Setting: School

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-srts-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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Strategy Profile: Active Recess

Posted on April 28, 2022

Three kids at the playground

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 Recess is a program to increase physical activity during elementary school recess with structured activities, playground markings, and/or portable play equipment. This program is implemented in elementary schools to promote physical activity during recess.

What population benefits?

Children in grades K-5 (5-11 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?
Train teachers and recess monitors on recess supervision strategies to increase physical activity • Time for trainer to lead trainings on supervision strategies to increase physical activity
• Time for teachers and recess monitors to attend trainings
• Travel costs for the trainers, teachers, and recess monitors		 School district coordinator
Paint markings onto outdoor play spaces • Time for volunteers to paint markings
• Time for school staff member to supervise painting
• Painting material costs		 School staff member
Purchase portable playground equipment • Playground equipment costs Schools
Strategy Modification

Some state and local health agencies have added to this strategy the costs of coordinating a broader state-level program when envisioning it being implemented in more than one district. This would add time for a state-level coordinator in the Department of Education to oversee the program and provide training to participating district-level coordinators. With this modification, this strategy could reach more children.

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:
McKinnon A, Barrett J, Cradock AL, Flax C. Salt Lake County: Active Recess {Issue Brief}. Salt Lake County Health Department, Salt Lake City, UT, 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-active-recess-salt-lake-county/

Suggested Citation

CHOICES Strategy Profile: Active Recess. 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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Brief: Improving Drinking Water Equity and Access in California Schools

Posted on March 23, 2022

School-aged girl drinking water from a reusable water bottle

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 California schools. This voluntary water equity and access program involves the installation of touchless chilled water dispensers on or near school cafeteria lunch lines in K-8 non-charter California public schools that have adequate plumbing.

The Issue

All children should have access to clean, appealing, and free drinking water no matter where they live or where they go to school. Providing appealing access to drinking water gives students a healthier alternative to sugary drinks, like sweetened fruit drinks, sports drinks, and soda. Students drink more water when schools provide access to water at lunch at no charge,1 and improving school water access can help kids grow up at a healthy weight.2,3

In California, one in 10 schools reported having no access to free drinking water where meals are served despite state and federal requirements.4,5 Additionally, only one in five schools reported meeting criteria considered the standard for excellence in water access.4 Creating a healthy, equitable school environment that includes appealing drinking water access can help set children up for a healthy future.

About the Water Dispensers in Schools Strategy

This strategy focuses on increasing water access by installing touchless water dispensers at schools serving primarily families with low income, which also have a greater share of Black/African American and Latino students than other schools in California. Promoting better drinking water access in schools has been shown to increase water intake during the day and may help promote a healthy weight.3 Thus, it is a strategy that can help local health departments reach the twin goals of increasing access to and promotion of safe drinking water while decreasing access to and consumption of sugary drinks.6 Putting this strategy into place would require resources for administering the program, installing and maintaining dispensers, utility and disposable cup usage, lead testing and remediation, and delivering water-promotion education.

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 (2020-2030).

Installation of touchless water dispensers in schools in California is an investment in a more equitable future. By the end of 2030:
If touchless water dispensers were installed in schools in California, then, by the end of 2030, 1.88 million children would be reached with improved access to safe drinking water in schools over 10 years; $12 million would be saved in health care costs over 10 years; and this intervention would cost $6 per child per year to implement.

Conclusions and Implications

Installing water dispensers in K-8 public schools is an effective strategy for increasing access to clean, appealing, and free drinking water. Over 10 years, this strategy is expected to improve drinking water access and consumption for over 1.8 million students in California. This strategy is estimated to prevent 3,660 cases of childhood obesity in 2030 and would cost on average $6 per child to implement each year. Comparatively, the value of lunch served to students is $3 per day or about $600 per year.7 While the costs to implement this strategy would be $21,500 per school over 10 years, there would be an estimated $12 million in obesity-related health care cost savings over the same time period.

Improving students’ access to free, clean drinking water could promote health equity. Latino youth report less availability of drinking water access in schools,8 and Black/African American youth are less likely to be adequately hydrated compared with White non-Latino youth.9 Focusing drinking water access improvements in schools with high percentages of Black/African American and Latino students may benefit these populations the most. In addition to promoting a healthy weight, this strategy may also benefit children in other ways. Adequate water consumption can lead to improvements in well-being and support cognitive function.10 Fluoridated water intake also prevents dental caries.11

Though investment is required, every student deserves access to clean, appealing drinking water, and this strategy can be a part of a suite of interventions that support children and their families. Many preventive strategies play a critical role in helping children establish healthy habits early on in life. Focusing on supporting these healthy habits now can help more children grow up at a healthy weight.

References

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

  2. 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.

  3. 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.

  4. Altman EA, Lee KL, Hecht CA, Hampton KE, Moreno G, Patel AI. Drinking water access in California schools: Room for improvement following implementation of school water policies. Preventive Medicine Reports. 2020;19:101143. Published 2020 Jun 8. doi:10.1016/j.pmedr.2020.101143.

  5. California Department of Education. Drinking Water for Students in Schools. Reviewed January 14, 2020. https://www.cde.ca.gov/ls/nu/he/water.asp#:~:text=California%20Education%20Code%20Section%2038086%20states%20that%20if%20a%20school,reasons%20why%2C%20whether%20due%20to. Accessed February 16, 2021. 

  6. California Department of Public Health. FFY 2020-2022 SNAP-Ed Local Health Departments Programmatic Priorities. Published December 10, 2018. https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/NEOPB/CDPH%20Document%20Library/Branch16Add2FFY20-22SNAPEdLHD.pdf. Accessed January 29, 2021.

  7. California Department of Education. 2019-20 CNP Reimbursement Rates. https://www.cde.ca.gov/ls/nu/rs/rates1920.asp. Accessed December 12, 2020.

  8. Onfurak SJ, Park S, Wilking C. Student-reported school drinking fountain availability by youth characteristics and state plumbing codes. Preventing Chronic Disease. 2014; 11: E60, doi: 10.5888/pcd11.130314. 

  9. Kenney EL, Long MW, Cradock AL, Gortmaker SL. Prevalence of inadequate hydration among U.S. children and disparities by gender and race/ethnicity: National Health and Nutrition Examination Survey, 2009–2012. American Journal of Public Health. 2015; 105(8): e113-8, doi: 10.2105/AJPH.2015.302572.

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

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

Suggested Citation:

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. 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 in collaboration with the California Department of Public Health and the County of Santa Clara Public Health Department 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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Stories from the Field: Allegheny County Strengthens Partnerships to Make Progress Toward Local Impact

Posted on June 24, 2021

Three kids at the playground

The information in this Story from the Field is intended only to provide educational information.

In this Story from the Field, partners in Allegheny County, Pennsylvania, used the CHOICES framework and tools to engage partners in identifying and prioritizing strategic opportunities for action to promote healthy weight for children in their community.

Identifying Priorities in Allegheny County, PA

The Allegheny County Health Department (ACHD) engaged community members and public health partners through the Mobilization for Action through Planning and Partnerships (MAPP) process to help prioritize their planning efforts. The ACHD identified reducing obesity among school-aged children as a key objective to improve chronic disease risk factors – a priority area identified in their Community Health Improvement Plan.

Strategic Alignment to Promote Child Health

The ACHD leveraged funds to support capacity building and infrastructure to establish the Healthy Kids Allegheny Task Force. This task force brought together partners with a multi-sectoral, collaborative focus on children’s health and wellness.

The task force looked to identify strategies to effectively reduce childhood obesity and to ensure their resources were being invested responsibly. They also were looking for ways to advance the strategic priorities of Live Well Allegheny – a county-wide campaign to improve the overall health and wellness of Allegheny County residents.

Engaging Partners to Create Evidence for Action

The ACHD teamed up with the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Project through its Learning Collaborative Partnership program. In this program, the CHOICES Project works with health agencies to create new, local evidence to inform decision-making. The ACHD team saw an opportunity to identify strategies to promote child health and learned how to use local data and apply cost-effectiveness analysis methods to prioritize effective strategies to reduce childhood obesity in Allegheny County. To identify relevant strategies, the ACHD team assembled a group of key partners:

• the Healthy Kids Allegheny Task Force
• Allegheny Partners for Out-of-School Time
• Healthy Out-of-School Time
• the United Way of Southwestern Pennsylvania
• Children’s Hospital of Pittsburgh
• Live Well Allegheny Schools and Community Partners

Evaluating Opportunities to Address Key Priorities

ACHD identified partners early in the process. This facilitated engagement in the selection of school and afterschool settings as key areas for collaboration. The ACHD CHOICES team opted to focus on Active Physical Education in schools and a Healthy Snack Policy in afterschool programs from the CHOICES menu of strategies with strong evidence for impact on health and data on cost-effectiveness.

Then, the team used CHOICES tools to identify the activities and resources needed to put these strategies into action, considered the interests of partners, and discussed what would be feasible to implement. These tools helped the team answer several key questions for planning:

1. What is the strategy?
2. Where is it implemented?
3. Which populations are impacted?
4. Who will be involved in implementing the strategy?
5. What is the status of this strategy in your state, county, or city?

Lessons Learned

The ACHD CHOICES team engaged partners to establish what would need to happen to implement their chosen strategies, who would need to be involved, and what impact these strategies would have in their community. These efforts enabled them to identify feasible implementation plans that are projected to make an impact on health. Using CHOICES tools and resources, the ACHD CHOICES team and partners developed evidence they could use to make a case for investing in these efforts to promote a healthy weight.

 

Active Physical Education in Schools

A policy requiring provision of 50% moderate-to-vigorous physical activity in physical education classes.

See what would happen if Active PE was implemented in schools in Allegheny County

Healthy Snack Policy in Afterschool Programs

A policy that sets nutrition standards to ensure that all food and beverages available in programs meet national standards to support good nutrition.

See what would happen if a healthy snack policy was implemented in afterschool programs in Allegheny County 

 

“Partnering with the CHOICES Team equipped the ACHD Team with a clear understanding of what it would take to implement the strategies that we modeled, and a very specific guide for doing so. Strategic alignment of our partners and the evidence from this work with CHOICES helped us to have more informed conversations with decision-makers.” – Hannah E. Hardy, Director, Chronic Disease & Injury Prevention Program, Allegheny County Health Department

Suggested Citation:

CHOICES Stories from the Field: Allegheny County Strengthens Partnerships to Make Progress Toward Local Impact. Allegheny County Health Department, Pittsburgh, PA, and the CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; June 2021.

This resource 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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Making CHOICES in a Health Department: Case 2 (Advanced)

Posted on May 13, 2021

People drawing on a whiteboard

In this advanced teaching case, which builds on Case 1, a fictional health department continues to work with the CHOICES Project’s Learning Collaborative Partnership to determine how to implement an evidence-based strategy that requires substantial investment, but they face a variety of additional challenges such as state politics and the complexities of health policy.

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Making CHOICES in a Health Department: Case 1 (Introductory)

Posted on May 13, 2021

In this introductory teaching case, a fictional health department engages with the CHOICES Project’s Learning Collaborative Partnership to help them narrow down a list of potential strategies to reduce childhood obesity in their county through a cost-effectiveness lens.

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Brief: Safe Routes to School in Wisconsin

Posted on May 5, 2021

Young girl riding bike at the Safe Routes to School Family Fun Night Event in Neenah, Wisconsin in May 2018; orange cone in the background

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

This brief summarizes a CHOICES Learning Collaborative Partnership model examining the expansion of a regional Safe Routes to School program in K-8 public and private schools in Wisconsin. Safe Routes to School Programs help children safely walk and bike to school by incorporating principles of the six E’s: engagement, encouragement, equity, engineering, education, and evaluation.

The Issue

In Wisconsin, just three out of every 10 children achieve the 60 minutes of physical activity recommended daily for health.1 Over recent decades, the number of students walking and bicycling to school has declined,2 eliminating an important physical activity opportunity. Adopting programs that make it safer and easier to walk or bike to school can increase the number of students using these physically active travel modes and can also allow students to incorporate physical activity into a daily routine.3 Every child should have the opportunity to be healthy, and all kids need opportunities to be physically active, no matter where they live or where they go to school. This study estimates the cost-effectiveness of increasing funding and diversifying funding sources to expand a regional model for Safe Routes to School programs for those schools that have not yet implemented comprehensive Safe Routes to School programs in Wisconsin.

About Safe Routes to School

Safe Routes to School programs that adopt the six E’s, including improvements to local sidewalks and roads around schools, providing pedestrian and bike safety education, and offering encouragement and promotion activities, can increase the number of students walking and bicycling to school.2 This study looked at the scaled expansion of East Central Wisconsin Regional Planning Commission’s Safe Routes to School program to other regional planning commissions across Wisconsin. A state-wide Safe Routes to School Program Coordinator would work with regional SRTS Coordinators and advisory committees, providing oversight and administration of the allocated funding to support projects in their region. Each regional planning commission would coordinate education, encouragement, and promotion activities across funded schools in their region. Local municipalities would lead projects to improve the safety of sidewalks and road infrastructure.

Comparing Costs and Outcomes

A CHOICES cost-effectiveness analysis compared the costs and outcomes of expanding Safe Routes to School in Wisconsin with the costs and outcomes associated with not implementing the program over 10 years (2020-2030).

Implementing Safe Routes to School in Wisconsin is an investment in child health. By the end of 2030:

If Safe Routes to School was expanded in Wisconsin, then by the end of 2030, 151,000 children would attend schools with safer transportation environments, and children who start walking or biking to school would get 48 more active minutes per week. This program would cost $58 per child annually to implement, for those children attending schools that adopt Safe Routes to School programs.

Conclusions and Implications

Every student should be able to walk or bike to school safely. Expanding East Central’s regional Safe Routes to School model in Wisconsin could support safer walking and biking environments and provide programmatic education and encouragement initiatives for 151,000 elementary and middle school students over 10 years. We estimate that the Safe Routes to School program, which includes education and promotion activities, improvements to sidewalks and road infrastructure, and coordination support, would cost $58 per student per year. Over 10 years, these activities to expand the regional SRTS model in Wisconsin would cost about $215,000 per school. At the same time, more than 8,000 students would start walking and biking to school, and they would get 48 more minutes of physical activity per week. This translates to better health outcomes and more kids at a healthy weight in Wisconsin, with 16 fewer cases of obesity in the year 2030 alone.

In addition to getting students more active,4,5 SRTS initiatives may also reduce the risk of pedestrian and bicycle injury, exposure to unsafe traffic, and air pollution.3,6,7 Greater safety, improved health from increased physical activity, and lesser environmental impact from decreased automobile use provide economic benefits to the community.8 In Wisconsin, the costs of implementing SRTS projects could be offset by savings associated with reduced vehicle travel, potentially amounting to $2.19 million in environment-related cost savings over 10 years. Further, families whose students start walking or bicycling would also drive less and could save an average of $1,120 by not driving their students to school. Walking and biking are great ways for kids to be active, and this program invests in ways to ensure that more students can do so safely while developing healthy lifestyle habits that would continue into adulthood.

References

  1. Child and Adolescent Health Measurement Initiative. 2018-2019 National Survey of Children’s Health (NSCH) data query. https://www.nschdata.org/browse/survey/results?q=7700&r=51. Accessed October 29, 2020.

  2. McDonald, NC. Active transportation to school: trends among US schoolchildren, 1969–2001. American Journal of Preventive Medicine. 2007; 32(6), 509-516.

  3. Stewart O, Vernez Moudon A, Claybrooke C. Multistate Evaluation of Safe Routes to School Programs. American Journal of Health Promotion. 2014;28(3);S89-S96.

  4. Cooper, Jago, Southard, Page. Active Travel and Physical Activity across the School Transition: The PEACH Project. Medicine & Science in Sports & Exercise. 2012; 44(13); 1890–1897.

  5. Huang WY, Wong SH, He G. Is change to active travel to school an important source of physical activity for Chinese children? Pediatric Exercise Science. 2017; 29(1):161-168.

  6. DiMaggio, C, & Li, G. Effectiveness of a safe routes to school program in preventing school-aged pedestrian injury. Pediatrics. 2013;131(2);290-296.

  7. DiMaggio C, Chen Q, Muennig PA, Li G. Timing and effect of a safe routes to school program on child pedestrian injury risk during school travel hours: Bayesian changepoint and difference-in-difference analysis. Injury Epidemiol. 2014;1:17.

  8. Jacob V, Chattopadhyay SK, Reynolds JA, et al. Economics of Interventions to Increase Active Travel to School: A Community Guide Systematic Review. American Journal of Preventive Medicine. 2021;60(1):e27-e40.

Suggested Citation:

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

Funding for the Survey of the Health of Wisconsin (SHOW) was provided by the Wisconsin Partnership Program PERC Award (233 AAG9971). The authors would also like to thank the University of Wisconsin Survey Center, SHOW administrative, field, and scientific staff, as well as all the SHOW participants for their contributions to this study.

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 Wisconsin Department of Health Services 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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