Increasing Low-income Children's Access to Healthy Structured Programming to Reduce Obesity

从低年级到中等年级的儿童（5-11岁）之间超重和肥胖（OWOB）患病率的差异 高收入家庭依然存在。结构化日假说假定，一天之内的结构，定义为一个前- 有计划的，分段的，和成人监督的强制性环境（如学校日），发挥着保护作用， 儿童对肥胖的行为，并最终防止发生负面的健康结果，如 体重过度增加从本质上讲，结构化的日子假设借鉴了“充实的时间”中的概念， 这种观点认为，充满有利活动的时间不可能充满不利活动。 儿童在校外至少有两个“脆弱的窗口”。这些极其重要的 窗口包括紧接着放学后的几个小时（即，下午3点至6点上课）和夏季的10周 度假存在可以提供健康结构化环境并防止不健康体重增加的计划 对于这两个时间段（即，课外活动和夏令营）。可惜这些 对于低收入家庭的孩子来说，这些项目太贵了。因此，根据需求方 融资，这有着悠久的历史，解决大规模的公共卫生问题，在美国，通过 联邦、州和地方计划，如补充营养援助计划和21世纪世纪 学习中心计划，我们将严格测试提供访问预先存在的，社区- 开展关于体重状况的课后和暑期项目（即，BMI z评分）和致肥胖行为（即， 体育活动，屏幕使用，饮食和睡眠）的小学儿童从低收入家庭。这种方法 将有可能比目前的肥胖治疗计划更便宜，目前的肥胖治疗计划每名儿童的费用高达4,600美元。这 研究将采用2x2全因子设计。这四组将是一个无治疗对照，课后计划 仅限代金券、仅限夏令营代金券、以及课后和夏令营代金券。我们 将实现以下具体目标：目标1：比较主要和次要结局的差异 在没有代金券的儿童中，只有课后代金券，只有夏令营代金券， 课后和夏令营的代金券。目标2：评估提供代金券的成本效益 只适用于课后、夏令营及课后及夏令营的代用券。 目标3：评估促进者和实施的障碍，有效性和可持续性的凭证 通过与关键利益相关者进行定性访谈（即，儿童、家长、工作人员、管理人员）。 这项研究意义重大，因为近五分之一的儿童肥胖， 尽管过去采取了以学校为基础的干预措施，但来自低收入和中高收入家庭的儿童仍然存在。这 这项研究是创新的，因为它代表了第一次尝试提供健康的结构， 在两个“脆弱窗口”期间为校外儿童编制节目。倘建议 干预策略被证明是有效的，它有可能减轻OWOB患病率的差异。

Disparities in overweight and obesity (OWOB) prevalence between children (ages 5-11) from low- and middle-to- high-income families persist. The structured days hypothesis posits that structure within a day, defined as a pre- planned, segmented, and adult-supervised compulsory environment (like a school day), plays a protective role for children against obesogenic behaviors and, ultimately, prevents the occurrence of negative health outcomes, such as excessive weight gain. Essentially, the structured days hypothesis draws upon concepts in the ‘filled-time perspective’ literature which posits that time filled with favorable activities cannot be filled with unfavorable activities. There are at least two “windows of vulnerability” for children outside of the school day. These critically important windows include the hours immediately following school (i.e., 3-6pm school days) and the 10 weeks of summer vacation. Programs that can provide a healthy structured environment and prevent unhealthy weight gains exist for both of these time periods (i.e., afterschool programs and summer day camps). Unfortunately, these programs are too expensive for children from low-income families to attend. Thus, based on demand-side financing, which has a long history addressing large scale public health problems in the United States through federal, state, and local programs like the Supplemental Nutrition Assistance Program and the 21st Century Learning Centers Program, we will rigorously test the impact of providing access to pre-existing, community- operated afterschool and summer programs on weight status (i.e., BMI z-score) and obesogenic behaviors (i.e., physical activity, screen use, diet, and sleep) of elementary children from low-income households. This approach will potentially be less costly than current obesity treatment programs which cost up to $4,600 per child. This study will employ a 2x2 full factorial design. The four groups will be a no-treatment control, afterschool program voucher only, summer day camp voucher only, and vouchers for afterschool and summer day camp combined. We will accomplish the following specific aims: AIM 1: Compare differences in primary and secondary outcomes among children provided no voucher, a voucher for after-school only, a voucher for summer camp only, and a voucher for both after-school and summer camp. AIM 2: Evaluate the cost-effectiveness of providing a voucher for after-school only, a voucher for summer camp only, and a voucher for both after-school and summer camp. Aim 3: Evaluate facilitators and barriers to the implementation, effectiveness, and sustainability of the voucher program by conducting qualitative interviews with key stakeholders (i.e., children, parents, staff, administrators). This study is significant because nearly one in five children are obese, and disparities in OWOB exist between children from low- and middle-to-high-income households persist despite past school-based interventions. This study is innovative because it represents one of the first attempts to provide access to healthy structured programming during two “windows of vulnerability” for children outside of the school day. Should the proposed intervention strategy prove effective, it has the potential to mitigate disparities in OWOB prevalence.