Policy to Practice: Statewide Rollout of YMCA Childhood Obesity Standards

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DESCRIPTION (provided by applicant): The YMCA's out-of-school time (OST) programs (afterschool programs ~3-6pm and all-day summer camp programs) serve millions of children nationally and represent one of the few settings outside the school where youth can be physically active and eat nutritious foods (e.g., fruits/vegetables [FV]). In November 2011, the YMCA of the USA adopted "Healthy Eating and Physical Activity Standards" for its OST programs that focus on the amount of activity children accumulate while attending YMCA OST programs and require that children are served FV and water each day at the programs. While these standards represent an important step towards creating healthier OST programs, they fail to describe the strategies YMCA OST programs can use to meet them. This results in a sizable gap between standards and changes in routine practice. Over the past 2 years, working with YMCA OST programs, we have pilot tested and refined a coordinated and comprehensive evidence-based set of strategies, the Healthy Eating and Physical Activity (HEPA) Strategies, to optimize the implementation of the Standards. Our objective here is to evaluate the impact of HEPA Strategies on achieving the "Healthy Eating and Physical Activity Standards" and the associated costs with using the HEPA Strategies. To accomplish this, we will use an immediate intervention vs. wait-listed standard practice comparison group design (total of 20 programs across the state) and will work with South Carolina YMCA leadership to implement the "Healthy Eating and Physical Activity Standards" and HEPA Strategies in YMCA programs across the state. We developed an innovative model to achieve the objectives and have drawn extensively from the restaurant/franchisee industry to create a diffusion-support framework for statewide implementation that utilizes existing YMCA OST programs as demonstration/training sites and develops regional training sites where program leaders and staff from across the state will receive hands-on experience implementing the Standards and Strategies in real-world settings. We will use direct observation and accelerometry to measure all primary outcomes. The following Aims are proposed: Aim 1. Evaluate the uptake of and adherence to the "Physical Activity and Healthy Eating Standards" and identify organizational, staff, and setting characteristics that influence the implementation process; Aim 2. Evaluate the impact of the "Physical Activity and Healthy Eating Standards" on children's physical activity levels and fruits/vegetables and water served in YMCA OST programs; Aim 3. Evaluate the cost-effectiveness of meeting the "Physical Activity and Healthy Eating Standards". This work is significant and represents an important step in identifying processes by which effective, low- and no-cost strategies can be integrated into the existing YMCA organizational framework to ensure national YMCA Standards are achieved. This application is innovative because it will establish the effectiveness of the Standards using a diffusion-support framework in real-world settings to increase children's physical activity and healthy eating in YMCA OST programs.