Impact of an Organizational Intervention Designed to Improve Snack and Beverage Quality in YMCA After-School Programs

摘要

Objectives. We evaluated the quality of snacks and beverages served at YMCA after-school programs before and after the programs' participation in a YMCA Learning Collaborative. Methods. We collected data on the types and brands of snacks and beverages (including fresh fruits and vegetables, whole grains, foods with trans fats, water, and sugar-sweetened beverages) served daily during 3 different time periods spanning 14 months in total, and the components of the healthy eating standards. We compared snack and beverage quality before and after the intervention. Results. Weekly servings of fresh fruits and vegetables (1.3 vs 3.9; P = .02) and weekly servings of fruits and vegetables as a whole (1.9 vs 5.2; P = .009) increased from baseline to postintervention; weekly servings of desserts (1.3 vs 0.5; P = .049), foods with added sugars (3.9 vs 2.4; P = .03), and foods containing trans fats (2.6 vs 0.7; P = .01) decreased. After the intervention, all YMCAs offered water daily, and none served sugar-sweetened beverages. The percentage of calories from fruits and vegetables significantly increased after the intervention, whereas the percentage of calories from foods containing trans fats and added sugars decreased. Conclusions. A learning collaborative can disseminate healthy eating standards among participating organizations and facilitate improvements in the quality of after-school snacks and beverages. Although after-school programs can influence children's food intake and physical activity, they have been underused in efforts to improve dietary patterns and reduce obesity risk. After-school programs serve approximately 6.5 million children in the United States each year, 1 a disproportionate number of whom are from low-income, Hispanic, or African American households, 2 which are at higher than average risk for obesity. 3 Evidence suggests that children's dietary patterns contribute to energy imbalances. Approximately 17% of US children aged 6 to 11 years are obese (i.e., above the 95th percentile with respect to body mass index [BMI; defined as weight in kilograms divided by height in meters squared]). 4 Recent research indicates that excess weight gain may reflect daily sustained energy imbalances of 110 to 165 calories among children and youths. 5 In addition, children's dietary quality is suboptimal, characterized by inadequate consumption of fruits and vegetables 6 , 7 and excessive consumption of sugar-sweetened beverages, 8 – 10 sweets, sweetened grains, 9 and trans fats. 11 Increasing children's fruit, vegetable, and fiber consumption and decreasing their intake of sugar-sweetened beverages, low-nutrient-density foods, and trans fat would improve their dietary quality and help protect them against obesity and chronic disease risk. 12 – 18 After-school programs offer approximately 3 hours of programming each day and typically provide snacks and drinks on site. Because snacks represent 24% of children's total daily energy intake 19 and childhood dietary habits often carry over into adolescence and adulthood, 20 – 23 the quality and types of snacks served at after-school programs deserve serious attention. Very few descriptive studies, however, have focused on the quality or types of snacks and beverages served at after-school programs. 24 Although 4 studies, to our knowledge, have tested environmental after-school interventions, these studies did not specify what foods were served. 25 – 28 The results of a fifth policy intervention study showed improvements in fruit but not vegetable offerings. 29 We evaluated evidence of improvements in the quality of snacks and beverages served in 7 YMCA after-school programs participating in an organizational change intervention.