Research & Action Report, Spring/Summer 2010

with Georgia Hall, Ph.D.

With funding through the Robert Wood Johnson Foundation ’s Active Living Research Program , the National Institute on Out-of-School Time (NIOST) at the Wellesley Centers for Women, has launched a one-year project designed to assess physical activity and healthy eating standards and practices in out-of-school time programs. A collaboration with the University of Massachusetts Boston and the YMCA of the USA, the project will look at out-of-school time programs that serve children and youth in grades K-12 during afternoons, evenings, holidays, and vacations. Programs serving low-income children of color will be a particular focus in the national sample studied. The project allows the investigators to initiate policy research that will assess current out-of-school physical activity and healthy eating policies and practices before new national policies are put in place.

Project directors Georgia Hall, Ph.D., senior research scientist at NIOST, and Jean Wiecha, Ph.D., associate professor in the UMass Boston department of exercise and health science, will work with Ellen Gannett, M.Ed., director of NIOST, and Barbara Roth, M.Ed., YMCA national director for youth and family programs, in carrying out the study.

What evidence most concerns you about the health of children in the United States?

Studies show that roughly one-third of American children don’t get enough physical activity and/or aren’t eating a sufficiently healthy diet. That’s really frightening in terms of the implications for the future health and well-being of our kids, and our country. It certainly motivates those of us with something to contribute to study the problem and work for change.


How important is out-of-school time in adressing childhood health?

First off, we know that 6.5 million children attend afterschool programs, spending roughly three hours a day there. That’s a big chunk of the day for millions of kids.

Let’s start with physical activity. We know that, for all kinds of medical reasons, the current recommendation is that children have at least 60 minutes of at least moderately intense activity every day. Almost all elementary schools provide, on average, 30 minutes of recess per day, but a recent study showed that only 3.8 percent provide daily physical education, and 30.7 percent don’t require any physical education at all.

So the stakes have been raised for settings outside of school to increase opportunities for physical activity. Meanwhile, there’s been a shift to less physical activity once kids get home. A lot of things have contributed to that, including the shift in families’ perception of neighborhood safety as well as kids’ opportunities to be more involved with TV, video, and computer games. There are many assets in media and technology that contribute to kids’ lives—but there’s really been a shift away from home time spent in physical activity. Afterschool programs have an opportunity to add back that time. As for healthy eating, we know that in general American children eat inadequate quantities of fruits and vegetables and too many sugar-sweetened beverages, sweets, sweetened grains, and trans fats. Out-of-school programs can help change at least part of that picture.


What do we know about current practices in out-of-school time programs?

Way too little. There are many sets of guidelines and standards issued by local and state licensing bodies that address physical activity and healthy eating. Nationally, there are guidelines set by the Centers for Disease Control and the National Institutes of Health, as well as by other institutions and national youth-serving organizations. But guidelines and standards don’t necessarily translate into implementation at the program level, and we suspect there are huge barriers to meeting these standards. There’s a need for more national understanding of what practices are in place, across the country. Our project will help provide critical national data about that.


What will you do with what you learn?

First, we want to help revise voluntary, national standards of quality in physical activity and healthy eating in out-ofschool time. There’s a need for stronger language and more rigorous guidelines in the policies that currently exist across a number of different organizations, and a need for setting up accountability structures, such as connections to funding and accreditation.

At the same time, we’ll need to work toward developing supports that will enable program staffs to meet the guidelines and standards.


You’ve spoken of having a “window of opp ortunity” to strengthen the national guidelines and standa rds for physica l ac tivity and healthy eating. What is this “window”?

Right now there’s great national momentum on this issue. The medical community has sent out the alarm about childhood obesity, and major organizations and institutions with vital roles in the national opinion about children’s health are now moving in the same direction. It’s a perfect time to gather baseline data that will help show us what we should be doing.

To top it off, this past February Michelle Obama announced her “Let’s Move” campaign to curb childhood obesity. I was in San Diego at the Active Living Research Conference when that announcement came out one morning as the headline on our newspaper.


That must have been exciting.

Very exciting! It’s wonderful to have someone in as high a rank as Michelle Obama put her energy and her stamp on this issue, declaring that it’s something we all need to be concerned about and put work and resources toward. That may have already stimulated policy-level changes within communities and even states. Right here in Massachusetts, our legislature has been considering policy change around the type of vending machines that are in placed in schools. I think we’re going to see more discussion and change around this issue because of the attention it’s getting at the national level, from a national figure.


You’ve said important children’s-health organizations are now moving in the same direction. Will this NIOST project involve some of them?

Yes. Besides working with our project partners, UMass Boston and the YMCA of the USA, we’ll be in steady conversation with the National Afterschool Association. And an important part of the project is that we’re bringing together a collaboration called “HOST”—healthy out-of-school time—made up of many different organizations concerned with physical activity and healthy eating during out-of-school time. The more we reach out to include these organizations, the more opportunity there’ll be for improvement in guidelines and standards across a variety of sectors. And this process invites perspectives from a lot of organizations and innovative ideas about trying to reverse this national dilemma.


What is the design of the project?

Robert Wood Johnson’s focus is on populations of children and youth who are of lower economic means ethnically diverse, and considered at risk. So our study is targeted on school districts in ten cities or regions that reflect these priorities.

One of our first tasks was to interview key people involved in these concerns across the United States, including some in the areas where we’re going to be collecting data. We asked them their perspectives on how well programs are able to meet existing guidelines and standards within their cities or regions, and whether more rigorous guidelines and standards could improve the programs’ ability to implement them. If not, what are some of the barriers preventing change?

We interviewed 17 of these people. Some are in state positions that involve out-of-school programming. Others come from intermediary organizations that work with a network of programs, or from youth-serving organizations that are significant providers of out-of-school time programs within those areas.

Now we’re using that information in preparing a programdirector survey for the ten areas we’ve targeted. The survey also uses previous work done by our partners, UMass Boston and the YMCA, information from our key interviews, and a review of current standards and guidelines. We plan to contact 80 to 100 program directors in each of the target areas.

Then we’ll synthesize and report out that information as an understanding of what’s going on in programs around the country regarding physical activity and healthy eating, what the relationship is between program characteristics and the kinds of practices they’re able to implement, what factors help programs have stronger practices, and what barriers programs face on the ground.


Will you be doing site visits and looking for promising practices?

Yes. When we’ve synthesized the information, we’ll visit and profile some programs that are doing exemplary work. There’s real value in profiling very successful practices that can be easily transferred into other programs. In spite of the barriers they face, sometimes program directors just need to know about a great practice—and know how somebody else is doing it—to all of a sudden make that change happen.


Say more about those barriers that programs often face.

I think we’re going to find some really huge barriers. For healthy eating, family economics is often a barrier. For example, there are now curriculums available that focus on healthy eating and offer wonderful recipes for children to bring home and make with their families. But families still need to be able to access the food in those recipes, and to purchase it. And, of course, they need to have the time to follow through.

For physical activity, time is a major barrier. As the content of the school day has shifted, not only have afterschool programs become more responsible for physical activity, but they’ve also taken on a huge responsibility for supporting students’ academic progress. Today a large chunk of out-ofschool programming is devoted to homework, tutoring, and academic support—which can cut heavily into the time for physical activity. Programs often feel very pressured, particularly around homework. There’s an expectation from families that when children come home from an afterschool program their homework is completed.

The lack of appropriate space is also a problem. Programs may be in shared spaces, or in spaces that are incompatible with outdoor—or even indoor—physical activity.

Out-of-school time staffing can pose particular problems, too. For example, staff turnover is often larger than in other fields, and many afterschool professionals need to hold other part-time jobs as well.

In terms of physical activity, even if there’s curriculum available, there often needs to be training. Some afterschool professionals are saying, “We’ll make the space and time available for physical activity in our program day, but we need to know how to do it. We’re not physical education specialists, we’re not coaches, we’re not trainers.”

Along that line, we’ve just started another project, working with Vida Health of Cambridge, Massachusetts. It’s called After School Gets Moving, and it’s funded by the Centers for Disease Control. For that project, Vida Health is creating a professional-development DVD series that we’ll eventually pilot test as one approach to training staff about improving physical activity for kids. In that study, we’ll actually be tracking kids’ activity through pedometers.

We can’t expect programs to come up with training and curriculum resources on their own.


What about the out-of-school times that children are not in programs— weekends, holidays, vacations?

Actually, many out-of-school time programs also serve kids during holiday times and school vacations. And the work that we do in this project can certainly have a role in the time kids spend at home on weekends, and so on.

NIOST is doing other work about understanding children’s physical trajectories, their paths of physical activity from younger to older ages. An on-going project called Physical Activity over Time, which is now in its final stages, is a secondary analysis of data about children’s physical activity collected from birth to ninth grade. In this project, we’re interested in learning how to promote a physical activity pathway for children and youth. What could be happening in out-of-school time hours that would change children’s and youths’ behaviors so that whatever setting they’re in, they’re going to continue being physically active because they’ve acquired a habit for it, a desire for it?

So we have some really nice synergy among a number of projects going on at the same time, all of which are related to children’s physical activity.


You’re an enthusiastic sports participant. Is physical activity a natural way of life for you and your family, or does it take some work?

Let’s call it active living. That’s the name of the Robert Wood Johnson research domain that covers this project, and I like that term.

I grew up in the time when we left the house on a Saturday morning at ten o’clock, breezed in for lunch, went back out, and came back when we heard someone calling us for dinner. That whole time we were running around, riding bikes, playing ball games, climbing trees.

Today it’s harder to be an active-living family. It takes more resources, more work, more planning, more transporting than it did years ago. There are safety and supervision concerns. Also, there’s a lot of pressure for families to compete with media. The lure of the computer, the DVD, is very strong.


What advice would you give other parents and caregivers to encourage healthier physical-activity habits for children and families?

It’s especially important for families and children, activity leaders and children, to be involved in activities together. Children are more likely to be enthusiastic, to be engaged in activities when the adult is also enthusiastic and engaged. It’s a dual benefit; you’re getting the activity, the children are seeing that you value the activity also. That’s the message you want to give.

Several years ago, I watched an indoor kickball game at a Boys’ and Girls’ Club. Twice the program director came and played in the game. When he had to step out for a while, the whole climate, the engagement in the game went down. When he returned, the engagement shot right back up. The children were really enjoying their time being physical. It was a really good example of how adult participation can stimulate a different experience for children.

It’s also important that adults help frame physical activity to be sure that there’s equal opportunity for involvement among kids. We need to be choosing activities that are both appealing and appropriate for different skill levels, and to be avoiding circumstances that can make kids feel demeaned.

Ultimately we’re trying to create habits and desire for being physically active so that children and youth as they grow older will make choices that keep them active. That involves giving them a broad experience of physical activities so they can gravitate toward something that will work for them in a variety of settings and at a variety of ages, and help them stay on an active living pathway.


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