The impact of summer programming on the obesogenic behaviors of children: behavioral outcomes from a quasi-experimental pilot trial

Abstract

Background: Children from low-income families experience accelerated BMI gain and learning loss during summer. Healthy Summer Learners (HSL) addresses accelerated BMI gain and academic learning loss during summer by providing academic-and health-focused programming. This manuscript reports the effects of HSL on underlying obesogenic behaviors (i.e., physical activity, screen time, sleep, diet) that lead to accelerated summer BMI gain, a necessary first step to informing a future randomized controlled trial of HSL. Methods: In the summer of 2018 and 2019 using a quasi-experimental study design, 180 children (90 per summer, 7.9 years [SD = 1.0], 94% non-Hispanic Black, 40% male) at two schools (i.e., one per summer) who were struggling academically (25-75% on a standardized reading test) were provided a free, school-based 6-week health-and academic-focused summer program (i.e., HSL, n = 60), a 4-to 6-week academic-focused summer program (i.e., 21st Century Summer Learning program (21C), n = 60), or no summer program (n = 60). Children wore the Fitbit Charge 2™ over a 10-week period during the summers (June-Aug) of 2018-2019. Differences within (within child days attend vs. not attend) and between (differences between groups attend vs. not attend) were evaluated using mixed effects linear regression. Results: Regression estimates indicated that, on days attending, HSL children experienced a greater reduction in sedentary minutes (− 58.6 [95% CI = − 92.7, − 24.4]) and a greater increase in moderate-to-vigorous physical activity (MVPA) (36.2 [95% CI = 25.1, 47.3]) and steps (2799.2 [95% CI = 2114.2, 3484.2]) compared to 21C children. However, both HSL and 21C children were more active (i.e., greater MVPA, total steps) and less sedentary (i.e., less sedentary minutes and total screen time) and displayed better sleeping patterns (i.e., earlier and less variability in sleep onset and offset) on days they attended than children in the control.

Obesogenic Behaviors of Rural Children on School and Nonschool Days

“…Finally, when exclusively nonschool days were explored (i.e., nonschool weekdays or weekend days), rural children in this study attending a day camp, program, or sports practice on a nonschool day were more active (+23 minutes MVPA), less sedentary (-55 minutes/day), and engaged in less screen time (-75 minutes/day) compared with days they did not attend. This finding lends support to the growing body of evidence showing other ''school-like'' environments-such as day camps and programs 19,20,22,53 can have a positive impact on obesogenic behaviors of all children. These findings highlight a potential mechanism through which future interventions can be centered on; implementing structured programming on days or times of the year when rural children may be removed from consistent school-like environments.…”

“…Exploring behaviors on different days is of paramount importance given the evidence that obesogenic behaviors are more favorable (e.g., increased physical activity and reduced sedentary time/ screen time) in urban-dwelling children during school days or when children are in a ''school-like'' environment (e.g., day camp/program) compared with days they are not. [17][18][19][20][21][22] There is a need for additional studies of rural children's obesogenic behaviors, specifically research exploring behaviors across different days to inform future intervention strategies targeting rural children and families. The purpose of this study was to provide preliminary evidence of rural children's physical activity, sedentary time, sleep, diet and screen time during school days, nonschool weekdays, and weekend days.…”

Differences in ​the proportion of children meeting behavior guidelines ​between summer ​and school by socioeconomic status and race

“…The findings of the current study align with past studies that have found children are less active and engage in more screen‐time during periods of less structure (i.e., summer, weekends, or holidays). 20 , 28 , 33 , 42 , 43 , 44 , 45 Given that children who are Black and children from low‐income households experience more dramatic accelerations in BMI during the summer than their White and middle‐to‐high‐income counterparts, 31 the finding in this study that the summer negatively impacted the MVPA of children who are Black and eligible for FRPL to a greater degree than children who are White or not eligible for FRPL is important. This finding suggests a specific behavioral mechanism, decreased MVPA, that may partially explain the greater increases in BMI gain during the summer for children who are Black and eligible for FRPL.…”

“…The findings of the current study align with past studies that have found children are less active and engage in more screen-time during periods of less structure (i.e., summer, weekends, or holidays). 20,28,33,[42][43][44][45] Given that children who are Black and children from low-income households experience more dramatic accelerations in BMI during the summer than their White and middle-to-highincome counterparts, 31 days and during the summer when compared to the school year. 21,33,48,49 However, these same studies show that children's bedtimes and wake times shift later and become more variable during the summer.…”

Children’s moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis

“…Since its publication in 2017, the SDH has informed several studies that have purposefully compared obesogenic behaviors during structured versus less-structured times, such as summer versus school months [9,10], summer camp/program days versus non camp/program days [11][12][13], and school-days versus non-school days [14][15][16]. Together, these studies align with the notion that children's obesogenic behaviors are more favorable on structured versus less-structured days, yet are limited by small sample sizes and specific population demographics, making it challenging to generalize findings.…”