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Issue Brief No. 45                                                                                                                                                                           November 2010

The Afterschool Alliance, in partnership with MetLife Foundation, is proud to present the third in a series of four issue briefs examining critical issues facing middle school youth and the vital role afterschool programs play in addressing these issues.  These issue briefs feature: the multiple benefits of afterschool for middle school youth; STEM; health and wellness for pre-teens and teens; and pathways to higher education and careers.  They examine just a few of the ways afterschool programs support middle school youth, families and communities.

With a growing number of school hours devoted to increased instructional time and physical education programs being scaled back in many schools, the afterschool hours are becoming increasingly crucial to ensuring the healthy development of our nation's youth.  Additionally, with students spending the majority of their waking hours and consuming the majority of their meals out of school, afterschool and summer learning programs present a unique opportunity to promote healthful eating and living habits.  Middle schoolers in particular, who are often fueled by their desire to find a place where they belong and are at risk of making decisions that negatively affect their overall health, can benefit greatly from the lessons on nutrition and the increased opportunities for physical activity that afterschool programs can provide.  Middle school programs across the country offer youth a mix of academic and physical enrichment that promotes positive physical, emotional and social development. By offering sports programs, teaching children about healthy food choices, supplying mentors to steer teens and pre-teens away from drugs, smoking and alcohol, and displaying other innovative ways to promote healthy lifestyles among adolescents, afterschool programs are leading the way toward healthier lifestyles for America's middle schoolers.

There is Work to Be Done to Promote a Healthier Generation of Teens and Pre-Teens

There are innumerable health issues facing middle school students. The childhood obesity crisis continues to worsen in the U.S., with an estimated one in six children (16 percent) from ages 10 to 17 considered to be obese.1. Type 2 diabetes, once known as “adult-onset diabetes”, is now becoming more common among adolescents, especially in minority communities.2 Additionally, overweight children are more likely to be the target of taunting and teasing in school, a serious risk to mental health, leading to lower self-confidence and a higher risk of depression.3 Middle school is also a time of increased independence, and with it comes the risks of poor decision-making, which can be reflected in poor food choices and in drug or alcohol use.  In addition, there are many recent developments that have led to the increased health dangers to pre-teens and teens:

• Until recently, physical education classes in schools could be relied on to engage children in a half hour or more of daily physical exercise and/or health class. Yet with the advent of the No Child Left Behind Act, an increased focus on testing has turned physical education into a luxury that many schools cannot afford.  Similarly, recess has been reduced or eliminated in schools across the country in favor of more math and language arts learning time.4
• One study found that in 2006 only 7.9 percent of middle schools provided students daily physical education during the school year.5
• Research shows that time spent engaged in outdoor activities correlates with increased fitness in children, yet children have turned to the TV remote, computer mouse and video game controller more often than outdoor recreation to occupy their down time.6
• According to the Centers for Disease Control, 61.5 percent of children do not participate in any organized physical activity outside of school hours.7
• The quality of children's diets has similarly been a detriment to their health, with fast food consumption tripling in the past 30 years,8 children's daily food intake rising gradually over the past quarter-century,9 and only 8 percent of vegetables consumed by children being dark green or orange.  Instead, fried potatoes make up about 46 percent of total vegetable consumption10.

The Future for Health and Wellness in Afterschool Looks Bright

Afterschool programs for middle schoolers that focus on positive physical, as well as academic, outcomes are an invaluable resource for alleviating the health crisis facing teens and pre-teens. The afterschool time allows schools and community organizations to reinforce nutritious food choices and encourage involvement in physical fitness activities. With more than 1.4 million middle school children currently participating in afterschool programs and an astounding 3.1 million more middle schoolers interested in getting involved, afterschool has powerful potential to impact the fitness and nutrition of a large portion of our nation's middle school youth.11  Afterschool programs can be a particularly valuable resource to middle schoolers' health because they:

• Serve children most at risk for being overweight, including minorities and those from lower socio-economic status families.
• Occur during a time of the day that many children would otherwise be sedentary and not likely to participate in physical activity.
• Provide meals and snacks that can serve as nutritious examples.
• Provide staff who understand children's needs and can promote healthy eating and active lifestyles.12
• Provide an opportunity for young people to interact with role models displaying healthy eating habits and leading healthy lifestyles.

Research shows that programs that utilize the afterschool space as a site for enjoying physical activity and learning about healthy lifestyles can improve student health outcomes.

• A study measuring the health and social benefits of afterschool programs found that controlling for baseline obesity, poverty status, and race and ethnicity, the prevalence of obesity was significantly lower for afterschool program participants (21 percent) compared to nonparticipants. (33 percent).13
• A report by the U.S. Department of Education found that 10-16 year olds who have a relationship with a mentor are 46 percent less likely to start using drugs and 27 percent less likely to start drinking alcohol.14
• Active adolescents are more likely than their sedentary peers to use contraception during sexual intercourse and delay the initiation of first sexual intercourse.15
• A recent evaluation of afterschool programs in California displayed that youth reached federally-recommended levels of moderate to vigorous physical activity levels for an average of 24.4 minutes daily when they participated in structured activities and received only 13 minutes through unstructured activities.16
• A study reported in the Journal of Adolescence found that youth whose summer arrangements involved regular participation in organized activities showed significantly lower risk for obesity than other youth. This was most evident during early adolescence – the middle school years. Youth whose regular summer arrangement was primarily parent care without organized activity participation showed the greatest risk for obesity.17

Despite Benefits, Barriers to Implementing Health and Wellness in Afterschool Are Prevalent

While afterschool programs offer countless health benefits to middle school youth, incorporating a focus on fitness and well-being presents some challenges to providers.

• Physical activity is often not perceived as an essential need, especially when limited time and resources force a comparison of physical activity to the academic needs of students.
• High staff turnover limits programs' ability to train staff to provide high-quality physical activity.
• Federal reimbursement rates for afterschool snacks do not adequately cover the cost of increasing the servings of fruits and vegetables and other nutrient-rich foods. 
• There is inadequate funding for staffing, professional development and equipment.
• There is limited space available to support physical activity, as sports leagues typically rent out fields, limiting access by afterschool programs.
• Girls are typically not interested in traditional physical activity programming.18
• For many programs, there is a lack of shared-use or joint-use agreements between schools and community-based organizations running programs, leaving much of the funding and resources that schools enjoy, such as equipment and access to kitchens or playing fields, untapped by afterschool partners.

Solutions Exist to Overcome Barriers and Encourage Stronger, Healthier and Smarter Middle Schoolers after School

Programs across the country are implementing innovative strategies to include health and wellness education in afterschool offerings. Here are just a few examples of ways that afterschool programs can promote healthy living and better prepare a generation of middle schoolers.

Afterschool programs encourage youth to monitor their nutrition and physical activity habits on a continuous basis and encourage improvement.  In addition, they can integrate interactive nutrition education and physical fitness learning through activities such as taste testing, planting vegetable gardens, analyzing food commercials, preparing healthy snacks, measuring fat content in typically consumed foods or visiting a local recreation facility.

The Youth Succeeding Under Pressure (YSUP) program at the New Britain-Berlin YMCA in Connecticut is a leadership development program structured around both academic learning and social engagement for middle school students. Along with a focus on strengthening children's motivation to learn and graduate from high school, the YSUP program promotes the importance of healthy living and seeks to fortify participants' self-esteem and deepen their personal values. The YSUP program includes a host of activities geared toward promoting healthy lifestyles, such as ‘Media Smart,' which educates students on how to eat healthy and avoid succumbing to the marketing of low-quality foods. The YMCA facility also offers youth access to a climbing center, pool, wellness center, basketball courts and racquetball courts to support physical fitness and stronger participation in wellness activities.

Afterschool programs can involve the entire family to ensure that the nutrition and fitness lessons learned after school are implemented in the home.

The San Antonio Youth Centers (SAYC), consist of nine afterschool programs in Texas that utilize funding from the federal and state-supported Carol M. White Physical Education Program to implement a physical education and youth development curriculum. The centers seek to promote healthy lifestyles, improve academic achievement, and foster and develop positive youth self-esteem. Middle schoolers at SAYC participate in at least 45 minutes of structured daily physical activities that are both fun and vigorous, including karate, swimming, cheerleading and rock-climbing. Additionally, SAYC educate youth about the dangers of smoking, alcohol and drugs to support healthy decision making.  They also offer weekly family Boot Camp sessions to cultivate parental involvement and help ensure that healthy living extends into the home.

Afterschool programs increase partnerships between schools, local governments, community-based organizations, and local businesses to enhance physical activity offerings after school.

Middle school participants at the Ed Snider Youth Hockey Foundation (ESYHF) in Philadelphia, Pennsylvania enjoy a host of positive youth development outcomes that stem from one basic hook: playing hockey. Developed by former Philadelphia Flyers and 76ers owner Ed Snider, ESYHF programs are targeted to youth from inner-city neighborhoods, who otherwise would not have an opportunity to participate in an afterschool program. In addition to on-the-ice physical development, the program also promotes increased school attendance rates, provides homework help and offers a Life Skills Curriculum which encourages healthy habits and smart choices.

Afterschool programs promote healthy eating by offering healthy meals and snacks – particularly through participation in the federal afterschool snack and supper programs.19  They also combine physical development with academic and social gains that encourage overall health in participants, especially among students who would otherwise be uninterested in fitness activities.

The main goal of the School Health Interdisciplinary Program (SHIP) in Gainesville, Florida is to combat childhood obesity through a combination of middle school-focused physical fitness, nutrition and science-and-math-related educational activities. In addition to teaching children about the water cycle and food pyramid, time is also dedicated to an array of active outdoor pursuits, such as endurance running, aerobics and energetic games that reinforce healthy eating habits. Utilizing local community-based organizations and undergraduate and graduate student volunteers from the University of Florida, the program also offers ninety minutes of weekly mentoring opportunities for students at two middle schools and a host of other beneficial health education activities.

Conclusion

While it's clear that there are barriers to supporting healthy nutrition and physical activity in afterschool, there are many programs that have been able to overcome those barriers and are succeeding in helping our nation raise a healthier generation of middle school students. There is a wealth of resources for programs looking to provide health and wellness after school, including:

• The Healthy Out of School Time (HOST) Coalition, led by the National Institute on Out-of-School Time at Wellesley College, is currently working on recommendations for healthy eating and activity in afterschool programs. The organization has compiled a list of voluntary standards and guidelines, including those from several states, the National Child Care Information and Technical Assistance Center, and others, that are excellent resources for programs.
• The Department of Health and Human Services' Promoting Physical Activity and Healthy Nutrition in Afterschool Settings publication is a useful resource that includes strategies for enacting health and nutrition guidelines and standards.
• The Quaker Chewy Get Active: Be Healthy Afterschool Toolkit, developed by the Afterschool Alliance and Quaker® Oats offers creative, easy-to-implement ideas for incorporating health and wellness into afterschool programs, including lesson plans, activities and games in addition to a comprehensive set of health-related resources that programs can access. 
• The First Lady's Let's Move campaign has recognized the value and importance of afterschool programs, and many of the recommendations put forward in the White House Task Force on Childhood Obesity Report to the President echo the current efforts and initiative of the afterschool field. The Let's Move website includes a variety of action steps that can be used by afterschool programs and families.
• The Alliance for a Healthier Generation has an excellent page of tips, ideas and success stories aimed at before-school and afterschool providers that address both physical activity and nutrition and snacks.
•  Action for Healthy Kids and the National Football League developed ReCharge! Energizing After-School, a fun-for-kids curriculum designed to teach students about good nutrition and engage them in physical activity.  ReCharge! is a complete, easy-to-use kit with lesson plans, equipment ideas, information for families and more.

In addition, policies that encourage shared-use or joint-use agreements, widespread adoption of guidelines and standards and funding for staff training and equipment will help afterschool programs effectively promote a healthy childhood for all middle school students. With an established track record, afterschool and summer learning programs should not be underestimated as potential ‘game changers' in promoting wellness among young people.