Policy to Practice: Statewide Rollout of YMCA Childhood Obesity Standards

描述（由申请人提供）：基督教青年会的校外时间（OST）计划（下午3点至6点的课后计划和全天夏令营计划）为全国数百万儿童提供服务，并代表了学校以外的少数几个环境之一，在那里青年可以进行身体活动并吃营养食品（例如，水果/蔬菜[FV]）。2011年11月，美国基督教青年会通过了“健康饮食和体育活动标准”，其OST方案侧重于儿童在参加基督教青年会OST方案时积累的活动量，并要求儿童每天在方案中获得FV和水。虽然这些标准代表了创建更健康的OST计划的重要一步，但它们未能描述YMCA OST计划可以用来满足它们的策略。这导致标准与常规做法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计划合作，对一套协调和全面的循证战略进行了试点测试和改进，即健康饮食和体育活动（HEPA）战略，以优化标准的实施。我们的目标是评估HEPA策略对实现“健康饮食和身体活动标准”的影响以及使用HEPA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标准实践比较组设计（全州共有20个项目），并将与南卡罗来纳州基督教青年会领导层合作，在全州基督教青年会项目中实施“健康饮食和体育活动标准”和HEPA策略。我们开发了一种创新的模式来实现目标，并广泛借鉴了餐厅/特许经营行业，为全州范围内的实施创建了一个扩散支持框架，该框架利用现有的基督教青年会OST计划作为示范/培训场所，并开发了区域培训场所，来自全州的计划负责人和工作人员将获得在现实环境中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。提出了以下目标：目标1。评估吸收和遵守“身体活动和健康饮食标准”，并确定组织，工作人员和设置的特点，影响实施过程;目标2。评估“身体活动和健康饮食标准”对青年会OST方案中儿童身体活动水平和水果/蔬菜和水的影响;目标3。评估符合“体力活动及健康饮食标准”的成本效益。这项工作意义重大，是确定将有效、低成本和无成本战略纳入基督教青年会现有组织框架以确保实现国家基督教青年会标准的进程的重要一步。该应用程序是创新的，因为它将建立标准的有效性，在现实世界中使用的扩散支持框架，以增加儿童的身体活动和健康饮食的基督教青年会OST计划。

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.