Physical Activity and Nutrition Intervention in Afterschool Programs

描述（由申请人提供）：在全国范围内，超过840万儿童（6- 14岁）参加课后课程（ASP，下午3- 6点），平均每周8小时，其中大多数来自低收入家庭。由于ASP与儿童有如此广泛的接触和接触，国家，州和地方组织呼吁他们通过针对体育活动和健康零食的政策来帮助对抗儿童肥胖症的流行。加州州的立法是两项最有可能广泛实施和产生影响的政策（第49号提案），该提案要求参加国家资助的ASP的儿童在项目期间每天应积累30分钟的中度到剧烈的身体活动（MVPA），以及哈佛零食营养指南，这需要每天供应水果和蔬菜（FV）并限制添加糖的食物（例如，苏打）。虽然这些公共卫生政策是促进健康行为的必要催化剂，但不知道的是，需要哪些资源和战略来成功实现这些政策目标。到目前为止，有几个有效的，低成本的战略，ASP可以采用，以满足身体活动和营养政策的目标。如果没有有效的战略，这些政策就不太可能实现其预期目的-增加每日最低消费额和提供营养小吃。我们的长期目标是推动通过和成功实施促进全国ASP体育活动和营养的政策。我们的目标是双重的。首先，我们将测试两种有前途的策略的有效性1）专业发展培训，旨在增加儿童在参加ASP时积累的身体活动量，2）现场干预，重点是改变购买决策和减少价格障碍，以提高儿童消费的零食质量。这是在制定以实践为基础的指导方针，以实现公共卫生政策目标方面迈出的重要一步（加州和哈佛）。我们将使用一项为期3年的延迟治疗、随机分组对照试验设计，其中包括20个ASP，主要服务于南卡罗来纳州哥伦比亚的低收入和少数民族儿童（约1300名6- 12岁儿童），并解决以下具体目标：目标1。评估工作人员一级干预的影响，一个专业发展培训计划，重点是核心能力，以促进身体活动，对儿童的身体活动水平;目标2。评估站点级干预的影响，包括折扣购买计划在内的零食修改计划，对供应和消费的零食质量的影响;目标3。评估员工和现场干预措施的实施情况，并确定影响实施这些措施的组织、员工和环境特征 战略布局这项研究是创新的，因为有限的信息存在有效的战略ASP可以用来实现重要的公共卫生政策目标。拟议的研究是重要的，因为我们的研究结果将加强有关在现实世界中实施这些战略以实现重要政策目标的科学知识基础。 公共卫生相关性：课后计划（ASP）代表了促进儿童体育活动和健康饮食的下一个前沿。目前在ASP的做法表明，他们正在下降的身体活动和营养的州和国家政策目标。拟议项目的目标是评估与两项创新战略有关的成果，这两项战略旨在帮助ASP实现活动和营养方面的政策目标，并审查与战略执行有关的因素。

DESCRIPTION (provided by applicant): Nationwide, more than 8.4 million children (6-14yrs) attend afterschool programs (ASP, 3-6pm) for an average of 8hrs/wk, with the majority from low-income households. Because ASPs have such extensive reach and contact with children, national, state, and local organizations have called on them to help combat the epidemic of childhood obesity through policies targeting physical activity and healthy snacks. Two policies that have the greatest potential for widespread implementation and impact are the State of California's legislation (Proposition 49), which mandates that children attending state-funded ASPs should accumulate e30 minutes of moderate-to-vigorous physical activity (MVPA) daily during the program, and the Harvard nutrition guidelines for snacks, which require serving fruits and vegetables (FV) each day and restricting foods with added sugars (e.g., soda). While these public health policies are a necessary catalyst for promoting healthier behaviors, what is not known is what resources and strategies are needed to successfully achieve these policy goals. To date, there are few effective, low-cost strategies ASPs can adopt to meet physical activity and nutrition policy goals. Without effective strategies, it is unlikely such policies will accomplsh their intended purpose - increased daily MVPA and serving nutritious snacks. Our long-term goal is to advance the adoption and successful implementation of policies that promote physical activity and nutrition in ASPs nationwide. Our objective here is twofold. First, we will test the effectiveness of two promising strategies 1) professional development training designed to increase the amount of physical activity children accumulate while attending an ASP and 2) a site-level intervention that focuses on altering purchasing decisions and reducing price barriers to improve the quality of snacks children consume. This represents a fundamental step in establishing practice-based guidelines for the uptake and achievement of public health policy goals (CA and Harvard). We will use a 3-year delayed treatment, cluster randomized controlled trial design with 20 ASPs that serve mostly low-income and minority children (approximately 1300 children ages 6-12yrs) in Columbia, SC and address the following specific aims: Aim 1. Evaluate the impact of a staff-level intervention, a professional development training program focused on core competencies to promote physical activity, on children's physical activity levels; Aim 2. Evaluate the impact of a site-level intervention, a snack modification program that includes a discount buying program, on the quality of snacks served and consumed; and Aim 3. Evaluate the implementation of the staff-level and site-level interventions and identify organizational, staff, and setting characteristics that influence the process of implementing these strategies. This study is innovative because limited information exists on effective strategies ASPs can use to achieve important public health policy goals. The proposed research is significant because our findings will strengthen the scientific knowledge-base regarding the implementation of these strategies in real-world settings to meet important policy goals. PUBLIC HEALTH RELEVANCE: Afterschool programs (ASPs) represent the next frontier in promoting physical activity and healthy eating for children. Current practice in ASPs indicates they are falling short of state and national policy goals for physical activity and nutrition. The goal of the proposed project is evaluate the outcomes associated with two innovative strategies designed to help ASPs meet policy goals for activity and nutrition and to examine factors associated with the implementation of the strategies.