title: Healthy kids out of school: using mixed methods to develop principles for promoting healthy eating and physical activity in out-of-school settings in the United States.
abstract: BACKGROUND
  Widespread practices supporting availability of healthful foods, beverages, and physical activity in out-of-school-time (OST) settings would further obesity prevention efforts. The objective of this article was to describe principles to guide policy development in support of healthy eating and physical activity practices in out-of-school settings to promote obesity prevention.
  
  
  METHODS
  The Institute of Medicine's L.E.A.D. framework (Locate Evidence, Evaluate it, Assemble it, and Inform Decisions) was used to identify practices relevant to children's healthful eating in most OST settings: 1) locate and evaluate information from a national survey of children's perceptions of healthful-food access; published research, reports, policies and guidelines; and roundtables with OST organizations' administrators; 2) assemble information to prioritize actionable practices; and 3) inform programmatic direction.
  
  
  RESULTS
  Three evidence-informed guiding principles for short-duration OST resulted: 1) drink right: choose water instead of sugar-sweetened beverages; 2) move more: boost movement and physical activity in all programs; and 3) snack smart: fuel up on fruits and vegetables.
  
  
  CONCLUSIONS
  Healthy Kids Out of School was launched to support the dissemination and implementation of these guiding principles in short-duration OST settings, complementing efforts in other OST settings to shift norms around eating and physical activity.
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111. E-mail: sarah.sliwa@tufts.edu.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Sliwa
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Shanti
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Tufts University, Boston, Massachusetts, and George Washington University, Washington, DC.
authors.forename: William H
authors.initials: WH
authors.lastname: Dietz
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Dolan
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Miriam E
authors.initials: ME
authors.lastname: Nelson
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Molly B
authors.initials: MB
authors.lastname: Newman
authors.affiliation: Tufts University, Boston, Massachusetts, and Global Policy Solutions, Washington DC.
authors.forename: Maya
authors.initials: M
authors.lastname: Rockeymoore
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Christina D
authors.initials: CD
authors.lastname: Economos
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D019422:Dietary Sucrose / Q000008:administration & dosage; D005069:Evaluation Studies as Topic; D055317:Evidence-Based Practice / Q000592:standards; D005247:Feeding Behavior / Q000523:psychology*; D017144:Focus Groups; D005638:Fruit; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods* / Q000592:standards; D006801:Humans; D009043:Motor Activity; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D009518:New York; D018673:Nutrition Policy; D009749:Nutrition Surveys; D064427:Nutritive Sweeteners / Q000008:administration & dosage; D009765:Obesity / Q000517:prevention & control; D012574:Schools; D014481:United States; D014675:Vegetables
chemical_list: D019422:Dietary Sucrose; D064427:Nutritive Sweeteners