[Recommended] HMP 501 Evaluation of The Fit 2 Play Park Program Questions

SOLUTION AT Academic Writers Bay Lab Protocol 9 HMP 501 Evaluation of the “FIT 2 PLAY” Park program Directions: Please work with a partner (hand in one report per group). Read the article in Canvas (under Lab 8) about the Effects of a Park-Based After-School Program on Participant Obesity-Related Health Outcomes by Dr. Sarah Messiah. Then write answers to the following questions: 1. What question(s) (the hypothesis) was the study seeking to answer? Was this a peerreviewed article? (if you don’t know, please see the Reference Librarians in Dimond Library). 2. Describe the population being studied in terms of size, gender, race/ethnicity, and age. 3. What health behaviors (exposure(s)) was examined by the study? How was this exposure measured? 4. What outcome(s) of interest were studied by this study? How were they measured? 5. What was the observed relationship(s) between the exposure and the outcome(s)? What measures of association were used? How strong was the relationship and in what direction (e.g. positive, negative, none)? 6. What type of study design was used to examine the relationship between the exposure and the outcome(s) of interest? Discuss the strengths and imitation(s) of this type of study design and their impact on being able to make definitive conclusions based on this study. 7. What conclusions did the researchers make based on the outcomes observed? If you were asked by a reporter from your local newspaper to comment about the conclusion(s) made by study authors, what would you say? 8. Write 3 important implications for public health (or medical) practice and/or policy based on the results of this article. T H E Q ^ ^ C I E N C E O F L I F E S T Y L E C H A N G E Fitness; Youth Effect of a Park-Based After-School Program on Participant Obesity-Related Health Outcomes Sarah E. Messiah, PhD, MPH; Allison Diego, MPA; Jack Kardys, MSM; Kevin Kirwin, MPA; Eric Hanson, MPA; Renae Nottage, BA; Shawn Ramirez, BS; Kristopher L. Arheart, EdD Abstract Purpose. The objective of this study was to examine the effect o f a structured after-school program housed in a large county parks system on participant health and wellness outcomes. Design. Longitudinal cohort study over one school year (fall 2011-spring 2012). Setting. A total of 23 county parks in Florida. Subjects. Children ages 5 to 16 (N = 349, 55 % non-Hispanic black, 40% Hispanic, mean age 8. 9 years). Intervention. A n after-school program called Fit-2-Play that integrates daily standardized physical activity and health and wellness education components. Measures. Preintervention (August/September 2011) and postintervention (May/June 2012) anthropometric, systolic/diastolic blood pressure, fitness, and health and wellness knowledge measurements were collected. Analysis. Comparison o f pre-post outcome measure means were assessed via general linear mixed models fo r normal-weight (body mass index [BMI] 85th percentile fo r age and sex) participants. Results. The overweight/obese group significantly decreased their mean (1) B M I z score (2.0 to 1.8, p 95% ) throughout the school year. Several of the larger parks provide daily transportation from a num ber of surrounding schools to the program . Analysis Means and standard deviations were generated for all continuous data (age, an th ropom etric m easures), and categorical data (gender, ethnicity) are rep o rted as frequencies and per­ centages. All outcom e m easures were dichotom ized by weight status: nor­ mal-weight (BMI 85th percentile for age and sex ).13 Normally distrib­ u ted outcom e variables, including BMI z score, hip circum ference, waist circum ference, m idarm circum fer­ ence, waist-hip ratio, bicep skinfold, triceps skinfold, subscapular skinfold, suprailiac skinfold, sum o f skinfold thicknesses, sit and reach test, 400-m ru n , systolic blood pressure, diastolic blood pressure, and the health and March/April 2015, Vol. 29, No. 4 219 Table 1 Baseline Characteristics of 349 Fit-2-Play After-School Program Participants by Normal or Overweight/Obese Group Status, 2011-2012 School Year* Entire Sample (N = 349) N (%) Sex Boys Girls Ethnicity Hispanic Non-Hispanic black or African American Non-Hispanic White Other Age, yr Anthropometric Measurements§ Weight, kg Weight, z score Weight, percentile Height, cm Height, z score Height, percentile BMI, kg/m2 BMI z score BMI percentile Waist circumference, cm Hip circumference, cm Waist-to-hip ratio, % Waist-to-height ratio, % Mid arm circumference, cm Biceps skinfold, mm Triceps skinfold, mm Subscapular skinfold, mm Suprailiac skinfoid, mm Sum of thicknesses of four skinfolds, mm Overweight (85th 95th BMI percentile) Mean (SD) Range (Minimum-Maximum) Normal Weightf (N = 210) N (%) Mean (SD) Overweight/ 0 beset (N = 139) N (%) 173 (50) 176 (50) 118 (56) 92 (44) 58 (42) 81 (58) 139 (40) 183 (55) 14(4) 3 (1 ) 74 (35) 125 (60) 10(5) 65 (47) 68 (49) 4 (3 ) 2 (1 ) 1 (0) 8.9 (2.1) 36.2 0.1 53.9 133.2 0.7 66.5 19.8 0.8 70.9 63.1 74.1 88.0 47.3 20.7 13.3 18.8 12.7 13.9 54.7 94 (27) 45 (13) (14.5) (1.1) (30.5) (13.4) (1.2) (29.3) (5.2) (1.0) (25.8) (12.4) (12.9) (45.2) (7.5) (5.7) (7.2) (7.9) (7.9) (8.7) (25.7) (5.1 to 16.6) (15.5 to 100.4) (-3 .7 to 3.3) (0.0 to 100.0) (103.5 to 166.1) (-2 .9 to 3.6) (0.2 to 100.0) (14.0 to 47.4) (-1 .4 to 3.0) (8.1 to 99.9) (47.1 to 114.6) (8.0 to 116.7) (65.4 to 106.3) (37.2 to 74.9) (5.3 to 82.4) (2.0 to 48.0) (5.0 to 49.3) (4.0 to 55.7) (3.3 to 41.7) (16.0 to 146.3) 8.8 (2.0) 29.3 -0.1 47.4 131.2 0.0 49.4 16.6 0.1 54.5 56.1 68.5 85.2 42.9 18.6 9.6 15.3 9.1 9.7 43.6 (8.2) (1.1) (29.2) (13.5) (0.8) (24.8) (1.5) (0.6) (20.5) (5.4) (8.6) (50.2) (2.7) (5.4) (3.9) (5.3) (4.0) (4.6) (15.2) Mean (SD) 9.1 (2.1) 46.6 0.5 63.8 136.2 1.8 92.3 24.5 1.9 95.6 73.6 82.6 92.2 54.0 23.8 19.2 25.0 19.2 21.6 78.3 – – – – – – (15.8) (1.1) (29.8) (12.7) (0.8) (11.1) (5.3) (0.5) (4.2) (12.6) (13.7) (35.9) (7.5) (4.6) (7.4) (7.8) (9.1) (9.2) (27.7) * BMI indicates body mass index. t BMI 85th percentile for age and sex.14 § Adjusted for age, sex, ethnicity, and park. wellness com posite scores, were ana­ lyzed with a general linear m ixed m odel to gen erate m eans an d stan­ dard errors. O utcom es with a binary distribution, including systolic prehy­ pertension, diastolic prehypertension, systolic hypertension, diastolic hyper­ tension, systolic norm o ten sio n , dia­ stolic n orm otension, an d correct responses for th e h ealth an d wellness knowledge items, are p resen ted as percentage an d stan d ard error. Data with a Poisson distribution, including sit-ups, push-ups, an d the PACER test, are p resen ted as m eans and standard 220 American Journal of Health Promotion errors. Both types o f data are analyzed with a generalized linear m ixed m od­ el. All m odels included fixed effects for BMI group, time, and the interac­ tion o f group and time. W hen appro­ priate, covariates for age, sex, and ethnicity were included to control for th eir possibly confounding effects. For exam ple, all physical fitness variables were adjusted for age, sex, ethnicity, an d park location in the analysis. A ran d om in tercep t was included with parks as a subject to account for betw een-park variation, and a n o th er random effect is included for the repeated-m easure time with partici­ pants nested within parks to account for the nesting o f participants within parks. Contrasts were used to d eter­ m ine the significance o f the change over tim e in each group and the significance o f the difference betw een groups in the changes. T he link function for binary data was the logit, and for Poisson data was the natural logarithm . T he .05 significance level d eterm in ed statistical significance. SAS 9.3 (SAS Institute, Inc., Cary, N orth Carolina) was used for all analyses. March/April 2015, Vol. 29, No. 4 Table 2 Change in Anthropometric Measurements Over the 10-Month 2011-2012 School Year by Weight Status Group Overweight and Obese (N = 139) Normal Weight (N = 210)t Primary end point BMI z score Secondary end pointsll Hip circumference, cm Waist circumference, cm Midarm circumference, cm Waist-to-hip ratio Waist-to-height ratio Biceps skinfold, mm Triceps skinfold, mm Subscapular skinfold, mm Suprailiac skinfold, mm Sum of thicknesses of four skinfolds, mm Baseline Mean (SE) 10-mo Mean (SE) Change (95% Cl)§ P Baseline Mean (SE) 10-mo Mean (SE) 0.2 (0.1) 0.3 (0.1) -0.1 (-0.1 to 0.0) 0.19 2.0 (0.1) 1.8 (0.1) -0 .9 0.6 0.4 6.1 0.5 0.0 1.2 0.7 0.9 0.28 0.14 0.33 0.22 0.13 0.98 0.01 0.05 0.03 82.3 73.5 24.1 95.5 53.7 18.4 24.6 19.4 21.6 0.01 80.1 (4.2) 69.3 57.1 19.0 88.5 42.9 9.1 14.6 8.7 9.2 (1.4) (1.3) (0.7) (6.1) (0.9) (1.0) (1.2) (1.1) (1.3) 41.6 (4.0) 70.1 56.5 18.7 82.4 42.4 9.1 13.4 7.9 8.3 (1.4) (1.4) (0.7) (6.3) (0.9) (1.0) (1.2) (1.1) (1.3) 38.6 (4.0) (-2 .5 to 0.7) (-0 .2 to 1.5) (-0 .4 to 1.1) (—3.9 to 16.1) (-0 .2 to 1.1) (-0 .8 to 0.7) (0.3 to 2.1) (0.0 to 1.4) (0.1 to 1.8) 3.0 (0.7 to 5.3) (1.5) (1.3) (0.7) (6.4) (0.9) (1.1) (1.2) (1.2) (1.3) 83.6 73.5 24.2 97.8 53.5 17.9 24.1 17.5 21.2 (1.5) (1.4) (0.7) (6.8) (1.0) (1.1) (1.2) (1.1) (1.3) 77.2 (4.2) Change (95% Cl) 0.2 (0.1 to 0.3) -1 .4 0.0 -0.1 -2 .2 0.3 0.4 0.5 1.9 0.4 (-3 .4 to 0.6) (—1.0 to 1.1) (-1.1 to 0.8) (-1 4 .5 to 10.1) (-0 .5 to 1.0) (-0 .5 to 1.4) (-0 .6 to 1.7) (0.9 to 2.9) (-0 .7 to 1.5) 2.9 (-0 .4 to 6.2) P 8 5 th pe rc e n tile fo r age and s e x .14 § C h a n g e re p rese nts d iffe re n c e be tw ee n ba se lin e an d 10-m o nth m ean pe rcentage. II A d ju s te d fo r age, sex, e th nicity, and park. H P re h yp e rte n sio n is d e fin e d if e ith e r s y s to lic o r d ia s to lic v a lu e s are a b o ve th e 90th p e rcen tile, a d ju ste d fo r age, sex, and h e ig h t.15 # H yp e rte n sio n is d e fin e d if e ith e r s y s to lic o r d ia s to lic v a lu e s are a b o ve th e 95th p e rcen tile, a d ju ste d fo r age, sex, and h e ig h t.15 resource for families and health care professionals. T he significant decreases in BMI z score in the overw eight/obese group and the stability o f BMI z scores shown in the normal-weight group coupled with significant decreases in skinfold thicknesses in both groups over the school year are particularly encourag­ ing. First, if norm al childhood growth trajectories such as those shown here in the normal-weight group can be m aintained, especially during critical years such as those w hen adiposity rebo u n d (period o f increasing BMI after the early childhood nadir) should occur (ages 5-7) the risk o f later onset overweight and obesity decreases. Spe­ cifically, adiposity reb o u n d has been found to predict both adult BMI37,38 and adult obesity,39-11 and the earlier the overweight occurs, the h ig h er the chance for obesity later in life. Second, although some have criti­ cized using only BMI to m easure improved health in this age group,42 others have suggested that simply 222 A m e ric a n Jo u rn a l o f H e alth P rom o tion conducting BMI measures indepen­ dently o f o ther intervention com po­ nents constitutes an effective public health obesity prevention strategy by drawing the attention and awareness of the public, schools, and parents to the results.43 Indeed, BMI for age has been shown to be a m ore valid m easurem ent tool than others (R ohrer index) for predicting overweight in children.44 Additionally, skinfold thickness m ea­ surem ents may n o t be practical for some community-based interventions because of lack of availability o f pro­ fessional staff resources to support a train-the-trainer m odel for m easure­ m en t oversight like the one here, as well as time constraints, experience of the staff, or scope of the assessment. O u r next key findings show that although n o t statistically significant, several strength (sit-ups and push-ups) and cardiovascular physical fitness tests (PACER test, significant im provem ent) im proved for both weight groups, and the percentage o f participants with norm al systolic blood pressure signifi­ cantly increased in the overweight group. T here are em erging data to suggest th at cardiovascular fitness may attenuate some o f the factors contrib­ uting to metabolic syndrome in ado­ lescence in d ep en d en t o f excess weight.45,46 Adult studies have shown that higher levels o f fitness provide greater protection against early m or­ bidity and m ortality attributable to cardiovascular disease.4′ T he findings here suggest that lifestyle interventions such as Fit-2-Play that incorporate daily physical activity can be the cornerstone o f both preventing and treating child­ hood obesity while simultaneously im­ proving cardiovascular health outcom es as children grow. The after-school setting in particular can provide an alternative setting for obesity prevention and wellness activi­ ties with potential for significant im­ pact (8 m illion children attend after­ school program s in the U nited States12). Yet this setting, and the park setting in particular, has rem ained relatively understudied as an alterna- M arch /A p ril 2015, V ol. 29, No. 4 Table 4 Change in Health and Wellness Knowledge Over the 10-Month 2011-2012 School Year by Weight Status Group* Normal Weight (N = 210)4: Baseline % Correct, Mean (SE) Test ItemsA/ariablest Being physically active is only for athletes It is healthy to eat fruits and vegetables at every meal Fruits and vegetables are full of nutrients and vitamins It is good to exercise an hour a day Watch TV instead of exercise I should limit the amount of TV How does being physically active help your body Identify the activity that is most physically active Identify the bad drink Overall composite 84.6 80.1 84.1 80.8 82.1 74.1 71.1 81.6 67.0 6.8 (3.6) (4.5) (4.7) (5.2) (5.2) (4.9) (6.0) (4.4) (6.4) (0.1) 10-mo % Correct, Mean (SE) 90.2 90.1 92.7 87.3 85.4 80.0 83.2 88.6 81.4 7.6 (2.7) (2.9) (2.7) (3.9) (4.5) (4,2) (4.3) (3.2) (4.6) (0.1) Overweight/Obese (N = 139)§ Change, %ll P -5 .6 -1 0 .0 -8 .6 -6 .5 -3 .4 -5 .9 -12.1 -7 .0 -1 4 .4 -0 .8 0.10 0.01 0.01 0.10 0.40 0.19 CLICK HERE TO GET A PROFESSIONAL WRITER TO WORK ON THIS PAPER AND OTHER SIMILAR PAPERS CLICK THE BUTTON TO MAKE YOUR ORDER