Darcy A. Freedman

Making policy practice in afterschool programs: A randomized controlled trial on physical activity changes

INTRODUCTION In the U.S., afterschool programs are asked to promote moderate to vigorous physical activity. One policy that has considerable public health importance is Californias afterschool physical activity guidelines that indicate all children attending an afterschool program accumulate 30 minutes each day the program is operating. Few effective strategies exist for afterschool programs to meet this policy goal. The purpose of this study was to evaluate a multistep adaptive intervention designed to assist afterschool programs in meeting the 30-minute/day moderate to vigorous physical activity policy goal. DESIGN A 1-year group randomized controlled trial with baseline (spring 2013) and post-assessment (spring 2014). Data were analyzed 2014. SETTING/PARTICIPANTS Twenty afterschool programs, serving >1,700 children (aged 6-12 years), randomized to either an intervention (n=10) or control (n=10) group. INTERVENTION The employed framework, Strategies To Enhance Practice, focused on intentional programming of physical activity opportunities in each afterschool programs daily schedule and included professional development training to establish core physical activity competencies of staff and afterschool program leaders with ongoing technical assistance. MAIN OUTCOME MEASURES The primary outcome was accelerometry-derived proportion of children meeting the 30-minute/day moderate to vigorous physical activity policy. RESULTS Children attending intervention afterschool programs had an OR of 2.37 (95% CI=1.58, 3.54) to achieve the physical activity policy at post-assessment compared to control afterschool programs. Sex-specific models indicated that the percentage of intervention girls and boys achieving the physical activity policy increased from 16.7% to 21.4% (OR=2.85, 95% CI=1.43, 5.68) and 34.2% to 41.6% (OR=2.26, 95% CI=1.35, 3.80), respectively. At post-assessment, six intervention afterschool programs increased the proportion of boys achieving the physical activity policy to ≥45% compared to one control afterschool program, whereas three intervention afterschool programs increased the proportion of girls achieving physical activity policy to ≥30% compared to no control afterschool programs. CONCLUSIONS The Strategies To Enhance Practice intervention can make meaningful changes in the proportion of children meeting the moderate to vigorous physical activity policy within one school year. Additional efforts are required to enhance the impact of the intervention.

Comparing Farmers’ Market Revenue Trends Before and After the Implementation of a Monetary Incentive for Recipients of Food Assistance

Introduction We examined the influence of an intervention to increase fruit and vegetable purchases at farmers’ markets for recipients of food assistance, Shop N Save (SNS), on revenue trends at a farmers’ market located at a federally qualified health center (FQHC) in rural South Carolina. We compared revenue trends for 20 weeks before the intervention (2011) and 20 weeks after (2012). Methods SNS provided one

Do people really know what food retailers exist in their neighborhood? Examining GIS-based and perceived presence of retail food outlets in an eight-county region of South Carolina.

5 monetary incentive per week to customers spending

Developing a Multicomponent Model of Nutritious Food Access and Related Implications for Community and Policy Practice

5 or more in food assistance at the farmers’ market. SNS was available to any farmers’ market customer using Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and/or Senior or WIC Farmers’ Market Nutrition Program (FMNP) vouchers. Sales receipts were recorded for each transaction at the farmers’ market to document payment type and the cost of the purchase. All SNS participants completed a one-time enrollment survey. Results A total of 336 customers self-enrolled in SNS from June through October 2012. Most SNS participants were female, African American, and patients at the FQHC. In total, the use of all forms of food assistance (SNAP, WIC, and FMNP) at the farmers’ market increased significantly after the intervention (from 10% before, to 25% after, P = .003). Senior FMNP vouchers and SNAP usage increased the most. Conclusion Interventions that provide incentives to recipients of food assistance programs at farmers’ markets are a viable strategy for increasing food assistance usage and revenue.

Salty or Sweet? Nutritional Quality, Consumption, and Cost of Snacks Served in Afterschool Programs.

Measures of neighborhood food environments have been linked to diet and obesity. However, the appropriate measurement methods and how people actually perceive their food environments are still unclear. In a cross-sectional study of 939 adults, the perceived presence of food outlets was compared to the geographic-based presence of outlets within a participants neighborhood, utilizing percent agreement and Kappa statistics. Perceived presence was based on survey-administered questions, and geographic-based presence was characterized using 1-, 2-, 3- and 5-mile (1-mile=1.6km) Euclidean- and network-based buffers centered on each participants residence. Analyses were also stratified by urban and non-urban designations. Overall, an individuals perceived neighborhood food environment was moderately correlated with the geographic-based presence of outlets. The performance of an individuals perception was most optimal using a 2- or 3-mile geographic-based neighborhood boundary and/or when the participant lived in a non-urban neighborhood. This study has implications for how researchers measure the food environment.

Making Healthy Eating Policy Practice: A Group Randomized Controlled Trial on Changes in Snack Quality, Costs, and Consumption in After-School Programs

Access to nutritious foods is limited in disenfranchised communities in the United States. Policies are beginning to focus on improving nutritious food access in these contexts; yet, few theories are available to guide this work. We developed a conceptual model of nutritious food access based on the qualitative responses of food consumers in 2 different regions of the American South. Five domains (economic, service delivery, spatial–temporal, social, and personal) and related dimensions of nutritious food access were identified. The conceptual model provides practical guidance to researchers, policy makers, and practitioners working to improve nutritious food access in communities.

The Cleveland-Cuyahoga County Food Policy Coalition: "we have evolved".

BACKGROUND Snacks served in afterschool programs (ASPs, 3-6 pm) represent an important opportunity to promote healthy eating. ASP policies suggest a fruit/vegetable is served daily, while sugar-sweetened foods/beverages and artificially flavored snacks are eliminated. Limited information exists on the types of snacks served in ASPs, if snacks meet existing nutrition policies, whether children eat the snacks, and their cost. METHODS Direct observation of snacks served and consumed was collected in 20 ASPs serving over 1700 elementary age children. The number of days that snacks were served/week was evaluated for compliance with nutrition policies. Costs of snacks were collected via receipts. RESULTS Programs served desserts and artificially flavored salty snacks on 2.7 and 2.1 days/week. Fruits and vegetables were served 0.6 and 0.1 days/week, respectively. Sugar-sweetened beverages were served 1.8 days/week. Of the children (N = 383) observed, 75% to 100% consumed the snack served, with 95% and 100% of served fruits/vegetables consumed. No ASP served fruit/vegetables daily, 18 served sugar-sweetened foods, 16 served artificially flavored snacks, and 14 served sugar-sweetened beverages. Desserts and salty snacks cost

Extending cancer prevention to improve fruit and vegetable consumption.

0.27-

Physical activity outcomes in afterschool programs: A group randomized controlled trial.

0.32/snack vs

Process Evaluation of Making HEPA Policy Practice: A Group Randomized Trial.

0.38-