Quality Elements for Healthy Afterschool Programs Creating an Environment Supportive of Healthy Eati

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Quality Elements for Healthy Afterschool
ProgramsCreating an Environment Supportive of
Healthy Eating and Physical Activity
Tanis Hastmann David Dzewaltowski, PhD Kansas
State University
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Childhood Obesity Prevalence Rising
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7.2
CDC, 2003-2004
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Contributing Factors

• At least 4 behaviors play a role in positive
  energy balance and the development of childhood
  obesity
• Lack of physical activity
• Lack of fruit and vegetable consumption
• Sugar-sweetened beverage consumption
• Use of television and video games (screen time)

(Coon et al., 2001 Dietz, 1998 DuRant et al.,
1994 Epstein et al., 1991 Enns, Mickle,
Goldman, 2002 Koplan, Liverman, Kraak, 2005
Pate and Ross, 1987 Rolls, Ello-Martin and
Tohill, 2004 Tucker, 1986 Troiano, Briefel,
Carroll, Bialostosky, 2000).
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Physical Activity (PA)

• Youth should engage in at least 60 minutes of
  moderate to vigorous PA (MVPA) each day (Strong
  et al., 2005).
• Many US children and adolescents do not meet
  these guidelines (Eaton et al., 2006)
• Over 60 of children in the US aged 9-13 yrs do
  not participate in any organized PA during their
  non-school hours (CDC, 2003)
• 23 are sedentary (CDC,2003)

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Healthy Eating (HE) Fruits/Vegetables (FV)

• Current recommendations for children requiring
  1,800 kcals daily
• 2 c fruit daily
• 2.5 c vegetables daily (USDHHS USDA, 2005)
• Only 20.1 of children met recommendation for one
  week (CDC, 2005)

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Opportunities in School/After-School

• Schools and after school programs, can provide
  opportunities to reach children and adolescents
  (PA HE) (I.O.M., Pate et al. 2006)
• 7hrs5 35hrs wk (2hrs more in A.S45hrs/wk)
• Potential environments for health promotion
  efforts obesity prevention programs
  (Dzewaltowski, In Press)
• Promote Pos Behaviors MVPA, HE obesity control
  (MSPAN Mckenzie et al., 2004, Planet Health
  Gortmaker, 1999 Wiecha, 2004, El Paso CATCH
  Coleman et al., 2005).
• Decrease Neg Behaviors Less unhealthy
  opportunities (i.e. sugar beverage consumption,
  screen time, sedentary) (Kelder, et al.,2005
  Pate et al., 2003 Robinson et al., 2003 Story
  et al., 2003 Wilson et al., 2005 Yin, Gutin et
  al., 2005 Yin, Hanes et al., 2005)

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Healthy Opportunities for Physical Activity and
Nutrition After School Program (HOPN)
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Primary Aim

• To evaluate the effectiveness of a multilevel
  after school program intervention for preventing
  at risk for overweight and overweight in 4th
  grade children.

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After School Settings

• 7 after-school programs
• Part of a community alliance of the local school
  district
• Boys and Girls Club
• Cooperative extension service
• Other community partners in Lawrence, KS

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Intervention HOPNQuality After School Elements

• Continuous Staff Training
• Weekly Nutrition and Physical Activity Skill
  Building Education
• HOPN After School Club (1 hr.)
• Daily Healthy Snack
• Daily Structured Physical Activity
• CATCH

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Weekly Nutrition and Physical Activity Education

• HOPN After School Club
• Provides a one-time weekly one-hour enrichment
  nutrition and physical activity curriculum
  activity.
• Builds students skills and self-efficacy for self
  advocacy and community advocacy for changing
  youth environments.
• Based on an ecologically-informed social
  cognitive theory approach that builds students
  skills and self-efficacy for self-regulation and
  for changing youth environments.

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HOPN After School Club

• Child Behavioral Goals
• Be physical active every day
• 30 minutes after school and 60 minutes daily
• Eat fruits vegetables at every meal or snack.
• Go, Slow, Whoa
• 2 1/2 cups vegetables, 1 1/2 cups fruits
• My Pyramid 1,800 Calorie Pattern
• Drink less soda juice drinks
• Drink water, No more than 1 can or small cup
  daily
• Cut back on TV and video games
• No more than 2 hours a day
• Remove TV from bedroom

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Daily Healthy Snack

• Program Sites
• Provide a healthy snack opportunity
• Meet and exceed USDA requirements for snack
  reimbursement
• USDA requirements must contain two of food
  components below
• 1 cup fluid milk
• 3/4 cup fruit or vegetable
• 1 unit grain/bread
• 1 ounce meat/meat alternative
• HOPN requirements
• Goal is 3/4 cup fruit or vegetable
• Program Leaders
• Encourage healthful eating during and outside of
  snack session.

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Daily Structured Physical Activity

• Program Sites
• Provide a daily structured physical activity
  period of 30 minutes per day.
• Group Leaders
• Engage all students in Moderate-To-Vigorous
  Physical Activity (MVPA) for at least 50 of
  class time (CATCH Activity Box)
• Children are Provided with Many Opportunities to
  Participate and Practice
• Use appropriate and effective class management
  and instructional methods.
• Encourage children to participate in physical
  activities during and outside of HOPN physical
  activity sessions.
• Adopt healthful personal behaviors to provide an
  active, enthusiastic role model for students.

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HOPN CATCH Quality Elements

• B.A.S.I.C.S.
• Boundaries for Activity Area and Routines
• Activity from Beginning until End.
• Start and Stop Signal
• Involvement by All
• Clear Instructions
• Supervision

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HOPN CATCH

• Getting Class Started Walk perimeter during
  instruction
• Lining Up Students Limit to 30 sec.
• Ex. Alphabetical, height, birthday month, color
  of clothing, pair off
• Distribute Equipment while walking perimeter
• Holding Equipment home position
• Ex. Ball bear bug or hold to belly button
• Ex. Hoop stand inside hoop

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HOPN CATCH

• Start and Stop Signal GO and WHOA
• Transitions Walk perimeter
• Warm up, Activity, Cool Down
• Supervising position self where eye contact
  maintained with all children Teach from
  perimeter, not middle of activity area
• Ending Class Encourage participation in PA
  before and after school Positive Feedback

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HOPN CATCH

• HOPN Rules
• Kids do not stand in line
• Every participant or every other participant gets
  a piece of equipment
• Game rules do not eliminate participants.
• If get OUT, then do activity to come back in
• Ex. Jumping jacks, sit ups, frog jumps
• Goal is participation and fun rather than winning

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Promoting FV PA

• Encourage children to eat Fruits Vegetables in
  school and out of school
• Encourage children to participate in physical
  activity during the after school program and
  outside of school
• Ex. Play games with kids
• Ex. Talk to kids about being active at home with
  family/friends

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RESULTS
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Frequency/Duration of Session Types Offered to
Children in After School
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Discussion Physical Activity

• 42 time in after school spent in recreation time
  
• 47 minutes of after school time in active
  recreation
• 49 organized activities, 51 in free play
• Spending significantly more time in MVPA while in
  free play compared to organized activities
• MVPA levels comparable to or exceed other
  estimates for in-school physical activity
  programs (Coleman et al., 2005 McKenzie et al.
  1995 2000 2004 2006)
• Vigorous physical activity (VPA) findings
  exceeded many of those reported (McKenzie et al.
  1995 2000 2004 2006)

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Discussion Physical Activity

• Leader Behavior
• As long children were moving, discouraging
  comments kept to a minimum
• Encouragement occurs more in organized
• Encouragement occurs more during MVPA

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Conclusions

• Independent of any intervention, after school
  settings may be structured to provide excellent
  opportunities for MVPA and VPA
• Free play in after-school settings results in
  high level of MVPA and VPA compared to in school
  PE reports
• After-school settings have room for improvement
  in quality of snack and are an ideal place to
  intervene
• Leaders are doing some promotion of physical
  activity within the after-school session, but are
  doing no promotion of fruit and vegetable
  consumption

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HOPN Research Team

• Kansas State University Community Health
  Institute
• David A. Dzewaltowski, Ph.D., Project Director
  and Professor of Kinesiology
• Sara Rosenkranz, Community Health Behavior Lab
  Manager
• Karly Geller, Research Assistant and Ph.D.
  Student in Human Nutrition
• George A. Milliken, Ph.D, Investigator and
  Professor of Statistics
• Ric Rosenkranz, Research Assistant and Ph.D.
  Student in Human Nutrition
• Tanis Hastmann, Research Assistant and MPH
  Student in Kinesiology
• Karla Bruggeman, Research Assistant and M.S.
  Student in Kinesiology
• San Diego Graduate School of Public Health
• Karen Coleman, Ph.D.
• K-State Research and Extension Douglas County
• Susan Krumm, Extension Agent
• Carrie A. Mershon, Extension Assistant
• Iowa State University
• Greg Welk, Ph.D

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Acknowledgements

• K-State Research and Extension Douglas County
• Lawrence, Kansas Boys and Girls Club
• Lawrence, Kansas Public School District
• This material is based upon work supported by the
  Cooperative State Research, Education, and
  Extension Service, U.S. Department of
  Agriculture, under Award No. 2005-35215-15418.

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QUESTIONS???