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Background: In the United States, 68% of children do not get the recommended nine hours of sleep, which can lead to many negative health outcomes (e.g., mental health). Mindfulness meditation mobile apps may be an option for improving children's sleep and mental health outcomes; however, there is limited research on how children across different ages access these types of apps, the content they prefer, and the benefits they experience. Objective: The purpose of this study was to describe parents' reports of how and why their children use the Calm mindfulness meditation app and how using Calm may impact their sleep and mental well-being across age and gender. Method: This study was a cross-sectional survey of Calm subscribers (N = 2437) with children who used Calm. Participants were asked how their child accessed content, why their child used Calm, and the benefits of Calm for their child's sleep and mental well-being. Results: Approximately half of the parents reported that they used Calm with their child. Older children (13-17 years) were more likely to use Calm independently, preferred content outside of Calm Kids, and were more likely to use Calm to manage emotions. Younger children (2-12 years) most commonly used Calm with their parents and on a parent's device and preferred Calm Kids Sleep Stories. Conclusion: To our knowledge, this is the first study to explore parents' perceptions of children's use of a commercial mindfulness meditation app across ages. Children use Calm differently based on their.

Background: Despite the numerous physiological, psychological, and academic benefits of physical activity (PA), declines in PA levels among girls have been observed over the last decade. The purpose of this preliminary study was to assess the short-term changes pertaining to Girls on the Run and Girls on Track developmentally focused youth sport programs (DYS) on global self-esteem, body image, commitment to PA, and PA frequency. Methods: This preliminary study employed a nonexperimental, one-group, pre- and postintervention study design using a 29-item paper-and-pencil assessment tool (n = 1034). Results: Paired sample t-tests from pre- to postintervention revealed statistically significant differences in self-esteem (p less than 0.001), body size satisfaction (p less than 0.001), and vigorous PA frequency (p less than 0.001). Stratification by the number of times participating in the intervention revealed the greatest changes at first participation followed with continued improvements in self-esteem (p = 0.013) and body size satisfaction (p less than 0.001) for those participating in a second time. Age differences were also observed between participants less than or equal to 10 years old and 11-15 years; in that significant improvements in commitment to PA (p = 0.003) were observed for the older girls. Conclusions: Findings suggest DYS programs Girls on the Run and Girls on Track may produce beneficial changes in self-esteem, body size satisfaction, PA commitment, and PA frequency. Although the findings from the current report are preliminary, they suggest that DYS programs designed exclusively for girls may provide the necessary framework to promote PA to achieve the numerous associated benefits. (Contains 4 tables.)

Background: In the United States, 68% of children do not get the recommended nine hours of sleep, which can lead to many negative health outcomes (e.g., mental health). Mindfulness meditation mobile apps may be an option for improving children's sleep and mental health outcomes; however, there is limited research on how children across different ages access these types of apps, the content they prefer, and the benefits they experience. Objective: The purpose of this study was to describe parents' reports of how and why their children use the Calm mindfulness meditation app and how using Calm may impact their sleep and mental well-being across age and gender. Method: This study was a cross-sectional survey of Calm subscribers (N = 2437) with children who used Calm. Participants were asked how their child accessed content, why their child used Calm, and the benefits of Calm for their child's sleep and mental well-being. Results: Approximately half of the parents reported that they used Calm with their child. Older children (13–17 years) were more likely to use Calm independently, preferred content outside of Calm Kids, and were more likely to use Calm to manage emotions. Younger children (2–12 years) most commonly used Calm with their parents and on a parent's device and preferred Calm Kids Sleep Stories. Conclusion: To our knowledge, this is the first study to explore parents' perceptions of children's use of a commercial mindfulness meditation app across ages. Children use Calm differently based on their. [ABSTRACT FROM AUTHOR]

Background: Afterschool programs (ASPs) can provide opportunities for children to accumulate moderate-to-vigorous physical activity (MVPA). The optimal amount of time ASPs should allocate for physical activity (PA) on a daily basis to ensure children achieve policystated PA recommendations remains unknown. Methods: Children (n = 1248, 5 to 12 years) attending 20 ASPs wore accelerometers up to 4 nonconsecutive week days for the duration of the ASPs during spring 2013 (February-April). Daily schedules were obtained from each ASP. Results: Across 20 ASPs, 3 programs allocated ≤ 30min, 5 approximately 45 min, 4 60 min, 4 75 min, and 4 ≥ 105 min for PA opportunities daily (min∙d-1). Children accumulated the highest levels of MVPA in ASPs that allocated ≥ 60 min∙d-1 for PA opportunities (24.8-25.1 min∙d-1 for boys and 17.1-19.4 min∙d-1 for girls) versus ASPs allocating ≤ 45 min∙d-1 for PA opportunities (19.7 min∙d-1 and 15.6 min∙d-1 for boys and girls, respectively). There were no differences in the amount of MVPA accumulated by children among ASPs that allocated 60 min∙d-1 (24.8 min∙d-1 for boys and 17.1 min∙d-1 for girls), 75 min∙d-1 (25.1 min∙d-1 for boys and 19.4 min∙d-1 for girls) or ≥ 105 min∙d-1 (23.8 min∙d-1 for boys and 17.8 min∙d-1 for girls). Across ASPs, 26% of children (31% for boys and 14% for girls) met the recommended 30 minutes of MVPA. Conclusions: Allocating more than 1 hour of PA opportunities is not associated with an increase in MVPA during ASPs. Allocating 60 min∙d-1, in conjunction with enhancing PA opportunities, can potentially serve to maximize children's accumulation of MVPA during ASPs. [ABSTRACT FROM AUTHOR]

Background: After-school programs (ASPs) across the nation have been asked to increase the amount of activity children accumulate during such programs. Policies/standards that benchmark the amount of total activity (light-to-vigorous physical activity, LVPA) and moderate-to-vigorous physical activity (M VPA) accumulated in an ASP have been developed. Little is known about the prevalence of children meeting these goals. Methods: Children (N = 812, 6 to 12 y old) attending 19 ASPs wore accelerometers for 4 days while attending an ASP. LVPA and MVPA were dichotomized according to existing ASP policies/standards. Data on whether a policy/standard was met were compared between gender, age, BMI, race/ethnicity, and ASP-type (faith-, school-, community-based) using mixed-model logistic-regression. Results: The prevalence of meeting an LVPA policy/standard ranged from 75.4% (National Afterschool Association [NAA], 20% of program time spent in LVPA) to 97.8% (NAA, 20% of time in attendance spent in LVPA), and meeting an MVPA policy/standard ranged from 0.3% (California, 60 min MVPA/d) to 26.9% (North Carolina, 20% of attendance spent in MVPA). Boys, younger children, nonwhites, and children attending faith- or community-based ASPs were more likely to meet any policy/standard. Conclusion: Current practice in ASPs is sufficient to meet LVPA policies/standards but insufficient to meet MVPA policy/standards. Efforts must be directed toward identifying the most appropriate policy/standard and strategies to meet it. [ABSTRACT FROM AUTHOR]

Background: Frontline-staff are critical to achieving policies related to child physical activity and nutrition (PAaN) in out-of-school-time programs (OSTP). Recent policies call upon staff to demonstrate behaviors related to PAaN. Currently, no instrument exists to measure these behaviors. This study fills the gap between policy mandates and staff behaviors by describing the development of the System for Observing Staff Promotion of Activity and Nutrition (SOSPAN) in OSTP. Methods: SOSPAN items were aligned with existing OSTP policies. Reliability and validity data of SOSPAN were collected across 8 OSTP: 4 summer day camps and 4 afterschool programs. Validity of SOSPAN staff behaviors/management of PA was established using the percent of children active measured concurrently via direct observation. Results: A total of 6437 scans were performed. Interrater percent agreement ranged from 74%-99% across PAaN behaviors. Children's activity was associated with staff facilitative behaviors/management, such as playing with the children and providing 2 or more activities for children to choose, while prohibitive behaviors/management, such as waiting in line were related to increased sedentary behavior. Staff nutrition behaviors were observed in less than 0.6% of scans. Conclusion: SOSPAN is a reliable and valid tool to assess staff behaviors/management of PAaN in OSTPs. [ABSTRACT FROM AUTHOR]

Background: National and state organizations have called upon afterschool programs (3-6 PM, ASP) to promote physical activity (PA). Few strategies exist that ASPs can use to increase the PA of children enrolled. This study evaluated a policy-level intervention (Movin' Afterschool, MAS) designed to increase PA through staff implemented policy-level changes and ongoing technical support. Methods: Twelve preexisting communitybased ASPs serving 580 children (5-12 yrs, 57% girls) were invited to take part in MAS. Evaluation of children's PA, staff behaviors (engaged or promote PA, other ASP tasks, general supervising), and environmental features (equipment, organized PA) at baseline (Fall 2010) and postassessment (Spring 2011) were collected using SOPLAY (System for Observing Play and Leisure Activity in Youth) for boys and girls, separately. Random effects models evaluated changes in PA categories (sedentary, walking, vigorous). Results: The percentage of boys and girls sedentary decreased by 11.8% and 11.4%, respectively. Girls walking increased by 6.9% while boys vigorous PA increased by 6.5%. Greater increases in vigorous activity were observed as postassessment in organized activities for boys and during indoor activities for girls. Conclusions: Findings indicate a policy-level approach targeting staff training and ongoing technical support can produce notable increases in PA within the ASP setting. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity continues to be a global epidemic and many child-based settings (e.g. school, afterschool programs) have great potential to make a positive impact on children's health behaviors. Innovative and time-sensitive methods of gathering health behavior information for the purpose of evaluation and strategically deploying support are needed in these settings.Purpose: The aim is to (1) demonstrate the feasibility of mobile health (mHealth) for monitoring implementation of healthy eating and physical activity (HEPA) standards and, (2) illustrate the utility of mHealth for identifying areas where support is needed, within the afterschool setting.Methods: Site leaders (N = 175) of afterschool programs (ASPs) were invited to complete an online observation checklist via a mobile web app (Healthy Eating and Physical Activity Mobile, HEPAm) once per week during ASP operating hours. Auto-generated weekly text reminders were sent to site leaders' mobile devices during spring and fall 2015 and 2016 and spring 2017 school semesters. Data from HEPAm was separated into HEPA variables, and expressed as a percent of checklists where an item was present. A higher percentage for a given item would indicate an afterschool has higher compliance with current HEPA standards.Results: A total of 141 site leaders of ASPs completed 13,960 HEPAm checklists. The average number of checklists completed per ASP was 43 (range 1-220) for healthy eating and 50 (range 1-230) for physical activity. For healthy eating, the most common challenge for ASPs was 'Staff educating children about healthy eating', and for physical activity checklists, 'Girls only physical activity is provided at ASP'.Conclusion: HEPAm was widely used and provided valuable information that can be used to strategically deploy HEPA support to ASPs. This study gives confidence to the adoption of mHealth strategies as a means for public health practitioners to monitor compliance of an initiative or intervention. [ABSTRACT FROM AUTHOR]

To better understand and promote youth physical activity (PA) it is important to determine settings and characteristics that promote or influence behavior. This study evaluated the utility of a multi-method approach (accelerometers plus direct observation) to better understand youth PA at recess. A total of 100 third through fifth grade children (52 males and 48 females) wore an Actigraph accelerometer during school recess for five consecutive days in both Fall and Spring. Trained observers coded PA behaviors at the same recess periods using the System for Observing Play and Leisure Activities (SOPLAY). Overall, gender comparisons based on both instruments indicated that boys were more active than girls. MVPA levels were higher during climbing/sliding activities (40-50%) and when the activity setting was supervised and equipped (30%). Both assessments indicated that boys were more active but the contextual data from the SOPLAY indicate that differences may vary according to the environmental context. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine the effectiveness of Ready for Recess: an elementary school recess intervention targeting staff training (ST) and providing recreational equipment (EQ). Methods: Ready for Recess had 4 intervention schools: I) EQ+ST, 2) EQ, 3) ST, and 4) control. Moderate-to-vigorous physical activity (MVPA) was assessed with accelerometers at the four schools in 257 3rd- to 6th-grade children. Random intercept models for overweight/obese (OWOB) and healthy weight (HW) for boys and girls separately, examined change in percentage of time spent in MVPA during recess across EQ+ST, EQ, and ST compared with the control from baseline to postintervention. Results: HW boys receiving EQ+ST increased MVPA by 19.4%, OWOB boys receiving ST increased MVPA by 4.5%, OWOB girls receiving EQ-ST increased MVPA by 6.0%, while HW girls receiving EQ decreased MVPA by 13.6% in comparison with the control. Conclusions: Ready for Recess represents a possible means to increase MVPA in OWOB girls/boys, populations least likely to meet MVPA recommendations. However, the effect of the intervention was not uniform across all subgroups. [ABSTRACT FROM AUTHOR]

Background: Summer day camps (SDCs) serve 14 million children yearly in the U.S. and aim to provide participating children with 60 minutes of moderate-to-vigorous physical activity (MVPA). This study evaluated an intervention designed to increase the percent of children meeting this MVPA guideline. Design: Two-group, pre-post quasi-experimental. Setting/Participants: Twenty SDCs serving 1,830 children aged 5–12 years were assigned to MVPA intervention (n = 10) or healthy eating attention control (n = 10). Intervention: The STEPs (Strategies to Enhance Practice) intervention is a capacity-building approach grounded in the Theory of Expanded, Extended and Enhanced Opportunities. Camp leaders and staff receive training to expand (e.g., introduction of activity breaks/active field trips), extend (e.g., schedule minimum of 3 hours/day for PA opportunities), and enhance (e.g., maximize MVPA children accumulate during schedule activity) activity opportunities. Camps in the comparison condition received support for improving the types of foods/beverages served. Main outcome measures: Percent of children accumulating the 60min/d MVPA guideline at baseline (summer 2015) and post-test (summer 2016) measured via wrist-accelerometry. Results: Multilevel logistic regression conducted fall 2016 indicated boys and girls attending intervention SDCs were 2.04 (95CI = 1.10,3.78) and 3.84 (95CI = 2.02,7.33) times more likely to meet the 60min/d guideline compared to boys and girls attending control SDCs, respectively. This corresponded to increases of +10.6% (78–89%) and +12.6% (69–82%) in the percentage of boys and girls meeting the guideline in intervention SDCs, respectively. Boys in comparison SDCs increased by +1.6% (81–83%) and girls decreased by -5.5% (76–71%). Process data indicated intervention SDCs successfully extended and enhanced PA opportunities, but were unable to expand PA opportunities, compared to control SDCs. Conclusions: Although substantial proportions of children met the MVPA guideline at baseline, no SDCs ensured all children met the guideline. This intervention demonstrated that, with support, SDCs can help all children in attendance to accumulate their daily recommended 60min MVPA. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Standards targeting children’s healthy eating and physical activity (HEPA) in after-school programs call for staff to display or refrain from HEPA-promoting or -discouraging behaviors that are linked to children’s HEPA. This study evaluated strategies to align staff behaviors with HEPA Standards. Staff at four after-school programs serving approximately 500 children participated in professional development training from January 2012 to May 2013. Site leaders also attended workshops and received technical support during the same time frame. Changes in staff behaviors were evaluated using the System for Observing Staff Promotion of Activity and Nutrition in a pre- (fall 2011) multiple-post (spring 2012, fall 2012, and spring 2013), no–control group study design. A total of 8,949 scans were completed across the four measurement periods. Of the 19 behaviors measured, 14 changed in the appropriate direction. For example, staff engaging in physical activity with children increased from 27% to 40% of scans and staff eating unhealthy foods decreased from 56% to 14% of days. Ongoing training and technical assistance can have a measureable impact on staff behaviors linked to child-level HEPA outcomes. Future research should explore the feasibility of disseminating ongoing trainings to after-school program staff on a large scale. [ABSTRACT FROM AUTHOR]

This study describes the link between level of implementation and outcomes from an intervention to increase after school programs' (ASPs) achievement of healthy eating and physical activity (HE-PA) Standards. Ten intervention ASPs implemented the Strategies-To-Enhance-Practice (STEPs), a multi-component, adaptive intervention framework identifying factors essential to meeting HE-PA Standards, while 10 control ASPs continued routine practice. All programs, intervention and control, were assigned a STEPs for HE-PA index score based on implementation. Mixed-effects linear regressions showed high implementation ASPs had the greatest percentage of boys and girls achieving 30min of moderate-to-vigorous physical activity (47.3 and 29.3%), followed by low implementation ASPs (41.3 and 25.0%), and control ASPs (34.8 and 18.5%). For healthy eating, high/low implementation programs served fruits and vegetables an equivalent number of days, but more days than control programs (74.0 and 79.1% of days versus 14.2%). A similar pattern emerged for the percent of days sugar-sweetened foods and beverages were served, with high and low implementation programs serving sugar-sweetened foods (8.0 and 8.4% of days versus 52.2%), and beverages (8.7 and 2.9% of days versus 34.7%) equivalently, but less often than control programs. Differences in characteristics and implementation of STEPs for HE-PA between high/low implementers were also identified. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine: (i) the effect of schools’ baseline community readiness (CR) on youth physical activity (PA) at recess prior to the Ready for Recess intervention; (ii) if changes in PA due to the intervention were explained by baseline CR and (iii) if specific components of the intervention altered an association between baseline CR and changes in youth PA. Methods that were employed included: six informants from each of 17 schools participated in CR interviews at baseline (N = 101). CR scores were calculated based on the CR model’s nine stages. Direct observation was used to measure PA. Poisson models evaluated the association between baseline CR and PA. Results were that seven schools were in denial, eight in vague awareness and two in pre-planning stages. CR marginally predicted pre-intervention PA. When compared with youth at schools in denial, youth at schools in vague awareness and pre-planning demonstrated significant increases in moderate/vigorous PA. Ready for Recess strengthened this association. This is the first study to demonstrate that school CR may explain changes in PA at recess after a school-based PA intervention. Low CR levels may contraindicate interventions. Efforts to increase school CR a priori may be critical to increasing PA among youth. [ABSTRACT FROM PUBLISHER]

Afterschool programs (3-6 p.m.) are positioned to play a critical role in combating childhood obesity. To this end, state and national organizations have developed policies related to promoting physical activity and guiding the nutritional quality of snacks served in afterschool programs. No conceptual frameworks, however, are available that describe the process of how afterschool programs will translate such policies into daily practice to reach eventual outcomes. Drawing from complex systems theory, this article describes the development of a framework that identifies critical modifiable levers within afterschool programs that can be altered and/or strengthened to reach policy goals. These include the policy environment at the national, state, and local levels; individual site, afterschool program leader, staff, and child characteristics; and existing outside organizational partnerships. Use of this framework and recognition of its constituent elements have the potential to lead to the successful and sustainable adoption and implementation of physical activity and nutrition policies in afterschool programs nationwide. [ABSTRACT FROM PUBLISHER]

Limited information is available on the cost-effectiveness of interventions to achieve healthy eating and physical activity policies in afterschool programs (ASPs). The objective of this study is to present the costs associated with a comprehensive intervention in ASPs. Intervention delivery inputs (IDIs) associated with a group randomized delayed treatment controlled trial involving 20 ASPs serving >1700 children (5-12yrs) were catalogued prospectively across 2-years (2014-2015). IDIs, analyzed 2015, were expressed as increases in per-child per-week enrollment fees based on a 34-week school year in US$. Total IDIs for year-1 were $15,058 (+$0.58/child/week enrollment fee). In year-2, total costs were $13,828 (+$0.52/child/week) for the delayed group and $7916 (+$0.30/child/week) for the immediate group, respectively. Site leader and staff hourly wages represented 11-17% and 45-46% of initial training costs; travel and trainer wages represented 31-42% and 50-58% of booster costs. Overall, a 1% increase in boys and girls, separately, accumulating 30 mins/d of moderate-to-vigorous physical activity ranged from $0.05 to $0.26/child/week, while a one-day increase in serving a fruit/vegetable or water, or not serving sugar-added foods/beverages ranged from $0.16 to $0.87/child/week. Costs associated with implementing the intervention were minimal. Additional efforts to reduce costs and improve intervention effectiveness are necessary. [ABSTRACT FROM AUTHOR]

Background Afterschool programs are an important setting in which to promote children's physical activity. This study examines the association of environmental and policy characteristics on the moderate-to-vigorous physical activity and sedentary behavior of children attending afterschool programs. Methods A total of 1302 children attending 20 afterschool programs across South Carolina wore accelerometers (ActiGraph GT3X +) for up to 4 non-consecutive days. Policy-level characteristics were evaluated using the Healthy Afterschool Program Index-Physical Activity scale. Physical activity space was measured using a measuring wheel (indoor, ft2) and Geographical Information Systems software (outdoor, acres). The structure (free-play or organized) of activity opportunities was evaluated via direct observation. Time spent in moderate-to-vigorous physical activity and sedentary, both indoors and outdoors, was estimated using accelerometry. Results For every 5000 ft2 of utilized indoor activity space an additional 2.4 and 3.3 min/day of sedentary behavior was observed among boys and girls, respectively. A higher ratio of free-play to organized play was associated with higher indoor sedentary behavior among boys and girls (3.9 min/day and 10.0 min/day, respectively). For every 1 acre of outdoor activity space used, an additional 2.7 min/day of moderate-to-vigorous physical activity was observed for boys. A higher free-play to organized play ratio was associated with higher outdoor moderate-to-vigorous physical activity for boys and girls (4.4 and 3.4 min/day increase, respectively). Policy characteristics were unrelated to moderate-to-vigorous physical activity levels and time spent sedentary. Conclusion Findings indicate that policies and size of activity space had limited influence on moderate-to-vigorous physical activity and sedentary behavior, suggesting that a programmatic structure may be a more effective option to improve moderate-to-vigorous physical activity levels of children attending afterschool programs. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]