Setting: Early Care and Education & Out-of-School Time

Strategy Report: New Opportunities for Healthy Afterschool Programs

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Suggested Citation

CHOICES National Action Kit: New Opportunities for Healthy Afterschool Programs Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Dar Alon, Stella Zhu, Shilpi Agarwal, Ana Paula Bonner Septien, Stephanie McCulloch, Jenny Reiner, Matt Lee, Zach Ward.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

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Strategy Report: Creating Healthier Early Care and Education Environments

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Suggested Citation

Barrett JL, Bolton AA, Gortmaker SL, Cradock AL. CHOICES National Action Kit: Creating Healthier Early Care and Education Environments Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Dar Alon, Stella Zhu, Shilpi Agarwal, Ana Paula Bonner Septien, Stephanie McCulloch, Jenny Reiner, Matt Lee, Zach Ward.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

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Strategy Report: Policy to Reduce TV Time in Early Care and Education Settings

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Suggested Citation

Barrett JL, Bolton AA, Gortmaker SL, Cradock AL. CHOICES National Action Kit: Policy to Reduce TV Time in Early Care and Education Settings Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Banapsha Rahman, Ya Xuan Sun, Shilpi Agarwal, Ana Paula Bonner Septien, Stephanie McCulloch, Jenny Reiner, Matt Lee, Zach Ward.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

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Strategy Report: More Movement in Early Care and Education Settings

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Suggested Citation

CHOICES National Action Kit: More Movement in Early Care and Education Settings Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Dar Alon, Stella Zhu, Shilpi Agarwal, Ana Paula Bonner Septien, Jenny Reiner, Matt Lee, Zach Ward.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

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Strategy Report: Program in Early Care and Education Settings to Reduce TV Viewing

Teacher playing with kids

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Suggested Citation

CHOICES National Action Kit: Program in Early Care and Education Settings to Reduce TV Viewing Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Banapsha Rahman, Ya Xuan Sun, Shilpi Agarwal, Ana Paula Bonner Septien, Jenny Reiner, Matt Lee, Zach Ward.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

← Back to Resources

Strategy Report: Creating Healthier Afterschool Environments

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Suggested Citation

CHOICES National Action Kit: Creating Healthier Afterschool Environments Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Dar Alon, Stella Zhu, Shilpi Agarwal, Ana Paula Bonner Septien, Jenny Reiner, Matt Lee, Zach Ward.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

← Back to Resources

Exploring the Cost-Effectiveness of Strategies to Improve Child Health in Boston, MA

The information in this brief is intended only to provide educational information.

The CHOICES Project at the Harvard T.H. Chan School of Public Health and the Boston Public Health Commission (BPHC) worked together as part of the Massachusetts-CHOICES Project (2019 – 2024), a training, technical assistance, and modeling initiative, to develop a playbook of strategies to promote healthy weight and advance health equity in addition to studying how cost-effectiveness metrics are used by partners throughout the state.

Methods & Strategies Modeled

CHOICES cost-effectiveness analysis examines: How many and what types of people would be affected by the policy or program? What the effect of the policy or program would be on health? What will be the implementation costs and the potential health care cost savings? How could the policy or program reduce health disparities and improve health equity?CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics.

Using CHOICES cost-effectiveness analysis and local data, the BPHC team worked with CHOICES to create a virtual population that mirrors the current population of Boston, MA. Then, the teams examined the expected costs, health outcomes, and health care costs saved if the following strategies were implemented in Boston, Massachusetts over a 10-year timeframe (2020-2029):

Reducing Screen Time in Early Child Care Settings
More Movement Program in Early Child Care Settings
Home Visits to Reduce Screen Time
Movement Breaks in the Classroom
Creating Healthier Afterschool Environments (OSNAP)

Reducing Screen Time in Early Child Care Settings

The strategy to reduce screen time in early child care settings involves providing voluntary training to early child care educators and resources to families to limit noneducational television time at child care and home. This strategy could support Boston’s efforts to improve early child care quality through the Boston Healthy Child Care Initiative. It would include training opportunities for early child care educators, offering ongoing support and technical assistance, and providing parents with educational materials that may lead to reducing screen time in young children.1,2

Helping educators to implement practices shown to be effective in reducing television time can help the children in Boston’s early education and care settings engage in fewer minutes of screen time.

Implementing a strategy to reduce screen time in early child care settings is an investment in the future. By the end of 2029: 18,200 children reached over 10 years; 33 fewer minutes of screen time per child per day; $16 per child per year

Additional Key Findings

If a strategy to reduce screen time in early child care settings was implemented in Boston, 125 cases of obesity would be prevented in 2029, saving $138,000 in health care costs over 10 years.

In addition, this strategy would train and provide technical assistance to early childhood educators on reducing screen time. In the initial training series, this strategy would provide additional skills training and professional development for 1,380 educators and more opportunities to reduce screen time in 570 (100%) child care programs serving 3-5 year olds.

To learn more about this strategy, read the research brief.

  • Bovenzi M, Carter S, Sabir M, Bolton AA, Barrett JL, Reiner JF, Cradock AL, Gortmaker SL. Boston, MA: Reducing Screen Time in Early Child Care Settings {Issue Brief}. Boston Public Health Commission and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2023.
References

1. Mendoza JA, Baranowski T, Jaramillo S, et al. Fit 5 Kids TV Reduction Program for Latino Preschoolers: A Cluster Randomized Controlled Trial. American Journal of Preventive Medicine. 2016;50(5):584-592.<
2. Dennison BA, Russo TJ, Burdick PA, Jenkins PL. An intervention to reduce television viewing by preschool children. Archives of Pediatrics and Adolescent Medicine. 2004;158(2):170-176.

More Movement Program in Early Child Care Settings

The more movement program provides training opportunities and resources for early child care educators to implement actions in their programs to encourage physical activity. This strategy could support Boston’s efforts to improve early child care quality through the Boston Healthy Child Care Initiative. It would include training opportunities for early child care educators in physical activity curricula, provide resources and instructional materials, and support technical assistance opportunities that may lead to higher physical activity levels among young children.1,2

Helping educators implement practices shown to be effective in increasing physical activity can help the children in Boston’s early education and care settings to move more.

Implementing the more movement program in early child care settings is an investment in the future. By the end of 2029: 18,200 children reached over 10 years; 7.4 additional minutes of moderate-to-vigorous physical activity per child per day; $16 per child per year

Additional Key Findings

If the more movement program in early child care settings was implemented in Boston, 94 cases of obesity would be prevented in 2029, saving $104,000 in health care costs over 10 years. Besides promoting a healthy weight, increasing physical activity is linked to improved bone and muscular health and better gross motor skills in young children.3-5

In addition, this strategy would train and provide technical assistance to early childhood educators. In the initial training series, the more movement program would provide additional skills training and professional development for 1,380 educators and more physical activity promotion opportunities in 570 (100%) child care programs serving 3-5 year olds.

To learn more about this strategy, read the research brief.

  • Bovenzi M, Carter S, Sabir M, Bolton AA, Barrett JL, Reiner JF, Cradock AL, Gortmaker SL. Boston, MA: More Movement Program in Early Child Care Settings {Issue Brief}. Boston Public Health Commission and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2023.
References

1. Fitzgibbon ML, Stolley MR, Schiffer LA, et al. Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: Postintervention Results. Obesity (Silver Spring). 2011;19(5):994-1003.
2. Kong A, Buscemi J, Stolley MR, Schiffer LA, Kim Y, Braunschweig CL, Gomez-Perez SL, Blumstein LB, Van Horn L, Dyer AR, Fitzgibbon ML. Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results. American Journal of Preventive Medicine. 2016 Feb;50(2):136-44.
3. U.S. Dept of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. U.S. Dept of Health and Human Services; 2018. Accessed Jul 23, 2021. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
4. Pate RR, Hillman CH, Janz KF, et al. Physical Activity and Health in Children Younger than 6 Years: A Systematic Review. Medicine & Science in Sports & Exercise. 06 2019;51(6):1282-1291.
5. Timmons BW, Leblanc AG, Carson V, et al. Systematic review of physical activity and health in the early years (aged 0-4 years). Applied Physiology, Nutrition, and Metabolism. Aug 2012;37(4):773-92.

Home Visits to Reduce Screen Time

The home visits to reduce screen time strategy aims to reduce the amount of screen time viewed at home by young children. Community health workers would provide counseling and resources on strategies to limit children’s screen time to children and families who participate in home visiting programs.

Through professional development training opportunities, community health workers would learn ways to support families and children in limiting their screen time. During a home visit, community health workers would share the importance of appropriate screen time limits and provide strategies and tools for families to use, including a screen time management device. Integrating this strategy through existing home visiting programs could help more children manage their screen time and grow up at a healthy weight.1Implementing the home visits to reduce screen time strategy is an investment in the future. By the end of 2029: 3,320 children reached over 10 years; 1.8 fewer hours of screen time per child per day; $44,600 saved in health care costs over 10 years

Additional Key Findings

If the home visits to reduce screen time strategy was implemented in Boston, 60 cases of childhood obesity would be prevented in 2029. Besides promoting a healthy weight, this strategy may also benefit children in other ways. Providing children and their families with strategies to move away from their screens allows for more time for activities like reading and active play.

By training and equipping 119 community health workers annually by ensuring that everyone has access to what they need to grow up healthy and strong, this strategy could help reach those families and children that may be at higher risk of having or developing obesity. Children in households with low income could see greater health benefits from this strategy.1

To learn more about this strategy, read the research brief.

  • Carter S, Bovenzi M, Sabir M, Bolton AA, Reiner JR, Barrett JL, Cradock AL, Gortmaker SL. Boston, MA: Home Visits to Reduce Screen Time {Issue Brief}. Boston Public Health Commission, Boston, MA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; February 2023.
References

1. Epstein LH, Roemmich JN, Robinson JL, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. Mar 2008;162(3):239-45. doi:10.1001/archpediatrics.2007.45

Movement Breaks in the Classroom

Movement breaks in the classroom is a strategy to promote physical activity during the school day by incorporating five-to-10-minute movement breaks in K-5 public elementary school classrooms. To implement the movement breaks strategy in Boston, teachers, Wellness Champions, and staff would receive training, equipment, and materials to incorporate short activity breaks in the classroom to help children move more.1,2

This aligns with Boston Public School’s (BPS) Physical Education and Physical Activity Policy that requires schools to offer physical activity opportunities during the school day,3 as well as BPS’ Whole School, Whole Community, Whole Child approach, which supports students’ holistic health by promoting positive classroom environments that foster physical activity and learning.

Implementing movement breaks in the classroom is an investment in the future. By the end of 2029: 29,400 students reached over 10 years; 25 additional minutes of moderate-to-vigorous physical activity per student per school week; $1.74 per child per year

Additional Key Findings

If movement breaks were incorporated into classrooms in Boston, 37 cases of childhood obesity would be prevented in 2029 and save $35,300 in health care costs related to excess weight over 10 years.

By training and equipping over 600 teachers and other school staff yearly to incorporate movement breaks in the classroom, this strategy could help all Boston Public Schools cultivate a positive school climate and improve social emotional learning.4 Participation in movement breaks are associated with students spending more time on task,5 and teachers report that students are more engaged, supportive of each other, and responsive to teacher instructions after participating in a movement break.6

To learn more about this strategy, read the research brief.

  • Carter J, Greene J, Neeraja S, Bovenzi, M, Sabir M, Carter S, Bolton AA, Barrett JL, Reiner JR, Cradock AL, Gortmaker SL. Boston, MA: Movement Breaks in the Classroom {Issue Brief}. Boston Public Schools, Boston Public Health Commission, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; August 2022.
References

1. Erwin HE, Beighle A, Morgan CF, Noland M. Effect of a low-cost, teacher-directed classroom intervention on elementary students’ physical activity. J Sch Health. 2011;81(8):455-461.
2. Murtagh E, Mulvihill M, Markey O. Bizzy Break! The effect of a classroom-based activity break on in-school physical activity levels of primary school children. Pediatr Exerc Sci. 2013;25(2):300-307.
3. Boston Public Schools. Physical Education & Physical Activity Policy. 2020:8. Superintendent’s Circular. https://drive.google.com/file/d/1rSGwpFaa4LsPKxjhdsHxz2IaXg3ZFVtE/view?usp=embed_facebook
4. School-Based Physical Activity Improves the Social and Emotional Climate for Learning. Centers for Disease Control and Prevention,. Accessed March 9, 2022. https://www.cdc.gov/healthyschools/school_based_pa_se_sel.htm
5. The Community Preventive Services Task Force. Physical Activity: Classroom-based Physical Activity Break Interventions. The Community Guide. 2021:8.
Campbell AL, Lassiter JW. Teacher perceptions of facilitators and barriers to implementing classroom physical activity breaks. J Educ Res. 2020;113(2):108-119

 

Creating Healthier Afterschool Environments (OSNAP)

The Out of School Nutrition and Physical Activity (OSNAP) initiative helps afterschool programs improve practices and policies that increase physical activity and consumption of healthy snacks.

To implement this initiative, the Boston Public Health Commission would provide professional development opportunities for afterschool program leaders serving students in grades K-5. Afterschool staff leaders would participate in three learning collaborative sessions and receive technical assistance to assess1 and modify their programs’ practices and policies2  to meet the OSNAP nutrition and physical activity goals.

Creating healthier afterschool environments is an investment in the future. By the end of 2029: 10,800 children reached over 10 years; $34,100 saved in health care costs in 2029; $18.30 per child per year

Additional Key Findings

If the OSNAP initiative was implemented in Boston, 37 cases of obesity would be prevented in 2029. It is also projected to be cost-effective at commonly accepted thresholds3 based on net population health improvement related to excess weight ($72,100 per quality-adjusted life year gained).

This strategy may also support children’s health in a variety of other ways. Regular physical activity, healthy eating, and adequate hydration can improve children’s mental and emotional well-being and their heart, lung, and bone health.4 These healthy behaviors can also strengthen students’ attention, memory,5,6 and cognitive functioning,5 all important components for learning and academic performance.

To learn more about this strategy, read the research brief.

  • Carter S, Bovenzi M, Clarke J, Bolton AA, Reiner JF, Barrett JL, Cradock AL, Gortmaker SL. Boston, MA: Creating Healthier Afterschool Environments (OSNAP) {Issue Brief}. Boston Public Health Commission, Massachusetts, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; July 2023.
References

1. Lee RM, Emmons KM, Okechukwu CA, Barrett JL, Kenney EL, Cradock AL, Giles CM, deBlois ME, Gortmaker SL. Validity of a practitioner-administered observational tool to measure physical activity, nutrition, and screen time in school-age programs. Int J Behav Nutr Phys Act. 2014 Nov 28;11:145. doi: 10.1186/s12966-014-0145-5.
2. Kenney EL, Giles CM, deBlois ME, Gortmaker SL, Chinfatt S, Cradock AL. Improving nutrition and physical activity policies in afterschool programs: results from a group-randomized controlled trial. Prev Med. 2014;66:159-166. doi:10.1016/j.ypmed.2014.06.011
3. Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness–the curious resilience of the $50,000-per-QALY threshold. New England Journal of Medicine. 2014 Aug 28;371(9):796-7. DOI: 10.1056/NEJMp1405158. PMID: 25162885.
4. Health Benefits of Physical Activity for Children. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/adults/health-benefits-of-physical-activity-for-children.html. Published Jan 12, 2022. Updated 2022-01-12T05:06:09Z. Accessed Dec 7, 2022.
5. Childhood Nutrition Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyschools/nutrition/facts.htm. Published 2022. Updated 2022-08-05T03:49:26Z. Accessed Dec 12, 2022.
6. Blanding N. Afterschool Programs in Boston, MA, Expand Opportunities for Obesity Prevention. Centers for Disease Control and Prevention; 2016. http://nccd.cdc.gov/nccdsuccessstories


The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This document was developed at the Harvard T.H. Chan School of Public Health through the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This document is intended for educational use only. This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

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Explore and compare these strategies and more using the CHOICES National Action Kit 2.0!

Strategy Profile: New Opportunities for Healthy Afterschool Programs

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Providing school-age children in grades K-5 attending Title I public schools with free state-administered afterschool programs that include 80 minutes of physical activity, a healthy snack, academic enrichment, and homework assistance.

What population benefits?

Children in grades K-5 who experience low income and are not currently participating in afterschool programs but would if programs were available.

What are the estimated benefits?

Relative to not implementing the strategy
Increase moderate-to-vigorous physical activity and, in turn, promote healthy child weight.

What are the additional benefits?

Relative to not implementing the strategy
The costs of implementing this strategy could be offset by savings from…
↓ Decrease in time cost of parent, relative, and non-relative caregivers to provide care for children newly attending afterschool programming

What activities and resources are needed?

Activities Resources Who Leads?
Administer funding and coordinate afterschool programming • Time of federal and state directors to lead administration and funding of afterschool programs in each state
• Time of federal, state, and district coordinators to coordinate afterschool programming and funding
Federal and state directors
Coordinate transportation for children attending afterschool programs • Time of district transportation coordinator School district transportation coordinator
Train afterschool program site directors and staff and school district food service directors to operate the afterschool programs Time of state physical activity training facilitator to lead annual trainings
• Time for afterschool program site directors and staff (teachers and paraprofessionals) to attend annual trainings
• Time for school district food service directors to attend annual trainings on operating a healthy afterschool snack program
State physical activity training facilitator
Purchase physical activity curricula, equipment, and materials for operating afterschool programs • Cost of physical activity curricula and equipment
• Cost of afterschool program handbook provided to families
School district coordinator
Provide afterschool snacks that meet USDA afterschool snack program guidelines from the National School Lunch Program or the Child and Adult Care Food Program • Cost of snacks School district food service director
Provide afterschool programming • Time of afterschool program site director
• Time of afterschool program staff (teachers and paraprofessionals)
• Time of school custodial staff to clean afterschool program space
Afterschool program site director
Provide transportation home from afterschool programs • Cost of bus transportation School district transportation coordinator

FOR ADDITIONAL INFORMATION

Cradock AL, Barrett JL, Kenney EL, Giles CM, Ward ZJ, Long MW, Resch SC, Pipito AA, Wei ER, Gortmaker SL. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Prev Med. 2017 Feb;95 Suppl: S17-S27. doi: 10.1016/j.ypmed.2016.10.017. Supplemental Appendix with strategy details available at: https://ars.els-cdn.com/content/image/1- s2.0-S0091743516303395-mmc1.docx


Suggested Citation

CHOICES Strategy Profile: New Opportunities for Healthy Afterschool Programs. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2023.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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Strategy Profile: Policy to Reduce TV Time in Early Care and Education Settings

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Policy to limit noneducational television time in licensed early care and education (ECE) programs to 30 minutes per week for young children ages 2-5.

What population benefits?

Children ages 2-5 who attend licensed early care and education programs.

What are the estimated benefits?

Relative to not implementing the strategy
Reduce child daily television time which can help promote healthy child weight.

What activities and resources are needed?

Activities Resources Who Leads?
Assess compliance with new policy to limit television time to no more than 30 minutes per week • Time for state licensor to assess compliance with new policy during monitoring visit
• Time for early care and education directors to participate in monitoring visit
State early care and education licensing agency
Provide materials and equipment for promoting physical activity (such as CDs with activity-promoting music and templates for parent newsletters) • Time for state licensor to provide technical assistance related to policy to limit television time
• Time for early care and education directors to receive technical assistance related to policy
State early care and education licensing agency
Produce educational materials about new policy for early care and education directors • Cost of educational materials State early care and education licensing agency
Strategy Modification

This strategy could be implemented at the state or local level through different mechanisms, including as a requirement for early care and education (ECE) programs participating in a state’s Quality Rating and Improvement System (QRIS) or as best practice recommendations for ECE providers issued by a local health department or via a resolution from a local board of health, alone or in combination with other health-related objectives. Using these mechanisms, the impact on health and the activities and resources needed to carry out the television time policy are expected to be similar, however the cost and reach may vary.


FOR ADDITIONAL INFORMATION

Kenney EL, Mozaffarian RS, Long MW, Barrett JL, Cradock AL, Giles CM, Ward ZJ, Gortmaker SL. Limiting television to reduce childhood obesity: cost-effectiveness of five population strategies. Child Obes. 2021 Oct;17(7):442-448. doi: 10.1089/chi.2021.0016.

Selected CHOICES research brief including cost-effectiveness metrics:

Grant T, Wiggins C, Shelson S, Cradock AL, Gortmaker SL, Pipito A, Kenney EL, Giles CM. Mississippi: State Regulations to Reduce Non-Educational Screen Time for Young Children in Licensed Care {Issue Brief}. Mississippi State Department of Health, Jackson, MS, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; April, 2017. Available at: https://choicesproject.org/publications/brief-state-regulations-screen-time-mississippi

Case S, Simpson K, Khan F, U’ren S, Giles C, Kenney EL, Flax CN, Gortmaker SL, Ward ZJ, Cradock AL. Oklahoma: Updated Requirements in Reaching for the Stars to Reduce Non-Educational Screen Time for Young Children in Family Child Care Homes {Issue Brief}. Oklahoma State Department of Health and Oklahoma State Department of Human Services, Oklahoma City, OK, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2017. Available at: https://choicesproject.org/publications/brief-ece-screen-time-oklahoma

Pharis M, Lawman H, Root M, Dryden S, Wagner A, Bettigole C, Mozaffarian, RS, Kenney EL, Cradock AL, Gortmaker SL, Giles CM, Ward ZJ. Philadelphia, PA: Childcare Policies Can Build a Better Future {Issue Brief}. Philadelphia Department of Public Health, Philadelphia, PA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2017. Available at: https://choicesproject.org/publications/brief-screen-time-philadelphia

Hill AB, Mozaffarian RS, Barrett JL, Cradock AL. Detroit: Best Practice Guidelines for Healthy Childcare {Issue Brief}. Detroit Health Department and United Way for Southeastern Michigan, Detroit, MI, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2019. Available at: https://choicesproject.org/publications/brief-ece-detroit


Suggested Citation

CHOICES Strategy Profile: Policy to Reduce TV Time in Early Care and Education Settings. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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Strategy Profile: Program in Early Care and Education Settings to Reduce TV Viewing

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Program to reduce television viewing among young children ages 2-5 in licensed early care and education centers by training educators in an evidence-based curriculum and engaging families in reducing television time at home

What population benefits?

Children ages 2-5 attending licensed early care and education centers.

What are the estimated benefits?

Relative to not implementing the strategy
Reduce child daily television time which can help promote healthy child weight.

What activities and resources are needed?

Activities Resources Who Leads?
Train early care and education directors and staff on an evidence-based curriculum (Fit5Kids) to reduce television time • Time for state early care and education agency training consultant to prepare for and lead trainings
• Time for early care and education program directors and staff to attend trainings
• Travel costs
State early care and education training consultant
Provide training materials for early care educators and administrators to engage children and families in reducing television time • Cost of training materials State government
Provide materials to children and families to promote reduced TV time • Cost of materials for children and families
• Cost of the book “The Berenstain Bears and Too Much TV”
Early care and education programs

FOR ADDITIONAL INFORMATION

Kenney EL, Mozaffarian RS, Long MW, Barrett JL, Cradock AL, Giles CM, Ward ZJ, Gortmaker SL. Limiting television to reduce childhood obesity: cost-effectiveness of five population strategies. Child Obes. 2021 Oct;17(7):442-448. doi: 10.1089/ chi.2021.0016.


Suggested Citation

CHOICES Strategy Profile: Program in Early Care and Education Settings to Reduce TV Viewing. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

← Back to Resources