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Background: The association between acculturation and physical activity (PA) among Mexican American (MA) adults is not understood. This study assessed potential mediating factors that may explain these associations among 75 healthy MA adults [age: 37.5 (9.3) y; 65.3% female]. Methods: Secondary data analysis using hierarchical logistic regression examined whether perceived environmental barriers, social support, and intention to exercise potentially mediated relationships between acculturation level, and total and leisure-time moderate to vigorous PA (MVPA). Data were collected via questionnaire. Results: Most participants (67%) reported lower average household monthly incomes ($0–$3000), completed some college or obtained a college degree (64.4%), and were first generation immigrants (59%). Acculturation was associated with greater odds of engaging in total MVPA [odds ratio (OR) = 1.7; 95% confidence interval (CI), 1.2–2.4] and leisure-time MVPA (OR = 1.6; 95% CI, 1.1–1.2). Perceived environmental barriers were associated with greater odds of engaging in both total and leisure-time MVPA (OR = 4.3; 95% CI, 2.1–5.8 and OR = 5.5; 95% CI, 2.0–7.0, respectively), and social support was associated with greater odds for total MVPA (OR = 3.7; 95% CI, 1.1–6.4). Conclusions: Results provide preliminary evidence for mediating factors that may explain the relationship between acculturation level and PA among MA adults. Contradicting prior evidence, results suggest that PA engagement, despite perceived environmental barriers, is possible among MA adults having stronger social support. [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: The purpose of this study was to describe which theory-based behavioral and technological features middle-aged women prefer to be included in a mobile application designed to help them adopt and maintain regular physical activity (PA). Methods: Women aged 30 to 64 years (N = 120) completed an online survey measuring their demographics and mobile PA application preferences. The survey was developed upon behavioral principles of Social Cognitive Theory, recent mobile app research, and technology adoption principles of the Unified Theory of Acceptance and Use of Technology. Frequencies were calculated and content analyses conducted to identify which features women most preferred. Results: Behavioral features that help women self-regulate their PA (PA tracking, goal-setting, progress monitoring) were most preferred. Technological features that enhance perceived effort expectancy and playfulness were most preferred. Many women reported the desire to interact and compete with others through the application. Conclusions: Theory-based PA self-regulation features and theory-based design features that improve perceived effort expectancy and playfulness may be most beneficial in a mobile PA application for middle-aged women. Opportunities to interact with other people and the employment of social, game-like activities may also be attractive. Interdisciplinary engagement of experts in PA behavior change, technology adoption, and software development is needed. [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) or providing recreational equipment (EQ) separately, and the combination (EQ+ST) on physical activity (PA). Methods: Participants were children attending 1 of 12 elementary schools (grades 3rd-6th) included in the study. Separate analytical models were used to evaluate the effects of the intervention conditions on children's accelerometry and direct observation derived PA measures. Results: Boys and girls were measured using accelerometry (n = 667). Boys in EQ+ST increased their MVPA by 14.1% while ST decreased their MVPA by -13.5%. Girls in ST decreased their MVPA by -11.4%. Neither boys nor girls in EQ increased their time spent in MVPA. A total of 523 (boys) and 559 (girls) observations were collected. For boys' and girls' sedentary and vigorous activity there were no significant main effects for treatment condition, time, or treatment condition-by-time effects. Conclusions: Environmental modifications are only as strong as the staff that implements them. Supervision, if not interactive, may be detrimental to PA participation, especially in girls. Research related to staff training for encouragement and promotion of PA coupled with appropriate use of equipment during recess is warranted. [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]

Introduction: The delivery of online interventions in cancer patients/survivors has increased. The measurement of participation in online interventions is important to consider, namely, the challenges of the remote assessment of activity. The purpose of this study was to report the measures used to assess intervention compliance and other physical activity participation in two online yoga studies, the relationship between the multimethod measures used, and the ability of cancer patients to complete these measures. Methods: The methods described are of two online yoga studies (feasibility and pilot). Cancer patients were asked to participate in 60 min/week of online yoga for 12 weeks, complete a weekly yoga log, wear a Fitbit daily for 12 weeks, and complete a weekly physical activity log. Finally, Clicky®, a web analytics software, was used to track online yoga participation. Results: Eighty-four people participated across both studies, with 63/84 participating in online yoga, averaging 57.5 ± 33.2min/week of self-reported yoga participation compared to 41.4 ± 26.1 min/week of Clicky® yoga participation (Lin concordance = 0.28). All 84 participants averaged 95.5 ± 111.8 min/week of self-reported moderate/vigorous physical activity compared with 98.1 ± 115.9 min/week of Fitbit-determined moderate/vigorous physical activity (Lin concordance = 0.33). Across both studies, 82.9% of the yoga logs were completed, the Fitbit was worn on 75.2% of the days, and 78.7% of the physical activity logs were completed. Conclusions:Weak relationships between self-report and objective measures were demonstrated, but the compliance rates were above 75% for the study measures. Future research is needed, investigating the intricacies of selfreport physical activity participation in remote interventions and the validation of a gold standard measurement for online interventions. [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: Children's achievement of recommendations for moderate-to-vigorous physical activity (MVPA) in afterschool programs (ASP) is complex. It is unclear what elements of the ASP environment influence children's physical activity (PA). The purpose of this study was to determine the relationship of staff behaviors and ASP features (eg, organized activity, recreational equipment) to MVPA participation in youth attending ASPs. Methods: Data were collected in 12 ASPs in the Midwest. Staff behavior and child PA was measured using the System for Observing Play and Leisure Activity in Youth. The percentage of children's MVPA was examined in relation to staff behaviors and ASP features. Results: Increases in MVPA were observed when staff were directly engaged in PA, verbally promoted MVPA, and when PA was organized and equipment was present. When 3 or more of these characteristics were present, the proportion of children engaged in MVPA increased by 25%-30%. Conversely, MVPA levels decreased when these characteristics were absent and when staff were attending to other ASP duties or were supervising. Conclusion: This study provides evidence about the specific staff behaviors that may influence higher proportions of youth being active during ASP and implies specific skills that need to be incorporated into ASP staff training. [ABSTRACT FROM AUTHOR]

Background: Ideal approaches to increasing long-term physical activity (PA) adherence in women remain unclear. This study used a longitudinal mixed-methods approach to 1) determine the effectiveness of an 8-month book club intervention for increasing PA participation and self-worth, and reducing barriers at 1-year followup; and 2) identify reasons why completers and noncompleters did or did not maintain PA. Methods: One year after the cessation of Women Bound to be Active (WBA), completers (participated in posttesting; n = 30) and noncompleters (did not participate in posttesting; n = 22) responded to questionnaires and interviews assessing their body mass index (BMI), current PA participation, barriers, and global self-worth. Results: Compared with noncompleters, completers reported decreases in BMI, higher motivation for PA, higher ratio of benefits to barriers, and more consistent PA. Both groups still reported barriers to PA, especially time; however, completers more often reported strategies for overcoming these barriers. Completers more directly discussed the impact of their improved self-worth on their PA participation. Conclusions: In the future, a greater focus on time management and self-regulation strategies should be emphasized in PA interventions, specifically those that focus on women. This may help to prevent program and long-term PA attrition. [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]

Objective: The purpose of this research was to assess young people's perceptions about how friends impact eating and physical activity (PA) behaviors. Methods: Emerging adults (N = 52; Mean age = 18.7±0.6 years; 50% female) attending a large 4-year college campus in the southwestern United States were enrolled in focus groups (N = 10). Following saturation, the research team met to establish consensus and co-create a codebook from which 2 researchers independently coded each focus group. Coders continually discussed themes to ensure consistency of coding. Results: Initially, youth reported that their friends did not influence their eating/PA. The major social facilitators identified by students were encouragement, social cues, celebrations, shared experiences, pressure. Conclusion: Several social facilitators impacted eating and PA. These factors should be considered when designing obesity interventions with emerging adults. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Many school-based recess interventions have been shown to be effective in increasing physical activity but their relative efficiency compared to other school-based programs are unknown. This study examined the cost-effectiveness of Ready for Recess, a program designed to increase students' physical activity in 2 elementary schools. METHODS Standard cost-effectiveness analysis method was used from a program's perspective for this study. Program effectiveness was measured as total metabolic equivalent (MET) hours gained. Program costs included equipment, training, and personnel costs during the 1-year intervention. The cost-effectiveness was measured as the ratio of program costs to total MET-hours gained. RESULTS Ready for Recess cost $27,643.97 for the 2 schools in the first year of implementation. Physical activity increased by 1.8 MET-hours per day per student. Approximately 32 cents were spent on Ready for Recess to produce an additional MET-hour per student per school day in the 2008-2009 school year. CONCLUSIONS Ready for Recess was cost-effective in its first year of implementation using 35 cents as a benchmark and it was cost-effective relative to other school-based physical activity interventions. The program may be more cost-effective if implemented for a longer time and on a larger scale. [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]

Objectives: women who have experienced miscarriage may be at increased risk for elevated depressive and anxiety symptoms in subsequent pregnancies. Exercise may be a useful strategy for coping with these symptoms. Little is known about how miscarriage influences prenatal exercise behavior. The study purpose was to examine the influences of miscarriage history and prepregnancy weight status on pregnant women's psychological health, exercise motivation, and behavior using the Theory of Planned Behavior. Participants/Setting: Pregnant women (N=203; 41 with prior miscarriage; 72 overweight/obese; BMI > 25.0) in the northeast United States. Design: Women prospectively reported their depressive/anxiety symptoms and exercise motivation/behavior in the 1st, 2nd, and 3rd trimesters via mailed surveys. Group differences in depressive/anxiety symptoms, exercise behavior, and its motivational determinants were examined using Chi Square analyses and Univariate and Multivariate Analyses of Covariance. Measurements and findings: Women with a history of miscarriage had higher 1st and 2nd trimester depressive/anxiety symptoms and lower 1st trimester attitudes about exercise and 1st and 2nd trimester perceived behavior control than women without a history of miscarriage. Overweight/obese women had higher 1st and 2nd trimester pregnancy depressive/anxiety symptoms, engaged in less prepregnancy exercise, and had lower levels of exercise intention, attitude, and perceived behavior control throughout pregnancy than normal weight women. Key Conclusions: Women with a history of miscarriage and overweight/obese women have poorer psychological health and lower motivation to exercise during pregnancy than women without a history of miscarriage and normal weight women. Implications for practitioners: Interventions and healthcare provider communications aimed at promoting perinatal exercise behavior and psychological health should take into account pre-pregnancy weight status and pregnancy history to identify strategies to help women, particularly overweight/obese women with a history of miscarriage, to overcome exercise barriers. [ABSTRACT FROM AUTHOR]

This study examines the link between implementation of Strategies to Enhance Practice (STEPs) and outcomes. Twenty after-school programs (ASPs) participated in an intervention to increase children’s accumulation of 30 minutes/day of moderate to vigorous physical activity (MVPA) and quality of snacks served during program time. Outcomes were measured via accelerometer (MVPA) and direct observation (snacks). STEPs implementation data were collected via document review and direct observation. Based on implementation data, ASPs were divided into high/low implementers. Differences between high/low implementers’ change in percentage of boys accumulating 30 minutes/day of MVPA were observed. There was no difference between high/low implementers for girls. Days fruits and/or vegetables and water were served increased in the high/low implementation groups, while desserts and sugar-sweetened beverages decreased. Effect sizes (ES) for the difference in changes between the high and low group ranged from low (ES = 0.16) to high (ES = 0.97). Higher levels of implementation led to increased MVPA for boys, whereas girls MVPA benefited from the intervention regardless of high/low implementation. ESs of the difference between high/low implementers indicate that increased implementation of STEPs increases days healthier snacks are served. Programs in the high-implementation group implemented a variety of STEPs strategies, suggesting local adoption/adaptation is key to implementation. [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]

Background: The purpose of this study is to determine the feasibility of three widely used wearable sensors in research settings for 24 h monitoring of sleep, sedentary, and active behaviors in middle-aged women. Methods: Participants were 21 inactive, overweight (M Body Mass Index (BMI) = 29.27 ± 7.43) women, 30 to 64 years (M = 45.31 ± 9.67). Women were instructed to wear each sensor on the non-dominant hip (ActiGraph GT3X+), wrist (GENEActiv), or upper arm (BodyMedia SenseWear Mini) for 24 h/day and record daily wake and bed times for one week over the course of three consecutive weeks. Women received feedback about their daily physical activity and sleep behaviors. Feasibility (i.e., acceptability and demand) was measured using surveys, interviews, and wear time. Results: Women felt the GENEActiv (94.7 %) and SenseWear Mini (90.0 %) were easier to wear and preferred the placement (68.4, 80 % respectively) as compared to the ActiGraph (42.9, 47.6 % respectively). Mean wear time on valid days was similar across sensors (ActiGraph: M = 918.8 ± 115.0 min; GENEActiv: M = 949.3 ± 86.6; SenseWear: M = 928.0 ± 101.8) and well above other studies using wake time only protocols. Informational feedback was the biggest motivator, while appearance, comfort, and inconvenience were the biggest barriers to wearing sensors. Wear time was valid on 93.9 % (ActiGraph), 100 % (GENEActiv), and 95.2 % (SenseWear) of eligible days. 61.9, 95.2, and 71.4 % of participants had seven valid days of data for the ActiGraph, GENEActiv, and SenseWear, respectively. Conclusion: Twenty-four hour monitoring over seven consecutive days is a feasible approach in middle-aged women. Researchers should consider participant acceptability and demand, in addition to validity and reliability, when choosing a wearable sensor. More research is needed across populations and study designs. [ABSTRACT FROM AUTHOR]

Afterschool programs (ASPs) have potential to provide children moderate to vigorous physical activity (MVPA). The availability and types (e.g., free play or organized activities) of physical activity opportunities, their structure (e.g., presence of lines, elimination games), and staff behaviors (e.g., encouragement, engaged) can influence children’s MVPA. This study explored these factors in 20 ASPs serving over 1,700 elementary-age children. The occurrence, types, and structure of physical activity opportunities, and staff behaviors were collected via the SOSPAN (System for Observing Staff Promotion of Physical Activity and Nutrition). A total of 4,660 SOSPAN scans were completed across 63 complete program days (1,733 during physical activity opportunities). Physical activity opportunities were observed on 60 program days across all 20 sites, with 73% of those opportunities classified as free play. ASPs scheduled an average of 66.3 minutes (range 15-150 minutes) of physical activity opportunities daily. Games played included basketball, tag, soccer, and football. Staff rarely engaged in physical activity promotion behaviors, and the structure of organized games discouraged MVPA. For example, staff verbally promoted physical activity in just 6.1% of scans, while organized games were more likely to involve lines and elimination. Professional development training may enhance staffs’ physical activity promotion and the structure of activity opportunities. [ABSTRACT FROM AUTHOR]

Background. After-school programs (ASPs) are a promising opportunity for increasing girls’ physical activity (PA). Few curricula are targeted specifically for the needs of girls, and the effectiveness of most of these curricula is unknown. One curriculum that is specifically designed to facilitate PA in girls in the ASP setting but has not been formally evaluated is GoGirlGo! (GGG). The purpose of the qualitative assessment was to explore staff’s overall satisfaction with GGG and to identify best practices for implementation. Method. A qualitative case study consisting of semistructured interviews with staff (n = 21) was conducted. Data were analyzed using the process of immersion/crystallization. Results. A majority of participants reported being satisfied with GGG. Best practices for implementation included having site directors schedule time and space for GGG and adapting GGG to fit the needs of the girls. Suggested improvements included increasing the intensity of the PA offered, adding visuals (e.g., videos), and providing interactive staff training. Discussion. This qualitative exploration of GGG provided several suggested modifications for GGG. These modifications may strengthen GGG and other girl-focused ASP programs to improve girls’ ability to obtain recommended levels of PA in ASPs. [ABSTRACT FROM AUTHOR]

Background: Fewer than 50% of middle-aged women participate in regular physical activity (PA). Innovative approaches that engage women who may not otherwise participate in PA programs are warranted. The purpose of this study was to explore the acceptability and feasibility of a 12-week tablet-based book club for improving middle-aged women's PA. Materials and Methods: Thirty women (35-64 years of age) were randomized to the Fit Minded Tablet (n =15) and the Standard Fit Minded (i.e., face-to-face intervention) (n =15) groups. The Fit Minded Tablet was adapted from the Standard Fit Minded, a previously tested, theory-based book club intervention using books as a platform for discussion and group support to help women adopt regular PA. Both interventions met weekly for 3 months, for a total of 12 sessions. Tablet group participants accessed materials (e.g., e-books, workbook, live/recorded videoconferencing) via a tablet computer; Standard group participants received materials (e.g., printed books, workbook, live face-to-face meetings) in person. Feasibility (i.e., implementation and expansion) was assessed using process evaluation, qualitative interviews, satisfaction surveys, and quantitative outcome assessments. Results: Women in the Tablet group attended fewer meetings (mean, 8.25) than women in the Standard group (mean, 9.9). Videoconferencing, digital literacy, and participant engagement limitations were observed in the Tablet group. Tablet participants enjoyed the e-books but thought technology barriers hindered their engagement during meetings. Women in both groups valued the support they received from other group members. Standard participants cited this support as a key contributor to their PA changes, whereas Tablet participants reported needing in-person contact to feel more connected. Conclusions: Given the popularity of tablet computers and the value that middle-aged women place on group interaction to support their PA behaviors, additional research is warranted to determine best strategies for optimizing social support, mitigating technology barriers, and improving engagement in online and mobile health promotion programs targeting middle-aged women. [ABSTRACT FROM AUTHOR]

Background The transition to parenthood is consistently associated with declines in physical activity. In particular, working parents are at risk for inactivity, but research exploring physical activity barriers and facilitators in this population has been scarce. The purpose of this study was to qualitatively examine perceptions of physical activity among working parents. Methods Working mothers (n = 13) and fathers (n = 12) were recruited to participate in one of four focus group sessions and discuss physical activity barriers and facilitators. Data were analyzed using immersion/crystallization in NVivo 10. Results Major themes for barriers included family responsibilities, guilt, lack of support, scheduling constraints, and work. Major themes for facilitators included being active with children or during children's activities, being a role model for children, making time/prioritizing, benefits to health and family, and having support available. Several gender differences emerged within each theme, but overall both mothers and fathers reported their priorities had shifted to focus on family after becoming parents, and those who were fitting in physical activity had developed strategies that allowed them to balance their household and occupational responsibilities. Conclusions The results of this study suggest working mothers and fathers report similar physical activity barriers and facilitators and would benefit from interventions that teach strategies for overcoming barriers and prioritizing physical activity amidst the demands of parenthood. Future interventions might consider targeting mothers and fathers in tandem to create an optimally supportive environment in the home. [ABSTRACT FROM AUTHOR]

Background GoGirlGo! (GGG) is designed to increase girls' physical activity (PA) using a health behavior and PA-based curriculum and is widely available for free to afterschool programs across the nation. However, GGG has not been formally evaluated. The purpose of this pilot study was to evaluate the effectiveness of the GGG curricula to improve PA, and selfefficacy for and enjoyment of PA in elementary aged girls (i.e., 5-13 years). Methods Nine afterschool programs were recruited to participate in the pilot (within subjects repeated measures design). GGG is a 12-week program, with a once a week, one-hour lesson 30 minutes of education and 30 minutes of PA). Data collection occurred at baseline, mid (twice), post, and at follow-up (3-months after the intervention ended). PA was assessed via accelerometry at each time point. Self-efficacy for and enjoyment of PA was measured using the Self-Efficacy Scale and the Short-PA enjoyment scale and was assessed at baseline, post, and follow-up. Fidelity was assessed at midpoint. Results Across all age groups there was a statistically significant increase in PA. Overall, on days GGG was offered girls accumulated an average of 11 minutes of moderate-to-vigorous PA compared to 8 minutes during non-GGG days. There was a statistically significant difference in girls' self-efficacy for PA reported between baseline and post, which was maintained at follow-up. An improvement in enjoyment of PA for girls was found between baseline and follow-up. According to fidelity assessment, 89% of the activities within the curriculum were completed each lesson. Girls appeared to respond well to the curriculum but girls 5-7 years had difficulties paying attention and understanding discussion questions. Conclusions Even though there were statistically significant differences in self-efficacy for PA and enjoyment of PA, minimal increases in girls' PA were observed. GGG curricula improvements are warranted. Future GGG programming should explore offering GGG every day, modifying activities so that they are moderate-to-vigorous in intensity, and providing additional trainings that allow staff to better implement PA and improve behavior management techniques. With modifications, GGG could provide a promising no-cost curriculum that afterschool programs may implement to help girls achieve recommendations for PA. [ABSTRACT FROM AUTHOR]

Background A limitation of traditional outcome studies from behavioral interventions is the lack of attention given to evaluating the influence of moderating variables. This study examined possible moderation effect of baseline activity levels on physical activity change as a result of the Ready for Recess intervention. Methods Ready for Recess (August 2009-September 2010) was a controlled trial with twelve schools randomly assigned to one of four conditions: control group, staff supervision, equipment availability, and the combination of staff supervision and equipment availability. A total of 393 children (181 boys and 212 girls) from grades 3 through 6 (8-11 years old) were asked to wear an Actigraph monitor during school time on 4-5 days of the week. Assessments were conducted at baseline (before intervention) and post intervention (after intervention). Results Initial MVPA moderated the effect of Staff supervision (β = -0.47 %; p < .05), but not Equipment alone and Staff + Equipment (p > .05). Participants in the Staff condition that were 1 standard deviation (SD) below the mean for baseline MVPA (classified as "low active") had lower MVPA levels at post-intervention when compared with their low active peers in the control condition (Mean diff = -10.8 ± 2.9 %; p = .005). High active individuals (+1SD above the mean) in the Equipment treatment also had lower MVPA values at postintervention when compared with their highly active peers in the control group (Mean diff = -9.5 ± 2.9 %; p = .009). Conclusions These results indicate that changes in MVPA levels at post-intervention were reduced in highly active participants when recess staff supervision was provided. In this study, initial MVPA moderated the effect of Staff supervision on children's MVPA after 6 months of intervention. Staff training should include how to work with inactive youth but also how to assure that active children remain active. [ABSTRACT FROM AUTHOR]

Background: Research provides strong evidence for improvements in depressive symptoms as a result of physical activity participation in many populations including pregnant and post-partum women. Little is known about how women who have experienced stillbirth (defined as fetal death at 20 or more weeks of gestation) feel about physical activity or use physical activity following this experience. The purpose of this study was to qualitatively explore women's beliefs about physical activity following a stillbirth. Methods: This was an exploratory qualitative research study. Participants were English-speaking women between the ages of 19 and 44 years who experienced a stillbirth in the past year from their recruitment date. Interviews were conducted over the phone or in-person based on participants' preferences and location of residence and approximately 30-45 minutes in length. Results: Twenty-four women participated in the study (M age = 33 ± 3.68 years; M time since stillbirth = 6.33 ± 3.06 months). Women's beliefs about physical activity after stillbirth were coded into the following major themes: barriers to physical activity (emotional symptoms and lack of motivation, tired, lack of time, guilt, letting go of a pregnant body, and seeing other babies), benefits to physical activity (feeling better emotionally/mentally, helping women to cope or be therapeutic), importance of physical activity (working through grief, time for self), motivators for physical activity (body shape/weight, health, more children, be a role model, already an exerciser). Health care providers and their role in physical activity participation was also a major theme. Conclusions: This is the first study to qualitatively explore beliefs about physical activity in women after a stillbirth. Women who have experienced stillbirth have unique beliefs about physical activity related to their experience with stillbirth. Findings from this study may help to improve the health and quality of life for women who have experienced stillbirth by utilizing physical activity as a strategy for improving depressive symptoms associated with experiencing a stillbirth. Future research in this area is highly warranted. [ABSTRACT FROM AUTHOR]

School community readiness (CR) for health promotion efforts may be critical to the effectiveness of school-based interventions aimed at promoting youth physical activity and reducing childhood obesity. The purpose of this study was to: (i) identify key informants who scored highest on school CR at baseline and (ii) determine the effects of Ready for Recess on changes in CR among school key informants from baseline to post-intervention. Key informants (N = 98) across 17 schools participated in CR interviews. Interview questions focused on school CR for physical activity and childhood obesity efforts across six dimensions. At baseline, principals scored higher than teachers in overall readiness and knowledge of the issue and higher than recess staff and nurses in leadership. Leadership readiness decreased across key informants at post-intervention and principals demonstrated greater decreases when compared with recess staff. Baseline disparities between principals and other key informants suggest principals may have overestimated the readiness of staff implementing the intervention. Declines among principals indicate that they may not have been prepared to deliver adequate support to successfully implement the intervention. These results illuminate the importance of assessing/improving school readiness prior to interventions. The CR model may provide an opportunity to improve school-based physical activity interventions. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to determine how pregnant women in the Midwestern United States use the internet for health information during pregnancy including information related to physical activity and nutrition, and to determine the impact of the internet on women's confidence in making decisions about physical activity participation and eating behaviors during pregnancy. This was a descriptive, exploratory study using a convenient, non-probabilistic sample. Women were recruited through handouts provided in person, fliers posted at venues, or local websites that cater to women who are pregnant or up to 1 year post-partum. Overall, 293 women (28.5 years ± 4.9) completed the survey online (Survey Monkey) or in-print. Data were analyzed using descriptive statistics, paired t tests, and analyses of covariance. Almost all women used the internet for health information during their pregnancy. Half of women used the internet for information related to physical activity during their pregnancy and some increased their physical activity as a result. Women reported an increase in their confidence for making decisions related to physical activity during pregnancy after using the internet for physical activity information. Women that reported increases in physical activity during pregnancy, had greater increases in confidence for making decisions from using the internet compared to women who decreased or did not change their physical activity. Findings related to nutrition were similar to physical activity. However, there were no significant differences in increases in confidence between those who did or did not change the foods they ate. This study provides health promotional professionals useful information to consider when designing future physical activity and/or nutrition interventions for pregnant women. [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]

Abstract: Objectives: The objective of this study is to report on the development of an instrument to assess non-physical aspects of physical activity (PA)-related self-worth (SW). Methods: Three hundred thirty five women (mean age=36.69±15.94 yrs, BMI=24.87±4.56) completed the Women''s Physical Activity Self-Worth Inventory (WPASWI), General SW Scale, and a PA Questionnaire. Rasch analysis was used to evaluate the WPASWI. Results: Three PA-related SW subscales were identified: PA Knowledge (16 items), PA Emotional (13 items), and PA Social (8 items). Rasch analysis supported construct validity, and items demonstrated acceptable internal consistency (Cronbach''s alpha=0.90, 0.87 and 0.72) and test-re-test reliability (r =0.79, 0.70, 0.81). Women who reported regular PA participation had higher PA Knowledge, PA Emotional, PA Social, and General SW than those who reported some or no PA (p <0.01) and correlations between Knowledge, Emotional, and Social SW subscales and General SW were 0.207, 0.130, and 0.220, respectively. PA Knowledge and PA Emotional SW had stronger correlations with PA (r =0.344, 0.273, respectively) than did General SW (r =0.133). Conclusions: The WPASWI demonstrated good internal consistency, reliability, construct validity and a stronger relationship with PA than a General SW instrument. [Copyright &y& Elsevier]

BACKGROUND: After-school programs (ASPs, 3 pm to 6 pm) have been called upon to increase the amount of daily physical activity children accumulate and improve the nutritional quality of the snacks served. To this end, state and national physical activity and nutrition (PAaN) policies have been proposed. Frontline staff who directly interact with children on a daily basis are charged with the responsibility to meet policy goals. Without appropriate skills, staffers' ability to achieve such goals is limited. The gap between policies and improvements in PAaN must be bridged through professional development training. This article describes the development of an ASP staff professional development training program. METHODS: A systematic review was performed to identify relevant theoretical perspectives, empirical evidence, and recommended best practices relating to promoting PAaN of children. RESULTS: A comprehensive professional development framework was developed that incorporated the key elements identified from the review. These elements were distilled into 5 primary categories and conceptually referred to as the 5 Ms: mission-clearly defined policy/standards for PAaN; motivate-providing choices, developmentally appropriate activities, feedback, and encouragement; manage-structuring and managing the environment for safety, routines, and discipline; monitor-ongoing evaluation of PAaN; and maximize-incorporating all former Ms. CONCLUSIONS: The application of this training framework should lead to improved implementation and eventual achievement of policy goals for PAaN in ASPs. These competencies need to be developed in all ASPs if widespread improvements in PAaN within the ASP setting are to be realized. [ABSTRACT FROM AUTHOR]

Background: Afterschool programs (3pm–6pm; ASPs) are positioned to play a vital role in the improvement of children''s daily physical activity. Recent guidelines specify that children should accumulate 4600 steps per day while attending an ASP. The extent to which ASPs currently meet this goal and how many steps per day children naturally accumulate within the ASP setting is unknown. Purpose: The purpose of this study was to describe the pedometer-determined physical activity of a large sample of children attending a diverse range of ASPs and evaluate the extent to which ASPs are meeting current physical activity guidelines. Methods: Children (N=934, 51% girls, average 8.2 years; range 4–14 years) enrolled across 25 ASPs wore Walk4Life MVPa pedometers (number of steps accumulated, time spent active [hours:minutes:seconds]) up to 4 days. Data were collected in fall/spring 2010–2011 and analyzed in summer 2011. Results: On average, children attended ASPs for 125 minutes per day, accumulated 2944 steps per day, and spent approximately 26.6 minutes per day in physical activity. Only 16.5% of the 1819 daily observations met the 4600 steps per day guideline. No differences in steps per day, minutes per day in physical activity, or demographics were observed among children measured a single day versus 2, 3, or 4 days. Based on current practice, children would need to spend approximately 3.4 hours per day at an ASP to reach 4600 steps per day. Conclusions: Activity levels in ASPs are well below recommendations. Substantial effort is needed to identify strategies ASPs can employ to ensure children are sufficiently active. [Copyright &y& Elsevier]

Little progress has been made toward increasing physical activity in women. This study aimed to determine if an 8-month theory-based book club intervention (Women Bound to Be Active) was effective in increasing: (a) self-worth, (b) benefits relative to barriers to physical activity, and (c) physical activity in women (n = 51). Findings suggested a book club was effective for improving: self-worth, the benefits relative to barriers to physical activity, and possibly participation in physical activity. This is an innovative model to help women become more active and learn skills that may enable them to be active on their own long after a physical activity program has ended. [ABSTRACT FROM AUTHOR]

The purpose of this study was to qualitatively examine factors related to physical activity adherence to understand why women continue to participate in long-term exercise after completing a structured exercise program. Data were collected from focus groups, interviews, and e-mails, and analysis used grounded theory. The central category related to physical activity adherence was self-worth. Motivation, activity enjoyment, priorities, body image, ability to access support, and self-regulation skills had an impact on the self-worth of nonadherers and adherers. Women must value themselves enough to continue to participate in physical activity once they start. Exercise and fitness professionals are encouraged to use strategies to increase self-worth and long-term adherence to physical activity. Some recommended strategies include (a) increasing motivation and enjoyment relative to activity, (b) making activity a high priority in a woman's 4/c, (c) improving or deemphasizing body image, (d) increasing a woman's ability to access support, and (e)facilitating the use of self-regulation strategies. This study is the first to examine qualitative perspectives of exercise adherence among women who completed a structured exercise program. Several concepts related to adherence presented in the quantitative literature are confirmed and enhanced in this study. [ABSTRACT FROM AUTHOR]

Background: Activate Omaha (AO), a community-wide health initiative, was awarded a grant by Active Living by Design in 2003. Purpose: To establish credibility of the partners in AO and increase awareness of active living in the community by emphasizing promotions (branding, logo recognition). Methods: Media, including billboards, TV and radio ads, high-profile spokespersons, grassroots efforts, and worksite “toolkits” featuring tips and creative messaging on physical activity were combined to incentivize people to be physically active. Campaign surveys were conducted by the Market Survey Research Group each year from 2005 to 2008. Results: Survey data based on the first campaign indicated that 86% of Omahans wanted to be part of an active community and to be active with younger generations. The second campaign focused on getting families physically active together, and this survey data showed that citizens wanted to be a part of an active community. A third campaign added practical examples of citizens being active within the community and efforts expanded to worksites with consistent messaging for employees. The final survey indicated that 78% of respondents found Omaha to be an active community compared to 63% who had that response 3 years earlier. Conclusions: Activate Omaha was successful in gaining credibility and leveraging additional funding to implement complementary programming and physical projects, and as a result, changing community perceptions and influencing policy decisions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Activate Omaha Kids, a community collaborative, was designed, implemented, and evaluated with the aim of preventing childhood obesity in the Omaha community. Activate Omaha Kids brought together key stakeholders and community leaders to create a community coalition. The coalition''s aim was to oversee a long-term sustainable approach to preventing obesity. Following a planning phase, a business plan was developed that prioritized best practices to be implemented in Omaha. Methods: The business plan was developed using the Ecological Model, Health Policy Model, and Robert Wood Johnson Foundation Active Living by Design 5P model. The three models helped the community identify target populations and activities that then created a single model for sustainable change. Results: Twenty-four initiatives were identified, over one million dollars in funding was secured, and evaluation strategies were identified. Conclusion: By using the models from the initial steps through evaluation, a clear facilitation of the process was possible, and the result was a comprehensive, feasible plan. The use of the models to design a strategic plan was pivotal in building a sustainable coalition to achieve measurable improvements in the health of children and prove replicable over time. [Copyright &y& Elsevier]

Background: Omaha, an urban Nebraska community, represents 26% of the state''s population. Activate Omaha, formed in 2003, addressed the obesity epidemic caused by physical inactivity and poor infrastructure to support active living in the community. Intervention: Activate Omaha''s efforts focused on a strategic social-marketing campaign, using baseline and annual data for guidance. Complementary programming was implemented parallel to the marketing campaigns. Safe Routes to School infrastructure projects were federally funded, and 20 miles of on-street bicycle facilities were funded privately. The mayor''s Bicycle Pedestrian Advisory Committee was formed, including directors from city planning and public works. Results: The initiative became recognized by the community as the lead resource promoting physical activity. This enabled the initiative to be instrumental in infrastructure changes and programming targeting the underserved. The initiative leveraged an additional $1,475,000 over 5 years. These funds created opportunities to invest in shared community resources such as providing bicycles for underserved youth, building infrastructure through Safe Routes to School initiatives, and successful worksite programming. Lessons learned: Partners should be utilized in a strategic manner, where they are engaged purposefully and serve a role in assuring successful outcomes. Community readiness should determine the focus on policy, physical projects, and promotional and programmatic strategies, as well as the integration of these strategies. Conclusions: Activate Omaha grew into a credible organization moving public policy and leveraging new public–private relationships through multilevel strategies. This approach ultimately led to sustainable changes in the community infrastructure and the behavior of its citizens. [Copyright &y& Elsevier]

Background: Policies call on afterschool programs to improve the physical activity and nutrition habits of youth attending. No tool exists to assess the extent to which the afterschool program environment meets physical activity and nutrition policies. Purpose: To describe the development of the Healthy Afterschool Activity and Nutrition Documentation (HAAND) instrument, which consists of two subscales: Healthy Afterschool Program Index for Physical Activity (HAPI-PA) and the HAPI-Nutrition (HAPI-N). Methods: Thirty-nine afterschool programs took part in the HAAND evaluation during fall/spring 2010–2011. Inter-rater reliability data were collected at 20 afterschool programs during a single site visit via direct observation, personal interview, and written document review. Validity of the HAPI-PA was established by comparing HAPI-PA scores to pedometer steps collected in a subsample of 934 children attending 25 of the afterschool programs. Validity of the HAPI-N scores was compared against the mean number of times/week that fruits and vegetables (FV) and whole grains were served in the program. Results: Data were analyzed in June/July 2011. Inter-rater percent agreement was 85%–100% across all items. Increased pedometer steps were associated with the presence of a written policy related to physical activity, amount/quality of staff training, use of a physical activity curriculum, and offering activities that appeal to both genders. Higher servings of FV and whole grains per week were associated with the presence of a written policy regarding the nutritional quality of snacks. Conclusions: The HAAND instrument is a reliable and valid measurement tool that can be used to assess the physical activity and nutritional environment of afterschool programs. [ABSTRACT FROM AUTHOR]

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]

Introduction: National physical activity standards call for all children to accumulate 60 minutes/day of moderate to vigorous physical activity (MVPA). The contribution of summer day camps toward meeting this benchmark is largely unknown. The purpose of this study was to provide estimates of children's MVPA during summer day camps.Methods: Children (n=1,061, 78% enrollment; mean age, 7.8 years; 46% female; 65% African American; 48% normal weight) from 20 summer day camps wore ActiGraph GT3x+ accelerometers on the wrist during camp hours for up to 4 non-consecutive days over the summer of 2015 (July). Accumulated MVPA at the 25th, 50th, and 75th percentile of the distribution was estimated using random-effects quantile regression. All models were estimated separately for boys and girls and controlled for wear time. Minutes of MVPA were dichotomized to ≥60 minutes/day of MVPA or <60 minutes/day to estimate percentage of boys and girls meeting the 60 minutes/day guideline. All data were analyzed in spring 2016.Results: Across the 20 summer day camps, boys (n=569) and girls (n=492) accumulated a median of 96 and 82 minutes/day of MVPA, respectively. The percentage of children meeting 60 minutes/day of MVPA was 80% (range, 41%-94%) for boys and 73% (range, 30%-97%) for girls.Conclusions: Summer day camps are a setting where a large portion of boys and girls meet daily physical activity guidelines. Public health practitioners should focus efforts on making summer day camps accessible for children in the U.S. [ABSTRACT FROM AUTHOR]

Introduction: Afterschool programs (ASPs) across the US are working towards achieving the standard of all children accumulating 30min of moderate-to-vigorous physical activity (MVPA) during program time. This study describes the two-year impact of an intervention designed to assist ASPs meeting the 30min/day MVPA standard.Methods: Using a two-year delayed treatment, group randomized controlled trial, 20 ASPs serving ~1700 children/year (6-12yrs) were randomized to either an immediate (n=10, baseline-2013 and 2yrs intervention fall-2013-to-spring-2015) or delayed group (n=10, baseline 2013-2014 and 1yr intervention fall-2014-to-spring-2015). The intervention, Strategies-To-Enhance-Practice (STEPs), focused on programming MVPA in the daily schedule, training of staff and leaders, and ongoing technical support/assistance. Accelerometry-derived proportion of children meeting the 30min/day MVPA standard was measured in the spring of each year. Mixed model logistic regressions were used to examine the change in the odds of achieving the MVPA standard. Analyses were conducted in 2015. Data were collected in one southeastern US state.Results: Immediate boys (n=677) and delayed girls (n=658) increased the percent achieving 30min MVPA/day from 35.9% to 47.0% (odds ratio [OR]=1.88, 95% CI 1.18-3.00) and 13.1% to 19.1% (OR=1.42, 95% CI 1.03-1.96). Immediate girls (n=613) and delayed boys (n=687) exhibited a nonsignificant increase from 19.1% to 21.6% (OR=1.20, 95% CI 0.84-1.72) and 29.0% to 31.3% (OR=1.13, 95%CI 0.80-1.58).Conclusions: STEPs can have an impact on children's MVPA and time spent sedentary, yet was unable to fully achieve the goal of all children accumulating 30minMVPA/day. Additional efforts are need to identify strategies ASPs can use to meet this important public health standard. [ABSTRACT FROM AUTHOR]

BACKGROUND: Staff in settings that care for children struggle to implement standards designed to promote moderate-to-vigorous physical activity (MVPA), suggesting a need for effective strategies to maximize the amount of time children spend in MVPA during scheduled PA opportunities. The purpose of this study was to compare the MVPA children accumulate during commonly played games delivered in their traditional format versus games modified according to the LET US Play principles. METHODS: Children (K-5th) participated in 1-hour PA sessions delivered on non-consecutive days (summer 2014). Using a randomized, counterbalanced design, one of the six games was played for 20min using either traditional rules or LET US Play followed by the other strategy with a 10min break in between. Physical activity was measured via accelerometry. Repeated-measures, mixed-effects regression models were used to estimate differences in percent of time spent sedentary and in MVPA. RESULTS: A total of 267 children (age 7.5years, 43% female, 29% African American) participated in 50, 1-hour activity sessions. Games incorporating LET US Play elicited more MVPA from both boys and girls compared to the same games with traditional rules. For boys and girls, the largest MVPA difference occurred during tag games (+20.3%). The largest reduction in the percent of time sedentary occurred during tag games (boys -27.7%, girls -32.4%). Overall, the percentage of children meeting 50% time in MVPA increased in four games (+18.7% to +53.1%). CONCLUSION: LET US Play led to greater accumulation of MVPA for boys and girls, and can increase the percent of children attaining the 50% of time in MVPA standard. [ABSTRACT FROM AUTHOR]