title: Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs.
abstract: The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness.
  
  
  
  (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards.
  
  
  
  HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework ( Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately.
  
  
  
  Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p ≤ .001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p ≤ .01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64).
  
  
  
  Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.
authors.affiliation: 1 University of South Carolina, Columbia, SC, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Weaver
authors.affiliation: 2 Wake Forest University, Winston-Salem, NC, USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Moore
authors.affiliation: 1 University of South Carolina, Columbia, SC, USA.
authors.forename: Brie
authors.initials: B
authors.lastname: Turner-McGrievy
authors.affiliation: 1 University of South Carolina, Columbia, SC, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Saunders
authors.affiliation: 3 University of Kentucky, Lexington, KY, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Beighle
authors.affiliation: 1 University of South Carolina, Columbia, SC, USA.
authors.forename: M Mahmud
authors.initials: MM
authors.lastname: Khan
authors.affiliation: 1 University of South Carolina, Columbia, SC, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Chandler
authors.affiliation: 1 University of South Carolina, Columbia, SC, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Brazendale
authors.affiliation: 1 University of South Carolina, Columbia, SC, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Randell
authors.affiliation: 1 University of South Carolina, Columbia, SC, USA.
authors.forename: Collin
authors.initials: C
authors.lastname: Webster
authors.affiliation: 1 University of South Carolina, Columbia, SC, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Beets
mesh_terms: D061725:Accelerometry / Q000379:methods; D002648:Child; D002656:Child Day Care Centers / Q000458:organization & administration; D000072001:Diet, Healthy / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005260:Female; D005638:Fruit; D006284:Health Plan Implementation / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012574:Schools / Q000458:organization & administration*; D014675:Vegetables
keywords: child health; health policy; out of school time; physical activity/exercise; youth