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

Objectives-We examined associations between material resources and late-life declines in health.Correspondence should be sent to Dawn E. Alley, PhD, 660 West Redwood Street #221B, Baltimore, MD 21201, (dalley@epi.umaryland.edu). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link. Note. The contents are solely the responsibility of the authors and do not reflect the views of the study sponsors. The authors had no conflicts of interest to report. Human Participant ProtectionInstitutional review board approval was granted by the University of Pennsylvania. NIH Public Access Author ManuscriptAm J Public Health. Author manuscript; available in PMC 2010 January 12. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptMethods-We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N=15 441). Results-Disadvantages in health care (odds ratio [OR]=1.39; 95% confidence interval [CI]=1.23, 1.58), food (OR=1.69; 95% CI=1.29, 2.22), and housing (OR=1.20; 95% CI=1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR=1.43; 95% CI=1.29, 1.58) and food (OR=1.64; 95% CI=1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage.Conclusions-Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone.The past century has witnessed tremendous advances in medical care and technology, along with gains in life expectancy. Yet, these gains in life expectancy have been unequally distributed and have come to a halt for some disadvantaged groups of Americans. 1 Throughout the life course, poor persons fare worse than higher-income individuals on key health indicators. The poor have lower self-rated health, a higher prevalence of chronic conditions, and higher mortality. 2,3 Health disparities by race/ethnicity appear similarly entrenched. 3,4 The association between socioeconomic status (SES) and health continues into old age and is evident across the income gradient. 5, 6 Higher SES, measured in terms of education, income, or occupational prestige, is associated with decreased mortality among persons aged 65 years and older,7 whereas lower levels of education, income, and occupation contribute to higher levels of morbidity and mortal...