Setting: School

Strategy Profile: Promoting Water Consumption in Schools

Posted on August 30, 2023

School-aged girl drinking water from a reusable water bottle

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.

  • Promoting increased water consumption among elementary and middle school students (grades K-8) with the installation of chilled drinking water dispensers in school cafeterias with viable plumbing in schools that participate in the National School Lunch Program.

What population benefits?

Children in grades K-8 attending schools with viable plumbing that participate in the National School Lunch Program.

What are the estimated benefits?

Relative to not implementing the strategy
Increase the availability of safe, free drinking water in schools. In turn, this would increase child water consumption and promote healthy child weight.

What activities and resources are needed?

Activities Resources Who Leads?
Purchase and install chilled water dispensers • Staffing resources necessary for installing water dispensers
• Costs associated with purchasing water dispensers		 School personnel
Deliver training to school food service directors in cleaning and maintaining the chilled water dispensers • Time to develop online training and materials
• Time for food service directors to access and attend online training		 School district food service staff
Maintain and clean water dispensers • Time for food service staff to clean water dispensers
• Cost of water dispenser filter replacement
• Time for food service staff to replace filters		 School food service staff
Increase utilities and disposable cup usage • Cost of incremental increase in water and electricity usage
• Cost of increased disposable cup usage		 Schools
Test lead levels in drinking water and remediate issues • Cost of lead testing and remediation for school drinking water Schools
Conduct administrative review related to drinking water • Time for the school district food service director to participate in administrative review
• Time for the National School Lunch Program administrator to conduct administrative review		 State government
Strategy Modification

Some state and local health agencies added to this strategy the costs of developing and disseminating educational materials on water consumption to further encourage water consumption among students. This would require additional time to develop and disseminate the educational materials and the additional cost of the educational materials.

FOR ADDITIONAL INFORMATION
Kenney EL, Cradock AL, Long MW, Barrett JL, Giles CM, Ward ZJ, Gortmaker SL. CostEffectiveness of Water Promotion Strategies in Schools for Preventing Childhood Obesity and Increasing Water Intake. Obesity. 2019;27(12):2037-2045. doi:10.1002/oby.22615.

Selected CHOICES research brief including cost-effectiveness metrics:
Gouck J, Whetstone L, Walter C, Pugliese J, Kurtz C, Seavey-Hultquist J, Barrett J, McCulloch S, Reiner J, Cradock AL. California: Improving Drinking Water Equity and Access in California Schools {Issue Brief}. California Department of Public Health, Sacramento, CA, the County of Santa Clara Public Health Department, San Jose, CA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2021. Available at: https://choicesproject.org/publications/brief-water-schools-california

McCulloch SM, Barrett JL, Reiner JF, Cradock AL. Massachusetts: Water Dispensers in Schools {Issue Brief}. The CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; June 2023. Available at: https://choicesproject.org/publications/brief-water-dispensers-ma

Suggested Citation

CHOICES Strategy Profile: Promoting Water Consumption in Schools. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; April 2022; revised August 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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Brief: Water Dispensers in Massachusetts Schools

Posted on June 28, 2023

Water fountain and filling station on a wall in a school

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

This brief summarizes a CHOICES Learning Collaborative Partnership model examining a strategy to improve access to drinking water in schools in Massachusetts. This strategy involves the installation of touchless chilled water dispensers on or near school cafeteria lunch lines in K-8 public schools with adequate plumbing.

The Issue

All students should have access to safe, clean, and appealing drinking water, no matter where they go to school. Yet, nearly half of K-8 public schools in Massachusetts have identified elevated concentrations of lead in their drinking water and need to improve their drinking water infrastructure.1

Providing access to appealing drinking water gives students a healthier alternative to sugary drinks, like sweetened fruit drinks, sports drinks, and soda. In 2021, most adolescents in Massachusetts reported consuming sugary drinks,2 which has been linked to excess weight gain, type 2 diabetes, and heart disease.3,4 Students drink more water when schools provide access to water at lunch at no charge,5 and improving school water access may help kids grow up at a healthy weight.6,7 Creating a healthy, equitable school environment with appealing drinking water access can help set children up for a healthy future.

About the Water Dispensers in Schools Strategy

This strategy applied an equity lens to increasing water access by installing touchless water dispensers on or near school cafeteria lunch lines in K-8 Massachusetts public schools with identified needs. Priority schools would be those with elevated concentrations of lead in drinking water documented via state lead testing programs1 and located in cities and towns with Environmental Justice designation based on the community’s share of households with lower incomes, limited English proficiency, or individuals identifying as Black, Indigenous, or people of color.8 Better drinking water access in schools has been shown to increase water intake and may help promote a healthy weight.6 The Massachusetts Departments of Public Health and Elementary and Secondary Education would provide outreach to school districts to encourage the installation of water dispensers through existing relationships. Putting this strategy into place would require resources for administering the program, installing and maintaining dispensers, utility costs, disposable cup provision, and lead testing and remediation.

Comparing Costs and Outcomes

A CHOICES cost-effectiveness analysis compared the costs and outcomes of installing touchless water dispensers in schools with the costs and outcomes associated with not implementing the voluntary water equity and access program over 10 years (2020-2029).

The installation of touchless water dispensers in schools in Massachusetts is an investment in a more equitable future. By the end of 2029:
If touchless water dispensers were installed in schools in Massachusetts, then by the end of 2029, 265,000 students would be reached with improved access to safe drinking water in schools over 10 years and 129,000 of these students would be Black and Latinx students. This intervention would only cost $9 per student per year to implement.

Conclusions and Implications

Installing water dispensers in K-8 public schools is an effective strategy for increasing access to clean and appealing drinking water, and over 10 years, it could improve drinking water access for 265,000 students in 304 schools in Massachusetts. Adequate water consumption can support well-being and cognitive function.9 Fluoridated water intake also prevents dental caries.10 Such preventive strategies play a critical role in promoting child health. This strategy is also projected to prevent 525 cases of childhood obesity in 2029 and cost, on average, $9 per child to implement each year. It is likely to be cost-effective at commonly accepted thresholds11 based on net cost per population health improvement related to excess weight, at a cost of $72,700 per quality-adjusted life year gained.

In Massachusetts, schools that participate in the state’s drinking water lead testing program are eligible to receive funding to install water dispensers.12 Expanding participation in this opportunity for drinking water testing and fixture installation would provide students and staff with better access to more appealing drinking water. Additionally, the proposed outreach strategy would prioritize installing water dispensers in schools that identify elevated concentrations of lead in their drinking water and in school districts located in communities meeting criteria for Environmental Justice designation.8 Because these communities have a higher proportion of residents who identify as people of color or households with low income, this strategy could promote health equity. Fifty percent of the students that would gain access to improved drinking water would be Black and Hispanic/Latinx, a higher proportion than the state’s student population overall.13

Though investment is required, every student deserves access to clean, appealing drinking water at school and this strategy would support the health of both students and staff in Massachusetts’ schools.

References

  1. MA Executive Office of Energy and Environmental Affairs. Lead and Copper in School Drinking Water Sampling Results. Accessed December 5, 2022. https://www.mass.gov/service-details/lead-and-copper-in-school-drinking-water-sampling-results

  2. Massachusetts Department of Elementary and Secondary Education. 2021 Youth Risk Behavior Survey (YRBS) Results. 2021.

  3. Malik VS, Pan A, Willett WC , Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(4):1084-1102.

  4. Chen L, Caballero B, Mitchell DC, et al. Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure a prospective study among United States adults. Circulation. 2010;121(22):2398-2406.

  5. Bogart LM, Babey SH, Patel AI, Want P, Schuster MA. Lunchtime school water availability and water consumption among California adolescents. J Adolesc Health. 2016; 58(1):98-103, doi: 10.1016/j.jadohealth.2015.09.007.

  6. Schwartz AE, Leardo M, Aneja S, Elbel B. Effect of a School-Based Water Intervention on Child Body Mass Index and Obesity. JAMA Pediatr. 2016; 170(3):220-226. doi:10.1001/jamapediatrics.2015.3778.

  7. Kenney EL, Cradock AL, Long MW, et al. Cost-Effectiveness of Water Promotion Strategies in Schools for preventing Childhood Obesity and Increasing Water Intake. Obesity. 2019;27(12):2037-2045.

  8. MA Executive Office of Energy and Environmental Affairs. Environmental Justice Populations in Massachusetts. Accessed April 7, 2023. https://www.mass.gov/info-details/environmental-justice-populations-in-massachusetts

  9. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010 Aug;68(8):439-58.

  10. American Dental Association and Centers for Disease Control. Nature’s Way to Prevent Tooth Decay: Water Fluoridation. Published 2006. Accessed July 13, 2021. https://www.cdc.gov/fluoridation/pdf/natures_way.pdf

  11. 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.

  12. The Massachusetts Clean Water Trust. About SWIG. Accessed May 5, 2022. https://www.mass.gov/service-details/about-swig

  13. Massachusetts Department of Elementary and Secondary Education. 2022-23 Enrollment By Race/Gender Report (District). Updated December 1, 2022. Accessed April 7, 2023. https://profiles.doe.mass.edu/statereport/enrollmentbyracegender.aspx

Suggested Citation:

McCulloch SM, Barrett JL, Reiner JF, Cradock AL, Gortmaker SL. Massachusetts: Water Dispensers in Schools {Issue Brief}. The CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; June 2023. For more information, please visit www.choicesproject.org

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

This issue brief 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 brief 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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Coffee Chat: What’s Up with School Wellness? Putting Physical Activity Policies into Practice

Posted on June 22, 2023

In this coffee chat, Nicole Good, School Wellness Specialist at the Massachusetts Department of Elementary and Secondary Education, shared how wellness policies can support implementation of evidence-based physical activity policies and programs and highlighted best practices for moving physical activity policies into practice.

View the resource round-up from this coffee chat.

Download the June 2023 coffee chat presentation slides.

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Brief: Movement Breaks in the Classroom in Massachusetts

Posted on June 22, 2023

School children stretching during a movement break during class time

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

This brief summarizes a CHOICES Learning Collaborative Partnership model examining a strategy to incorporate movement breaks, five-to-10-minute physical activity breaks during class time, into school classrooms in Massachusetts.

The Issue

Every child should have opportunities to be physically active. Students who are physically active tend to have better grades,1 attendance in school,1 and stronger muscles and bones.2 Regular physical activity can improve cognition, reduce symptoms of depression, help children maintain a healthy weight, and prevent risk of future chronic disease.2

Experts suggest that schools can provide students with opportunities to be physically active to help meet the national recommendation of 60 minutes per day.2 Incorporating five-to-10-minute movement breaks during class time can supplement other school physical activity opportunities, like physical education and recess. While some Massachusetts public schools offer classroom movement breaks at the middle school level,3 there are little to no data suggesting classroom movement breaks are provided for all younger students. Helping all classroom teachers integrate best practices for movement breaks will ensure more students have an opportunity to be active and help children grow up healthy and ready to learn.

About the Movement Breaks in the Classroom Strategy

To implement this evidence-based strategy,4 the Massachusetts Departments of Public Health and Elementary and Secondary Education would collaborate to connect school districts to the School Wellness Coaching Program. This program helps school districts integrate movement breaks into their local wellness policies and meet state and federal physical activity recommendations. Teachers in kindergarten to fifth-grade classrooms would receive training, technical assistance, and materials to support implementation. School wellness champions could also elect to be trained. This strategy aligns with the School Wellness Coaching Program5 and the Whole School, Whole Community, Whole Child initiative6 to create school environments that prioritize students’ health, well-being, and ability to learn.

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes over a 10-year time horizon (2020-2029) of implementing movement breaks in the classroom with the costs and outcomes associated with not implementing the program.

Integrating movement breaks in the classroom is an investment in the future. By the end of 2029:
If movement breaks in the classroom was integrated into Massachusetts schools, then by the end of 2029: 31,600 children would be reached over 10 years; per school week, each student would gain 25 additional minutes of moderate-to-vigorous physical activity; and this strategy would cost $5.72 per child per year to implement.

Conclusions and Implications

Not all students have access to safe streets, playgrounds, or spaces to be physically active. If movement breaks were incorporated into classrooms in Massachusetts, 31,600 elementary school students would benefit. These students could increase their moderate-to-vigorous physical activity levels by 25 minutes per school week, helping them reach the recommended physical activity levels.2 We project that 36 cases of obesity would be prevented in 2029 and $30,800 in health care costs related to excess weight would be saved over 10 years. This strategy would cost less than $6 per child per year to implement in Massachusetts and is likely to be cost-effective at commonly accepted thresholds7 based on net cost per population health improvement related to excess weight ($66,200 per quality-adjusted life year gained).

Classroom movement breaks provide all students with the opportunity to be physically active. This is particularly important for those students with fewer options outside of school. By training and equipping over 200 teachers and other school staff to incorporate movement breaks in the classroom, this strategy could help Massachusetts public schools cultivate a positive school climate and improve social emotional learning.8 Additionally, movement breaks allow students an opportunity for a “brain break” to refocus, reconnect and bring their attention back to their academic work. Students who participate in movement breaks spend more time on task4 and teachers report that students are more engaged, supportive of each other, and responsive to teacher instructions after participating in a movement break.9

Regular physical activity is important for healthy growth and development. Many preventive strategies can play a critical role in helping children establish healthy habits early on in life. Movement breaks provide an opportunity to invest in students and support their healthy growth and academic success.

References

  1. Centers for Disease Control and Prevention. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020-04-21T09:02:35Z 2010.

  2. US Dept of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. US Dept of Health and Human Services; 2018. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

  3. Centers for Disease Control and Prevention. School Health Profiles 2018: Characteristics of Health Programs Among Secondary Schools. Centers for Disease Control and Prevention;2019:205. https://www.cdc.gov/healthyyouth/data/profiles/pdf/2018/CDC-Profiles-2018.pdf

  4. The Community Preventive Services Task Force. Physical Activity: Classroom-based Physical Activity Break Interventions. The Community Guide; 2021. Accessed Jun 20, 2023. https://www.thecommunityguide.org/pages/tffrs-physical-activity-classroom-based-physical-activity-break-interventions.html

  5. School Wellness Initiative for Thriving Community Health (SWITCH). Initiatives: Massachusetts School Wellness Coaching Program. Published 2022. Accessed Oct 5, 2022. https://massschoolwellness.org/initiatives

  6. Massachusetts Department of Elementary and Secondary Education. Student and Family Support (SFS): Whole School, Whole Community, Whole Child (WSCC). Published 2021. Accessed Oct 5, 2022. https://www.doe.mass.edu/sfs/wscc

  7. 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.

  8. Centers for Disease Control and Prevention. School-Based Physical Activity Improves the Social and Emotional Climate for Learning. CDC Healthy Schools. Published 2021. Accessed March 9, 2022. https://www.cdc.gov/healthyschools/school_based_pa_se_sel.htm

  9. Campbell AL, Lassiter JW. Teacher perceptions of facilitators and barriers to implementing classroom physical activity breaks. Journal of Educational Research. 2020;113(2):108-119. DOI: 10.1080/00220671.2020.1752613

Suggested Citation:

Good N, Bolton AA, Barrett JL, Reiner JF, Cradock AL, Gortmaker SL. Massachusetts: Movement Breaks in the Classroom {Issue Brief}. The CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; June 2023. For more information, please visit www.choicesproject.org

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

This issue brief 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 brief 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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Fact Sheet: Movement Breaks in the Classroom (Grades K-5)

Posted on March 21, 2023

Teacher leading a movement break in the classroom

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.

Not all students have access to safe streets, playgrounds, or spaces to be physically active. Movement breaks in the classroom provide students with the opportunity to be physically active and help them meet the national physical activity standards1 of at least 60 minutes per day.

  • Movement breaks are short physical activity opportunities done in the classroom.
  • Only one in four children2 meets the national recommendations1 of physical activity. Movement breaks can supplement other school physical activity opportunities, like recess and physical education, to help more children meet physical activity guidelines.3,4
  • Students enjoy having opportunities to be physically active in the classroom, and movement breaks allow students to refocus and bring full attention back to academic work.5-7

Movement breaks can help teachers create a positive classroom climate and culture.8

  • Movement breaks in the classroom can increase students’ time spent on tasks3,4 and engagement in learning.4
  • Movement breaks can help with classroom management when implemented appropriately.4,5
  • Students say they can focus and learn better and are more excited about school after movement breaks.6,7
  • Teachers enjoy leading movement breaks. When teachers participate in the breaks, they can also experience the health benefits of being physically active.4

Childhood is a crucial period for developing movement skills and healthy habits. Providing students with physical activity will help them build a foundation for overall health and well-being.

  • Regular physical activity can reduce anxiety, stress, and symptoms of depression and improve self-esteem.1
  • Active students generally have better heart and lung health, stronger muscles and bones, and healthier body weight than inactive students.1
  • Students who are physically active tend to have better grades, attendance at school, memory, and attention.9

Experts agree that students should have opportunities for classroom physical activity. Teachers can help students meet the physical activity recommendations by incorporating movement breaks in the classroom.10-12

  • Providing resources and proper training in effective ways to promote movement in the classroom can increase teacher uptake and confidence in implementation and provide children with opportunities for physical activity.4
  • Some tips to help teachers run movement breaks are:

✓Introduce and demonstrate activity breaks using a video or other examples.7 Tailor the breaks to the context of your classroom.4

✓Be consistent with the days and times you do movement breaks.7

✓Outline expectations for students and make sure children are aware of their physical space.7 Modify activities to allow all students to participate in the breaks.4 Deep breaths after the movement break can help students transition to the next activity.5

✓Participate in the movement break activities with the students when possible.4

✓Explain the benefits of moving during the school day and provide students with positive reinforcement, especially those who may find movement breaks more challenging.7

✓Consider students’ preferences when doing breaks.3 Students like movement breaks that allow choice, imagination, and that are at an appropriate level of difficulty. They do not like breaks that are too difficult or silly.6

Additional Resources

References

  1. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd Edition. U.S. Department of Health and Human Services; 2018:118. Accessed November 29, 2021. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
  2. Data Resource Center for Child & Adolescent Health. National Performance Measure 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day. Childhealthdata.org. Accessed August 15, 2022. https://www.childhealthdata.org/browse/survey/results?q=9184&r=1
  3. The Community Preventive Services Task Force. Physical Activity: Classroom-based Physical Activity Break Interventions. The Guide to Community Preventive Services (The Community Guide). Published August 9, 2021. Accessed November 29, 2021. https://www.thecommunityguide.org/findings/physical-activity-classroom-based-physical-activity-break-interventions
  4. Centers for Disease Control and Prevention. Strategies for Classroom Physical Activity in Schools. U.S. Department of Health and Human Services; 2018:25. Accessed November 29, 2021. https://www.cdc.gov/healthyschools/physicalactivity/classroom-pa.htm
  5. Campbell AL, Lassiter JW. Teacher perceptions of facilitators and barriers to implementing classroom physical activity breaks. J Educ Res. 2020;113(2):108-119. doi:10.1080/00220671.2020.1752613
  6. Watson A, Timperio A, Brown H, Hesketh KD. Process evaluation of a classroom active break (ACTI-BREAK) program for improving academic-related and physical activity outcomes for students in years 3 and 4. BMC Public Health. 2019;19(1):633. doi:10.1186/s12889-019-6982-z
  7. Cline A, Knox G, De Martin Silva L, Draper S. A Process Evaluation of A UK Classroom-Based Physical Activity Intervention—‘Busy Brain Breaks.’ Children. 2021;8(2):63. doi:10.3390/children8020063
  8. Centers for Disease Control and Prevention. School-Based Physical Activity Improves the Social and Emotional Climate for Learning.Cdc.gov. Published March 29, 2021. Accessed March 9, 2022. https://www.cdc.gov/healthyschools/school_based_pa_se_sel.htm
  9. Centers for Disease Control and Prevention. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. U.S. Department of Health and Human Services; 2010:84. Accessed November 29, 2021. https://www.cdc.gov/healthyyouth/health_and_academics/pdf/pa-pe_paper.pdf
  10. SHAPE America. Shape of the Nation: Status of Physical Education in the USA. SHAPE America – Society of Health and Physical Educators. 2016:142. Accessed November 29, 2021. https://www.shapeamerica.org/advocacy/son/
  11. Institute of Medicine. Educating the Student Body: Taking Physical Activity and Physical Education to School. National Academies Press. 2013:420. Accessed August 17, 2022. https://nap.nationalacademies.org/catalog/18314/educating-the-student-body-taking-physical-activity-and-physical-education
  12. Centers for Disease Control and Prevention. Classroom Physical Activity. Cdc.gov. Published July 27, 2022. Accessed Oct 8, 2021. https://www.cdc.gov/healthyschools/physicalactivity/classroom-pa.htm

Suggested Citation

Get the Facts: Movement Breaks in the Classroom (Grades K-5). Prevention Research Center on Nutrition and Physical Activity Team at the Harvard T.H. Chan School of Public Health, Boston, MA; March 2023.

Funding

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. 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. 

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Strategy Profile: Movement Breaks in the Classroom

Posted on October 6, 2022

Teacher leading a movement break in the classroom with young kids

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.

  • 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. 

What population benefits?

 Children in grades K-5 attending public elementary schools. 

What are the estimated benefits?

Relative to not implementing the strategy

Increase students’ moderate-to-vigorous physical activity levels and, in turn, promote healthy child weight. 

What activities and resources are needed?

Activities Resources Who Leads?
Identify and compile materials and content for training and implementation • Time for physical activity coordinator to identify and compile materials/content to train teachers
• Time for physical activity coordinator to develop a movement break library to support teachers with implementation		 Physical activity coordinator
Recruit schools and coordinate training • Time for physical activity coordinator to communicate and plan training activities with schools Physical activity coordinator
Train classroom teachers in movement breaks • Time for physical activity coordinator to provide training
• Time for classroom teachers to attend trainings		 Physical activity coordinator
Materials and equipment provided to teachers to implement movement breaks • Material costs School districts or local government

FOR ADDITIONAL INFORMATION

The Community Preventive Services Task Force. Physical Activity: Classroom-based Physical Activity Break Interventions. The Community Guide. 2021:8. Available at: https://www.thecommunityguide.org/findings/physical-activity-classroom-based-physical-activity-break-interventions

Selected CHOICES research brief including cost-effectiveness metrics:

Carter J, Greene J, Neeraja S, Bovenzi, M, Sabir M, Carter S, Bolton AA, Barrett JL, Reiner JR, Cradock AL. 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. Available at: https://choicesproject.org/publications/brief-movement-breaks-boston

Good N, Bolton AA, Barrett JL, Reiner JF, Cradock AL. Massachusetts: Movement Breaks in the Classroom {Issue Brief}. The CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; June 2023. Available at: https://choicesproject.org/publications/brief-movement-breaks-ma

Suggested Citation

CHOICES Strategy Profile: Movement Breaks in the Classroom. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2022.

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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Brief: Movement Breaks in the Classroom in Boston, MA

Posted on August 9, 2022

Teacher leading a movement break in the classroom with young kids

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

A version of this brief was published in May 2022. This brief was updated in August 2022 to reflect revised projections for Boston’s population.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining a strategy to integrate movement breaks into school classrooms in Boston, MA. This strategy incorporates five-to-10-minute classroom physical activity breaks during class time in kindergarten to fifth grade classrooms. 

The Issue

One in three first-graders in Boston has overweight or obesity.1 Being physically active can support children in growing up at a healthy weight, though not all schools provide students with the recommended 150 minutes of physical activity per week or 30 minutes per day.2,3 Regular physical activity can boost brain health, including improved cognition and reduced symptoms of depression.4 Students who are physically active also tend to have better grades, attendance at school, and stronger muscles and bones.4

Experts suggest that schools provide opportunities for classroom physical activity,5 but few schools offer it.6 Movement breaks supplement other critical school physical activity opportunities, like recess and physical education, and help children meet recommendations for physical activity.5 Providing all students with opportunities to be physically active will ensure more students are growing up at a healthy weight and ready to learn.

About the Movement Breaks in the Classroom Strategy

We can provide healthier opportunities for all children by initiating strategies with strong evidence for effectiveness. To implement the Movement Breaks strategy, teachers, Wellness Champions, and staff would receive training, equipment, and materials to incorporate short activity breaks in the classroom to help children move more.7,8 Initiating strategies with strong evidence for effectiveness like Movement Breaks in the Classroom helps fulfill Boston Public School’s (BPS) Physical Education and Physical Activity Policy requirements for schools to offer physical activity opportunities during the school day.3 This strategy also aligns with BPS’ Whole School, Whole Community, Whole Child approach, which supports students’ holistic health by promoting positive classroom environments that foster physical activity and learning.

Comparing Costs and Outcomes

A CHOICES cost-effectiveness analysis compared the costs and outcomes over a 10-year time horizon (2020-2030) of implementing movement breaks with the costs and outcomes associated with not implementing them. We assumed that elementary schools in Boston Public Schools serving grades K-5 would receive training, equipment, and materials to implement movement breaks. The model assumes that 56% of those trained would implement the movement breaks in classrooms.

Implementing movement breaks in the classroom is an investment in the future. By the end of 2030:
If movement breaks in the classroom was implemented in Boston, 29,400 students would be reached over 10 years, it would cost $1.74 per child to implement, and per school week, each student would engage in 25 additional minutes of moderate-to-vigorous physical activity.

Conclusions and Implications

If movement breaks were incorporated into classrooms, we project that over 10 years, 29,400 students would benefit. The students would increase their moderate-to-vigorous-physical activity levels by 25 minutes per school week, helping them meet wellness goals of 150 minutes of physical activity per week.3 This strategy would also prevent 37 cases of childhood obesity (in 2030) and save $35,300 in health care costs related to excess weight over 10 years. The average annual cost to implement this program in every public elementary school (Grades K-5) in Boston would be $1.74 per student, or just over $1,000 per school per year.

In addition to promoting a healthy weight, classroom physical activity benefits students in other important ways. 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.9 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.10

Childhood is a crucial period for developing healthy habits. Many preventive strategies can play a critical role in helping children establish healthy behaviors early on in life. Providing movement breaks in the classroom is an easy and relatively low-cost way to increase physical activity and support the overall health and wellness of all Boston students. 

References

  1. School Health Services, Department of Public Health. Results from the Body Mass Index Screening in Massachusetts Public School Districts, 2017. 2020:88. https://www.mass.gov/doc/the-status-of-childhood-weight-in-massachusetts-2017

  2. Boston Public Schools, Health and Wellness Department. School Health Profiles [2018]: Boston, MA.

  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. Centers for Disease Control and Prevention. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020-04-21T09:02:35Z 2010.

  5. The Community Preventive Services Task Force. Physical Activity: Classroom-based Physical Activity Break Interventions. The Community Guide. 2021:8.

  6. Classroom Physical Activity. Centers for Disease Control and Prevention. Accessed Oct 8, 2021. https://www.cdc.gov/healthyschools/physicalactivity/classroom-pa.htm

  7. 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.

  8. 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.

  9. 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

  10. Campbell AL, Lassiter JW. Teacher perceptions of facilitators and barriers to implementing classroom physical activity breaks. J Educ Res. 2020;113(2):108-119

Suggested Citation:

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. For more information, please visit www.choicesproject.org

A version of this brief was published in May 2022. This brief was updated in August 2022 to reflect revised projections for Boston’s population.

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

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Boston Public Health Commission through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief 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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May 2022 Coffee Chat Resource Round-Up

Posted on June 2, 2022

This document compiles resources and information shared during the May 19, 2022 coffee chat, which featured partners who shared how improving access to safe and appealing drinking water in schools and communities is a key strategy for helping children grow up healthy.

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Strategy Profile: Safe Routes to School

Posted on April 28, 2022

Kids crossing street with crossing guard

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.

  • Safe Routes to School is a program that supports the use of physically active modes of transportation to and from school, and aims to help children in grades K-8 safely walk and bicycle to school through infrastructure improvements, education, enforcement, and promotional activities.

What population benefits?

Children in grades K-8 who switch from passive to active travel to school after their school adopts an active transport program.

What are the estimated benefits?

Relative to not implementing the strategy
Increase 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 driving, parking, and vehicle ownership and operation costs
↓ Decrease in travel time for families using their own vehicles for transportation
↓ Decrease in pedestrian and bicycle injuries and vehicle crash costs
↓ Decrease in air, greenhouse gas, water, and noise pollution costs

What activities and resources are needed?

Activities Resources Who Leads?
Oversee implementation of Safe Routes to School program • Time for Safe Routes to School coordinator(s) to oversee and manage implementation of the program
• Time for Safe Routes to School committee to select and provide guidance on projects, including advise and award grants, provide technical assistance to programs, communicate between Safe Routes to School programs and partners, and advocate for programs		 Safe Routes to School coordinator(s) and committee members
Attend Safe Routes to School committee meetings • Time for Safe Routes to School committee members to attend meetings
• Travel costs for Safe Routes to School committee members		 Safe Routes to School committee members
Improve infrastructure around schools • Infrastructure project costs Local government or other organization and schools
Adopt key components of Safe Routes to School Framework (e.g., education, encouragement, equity, enforcement, and evaluation) • Non-infrastructure project costs Local government or other organization and schools

FOR ADDITIONAL INFORMATION

Selected CHOICES research brief including cost-effectiveness metrics:
McCulloch SM, Barrett JL, Reiner JF, Cradock AL. Wisconsin: Safe Routes to School {Issue Brief}. Wisconsin Department of Health Services, Division of Public Health, Madison, WI, & East Central Wisconsin Regional Planning Commission, Menasha, WI and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2021. Available at: https://choicesproject.org/publications/brief-safe-routes-to-school-wisconsin/

Reiner J, Barrett J, Giles C, Cradock AL. Houston: Safe Routes to School {Issue Brief}. Houston Health Department, Houston, TX 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-srts-houston-tx

Pelletier J, Reiner J, Barrett J, Cradock AL, Giles C. Minnesota: Safe Routes to School (SRTS) {Issue Brief}. Minnesota Department of Health (MDH), St. Paul, MN, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; March 2019. Available at: https://choicesproject.org/publications/brief-saferoutes-to-school-minnesota

Suggested Citation

CHOICES Strategy Profile: Safe Routes to School. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; April 2022.

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: Active Physical Education (Active PE)

Posted on April 28, 2022

A diverse group of children playing basketball.

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.

  • Active PE is a policy that requires that 50% of time provided in physical education classes for grades K-8 be spent in moderate-to-vigorous physical activity. Physical education teachers are trained to promote physical activity during PE classes using the SPARK or CATCH curricula.

What population benefits?

Children in grades K-8 (5-14 years old).

What are the estimated benefits?

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

What activities and resources are needed?

Activities Resources Who Leads?
Oversee training and implementation of Active PE in schools • Time for state PE coordinator to oversee implementation and training State PE coordinator
Monitor compliance with moderate-to-vigorous physical activity policy • Time for state PE coordinator to monitor compliance with policy State PE coordinator
Train PE teachers through state trainings • Time for SPARK/CATCH training consultant to lead trainings
• Time for PE teachers to attend trainings
• Travel costs for PE teachers and SPARK/CATCH training consultants to attend trainings		 SPARK/CATCH training consultant
Purchase PE equipment and curricula • PE equipment costs
• SPARK or CATCH curricula costs		 Schools
Train principals in assessing moderate-to-vigorous physical activity in PE classes at a state principals association event • Time for training consultant to lead trainings
• Incremental time increase for principals to attend trainings on evaluating PE
• Travel costs for training consultants		 Training consultant
Strategy Modification

State and local health agencies modified this strategy in the following ways. 1) Some health agencies modified this strategy to be a best practice or implementation guideline instead of a policy. With this modification, the strategy would cost less because activities to monitor compliance, including training principals, would not occur. Additionally, a percentage – instead of all PE teachers – might be trained using this modification, which would mean reaching fewer children. 2) Some health agencies modified this strategy to use a train-the-trainer model. This modifies the training model so that the training consultants train school district master trainers and the master trainers lead trainings for the PE teachers. Modifying the strategy this way could cost less.

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

Selected CHOICES research brief including cost-effectiveness metrics:
Hopkins H, Lange J, Olson E, Taylor-Watts S, Jenkins L, McCulloch S, Barrett J, Reiner J, and Cradock AL. Iowa: Active Physical Education (PE) {Issue Brief}. Iowa Department of Public Health, Iowa Department of Education, Des Moines, IA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; April 2021. Available at: https://choicesproject.org/publications/brief-active-pe-iowa

Suggested Citation

CHOICES Strategy Profile: Active Physical Education (Active PE). CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; April 2022.

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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