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Background  There is an urgent need for scaled-up effective interventions which overcome barriers to health-enhancing physical activity for children and adolescents. In New South Wales (NSW), Australia, the state government implemented a universal voucher program, ‘Active Kids’ to support the cost of structured physical activity registration for school-enrolled children aged 4.5–18 years old. The objective of this study was to understand the effects a financial incentive intervention delivered in a real-world setting has on children and adolescent’s physical activity participation.    Method  In 2018, all children and adolescents registered for an Active Kids voucher provided sociodemographic characteristics, physical activity and research consent. This prospective cohort study used an online survey with validated items to measure physical activity and other personal and social factors in children and adolescents who used an Active Kids voucher. Generalized linear mixed models were used to examine changes from registration to after voucher use at ≤8 weeks, 9–26 weeks and ≥ 6 months.    Results  Study participants reported increasing their days achieving physical activity guidelines from 4.0 days per week (95%CI 3.8, 4.2) at registration ( n  = 37,626 children) to 4.9 days per week (95%CI 4.7, 5.1) after 6 months ( n  = 14,118 children). Increased physical activity was observed for all sociodemographic population groups. The voucher-specific activity contributed 42.4% (95%CI 39.3, 45.5) to the total time children participated in structured physical activities outside of school. Children and adolescents who increased to, or maintained, high levels of activity were socially supported to be active, had active parent/caregivers, had better concentration and were overall happier than their low-active counterparts.    Conclusion  The Active Kids program significantly increased children’s physical activity levels and these increases continued over a six-month period. The Active Kids voucher program shows promise as a scaled-up intervention to increase children and adolescents’ physical activity participation.    Trial registration  Australian New Zealand Clinical Trial Registry  ACTRN12618000897268 , approved May 29th, 2018 - Retrospectively registered.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12889-020-10060-5.

Effects of the Active Kids voucher program on children and adolescents’ physical activity: a natural experiment evaluating a state-wide intervention