Progress 03/01/05 to 02/28/10
Outputs
OUTPUTS: The Healthy Opportunities for Physical Activity and Nutrition (HOP'N) After-School Project had three major objectives. Objective A was to evaluate the impact of the HOP'N intervention on body mass index (BMI), health behavior (fruit and vegetable consumption, physical activity), and child development (e.g., self-efficacy). Objective B was to determine the impact of the intervention program on the community's adult leadership and child leadership for food and physical activity (PA) environmental change. Objective C was to determine the multilevel community, school/out-of-school setting, and child development factors that influence the prevention of obesity by studying the processes that mediate and moderate health behavior change. To meet these objectives, eight schools nested within the Lawrence, Kansas out-of-school program alliance of Cooperative Extension Service, Boys and Girls Club, and the Public School District were recruited to participate in the study. Then, we conducted a nested cross section group randomized controlled effectiveness trial where we recruited a new cross section of children and their parents each year of the three year study. After a baseline assessment year (2005-2006), school and after-school sites were randomized to receive the HOP'N after-school program (n=4 sites) or control (n=3 sites), and assessed for two subsequent years (intervention year 1, 2006-2007; intervention year 2, 2007-2008). During the intervention years, the HOP'N after-school sites were targeted to receive the following quality elements: Cooperative Extension led community development and three time yearly training of after-school staff to deliver 30-minutes of physical activity (PA) (following CATCH guidelines), a daily fruit and vegetable (FV) snack, and the HOP'N Club (a weekly social cognitive theory-based curriculum delivered by an Extension Assistant). To support program implementation, training resources and club resources were developed, delivered, and disseminated (www.hopn.org). At the beginning and end of each academic year, a team of at least two students traveled to the school and after-school sites and collected child height and weight data, child survey data, and parent survey data. Throughout the year, sites were visited six times, where accelerometers were placed on the children to measure PA objectively and the after-school sessions were observed for staff behavior, PA and snack quality. As data was collected, the research team managed the data, cleaned the data, and conducted preliminary analyses. At the end of each intervention year, semi structured interviews and surveys were conducted with organizational leaders, site program leaders, and fourth grade group leaders. Interviews were recorded, transcribed, coded for common themes and analyzed using QSR NVivo software. Presentations and publications were completed throughout the project. Data for the project primary outcomes of were analyzed and submitted for publication in 2009. PARTICIPANTS: Dr. David Dzewaltowski directed the project research and extension team. Dr. Dzewaltowski led the design of the project outcome and process evaluation, development of the intervention, and the analysis of the data. Dr. Karen Coleman assisted with the design of the process evaluation and trained staff in behavioral observation methods. Dr. George Milliken developed the statistical analysis model. Stewart Trost assisted in the design of the study data collection protocol and the processing of physical activity accelerometer data prior to his move to Oregon State University. Dr. Greg Welk from Iowa State University replaced Dr. Trost role on the project. The Douglas County Cooperative Extension office coordinated the delivery of the program. Susan Krumm, County Extension Agent, lead community development efforts and supervised Carri Mershon in her role as an Extension Assistant. Kari assisted with the development of program, coordinated staff training, and delivered the HOP'N Club component of the program to after-school sites. Several graduate students worked on the project. Karly Geller, Richard Rosenkranz, Tanis Hastmann, and Karla Foster contributed to the development of the intervention, led data collection teams of graduate and undergraduate students, and analyzed and wrote peer reviewed papers. Rebekka Tang and numerous undergraduate students assisted with data collection. Drs. Geller and Rosenkranz completed their Ph.Ds in Human Nutrition. Tanis Hastmann completed her Masters of Public Health Degree. Karla Foster and Rebekka Tang completed their Master of Science Degrees in Kinesiology. David Goodrich coordinated data collection and data management for the first year of the project. Sara Rosenkranz took over his role for the rest of the project. Sara completed her Ph.D. degree in Human Nutrition. Cooperative Extension provided training to after-school staff, who were employed by Boys and Girls Club and the Lawrence, Kansas Public Schools. TARGET AUDIENCES: Seven after-school sites participated across the three-year study. For the after-school sample (n=273), across all years of the study, 90% of control site children (n=112) and 91% (n=134) of intervention site students completed both the fall and spring assessments. Of all fourth grade students (including those not attending after-school programs), after- school programs reached 32% across the study years. To examine representativeness of the data, we compared the fourth grade after-school students to demographic information reported by the schools in aggregate for all fourth graders attending during the fall semester. After-school participants were similar to all fourth graders in terms of gender (after-school=50%; school=50%, but were more diverse with lower percentage of non-Hispanic white (after-school=62%; School=72%), and a greater percentage of free/reduced lunch eligible status (after-school=48%; school=38%). The school fourth grade sample (n=716) reached 86% of the total students enrolled each fall across the three years of the study. Fourth grade participants were 50% male, 71% nonhispanic white, 31% overweight or obese 15% obese, and 39% qualified for free and reduced lunch. Adult participants interviewed and surveyed were Organizational Leaders (OL) of the HOP'N after-school program, after-school site Program Managers (PM) who were responsible for each school's program, and Group Leaders (GL) who were responsible for supervising a group of approximately 15 students. The OL's included the executive director of Boys & Girls Club, executive director of planning and program improvement for the school district, and the school food service director. The director of the Boys & Girls Club was responsible for two of the after-school programs, and the director of the school district was responsible for the other two sites. The PMs included the coordinator who supervised the after-school staff at each school site (n=4). GLs were included if they were in charge of the fourth grade students, or if they lead 30 minutes of CATCH PA at least once a week to the fourth grade students (year 1, n = 10; year 2, n = 9). PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
The HOP'N After-School program impacted health behavior and child development outcomes but did not impact BMI. Specifically, HOP'N improved the physical activity (PA) of children. HOP'N site overweight/obese children increased in after-school moderate-to-vigorous PA 5.9 min per day, which eliminated a baseline year 9.7 min deficit (p < 0.05) compared to control site overweight/obese children. HOP'N also impacted child development outcomes. Children participating in the HOP'N after-school club asked their parent (22%) or teacher (30.3%) to provide PA or fruit and vegetable (FV) options. However, these health behavior and child development outcomes in did not impact changes in BMI or age and gender adjusted BMI Z-scores over the academic year. More comprehensive influences on health behavior and child development may need to occur to impact BMI. For example, the project was not successful in impacting a wide variety of child development outcomes, such as self-efficacy. The HOP'N After-School program did influence adult leadership and child leadership for environmental change. Specifically, Cooperative Extension led community development and after-school staff training efforts resulted in impacting the after-school conditions of children. After-school staff restructured after-school site time to have more active recreation sessions, with HOP'N sites having 23.4 min (intervention yr 1, p = 0.01) and 14.2 min (intervention yr 2, p = 0.10) greater time than control sites. HOP'N did not impact the FV offered at snack, however. Thus, this project provides promising evidence that a Cooperative Extension led community development and staff training model may be effective. But the HOP'N program's focus on influencing individual after-school staff behavior may have missed key organizational issues providing barriers to after-school environmental outcomes, such as FV snacks. Adult leaders indicated that there were several larger organizational barriers to implementation including lack of priority for PA, lack of school administration support, high staff employee turnover, lack of trust in after-school staff by school food service, and low school district priority of snack. Future efforts may be more successful if staff training is balanced with a strong emphasis on community development efforts targeting organizational issues. HOP'N focused on building children's confidence to lead environmental change (proxy efficacy) to ask adult staff and parents for healthful FV and PA options. While child surveys did not demonstrate evidence for influencing this mediator of health behavior change, some children reported that they asked parents and teachers for FV and PA options. In fact, parents reported that they received HOP'N Club materials (79%), were satisfied (66%), used HOP'N information (42%), and made changes in the home environment (32%). Although this project did not have rigorous measures of home environmental change, there is some evidence that parents may be reached through an intervention that has activities that target building the skills and efficacy of children to change home environments.
Publications
- Dzewaltowski, D.A. (2008). Community out-of-school physical activity promotion. Chapter 15 in A.L. Smith & S.J.H. Biddle, (eds.), Youth Physical Activity and Inactivity: Challenges and Solutions. Human Kinetics Publishers, Inc., Champaign, IL, p.377-401.
- Dzewaltowski, D.A., Geller, K.S., Rosenkranz, R.R., & Karteroliotis, K. (2010). Children's self-efficacy and proxy efficacy for out-of-school activity. Psychology of Sport and Exercise, 11, 100-106.
- Geller, K.S., & Dzewaltowski, D.A. (2009). Examining Elementary School-Aged Children's Self-Efficacy and Proxy Efficacy for Fruit and Vegetable Consumption. Health Education and Behavior. Epub ahead of print. (In press).
- Geller, K.S., Dzewaltowski, D.A., Rosenkranz, R.R., and Karteroliotis, K.(2009). Measuring children's self-efficacy and proxy efficacy related to fruit and vegetable consumption. Journal of School Health, 79, 51-57.
- Coleman, K.J., Geller, K.S., Rosenkranz, R.R., and Dzewaltowski, D.A. (2008). Physical activity and healthy eating in the after-school environment, Journal of School Health, 78, 633-640.
- Trost, S., Rosenkranz, R.R. and Dzewaltowski, D.A. (2008). Physical activity levels among children attending after-school programs. Medicine and Science in Sports and Exercise, 44, 622-629.
- Rosenkranz, R.R., Welk, G.J., Hastmann, T.J., & Dzewaltowski, D.A. (2010). Psychosocial and demographic correlates of objectively measured physical activity in structured and unstructured after-school recreation sessions. Paper to be presented at the annual meeting of the International Society for Behavioral Nutrition and Physical Activity. (Pending).
- Dzewaltowski, D.A., Welk, G,J, Rosenkranz, R.R., Geller, K., Hastmann, T., & Coleman, K. J. (2009) Healthy opportunities for physical activity and nutrition project: Physical activity outcomes. Paper presented at the annual meeting for the American College of Sports Medicine May, Seattle, WA. Medicine & Science in Sports & Exercise, 2009, 41(5):101-102
- Hastmann, T.J., Geller, K.S., & Dzewaltowski, D.A. (2009). Understanding challenges to implementing improved snack quality in after-school programs. Paper presented at the Annual Meeting of the Society of Behavioral Medicine. Annals of Behavioral Medicine, 2009, 36, S63.
- Rosenkranz, R.R. & Dzewaltowski, D.A. (2008). Home Environmental Influences on Children's Physical Activity, Healthful Eating, and Weight Status. Paper presented at the annual meeting for the Society of Behavioral Medicine, Annals of Behavioral Medicine, 2008, 35, S27.
- Geller, K.S., Dzewaltowski, D.A., 7 Rosenkranz, R. (2008). Measurement and influences of children's self-efficacy for fruit and vegetable consumption. Paper presented at the annual meeting for the Society of Behavioral Medicine. Annals of Behavioral Medicine, 2008,35, S128.
- Hastmann, T.J., Boop., M., Fallon E.A., & Dzewaltowski, D.A., (2008). Factors influencing the implementation of 30 minutes structured physical activity in an after school program. Paper presented at the annual meeting for the American College of Sports Medicine. Medicine & Science in Sports & Exercise, 2008, 40, S322.
- Dzewaltowski, D.A., Geller, K.S., Rosenkranz, R.R., Karteroliotis, K. (2008) Measurement of self-efficacy and proxy efficacy after school. Paper presented at the annual meeting for the American College of Sports Medicine. Medicine & Science in Sports & Exercise. 2008, 40, S319-S320.
- Rosenkranz, R.R., Geller, K.S., & Dzewaltowski, D.A. (2008). Measures of Parental Social Support for Physical Activity and Consumption of Fruits and Vegetables. Paper presented at the annual meeting for the America College of Sports Medicine. Medicine & Science in Sports & Exercise, 2008, 40, S27.
- Coleman, K.J., Geller, K.S., Rosenkranz, R.R., Dzewaltowski, D.A.. (2008). After-school program environments: Quality elements necessary for promoting healthy eating and physical activity to prevent obesity. Paper presented at the annual meeting for the American College of Sports Medicine. Medicine & Science in Sports & Exercise, 2008,40, S30.
- Trost, S.G., & Dzewaltowski, D.A. (2007). Objectively measured physical activity in school children attending after-school programs. Paper presented at the for the American College of Sports Medicine Conference. Medicine & Science in Sports & Exercise, 2007, 39, S17.
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Progress 03/01/08 to 02/28/09
Outputs
OUTPUTS: Within the Lawrence, Kansas out-of-school program alliance of Cooperative Extension Service, Boys and Girls Club, and the Public School District, the Healthy Opportunities for Physical Activity and Nutrition (HOP'N; www.hopn.org) program was implemented in 4 after school programs compared to 3 programs randomized to a control condition. A baseline year (2005-2006), first intervention year (2006-2007), and second intervention year (2007-2008) have been completed. Each year, children attending after school were assessed in the Fall (pretest) and Spring (posttest) on body mass index (BMI) and surveyed on youth development (e.g., self-efficacy). Six times throughout the year all sites were observed on several measures of the healthful eating (HE) and physical activity (PA) environment and children's PA was measured objectively with accelerometers. During the baseline year, observational data showed that after-school sites offered 4 different types of sessions per day (active recreation, academic time, nonactive recreation, and enrichment activities). Children were provided with a daily snack. On 36% of the days observed, this snack included fruit, fruit juice, or vegetables. There was significantly more time spent in moderate and vigorous physical activity (MVPA) during free play sessions (69%) compared to organized adult-led sessions (51%). There was also significantly more discouragement of physical activity during organized adult-led sessions (29%) as compared to the free play sessions (6%). According to accelerometer data (Trost, Rosenkranz, & Dzewaltowski 2008), during the baseline year on average, participants exhibited 42.6 min of sedentary (SED), 13.4 min of moderate physical activity (MPA), and 5.3 min of vigorous physical activity (VPA). The average accumulation of moderate and vigorous physical activity (MVPA) was 20.3 min. Boys exhibited higher levels of MPA, VPA, and MVPA, and lower levels of SED and LPA, than girls. Obese and overweight students exhibited significantly less VPA than normal weight students, but similar levels of LPA, MPA, and MVPA. MVPA levels were significantly higher during free-play activity sessions than during organized or structured activity sessions. From baseline results, we concluded that the quality of after-school programs may be improved by providing fruits and vegetables as snacks; offering more free play activities; training the afterschool staff in simple, structured games for use in a variety of indoor and outdoor settings; and training after-school staff to promote and model MVPA and HE in and out of the after-school setting. Over two subsequent years, the intervention was implemented and data were collected at the sites. Results of these analyses are forthcoming. Curriculum materials for training after school staff and for implementing a weekly nutrition and physical activity enrichment experience were produced as a part of this project. PARTICIPANTS: The project partnered with Lawrence, Kansas public schools and Boys and Girls Club. The project supported the following graduate students: Karla Foster (M.S. In Kinesiology Spring 2008), Karly Geller (ABD, Human Nutrition), Tanis Hastman (Master in Public Health Spring 2008), and Richard Rosenkranz (Ph.D. Human Nutrition Spring 2008). TARGET AUDIENCES: Third and Fourth grade students attending after school programs in Lawrence, KS. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
After school programs offer food and physical activity options that may contribute to the prevention of obesity in children and adolescents. The quality of after-school programs may be improved by providing fruits and vegetables as snacks; offering more free play activities; training the afterschool staff in simple, structured games for use in a variety of indoor and outdoor settings; and training after-school staff to promote and model physical activity and healthful eating in and out of the after-school setting.
Publications
- Coleman, K.J., Geller, K.S., Rosenkranz, R.R., Dzewaltowski, D.A.. (2008).Physical activity and healthy eating in the after-school environment. Journal of School Health, 78(12), 633-640.
- Dzewaltowski, D.A. (2008). Community out-of-school physical activity promotion. In Smith, A.L., & Biddle, S.J.H. (Eds.). Youth Physical Activity and Inactivity: Challenges and Solutions. Champaign, IL: Human Kinetics Publishers, Inc.
- Geller, K.S., Dzewaltowski, D.A., Rosenkranz, R.R., & Kateroliotis, K (2008). Childrens self-efficacy and proxy efficacy for fruit and vegetable consumption after-school. Journal of School Health. (In press).
- Trost, S., Rosenkranz, R., Dzewaltowski, D.A. (2008). Physical activity levels among children attending after-school programs. Medicine and Science in Sports and Exercise, 44, 622-629.
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