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1.
N Engl J Med ; 381(25): 2440-2450, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31851800

RESUMO

BACKGROUND: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity. METHODS: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes. RESULTS: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2). CONCLUSIONS: Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).


Assuntos
Obesidade Mórbida/epidemiologia , Obesidade/epidemiologia , Adulto , Índice de Massa Corporal , Feminino , Previsões , Humanos , Renda , Masculino , Obesidade/etnologia , Obesidade Mórbida/etnologia , Prevalência , Autorrelato , Distribuição por Sexo , Estados Unidos/epidemiologia
2.
BMC Public Health ; 19(1): 1587, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31779603

RESUMO

BACKGROUND: There is a great need to identify implementation strategies to successfully scale-up public health interventions in order to achieve their intended population impact. The Out-of-school Nutrition and Physical Activity group-randomized trial previously demonstrated improvements in children's vigorous physical activity and the healthfulness of foods and beverages consumed. This implementation study aimed to assess the effects and costs of two training models to scale-up this evidence-based intervention. METHODS: A 3-arm group-randomized trial was conducted to compare effectiveness of in-person and online training models for scaling up the intervention compared to controls. One-third of sites were randomized to the in-person train-the-trainer model: local YMCA facilitators attended a training session and then conducted three learning collaborative meetings and technical assistance. One-third were assigned to the online model, consisting of self-paced monthly learning modules, videos, quizzes, and facilitated discussion boards. Remaining sites served as controls. Fifty-three afterschool sites from three YMCA Associations in different regions of the country completed baseline and follow-up observations using a validated tool of afterschool nutrition and physical activity practices. We used multivariable regression models, accounting for clustering of observations, to assess intervention effects on an aggregate afterschool practice primary outcome, and conducted secondary analyses of nine intervention goals (e.g. serving water). Cost data were collected to determine the resources to implement each training model. RESULTS: Changes in the primary outcome indicate that, on average, sites in the in-person arm achieved 0.44 additional goals compared to controls (95%CI 0.02, 0.86, p = 0.04). Increases in the number of additional goals achieved in sites in the online arm were not significantly greater than control sites (+ 0.28, 95% CI -0.18, 0.73, p = 0.24). Goal-specific improvements were observed for increasing water offered in the in-person arm and fruits and vegetables offered in the online arm. The cost per person trained was $678 for the in-person training model and $336 for the on-line training model. CONCLUSIONS: This pilot trial presents promising findings on implementation strategies for scale-up. It validated the in-person training model as an effective approach. The less expensive online training may be a useful option for geographically disbursed sites where in-person training is challenging. TRIAL REGISTRATION: Although this study does not report the results of a health care intervention on human subjects, it is a randomized trial and was therefore retrospectively registered in ClinicalTrials.gov on July 4, 2019 in accordance with the BMC guidelines to ensure the complete publication of all results (NCT04009304).

3.
Obesity (Silver Spring) ; 27(12): 2037-2045, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31746555

RESUMO

OBJECTIVE: This study aimed to estimate the cost-effectiveness and impact on childhood obesity of installation of chilled water dispensers ("water jets") on school lunch lines and to compare water jets' cost, reach, and impact on water consumption with three additional strategies. METHODS: The Childhood Obesity Intervention Cost Effectiveness Study(CHOICES) microsimulation model estimated the cost-effectiveness of water jets on US childhood obesity cases prevented in 2025. Also estimated were the cost, number of children reached, and impact on water consumption of the installation of water jets and three other strategies. RESULTS: Installing water jets on school lunch lines was projected to reach 29.6 million children (95% uncertainty interval [UI]: 29.4 million-29.8 million), cost $4.25 (95% UI: $2.74-$5.69) per child, prevent 179,550 cases of childhood obesity in 2025 (95% UI: 101,970-257,870), and save $0.31 in health care costs per dollar invested (95% UI: $0.15-$0.55). In the secondary analysis, installing cup dispensers next to existing water fountains was the least costly but also had the lowest population reach. CONCLUSIONS: Installating water jet dispensers on school lunch lines could also save almost half of the dollars needed for implementation via a reduction in obesity-related health care costs. School-based interventions to promote drinking water may be relatively inexpensive strategies for improving child health.

4.
Prev Med Rep ; 15: 100940, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31367511

RESUMO

Many children are not sufficiently physically active. This study uses a quasi-experimental design to evaluate whether participation in a before-school physical activity program called Build Our Kids' Success (BOKS) increases physical activity. Participants (n = 426) were students in Fall, 2016 enrolled in BOKS programming and matched non-BOKS control students from the same grades (Kindergarten-6) and schools in Massachusetts and Rhode Island. Analyses conducted in 2017 examined differences between children in BOKS versus controls in total daily steps, minutes of moderate-to-vigorous (MVPA), vigorous (VPA), and total physical activity (TPA) assessed via Fitbit Charge HR™ monitors. Additional analyses compared physical activity on program days and non-program days. Students (mean age = 8.6 y; 47% female, 58% White, Non-Hispanic) wore monitors an average of 21.7 h/day on 3.2 days during the school week. Compared with controls, on BOKS days, BOKS participants accumulated more steps (1147, 95% confidence interval (CI): 583-1712, P < 0.001), MVPA minutes (13.4, 95% CI: 6.6-20.3, P < 0.001), and VPA minutes (4.0, 95% CI: 1.2-6.7, P = 0.005). Across all school days, BOKS participants accumulated more total steps than controls (716, 95% CI: 228-1204, P = 0.004). Compared to days without BOKS programming, on BOKS days, BOKS participants accumulated more steps (1153; 95% CI: 841-1464, P < 0.001) and daily minutes of MVPA (8.8, 95% CI: 5.3-12.2, P < 0.001), VPA (3.0, 95% CI: 1.6-4.5, P < 0.001), and TPA (20.8, 95% CI: 13.6-28.1, P < 0.001). BOKS programming promotes engagement in additional accumulated steps during the school week and physical activity on days that students participate. Clinical Trial Registration: www.ClinicalTrials.gov, NCT03403816, available at: https://clinicaltrials.gov/ct2/show/NCT03403816?term=NCT03403816&rank=1.

5.
Am J Health Promot ; 32(3): 657-666, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29108441

RESUMO

PURPOSE: To assess predictors of stated support for policies promoting physically active transportation. DESIGN: Cross-sectional. SETTING: US counties selected on county-level physical activity and obesity health status. PARTICIPANTS: Participants completing random-digit dialed telephone survey (n = 906). MEASURES: Survey measures assessed stated support for 5 policies to promote physically active transportation, access to active transportation facilities, and time spent in a car. County-level estimates included household car dependence and funding for bicycle-pedestrian projects. ANALYSIS: Multivariable generalized linear mixed models using binary distribution and logit link, accounting for clustering within county. RESULTS: Respondents supported policies for accommodating bicyclists and pedestrians through street improvements (89%), school active transportation programs (75%), employer-funded active commuting incentives (67%), and allocation of public funding (68%) and tax support (56%) for building and maintaining public transit. Residents spending >2 h/d (vs <0.7 hours) in cars were more likely to support street (odds ratio [OR]: 1.87; confidence interval [CI]: 1.09-3.22) and public transit (OR: 1.85; CI: 1.24-2.77) improvements. Residents in counties investing >$1.6 million in bicycle and pedestrian improvements expressed greater support for funding (OR: 1.71; CI: 1.04-2.83) and tax increases (OR: 1.73; CI: 1.08-2.75) for transit improvements compared to those with lower prior investments (<$276 100). CONCLUSION: Support for policies to enable active transportation is higher where relevant investments in active transportation infrastructure are large (>$1.6 M), public transit is nearby, and respondents drive >2 h/d.


Assuntos
Ciclismo , Políticas , Transportes/métodos , Transportes/estatística & dados numéricos , Caminhada , Adolescente , Adulto , Idoso , Estudos Transversais , Planejamento Ambiental/economia , Planejamento Ambiental/estatística & dados numéricos , Exercício , Feminino , Financiamento Governamental/economia , Financiamento Governamental/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores Socioeconômicos , Impostos/estatística & dados numéricos , Transportes/economia , Estados Unidos/epidemiologia , Adulto Jovem
6.
J Athl Train ; 52(10): 946-954, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28937785

RESUMO

CONTEXT: Female athletic trainers (ATs) can face barriers to employment within the profession. Although there is evidence for an increasing percentage of women in athletic training, the portion providing medical care to male sport teams within the professional sport and collegiate settings continues to be small. OBJECTIVE: To investigate the experiences of female ATs when seeking employment with male sport teams within the Division I setting. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association (NCAA) Division I. PATIENTS OR OTHER PARTICIPANTS: A total of 15 NCAA Division I female ATs providing medical care to a male sport team participated in our study. Their mean age was 33 ± 9 years, and they had a mean of 11 ± 9 years of overall clinical experience. DATA COLLECTION AND ANALYSIS: All participants completed one-on-one phone interviews, which were recorded and transcribed. Analysis of the data followed thematic analysis using a phenomenologic approach. Credibility was established through credibility checks, peer review, and researcher triangulation. RESULTS: Factors that played a role in women gaining employment with male sport teams were (1) preexisting professional relationships, (2) prior experience with a male sport, and (3) perseverance. Participants in our study were most attracted to their current positions because of (1) the environment of the collegiate setting and (2) the location of the university. CONCLUSIONS: Job access for female ATs in this study was not viewed as a challenge. Familiarity through previous connections with the university and staff and commitment to career goals helped these women obtain the positions they held. The desire to work in male sports was not a primary contributing factor to the decision-making process. Progress continues for women in athletic training, as evidenced by the reported ease of job access with male sport teams.


Assuntos
Emprego , Educação Física e Treinamento/estatística & dados numéricos , Fatores Sexuais , Esportes/educação , Mulheres Trabalhadoras/estatística & dados numéricos , Adulto , Emprego/estatística & dados numéricos , Feminino , Humanos , Candidatura a Emprego , Masculino , Pesquisa Qualitativa , Inquéritos e Questionários , Universidades/estatística & dados numéricos , Adulto Jovem
7.
Obesity (Silver Spring) ; 25(7): 1175-1182, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28653502

RESUMO

OBJECTIVE: To examine changes in prevalence of obesity and target health behaviors (fruit, vegetable, and beverage consumption; physical activity; screen time; sleep duration) among students from communities that participated in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project compared to controls. METHODS: MA-CORD was implemented in two low-income communities. School-level prevalence of obesity among students in first, fourth, and seventh grades was calculated for the intervention communities and nine matched control communities pre and post intervention. Fourth- and seventh-grade students' self-reported health behaviors were measured in intervention communities at baseline and post intervention. RESULTS: Among seventh-graders (the student group with greatest intervention exposure), a statistically significant decrease in prevalence of obesity from baseline to post intervention in Community 2 (-2.68%, P = 0.049) and a similar but nonsignificant decrease in Community 1 (-2.24%, P = 0.099) was observed. Fourth- and seventh-grade students in both communities were more likely to meet behavioral targets post intervention for sugar-sweetened beverages (both communities: P < 0.0001) and water (Community 1: P < 0.01; Community 2: P = 0.04) and in Community 2 for screen time (P < 0.01). CONCLUSIONS: This multisector intervention was associated with a modest reduction in obesity prevalence among seventh-graders in one community compared to controls, along with improvements in behavioral targets.


Assuntos
Comportamentos Relacionados com a Saúde , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/terapia , Bebidas , Índice de Massa Corporal , Criança , Estudos Transversais , Água Potável , Exercício , Feminino , Seguimentos , Frutas , Humanos , Estilo de Vida , Masculino , Massachusetts/epidemiologia , Prevalência , Autorrelato , Sono , Fatores Socioeconômicos , Estudantes , Resultado do Tratamento , Verduras
8.
Obesity (Silver Spring) ; 25(7): 1159-1166, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28653504

RESUMO

OBJECTIVE: To examine the extent to which a clinical intervention resulted in reduced BMI z scores among 2- to 12-year-old children compared to routine practice (treatment as usual [TAU]). METHODS: The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a multifaceted initiative to prevent childhood obesity among low-income children. At the federally qualified community health centers (FQHCs) of two communities (Intervention Site #1 and #2), the following were implemented: (1) pediatric weight management training, (2) electronic decision supports for clinicians, (3) on-site Healthy Weight Clinics, (4) community health worker integration, and (5) healthful clinical environment changes. One FQHC in a demographically matched community served as the TAU site. Using electronic health records, we assessed BMI z scores and used linear mixed models to examine BMI z score change over 2 years in each intervention site compared to a TAU site. RESULTS: Compared to children in the TAU site (n = 2,286), children in Intervention Site #2 (n = 1,368) had a significant decline in BMI z scores following the start of the intervention (-0.16 units/y; 95% confidence interval: -0.21 to -0.12). No evidence of an effect was found in Intervention Site #1 (n = 111). CONCLUSIONS: The MA-CORD clinical interventions were associated with modest improvement in BMI z scores in one of two intervention communities compared to a TAU community.


Assuntos
Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Índice de Massa Corporal , Peso Corporal , Criança , Pré-Escolar , Agentes Comunitários de Saúde , Registros Eletrônicos de Saúde , Exercício , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Estudos Longitudinais , Masculino , Massachusetts/epidemiologia , Pobreza , Prevalência , Resultado do Tratamento
9.
J Athl Train ; 52(4): 368-376, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28318314

RESUMO

CONTEXT: Mentorship is a helpful resource for individuals who transition from doctoral student to tenure-track faculty member. The National Athletic Trainers' Association (NATA) Research & Education Foundation offers a Research Mentor Program to provide mentorship to promising investigators, particularly as they work to establish independent lines of research. OBJECTIVE: To gain the perspectives of promising and established investigators on their participation in the NATA Foundation Research Mentor Program. DESIGN: Qualitative, phenomenological research. SETTING: Higher education institutions. PATIENTS OR OTHER PARTICIPANTS: Seven promising investigators (5 women, 2 men) and 7 established investigators (2 women, 5 men), all of whom had completed the NATA Foundation Research Mentor Program. Data Collection and Analysis We developed and piloted intervi: ew guides designed to gain participants' perspectives on their experiences participating in the NATA Foundation Research Mentor Program. Semistructured telephone interviews were completed with each individual and transcribed verbatim. Data were analyzed using a phenomenological approach, and saturation was obtained. Trustworthiness was established with the use of member checking, multiple-analyst triangulation, and data-source triangulation. RESULTS: Three themes emerged from the interviews: (1) motivation, (2) collaboration, and (3) resources. Participants were motivated to become involved because they saw the value of mentorship, and mentees desired guidance in their research. Participants believed that collaboration on a project contributed to a positive relationship, and they also desired additional program and professional resources to support novice faculty. CONCLUSIONS: Promising and established investigators should be encouraged to engage in mentoring relationships to facilitate mentees' research agendas and professional development. The NATA Foundation and athletic training profession may consider providing additional resources for novice faculty, such as training on effective mentoring; grant writing and other research-related tasks; and support for broader faculty responsibilities, such as teaching, service, and work-life balance.


Assuntos
Pesquisa Biomédica/educação , Tutoria , Mentores/educação , Esportes/educação , Adulto , Coleta de Dados , Docentes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Pesquisadores , Comportamento Social , Desenvolvimento de Pessoal , Estudantes
10.
Prev Med ; 95 Suppl: S17-S27, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27773710

RESUMO

Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives, we simulate the national implementation, impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school, afterschool and childcare settings. In 2016, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015-2025 including changes in mean MET-hours/day, intervention reach and cost per person, cost per MET-hour change, ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.14. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity, including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas.


Assuntos
Análise Custo-Benefício , Exercício , Promoção da Saúde/métodos , Obesidade Pediátrica/prevenção & controle , Criança , Cuidado da Criança , Política de Saúde , Humanos , Instituições Acadêmicas
11.
JAMA Pediatr ; 170(2): 155-62, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26641557

RESUMO

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.


Assuntos
Promoção da Saúde/métodos , Atividade Motora , Serviços de Saúde Escolar , Acelerometria , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Massachusetts , Instituições Acadêmicas
12.
Health Aff (Millwood) ; 34(11): 1932-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26526252

RESUMO

Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. We estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery. We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015-25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals. In our model, three of the seven interventions--excise tax, elimination of the tax deduction, and nutrition standards for food and beverages sold in schools outside of meals--saved more in health care costs than they cost to implement. Each of the three interventions prevented 129,000-576,000 cases of childhood obesity in 2025. Adolescent bariatric surgery had a negligible impact on obesity prevalence. Our results highlight the importance of primary prevention for policy makers aiming to reduce childhood obesity.


Assuntos
Promoção da Saúde/economia , Obesidade Pediátrica/prevenção & controle , Formulação de Políticas , Adolescente , Criança , Análise Custo-Benefício , Humanos , Estados Unidos
13.
Am J Prev Med ; 49(1): 102-11, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26094231

RESUMO

INTRODUCTION: The childhood obesity epidemic continues in the U.S., and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However, cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE). METHODS: Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015-2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness, implementation, and equity issues were reviewed. RESULTS: Population reach varied widely, and cost per BMI change ranged from $1.16 (TV AD) to $401 (Active PE). At 10 years, assuming maintenance of the intervention effect, three interventions would save net costs, with SSB and TV AD saving $55 and $38 for every dollar spent. The SSB intervention would avert disability-adjusted life years, and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue. CONCLUSIONS: The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity. Cost-effectiveness evaluations of childhood obesity interventions can provide decision makers with information demonstrating best value for the money.


Assuntos
Análise Custo-Benefício , Obesidade Pediátrica/economia , Obesidade Pediátrica/prevenção & controle , Adolescente , Adulto , Índice de Massa Corporal , Criança , Pré-Escolar , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Televisão , Estados Unidos , Adulto Jovem
14.
Am J Prev Med ; 49(1): 148-59, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26094235

RESUMO

INTRODUCTION: Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA, less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state "active PE" policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA. METHODS: A cohort model was used to simulate the impact of an active PE policy on physical activity, BMI, and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6-11 years. Data were analyzed in 2014. RESULTS: An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23, 2.51) and cost $70.7 million (95% UI=$51.1, $95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15, $2.15), and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148, $3,100). From 2015 to 2025, the policy would cost $235 million (95% UI=$170 million, $319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million, $153 million). CONCLUSIONS: Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.


Assuntos
Política de Saúde/legislação & jurisprudência , Educação Física e Treinamento/economia , Educação Física e Treinamento/estatística & dados numéricos , Serviços de Saúde Escolar/economia , Criança , Análise Custo-Benefício , Feminino , Humanos , Masculino , Obesidade/economia , Estados Unidos
15.
Int J Behav Nutr Phys Act ; 11: 145, 2014 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-25429898

RESUMO

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.


Assuntos
Comportamento Infantil , Atividade Motora , Estado Nutricional , Variações Dependentes do Observador , Bebidas , Criança , Ingestão de Líquidos , Feminino , Seguimentos , Frutas , Humanos , Modelos Lineares , Masculino , Avaliação Nutricional , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Projetos de Pesquisa , Instituições Acadêmicas , Comportamento Sedentário , Lanches , Televisão , Fatores de Tempo , Verduras , Jogos de Vídeo
16.
Am J Health Promot ; 28(3 Suppl): S54-64, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24380467

RESUMO

PURPOSE: To test effectiveness of Active School Day policy implementation on physical activity outcomes and estimate school-level implementation costs. DESIGN: The design of the study was quasi-experimental (pretest-posttest matched controls). SETTING: The study took place in six elementary schools with three matched pairs in Boston, Massachusetts, February to June 2011. SUBJECTS: Subjects were 455 consenting fourth- and fifth-grade students among 467 eligible. INTERVENTION: Active School Day policy implementation provided equipment, curricular materials, and training to physical educators and school wellness champions to promote 150 weekly minutes of quality physical education, recess, and physical activity integrated into classrooms. MEASURES: Accelerometer assessments of accumulated minutes and bouts of moderate, vigorous, and sedentary physical activity on 5 school days before and after implementation were used. Implementation costs were collected by record review and reported resource utilization. ANALYSIS: Analysis was conducted using multivariate mixed models estimated with repeated measures of daily physical activity, adjusted for student demographics and other confounding and design/clustering variables. RESULTS: Accelerometer data were provided by 201 intervention and 192 comparison students for an average of 4 days per period (84% response). During school time, students in intervention schools demonstrated greater increases in minutes per day of moderate-to-vigorous physical activity (3.9, 95% confidence interval [CI] 1.8-6.0; p < .001) and vigorous physical activity (1.8, 95% CI .7-3.0; p < .001), and greater decreases in minutes per day of sedentary time (-10.6, 95% CI -15.3- -5.8; p < .001) than controls. Ongoing annual implementation costs totaled $4,523/school ($14/student). CONCLUSION: Active School Day implementation increased student moderate-to-vigorous physical activity levels by 24% and decreased sedentary time during school at modest cost.


Assuntos
Promoção da Saúde/normas , Atividade Motora/fisiologia , Serviços de Saúde Escolar/normas , Acelerometria , Boston , Criança , Feminino , Implementação de Plano de Saúde/economia , Promoção da Saúde/economia , Promoção da Saúde/métodos , Humanos , Masculino , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Análise Multivariada , Avaliação de Programas e Projetos de Saúde/métodos , Serviços de Saúde Escolar/economia
17.
J Public Health Manag Pract ; 19(3 Suppl 1): S34-40, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23529053

RESUMO

School-based physical education (PE) and physical activity (PA) policies can improve PA levels of students and promote health. Studies of policy implementation, communication, monitoring, enforcement, and evaluation are lacking. To describe how states implement, communicate, monitor, enforce, and evaluate key school-based PE and PA policies, researchers interviewed 24 key informants from state-level organizations in 9 states, including representatives from state departments of health and education, state boards of education, and advocacy/professional organizations. These states educate 27% of the US student population. Key informants described their organizations' roles in addressing 14 school-based PE and PA state laws and regulations identified by the Bridging the Gap research program and the National Cancer Institute's Classification of Laws Associated with School Students (C.L.A.S.S.) system. On average, states had 4 of 14 school-based PE and PA laws and regulations, and more than one-half of respondents reported different policies in practice besides the "on the books" laws. Respondents more often reported roles implementing and communicating policies compared with monitoring, enforcing, and evaluating them. Implementation and communication strategies used included training, technical assistance, and written communication of policy to local education agency administrators and teachers. State-level organizations have varying roles in addressing school-based PE and PA policies. Opportunities exist to focus state-level efforts on compliance with existing laws and regulations and evaluation of their impact.


Assuntos
Política de Saúde , Atividade Motora , Educação Física e Treinamento/organização & administração , Instituições Acadêmicas/organização & administração , Criança , Comunicação , Coleta de Dados , Exercício , Humanos , Objetivos Organizacionais , Desenvolvimento de Programas , Governo Estadual , Estados Unidos
18.
Health Place ; 18(1): 16-23, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22243903

RESUMO

In 2005, the United States Congress authorized $612 million for use in implementing the US Safe Routes to School program to address physical inactivity, air quality, safety and traffic near schools. Each US state developed administrative practices to implement the program. Based on state-specific annual obligations, on average, states have obligated 44% of available funds. State project obligations were directly associated with programmatic factors, including broader adherence to federal agency administrative guidance objectives and the number of years for which the states obligated new projects and indirectly associated with student enrollment and state child poverty. Research and policy recommendations are discussed.


Assuntos
Financiamento Governamental/estatística & dados numéricos , Segurança/economia , Instituições Acadêmicas , Criança , Demografia , Geografia , Humanos , Áreas de Pobreza , Desenvolvimento de Programas , Política Pública/economia , População Rural , Instituições Acadêmicas/economia , Instituições Acadêmicas/organização & administração , Fatores Socioeconômicos , Transportes/economia , Estados Unidos , População Urbana
19.
Prev Chronic Dis ; 8(4): A72, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21672396

RESUMO

INTRODUCTION: Recreational and transportation infrastructure can promote physical activity among children and adolescents. The Play Across Boston community-based research project sought to estimate and compare playground renovation rates across Boston areas before and after a playground quality assessment, to describe changes in playground quality among a subset of parks, and to document features of local transportation infrastructure around parks. METHODS: We used an observational pretest-posttest design to estimate playground renovation rates among 103 city-operated parks. Renovation rates were calculated on the basis of annual city Parks Department capital budgets from fiscal years 1996 through 2007. We used the same design to describe changes between a 2000 to 2001 baseline assessment of playground quality and a 2007 follow-up measured via observation of a subsample of 18 low-scoring parks in disadvantaged areas. We used χ(2 ) analysis to compare percentages of playgrounds renovated across city areas before and after baseline assessment, logistic regression analysis to calculate odds ratios comparing renovation rates after baseline by city area, and paired t tests to compare playground quality at baseline and follow-up. RESULTS: Overall playground renovation rates before (29%) and after (34%) baseline assessment were similar. Parks scoring low on playground quality at baseline were renovated after baseline at a higher rate than high-scoring playgrounds. After accounting for baseline playground quality, parks in disadvantaged areas were renovated at a rate similar to those in other areas. Playground quality scores improved between baseline (mean, 38.3; 95% confidence interval, 35.3-41.3) and 2007 in a subsample of previously low-scoring parks in disadvantaged areas. CONCLUSION: The findings of the 2007 follow-up assessment indicate an equitable rate of playground renovation across city areas according to need.


Assuntos
Atividades Cotidianas , Acessibilidade Arquitetônica/normas , Jogos e Brinquedos , Gestão da Segurança/normas , Adolescente , Boston , Criança , Humanos , Estudos Retrospectivos
20.
Prev Chronic Dis ; 8(4): A74, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21672398

RESUMO

INTRODUCTION: Consumption of sugar-sweetened beverages has increased among youth in recent decades, accounting for approximately 13% of total calories consumed. The Boston Public Schools passed a policy restricting sale of sugar-sweetened beverages in Boston schools in June 2004. The objective of this study was to determine whether high school students' consumption of sugar-sweetened beverages declined after this new policy was implemented. METHODS: We conducted a quasi-experimental evaluation by using data on consumption of sugar-sweetened beverages by public high school students who participated in the Boston Youth Survey during February through April 2004 and February through April 2006 (N = 2,033). We compared the observed change with national trends by using data from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Regression methods were adjusted for student demographics. RESULTS: On average, Boston's public high school students reported daily consumption of 1.71 servings of sugar-sweetened beverages in 2004 and 1.38 servings in 2006. Regression analyses showed significant declines in consumption of soda (-0.16 servings), other sugar-sweetened beverages (-0.14 servings), and total sugar-sweetened beverages (-0.30 servings) between 2004 and 2006 (P < .001 for all). NHANES indicated no significant nationwide change in adolescents' consumption of sugar-sweetened beverages between 2003-2004 and 2005-2006. DISCUSSION: Data from Boston youth indicated significant reductions in consumption of sugar-sweetened beverages, which coincided with a policy change restricting sale of sugar-sweetened beverages in schools. Nationally, no evidence was found for change in consumption of sugar-sweetened beverages among same-aged youth, indicating that implementing policies that restrict the sale of sugar-sweetened beverages in schools may be a promising strategy to reduce adolescents' intake of unnecessary calories.


Assuntos
Bebidas Gaseificadas/estatística & dados numéricos , Sacarose na Dieta , Inquéritos Nutricionais/métodos , Obesidade/prevenção & controle , Formulação de Políticas , Instituições Acadêmicas/legislação & jurisprudência , Estudantes/estatística & dados numéricos , Adolescente , Bebidas , Boston/epidemiologia , Estudos Transversais , Distribuidores Automáticos de Alimentos/estatística & dados numéricos , Humanos , Incidência , Obesidade/epidemiologia , Obesidade/etiologia , Estudos Retrospectivos , Fatores de Risco , Edulcorantes , Ganho de Peso , Adulto Jovem
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