Policy to Practice: Statewide Rollout of YMCA Childhood Obesity Standards

描述（由申请人提供）：YMCA的校外时间（OST）计划（课后计划~下午3-6点和全天夏令营计划）为全国数百万儿童提供服务，是校外为数不多的年轻人可以锻炼身体和吃营养食品（如水果/蔬菜[FV]）的场所之一。2011年11月，美国基督教青年会在其OST项目中采用了“健康饮食和体育活动标准”，重点关注儿童在参加YMCA OST项目时积累的活动量，并要求儿童每天在项目中提供FV和水。虽然这些标准代表了朝着创建更健康的OST项目迈出的重要一步，但它们未能描述YMCA OST项目可以使用的策略来满足这些标准。这导致在标准和日常实践的变化之间存在相当大的差距。在过去的两年里，我们与基督教青年会OST项目合作，试点测试并完善了一套协调的、全面的、以证据为基础的战略，即健康饮食和体育活动（HEPA）战略，以优化标准的实施。我们在此的目的是评估高效能环境策略对达到“健康饮食和身体活动标准”的影响，以及使用高效能环境策略的相关成本。为了实现这一目标，我们将使用即时干预与等待列表标准实践比较组设计（全州共20个项目），并将与南卡罗来纳州基督教青年会领导层合作，在全州的基督教青年会项目中实施“健康饮食和体育活动标准”和HEPA战略。我们开发了一种创新的模式来实现目标，并从餐厅/特许经营行业广泛借鉴，创建了一个推广支持框架，用于全州范围内的实施，利用现有的YMCA OST项目作为示范/培训地点，并开发了区域培训地点，全州的项目负责人和员工将在实际环境中获得实施标准和战略的实践经验。我们将使用直接观察和加速度计来测量所有主要结果。提出以下目标：目标1。评估对“身体活动和健康饮食标准”的理解和遵守情况，并确定影响实施过程的组织、员工和环境特点；目标2。评估“身体活动和健康饮食标准”对儿童身体活动水平和基督教青年会OST计划中提供的水果/蔬菜和水的影响；目标3。评估符合“身体活动与健康饮食标准”的成本效益。这项工作意义重大，是确定有效、低成本和无成本战略可以整合到现有YMCA组织框架以确保达到国家YMCA标准的重要一步。这个应用程序是创新的，因为它将在现实环境中使用扩散支持框架来建立标准的有效性，以增加YMCA OST项目中儿童的身体活动和健康饮食。

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.