Beets Michael W, Burkart Sarah, Pfledderer Christopher, Adams Elizabeth, Weaver R Glenn, Armstrong Bridget, Brazendale Keith, Zhu Xuanxuan, Chen Brian, McLain Alexander
Arnold School of Public Health, University of South Carolina, Columbia.
UTHealth Houston, School of Public Health, Houston, Texas.
JAMA Pediatr. 2024 Dec 1;178(12):1252-1259. doi: 10.1001/jamapediatrics.2024.3693.
Children experience accelerated gains in body mass index (BMI) during the summer months when school is not in session. Children from low-income households are most susceptible. Accelerated BMI gain in summer may be due to the removal of the health-promoting structure provided by schools. During summer, a common form of health-promoting structure is summer day camps (SDCs). Summer day camps are predominately fee for service, which creates a financial barrier for children from low-income households. One solution to mitigate accelerated BMI gain is providing free access to an existing SDC.
To investigate whether providing free access to an existing community SDC can mitigate accelerated BMI z score (zBMI) gain in elementary school-age children.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted during the summers of 2021, 2022, and 2023 in the southeastern United States. Participants were children (kindergarten through fourth grade) from predominantly low-income households who were randomized to attend an SDC operated by a parks and recreation commission or continue summer as usual (control).
Free SDC every weekday (Monday through Friday) for 8 to 10 weeks.
The primary outcome was between-group differences in change of zBMI measured before school ended (May) and on return to school from summer (late August). Secondary analyses examined the dose response of zBMI change with parent-reported child attendance at SDCs during the summer for all children (intervention and control).
A total of 422 children (mean [SD] age, 8.2 [1.5] years; 202 [48%] female, 220 [52%] male, 292 [69%] at or below 200% federal poverty level, 127 [30%] with food insecurity) were randomized to 1 of 2 conditions: summer as usual (control, n = 199) or free SDC (n = 223). Intent-to-treat analysis indicated mean (SE) change in zBMI at the end of the summer was 0.046 (0.027) for the control and -0.048 (0.025) for the intervention group, representing a significant between-group difference of -0.094 (95% CI, -0.166 to -0.022). Dose-response analyses indicated that every 1 day per week increase in attending an SDC resulted in a -0.034 to -0.018 zBMI reduction, which translates to a gain of 0.046 to 0.080 zBMI for children never attending summer programming vs -0.09 to -0.04 zBMI reduction for children attending summer programming every weekday.
Providing children free access to existing community summer programming can have a meaningful effect on children's zBMI gain during the summer. Future studies should replicate these findings across different regions and identify the optimal dose of programming to mitigate unhealthy zBMI gains.
ClinicalTrials.gov Identifier: NCT04072549.
在学校放假的夏季月份，儿童的体重指数（BMI）增长加速。低收入家庭的儿童最易受到影响。夏季BMI加速增长可能是由于学校提供的促进健康的结构消失。在夏季，一种常见的促进健康的结构形式是夏日日间营（SDC）。夏日日间营主要是收费服务，这给低收入家庭的孩子造成了经济障碍。减轻BMI加速增长的一个解决办法是让低收入家庭的孩子免费参加现有的夏日日间营。
调查让小学适龄儿童免费参加现有的社区夏日日间营是否能减轻BMI z评分（zBMI）的加速增长。
设计、地点和参与者：这项随机临床试验于2021年、2022年和2023年夏季在美国东南部进行。参与者是主要来自低收入家庭的儿童（幼儿园至四年级），他们被随机分配参加由公园和娱乐委员会运营的夏日日间营或照常度过夏天（对照组）。
工作日（周一至周五）每天免费参加8至10周的夏日日间营。
主要结局是在学年结束时（5月）和夏季结束返校时（8月下旬）测量的zBMI变化的组间差异。次要分析检查了所有儿童（干预组和对照组）在夏季家长报告的孩子参加夏日日间营的情况与zBMI变化的剂量反应关系。
共有422名儿童（平均[标准差]年龄8.2[1.5]岁；202名[48%]为女性，220名[52%]为男性，292名[69%]处于或低于联邦贫困线的200%，127名[30%]有粮食不安全问题）被随机分配到2种情况中的1种：照常度过夏天（对照组，n = 199）或免费参加夏日日间营（n = 223）。意向性分析表明，夏季结束时对照组zBMI的平均（标准误）变化为0.046（0.027），干预组为 -0.048（0.025），组间差异显著为 -0.094（95%置信区间，-0.166至 -0.022）。剂量反应分析表明，每周参加夏日日间营的天数每增加1天，zBMI降低 -0.034至 -0.018，这意味着从未参加过暑期活动的儿童zBMI增加0.046至0.080，而每天都参加暑期活动的儿童zBMI降低 -0.09至 -0.04。
让儿童免费参加现有的社区暑期活动对儿童夏季zBMI的增长有显著影响。未来的研究应在不同地区重复这些发现，并确定减轻不健康的zBMI增长的最佳活动剂量。
ClinicalTrials.gov标识符：NCT04072549。
