The Summer Activity Study of Somerville Youth (SASSY)

Background: Research indicates that in the United States, children experience healthier BMI and fitness levels during school vs. summer, but research is limited. The primary goal of this pilot study was to assess where children spend their time during the months that school is not in session and to learn about the different types of activities they engage in within different care settings. A secondary goal of this pilot study was to learn what children eat during the summer months. Methods: A nine-week summer study of 57 parents of second and third grade students was conducted in an economically, racial/ethnically and linguistically diverse US urban city. Weekly telephone interviews queried time and activities spent on/in 1) the main caregiver’s care 2) someone else’s care 3) vacation 4) and camp. Activities were categorised as sedentary, light, moderate, or vigorous (0-3 scale). For each child, a mean activity level was calculated and weighted for proportion of time spent in each care situation, yielding a weighted activity index. On the last phone call, parents answered questions about their child’s diet over the summer. Two post-study focus groups were conducted to help interpret findings from the weekly activity interviews. Results: The mean activity index was 1.05 ± 0.32 and differed between gender (p = 0.07), education (p = 0.08) and primary language spoken in the household (p = 0.01). Children who spent a greater percentage of time in parent care had on average a lower activity index (b = -0.004, p = 0.01) while children who spent a greater percentage of time in camp had a higher activity index (b = 0.004, p = 0.03). When stratified into type of camp, percentage of time spent in active camp was also positively associated with mean activity index (b = 0.005, p =< 0.001). With regards to diet, after adjusting for maternal education, children who attended less than five weeks of camp were four times more likely to eat their meals in front of the TV often/almost all of the time (OR = 4.0, 95%CI 1.0-16.2, p < 0.06). Conclusions: Summer activities and some dietary behaviours are influenced by situation of care and sociodemographic characteristics. In particular, children who spend a greater proportion of time in structured environments appear to be more active. We believe that this pilot study is an important first step in our understanding of what children do during the summer months. * Correspondence: [email protected] John Hancock Research Center on Physical Activity, Nutrition and Obesity Prevention, Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 0211, USA Tovar et al. BMC Pediatrics 2010, 10:16 http://www.biomedcentral.com/1471-2431/10/16 © 2010 Tovar et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background The dramatic increase in the prevalence rates for overweight and obesity in children over the past several decades is a particular public health concern among low-income communities [1] and among ethnic minorities [2]. In urban environments the relative lack of recreational facilities and green space, difficulty in promoting walkability and bikeability, and concern over neighbourhood safety may limit outdoor activity, while lack of full-service supermarkets may limit access to healthful food products [3-7]. Overall, this environment can lead to decreased physical activity and increased intake of energy dense foods. Recent studies have shown that rate of change in BMI over the summer is larger than during the school year [8-10]. This has been shown to be true especially for black and Hispanic children and for children who are already overweight [8]. The reason for this pattern has yet to be firmly established. The popular press has speculated [11,12] that both diet and physical activity play a role in weight increases during the summer. Some evidence suggests that physical fitness declines during the summer months [13,14]. In one study of 17 children, fitness levels decreased, while insulin levels and body fat percentage increased during the summer break [14]. A second study, which included 178 elementary school children, found significant physical fitness improvements during the school year but not during summer recess [13]. Contrary to these findings, a few studies have shown that children are more active during the summer months compared to the winter [15-17]. These studies however, used different activity methods, such as pedometers, and were completed in European populations, which have school and holiday calendars that differ from those in the United States. The majority of these studies point to an increase in overweight and obesity as well as a decrease in physical fitness during the summer months. Energy dense foods, large portion sizes and low intake of fruits and vegetables have been identified as contributors to the increasing rates of obesity among children [18]. A number of studies suggest that school plays a role in promoting a more healthful diet [19,20]. School policies have been effective in improving the food environment and dietary intake in schools [21]. A review of prevention interventions suggests that combined diet and physical activity school-based interventions may help prevent children from becoming overweight [22]. One recent study, completed among a nationally representative sample of 2,314 children, found that on a typical school day, children consumed 527 “empty calories” during a 24hour period and that eating at home provided the highest mean energy from low-nutrient, energy dense foods (276 kcal at home vs. 174 kcal at school and 78 kcal at other locations) [20]. No studies have looked at children’s dietary intake specifically during the summer months when children are not at school. Although there is emerging evidence that children gain more weight than they might be expected to for normal growth over the summer, no studies, to our knowledge, have explored the possible contributory behavioural factors. Therefore, the primary goal of this pilot study was to assess where children spend their time during the months that school is not in session and to learn about the different types of activities they engage in within different care settings. A secondary goal of this pilot study was to learn what children eat during the summer months.