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

中低龄儿童(5-11岁)超重和肥胖(OWOB)患病率的差异 高收入家庭依然存在。结构化天数假说假设这种结构在一天内，定义为前一天 有计划的、分段的和成人监督的强制性环境(如上学日)，对 防止儿童的肥胖行为，并最终防止负面健康后果的发生，如 因为体重增加过多。从本质上讲，结构化天数假说借鉴了“充实时间”中的概念 透视文学认为，充斥着有利活动的时间不可能充满不利的活动。 在学校之外，孩子们至少有两个“脆弱之窗”。这些至关重要的因素 窗口包括放学后紧接的时间(即上学日下午3点至6点)和夏季的10周。 放假。可以提供健康的结构化环境和防止不健康的体重增加的计划已经存在 在这两个时间段(即课后计划和夏令营)。不幸的是，这些 对于来自低收入家庭的孩子来说，这些项目太昂贵了。因此，基于需求侧 融资，在解决美国大规模公共卫生问题方面有着悠久的历史，通过 联邦、州和地方计划，如补充营养援助计划和21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的影响- 开展课后和暑期体重状况(即BMI z评分)和肥胖行为(即 来自低收入家庭的小学儿童的体力活动、屏幕使用、饮食和睡眠)。这种方法 这可能会比目前每个儿童高达4600美元的肥胖治疗计划成本更低。这 研究将采用2x2全析因设计。这四个小组将是一个无治疗的对照组，课后计划 仅限代金券、仅限夏令营代金券、课后代金券和夏令营代金券。我们 将实现以下具体目标：目标1：比较主要和次要成果的差异 儿童不提供代金券，仅提供课后代金券，仅提供夏令营代金券，以及 课外活动和夏令营的代金券。目标2：评估提供代金券的成本效益 仅限课后，一张夏令营代金券，一张课后和夏令营代金券。 目标3：评价代金券执行、有效性和可持续性的促进者和障碍 通过与关键利益相关者(即儿童、父母、工作人员、管理人员)进行定性访谈，制定计划。 这项研究具有重要意义，因为近五分之一的儿童患有肥胖症，而且 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 这项研究具有创新性，因为它代表了提供健康结构化访问途径的首批尝试之一 在课外儿童的两个“易受伤害的窗口”期间进行节目设计。如果提议的 如果干预策略被证明是有效的，它有可能缓解单边带菌流行率的差异。

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.