviors (i.e., physical activity, diet, screen time, and/or sleep).

METHODS

From February to April of 2020, four databases (i.e., Embase, PubMed, Web of Science, and PsychINfo) were searched for cross-sectional, longitudinal, and intervention (i.e., baseline data only) studies reporting obesogenic behaviors on more structured versus less structured days (i.e., weekday versus weekend or school year versus summer/holiday).

RESULTS

A total of 42,878 unique titles and abstracts were screened with 2767 full-text articles retrieved. After review of full-text articles, 296 studies were identified (sleep k = 147, physical activity k = 88, screen time k = 81, diet k = 8). Most studies were conducted in North America, Europe & Central Asia, or East Asia & the Pacific used self-report measures and compared school days to weekend days. Meta-analyses indicated that adolescents' physical activity (standardized mean difference [SMD] = -0.25 [95%CI - 0.48, -0.03]) and screen time (SMD = -0.48 [95%CI - 0.66, -0.29]) were less healthy on less structured days. Differences did not reach statistical significance for sleep (SMD = -0.23 [95%CI - 0.48, 0.02]) and diet (SMD = -0.13 [95%CI - 0.77, 0.51]), however, sleep timing (SMD = -1.05 [95%CI - 1.31, -0.79]) and diet quantity (SMD = -0.29 [95%CI - 0.35, -0.23]) were less healthy on less structured days. The review identified studies with large heterogeneity.

CONCLUSIONS

Findings indicate that adolescents' physical activity, screen time, sleep timing, and diet quantity are less healthy on less structured days. Interventions for adolescents to prevent and treat obesity may be more successful if they are designed to target times that are less structured.

The Immediate and Lasting Effects of Resident Summer Camp on Movement Behaviors Among Children

This study aims to examine the immediate and lasting effects of resident summer camp on movement behaviors among children with repeated pre-, during-, and post-intervention measurements. In total, 21 children (aged 10.3 ± 1.2 years, 17 boys and 4 girls) participated in a 31-day nature-based resident summer camp in Japan. Daily children's movement behaviors (moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), and sleep) were continuously monitored before, during, and after the summer camp (i.e., 75 continuous days). It was found that the children engaged more time in MVPA (9.6%), less time in SB (58.0%), had more steps (22,405 steps/day), and an earlier midpoint of sleep (0:24 a.m.) in the summer camp as compared to the other periods (before and after the camp). However, the children engaged in unfavorable behaviors [reduction in MVPA (3.6%), increased SB (67.3%), and a later midpoint of sleep (1:32 a.m.)] during the summer vacation after the camp. This study indicates that the resident summer camp was effective in improving children's movement behaviors during the camp. However, the lasting effects were negligible or at least limited after its completion.

Seasonal variation in added sugar or sugar sweetened beverage intake in Alaska native communities: an exploratory study

Excess added sugar intake contributes to tooth decay risk in Alaska Native communities. The goal of this exploratory study was to determine if there is seasonal variation in total added sugar intake or in the leading sources of added sugars in a Yup'ik population. Data were collected in spring and winter from 2008-2010 using self-reported intake data measured by 24-hour recall and by hair biomarker (carbon and nitrogen stable isotope). Seventy Yup'ik participants ages 14-70 years were recruited from two communities and data were collected twice from a subset of 38 participants. Self-reported added sugar intake (g/day), biomarker-predicted added sugar intake (g/day), and leading sources of added sugar were calculated. Seasonal variation was evaluated using a paired sample t-test. Total added sugar intake was 93.6 g/day and did not significantly differ by season. Sodas and other sugar-sweetened beverages (e.g. Tang, Kool-Aid) were the leading sources and added sugar from these sources did not significantly differ by season (p=.54 and p=.89, respectively). No seasonal variation in added sugar intake was detected by either self-report or biomarker. Dietary interventions that reduce intake of added sugars have the potential to reduce tooth decay in Yup'ik communities.

Differences in ​the proportion of children meeting behavior guidelines ​between summer ​and school by socioeconomic status and race

OBJECTIVE

Children who fail to meet activity, sleep, and screen-time guidelines are at increased risk for obesity. Further, children who are Black are more likely to have obesity when compared to children who are White, and children from low-income households are at increased risk for obesity when compared to children from higher-income households. The objective of this study was to evaluate the proportion of days meeting obesogenic behavior guidelines during the school year compared to summer vacation by race and free/reduced priced lunch (FRPL) eligibility.

METHODS

Mixed-effects linear and logistic regressions estimated the proportion of days participants met activity, sleep, and screen-time guidelines during summer and school by race and FRPL eligibility within an observational cohort sample.

RESULTS

Children (n = 268, grades = K - 4, 44.1%FRPL, 59.0% Black) attending three schools participated. Children's activity, sleep, and screen-time were collected during an average of 23 school days and 16 days during summer vacation. During school, both children who were White and eligible for FRPL met activity, sleep, and screen-time guidelines on a greater proportion of days when compared to their Black and non-eligible counterparts. Significant differences in changes from school to summer in the proportion of days children met activity (-6.2%, 95CI = -10.1%, -2.3%; OR = 0.7, 95CI = 0.6, 0.9) and sleep (7.6%, 95CI = 2.9%, 12.4%; OR = 2.1, 95CI = 1.4, 3.0) guidelines between children who were Black and White were observed. Differences in changes in activity (-8.5%, 95CI = -4.9%, -12.1%; OR = 1.5, 95CI = 1.3, 1.8) were observed between children eligible versus uneligible for FRPL.

CONCLUSIONS

Summer vacation may be an important time for targeting activity and screen-time of children who are Black and/or eligible for FRPL.

Time-Limited Eating and Continuous Glucose Monitoring in Adolescents with Obesity: A Pilot Study

Due to its simplicity, time-limited eating (TLE) may represent a more feasible approach for treating adolescents with obesity compared to other caloric restriction regimens. This pilot study examines the feasibility and safety of TLE combined with continuous glucose monitoring (CGM) in adolescents. Fifty adolescents with BMI ≥95th percentile were recruited to complete a 12-week study. All received standard nutritional counseling, wore a CGM daily, and were randomized to: (1) Prolonged eating window: 12 h eating/12 h fasting + blinded CGM; (2) TLE (8 h eating/16 h fasting, 5 days per week) + blinded CGM; (3) TLE + real-time CGM feedback. Recruitment, retention, and adherence were recorded as indicators of feasibility. Weight loss, dietary intake, physical activity, eating behaviors, and quality of life over the course of the intervention were explored as secondary outcomes. Forty-five participants completed the study (16.4 ± 1.3 years, 64% female, 49% Hispanic, 75% public insurance). There was high adherence to prescribed eating windows (TLE 5.2 d/wk [SD 1.1]; control 6.1 d/wk [SD 1.4]) and daily CGM wear (5.85 d/wk [SD 4.8]). Most of the adolescents (90%) assigned to TLE reported that limiting their eating window and wearing a CGM was feasible without negative impact on daily functioning or adverse events. There were no between-group difference in terms of weight loss, energy intake, quality of life, physical activity, or eating behaviors. TLE combined with CGM appears feasible and safe among adolescents with obesity. Further investigation in larger samples, with a longer intervention duration and follow-up assessments are needed.

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.

Obesogenic Behaviors of Rural Children on School and Nonschool Days

Background: Children living in rural areas are at increased risk of overweight and obesity compared with their urban-dwelling counterparts. The purpose of this study was to provide preliminary evidence of rural children's obesogenic behaviors (e.g., activity, sedentary behaviors, sleep, and diet) during school days, nonschool weekdays, and weekend days. Methods: A repeated measures 14-day observational study was conducted early March 2020. Children (n = 54, 92% 6-11 years old; 66% female; 98% non-Hispanic white; 22% overweight or obese) wore accelerometers on the nondominant wrist for 24 hours/day for 14 consecutive days to capture moderate-to-vigorous physical activity (MVPA), sedentary time, and sleep. Parents completed diaries to report daily activities, diet, and screen time of their child each day. Mixed effect models compared behaviors between school days, nonschool weekdays, and weekend days. Results: Children accumulated +16 additional minutes/day of MVPA (95% confidence interval, CI: +10 to +23 minutes/day), reduced sedentary time (-68 minutes/day, 95% CI: -84 to -51 minutes/day), and reduced screen time (-99 minutes/day; 95% CI: -117 to -81 minutes/day) on school days vs. nonschool weekdays. Similar patterns were observed on school weekdays days vs. weekend days, and on nonschool days when children attended a structured program vs. days they did not attend. Minimal differences were observed in reported consumption of food groups across different days. Conclusions: Preliminary evidence suggests rural children display multiple unfavorable obesogenic behaviors on days when they do not attend school or other structured programs. Future interventions targeting obesogenic behaviors of rural children may want to target times when rural children are not engaged in school and "school-like" environments.

Changes in Physical Fitness during Summer Months and the School Year in Austrian Elementary School Children-A 4-Year Longitudinal Study

Even though physical fitness is an important component in children's health and well-being, there has been a decline in physical fitness over the last several decades. The present study examined potential differences in the development of physical fitness during the academic year and summer vacation in Austrian elementary-school children. A total of 214 children (52.3% boys) completed the German motor test in the fall (after summer vacation) and spring (prior to summer vacation) of every grade throughout their elementary school years. This resulted in eight assessments of cardio-respiratory endurance, muscular fitness, flexibility, speed, agility, and balance over a 4-year period. As expected, physical fitness increased with age but the improvement in cardio-respiratory endurance and muscular fitness was more pronounced during summer vacation (p < 0.01), while the improvement in speed was more pronounced during the academic year (p < 0.01). These results indicate an influence of weather conditions on health-enhancing physical activity in addition to structural and social support. Particularly in geographical regions with cold winters and shorter days, health-enhancing physical activity may be limited. Accordingly, schools need to provide additional opportunities to ensure an adequate amount of physical activity that stimulates the development of physical fitness.

Real-time effects of COVID-19 pandemic lockdown on pediatric respiratory patients

OBJECTIVE

A national lockdown was implemented in Israel to slow the viral spread of COVID-19. We assessed the real-time effects of the lockdown on disease expression and lifestyle modifications in pediatric patients with chronic respiratory disorders.

METHODS

An anonymous electronic questionnaire was distributed during lockdown (March-May 2020) to caregivers of patients with chronic respiratory disorders. The primary outcome was change in disease expression and the secondary outcomes were changes in lifestyle and caregivers' emotional status.

RESULTS

The clinical status of one-third of the 445 participating patients (age 0-18 years) reportedly improved, including decreased respiratory symptoms (n = 133, 33%), exacerbation frequency (n = 147, 35%), and use of reliever medications (n = 101, 27.4%). The condition of ~10% of the patients worsened. Clinical improvement was noted mostly in young patients <5 years (p = .001), asthmatic patients (p = .033), and patients with multiple underlying respiratory disorders (p = .015). Patients whose condition significantly worsened were more likely to be >5 years (p < .001), had increased screen time, decreased physical activity, and shorter sleep duration compared to their younger counterparts (p = .008, <.001, and .001, respectively). Caregivers' reports (n = 236 [58%]) of their own anxiety levels and perceptions of the patients' elevated health risk were increased, regardless of the children's actual clinical status.

CONCLUSION

COVID-19 lockdown was associated with clinical improvement/stability for most of the surveyed children; however, their caregivers' anxiety level was heightened. An increased sedentary lifestyle was reported mostly in older children.

Seasonal Variability in Weight Gain Among American Indian, Black, White, and Hispanic Children: A 3.5-Year Study

INTRODUCTION

Several studies have reported that children gain more weight during the summer season. Despite high obesity rates, little research has included American Indian/Alaskan Native children, and few studies have been longitudinal. This observational study examines seasonal weight variability over 3.5 years among ethnically diverse children, including 2,184 American Indian/Alaskan Native children.

METHODS

Children's height and weight were measured before and after the summer from 2012-2015 and analyzed in 2019-2020, including children with ≥2 consecutive measurements (N=7,890, mean age=8.4 [SD=2.8] years). Mixed-effects models tested whether the percentage of the 95th BMI percentile and BMI differed by season (summer versus the rest of the year) and ethnicity.

RESULTS

American Indian/Alaskan Native (23.7%), Hispanic (19.8%), and Black (17.8%) children had significantly higher baseline obesity rates than White children (7.1%). The percentage of the 95th BMI percentile significantly increased during the summer compared with the percentage during the rest of the year, with the strongest effects for children who were obese (b=2.69, 95% CI=1.35, 4.03, p<0.001) or overweight (b=1.47, 95% CI=0.56, 2.35, p<0.01). In BMI units, summer BMI increase was 0.50 kg/m² higher (obese model) and 0.27 kg/m² higher (overweight) than that of the rest of the year. Seasonal effects were significantly less pronounced for American Indian/Alaskan Native children than for White children.

CONCLUSIONS

Children gained significantly more weight during the summer season, with the strongest effects for children who were obese. American Indian/Alaskan Native children had less seasonal variability than White children, but higher overall obesity rates. These data underscore summer as a critical time for obesity prevention among children who are overweight/obese but suggest that seasonal patterns may vary for American Indian/Alaskan Native children.

Dynamics of sleep, sedentary behavior, and moderate-to-vigorous physical activity on school versus nonschool days

STUDY OBJECTIVES

Studies examining time-use activity behaviors (sleep, sedentary behavior, and physical activity) on school days compared with nonschool days have examined these behaviors independently, ignoring their interrelated nature, limiting our ability to optimize the health benefits of these behaviors. This study examines the associations of school-day (vs. nonschool day) with time-use activity behaviors.

METHODS

Time series data (6,642 days) from Fitbits (Charge-2) were collected (n = 196, 53% female, 5-10 years). We used a variable-centered dynamic structural equation modeling approach to estimate day-to-day associations of time-use activity behaviors on school days for each child. We then used person-centered cluster analyses to group individuals based on these estimates.

RESULTS

Within-participant analysis showed that on school days (vs. nonschool days), children (1) slept less (β = -0.17, 95% CI = -0.21, -0.13), (2) were less sedentary (β = -0.05, 95% CI = -0.09, -0.02), and (3) had comparable moderate-to-vigorous physical activity (MVPA; β = -0.05, 95% CI = -0.11, 0.00). Between-participant analysis showed that, on school days, children with higher sleep carryover experienced greater decreases in sleep (β = 0.44, 95% CI = 0.08, 0.71), children with higher body mass index z-score decreased sedentary behavior more (β = -0.41, 95% CI = -0.64, -0.13), and children with lower MVPA increased MVPA more (β = -0.41, 95% CI -0.64, -0.13). Cluster analysis demonstrated four distinct patterns of connections between time-use activity behaviors and school (High Activity, Sleep Resilient, High Sedentary, and Dysregulated Sleep).

CONCLUSIONS

Using a combination of person-centered and more traditional variable-centered approaches, we identified patterns of interrelated behaviors that differed on school, and nonschool days. Findings can inform targeted intervention strategies tailored to children's specific behavior patterns.

Children's moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis

Purpose

The Structured Days Hypothesis (SDH) posits that children’s behaviors associated with obesity – such as physical activity – are more favorable on days that contain more ‘structure’ (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children’s moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset.

Methods

Data were received from the International Children’s Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status.

Results/findings

Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively.

Conclusions

Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.

Physical Activity Drops During Summer Holidays for 6- to 9-Year-Old Children

Regular physical activity (PA) reduces the health risk of childhood obesity and associated chronic diseases as well as mental health problems. Since PA declines as children age as well with future generations it is of highest importance to intervene in school and out-of-school settings. Out-of-school periods affect children's PA as it is mainly left to the interest and motivation of their parents. We compared accelerometer-based PA patterns in 93 6- to 9-year old children assessed four times: before (May/June), during (August), and after (September) summer holidays and at a 1-year follow up (May/June). Before summer holidays children were assessed also for anthropometry and motor tests. During summer holidays overall PA decreased by 18% (p < 0.001), physical inactivity increased by 5.5% (p < 0.001), moderate PA decreased by 53% (p < 0.001) and moderate to vigorous PA decreased by 45% (p < 0.001) when compared to before summer holidays. Furthermore, overall PA remained diminished also after summer holidays by 8.8% (p = 0.001) but recovered to baseline values at 1-year follow up. About 30% of overall PA and moderate to vigorous PA decrease during summer holidays could be explained by children's fitness level as a greater decrease was found in children with better results in standing long jump and 300-meter running time. Our finding detects an alarming summer holiday decrease in children PA that should not be neglected in future studies and intervention designs.

The impact of summer vacation on children's obesogenic behaviors and body mass index: a natural experiment

BACKGROUND

Children's BMI gain accelerates during summer. The Structured Days Hypothesis posits that the lack of the school day during summer vacation negatively impacts children's obesogenic behaviors (i.e., physical activity, screen time, diet, sleep). This natural experiment examined the impact of summer vacation on children's obesogenic behaviors and body mass index (BMI).

METHODS

Elementary-aged children (n = 285, 5-12 years, 48.7% male, 57.4% African American) attending a year-round (n = 97) and two match-paired traditional schools (n = 188) in the United States participated in this study. Rather than taking a long break from school during the summer like traditional schools, year-round schools take shorter and more frequent breaks from school. This difference in school calendars allowed for obesogenic behaviors to be collected during three conditions: Condition 1) all children attend school, Condition 2) year-round children attend school while traditional children were on summer vacation, and Condition 3) summer vacation for all children. Changes in BMI z-score were collected for the corresponding school years and summers. Multi-level mixed effects regressions estimated obesogenic behaviors and monthly zBMI changes. It was hypothesized that children would experience unhealthy changes in obesogenic behaviors when entering summer vacation because the absence of the school day (i.e., Condition 1 vs. 2 for traditional school children and 2 vs. 3 for year-round school children).

RESULTS

From Condition 1 to 2 traditional school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 24.2, 95CI = 10.2, 38.2), screen time minutes (∆ = 33.7, 95CI = 17.2, 50.3), sleep midpoint time (∆ = 73:43, 95CI = 65:33, 81:53), and sleep efficiency percentage (-∆ = 0.7, 95CI = -1.1, - 0.3) when compared to year-round school children. Alternatively, from Condition 2 to 3 year-round school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 54.5, 95CI = 38.0, 70.9), light physical activity minutes (∆ = - 42.2, 95CI = -56.2, - 28.3) MVPA minutes (∆ = - 11.4, 95CI = -3.7, - 19.1), screen time minutes (∆ = 46.5, 95CI = 30.0, 63.0), and sleep midpoint time (∆ = 95:54, 95CI = 85:26, 106:22) when compared to traditional school children. Monthly zBMI gain accelerated during summer for traditional (∆ = 0.033 95CI = 0.019, 0.047) but not year-round school children (∆ = 0.004, 95CI = -0.014, 0.023).

CONCLUSIONS

This study suggests that the lack of the school day during summer vacation negatively impacts sedentary behaviors, sleep timing, and screen time. Changes in sedentary behaviors, screen time, and sleep midpoint may contribute to accelerated summer BMI gain. Providing structured programming during summer vacation may positively impact these behaviors, and in turn, mitigate accelerated summer BMI gain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03397940 . Registered January 12th 2018.

Effects of Four-Day School Weeks on Physical Education Exposure and Childhood Obesity

BACKGROUND

Use of 4-day school weeks (FDSWs) as a cost-saving strategy has increased substantially as many US school districts face funding declines. However, the impacts of FDSWs on physical activity exposure and related outcomes are unknown. This study examined physical education (PE) exposure and childhood obesity prevalence in 4- versus 5-day Oregon schools; the authors hypothesized lower PE exposure and higher obesity in FDSW schools, given reduced school environment exposure.

METHODS

The authors utilized existing data from Oregon to compare 4- versus 5-day models: t tests compared mean school-level factors (PE exposure, time in school, enrollment, and demographics) and complex samples weighted t tests compared mean child-level obesity data for a state representative sample of first to third graders (N = 4625).

RESULTS

Enrollment, time in school, and student-teacher ratio were significantly lower in FDSW schools. FDSW schools provided significantly more PE, both in minutes (120 vs 101 min/wk in 4- vs 5-d schools, P < .01) and relative to total time in school (6.9% vs 5.0%, P < .0001). Obesity prevalence did not differ significantly between school models.

CONCLUSION

Greater PE exposure in FDSW schools was observed, and it remains unknown whether differences in PE exposure contributed to obesity prevalence in this sample of students. Efforts to better understand how FDSWs impact physical activity, obesity risk, and related factors are needed.

The Diet Quality of a Sample of Predominantly Racial Minority Children From Low-Income Households Is Lower During the Summer vs School Year: Results From the Project Summer Weight and Environmental Assessment Trial Substudy

BACKGROUND

Little is known about the diet quality of racial minority children during the summertime when school is out of session and there is risk of accelerated weight gain. Project Summer Weight and Environmental Assessment Trial was an observational, prospective study exploring child weight status and health trends during the summer.

OBJECTIVE

The objective of this substudy of Project Summer Weight and Environmental Assessment Trial was to examine the diet quality of elementary-aged racial minority children during the summertime vs school year.

DESIGN

This observational, prospective substudy was conducted from June to September 2017.

PARTICIPANTS/SETTING

Students in prekindergarten through fifth grade were recruited from 2 schools located in low-income urban neighborhoods of Columbus, OH, with a predominantly Black population. Sixty-two children (39 families) enrolled.

MAIN OUTCOME MEASURES

Twenty-four-hour dietary recalls (2 weekdays, 1 weekend day) were collected at 3 time points: (1) beginning of summer (T0); (2) midsummer (T1); and (3) beginning of subsequent school year (T2). Healthy Eating Index (HEI)-2015 total and component scores were calculated to assess diet quality. Daily calories (kilocalories) and servings of types of foods within food groups were also assessed.

STATISTICAL ANALYSES

Repeated measures analysis of variance and Tukey's post hoc analyses were performed.

RESULTS

Retention was 76% (n = 47). Mean age was 7.0 ± 0.3 years, 79% (n = 37) were African American, and 58% of participants (n = 26) reported annual household incomes ≤$20,000. HEI-2015 total score was significantly lower during the summertime vs school year (P = .02). HEI-2015 component score for whole fruits (P = .04) was also lower in the summer vs school year, along with total vegetables (P < .001), greens and beans (P < .001) specifically, and legumes (P < .001). The HEI-2015 component score for added sugars (P = .04) was significantly lower in the summer vs the school year as well, indicating a higher intake of added sugars during the summer. On the other hand, whole grains were higher during the summer vs school year (P < .01), specifically snack chips (P = .03) and popcorn (P < .01). Total daily calories did not differ between the summertime vs school year.

CONCLUSIONS

In a small sample of predominantly racial minority school-aged children from low-income households, child diet quality is better during the school year vs summer. Future research is needed to determine if and to what extent summer vs school year diet quality may be associated with differences in weight status.

The impact of summer programming on the obesogenic behaviors of children: behavioral outcomes from a quasi-experimental pilot trial

BACKGROUND

Children from low-income families experience accelerated BMI gain and learning loss during summer. Healthy Summer Learners (HSL) addresses accelerated BMI gain and academic learning loss during summer by providing academic- and health-focused programming. This manuscript reports the effects of HSL on underlying obesogenic behaviors (i.e., physical activity, screen time, sleep, diet) that lead to accelerated summer BMI gain, a necessary first step to informing a future randomized controlled trial of HSL.

METHODS

In the summer of 2018 and 2019 using a quasi-experimental study design, 180 children (90 per summer, 7.9 years [SD = 1.0], 94% non-Hispanic Black, 40% male) at two schools (i.e., one per summer) who were struggling academically (25-75% on a standardized reading test) were provided a free, school-based 6-week health- and academic-focused summer program (i.e., HSL, n = 60), a 4- to 6-week academic-focused summer program (i.e., 21st Century Summer Learning program (21C), n = 60), or no summer program (n = 60). Children wore the Fitbit Charge 2™ over a 10-week period during the summers (June-Aug) of 2018-2019. Differences within (within child days attend vs. not attend) and between (differences between groups attend vs. not attend) were evaluated using mixed effects linear regression.

RESULTS

Regression estimates indicated that, on days attending, HSL children experienced a greater reduction in sedentary minutes (- 58.6 [95% CI = - 92.7, - 24.4]) and a greater increase in moderate-to-vigorous physical activity (MVPA) (36.2 [95% CI = 25.1, 47.3]) and steps (2799.2 [95% CI = 2114.2, 3484.2]) compared to 21C children. However, both HSL and 21C children were more active (i.e., greater MVPA, total steps) and less sedentary (i.e., less sedentary minutes and total screen time) and displayed better sleeping patterns (i.e., earlier and less variability in sleep onset and offset) on days they attended than children in the control.

CONCLUSIONS

HSL produced greater changes in physical activity than 21C. However, attendance at either HSL or 21C leads to more healthy obesogenic behaviors. Based on the behavioral data in this pilot study, a larger trial may be warranted. These results must be considered along with the pending primary outcomes (i.e., academics and BMI z-score) of the HSL pilot to determine if a full-scale trial is warranted.

TRIAL REGISTRATION

NIH-NCT03321071. Registered 25 October 2017.

A qualitative exploration of potential determinants of accelerated summer weight gain among school-age children: perspectives from parents

Background

There is growing evidence that school children in the United States gain weight more rapidly during the summer than the school year, but few studies have explored the causes of this phenomenon. The goal of this study was to qualitatively explore potential determinants of accelerated summer weight gain by interviewing parents of school-age children.

Methods

Key informant interviews were conducted with parents of third and fourth grade students enrolled in a school-based physical activity intervention in three peri-urban communities in Eastern Massachusetts. A structured interview guide was developed to assess school year and summertime differences in child diet, physical activity, daily routine, and family rules. Interviews were recorded and transcribed verbatim. Transcripts were coded and major themes were identified using thematic analysis.

Results

Summer activities varied substantially by family. Many parents characterized summer as a time with less structure and more relaxed rules, particularly around bedtime and screen use. Parents perceived their child to be more physically active in the summer and reported few barriers to summertime physical activity. Parents reported increases in both positive (increased consumption of fruits and vegetables) and negative (increased consumption of “sweets” and “junk foods”) dietary behaviors. They highlighted several stressors unique to summer, such as the high cost of camps and the need to coordinate childcare and manage children’s time.

Conclusions

Parents perceived their children to be more physically active in the summer and consume more fruits and vegetables than during the school year. However, they also perceived children to consume more energy-dense, nutrient poor foods, engage in more screen time, and have later bedtimes during the summer. These behaviors are important targets for summertime obesity prevention interventions. Large-scale quantitative studies are needed to determine whether these parent perceptions reflect meaningful risk factors for accelerated summer weight gain.

Associations between the Home Physical Environment and Children's Home-Based Physical Activity and Sitting

It is important to understand the correlates of children's physical activity (PA) and sitting at home, where children spend significant time. The home social environment has an important influence; however, much less is known about the home physical environment. Therefore, the study aimed to assess relationships between the physical environment and children's sitting and PA at home. In total, 235 child-parent dyads were included in the analyses. Children spent 67% of their time at home sitting. Linear regression analyses examined associations between physical home environmental factors obtained via an audit and children's (55% girl, 10.2 ± 0.7) objective PA and sitting at home. Following adjustment for socio-demographics and social environmental factors, an open plan living area (OPLA), musical instrument accessibility and availability, and perceived house size were negatively and positively associated, whereas media equipment accessibility and availability was positively and negatively associated with sitting and standing, respectively. Additionally, an OPLA was positively associated with total and moderate-to-vigorous PA. Furthermore, sitting breaks were positively associated with objective garden size and negatively associated with digital TV. The physical home environment may have an important influence on children's sitting, standing and PA at home; therefore, interventions that target this environment are needed.

Examining the impact of a summer learning program on children's weight status and cardiorespiratory fitness: A natural experiment

This study examined the impact of an existing 7-week summer learning program on children's weight status and cardiorespiratory fitness (CRF).

METHODS

Using an observational repeated measures within-subjects design, children's (N = 20 mean age = 6.35; 45% female; 80% African American) height, weight, and CRF (i.e., Fitnessgram PACER), were measured during the first and final week of the seven week program. Descriptive statistics were calculated for all variables. Median regression analysis examined estimated the differences in BMI zscore, overweight and obesity prevalence, and CRF during the first week (baseline) compared to the final week (outcome).

RESULTS

Of those enrolled initially in the program, 77% attended for more than 4 weeks. When controlling for attendance and sex, no statistically significant changes were observed for, median zBMI (pre: 0.12, post: 0.11) or CRF (pre: 10, post: 13.5 PACER laps). All children except for one maintained the same weight status (e.g. normal weight, overweight) from baseline to outcome. A total of 12 participants increased or maintained the number of PACER laps completed, while 8 participants' PACER laps decreased.

CONCLUSION

The results of this natural experiment provides preliminary evidence that participation in a structured summer program can potentially mitigate unhealthy weight gains and fitness loss over the summer for some children. Future studies with larger more representative samples are needed to establish the impact of structured summer programming on children's CRF and weight status.

Physical Activity during the School Holidays: Parent Perceptions and Practical Considerations

Children’s physical activity decreases during school holidays. Less structured days and reduced participation in organised activities may account for some of the decrease. Little is known about the factors that influence parents’ decision to enrol their child in organised activity such as holiday clubs. This paper sought to explore parents’ perceptions of their child’s physical activity during school holidays and the factors that influence holiday activity-based decision making. Semi-structured telephone interviews were conducted with 42 parents of children aged 10–11 years in July 2017 or March 2018. Data were analysed using a combination of inductive and deductive content analysis to explore parents’ perceptions of holiday-based physical activity and the factors associated with how they provide physical activity opportunities for their children. The data revealed that most parents consider their child’s physical activity levels when planning for the school holidays. However, work commitments in the holidays meant many parents had to rely on both informal and formal childcare. Grandparents were the primary source of informal childcare, despite a perception that children were not as physically active when with them. Holiday clubs were also a viable option, but the cost, location and age-appropriateness of provision inhibit parents signing older children up to these regularly.

The Academic, Behavioral, and Health Influence of Summer Child Nutrition Programs: A Narrative Review and Proposed Research and Policy Agenda

Since 1975, the US Department of Agriculture has sponsored the Summer Food Service Program as a nationwide strategy for providing nutritious meals to children and youth (aged 18 years or younger) in low-income communities during the summer months. Many programs are sponsored by community organizations as well as school districts that may offer the program through the Summer Food Service Program or a seamless waiver, allowing them to extend school meals programs into the summer. These summer nutrition programs are designed to decrease food insecurity and improve health outcomes among at-risk populations. However, the characteristics of these programs, including the types of participants reached, and the programs' influence on outcomes such as academics, behavior, and physical and mental health, have not been summarized. The aims of this narrative review are to present existing knowledge about the characteristics of summer nutrition programs and their influence on students, to identify knowledge gaps, and to identify future research needs. An extensive search identified eight peer-reviewed articles and 10 reports, briefs, or other documents reporting research on the Summer Food Service Program. A variety of additional literature was reviewed to provide relevant information about summer nutrition programs. The review revealed a dearth of research regarding current Summer Food Service Program implementation. Summer nutrition programs alleviated food insecurity among at-risk populations; however, little research was found about the influence of summer programs on students' dietary intake or weight outcomes. More rigorous and mixed-methods studies examining the characteristics and influence of summer nutrition programs are needed.