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

夏季是儿童（5- 12岁）BMI加速增加的时期。研究表明，几乎所有的BMI增加都发生在 在夏季，无论儿童的体重状况（即，正常体重、超重或肥胖）。我们 一个研究小组最近提出了结构化日假说（SDH），这可能解释了夏季BMI加速的原因 增益SDH认为，结构，定义为预先计划，分段，和成人监督的义务 环境，保护儿童免受肥胖行为和防止过度的BMI增加。SDH借鉴了 “充满时间的观点”，认为充满有利活动的时间不能被不利活动填满。 活动在SDH的背景下，这意味着儿童参与更多的致肥行为，导致 在较少结构化的时间期间增加的体重增加（例如，夏季）相比， 结构化（例如，上学的日子）。根据SDH，以前存在的社区经营的夏令营（例如，B&G 俱乐部，基督教青年会），可能会产生积极的影响，夏季体重指数的增益，限制儿童的参与肥胖 行为。最近的初步研究表明，孩子们在参加夏季活动的日子里， 日营，BMI的增加并没有加速这些孩子。这些初步的严格性的一个主要弱点是 研究是，他们不能确定结构化的夏季规划之间的剂量反应关系， 夏季BMI增加。剂量-反应研究可以明确确定观察到有效效应的最小剂量 而同时揭示了最大剂量，超过该最大剂量就没有进一步的有益效果。以同样的方式 确定结构的有效剂量，以减轻负面的健康结果是必要的，以告知可行的，可扩展的 干预措施和卫生政策。拟定的随机剂量反应研究将确定剂量反应 夏季编程量与夏季BMI增加之间的关系。4周的影响（n=90，20天）， 6周（n=90，30天）和8周（n=90，40天）的夏季编程相比，没有程序（n=90）将 被评价。我们还将进行全面的执行情况监测，以评估执行情况， 确定与儿童夏季BMI增加和致肥胖行为相关的因素。这项研究的目的是： 目标1。评估结构化的夏季计划对儿童BMI增加和致胖行为的影响。 目标二。评估实施和环境因素及其与儿童夏季BMI增加的关系， 肥胖行为目标3。确定4、6、8周暑期课程的成本效益， 夏季BMI增加。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- 在暑假期间，当大量的，长期的负面影响发生时，通过编程。这 应用是创新的，因为重点是确定结构化夏季之间的剂量-反应关系， 编程和夏季BMI增加。这一创新解决了以往研究在严谨性方面的一个弱点， 这对于确定缓解夏季BMI加速增加的夏季规划的理想剂量至关重要。

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.