Identifying the Ideal Dose of Structured Summer Programming for Mitigating Accelerated Summer BMI Gain

夏季是儿童(5-12岁)体重指数加速增长的时期。研究表明，几乎所有BMI的增加都发生在 暑假期间，无论儿童在暑期入学时的体重状况(即正常体重、超重或肥胖)如何。我们的 研究小组最近提出了结构性天数假说(SDH)，这可能解释了夏季BMI加速的原因 收获。SDH假定这种结构被定义为预先计划、分段和成人监督的强制性 环境，保护儿童免受肥胖行为的影响，防止体重指数过度增加。SDH利用 “充裕时间观”认为，充斥着有利活动的时间不可能充满不利因素。 活动。在SDH的背景下，这意味着儿童参与了更多的肥胖行为，从而导致 与结构较多的时间相比，结构较差的时间(例如夏日)增加的体重增加 有条理的(例如，上学日)。基于SDH，预先存在的社区运营的夏令营(例如，B&G Club，YMCA)，可能通过限制儿童参与肥胖对夏季BMI增加产生积极影响 行为。最近的初步研究表明，孩子们在他们进入夏季的日子里会有更健康的行为 对于这些孩子来说，体重指数的增加不会加速。这些初步调查的严谨性中的一个主要弱点 研究表明，他们不能确定有组织的夏季计划和 夏季体重指数上升。剂量反应研究可以明确地确定观察到有用效应的最小剂量。 同时揭示了最大剂量，超过该剂量则没有进一步的有益效果。以同样的方式 确定减轻负面健康后果的结构的有效剂量是必要的，以便提供可行、可扩展的 干预措施和卫生政策。拟议的随机剂量-反应研究将确定剂量-反应 夏季运动量与夏季BMI增加之间的关系。4周的影响(n=90，20天)， 与没有计划(n=90)相比，6周(n=90，30天)和8周(n=90，40天)的夏季计划将 被评估。我们还将进行全面的执行监测，以评估执行情况，并 确定与儿童夏季BMI增加和肥胖行为相关的因素。研究的目的是： 目的1.评估有组织的暑期计划对儿童体重指数增长和肥胖行为的影响。 目标2.评估实施情况和背景因素及其与儿童夏季BMI增加和 肥胖行为。目标3.确定为期4周、6周、8周的夏季计划的成本效益 夏季BMI加速增长。这项工作意义重大，因为它解决了一个关键的公共卫生目标--减少肥胖。 通过在暑假这段时间内编写程序，这段时间会产生实质性的、持久的负面影响。这 应用是创新的，因为重点是确定结构性夏季之间的剂量-反应关系 编程和夏季体重指数的增加。这一创新解决了以前研究的严谨性中的一个弱点，并 对于确定夏季计划的理想剂量以缓解夏季BMI加速增加至关重要。

Summer is a period of accelerated BMI gain for children (5-12yrs). Studies show that virtually all increases in BMI occur during the summer, no matter children’s’ weight status (i.e., normal weight, overweight, or obese) at summer entry. Our research team recently developed the Structured Days Hypothesis (SDH), which may explain accelerated summer BMI gain. The SDH posits that structure, defined as pre-planned, segmented, and adult-supervised compulsory environments, protect children against obesogenic behaviors and prevent excessive BMI gain. The SDH draws upon the ‘filled-time perspective’, which posits that time filled with favorable activities cannot be filled with unfavorable activities. In the context of the SDH, this means that children engage in more obesogenic behaviors that lead to increased weight gain during times that are less-structured (e.g., summer days) compared to times that are more structured (e.g., school days). Based on the SDH, pre-existing community-operated summer day camps (e.g., B&G Club, YMCA), may exert a positive influence on summer BMI gain by limiting children’s engagement in obesogenic behaviors. Recent preliminary studies show that children engage in healthier behaviors on days that they attend summer day camps, and that BMI gain does not accelerate for these children. A major weakness in the rigor of these preliminary studies is that they cannot identify the dose-response relationship between structured summer programming and summer BMI gain. Dose-response studies can definitively identify the smallest dose at which a useful effect is observed while simultaneously revealing the maximum dose beyond which there is no further beneficial effect. In the same way determining the effective dose of structure to mitigate negative health outcomes is necessary to inform feasible, scalable interventions and health policy. The proposed randomized dose-response study will identify the dose-response relationship between amount of summer programming and summer BMI gain. The impact of 4 weeks (n=90, 20 days), 6 weeks (n=90, 30 days), and 8 weeks (n=90, 40 days) of summer programming compared to no program (n=90) will be evaluated. We will also conduct comprehensive implementation monitoring to evaluate implementation, and to identify factors associated with children’s summer BMI gain and obesogenic behaviors. The aims of the study are to: Aim 1. Evaluate structured summer programming’s impact on children’s BMI gain and obesogenic behaviors. Aim 2. Evaluate implementation and contextual factors and their relationship with children’s summer BMI gain and obesogenic behaviors. Aim 3. Determine the cost effectiveness of 4, 6, 8 weeks of summer programming for mitigating accelerated summer BMI gain. This work is significant as it addresses a critical public health goal – reducing obesity – through programing during a timeframe – summer vacation – when substantial, long-lasting negative effects occur. This application is innovative because of the focus on identifying the dose-response relationship between structured summer programming and summer BMI gain. This innovation addresses a weakness in the rigor of previous studies and is critical for identifying the ideal dose of summer programming for mitigating accelerated summer BMI gain.