Active Living Research

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.

Physical activity (PA) participation levels among youth remain well below national recommendations. Thus, a variety of strategies to promote youth PA have been advocated, including multifaceted, school-based approaches. One identified as having great potential is a comprehensive school physical activity program (CSPAP). The goal of a CSPAP is to develop a school culture conducive to promoting lifelong PA across five integral components, each serving as a plausible point of intervention: (a) physical education, (b) PA during school, (c) PA before and after school, (d) staff involvement, and (e) family/community involvement. The purpose of this article is to provide an up-to-date review on all CSPAP components, propose the potential of such comprehensive interventions in increasing youth PA levels, and provide future directions for CSPAP research.

BACKGROUND: Evidence of associations between the built environment and obesity risk has been steadily building, yet few studies have focused on the relationship between the built environment and aspects of metabolism related to obesity’s most tightly linked comorbidity, type 2 diabetes. PURPOSE: To examine the relationship between aspects of the neighborhood built environment and insulin resistance using accurate laboratory measures to account for fat distribution and adiposity. METHODS: Data on 453 Hispanic youth (aged 8–18 years) from 2001 to 2011 were paired with neighborhood built environment and 2000 Census data. Analyses were conducted in 2011. Walking distance buffers were built around participants’ residential locations. Body composition and fat distribution were assessed using dual x-ray absorptiometry and waist circumference. Variables for park space, food access, walkability, and neighborhood sociocultural aspects were entered into amultivariate regression model predicting insulin resistance as determined by the homeostasis model assessment. RESULTS: Independent of obesity measures, greater fast-food restaurant density was associated with higher insulin resistance. Increased park space and neighborhood linguistic isolation were associated with lower insulin resistance among boys. Among girls, park space was associated with lower insulin resistance, but greater neighborhood linguistic isolation was associated with higher insulin resistance. A significant interaction between waist circumference and neighborhood linguistic isolation indicated that the negative association between neighborhood linguistic isolation and insulin resistance diminished with increased waist circumference. CONCLUSIONS: Reducing access to fast food and increasing public park space may be valuable to addressing insulin resistance and type 2 diabetes, but effects may vary by gender.

BACKGROUND: Licensed child-care centers represent an opportunity to positively influence children's health behaviors. Valid and easy-to-use measures of the child-care environment are needed to assess the influence of environmental change on health. OBJECTIVE: To develop and validate a self-administered survey to assess the nutrition and physical activity environment of child-care centers, and to identify domains that may be evaluated adequately through self-report. DESIGN: A survey was developed to assess four areas related to nutrition and physical activity: center policies, practices related to the social environment, physical environment, and nutrition quality. Development involved review of the literature, existing measures, and regulations/standards as well as collaboration with a working group. The survey was pilot tested and feedback was sought from expert consultants. It was administered statewide and validated against a menu rating tool, interviews with a center director, and a direct observation tool that was developed for this study. PARTICIPANTS/SETTING: Participating sites were drawn from Child and Adult Care Food Program-participating licensed Connecticut child-care centers serving 13 or more children aged 3 to 5 years. Survey responses from 146 center directors were included, as were 62 center menus, and director interviews and observational data from 33 sites. PRIMARY OUTCOMES/STATISTICAL ANALYSES: Criterion validity of the survey was assessed through percent agreement with mirroring items in the additional measures. Healthy and unhealthy food scores were calculated for menu and survey tools, and Pearson correlations were computed. RESULTS: Percent agreement with criterion outcomes ranged from 39% to 97%, with 61% of items achieving agreement ≥80%. Agreement was highest for nutrition and policy domains, and lowest for physical activity and barriers to promoting health. Correlations between food scores across measures were moderate. CONCLUSIONS: The self-report survey demonstrated adequate criterion validity. We make recommendations for improving validity of low-agreement items and for the use of more labor-intensive evaluation procedures for domains not adequately assessed through self-report.

BACKGROUND: There is a growing interest in studying the influence of child-care center policies on the health of preschool-aged children. OBJECTIVE: To develop a reliable and valid instrument to quantitatively evaluate the quality of written nutrition and physical activity policies at child-care centers. DESIGN: Reliability and validation study. A 65-item measure was created to evaluate five areas of child-care center policies: nutrition education, nutrition standards for foods and beverages, promoting healthy eating in the child-care setting, physical activity, and communication and evaluation. The total scale and each subscale were scored on comprehensiveness and strength. SETTING: Analyses were conducted on 94 independent policies from Connecticut child-care centers participating in the Child and Adult Care Food Program. STATISTICAL ANALYSES PERFORMED: Intraclass correlation coefficient was calculated to measure inter-rater reliability, and Cronbach's α was used to estimate internal consistency. To test construct validity, t tests were used to assess differences in scores between Head Start and non-Head Start centers and between National Association for the Education of Young Children-accredited and nonaccredited centers. RESULTS: Inter-rater reliability was high for total comprehensiveness and strength scores (intraclass correlation coefficient=0.98 and 0.94, respectively) and subscale scores (intraclass correlation coefficient=0.84 to 0.99). Subscales were adequately internally reliable (Cronbach's α=.53 to .83). Comprehensiveness and strength scores were higher for Head Start centers than non-Head Start centers across most domains and higher for National Association for the Education of Young Children-accredited centers than nonaccredited centers across some but not all domains, providing evidence of construct validity. CONCLUSIONS: This instrument provides a standardized method to analyze and compare the comprehensiveness and strength of written nutrition and physical activity policies in child-care centers.

BACKGROUND: The Robert Wood Johnson Foundation Active Living Research (ALR) program commissioned an evaluation of its initiative to assess 10 years (2001–2011) of progress in establishing a new interdisciplinary field to develop and translate research focused on policy and environmental factors affecting physical activity in children and families. PURPOSE: The second-phase evaluation (ALR-2) was conducted from March to July 2011 to measure progression from evidence- and field-building (Goals 1 and 2) to policy and practice contributions (Goal 3) to inform childhood obesity strategies, and to develop recommendations for a third phase (ALR-3). METHODS: The evaluation was a retrospective, in-depth descriptive study utilizing qualitative and quantitative methods. Key informant interviews (N¼100) across seven stakeholder groups were conducted and analyzed in 2011. Data from web-based surveys of grantee investigators conducted from 2007 to 2011 and analyzed in 2011 served as the primary quantitative source. RESULTS: Key indicators of ALR’s overall progress confirmed ALR’s success across its three goals: (1) establishing a strong research base: 309 publications filling major knowledge gaps; (2) building an interdisciplinary and diverse field: grantees represented 31 disciplines, with more than one quarter (28%) of investigators having r5 years of experience, of which 39% were people of color; and (3) using research to inform policy and practice: 62 examples, of which slightly more than one half (n¼32) resulted in actual policy or practice change. CONCLUSIONS: Overall, ALR met its three goals during ALR-2 and was well positioned to implement a third phase of the program to further accelerate the translation of its research into policy and practice.

The second phase of Active Living Research (ALR-2, 2007–2012) focused on advancing the Robert Wood Johnson Foundation (RWJF)’s goal of reversing the childhood obesity epidemic. The mission was to stimulate and support research to identify environmental factors and policies that influence physical activity for children and families to inform effective childhood obesity prevention strategies, with an emphasis on the lower-income and racial/ethnic communities with highest childhood obesity prevalence. The present report describes ALR activities undertaken to accomplish three goals.

The first goal—to build an evidence base—was furthered by funding 230 competitive grants to identify and evaluate promising environment and policy changes. More than 300 publications have been produced so far. The second goal—to build an interdisciplinary and diverse field of investigators—was supported through annual conferences and linked journal supplements, academic outreach to multiple disciplines, and grants targeting young investigators and those representing groups historically disadvantaged or underrepresented in RWJF-funded research. The third goal—to use research to inform policy and practice—was advanced through research briefs; webinars; research translation grants supporting ALR grantees to design communications tailored to decision-maker audiences; active engagement of policymakers and other stakeholders in ALR program meetings and annual conferences; ALR presentations at policy-related meetings; and broad outreach through a widely used website, e-mailed newsletters, and social media. ALR-2 findings and products have contributed to a rapid increase in the evidence base and field of active living research, as documented by an independent program evaluation.