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Participation in structured programming may prevent unhealthy weight gain during the summer in school-aged children from low-income neighbourhoods: feasibility, fidelity and preliminary efficacy findings from the Camp NERF study

  • Laura C Hopkins (a1) (a2), Christopher Holloman (a3), Bernadette Melnyk (a4), Mary Fristad (a5), Jacqueline D Goodway (a1), Julie A Kennel (a1), Ihuoma Eneli (a6) and Carolyn Gunther (a1) (a2) (a7)...



Evaluate the feasibility, fidelity and preliminary efficacy of Camp NERF to prevent unhealthy weight gain and promote healthy behaviours in children during the summer.


Camp NERF was an 8-week, multicomponent, theory-based programme coupled with the US Department of Agriculture’s Summer Food Service Program. Twelve eligible elementary-school sites were randomized to one of three treatment groups: (i) Active Control (non-nutrition, -physical activity (PA), -mental health); (ii) Standard Care (nutrition and PA); or (iii) Enhanced Care (nutrition and PA, plus cognitive behavioural techniques) programming. Efficacy was determined by assessing mean change by group in child outcomes using hierarchical linear regression models.


Low-income, urban neighbourhoods in Columbus, OH, USA.


Economically disadvantaged, racial minority children of elementary school age (kindergarten–5th grade).


Eighty-seven child–caregiver dyads consented; eighty-one completed pre- and post-intervention assessments resulting in a 93·10 % retention rate. Delivery of the intended lesson occurred 79–90 % of the time. Of the children, 56·98 % (n 49) were female; 89·53 % (n 77) were Black. Overall mean change in BMI Z-score from baseline to post-intervention was −0·03 (se 0·05); change in BMI Z-score did not differ significantly between treatment group. Change in nutrition, PA, mental health or psychosocial outcomes did not differ between groups.


Results from the current study demonstrate feasibility and fidelity, yet no intervention effect of Camp NERF. Instead, findings suggest that participation in structured programming of any type (health behaviour-related or not) may prevent unhealthy summer weight gain. Additional studies are needed to confirm findings. Results have implications for child nutrition policy addressing the issue of summer health.


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1. Ogden, CL, Carroll, MD, Kit, BK et al. (2014) Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 311, 806814.
2. Hopkins, LC, Fristad, M, Goodway, JD et al. (2016) Camp NERF: methods of a theory-based nutrition education recreation and fitness program aimed at preventing unhealthy weight gain in underserved elementary children during summer months. BMC Public Health 16, 1122.
3. Hales, CM, Carroll, MD, Fryar, CD et al. (2017) Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. NCHS Data Brief no. 288. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
4. Halfon, N, Larson, K & Slusser, W (2013) Associations between obesity and comorbid mental health, developmental, and physical health conditions in a nationally representative sample of US children aged 10 to 17. Acad Pediatr 13, 613.10.1016/j.acap.2012.10.007
5. Taras, H & Potts-Datema, W (2005) Obesity and student performance at school. J Sch Health 75, 291295.
6. von Hippel, PT, Powell, B, Downey, DB et al. (2007) The effect of school on overweight in childhood: gain in body mass index during the school year and during summer vacation. Am J Public Health 97, 696702.10.2105/AJPH.2005.080754
7. Moreno, JP, Johnston, CA & Woehler, D (2013) Changes in weight over the school year and summer vacation: results of a 5-year longitudinal study. J Sch Health 83, 473477.10.1111/josh.12054
8. Moreno, JP, Johnston, CA, Chen, T-A et al. (2015) Seasonal variability in weight change during elementary school. Obesity (Silver Spring) 23, 422428.
9. Kobayashi, M & Kobayashi, M (2006) The relationship between obesity and seasonal variation in body weight among elementary school children in Tokyo. Econ Hum Biol 4, 253261.10.1016/j.ehb.2005.08.002
10. Smith, DT, Bartee, RT, Dorozynski, CM et al. (2009) Prevalence of overweight and influence of out-of-school seasonal periods on body mass index among American Indian schoolchildren. Prev Chronic Dis 6, A20.
11. Baranowski, T, O’Connor, T, Johnston, C et al. (2014) School year versus summer differences in child weight gain: a narrative review. Child Obes 10, 1824.
12. Franckle, R, Adler, R & Davison, K (2014) Accelerated weight gain among children during summer versus school year and related racial/ethnic disparities: a systematic review. Prev Chronic Dis 11, E101.
13. Briefel, RR, Crepinsek, MK, Cabili, C et al. (2009) School food environments and practices affect dietary behaviors of US public school children. J Am Diet Assoc 109, 2 Suppl., S91S107.
14. Brazendale, K, Beets, MW, Weaver, RG et al. (2017) Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act 14, 100.
15. US Department of Agriculture, Food and Nutrition Service (2015) Summer Food Service Program. (accessed December 2015).
16. Hayes, C, Rosso, R, Anderson, S et al. (2017) Hunger Doesn’t Take a Vacation: Summer Nutrition Status Report. (accessed November 2018).
17. Hopkins, LC, Webster, A, Sharn, A et al. (2016) Camp NERF: caregiver outcomes from a theory-based nutrition education recreation and fitness program aimed at preventing unhealthy weight gain in disadvantaged children during summer months. Presented at The Ohio State University Extension Family and Consumer Sciences All Programs Conference, Columbus, OH, USA, October 2016.
18. US Department of Health and Human Services (2015) 2015 Poverty Guidelines. (accessed November 2018).
19. Centers for Disease Control and Prevention (2007) National Health and Nutrition Examinatory Survey (NHANES): Anthropometry Procedures Manual. Atlanta, GA: CDC.
20. StataCorp (2015) Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.
21. Domel, SB, Baranowski, T, Davis, H et al. (1993) Measuring fruit and vegetable preferences among 4th- and 5th-graders. Prev Med 22, 866879.
22. Domel, SB, Baranowski, T, Davis, HC et al. (1996) A measure of stages of change in fruit and vegetable consumption among fourth- and fifth-grade school children: reliability and validity. J Am Coll Nutr 15, 5664.
23. Bandura, A (2004) Health promotion by social cognitive means. Health Educ Behav 31, 143164.
24. Tavakol, M & Dennick, R (2011) Making sense of Cronbach’s alpha. Int J Med Educ 2, 5355.
25. Burrows, TL, Martin, RJ & Collins, CE (2010) A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water. J Am Diet Assoc 110, 15011510.
26. Baxter Domel, S, Thompson, WO, Litaker, MS et al. (2003) Accuracy of fourth-graders’ dietary recalls of school breakfast and school lunch validated with observations: in-person versus telephone interviews. J Nutr Educ Behav 35, 124134.
27. Baxter, SD, Hardin, JW, Guinn, CH et al. (2009) Fourth-grade children’s dietary recall accuracy is influenced by retention interval (target period and interview time). J Am Diet Assoc 109, 846856.
28. Conway, JM, Ingwersen, LA, Vinyard, BT et al. (2003) Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women. Am J Clin Nutr 77, 11711178.
29. Conway, JM, Ingwersen, LA & Moshfegh, AJ (2004) Accuracy of dietary recall using the USDA five-step multiple-pass method in men: an observational validation study. J Am Diet Assoc 104, 595603.10.1016/j.jada.2004.01.007
30. University of Minnesota Nutrition Coordinating Center (2014) Nutrition Data System for Research. (accessed November 2015).
31. Hoelscher, DM, Barroso, CS, Springer, A et al. (2009) Prevalence of self-reported activity and sedentary behaviors among 4th-, 8th-, and 11 th-grade Texas public school children: the school physical activity and nutrition study. J Phys Act Health 6, 535547.
32. Hoelscher, DM, Springer, AE, Ranjit, N et al. (2010) Reductions in child obesity among disadvantaged school children with community involvement: the Travis County CATCH Trial. Obesity (Silver Spring) 18, Suppl. 1, S36S44.
33. Hoelscher, DM, Day, RS, Kelder, SH et al. (2003) Reproducibility and validity of the secondary level School-Based Nutrition Monitoring student questionnaire. J Am Diet Assoc 103, 186194.
34. Penkilo, M, George, GC & Hoelscher, DM (2008) Reproducibility of the school-based nutrition monitoring questionnaire among fourth-grade students in Texas. J Nutr Educ Behav 40, 2027.
35. Centers for Disease Control and Prevention (2016) Youth Risk Behavior Surveillance System (YRBSS). (accessed December 2016).
36. Laurent, J, Catanzaro, SJ, Joiner, TE et al. (1999) A measure of positive and negative affect for children: scale development and preliminary validation. Psychol Assess 11, 326338.
37. Joiner, TE, Catanzaro, SJ & Laurent, J (1996) Tripartite structure of positive and negative affect, depression, and anxiety in child and adolescent psychiatric inpatients. J Abnorm Psychol 105, 401409.
38. Fitzgerald, A, Heary, C, Kelly, C et al. (2013) Self-efficacy for healthy eating and peer support for unhealthy eating are associated with adolescents’ food intake patterns. Appetite 63, 4858.
39. Anderson Steeves, E, Jones-Smith, J, Hopkins, L et al. (2016) Perceived social support from friends and parents for eating behavior and diet quality among low-income, urban, minority youth. J Nutr Educ Behav 48, 304310.e1.10.1016/j.jneb.2015.12.014
40. Banbury-Robinson, J (1999) Ohio’s 4H Cloverbud Program. Columbus, OH: The Ohio State University Extension.
41. Hans, J & McGaugh, M (2013) Oklahoma CATCH Kids Club: 2011–2012 Analysis. (accessed December 2014).
42. Sharpe, EK, Forrester, S & Mandigo, J (2011) Engaging community providers to create more active after-school environments: results from the Ontario CATCH Kids Club Implementation Project. J Phys Act Health 8, Suppl. 1, S26S31.
43. Luton, S & Berry, J (2011) CATCH Kids Club Healthy Habits & Nutrition: An After-School Curriculum for Grades K–5. Hasbrouck Heights, NJ: FlagHouse, Inc.
44. Melnyk, BM (2015) Creating Opportunities for Personal Empowerment: A 7-Session Cognitive Behavioral Skills Building Program for Children. COPE2Trive, LLC.
45. Hopkins, LC, Rose, A & Gunther, CW (2015) Camp NERF: Feasibility, Acceptability, and Potential Efficacy of a Theory-Based Nutrition Education Recreation and Fitness Program Aimed at Preventing Unhealthy Weight Gain in Disadvantaged Children during Summer Months. Boston, MA: Experimental Biology.
46. Hopkins, LC, Rose, A, Higgins, E et al. (2015) Methods and Fidelity of a Nutrition Education Recreation and Fitness Program to Prevent Child Weight Gain during Summer. Pittsburgh, PA: Society for Nutrition Education and Behavior.
47. Rubin, DB (1987) Multiple Imputation for Nonresponse in Surveys. Wiley: New York.
48. Schafer, JL (1997) Analysis of Incomplete Multivariate Data. Boca Raton, FL: Chapman & Hall/CRC.
49. Centers for Disease Control and Prevention (2018) Exercise or Physical Activity. (accessed November 2018).
50. Janssen, X, Mann, KD, Basterfield, L et al. (2016) Development of sedentary behavior across childhood and adolescence: longitudinal analysis of the Gateshead Millennium Study. Int J Behav Nutr Phys Act 13, 88.10.1186/s12966-016-0413-7
51. Cooper, AR, Goodman, A, Page, AS et al. (2015) Objectively measured physical activity and sedentary time in youth: the International Children’s Accelerometry Database (ICAD). Int J Behav Nutr Phys Act 12, 113.10.1186/s12966-015-0274-5
52. Kraemer, HC, Mintz, J, Noda, A et al. (2006) Caution regarding the use of pilot studies to guide power calculations for study proposals. Arch Gen Psychiatry 63, 484489.
53. Contento, I, Balch, G, Bronner, Y et al. (1995) The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of research. J Nutr Educ 27, issue 6.
54. Katz, DL, O’Connell, M, Yeh, M-C et al. (2005) Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep 54, 112.



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