ImportanceChildren experience accelerated gains in body mass index (BMI) during the summer months when school is not in session. Children from low-income households are most susceptible. Accelerated BMI gain in summer may be due to the removal of the health-promoting structure provided by schools. During summer, a common form of health-promoting structure is summer day camps (SDCs). Summer day camps are predominately fee for service, which creates a financial barrier for children from low-income households. One solution to mitigate accelerated BMI gain is providing free access to an existing SDC.ObjectiveTo investigate whether providing free access to an existing community SDC can mitigate accelerated BMI z score (zBMI) gain in elementary school–age children.Design, Setting, and ParticipantsThis randomized clinical trial was conducted during the summers of 2021, 2022, and 2023 in the southeastern United States. Participants were children (kindergarten through fourth grade) from predominantly low-income households who were randomized to attend an SDC operated by a parks and recreation commission or continue summer as usual (control).InterventionFree SDC every weekday (Monday through Friday) for 8 to 10 weeks.Main Outcomes and MeasuresThe primary outcome was between-group differences in change of zBMI measured before school ended (May) and on return to school from summer (late August). Secondary analyses examined the dose response of zBMI change with parent-reported child attendance at SDCs during the summer for all children (intervention and control).ResultsA total of 422 children (mean [SD] age, 8.2 [1.5] years; 202 [48%] female, 220 [52%] male, 292 [69%] at or below 200% federal poverty level, 127 [30%] with food insecurity) were randomized to 1 of 2 conditions: summer as usual (control, n = 199) or free SDC (n = 223). Intent-to-treat analysis indicated mean (SE) change in zBMI at the end of the summer was 0.046 (0.027) for the control and −0.048 (0.025) for the intervention group, representing a significant between-group difference of −0.094 (95% CI, −0.166 to −0.022). Dose-response analyses indicated that every 1 day per week increase in attending an SDC resulted in a −0.034 to −0.018 zBMI reduction, which translates to a gain of 0.046 to 0.080 zBMI for children never attending summer programming vs −0.09 to −0.04 zBMI reduction for children attending summer programming every weekday.Conclusions and RelevanceProviding children free access to existing community summer programming can have a meaningful effect on children’s zBMI gain during the summer. Future studies should replicate these findings across different regions and identify the optimal dose of programming to mitigate unhealthy zBMI gains.Trial RegistrationClinicalTrials.gov Identifier: NCT04072549

中文翻译：

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免费暑期节目和低收入家庭学童体重指数


重要性在夏季学校不上课的几个月里，儿童的体重指数 （BMI） 会加速增加。来自低收入家庭的儿童最容易受到影响。夏季 BMI 加速增加可能是由于取消了学校提供的促进健康的结构。在夏季，一种常见的促进健康的结构形式是夏令营 （SDC）。夏令营主要是服务费，这给来自低收入家庭的孩子造成了经济障碍。减少 BMI 加速增加的一种解决方案是免费提供对现有 SDC 的访问。目的调查提供免费访问现有社区 SDC 是否可以减轻小学生加速 BMI z 评分 （zBMI） 的增加。设计、设置和参与者这项随机临床试验于 2021 年、2022 年和 2023 年夏季在美国东南部进行。参与者是来自主要低收入家庭的儿童（幼儿园到四年级），他们被随机分配到公园和娱乐委员会运营的 SDC 或照常参加暑假（对照）。干预 每个工作日（周一至周五）进行一次 SDC，持续 8 至 10 周。主要结局和测量主要结局是放学前（5 月）和夏季返校时（8 月下旬）测量的 zBMI 变化的组间差异。二次分析检查了 zBMI 变化的剂量反应与父母报告的所有儿童在夏季参加 SDC 的情况（干预和对照）。结果共有 422 名儿童 （平均 [SD] 年龄，8.2 [1.5] 年;202 名 [48%] 女性，220 名 [52%] 男性，292 名 [69%] 处于或低于 200% 的联邦贫困线，127 名 [30%] 粮食不安全）被随机分配到 2 种情况中的 1 种：照常夏季（对照，n = 199）或免费 SDC（n = 223）。意向治疗分析表明，夏末 zBMI 的平均 （SE） 变化为对照组 0.046 （0.027），干预组为 -0.048 （0.025），组间差异显著 -0.094 （95% CI，-0.166 至 -0.022）。剂量反应分析表明，每周参加 SDC 的人数每增加 1 天，导致 -0.034 至 -0.018 zBMI 降低，这意味着从未参加暑期课程的儿童增加 0.046 至 0.080 zBMI，而每个工作日参加夏季课程的儿童减少 -0.09 至 -0.04 zBMI。结论和相关性为儿童提供免费访问现有社区暑期计划的机会可以对儿童在夏季的 zBMI 增长产生有意义的影响。未来的研究应该在不同地区复制这些发现，并确定减轻不健康的 zBMI 增益的最佳编程剂量。试验注册临床试验。gov 标识符： NCT04072549