Promoting Physical Activity and Healthy Nutrition in Afterschool Settings: Strategies for Program Leaders and Policymakers
August 2006

The Afterschool Investments Project

The Child Care and Development Fund (CCDF) provides federal resources for child care that support both direct services and quality enhancements. The U.S. Department of Health and Human Services’ Child Care Bureau awards CCDF grants to states, territories, and tribes. With nearly half of the children receiving services being of school or kindergarten age, CCDF provides significant funding for afterschool care in a variety of settings. The majority of CCDF dollars are used to provide subsidies to eligible low-income children under age 13. A portion of CCDF funding is also used for quality improvement initiatives, such as professional development and technical assistance, with the goal of building the capacity of states to deliver quality services including programs before and afterschool, during summers, and on school holidays.

To support state efforts to provide quality afterschool opportunities, the Child Care Bureau awarded a technical assistance contract on out-of-school time to The Finance Project and its partner, The National Governors Association Center for Best Practices. The Afterschool Investments project provides technical assistance to Child Care and Development Fund grantees and other state and local leaders who support afterschool efforts. The goals of the project include:

• Identifying ways that states and communities are using Child Care and Development Fund (CCDF) subsidy and quality dollars to support out-of-school time programs, and sharing these practices and approaches with other states;
  
• Identifying administrative and implementation issues related to CCDF investments in out-of-school time programs, and providing information and context (about barriers, problems, opportunities) as well as practical tools that will help CCDF administrators make decisions; and
  
• Identifying other major programs and sectors that are potential partners for CCDF in supporting out-of-school time programs, and providing models, strategies, and tools for coordination with other programs and sectors.

To meet these goals, the Afterschool Investments Project:

• Develops state profiles of afterschool resources, policies, and issues;
  
• Creates tools and materials to support the development and sustainability of afterschool efforts; and
  
• Provides technical assistance at meetings and conferences around building state collaborations for afterschool.

For more information about the project or to submit a request for technical assistance or information, contact The Finance Project at (202) 587-1000 or by email at afterschool@financeproject.org, or visit http://nccic.acf.hhs.gov/afterschool

Table of Contents

Introduction

Afterschool Program Elements that Promote Healthy Lifestyles

Developing Policies to Provide Support and Build Capacity for Afterschool Programs

Finding Resources and Developing Creative Financing Strategies

Conclusion

Acknowledgments

Appendix

Introduction

Childhood obesity has emerged as a public health problem of formidable proportions. But amidst the startling statistics there are stories of creative strategies communities throughout the county that are implementing to reverse childhood obesity trends by promoting healthy lifestyles for children and youth. This strategy brief outlines the important role that afterschool programs can play in efforts to prevent childhood obesity. It includes ideas for incorporating nutrition and physical activity into afterschool programming, strategies for financing these efforts, and examples of policies that can support and encourage the afterschool community’s endeavors to steer children toward healthy choices.

How Bad Is the Childhood Obesity Problem?

Nationwide, an estimated 9 million children and adolescents ages 6 to 19—15 percent of the nation’s children—are considered obese.¹ For children aged 6 to 11, the prevalence of obesity has more than tripled since the 1970s.²

Source: Adapted from Preventing Childhood Obesity: Health in the Balance, Institute of Medicine, 2005. Obesity is defined as BMI at or above age- and gender-specific 95th percentile cutoff points.

What's at Stake for Overweight Children?

Obese children are not only at risk for serious health problems in adulthood, they also experience adverse effects on their physical and mental health in childhood. Many develop multiple risk factors for heart disease while still adolescents. Once rare in children, incidence of type 2 diabetes— formerly referred to as "adult onset" diabetes and a consequence of obesity—has risen tenfold and now accounts for over a third of new cases of diabetes in adolescents.³ Overweight children are also more likely to be teased and ostracized, which can have devastating consequences on self-confidence, placing them at risk for depression.⁴ Longer-term impacts on mortality and health care costs are also staggering. This generation of children may be the first in centuries to have a shorter life span than their parents, and hospital costs related to childhood obesity have quadrupled in the past 25 years to almost $127 million in 1999.⁵

The data shown in these maps were collected through Center for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data through a series of monthly telephone interviews with U.S. adults.

Why Has Obesity Become So Prevalent in Children and Adolescents?

Many factors—including genetics, poor diets, sedentary lifestyles and suburban sprawl—have been blamed for the rapid escalation in numbers of overweight children.⁶ While no single factor is responsible for the entire increase, each has contributed to an environment in which children participate in fewer physical activities and practice poor dietary habits.

Lack of physical activity: Schools strapped for funding and seeking to maximize instructional time have eliminated or reduced many physical education and athletic programs in the past decade; only 8 percent of elementary schools and 6.4 percent of middle schools provide daily physical education during the school year.⁷ Today’s children rarely ride bicycles or walk to school, often because schools are located on the periphery of the community or require crossing busy streets or navigating unsafe neighborhoods. Children ages 8 to 18 spend an average of 4.5 hours per day watching television and movies or playing video games. One study found that each additional hour of TV watching increased a child’s risk of obesity by 2 percent, due largely to the consumption of high-fat, sugary snacks while watching TV.⁸

Poor dietary habits: While physical activity has declined, children’s average daily food intake has steadily increased over the past quarter-century. Much of this caloric increase has come from foods of little nutritional value. By the time they are 14 years of age, 32 percent of girls and 52 percent of boys are consuming three or more servings of soda every day; French fries account for 46 percent of vegetable servings for children ages 2 to 19.⁹ Cultural factors also contribute to these dietary habits; consumption of meals at fast food restaurants has tripled in the past 30 years,¹⁰ and the typical American child sees 40,000 television commercials per year, the majority of them for candy, soda, and fast food.¹¹

How Can Afterschool Programs Help?

Just as the causes of childhood obesity are varied and complex, solutions will also have to be multifaceted and comprehensive. While afterschool programs cannot single-handedly reverse health and cultural trends decades in the making, they are an ideal venue for contributing to the improved health and physical activity of children.

Afterschool programs:

• Serve many groups of children most at risk for being overweight —specifically minorities and those in poverty;
• Occur during a time of day when children are likely to be sedentary if not given active options;
• Reach children at the developmental stage when they are forming the health patterns they will carry into adulthood;
• Provide meals and snacks that can serve as nutritious examples for dietary habits;
• Act as liaisons to parents who make critical nutrition and physical activity decisions for their children;
• Have experience in making learning fun and modifying lessons for the needs of their students and clients;
• Offer a supportive, safe environment in which children can feel comfortable trying new activities and building new skills; and
• Are led by caring adults who can act as role models with positive influence on children’s health and nutrition choices.

Though afterschool programs are well-positioned to address health, physical activity, and nutrition issues, they need guidance to do so. The following sections outline specific ways in which the afterschool field can contribute to the burgeoning obesity prevention movement, and provide examples of how these ideas have been applied on the federal, state, and local levels. The strategies discussed here fall into three broad categories:

• Incorporating physical activity and nutrition into afterschool programming;
• Using policy levers to build provider capacity and facilitate the afterschool community’s involvement in policy discussions; and
• Accessing resources and developing financing strategies.

Afterschool Program Elements that Promote Healthy Lifestyles

Afterschool programs are structured in a number of different ways. Some emphasize homework assistance and mentoring, while others focus on enrichment activities such as drama, art, and sports, or a combination of these. Programs occur in a range of settings and may occur before and afterschool, on school holidays, and during summer months. Regardless of structure, location, and resources, all afterschool programs have opportunities to incorporate elements into their program that will encourage children and youth to be healthy. Ideas for increasing physical activity, promoting good nutrition, and educating parents follow.

Increasing Physical Activity

Physical activity can have an enormous impact on improving a child’s physical and emotional well-being. Research has shown that increased exercise and sports participation can simultaneously help children maintain a healthy body weight, enhance their self-confidence, and offer "opportunities for social contact, nurturing, and maturational guidance."¹² Yet a quarter of adolescents report that they engage in no physical activity during their free time.¹³ Afterschool programs across the country have pioneered a number of innovative physical activities to help children achieve the level of activity they need. In addition, many national, state, and community-level campaigns and initiatives offer resources and support that can benefit afterschool programs. Some interesting examples include:

• Girls on Track is a year-long program in Vermont that uses games, interactive learning, and training workouts to expose middle school girls to healthy lifestyle choices. The program begins with an intensive eight-week summer session, where the girls train for a 5K race and explore a number of relevant issues including goal-setting, addressing challenges and overcoming barriers, building self-esteem and positive body image, and understanding the importance of good nutrition. During the school year, the program switches to monthly activities and introduces the girls to alternative forms of physical activity ranging from hiking to yoga. The program culminates in May, when the state’s 20 sites meet to run the "YAM Scram" (a two-mile run) in the Vermont City Marathon. Girls on Track is funded in partnership by the Vermont Department of Health, Blue Cross Blue Shield of Vermont, and the American Heart Association. For more information see http://healthvermont.gov/family/gt/girls_on_track.aspx.
  
  
• The Promoting Healthy Activities Together (P.H.A.T.) Campaign was developed by the California Adolescent Nutrition and Physical Activity (CANFit) Program. This statewide, non-profit organization’s mission is to engage communities and build their capacity to improve the nutrition and physical activity status of California’s low-income African American, American Indian, Latino, Asian American, and Pacific Islander youth age 10 to14. The PHAT Campaign utilizes a community-based approach which embraces music, dance, emceeing, and other elements of hip-hop culture (in community centers, schools, afterschool programs, and other organized settings) to deliver important messages about healthy eating and physical activity. As a follow-up to the P.H.A.T. campaign, CANFit created a multi-media package to encourage community-based organizations to use hip-hop to keep youth active and to educate them about the importance of healthy eating. Each package contains a video that includes 15 minutes of educational messages and a 40 minute instructional hip-hop dance routine, a music CD that features original tracks, and a 36-page guidebook filled with information, resources, and discussion activities. For more information on the P.H.A.T. curriculum, go to: http://www.canfit.org/phat/.
  
  
• VERB™ It’s what you do is a national campaign coordinated by the Centers for Disease Control and Prevention to encourage young people ages 9 to 13 to be physically active every day. The campaign has shown a 34 percent increase in weekly free-time physical activity among 8.6 million children ages 9 and 10. Afterschool programs can download materials—including kits to help children create new games and explore games from around the world, a tool to help track daily physical activity, and ideas for rewarding completed physical activity goals. For more information, go to http://www.cdc.gov/youthcampaign/.¹⁴

Promoting Good Nutrition

Afterschool programs provide opportunities for children to not only consume nutritious snacks but also to learn real-life strategies for evaluating food options and making healthy choices. Many programs have developed creative ideas for giving children the skills and information they need in order to build healthy and nutritious eating habits.

• Power of Choice is a curriculum for afterschool providers developed through a partnership between the U.S. Department of Agriculture and the Food and Drug Administration. This resource guide is intended to help afterschool program coordinators develop activities that promote healthy eating and physical activity choices among adolescents. The guide contains many quick and simple activities that require little or no preparation time, such as making four different kinds of drinks and analyzing their nutrients by using Nutrition Facts label skills, or scooping fat (shortening) into a plastic bag and determining how much of it is in a favorite food. The curriculum contains a CD with ten interactive sessions, activities, recipes, posters, and videos. To download this guide, go to: http://www.fns.usda.gov/tn/Resources/power_of_choice.html.
  
  
• The Edible Schoolyard at Martin Luther King, Jr. Middle School in Berkeley, California established school gardens and afterschool cooking classes that have increased interest and understanding of healthy food preparation. Fully integrated into the school’s curriculum, the Edible Schoolyard used a "seed to table" approach to promote healthy eating. Students participate in all aspects of the food production process, including the preparation of beds, planting of seeds and seedlings, tending crops, and harvesting produce. The seed to table experience exposes children to different subjects, such as ecology and nutrition, and fosters an appreciation of meaningful work, as well as fresh and natural food. For more information about this program and resources for starting a school garden and kitchen, see http://www.edibleschoolyard.org.

Engaging Parents to Encourage Healthy Choices at Home

Parents are key partners in the fight to prevent childhood obesity. The pervasiveness of contradictory and confusing information on proper diet and exercise has made it critical to re-educate parents about the importance of good nutrition and physical activity, particularly since they often serve as the primary role models for their children. Many afterschool programs are involving parents in activities designed to promote good dietary and exercise habits in order to reinforce healthy behaviors at home.

• We Can! (Ways to Enhance Children’s Activity and Nutrition) is a national public outreach program created by the National Institutes of Health to encourage healthy weights for children. In addition to community and youth outreach, We Can! provides resources to educate parents and caregivers about how they can support healthy choices and educate their children about the importance of good nutrition. We Can! encourages parents and primary caregivers to:
  
  
  • Increase the availability and accessibility of healthy foods in the home;
    
    
  • Limit the availability and accessibility in the home of sweetened beverages, high-fat foods, and energy-dense foods with low nutrient value;
    
    
  • Enjoy small portions at home and at restaurants;
    
    
  • Support and enable family physical activity;
    
    
  • Support and enable reduced screen time.
    
    
  We Can! has produced Families Finding the Balance, a handbook for parents that provides background information on the obesity epidemic, and practical, useful tools to help families adopt healthier lifestyles. For more information, visit http://wecan.nhlbi.nih.gov.
  
  
• Team Nutrition is a USDA initiative that helps foodservice personnel provide nutrition education for children and their caregivers and provide support to healthy eating and physical activity. Team Nutrition encourages parents and schools to work together to help children understand the importance of healthy eating and physical activity at home. For more information, go to http://teamnutrition.usda.gov/team.html.
  
  
• Eat Smart. Play Hard™ is a national nutritional education and promotion campaign designed by the USDA’s Food and Nutrition Services to convey science-based, behaviorfocused, and motivational messages about healthy eating and physical activity. The campaign uses a character named "Power Panther" to communicate its four major themes to children and caregivers, including the importance of eating breakfast, balancing your day with food and activity, and taking family time to emphasize being 16 active. The campaign aims to promote wellness and encourage families to adopt behaviors consistent with the new dietary guidelines. One of the main target audiences is school-aged children; as such, an array of support materials is available to help caregivers implement activities, including posters, "Power Panther" costumes, and slogans. For more information about this program, go to: http://www.fns.usda.gov/eatsmartplayhard/About/overview.html.

Developing Policies to Provide Support and Build Capacity for Afterschool Programs

While afterschool providers have a variety of opportunities to incorporate health, nutrition, and physical activity into their programs, policy makers also have a number of opportunities to guide and encourage these efforts. Supportive policies can help afterschool providers by:

• Educating them about health, physical activity, and nutrition and holding them accountable for incorporating these principles into their programs;
  
  
• Facilitating their access to federal food programs;
  
  
• Informing them of promising practices in the afterschool wellness field; and
  
  
• Involving them in relevant policy discussions.

Develop Health and Nutrition Guidelines and Training for Afterschool Providers

Afterschool program directors face the same onslaught of health-related information that inundates the general public—each new day means a new study, statistic, or trend related to physical activity and nutrition. Even the most well-intentioned providers may be overwhelmed when sifting through various news reports to figure out how their suggestions and data apply to the children in their programs. Thoughtful policies can outline standards and guidelines for providers who want to implement healthful programs but struggle to do so. These guidelines, along with training on how to implement them, can help spread awareness of health and nutrition issues to afterschool providers who may not have considered the impact their programs can have on the children they serve. Supportive policies also can hold providers accountable for incorporating health and nutrition guidelines into their programs by integrating them with licensing and accreditation standards.

• In 2002, the Massachusetts Office of Child Care Services (OCCS, now the Department of Early Education and Care) collaborated with the Harvard School of Public Health and Massachusetts Department of Education’s USDA Nutrition Education Program to develop the Healthy Kids Move training curriculum to educate child care providers on the state’s new health-related licensing requirements. The six-hour training and 150-page manual instruct child care providers and other youth-serving professionals on relevant statistics, physical developmental milestones, and proper nutrition. Healthy Kids Move offers information on incorporating physical activity into children’s days and healthy nutrition habits into meals and snacks. It also provides information on how to adapt activities for children with special needs, share strategies with families, and observe the impact of physical activity and nutrition guidance on the health of the children in the program. OCCS has conducted train-the-trainer sessions with all Child Care Resource and Referral agencies in the state, who are in turn training the child care community. For more information, visit http://www.eec.state.ma.us.
  
  
• The Florida Children’s Forum division of school-age services offers training in the Sports, Play, and Active Recreation for Kids (SPARK) curriculum to school-age child care providers throughout Florida. SPARK sessions provide participants with tips to increase the quality and quantity of physical activity in their programs, with a focus on helping children develop healthy lifestyles, motor skills, and social and personal skills. For more information, see http://www.flchild.com/schoolage.htm.
  
  
• The National AfterSchool Association (NAA), a professional membership organization for school-age child care providers, grants accreditation to programs which meet established quality criteria. NAA accreditation standards require that programs provide children with opportunities to play outdoors for at least 30 minutes out of every three-hour period and have suitable playground equipment. Some states reward providers that achieve accreditation with higher reimbursement rates when serving children that receive federal child care subsidies. For more information, see http://www.naaweb.org.
  
  
• The National Institute on Out-of-School Time (NIOST) recently published a report that investigates the links between NAA standards and available physical activity and nutrition programs and curricula. Afterschool programs may want to review this report before investing in a particular curriculum. The report is available for download at http://www.niost.org/publications/healthy%20choices%20afterschool.pdf.
  
  

Help for Afterschool Programs to Access Food and Nutrition Entitlement Programs

Afterschool programs play an important role in providing children with healthy and nutritious food. The federal government provides free and reduced-price lunches and snacks for eligible children in schools, child care centers, and afterschool programs through several USDA programs:

• The National School Lunch Program (NSLP) includes an afterschool snack program which provides reimbursement for snacks to school-sponsored afterschool programs. A school-sponsored program can either be operated by a school or another organization, and may be located on or off school grounds. Generally, the program will provide snacks for eligible children up to age 18 who either reside in a low-income area or household.
  
  
• The Child and Adult Care Food Program (CACFP) provides reimbursement for snacks, and, in some cases, meals to afterschool programs that are operated by schools, local government agencies, and private non-profit organizations.
  
  
• The Summer Food Service Program (SFSP) is a federal nutrition program available to schools, local government agencies, and private non-profit organizations to feed children during summer vacation and—for students attending year-round schools—during breaks that replace a traditional summer vacation.

By accessing these programs, afterschool providers supply eligible children with a substantial portion of the nutrition they receive each day while also gaining access to informational resources and educational materials about proper nutrition. Accessing these funds can be administratively complex, sometimes requiring staff and resources unavailable to many small afterschool programs. In response to this challenge, organizations and partnerships have emerged to help afterschool programs navigate the system and simplify access to funds. A number of states and communities have intermediary organizations to assist afterschool programs. For example:

• The Children’s Hunger Alliance of Ohio, works to maximize and leverage USDA nutrition funds for eligible programs, and helps afterschool programs access funds. For more information, see page 26.
  
  
• The Food Research and Action Center (FRAC) has developed a toolkit for afterschool programs to access federal food programs. The toolkit provides an overview of each federal nutrition program and step-by-step instructions for participating and receiving funding. The toolkit is available online at http://www.frac.org/Afterschool_Guide.pdf.
  
  

Encourage and Disseminate Research on Afterschool Programs’ Impact on Health

The potential of afterschool programs to have lasting impact on child health is clear, yet little is known about which specific approaches have the most significant results. Studies that track health behaviors in children and adolescents rarely isolate afterschool programs’ effects on changing those behaviors. Programs that implement creative approaches to promoting health and nutrition need guidance in how to best assess the impact of obesity prevention efforts on children’s health. Studies of "what works" can be shared with the afterschool community and translated into user-friendly guidelines and assessment tools for use by program providers. Examples of promising studies currently being conducted include:

• The Girls Health Enrichment Multi-Site Studies (GEMS). GEMS studies are testing interventions to prevent excessive weight gain in African-American adolescent girls. Four separate clinical trials are being conducted in two phases over seven years. One pilot study conducted by the University of Minnesota developed an afterschool program called Girlfriends for KEEPS: Keys to Exercising, Eating, Playing, and Sharing that focused on increasing physical activity and healthful eating and incorporated a family involvement component. Early measurements indicated that the program was well-attended and well received, and that participants decreased consumption of soda and high-fat snacks. Researchers concluded that afterschool obesity prevention models hold promise for future efforts. Another site found that a summer day camp model may also be effective. For more information, see http://www.epi.umn.edu/cyhp/r_gems2.htm.
  
  
• The Trial of Activity for Adolescent Girls (TAAG). The goal of the TAAG study is to determine if linking schools to community organizations can help limit the reduction in physical activity that commonly occurs in middle school girls. The project is operating in 36 middle schools in six sites throughout the country. Sixth grade girls in treatment schools receive afterschool physical and health education classes focused on their preferences and participate in physical activity programming developed in partnership with community groups. The study will compare girls receiving this intervention to a control group to determine if they engage in more physical activity, improve physical activity or body composition, and change attitudes or beliefs about physical activity. For more information, see http://www.cscc.unc.edu/taag/desc.php.

Involve Afterschool Providers in Childhood Obesity Policy Discussions

Schools, communities, and states are implementing a range of policies designed to ensure that students are engaged in physical activity and have access to nutritious foods. Supportive policies are prohibiting access to vending machines in schools, mandating time for recess and physical education, and redesigning neighborhoods to encourage walking and biking. Many of these approaches affect the afterschool community and can benefit from including afterschool providers in their development.

• Local Wellness Policies. When federal nutrition programs were reauthorized in 2004, the legislation added a new requirement for school districts (local educational agencies, or LEAs) participating in child nutrition programs such as the free and reduced-price meals program. Each participating LEA is now required to create, by the 2006-07 school year, a local wellness policy that outlines its goals for nutrition education, physical activity, and other school-based wellness initiatives. The LEA is required to include students, parents, school administrators, the school food authority, the school board, and the public in developing the local wellness policy. School districts have flexibility in how they define the school day and have the option to include afterschool program activities as a part of a school wellness plan. District leaders and afterschool providers can work together to ensure that afterschool and child care providers are key partners whose needs and concerns influence the content of plans. For more information, see http://www.fns.usda.gov/tn/Healthy/wellnesspolicy.html.
  
  
• Physical Activity Requirements. Nearly all states have some type of physical education requirement for schools. In response to the childhood obesity epidemic, many states are revising these requirements to increase opportunities for physical activity. Legislation enacted in Kentucky in 2005, for example, mandates 30 minutes of exercise each day for elementary school students. Some worry that strict mandates will strain budgets of schools if they are required to hire additional physical education instructors and negatively impact educational achievement if physical activity detracts from instructional time. Afterschool programs that are school-based or school-linked can ease the strain of implementing such requirements by extending both learning time and physical activity time. Involving afterschool programs in these policy discussions can help both legislators and educators think of creative ways to achieve their shared goals for healthy children while taking advantage of the expertise and resources of afterschool programs in their communities. For more information on state childhood obesity-related legislation, see http://www.ncsl.org/programs/health/childhoodobesity-2005.htm.
  
  
• Built Environment Designs. Many local governments, task forces, and community organizations are assessing whether the "built environment" in their communities is conducive to physical activity. They are evaluating factors such as whether sidewalks promote walking through neighborhoods and how local facilities meet the need for sports and recreation. Given that changes to the built environment can enhance opportunities for children and youth to be more physically active, these policies have a significant effect on the ability of afterschool programs to provide opportunities for physical activity. When communities develop surveys, plans, and mapping tools to assess the "built environment," they can carefully consider the needs of a range of community programs and partners including afterschool programs. For more information on children’s health and the built environment, see http://www.cdc.gov/healthyplaces/healthtopics/children.htm.

Finding Resources and Developing Creative Financing Strategies

The above discussion shows that a variety of promising initiatives aimed at preventing childhood obesity are already underway at the national, state, and community levels. Identifying relevant funding sources and developing creative financing strategies to support and sustain this work is critical for making progress toward healthier outcomes for children and youth.

Programs and policy makers interested in learning more about Strategy 2: Maximizing Federal Funding should review the chart in Appendix on page 29.¹⁶ This chart provides an overview of potential strategies that may be used in afterschool programming and a sampling of appropriate federal funding sources that can support these strategies.

Other examples of financing strategies may include more program-level approaches like blending funding streams, coordinating programming efforts, tapping into existing funding streams, building a pot of flexible dollars, and integrating low-cost activities. Afterschool programs seeking funds to support physical activity and nutrition efforts will need to employ a variety of funding strategies. The following examples illustrate how a diverse group of providers have accessed a variety of sources and strategies to finance their obesity prevention efforts.

Leveraging Dollars to Support Physical Activity and Nutrition Efforts

The YMCA of Santa Clara County, California had a long-term goal of building capacity in the afterschool community to provide physical activity and nutrition opportunities for children. Although they always had health and wellness as part of their mission, program leaders wanted to be more strategic in ensuring that the curricula used by their 57 afterschool programs—including 32 licensed child care providers—was consistent with this mission. The description below shows how this organization has used both grant writing and partnerships to secure a diverse portfolio of funding sources to support their efforts to integrate physical fitness and nutrition into their afterschool programming.

Using Intermediaries to Build the Capacity of Afterschool to Incorporate Physical Activity and Nutrition into Their Programming

Some states and communities have non-profit agencies or government structures that serve as intermediaries. These intermediaries provide training, technical assistance, and resources for afterschool programs to incorporate physical activity and nutrition activities into their programming. The next example is a nonprofit organization from Ohio that is working on several fronts to support the nutrition and physical activity movement in afterschool programs.

Maximizing State and Federal Revenue While Building a Pot of Flexible Dollars

While providers need to keep abreast of the funding opportunities from both federal and state agencies, sustainability of programs is more likely if afterschool leaders can create a diverse funding portfolio that will support their work. Included in the mix of dollars that programs should seek are funds that are not tied to any agendas or requirements. These so-called "flexible dollars" may come from private donors, savings garnered from doing work more efficiently, or fundraising activities. The project described below has done well with coordinating dollars from several funding sources. In addition, the program leaders have involved the youth participants in fundraising activities to build flexible dollars for the program.

The table below summarizes the strategies used by each of the examples discussed on pages 25-27.

Conclusion

Afterschool programming is the ideal setting for promoting healthy lifestyles among school-age children. The examples provided in this publication are meant to encourage program leaders and policy makers to continue to think creatively about incorporating nutrition and physical activity into afterschool programming as well as craft policies and develop financing strategies to ensure that this work is done effectively and efficiently.

Acknowledgments

This brief was prepared by Dionne Dobbins-Harper and Lucinda Fickel of The Finance Project, for the Afterschool Investments Project, a multiyear technical assistance effort funded by the Child Care Bureau of the U.S. Department of Health and Human Services. The authors would like to thank the many individuals who contributed their comments and guidance on earlier drafts, including, Sharon Deich and Michelle Jones of The Finance Project; Sandra Williams at the Department of Health and Human Services; and Steve Fowler from the Afterschool Alliance. Many thanks, also, to the numerous program developers who were willing to share their experiences to educate others in the field, including Mary Hoshiko, Bricca Sweet, and J. D. Beiting.

Appendix

Potential Federal Funding Opportunities For Afterschool Nutrition and Physical Activity By Category Healthy Lifestyles

Targeting Obesity

• State Nutrition and Physical Activity Programs to Prevent Obesity and Related Chronic Diseases
  http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/

Targeting Special Populations

• Health Disparities in Minority Health Grant Program
  http://www.federalgrantswire.com/health_disparities_in_minority_health.html
  http://www.educationmoney.com/prgm_93.100_minr.html
• Children, Youth, and Families at Risk State Strengthening Projects
  http://www.csrees.usda.gov/nea/family/in_focus/youthdev_if_cyfar.html

General Health and Wellness

• Steps to a HealthierUS Cooperative Agreement
  http://www.healthierus.gov/steps/index.html
• Preventive Health and Human Services Block Grant
  http://www.cdc.gov/nccdphp/blockgrant/

Physical Activity

• Carol M. White Physical Education Program
  http://www.ed.gov/programs/whitephysed/index.html
• National Youth Sports Program Fund
  http://www.nyscorp.org/nysp/home.html

Physical Activity and Nutrition Education

• Team Nutrition Training Grant
  http://www.federalgrantswire.com/team_nutrition_grants.html
  http://www.educationmoney.com/prgm_10.574_agric.html
  http://www.fns.usda.gov/tn/Grants/2006app.html
• 21st Century Community Learning Centers Block Grant
  http://www.ed.gov/programs/21stcclc/index.html

Parent Involvement

• Parent Resource Information and Resource Centers Grant Program
  http://www.pirc-info.net/
• Even Start Program: State Agency Block Grant
  http://www.ed.gov/programs/evenstartformula/index.html

Access to Safe Environment

• Community Development Block Grant Program
  http://www.hud.gov/offices/cpd/communitydevelopment/programs/index.cfm

Access to Adequate Amounts of Healthy Food

• National School Lunch Program/National School Lunch Program: Afternoon Snacks
  http://www.fns.usda.gov/cnd/Lunch/default.htm
  http://www.fns.usda.gov/cnd/Afterschool/default.htm
• National School Breakfast Program
  http://www.fns.usda.gov/cnd/breakfast/
• Summer Food Service Program
  http://www.fns.usda.gov/cnd/summer/
• Child and Adult Care Food Program
  http://www.fns.usda.gov/cnd/Care/CACFP/cacfpfaqs.htm
• Food Stamp/Food Stamp Nutrition Education Program
  http://www.fns.usda.gov/fsp/
  http://www.fns.usda.gov/fns/nutrition.htm
• Women Infants and Children (WIC)/ WIC Farmers Market Program
  http://www.fns.usda.gov/wic/
  http://www.fns.usda.gov/wic/FMNP/FMNPfaqs.htm
• Community Food Project
  http://www.federalgrantswire.com/community_food_projects.html

Endnotes

¹Institute of Medicine of the National Academies, Preventing Childhood Obesity: Health in the Balance, (Washington, D.C.: National Academies Press, 2005). [Back]
² Ibid. [Back]
³ O. Pinhas-Hamiel et al, "Increasing Incidence of Non-insulin Dependent Diabetes Melittus in Children and Adolescents," Journal of Pediatrics (1996), 127:608-615. [Back]
⁴ Marla E. Eisenberg et al. "Association of Weight-based Teasing and Emotional Well-Being Among Adolescents," Archives of Pediatrics and Adolescent Medicine (2003), 157:733-738. [Back]
⁵ S. Jay Olshansky et al, "A Potential Decline in Life Expectancy in the United States in the 21st Century," The New England Journal of Medicine 352, no. 11 (2005): 1138-45; Wang G, Dietz WH, "Economic Burden of Obesity in Youths Aged 6 to 17 years: 1979-1999," Pediatrics 2002,109(5):E81-1. [Back]
⁶ Institute of Medicine, op cit. [Back]
⁷ C.R. Burgeson et al, "Physical Education and Activity: Results from the School Health Policies and Programs Study 2000," Journal of School Health 2001, 71(7): 279-239. [Back]
⁸ W. Dietz and S. Gortmaker, "Do We Fatten Our Children at the TV Set? Obesity and Television Viewing in Children and Adolescents," Pediatrics 75(1985):807-B12; Oded Bar-Or, "Juvenile Obesity, Physical Activity, and Lifestyle Changes," The Physician and Sports Medicine, 28: 51-58, 2000. [Back]
⁹ J.F. Guthrie and J.F. Morton, "Food Sources of Added Sweeteners in the Diets of Americans," Journal of the American Dietetic Association, 100:43-51. [Back]
¹⁰ Elizabeth Frazao, ed., America’s Eating Habits: Changes and Consequences, (Washington, D.C.: U.S. Department of Agriculture, 1999). [Back]
¹¹ Kaiser Family Foundation, The Role of Media in Childhood Obesity, (Menlo Park, Calif.: Author, 2004) [Back]
¹² Institute of Medicine, op cit. [Back]
¹³Centers for Disease Control and Prevention, "Physical Activity Levels Among Children aged 9-13 years: United States, 2002," Morbidity and Mortality Weekly Report, 52: 785-788, 2003. [Back]
¹⁴Though funding for the VERB campaign has been discontinued, as of October 2006, the VERB website and related resources remain accessible. [Back]
¹⁵Cheryl Hayes, Thinking Broadly: Financing Strategies for Comprehensive Child and Family Initiatives (Washington, DC: The Finance Project, 2002). [Back]
¹⁶Carol Cohen and Dionne Dobbins, Financing Childhood Obesity Prevention Programs: Federal Funding Sources and Other Strategies (Washington, D.C.: The Finance Project, 2004) [Back]

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