Childhood self-regulatory skills predict adolescent smoking behavior.

Cigarette smoking is the primary preventable cause of premature death. Better self-regulatory capacity is a key psychosocial factor that has been linked with reduced likelihood of tobacco use. Studies point to the importance of multiple forms of self-regulation, in the domains of emotion, attention, behavior, and social regulation, although no work has evaluated all of these domains in a single prospective study. Considering those four self-regulation domains separately and in combination, this study prospectively investigated whether greater self-regulation in childhood is associated with reduced likelihood of either trying cigarettes or becoming a regular smoker. Hypotheses were tested using longitudinal data from a cohort of 1709 US children participating in the Panel Study of Income Dynamics--Child Development Supplement. Self-regulation was assessed at study baseline when children ranged in age from 6 to 14 years, using parent-reported measures derived from the Behavior Problems Index and Positive Behavior Scale. Children ages 12-19 self-reported their cigarette smoking, defined in two ways: (1) trying and (2) regular use. Separate multiple logistic regression models were used to evaluate odds of trying or regularly using cigarettes, taking account of various potential confounders. Over an average of five years of follow-up, 34.5% of children ever tried cigarettes and 10.6% smoked regularly. Higher behavioral self-regulation was the only domain associated with reduced odds of trying cigarettes (odds ratio (OR) = .85, 95% confidence interval (CI) = .73-.99). Effective regulation in each of the domains was associated with reduced likelihood of regular smoking, although the association with social regulation was not statistically significant (ORs range .70-.85). For each additional domain in which a child was able to regulate successfully, the odds of becoming a regular smoker dropped by 18% (95% CI = .70-.97). These findings suggest that effective childhood self-regulatory skills across multiple domains may reduce future health risk behaviors.

Validity of a practitioner-administered observational tool to measure physical activity, nutrition, and screen time in school-age programs.

BACKGROUND: Nutrition and physical activity interventions have been effective in creating environmental changes in afterschool programs. However, accurate assessment can be time-consuming and expensive as initiatives are scaled up for optimal population impact. This study aims to determine the criterion validity of a simple, low-cost, practitioner-administered observational measure of afterschool physical activity, nutrition, and screen time practices and child behaviors. METHODS: Directors from 35 programs in three cities completed the Out-of-School Nutrition and Physical Activity Observational Practice Assessment Tool (OSNAP-OPAT) on five days. Trained observers recorded snacks served and obtained accelerometer data each day during the same week. Observations of physical activity participation and snack consumption were conducted on two days. Correlations were calculated to validate weekly average estimates from OSNAP-OPAT compared to criterion measures. Weekly criterion averages are based on 175 meals served, snack consumption of 528 children, and physical activity levels of 356 children. RESULTS: OSNAP-OPAT validly assessed serving water (r = 0.73), fruits and vegetables (r = 0.84), juice >4oz (r = 0.56), and grains (r = 0.60) at snack; sugary drinks (r = 0.70) and foods (r = 0.68) from outside the program; and children's water consumption (r = 0.56) (all p <0.05). Reports of physical activity time offered were correlated with accelerometer estimates (minutes of moderate and vigorous physical activity r = 0.59, p = 0.02; vigorous physical activity r = 0.63, p = 0.01). The reported proportion of children participating in moderate and vigorous physical activity was correlated with observations (r = 0.48, p = 0.03), as were reports of computer (r = 0.85) and TV/movie (r = 0.68) time compared to direct observations (both p < 0.01). CONCLUSIONS: OSNAP-OPAT can assist researchers and practitioners in validly assessing nutrition and physical activity environments and behaviors in afterschool settings. TRIAL REGISTRATION: Phase 1 of this measure validation was conducted during a study registered at clinicaltrials.gov NCT01396473.

Improving nutrition and physical activity policies in afterschool programs: results from a group-randomized controlled trial.

OBJECTIVE: Afterschool programs can be health-promoting environments for children. Written policies positively influence nutrition and physical activity (PA) environments, but effective strategies for building staff capacity to write such policies have not been evaluated. This study measures the comprehensiveness of written nutrition, PA, and screen time policies in afterschool programs and assesses impact of the Out of School Nutrition and Physical Activity (OSNAP) intervention on key policies. METHODS: Twenty afterschool programs in Boston, MA participated in a group-randomized, controlled trial from September 2010 to June 2011. Intervention program staff attended learning collaboratives focused on practice and policy change. The Out-of-School Time (OST) Policy Assessment Index evaluated written policies. Inter-rater reliability and construct validity of the measure and impact of the intervention on written policies were assessed. RESULTS: The measure demonstrated moderate to excellent inter-rater reliability (Spearman's r=0.53 to 0.97) and construct validity. OSNAP was associated with significant increases in standards-based policy statements surrounding snacks (+2.6, p=0.003), beverages (+2.3, p=0.008), screen time (+0.8, p=0.046), family communication (+2.2, p=0.002), and a summary index of OSNAP goals (+3.3, p=0.02). CONCLUSIONS: OSNAP demonstrated success in building staff capacity to write health-promoting policy statements. Future research should focus on determining policy change impact on practices.

Promoting Physical Activity With the Out of School Nutrition and Physical Activity (OSNAP) Initiative: A Cluster-Randomized Controlled Trial.

IMPORTANCE: Millions of children attend after-school programs in the United States. Increasing physical activity levels of program participants could have a broad effect on children's health. OBJECTIVE: To test the effectiveness of the Out of School Nutrition and Physical Activity (OSNAP) Initiative in increasing children's physical activity levels in existing after-school programs. DESIGN, SETTING, AND PARTICIPANTS: Cluster-randomized controlled trial with matched program pairs. Baseline data were collected September 27 through November 12, 2010, with follow-up data collected April 25 through May 27, 2011. The dates of our analysis were March 11, 2014, through August 18, 2015. The setting was 20 after-school programs in Boston, Massachusetts. All children 5 to 12 years old in participating programs were eligible for study inclusion. INTERVENTIONS: Ten programs participated in a series of three 3-hour learning collaborative workshops, with additional optional opportunities for training and technical assistance. MAIN OUTCOMES AND MEASURES: Change in number of minutes and bouts of moderate to vigorous physical activity, vigorous physical activity, and sedentary activity and change in total accelerometer counts between baseline and follow-up. RESULTS: Participants with complete data were 402 racially/ethnically diverse children, with a mean age of 7.7 years. Change in the duration of physical activity opportunities offered to children during program time did not differ between conditions (-1.2 minutes; 95% CI, -14.2 to 12.4 minutes; P = .87). Change in moderate to vigorous physical activity minutes accumulated by children during program time did not differ significantly by intervention status (-1.0; 95% CI, -3.3 to 1.3; P = .40). Total minutes per day of vigorous physical activity (3.2; 95% CI, 1.8-4.7; P < .001), vigorous physical activity minutes in bouts (4.1; 95% CI, 2.7-5.6; P < .001), and total accelerometer counts per day (16,894; 95% CI, 5101-28,686; P = .01) increased significantly during program time among intervention participants compared with control participants. CONCLUSIONS AND RELEVANCE: Although programs participating in the OSNAP Initiative did not allot significantly more time for physical activity, they successfully made existing time more vigorously active for children receiving the intervention. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01396473.