The Effectiveness of the Healthy Kids Out of School Initiative• Out-of-school time (OST) programs are well positioned to contribute to the establishment of healthy habits. They engage

In collaboration with

The Effectiveness of the Healthy Kids Out of School Initiative

Presented by:

Clarissa M Brown MS, MPH

Research Team:

Economos CE, Anzman-Frasca S, Koomas A, Folta S, Fullerton K,

Gonsalves D, Sacheck J, Brown C, Nelson ME

• Out-of-school time (OST) programs are well positioned to

contribute to the establishment of healthy habits. They engage

millions of children, including large numbers of minority youth.

Healthy Kids Out of School

The Opportunity

Sliwa SA, Sharma S, Dietz WH, Dolan PR, Nelson ME, Newman MB, et al. Healthy Kids Out of School: Using

Mixed Methods to Develop Principles for Promoting Healthy Eating and Physical Activity in Out-of-School Settings

in the United States. Prev Chronic Dis 2014;11:140207. DOI: http://dx.doi.org/10.5888/pcd11.140207.




• Research suggests opportunities for healthy eating and physical activity in the OST setting have room for improvement. To date,

most research has focused on structured, staff-led after-school

programs.


The Opportunity







• Research suggests opportunities for healthy eating and physical activity in the OST setting have room for improvement. To date,

most research has focused on structured, staff-led after-school

programs.

• Healthy Kids Out of School (HKOS) identified, developed and

supported the implementation of principles to improve nutrition

and physical activity practices in volunteer-led OST programs.


The Opportunity





Three Guiding Principles

Drink Right: Choose water instead of

sugar-sweetened beverages.

Move More: Boost movement and

physical activity in all programs.

Snack Smart: Fuel up on fruits

and vegetables.


Three Guiding Principles

Folta SC, Koomas A, Metayer N, Fullerton KJ, Hubbard KL, Anzman-Frasca S, et al. Engaging Stakeholders From

Volunteer-Led Out-of-School Time Programs in the Dissemination of Guiding Principles for Healthy Snacking and

Physical Activity. Prev Chronic Dis 2015.


Evaluation

Anzman-Frasca S, Boulos R, Hofer T, Folta SC, Koomas A, Nelson ME, Sacheck JM, Economos CD:

Validation of the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire. Child

Obes 2015.

GOAL: To assess the extent to which the three healthy practices were

being met before and after the implementation of the HKOS

interventions promoting them.

METHODS: Validated online survey (Out-of-School-Time Snacks,

Beverages, and Physical Activity Questionnaire) measuring nutrition

and physical activity offerings as reported by OST program leaders in

Maine, Massachusetts and New Hampshire.

ANALYSIS: Frequencies were calculated to the extent to which healthy

snack, beverage, and physical activity criteria were met at baseline

and follow-up.


Defining Success

• Success variables were created to indicate implementation of

healthy snack, beverage, and PA practices as defined by the

evidence-based HKOS principles.

• Successful typical meeting practices:

Offer water as the only beverage.

Serve fruits and/or vegetables for snack.

Include physical activity during programming time.

Full Sample

n=562

HKOS Evaluation: Enrichment Programs

Sample Overview

Online Survey

Baseline Follow-Up

Full Sample

n=320



Obes 2015.

Baseline (n=530) Follow-up (n=294)

Participant

Characteristics

Mean

(%)Median

Mean

(%)Median

Race/Ethnicity

White 90.5 99 89.6 99

Black 3.1 0 2.8 0

Hispanic 2.3 0 1.9 0

Other 2.2 0 3.2 0

Asian 1.9 0 2.6 0

Gender

Boys 79.5 100 80.5 100

Girls 20.5 0 19.6 0

Age (years)

< 5 0.5 0 0.5 0

5-7 17.5 0 16 0

8-12 54.6 50 49.7 50

> 13 27.5 6 33.8 25

Child Demographics: Enrichment ProgramsBaseline vs Follow-up

HKOS Success Indicators: Enrichment ProgramsBaseline vs Follow-up

49.1%

29.5% 29.4%

55.0%

38.8%42.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Snacks Beverages Physical Activity

Pe

rce

nt

of

Le

ad

ers

Success Indicators

Baseline (n=562)

Follow up (n=320)

Percent Meeting Two or More

27.6% Baseline vs 40.6% Follow-up

Full Sample

n=136

HKOS Evaluation: Sports Programs

Brief Overview

Online Survey

Baseline Follow-Up

Full Sample

n=133



Obes 2015.

Baseline (133) Follow-up (n=127)

Participant

Characteristics Mean Median Mean Median

Race/Ethnicity

White 81.8 90 83.1 90

Black 5 0 3.7 0

Hispanic 4.7 0 4.2 0

Other 4.8 0 3.9 0

Asian 3.7 0 5.1 0

Gender

Boys 52.1 60 43.4 40

Girls 47.9 40 56.6 60

Age (years)

< 5 0.9 0 4.6 0

5 - 7 12.7 0 23.8 0

8 - 12 82.6 100 68.7 100

> 13 3.8 0 2.8 0

Child Demographics: Sports ProgramsBaseline vs Follow-up

HKOS Sports Success IndicatorsBaseline vs Follow-up

Percent Meeting Two or More

82.4% Baseline vs 78.9% Follow-up

72.8%78.7%

71.3%77.4% 75.2%

65.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Snacks Beverages Physical Activity

Pe

rce

nt

of

Le

ad

ers

Principle

Success Indicators

Baseline (n=136)

Follow-up (n=133)

• Volunteer-led out-of-school time (OST) programs can promote nutrition

and physical activity by implementing three simple, actionable

principles.

– Our national partner organizations have enthusiastically adopted the

evidence-based principles based on the success of our pilot-program.

• These programs are relevant from a public health standpoint given the

large population of children regularly participating in these programs,

many for multiple years, and the potential for repeated exposure.

• More research in other geographic areas can further elucidate the

generalizability of the current results.


Conclusions

Acknowledgements

• Harvard Pilgrim Healthcare Foundation (funding

organization)

• Partner OST organizations:

• Boy Scouts of America

• 4-H

• US Youth Soccer

• Pop Warner Football

• Healthy Kids Out of School Team: Alyssa Koomas, Megan

Halmo, Anna Marie Finley, Karen Fullerton, Diane Gonsalves

http://www.healthykidshub.org

http://www.healthykidshub.org/

Questions?

Supplementary Slides

10.8%

20.7%

50.5%

18.0%

8.5%

23.6%

49.2%

18.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

City Suburb Small town Rural or farm area

Location

Baseline (n=527)

Follow up (n=293)

Pe

rce

nt

of

Le

ad

ers

Leader Demographics: Enrichment ProgramsBaseline vs Follow-up

Age of

Leaders

Mean

(years)

Standard

Deviation

Baseline

(n=525)48 9.5

Followup

(n=292)48.5 8.8

Race of

Leaders

Baseline

Frequency

(n=503)

Follow-up

Frequency

(n=281)

White 494 271

Other 7 2

Black 0 1

Asian 0 2

American

Indian or

Alaskan

Native

2 5

Leader Demographics: Enrichment ProgramsBaseline vs Follow-up

15.5%

21.4%

63.2%

18.8%20.9%

60.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Maine New Hampshire Massachusetts

State

Representation by State

Baseline (n=562)

Follow up (n=320)

Pe

rce

nt

of

Le

ad

ers

Enrichment Results: Snacks Provided for Group Baseline vs Follow-up

44.6%48.3%

7.1%

36.5%

45.3%

18.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

None Some Most/Every

Meeting Times

Packaged Fruits and Vegetables

Baseline (n=294)

Follow up (n=170)

17.8%

52.5%

29.6%

20.1%

39.7% 40.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Meeting Times

Fresh Fruits and Vegetables

Baseline (n=297)

Follow up (n=174)

Pe

rce

nt

of

Le

ad

ers

Pe

rce

nt

of

Le

ad

ers

6.4%

17.7%

25.4%

50.6%

4.8%

13.9% 16.1%

65.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

None Some Most Every

Meeting Times

Water Served to Group

Baseline (n=362)

Follow up (n=230)

Enrichment Results: Beverages Provided for Group Baseline vs Follow-up

Pe

rce

nt

of

Le

ad

ers

31.3%

43.7%

16.9%

8.2%

34.7%

43.4%

13.6%

8.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Meeting Times

Juice

Baseline (n=355)

Follow up(n=228)

50.3%

35.0%

11.0%

3.7%

58.3%

35.0%

4.5%2.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Meeting Times

Sugar Sweetened Beverages

Baseline (n=354)

Follow up (n=223)

Pe

rce

nt

of

Le

ad

ers

Pe

rce

nt

of

Le

ad

ers

Enrichment Results: Beverages Provided for Group Baseline vs Follow-up

7.04%

28.2%

36.3%

28.5%

3.30%

21.1%

36.3%39.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Pe

rce

nt

of

Le

ad

ers

Meeting Times

Number of Opportunities for PA

Baseline (n=540)

Follow up (n=303)

Enrichment Results: Physical ActivityBaseline vs Follow-up

2.69%

59.9%

31.0%

3.9%1.5% 1.0%2.10%

45.3%40.8%

7.6%3.1%

1.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Zero 1-15 16-30 31-45 46-60 60+

Pe

rce

nt

of

Le

ad

ers

Number of Minutes

Number of PA Minutes

Baseline (n=484)

Follow up (n=289)

Enrichment Results: Physical ActivityBaseline vs Follow-up

Race of Leaders

Baseline

(n=133)

Frequency

Follow-up

(n=127)

Frequency

White 117 108

Other 4 4

Black 5 2

Asian 4 9

American Indian

or Alaskan Native2 0

Pe

rce

nt

of

Le

ad

ers

0.7%

5.9%

93.4%

0.8%4.5%

94.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Maine New Hampshire Massachusetts

State

Representation by State

Baseline (n=136)

Follow up (n=133)

Leader Demographics: Sports ProgramsBaseline vs Follow-up

Leaders of Hispanic or

Latino BackgroundPercent

Baseline (133) 5.3%

Followup (127) 3.2%

Pe

rce

nt

of

Le

ad

ers

Leader Demographics: Sports ProgramsBaseline vs Follow-up

Age of

Leaders

Mean

(years)

Standard

Deviation

Baseline

(n=131)42.1 6.3

Follow-up

(n=124)41.5 6.4

18.8%

39.8% 39.8%

0.8%

14.2%

52.0%

31.5%

2.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

City Suburb Small town Rural or farmarea

Location

Baseline (n=133)

Follow up (n=127)

0.8% baseline & 0.0% follow-up responded ‘prefer not to answer’.

Sports Results: SnacksBaseline vs Follow-up

21.3% 21.3%

65.9%

21.8%17.3%

64.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Group Provided Individual Provided No Snack

Pe

rce

nt

of

Le

ad

ers

Snack Provision

Snacks at Typical Meetings

Baseline (n=136)

Follow up (n=133)

Sports Results: Snacks Provided for Group Baseline vs Follow-up

10.3%

31.0%

48.3%

17.2%

10.3%

72.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Pe

rce

nt

of

Le

ad

ers

Meeting Times

Fresh Fruits and VegetablesBaseline (n=29)

Follow up(n=29)

72.4%

6.9%3.4%

86.2%

6.9%3.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Pe

rce

nt

of

Le

ad

ers

Meeting Times

Packaged Fruits and Vegetables

Baseline (n=29)

Follow up (n=29)

10.3% baseline & 0.0% follow-up responded ‘don’t know’. 17.2% baseline & 3.4% follow-up responded ‘don’t know’.

Sports Results: BeveragesBaseline vs Follow-up

19.1%

93.4%

1.5% 0.0%

17.3%

94.7%

7.5%

0.0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Group Provided Child Provided Water Fountain No Beverages

Pe

rce

nt

of

Le

ad

ers

Category

Beverages at Typical Meetings

Baseline (n=136)

Follow up (n=133)

Sports Results: Beverages Provided for Group Baseline vs Follow-up

Pe

rce

nt

of

Le

ad

ers

46.2%

23.1%

11.5%

0.0%

47.8%

30.4%

4.3%8.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Meeting Times

Sugar Sweetened Beverages

Baseline (n=26)

Follow up (n=23)

0.0%

7.7% 7.7%

84.6%

0.0%

8.7%4.3%

87.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

None Some Most EveryMeeting Times


Baseline (n=26)

Follow up (n=23)


Sports Results: Individual BeveragesBaseline vs Follow-up

Pe

rce

nt

of

Le

ad

ers

0.0% 0.8%

23.6%

75.6%

0.0% 0.0%

25.4%

74.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Baseline (n=127)

Follow up(n=126)

0.0% 0.8%

23.6%

75.6%

0.0% 0.0%

25.4%

74.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Baseline (n=127)

Follow up (n=126)


Sports Results: Physical ActivityBaseline vs Follow-up

0.00% 0.00% 1.47%

98.53%

0.00% 0.00% 0.78%

99.22%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Pe

rce

nt

of

Le

ad

ers

Meeting Times

Number of Opportunities for PA

Baseline (n=136)

Follow up (n=129)

0.0% baseline & 0.0% follow-up responded ‘don’t know’.


0.7 % baseline & 0.8% follow-up responded ‘don’t know’.

0.0% 0.7%

8.1%

90.4%

0.0% 0.0%3.9%

87.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

None Some Most All

Pe

rce

nt

of

Le

ad

ers

Meeting Times

Children Participating in Physical Activity

Baseline (n=136)

Follow up (n=128)


0.0% 2.2%6.6%

19.1%

41.9%

29.4%

0.0% 0.0%

7.8%

22.7%

43.8%

25.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Zero 1-15 16-30 31-45 46-60 60+

Pe

rce

nt

of

Le

ad

ers

Number of Minutes

Number of PA Minutes

Baseline (n=136)

Follow up (n=128)

0.7 % baseline & 0.0% follow-up responded ‘don’t know’.

Sports Results: Special EventsBaseline vs Follow-up

56.62%

15.4%

29.4%24.3%

9.6%

45.04%

12.2%

29.8%26.7%

9.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FFV PFV Salty Sweet Protein

Pe

rce

nt

of

Le

ad

ers

Category

Snacks at Special Events

Baseline (n=136)

Follow up (n=131)83.8%

5.2%

27.9%

40.4%

77.9%

1.5%

19.9%

27.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Water Milk Juice SSBP

erc

en

t o

f L

ea

de

rsCategory

Beverages at Special Events

Baseline (n=136)

Follow up (n=131)

Qualitative Analysis

Key Informant Interviews

Actions TakenThe majority of program leaders indicated that they had adopted all 3 of the

principles in some form.





ReactionsMany leaders felt that increasing physical activity and not serving sugary foods

caused the kids to be calmer and increased their ability to focus.







Sustainability All leaders expected to maintain the changes that they had made, and some

anticipated additional changes.







Sustainability All leaders expected to maintain the changes that they had made, and some

anticipated additional changes.

But it was so easy, honestly, to incorporate -- you know, water? Boom. Done. That’s an immediate change. The 15 minutes of physical activity? What boy doesn’t like to get out there and, you know, mess around? (BSA)

Documents

The Effectiveness of the Healthy Kids Out of School Initiative• Out-of-school time (OST) programs are well positioned to contribute to the establishment of healthy habits. They engage