Healthy Youth Places: A Randomized Controlled Trial to Determine the Effectiveness of Facilitating Adult and Youth Leaders to Promote Physical Activity and Fruit and Vegetable Consumption in Middle Schools

Abstract

The Healthy Youth Places (HYP) intervention targeted increased fruit and vegetable consumption (FV) and physical activity (PA) through building the environmental change skills and efficacy of adults and youth. HYP included group training for adult school site leaders, environmental change skill curriculum, and youth-led FV and PA environment change teams. Sixteen schools were randomized to either implement the HYP program or not. Participants (N =1,582) were assessed on FV and PA and hypothesized HYP program mediators (e.g., proxy efficacy) at the end of sixth grade (baseline), seventh grade (Postintervention Year 1), and eighth grade (Postintervention Year 2). After intervention, HYP schools did not change in FV but did significantly change in PA compared to control schools. Proxy efficacy to influence school PA environments mediated the program effects. Building the skills and efficacy of adults and youth to lead school environmental change may be an effective method to promote youth PA.

Factors Influencing the Implementation of Organized Physical Activity and Fruit and Vegetable Snacks in the HOP'N After-School Obesity Prevention Program

“…However, our baseline data demonstrated that sites did not deliver the school district's menu as intended. 17 Furthermore, interviews corroborated baseline data, indicating that there was wide variability in snack offerings between after-school programs. In both years, all participants reported that the goal of FV being offered at every snack was not met.…”

“…The lead author developed themes for an initial coding guide based on the interview guide, knowledge (from transcribing the interviews), and was organized based on an ecologically informed social cognitive approach that informed the HOP'N after-school program. [15][16][17] A social ecological approach 20 allowed coders to illustrate staff (individual) and organizational influences on implementation. After the initial development of the coding guide, four experts reviewed it, and the guide went through several revisions.…”

“…15 Consistent with other research, a continuous quality improvement model for training the after-school staff appeared to be an important facilitator for implementation. 17,21,22 Afterschool staff typically lack formal training in healthy eating and PA, so providing a hands-on training was effective for successful implementation. Furthermore, it is likely that one-time trainings are not effective for several reasons.…”

“…Trainings were modelled after the Healthy Places "performance community hub" where participants were encouraged to share and problem solve their implementation challenges, 16,17 and received hands-one training on how to implement the HOP'N quality elements.…”

“…The HOP'N model provides multilevel intervention framework for obesity prevention that shows promise for wide spread dissemination. 16,17 Second, governmental agencies and foundations that support after-school programs need to include implementation of daily PA and a healthy snack as a required quality element for funding. The American Dietetic Association, School Nutrition Association and Society for Nutrition Education developed a position that coordinated school health programs must include comprehensive, integrated nutrition services.…”