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 In collaboration with
Healthy Kids Out of School The Opportunity 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. 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 The Opportunity 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. 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 The Opportunity 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. 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
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. 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 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. 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.
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.
HKOS Evaluation: Enrichment Programs Sample Overview Online Survey Baseline Full Sample n=562 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.
Child Demographics: Enrichment Programs Participant Characteristics Race/Ethnicity Gender Baseline (n=530) Mean Median (%) Follow-up (n=294) Mean Median (%) 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 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
Percent of Leaders HKOS Success Indicators: Enrichment Programs 10 8 7 3 Success Indicators Baseline (n=562) Follow up (n=320) 55. 49.1% 38.8% 42.5% 29.5% 29.4% Snacks Beverages Physical Activity Percent Meeting Two or More 27.6% Baseline vs 40.6% Follow-up
HKOS Evaluation: Sports Programs Brief Overview Online Survey Baseline Full Sample n=136 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.
Child Demographics: Sports Programs 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
Percent of Leaders HKOS Sports Success Indicators Success Indicators 10 Baseline (n=136) 8 7 72.8% 77.4% 78.7% 75.2% Follow-up (n=133) 71.3% 65.4% 3 Snacks Beverages Physical Activity Principle Percent Meeting Two or More 82.4% Baseline vs 78.9% Follow-up
Healthy Kids Out of School Conclusions 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.
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
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Percent of Leaders Leader Demographics: Enrichment Programs Location 10 8 7 50.5% 49.2% Baseline (n=527) Follow up (n=293) Age of Leaders Baseline (n=525) Followup (n=292) Mean (years) Standard Deviation 48 9.5 48.5 8.8 3 10.8% 8.5% 20.7% 23.6% 18. 18.8% City Suburb Small town Rural or farm area
Percent of Leaders Leader Demographics: Enrichment Programs 10 8 7 Baseline (n=562) Follow up (n=320) Representation by State 63.2% 60.3% Race of Leaders Baseline Frequency (n=503) Follow-up Frequency (n=281) White 494 271 Other 7 2 Black 0 1 Asian 0 2 3 18.8% 15.5% 21.4% 20.9% American Indian or Alaskan Native 2 5 Maine New Hampshire Massachusetts State
Percent of Leaders Percent of Leaders Enrichment Results: Snacks Provided for Group 10 8 Fresh Fruits and Vegetables Baseline (n=297) Follow up (n=174) 10 8 Packaged Fruits and Vegetables Baseline (n=294) Follow up (n=170) 7 7 3 20.1% 17.8% 52.5% 39.7% 40.2% 29.6% 3 44.6% 36.5% 48.3% 45.3% 18.2% None Some Most/Every Meeting Times 7.1% None Some Most/Every Meeting Times
Percent of Leaders Enrichment Results: Beverages Provided for Group 10 8 Water Served to Group Baseline (n=362) Follow up (n=230) 7 3 6.4% 4.8% 17.7% 13.9% 25.4% 16.1% 50.6% None Some Most Every Meeting Times 65.2%
Percent of Leaders Percent of Leaders Enrichment Results: Beverages Provided for Group 10 8 7 3 34.7% 31.3% 43.7% 43.4% Juice Baseline (n=355) Follow up (n=228) 10 8 7 3 50.3% 58.3% Sugar Sweetened Beverages 35. 35. Baseline (n=354) Follow up (n=223) 16.9% 13.6% 8.2% 8.3% None Some Most Every Meeting Times 11. 4.5% 3.7% 2.2% None Some Most Every Meeting Times
Percent of Leaders Enrichment Results: Physical Activity 10 8 Number of Opportunities for PA Baseline (n=540) Follow up (n=303) 7 3 36.3% 36.3% 39.3% 28.2% 28.5% 21.1% 7.04% 3.3 None Some Most Every Meeting Times
Percent of Leaders Enrichment Results: Physical Activity 10 Number of PA Minutes 8 Baseline (n=484) Follow up (n=289) 7 59.9% 3 45.3% 31. 40.8% 7.6% 2.69% 2. 3.9% 1.5% 3.1% 1. 1.1% Zero 1-15 16-30 31-45 46-60 60+ Number of Minutes
Percent of Leaders Leader Demographics: Sports Programs 10 8 7 Representation by State 93.4% 94.7% Baseline (n=136) Follow up (n=133) Baseline Race of Leaders (n=133) Frequency Follow-up (n=127) Frequency White 117 108 Other 4 4 Black 5 2 Asian 4 9 3 American Indian or Alaskan Native 2 0 0.7% 0.8% 5.9% 4.5% Maine New Hampshire Massachusetts State Leaders of Hispanic or Latino Background Percent Baseline (133) 5.3% Followup (127) 3.2%
Percent of Leaders Leader Demographics: Sports Programs 10 8 Location Baseline (n=133) Follow up (n=127) Age of Leaders Baseline (n=131) Mean (years) Standard Deviation 42.1 6.3 7 3 18.8% 14.2% 52. 39.8% 39.8% 31.5% Follow-up (n=124) 41.5 6.4 0.8% 2.4% City Suburb Small town Rural or farm area 0.8% baseline & 0. follow-up responded prefer not to answer.
Percent of Leaders Sports Results: Snacks 10 8 7 Snacks at Typical Meetings Baseline (n=136) Follow up (n=133) 65.9% 64.7% 3 21.3% 21.8% 21.3% 17.3% Group Provided Individual Provided No Snack Snack Provision
Percent of Leaders Percent of Leaders Sports Results: Snacks Provided for Group 10 Fresh Fruits and Vegetables Baseline (n=29) 10 Packaged Fruits and Vegetables 8 7 Follow up (n=29) 72.4% 8 7 86.2% 72.4% Baseline (n=29) Follow up (n=29) 48.3% 3 17.2% 10.3% 31. 10.3% None Some Most/Every Meeting Times 3 6.9% 6.9% 3.4% 3.4% None Some Most/Every Meeting Times 10.3% baseline & 0. follow-up responded don t know. 17.2% baseline & 3.4% follow-up responded don t know.
Sports Results: Beverages Percent of Leaders 10 93.4% 94.7% 8 7 3 Beverages at Typical Meetings Baseline (n=136) Follow up (n=133) 19.1% 17.3% 7.5% 1.5% 0. 0. Group Provided Child Provided Water Fountain No Beverages Category
Percent of Leaders Sports Results: Beverages Provided for Group 10 8 7 3 0. 0. Water Served to Group Baseline (n=26) Follow up (n=23) 7.7% 8.7% 7.7% 4.3% 84.6% 87. None Some Most Every Meeting Times 10 8 7 3 46.2% 47.8% Sugar Sweetened Beverages 30.4% 23.1% Baseline (n=26) Follow up (n=23) 11.5% 4.3% 0. 8.7% None Some Most Every Meeting Times 0. baseline & 0. follow-up responded don t know. 19.2% baseline & 8.7% follow-up responded don t know.
Percent of Leaders Sports Results: Individual Beverages 10 8 7 Water Served to Group Baseline (n=127) Follow up (n=126) 75.6% 74.6% 10 8 7 Water Served to Group Baseline (n=127) Follow up (n=126) 75.6% 74.6% 3 23.6% 25.4% 3 23.6% 25.4% 0. 0. 0.8% 0. None Some Most Every Meeting Times 0. 0. 0.8% 0. None Some Most Every Meeting Times 0. baseline & 0. follow-up responded don t know. 11. baseline & 11.1% follow-up responded don t know.
Percent of Leaders Sports Results: Physical Activity 10 Number of Opportunities for PA Baseline (n=136) 98.53% 99.22% 8 7 3 Follow up (n=129) 0.0 0.0 0.0 0.0 1.47% 0.78% None Some Most Every Meeting Times 0. baseline & 0. follow-up responded don t know.
Percent of Leaders Sports Results: Physical Activity Children Participating in Physical Activity 10 8 Baseline (n=136) Follow up (n=128) 90.4% 87.5% 7 3 8.1% 3.9% 0. 0. 0.7% 0. None Some Most All Meeting Times 0.7 % baseline & 0.8% follow-up responded don t know.
Percent of Leaders Sports Results: Physical Activity 10 8 Number of PA Minutes Baseline (n=136) Follow up (n=128) 7 3 41.9% 43.8% 29.4% 22.7% 25. 19.1% 6.6% 7.8% 0. 0. 2.2% 0. Zero 1-15 16-30 31-45 46-60 60+ Number of Minutes 0.7 % baseline & 0. follow-up responded don t know.
Percent of Leaders Percent of Leaders Sports Results: Special Events 10 8 Snacks at Special Events Baseline (n=136) Follow up (n=131) 10 8 83.8% 77.9% Beverages at Special Events Baseline (n=136) Follow up (n=131) 7 7 56.62% 3 45.04% 29.4% 29.8% 26.7% 24.3% 15.4% 12.2% 9.6% 9.2% FFV PFV Salty Sweet Protein Category 3 40.4% 27.9% 27.5% 19.9% 5.2% 1.5% Water Milk Juice SSB Category
Qualitative Analysis Key Informant Interviews Actions Taken The majority of program leaders indicated that they had adopted all 3 of the principles in some form.
Qualitative Analysis Key Informant Interviews Actions Taken The majority of program leaders indicated that they had adopted all 3 of the principles in some form. Reactions Many 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 Taken The majority of program leaders indicated that they had adopted all 3 of the principles in some form. Reactions Many 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 Taken The majority of program leaders indicated that they had adopted all 3 of the principles in some form. Reactions Many 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)