Beets Michael W, Glenn Weaver R, Turner-McGrievy Gabrielle, Huberty Jennifer, Ward Dianne S, Freedman Darcy A, Saunders Ruth, Pate Russell R, Beighle Aaron, Hutto Brent, Moore Justin B
University of South Carolina.
University of South Carolina.
Contemp Clin Trials. 2014 Jul;38(2):291-303. doi: 10.1016/j.cct.2014.05.013. Epub 2014 Jun 2.
National and state organizations have developed policies calling upon afterschool programs (ASPs, 3-6 pm) to serve a fruit or vegetable (FV) each day for snack, while eliminating foods and beverages high in added-sugars, and to ensure children accumulate a minimum of 30 min/d of moderate-to-vigorous physical activity (MVPA). Few efficacious and cost-effective strategies exist to assist ASP providers in achieving these important public health goals. This paper reports on the design and conceptual framework of Making Healthy Eating and Physical Activity (HEPA) Policy Practice in ASPs, a 3-year group randomized controlled trial testing the effectiveness of strategies designed to improve snacks served and increase MVPA in children attending community-based ASPs. Twenty ASPs, serving over 1800 children (6-12 years) will be enrolled and match-paired based on enrollment size, average daily min/d MVPA, and days/week FV served, with ASPs randomized after baseline data collection to immediate intervention or a 1-year delayed group. The framework employed, STEPs (Strategies To Enhance Practice), focuses on intentional programming of HEPA in each ASPs' daily schedule, and includes a grocery store partnership to reduce price barriers to purchasing FV, professional development training to promote physical activity to develop core physical activity competencies, as well as ongoing technical support/assistance. Primary outcome measures include children's accelerometry-derived MVPA and time spend sedentary while attending an ASP, direct observation of staff HEPA promoting and inhibiting behaviors, types of snacks served, and child consumption of snacks, as well as, cost of snacks via receipts and detailed accounting of intervention delivery costs to estimate cost-effectiveness.
国家和州级组织已制定政策，要求课后项目（下午3点至6点）每天提供一份水果或蔬菜作为零食，同时杜绝添加糖含量高的食品和饮料，并确保儿童每天至少进行30分钟的中等至剧烈身体活动（MVPA）。几乎没有有效且具成本效益的策略来帮助课后项目提供者实现这些重要的公共卫生目标。本文报告了“课后项目中促进健康饮食和身体活动（HEPA）政策实践”的设计和概念框架，这是一项为期3年的群组随机对照试验，旨在测试旨在改善所提供零食并增加参加社区课后项目儿童的MVPA的策略的有效性。将招募20个课后项目，为1800多名6至12岁儿童提供服务，并根据招生规模、平均每日MVPA分钟数和每周提供水果和蔬菜的天数进行匹配配对，在收集基线数据后将课后项目随机分为立即干预组或1年延迟组。所采用的框架“增强实践策略（STEPs）”侧重于在每个课后项目的日常安排中有意安排HEPA，并包括与杂货店建立伙伴关系以降低购买水果和蔬菜的价格障碍、开展专业发展培训以促进身体活动从而培养核心身体活动能力，以及持续的技术支持/援助。主要结局指标包括儿童通过加速度计得出的MVPA以及在参加课后项目时久坐的时间、对工作人员促进和抑制HEPA行为的直接观察、所提供零食的类型、儿童对零食的消费情况，以及通过收据计算的零食成本和干预实施成本的详细账目以估计成本效益。
