The goal of this clinical trial is to learn if "prescribing" afterschool care to children at risk for poor heart health later in life increases their physical activity and improves their heart health. 'Prescriptions' will be provided by pediatricians at participating Federally Qualified Health Centers and vouchers to existing afterschool programs (e.g., YMCA, Boys and Girls Clubs) will be provided by the research study. The main questions this study aims to answer are:
Can afterschool care providers and health care providers easily offer and keep using the voucher program?
Will families use the voucher? Do they go to afterschool care regularly, and do the families who use them represent a wide range or backgrounds?
Does going to afterschool care help children be more physical activity?
Does going to afterschool care improve heart health?
Researchers will compare two randomly assigned time periods; one semester when families get the voucher and one semester where they do not. They will look at whether use of the afterschool care voucher leads to more physical activity and improved heart health.
A child must be entering 1st-4th grade when recruited (i.e., 5-11 years old)
A child must have one or more cardiovascular risk factors as identified by a clinical care provider (i.e., obesity, hypertension, hyperglycemia, hyperlipidemia)
Attend an elementary school patterned with a participating afterschool program
Belong to a family at or below 250% of the federal poverty level
If the child does not meet the inclusion criteria for attending the participating afterschool programs (e.g., children that require specially trained staff to safely provide care),
If the child is pregnant
If it is unsafe for the child to participate in any of the study measures as determined by their clinical care provider (i.e., can not safely complete a 6-min walk test or finger stick)
Crossover
Voucher for Afterschool Care
BehavioralIntervention includes a voucher for afterschool care and enrollment assistance
Proportion of families who complete the study (RE-AIM: Individual Reach)
Study logs will be used to determine the proportion of families who complete the study. Participants are considered to have completed the study if they do not withdraw or drop out. A successful outcome will be considered if ≥80% of families in both groups are retained in the study and families in both sequences (AB/BA) are retained in the study at equivalent rates.
Proportion of children who attend afterschool care during intervention allocation (RE-AIM: Individual Implementation)
Attendance records provided by afterschool care programs will be used to determine the proportion of children who attend afterschool care during intervention allocation. Success will be defined as ≥80% of children attend afterschool care during intervention assignment.
Proportion of families that express a desire to continue attending afterschool care after the study ends (RE-AIM: Potential Maintenance)
Qualitative interviews with families at the school year will be used to determine families' interest in continuing to utilize afterschool care. A successful outcome will be defined as ≥80% of families in both groups express a desire to continue attending afterschool care after study ends.
Portion of clinics and clinicians that participate in prescribing afterschool care (REAIM: Setting-level Adoption)
Study records will be used to measure the proportion of clinics and clinicians that prescribe afterschool care to eligible children. A successful outcome will be defined as a referral rate of ≥60% eligible children.
Average proportion of afterschool time (14:30-19:00) spent in moderate-to-vigorous physical activity during the intervention condition compared to comparison condition
An AX3 Axivity placed on children's non-dominate wrist will be used to collect minutes of afterschool time (14:30-19:00) spent in moderate-to-vigorous physical activity (data processed using Hildebrand thresholds).
Average proportion of afterschool time spent sedentary during the intervention condition compared to comparison condition
An AX3 Axivity placed on children's non-dominate wrist will be used to collect minutes of afterschool time (14:30-19:00) spent sedentary (data processed using Hildebrand thresholds).
Average duration of daily screen use during the intervention condition compared to comparison condition
Parent-reported minutes spent using a screen (e.g., phone, computer, television) collected via electronic daily diaries will be used to calculate average duration of daily screen use.
Average sleep midpoint during the intervention condition compared to comparison condition
Parent-reported sleep log and Ax3 Axivity on non-dominate wrist will be used to calculate the average time halfway between sleep onset and offset (hh:mm).
Within-person change in BMI z-score during the intervention condition compared to comparison condition
Age-and-sex standardized calculation of body mass index for children using height measuared in cm and weight measured in kg.
Within-person change in percent fat mass during the intervention condition compared to comparison condition
Change in proportion of body fat (presented as a percent, initially measured in kg)
Within-person change in blood pressure percentile during the intervention condition compared to comparison condition
Change in age-and-sex specific blood pressure percentile (presented as a percentile, initially measured in mmHg).
Within-person change in total cholesterol during the intervention condition compared to comparison condition
Change in total cholesterol measured in mmol/L
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Augusta University
Lead sponsor
American Heart Association
Collaborator
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