Post on 06-Aug-2020
transcript
In collaboration with
The Effectiveness of the Healthy Kids Out of School Initiative
Presented by:
Clarissa M Brown MS, MPH
Research Team:
Economos CE, Anzman-Frasca S, Koomas A, Folta S, Fullerton K,
Gonsalves D, Sacheck J, Brown C, Nelson ME
• Out-of-school time (OST) programs are well positioned to
contribute to the establishment of healthy habits. They engage
millions of children, including large numbers of minority youth.
Healthy Kids Out of School
The Opportunity
Sliwa SA, Sharma S, Dietz WH, Dolan PR, Nelson ME, Newman MB, et al. Healthy Kids Out of School: Using
Mixed Methods to Develop Principles for Promoting Healthy Eating and Physical Activity in Out-of-School Settings
in the United States. Prev Chronic Dis 2014;11:140207. DOI: http://dx.doi.org/10.5888/pcd11.140207.
• Out-of-school time (OST) programs are well positioned to
contribute to the establishment of healthy habits. They engage
millions of children, including large numbers of minority youth.
• Research suggests opportunities for healthy eating and physical activity in the OST setting have room for improvement. To date,
most research has focused on structured, staff-led after-school
programs.
Healthy Kids Out of School
The Opportunity
Sliwa SA, Sharma S, Dietz WH, Dolan PR, Nelson ME, Newman MB, et al. Healthy Kids Out of School: Using
Mixed Methods to Develop Principles for Promoting Healthy Eating and Physical Activity in Out-of-School Settings
in the United States. Prev Chronic Dis 2014;11:140207. DOI: http://dx.doi.org/10.5888/pcd11.140207.
• Out-of-school time (OST) programs are well positioned to
contribute to the establishment of healthy habits. They engage
millions of children, including large numbers of minority youth.
• Research suggests opportunities for healthy eating and physical activity in the OST setting have room for improvement. To date,
most research has focused on structured, staff-led after-school
programs.
• Healthy Kids Out of School (HKOS) identified, developed and
supported the implementation of principles to improve nutrition
and physical activity practices in volunteer-led OST programs.
Healthy Kids Out of School
The Opportunity
Sliwa SA, Sharma S, Dietz WH, Dolan PR, Nelson ME, Newman MB, et al. Healthy Kids Out of School: Using
Mixed Methods to Develop Principles for Promoting Healthy Eating and Physical Activity in Out-of-School Settings
in the United States. Prev Chronic Dis 2014;11:140207. DOI: http://dx.doi.org/10.5888/pcd11.140207.
Healthy Kids Out of School
Three Guiding Principles
Drink Right: Choose water instead of
sugar-sweetened beverages.
Move More: Boost movement and
physical activity in all programs.
Snack Smart: Fuel up on fruits
and vegetables.
Healthy Kids Out of School
Three Guiding Principles
Folta SC, Koomas A, Metayer N, Fullerton KJ, Hubbard KL, Anzman-Frasca S, et al. Engaging Stakeholders From
Volunteer-Led Out-of-School Time Programs in the Dissemination of Guiding Principles for Healthy Snacking and
Physical Activity. Prev Chronic Dis 2015.
Healthy Kids Out of School
Evaluation
Anzman-Frasca S, Boulos R, Hofer T, Folta SC, Koomas A, Nelson ME, Sacheck JM, Economos CD:
Validation of the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire. Child
Obes 2015.
GOAL: To assess the extent to which the three healthy practices were
being met before and after the implementation of the HKOS
interventions promoting them.
METHODS: Validated online survey (Out-of-School-Time Snacks,
Beverages, and Physical Activity Questionnaire) measuring nutrition
and physical activity offerings as reported by OST program leaders in
Maine, Massachusetts and New Hampshire.
ANALYSIS: Frequencies were calculated to the extent to which healthy
snack, beverage, and physical activity criteria were met at baseline
and follow-up.
Healthy Kids Out of School
Defining Success
• Success variables were created to indicate implementation of
healthy snack, beverage, and PA practices as defined by the
evidence-based HKOS principles.
• Successful typical meeting practices:
Offer water as the only beverage.
Serve fruits and/or vegetables for snack.
Include physical activity during programming time.
Full Sample
n=562
HKOS Evaluation: Enrichment Programs
Sample Overview
Online Survey
Baseline Follow-Up
Full Sample
n=320
Anzman-Frasca S, Boulos R, Hofer T, Folta SC, Koomas A, Nelson ME, Sacheck JM, Economos CD:
Validation of the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire. Child
Obes 2015.
Baseline (n=530) Follow-up (n=294)
Participant
Characteristics
Mean
(%)Median
Mean
(%)Median
Race/Ethnicity
White 90.5 99 89.6 99
Black 3.1 0 2.8 0
Hispanic 2.3 0 1.9 0
Other 2.2 0 3.2 0
Asian 1.9 0 2.6 0
Gender
Boys 79.5 100 80.5 100
Girls 20.5 0 19.6 0
Age (years)
< 5 0.5 0 0.5 0
5-7 17.5 0 16 0
8-12 54.6 50 49.7 50
> 13 27.5 6 33.8 25
Child Demographics: Enrichment ProgramsBaseline vs Follow-up
HKOS Success Indicators: Enrichment ProgramsBaseline vs Follow-up
49.1%
29.5% 29.4%
55.0%
38.8%42.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Snacks Beverages Physical Activity
Pe
rce
nt
of
Le
ad
ers
Success Indicators
Baseline (n=562)
Follow up (n=320)
Percent Meeting Two or More
27.6% Baseline vs 40.6% Follow-up
Full Sample
n=136
HKOS Evaluation: Sports Programs
Brief Overview
Online Survey
Baseline Follow-Up
Full Sample
n=133
Anzman-Frasca S, Boulos R, Hofer T, Folta SC, Koomas A, Nelson ME, Sacheck JM, Economos CD:
Validation of the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire. Child
Obes 2015.
Baseline (133) Follow-up (n=127)
Participant
Characteristics Mean Median Mean Median
Race/Ethnicity
White 81.8 90 83.1 90
Black 5 0 3.7 0
Hispanic 4.7 0 4.2 0
Other 4.8 0 3.9 0
Asian 3.7 0 5.1 0
Gender
Boys 52.1 60 43.4 40
Girls 47.9 40 56.6 60
Age (years)
< 5 0.9 0 4.6 0
5 - 7 12.7 0 23.8 0
8 - 12 82.6 100 68.7 100
> 13 3.8 0 2.8 0
Child Demographics: Sports ProgramsBaseline vs Follow-up
HKOS Sports Success IndicatorsBaseline vs Follow-up
Percent Meeting Two or More
82.4% Baseline vs 78.9% Follow-up
72.8%78.7%
71.3%77.4% 75.2%
65.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Snacks Beverages Physical Activity
Pe
rce
nt
of
Le
ad
ers
Principle
Success Indicators
Baseline (n=136)
Follow-up (n=133)
• Volunteer-led out-of-school time (OST) programs can promote nutrition
and physical activity by implementing three simple, actionable
principles.
– Our national partner organizations have enthusiastically adopted the
evidence-based principles based on the success of our pilot-program.
• These programs are relevant from a public health standpoint given the
large population of children regularly participating in these programs,
many for multiple years, and the potential for repeated exposure.
• More research in other geographic areas can further elucidate the
generalizability of the current results.
Healthy Kids Out of School
Conclusions
Acknowledgements
• Harvard Pilgrim Healthcare Foundation (funding
organization)
• Partner OST organizations:
• Boy Scouts of America
• 4-H
• US Youth Soccer
• Pop Warner Football
• Healthy Kids Out of School Team: Alyssa Koomas, Megan
Halmo, Anna Marie Finley, Karen Fullerton, Diane Gonsalves
http://www.healthykidshub.org
Questions?
Supplementary Slides
10.8%
20.7%
50.5%
18.0%
8.5%
23.6%
49.2%
18.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
City Suburb Small town Rural or farm area
Location
Baseline (n=527)
Follow up (n=293)
Pe
rce
nt
of
Le
ad
ers
Leader Demographics: Enrichment ProgramsBaseline vs Follow-up
Age of
Leaders
Mean
(years)
Standard
Deviation
Baseline
(n=525)48 9.5
Followup
(n=292)48.5 8.8
Race of
Leaders
Baseline
Frequency
(n=503)
Follow-up
Frequency
(n=281)
White 494 271
Other 7 2
Black 0 1
Asian 0 2
American
Indian or
Alaskan
Native
2 5
Leader Demographics: Enrichment ProgramsBaseline vs Follow-up
15.5%
21.4%
63.2%
18.8%20.9%
60.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Maine New Hampshire Massachusetts
State
Representation by State
Baseline (n=562)
Follow up (n=320)
Pe
rce
nt
of
Le
ad
ers
Enrichment Results: Snacks Provided for Group Baseline vs Follow-up
44.6%48.3%
7.1%
36.5%
45.3%
18.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most/Every
Meeting Times
Packaged Fruits and Vegetables
Baseline (n=294)
Follow up (n=170)
17.8%
52.5%
29.6%
20.1%
39.7% 40.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most/Every
Meeting Times
Fresh Fruits and Vegetables
Baseline (n=297)
Follow up (n=174)
Pe
rce
nt
of
Le
ad
ers
Pe
rce
nt
of
Le
ad
ers
6.4%
17.7%
25.4%
50.6%
4.8%
13.9% 16.1%
65.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most Every
Meeting Times
Water Served to Group
Baseline (n=362)
Follow up (n=230)
Enrichment Results: Beverages Provided for Group Baseline vs Follow-up
Pe
rce
nt
of
Le
ad
ers
31.3%
43.7%
16.9%
8.2%
34.7%
43.4%
13.6%
8.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most Every
Meeting Times
Juice
Baseline (n=355)
Follow up(n=228)
50.3%
35.0%
11.0%
3.7%
58.3%
35.0%
4.5%2.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most Every
Meeting Times
Sugar Sweetened Beverages
Baseline (n=354)
Follow up (n=223)
Pe
rce
nt
of
Le
ad
ers
Pe
rce
nt
of
Le
ad
ers
Enrichment Results: Beverages Provided for Group Baseline vs Follow-up
7.04%
28.2%
36.3%
28.5%
3.30%
21.1%
36.3%39.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most Every
Pe
rce
nt
of
Le
ad
ers
Meeting Times
Number of Opportunities for PA
Baseline (n=540)
Follow up (n=303)
Enrichment Results: Physical ActivityBaseline vs Follow-up
2.69%
59.9%
31.0%
3.9%1.5% 1.0%2.10%
45.3%40.8%
7.6%3.1%
1.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Zero 1-15 16-30 31-45 46-60 60+
Pe
rce
nt
of
Le
ad
ers
Number of Minutes
Number of PA Minutes
Baseline (n=484)
Follow up (n=289)
Enrichment Results: Physical ActivityBaseline vs Follow-up
Race of Leaders
Baseline
(n=133)
Frequency
Follow-up
(n=127)
Frequency
White 117 108
Other 4 4
Black 5 2
Asian 4 9
American Indian
or Alaskan Native2 0
Pe
rce
nt
of
Le
ad
ers
0.7%
5.9%
93.4%
0.8%4.5%
94.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Maine New Hampshire Massachusetts
State
Representation by State
Baseline (n=136)
Follow up (n=133)
Leader Demographics: Sports ProgramsBaseline vs Follow-up
Leaders of Hispanic or
Latino BackgroundPercent
Baseline (133) 5.3%
Followup (127) 3.2%
Pe
rce
nt
of
Le
ad
ers
Leader Demographics: Sports ProgramsBaseline vs Follow-up
Age of
Leaders
Mean
(years)
Standard
Deviation
Baseline
(n=131)42.1 6.3
Follow-up
(n=124)41.5 6.4
18.8%
39.8% 39.8%
0.8%
14.2%
52.0%
31.5%
2.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
City Suburb Small town Rural or farmarea
Location
Baseline (n=133)
Follow up (n=127)
0.8% baseline & 0.0% follow-up responded ‘prefer not to answer’.
Sports Results: SnacksBaseline vs Follow-up
21.3% 21.3%
65.9%
21.8%17.3%
64.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Group Provided Individual Provided No Snack
Pe
rce
nt
of
Le
ad
ers
Snack Provision
Snacks at Typical Meetings
Baseline (n=136)
Follow up (n=133)
Sports Results: Snacks Provided for Group Baseline vs Follow-up
10.3%
31.0%
48.3%
17.2%
10.3%
72.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most/Every
Pe
rce
nt
of
Le
ad
ers
Meeting Times
Fresh Fruits and VegetablesBaseline (n=29)
Follow up(n=29)
72.4%
6.9%3.4%
86.2%
6.9%3.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most/Every
Pe
rce
nt
of
Le
ad
ers
Meeting Times
Packaged Fruits and Vegetables
Baseline (n=29)
Follow up (n=29)
10.3% baseline & 0.0% follow-up responded ‘don’t know’. 17.2% baseline & 3.4% follow-up responded ‘don’t know’.
Sports Results: BeveragesBaseline vs Follow-up
19.1%
93.4%
1.5% 0.0%
17.3%
94.7%
7.5%
0.0%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Group Provided Child Provided Water Fountain No Beverages
Pe
rce
nt
of
Le
ad
ers
Category
Beverages at Typical Meetings
Baseline (n=136)
Follow up (n=133)
Sports Results: Beverages Provided for Group Baseline vs Follow-up
Pe
rce
nt
of
Le
ad
ers
46.2%
23.1%
11.5%
0.0%
47.8%
30.4%
4.3%8.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most Every
Meeting Times
Sugar Sweetened Beverages
Baseline (n=26)
Follow up (n=23)
0.0%
7.7% 7.7%
84.6%
0.0%
8.7%4.3%
87.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most EveryMeeting Times
Water Served to Group
Baseline (n=26)
Follow up (n=23)
0.0% baseline & 0.0% follow-up responded ‘don’t know’. 19.2% baseline & 8.7% follow-up responded ‘don’t know’.
Sports Results: Individual BeveragesBaseline vs Follow-up
Pe
rce
nt
of
Le
ad
ers
0.0% 0.8%
23.6%
75.6%
0.0% 0.0%
25.4%
74.6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most EveryMeeting Times
Water Served to Group
Baseline (n=127)
Follow up(n=126)
0.0% 0.8%
23.6%
75.6%
0.0% 0.0%
25.4%
74.6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most EveryMeeting Times
Water Served to Group
Baseline (n=127)
Follow up (n=126)
0.0% baseline & 0.0% follow-up responded ‘don’t know’. 11.0% baseline & 11.1% follow-up responded ‘don’t know’.
Sports Results: Physical ActivityBaseline vs Follow-up
0.00% 0.00% 1.47%
98.53%
0.00% 0.00% 0.78%
99.22%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most Every
Pe
rce
nt
of
Le
ad
ers
Meeting Times
Number of Opportunities for PA
Baseline (n=136)
Follow up (n=129)
0.0% baseline & 0.0% follow-up responded ‘don’t know’.
Sports Results: Physical ActivityBaseline vs Follow-up
0.7 % baseline & 0.8% follow-up responded ‘don’t know’.
0.0% 0.7%
8.1%
90.4%
0.0% 0.0%3.9%
87.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
None Some Most All
Pe
rce
nt
of
Le
ad
ers
Meeting Times
Children Participating in Physical Activity
Baseline (n=136)
Follow up (n=128)
Sports Results: Physical ActivityBaseline vs Follow-up
0.0% 2.2%6.6%
19.1%
41.9%
29.4%
0.0% 0.0%
7.8%
22.7%
43.8%
25.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Zero 1-15 16-30 31-45 46-60 60+
Pe
rce
nt
of
Le
ad
ers
Number of Minutes
Number of PA Minutes
Baseline (n=136)
Follow up (n=128)
0.7 % baseline & 0.0% follow-up responded ‘don’t know’.
Sports Results: Special EventsBaseline vs Follow-up
56.62%
15.4%
29.4%24.3%
9.6%
45.04%
12.2%
29.8%26.7%
9.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
FFV PFV Salty Sweet Protein
Pe
rce
nt
of
Le
ad
ers
Category
Snacks at Special Events
Baseline (n=136)
Follow up (n=131)83.8%
5.2%
27.9%
40.4%
77.9%
1.5%
19.9%
27.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Water Milk Juice SSBP
erc
en
t o
f L
ea
de
rsCategory
Beverages at Special Events
Baseline (n=136)
Follow up (n=131)
Qualitative Analysis
Key Informant Interviews
Actions TakenThe majority of program leaders indicated that they had adopted all 3 of the
principles in some form.
Qualitative Analysis
Key Informant Interviews
Actions TakenThe majority of program leaders indicated that they had adopted all 3 of the
principles in some form.
ReactionsMany leaders felt that increasing physical activity and not serving sugary foods
caused the kids to be calmer and increased their ability to focus.
Qualitative Analysis
Key Informant Interviews
Actions TakenThe majority of program leaders indicated that they had adopted all 3 of the
principles in some form.
ReactionsMany leaders felt that increasing physical activity and not serving sugary foods
caused the kids to be calmer and increased their ability to focus.
Sustainability All leaders expected to maintain the changes that they had made, and some
anticipated additional changes.
Qualitative Analysis
Key Informant Interviews
Actions TakenThe majority of program leaders indicated that they had adopted all 3 of the
principles in some form.
ReactionsMany leaders felt that increasing physical activity and not serving sugary foods
caused the kids to be calmer and increased their ability to focus.
Sustainability All leaders expected to maintain the changes that they had made, and some
anticipated additional changes.
But it was so easy, honestly, to incorporate -- you know, water? Boom. Done. That’s an immediate change. The 15 minutes of physical activity? What boy doesn’t like to get out there and, you know, mess around? (BSA)