***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION This study evaluated whether intervening with child care providers would increase physical activity ( PA )  and reduce adiposity in preschoolers . METHODS This was a two-arm , parallel group , cluster RCT whereby six child care centers were r and omly assigned in equal numbers to intervention ( n=40 children ) or control ( n=43 children ) . Participants were aged 3 - 5 years and attended licensed child care centers . Child care providers received two 3-hour train-the-trainer workshops and a training manual at program initiation aim ed at increasing structured and unstructured PA through active play . Control child care centers implemented their st and ard curriculum .  PA and sedentary behavior were measured by accelerometry , and body composition was measured using bioelectrical impedance at baseline and 6 months . Data were collected in 2011 - 2012 and analyzed in April 2015 . RESULTS Linear mixed-effects modeling showed that at 6 months , children in the intervention group demonstrated greater increases in minutes per preschool day spent in overall PA ( 22.5 minutes , 95 % CI=8.9 , 36.1 , p=0.002 ) , and light-intensity PA ( 16.1 minutes , 95 % CI=5.2 , 26.7 , p=0.004 ) , but changes between groups in moderate to vigorous PA did not differ . The intervention group showed greater reductions in body fat percentage ( -1.9 % , 95 % CI=-3.5 , -0.3 , p=0.023 ) and fat mass ( -0.3 kg , 95 % CI=-0.7 , -0.1 , p=0.018 ) , but groups did not differ on fat-free mass , BMI , or z- BMI . CONCLUSIONS Provider-led intervention in child care centers increased preschoolers '  PA and reduced adiposity , therefore may represent a viable approach to promoting PA and related health benefits in preschool-aged children . TRIAL REGISTRATION This study is registered at www . clinical trials.gov NCT02293278 BACKGROUND Sugar-sweetened beverages and maternal weight are strong drivers of child obesity , but few studies have targeted these risk factors as an obesity prevention strategy in children . OBJECTIVE The objective of this study was to test the efficacy of a smartphone-delivered intervention to reduce parent-provided  sugar-sweetened beverage and juice ( SSB/juice ) consumption among children ages 3 - 5 and maternal weight . METHODS Mothers with overweight or obesity , who had a child ages 3 - 5 that consumed at least 12 fl . oz./day of SSB/juice ( N = 51 dyads ) were r and omized to the Smart Moms  group that received one group session , lessons on a mobile website , and text messages , or to a waitlist control group . Mothers self-monitored their children 's beverages in addition to their own beverages , high-calorie foods , and weight . Assessment s at baseline , 3 , and 6 months included dietary recalls to measure SSB/juice intake and objective ly measured maternal weight . RESULTS Using linear mixed models controlling for baseline values , child age and race , there was a greater reduction in child SSB/juice in Smart Moms compared with control at 6 months ( -9.7 oz./day vs. 1.7 oz./day , p < .01 ) . Mothers in Smart Moms lost 2.4 kg at 6 months compared with a 0.9-kg gain in the control group ( p < .01 ) . CONCLUSIONS An intervention delivered using mHealth technologies can target mothers to change child dietary behaviours and improve maternal weight , which suggests a novel approach to family-based obesity prevention Background The primary aim of this study was to evaluate the effectiveness of an intervention to increase the implementation of healthy eating and physical activity policies and practice s by centre-based childcare services . The study also sought to determine if the intervention was effective in improving child dietary intake and increasing child physical activity levels while attending childcare . Methods A parallel group , r and omised controlled trial was conducted in a sample of 128 childcare services . Intervention strategies included provision of implementation support staff , securing executive support , staff training , consensus processes , academic detailing visits , tools and re sources , performance monitoring and feedback and a communications strategy . The primary outcome of the trial was the proportion of services implementing all seven healthy eating and physical activity policies and practice s targeted by the intervention . Outcome data were collected via telephone surveys with nominated supervisors and room leaders at baseline and immediately post-intervention . Secondary trial outcomes included the differences between groups in the number of serves consumed by children for each food group within the Australian Guide to Healthy Eating and in the proportion of children engaged in sedentary , walking or very active physical activity assessed via observation in a r and om sub sample of 36 services at follow-up . Results There was no significant difference between groups for the primary trial outcome ( p = 0.44 ) . Relative to the control group , a significantly larger proportion of intervention group services reported having a written nutrition and physical activity policy ( p = 0.05 ) and providing adult-guided activities to develop fundamental movement skills ( p = 0.01 ) . There were no significant differences between groups at follow-up on measures of child dietary intake or physical activity . Conclusions The findings of the trial were equivocal . While there was no significant difference between groups for the primary trial outcome , the intervention did significantly increase the proportion of intervention group services implementing two of the seven healthy eating and physical activity policies and practice s. High levels of implementation of a number of policies and practice s at baseline , significant obesity prevention activity in the study region and higher than previously reported intra-class correlation of child behaviours may , in part , explain the trial findings .Trial registration Australian Clinical Trials Registry ( reference ACTRN12612000927820 ) BACKGROUND The prevalence of obesity in the United States is a significant public health problem . Many obesity-related risk factors are more prevalent in minority population s. Given the recalcitrant nature of weight loss interventions for adults , prevention of overweight and obesity has become a high priority . The present study reports baseline data from an obesity prevention intervention developed for minority preschool children . METHODS Hip-Hop to Health Jr. is a 5-year r and omized controlled intervention that targets 3- to 5-year-old minority children enrolled in 24 Head Start programs . Our primary aim is to test the effect of the intervention on change in body mass index . Data were collected on sociodemographic , anthropometric , behavioral , and cognitive variables for the children and parents at baseline . RESULTS Participants included 416 black children , 337 black parents , 362 Latino children , and 309 Latino parents . Using body mass index for age and sex > or = the 95th percentile as the definition of overweight , 15 % of the black children and 28 % of the Latino children were overweight . More than 75 % of the parents were either overweight or obese . DISCUSSION The development of interventions to effectively prevent or control obesity early in life is crucial . These data highlight the escalating problem of weight control in minority population Background Little is known about preschool-aged children ’s levels of  physical activity ( PA ) over the course of the day . Using time-stamped data , we describe the levels and patterns of PA in a population -based sample of four-year-old British children . Methods Within the Southampton Women ’s Survey the PA levels of 593 4-year-old children ( 51 % female ) were measured using ( Actiheart ) accelerometry for up to 7 days . Three outcome measures : minutes spent sedentary ( < 20 cpm ) ; in light ( LPA : ≥20 – 399 cpm ) and in moderate-to-vigorous activity ( MVPA : ≥400 cpm ) were derived . Average daily activity levels were calculated and then segmented across the day ( morning , afternoon and evening ) . MVPA was log-transformed . Two-level r and om intercept models were used to analyse associations between activity level and temporal and demographic factors . Results Children were active for 67 % ( mean 568.5 SD 79.5 minutes ) of their daily registered time on average , with 88 % of active time spent in LPA . All children met current UK guidelines of 180 minutes of daily activity . There were no differences in children ’s average daily levels of sedentary activity and LPA by temporal and demographic factors : differences did emerge when activity was segmented across the day . Sex differences were largest in the morning , with girls being more sedentary , spending fewer minutes in LPA and 18 % less time in MVPA than boys . Children were more sedentary and less active ( LPA and MVPA ) in the morning if they attended childcare full-time compared to part-time , and on weekend mornings compared to weekdays . The reverse was true for weekend afternoons and evenings . Children with more educated mothers were less active in the evenings . Children were less sedentary and did more MVPA on summer evenings compared to winter evenings . Conclusions Preschool-aged children meet current physical activity guidelines , but with the majority of their active time spent in LPA , investigation of the importance of activity intensity in younger children is needed . Activity levels over the day differed by demographic and temporal factors , highlighting the need to consider temporality in future interventions . Increasing girls ’ morning activity and providing opportunities for daytime activity in winter months may be worthwhile Background There is considerable scope to improve the delivery of practice s that increase the physical activity of children in centre based childcare services . Few studies have reported the effectiveness of interventions to address this , particularly at a population level . The primary aim of this study was to describe the impact of an intervention to increase the adoption of multiple policies and practice s to promote physical activity in centre based childcare services . Methods A quasi experimental study was conducted in centre based childcare services ( n = 228 ) in New South Wales ( NSW ) , Australia and involved a three month intervention to increase the adoption of eight practice s within childcare services that have been suggested to promote child physical activity . Intervention strategies to support the adoption of practice s included staff training , re sources , incentives , follow-up support and performance monitoring and feedback .  R and omly selected childcare services in the remainder of NSW acted as a comparison group ( n = 164 ) and did not receive the intervention but may have been exposed to a concurrent NSW government healthy eating and physical activity initiative . Self reported information on physical activity policies , fundamental movement skills sessions , structured physical activity opportunities , staff involvement in active play and provision of verbal prompts to encourage physical activity , small screen recreation opportunities , sedentary time , and staff trained in physical activity were collected by telephone survey with childcare service managers at baseline and 18 months later . Results Compared with the comparison area , the study found significantly greater increases in the prevalence of intervention services with a written physical activity policy , with policy referring to placing limits on small screen recreation , and with staff trained in physical activity . In addition , non-significant trends towards a greater increase in the proportion of intervention services conducting daily fundamental movement skill sessions , and such services having a physical activity policy supporting physical activity training for staff were also evident . Conclusion The intervention was effective in improving a number of centre based childcare service policies and practice s associated with promoting child physical activity . Adoption of a broader range of practice s may require more intensive and prolonged intervention support OBJECTIVE Determine whether Color Me Healthy ( CMH ) , an interactive nutrition and physical activity program for preschool children , increases fruit and vegetable consumption . DESIGN Intervention study . Data were collected at baseline , 1 week post-intervention , and 3 months post-intervention . SETTING Child care centers . PARTICIPANTS Preschool children ( n = 263 ) in 17 child care centers . INTERVENTION Child care centers were r and omly assigned to 1 of 2 conditions ; children ( n = 165 ) in 10 centers received the CMH curriculum , and children ( n = 98 ) in 7 centers acted as comparisons and did not receive the curriculum . MAIN OUTCOME MEASURES Process and outcome evaluation . Consumption of fruit and vegetable snacks . ANALYSIS Data were analyzed using repeated- measures analysis of variance and hierarchical linear modeling . RESULTS Children who received CMH significantly increased their consumption of fruit snacks by approximately 20.8 % and vegetable snacks by approximately 33.1 % between baseline assessment and the assessment conducted 3 months after the completion of the CMH program . Hierarchical linear modeling determined that group assignment ( ie , CMH or control ) was the only significant predictor of fruit and vegetable consumption . CONCLUSIONS AND IMPLICATION S Findings suggest that CMH may be used in child care setting s for developing healthful eating habits BACKGROUND The Child Health Initiative for Lifelong Eating and Exercise is a multicomponent obesity-prevention intervention , which was evaluated among Head Start ( HS ) centers in American Indian and predominantly Hispanic communities in rural New Mexico . This study examines the intervention 's foodservice outcomes : fruits , vegetables , whole grains , discretionary fats , added sugars , and fat from milk served in meals and snacks . METHODS Sixteen HS centers were r and omized to intervention/comparison groups , following stratification by ethnicity and preintervention median body mass index of enrolled children . The foodservice component included quarterly trainings for foodservice staff about food purchasing and preparation . Foods served were evaluated before and after the 2-year intervention , in the fall 2008 and spring 2010 . RESULTS The intervention significantly decreased fat provided through milk and had no significant effect on fruit , vegetables and whole-grain servings , discretionary fats , and added sugar served in HS meals and snacks . When effect modification by site ethnicity was examined , the effect on fat provided through milk was only found in American Indian sites . CONCLUSIONS Foodservice interventions 
    Output:
    
It is uncertain whether the strategies tested improved the implementation of policies , practice s or programmes that promote child healthy eating , physical activity and /or obesity prevention .
No intervention improved the implementation of all policies and practice s targeted by the implementation strategies relative to a comparison group .
Current research provides weak and inconsistent evidence of the effectiveness of such strategies in improving the implementation of policies and practice s , childcare service staff knowledge or attitudes , or child diet , physical activity or weight status .