Physical Activity and Nutrition Intervention in Afterschool Programs

描述(申请人提供)：在全国范围内，超过840万儿童(6-14岁)参加课外项目(ASP，下午3-6点)，平均每周8小时，其中大部分来自低收入家庭。由于ASP与儿童有着如此广泛的联系和联系，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抗击儿童肥胖症的流行。最有可能广泛实施和产生影响的两项政策是加利福尼亚州的立法(第49号提案)，该立法要求参加州政府资助的ASP的儿童在计划期间每天积累30分钟的中等到剧烈的体力活动(MVPA)，以及哈佛零食营养指南，该指南要求每天供应水果和蔬菜(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，但尚不清楚成功实现这些政策目标需要哪些资源和战略。到目前为止，几乎没有什么有效的、低成本的战略可以用来满足体力活动和营养政策的目标。如果没有有效的战略，这些政策不太可能实现其预期目标--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体力活动和营养的政策的采纳和成功实施。我们在这里的目标有两个。首先，我们将测试两个有希望的战略的有效性：1)专业发展培训，旨在增加儿童在参加ASP期间积累的体力活动数量；2)现场干预，重点是改变购买决定，减少价格壁垒，以提高儿童消费的零食质量。这是为采纳和实现公共卫生政策目标建立以实践为基础的指导方针的基本步骤(CA和哈佛大学)。我们将使用为期3年的延迟治疗随机对照试验设计，研究对象为南卡罗来纳州哥伦比亚市的20名主要服务于低收入和少数族裔儿童(约1300名6-12岁儿童)，并针对以下具体目标：目标1.评估员工水平干预对儿童体力活动水平的影响；目标2.评估现场水平干预对零食供应和消费质量的影响；目标2.评估现场水平干预的影响；和目标3.评价工作人员一级和现场一级干预措施的实施情况，并确定影响实施这些措施的过程的组织、工作人员和环境特点 战略。这项研究具有创新性，因为关于ASP可用于实现重要公共卫生政策目标的有效策略的信息有限。拟议的研究具有重要意义，因为我们的发现将加强关于在现实世界环境中实施这些战略以实现重要政策目标的科学知识基础。

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.