title: Improving nutrition and physical activity policies in afterschool programs: results from a group-randomized controlled trial.
abstract: 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.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA. Electronic address: ekenney@hsph.harvard.edu.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Kenney
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Giles
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA.
authors.forename: Madeleine E
authors.initials: ME
authors.lastname: deBlois
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA.
authors.forename: Sherene
authors.initials: S
authors.lastname: Chinfatt
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA.
authors.forename: Angie L
authors.initials: AL
authors.lastname: Cradock
mesh_terms: D001900:Boston; D057191:Capacity Building; D002648:Child; D015444:Exercise; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D018673:Nutrition Policy; D011050:Policy Making; D012572:School Health Services / Q000592:standards
keywords: Capacity building; Child health; Health policy; Nutrition policy; Physical activity; Program development; Program evaluation; Randomized controlled trial; School health promotion