Physical Activity and Nutrition Intervention in Afterschool Programs

描述（由申请人提供）：在全国范围内，超过840万儿童（6-14岁）参加课外活动（ASP，下午3-6点），平均每周8小时，其中大多数来自低收入家庭。由于asp与儿童有着如此广泛的接触和联系，国家，州和地方组织呼吁他们通过针对体育活动和健康零食的政策来帮助对抗儿童肥胖的流行。有两项政策最有可能被广泛实施并产生影响，一项是加利福尼亚州的立法（第49号提案），它要求参加国家资助的儿童在项目期间每天应累计30分钟的中等至高强度体育活动（MVPA），另一项是哈佛大学的零食营养指南，它要求每天提供水果和蔬菜（FV），并限制添加糖的食物（如苏打水）。虽然这些公共卫生政策是促进更健康行为的必要催化剂，但不知道需要哪些资源和战略才能成功实现这些政策目标。迄今为止，很少有有效的，低成本的策略，asp可以采用，以满足身体活动和营养政策的目标。如果没有有效的策略，这些政策不太可能实现其预期的目的——增加每日MVPA和提供营养零食。我们的长期目标是推动在全国范围内促进残疾人身体活动和营养的政策的采纳和成功实施。我们的目标是双重的。首先，我们将测试两种有前景的策略的有效性：1)专业发展培训，旨在增加儿童在参加ASP时积累的体育活动量；2)现场干预，侧重于改变购买决策和减少价格障碍，以提高儿童消费的零食质量。这是在为接受和实现公共卫生政策目标制定基于实践的准则方面迈出的重要一步（美国卫生协会和哈佛大学）。我们将使用一项3年延迟治疗的聚类随机对照试验设计，其中包括20个asp，主要服务于哥伦比亚，南卡罗来纳州的低收入和少数民族儿童（约1300名6-12岁的儿童），并解决以下具体目标：评估工作人员层面的干预措施、以促进体育活动的核心能力为重点的专业发展培训计划对儿童体育活动水平的影响；目标2。评估现场干预的影响，包括折扣购买计划的零食修改计划，对供应和消费的零食质量的影响；和Aim 3。评估员工级和现场级干预措施的实施情况，并确定影响实施这些措施过程的组织、员工和环境特征

DESCRIPTION (provided by applicant): Nationwide, more than 8.4 million children (6-14yrs) attend afterschool programs (ASP, 3-6pm) for an average of 8hrs/wk, with the majority from low-income households. Because ASPs have such extensive reach and contact with children, national, state, and local organizations have called on them to help combat the epidemic of childhood obesity through policies targeting physical activity and healthy snacks. Two policies that have the greatest potential for widespread implementation and impact are the State of California's legislation (Proposition 49), which mandates that children attending state-funded ASPs should accumulate e30 minutes of moderate-to-vigorous physical activity (MVPA) daily during the program, and the Harvard nutrition guidelines for snacks, which require serving fruits and vegetables (FV) each day and restricting foods with added sugars (e.g., soda). While these public health policies are a necessary catalyst for promoting healthier behaviors, what is not known is what resources and strategies are needed to successfully achieve these policy goals. To date, there are few effective, low-cost strategies ASPs can adopt to meet physical activity and nutrition policy goals. Without effective strategies, it is unlikely such policies will accomplsh their intended purpose - increased daily MVPA and serving nutritious snacks. Our long-term goal is to advance the adoption and successful implementation of policies that promote physical activity and nutrition in ASPs nationwide. Our objective here is twofold. First, we will test the effectiveness of two promising strategies 1) professional development training designed to increase the amount of physical activity children accumulate while attending an ASP and 2) a site-level intervention that focuses on altering purchasing decisions and reducing price barriers to improve the quality of snacks children consume. This represents a fundamental step in establishing practice-based guidelines for the uptake and achievement of public health policy goals (CA and Harvard). We will use a 3-year delayed treatment, cluster randomized controlled trial design with 20 ASPs that serve mostly low-income and minority children (approximately 1300 children ages 6-12yrs) in Columbia, SC and address the following specific aims: Aim 1. Evaluate the impact of a staff-level intervention, a professional development training program focused on core competencies to promote physical activity, on children's physical activity levels; Aim 2. Evaluate the impact of a site-level intervention, a snack modification program that includes a discount buying program, on the quality of snacks served and consumed; and Aim 3. Evaluate the implementation of the staff-level and site-level interventions and identify organizational, staff, and setting characteristics that influence the process of implementing these strategies. This study is innovative because limited information exists on effective strategies ASPs can use to achieve important public health policy goals. The proposed research is significant because our findings will strengthen the scientific knowledge-base regarding the implementation of these strategies in real-world settings to meet important policy goals. PUBLIC HEALTH RELEVANCE: Afterschool programs (ASPs) represent the next frontier in promoting physical activity and healthy eating for children. Current practice in ASPs indicates they are falling short of state and national policy goals for physical activity and nutrition. The goal of the proposed project is evaluate the outcomes associated with two innovative strategies designed to help ASPs meet policy goals for activity and nutrition and to examine factors associated with the implementation of the strategies.