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Prev Med. 2019 Feb;119:37-43. doi: 10.1016/j.ypmed.2018.12.007. Epub 2018 Dec 19.

Dissemination of healthy kids out of school principles for obesity prevention: A RE-AIM analysis.

Author information

1
ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, United States of America. Electronic address: Christina.Economos@tufts.edu.
2
Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, United States of America.
3
ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, United States of America.
4
Friedman School of Nutrition Science and Policy, Tufts University, United States of America.
5
Friedman School of Nutrition Science and Policy, Tufts University, United States of America; Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, United States of America.
6
ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, United States of America; Hampshire College, United States of America.

Abstract

Health-promoting behaviors for childhood obesity prevention are needed across multiple environments where children spend time, including out-of-school time (OST). Therefore Healthy Kids Out of School (HKOS) developed intervention strategies to promote three evidence-based principles (Drink Right, Move More, Snack Smart) for obesity prevention in OST. The strategies were developed with stakeholder input, disseminated, and evaluated (2012-2015) in two volunteer-led OST organizations, Boy Scouts of America (BSA) and 4-H, across three US states using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Mixed methods were used involving surveys, key informant interviews, and organizational-level data collection. Sixty out of 81 (74.1%) BSA districts and 4-H counties reaching 84,590 children (72% of children participating in BSA and 4-H in three states) adopted the strategies. 530 surveys completed by local OST leaders at baseline and 294 at follow-up showed the percentage of programs offering healthy beverages and opportunities for physical activity increased from baseline to follow-up (beverages 26% baseline, 35% follow-up, odds ratio (OR) 1.53; physical activity 31% baseline, 45% follow-up, OR 1.79; all p < 0.05). The increasing trend for healthy snacks was statistically non-significant (p = 0.09). Leaders interviewed reported the strategies were easy to implement, a good fit with their program, facilitated success, and they expected to maintain the changes. Integration of HKOS customized materials (BSA patch and 4-H pin) on BSA and 4-H national websites is a broader indicator of maintenance. Intervention strategies developed with stakeholder input and disseminated with training can effectively facilitate healthy environments for children, and have potential for national scale.

KEYWORDS:

Afterschool; Beverages; Health promotion; Nutrition; OST; Obesity prevention; Out-of-school; Physical activity; RE-AIM; Snacks

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