In this coffee chat hosted by the CHOICES Community of Practice, Dr. Steven Gortmaker, Principal Investigator of the CHOICES Project at the Harvard T.H. Chan School of Public Health, highlights the new features available in the Action Kit 2.0, including more detailed information on costs and health equity impacts. Dr. Gortmaker also discusses how this information can be helpful for planning and prioritization purposes to ensure responsible investments to improve child health, nutrition, physical activity, and health equity.
Topic: Active Living
Strategy Report: More Movement in Early Care and Education Settings
The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.
Overview
CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.
Continue reading in the full report.
Contact choicesproject@hsph.harvard.edu for an accessible version of this report.
Suggested Citation
CHOICES National Action Kit: More Movement in Early Care and Education Settings Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.
The design for this report and its graphics were developed by Molly Garrone, MA and partners at Burness.
Funding
This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose
For further information, contact choicesproject@hsph.harvard.edu
Strategy Report: Active Recess
The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.
Overview
CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.
Continue reading in the full report.
Contact choicesproject@hsph.harvard.edu for an accessible version of this report.
Suggested Citation
CHOICES National Action Kit: Active Recess Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.
The design for this report and its graphics were developed by Molly Garrone, MA and partners at Burness.
Funding
This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose
For further information, contact choicesproject@hsph.harvard.edu
Strategy Report: Creating Healthier Afterschool Environments
The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.
Overview
CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.
Continue reading in the full report.
Contact choicesproject@hsph.harvard.edu for an accessible version of this report.
Suggested Citation
CHOICES National Action Kit: Creating Healthier Afterschool Environments Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.
The design for this report and its graphics were developed by Molly Garrone, MA and partners at Burness.
Funding
This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose
For further information, contact choicesproject@hsph.harvard.edu
Strategy Profile: Active School Day
The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.
- Policy requiring schools to provide at least 30 daily, or 150 weekly, minutes of physical activity during the school day for grades K-8. Wellness champions and instructional coaches support promotion of physical activity in physical education, recess, and movement breaks in the classroom.
What population benefits?
Children in grades K-8 (ages 5-14).
What are the estimated benefits?
Relative to not implementing the strategy
Increase students’ moderate-to-vigorous physical activity levels and, in turn, promote healthy weight.
What activities and resources are needed?
| Activities | Resources | Who Leads? |
| Coordinate and support implementation of the active school day policy | • Time for school health and wellness staff (Director, Assistant Director, Physical Education Director, Coordinators, and business office staff) to provide support | School district |
| Train Wellness Champions, physical education teachers, and lunch monitors in physical activity promotion | • Time for training consultant to train physical education teachers, Wellness Champions, and lunch monitors • Time for Wellness Champions to attend trainings on policy and implementation strategies (either recess or movement breaks in the classroom) • Time for physical education teachers to attend training on quality PE strategies • Time for lunch monitors to attend trainings on recess strategies (in schools implementing recess strategies) • Travel costs for lunch monitors to attend trainings • Cost of space rental, food, and promotional flyers for trainings |
School district |
| Develop and maintain materials to support implementation | • Cost to develop an online portal or printed materials to support implementation • Cost to maintain the online portal or replace printed materials in subsequent years |
School |
| Implement strategies that promote physical activity in schools | • Time for Wellness Champions and instructional coaches to lead implementation of strategies promoting physical activity • Time for Wellness Champions and school principals to review performance on strategy implementation |
School district |
| Purchase equipment and materials for a more active school day | • Cost of equipment and curricula for promoting physical activity in physical education and in recess or the classroom | School district |
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
- Browse more CHOICES research briefs & reports in the CHOICES Resource Library.
- Explore and compare this strategy with other strategies on the CHOICES National Action Kit.
Suggested Citation
CHOICES Strategy Profile: Active School Day. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 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
©2015 President and Fellows of Harvard College. All rights reserved. The CHOICES name, acronym and logo are marks of the President and Fellows of Harvard College.
Exploring the Cost-Effectiveness of Strategies to Improve Child Health in Boston, MA
The information in this brief is intended only to provide educational information.
The CHOICES Project at the Harvard T.H. Chan School of Public Health and the Boston Public Health Commission (BPHC) worked together as part of the Massachusetts-CHOICES Project (2019 – 2024), a training, technical assistance, and modeling initiative, to develop a playbook of strategies to promote healthy weight and advance health equity in addition to studying how cost-effectiveness metrics are used by partners throughout the state.
Methods & Strategies Modeled
CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics.
Using CHOICES cost-effectiveness analysis and local data, the BPHC team worked with CHOICES to create a virtual population that mirrors the current population of Boston, MA. Then, the teams examined the expected costs, health outcomes, and health care costs saved if the following strategies were implemented in Boston, Massachusetts over a 10-year timeframe (2020-2029):
• Reducing Screen Time in Early Child Care Settings
• More Movement Program in Early Child Care Settings
• Home Visits to Reduce Screen Time
• Movement Breaks in the Classroom
• Creating Healthier Afterschool Environments (OSNAP)
Reducing Screen Time in Early Child Care Settings
The strategy to reduce screen time in early child care settings involves providing voluntary training to early child care educators and resources to families to limit noneducational television time at child care and home. This strategy could support Boston’s efforts to improve early child care quality through the Boston Healthy Child Care Initiative. It would include training opportunities for early child care educators, offering ongoing support and technical assistance, and providing parents with educational materials that may lead to reducing screen time in young children.1,2
Helping educators to implement practices shown to be effective in reducing television time can help the children in Boston’s early education and care settings engage in fewer minutes of screen time.
Additional Key Findings
If a strategy to reduce screen time in early child care settings was implemented in Boston, 125 cases of obesity would be prevented in 2029, saving $138,000 in health care costs over 10 years.
In addition, this strategy would train and provide technical assistance to early childhood educators on reducing screen time. In the initial training series, this strategy would provide additional skills training and professional development for 1,380 educators and more opportunities to reduce screen time in 570 (100%) child care programs serving 3-5 year olds.
To learn more about this strategy, read the research brief.
References
1. Mendoza JA, Baranowski T, Jaramillo S, et al. Fit 5 Kids TV Reduction Program for Latino Preschoolers: A Cluster Randomized Controlled Trial. American Journal of Preventive Medicine. 2016;50(5):584-592.<
2. Dennison BA, Russo TJ, Burdick PA, Jenkins PL. An intervention to reduce television viewing by preschool children. Archives of Pediatrics and Adolescent Medicine. 2004;158(2):170-176.
More Movement Program in Early Child Care Settings
The more movement program provides training opportunities and resources for early child care educators to implement actions in their programs to encourage physical activity. This strategy could support Boston’s efforts to improve early child care quality through the Boston Healthy Child Care Initiative. It would include training opportunities for early child care educators in physical activity curricula, provide resources and instructional materials, and support technical assistance opportunities that may lead to higher physical activity levels among young children.1,2
Helping educators implement practices shown to be effective in increasing physical activity can help the children in Boston’s early education and care settings to move more.
Additional Key Findings
If the more movement program in early child care settings was implemented in Boston, 94 cases of obesity would be prevented in 2029, saving $104,000 in health care costs over 10 years. Besides promoting a healthy weight, increasing physical activity is linked to improved bone and muscular health and better gross motor skills in young children.3-5
In addition, this strategy would train and provide technical assistance to early childhood educators. In the initial training series, the more movement program would provide additional skills training and professional development for 1,380 educators and more physical activity promotion opportunities in 570 (100%) child care programs serving 3-5 year olds.
To learn more about this strategy, read the research brief.
References
1. Fitzgibbon ML, Stolley MR, Schiffer LA, et al. Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: Postintervention Results. Obesity (Silver Spring). 2011;19(5):994-1003.
2. Kong A, Buscemi J, Stolley MR, Schiffer LA, Kim Y, Braunschweig CL, Gomez-Perez SL, Blumstein LB, Van Horn L, Dyer AR, Fitzgibbon ML. Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results. American Journal of Preventive Medicine. 2016 Feb;50(2):136-44.
3. U.S. Dept of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. U.S. Dept of Health and Human Services; 2018. Accessed Jul 23, 2021. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
4. Pate RR, Hillman CH, Janz KF, et al. Physical Activity and Health in Children Younger than 6 Years: A Systematic Review. Medicine & Science in Sports & Exercise. 06 2019;51(6):1282-1291.
5. Timmons BW, Leblanc AG, Carson V, et al. Systematic review of physical activity and health in the early years (aged 0-4 years). Applied Physiology, Nutrition, and Metabolism. Aug 2012;37(4):773-92.
Home Visits to Reduce Screen Time
The home visits to reduce screen time strategy aims to reduce the amount of screen time viewed at home by young children. Community health workers would provide counseling and resources on strategies to limit children’s screen time to children and families who participate in home visiting programs.
Through professional development training opportunities, community health workers would learn ways to support families and children in limiting their screen time. During a home visit, community health workers would share the importance of appropriate screen time limits and provide strategies and tools for families to use, including a screen time management device. Integrating this strategy through existing home visiting programs could help more children manage their screen time and grow up at a healthy weight.1
Additional Key Findings
If the home visits to reduce screen time strategy was implemented in Boston, 60 cases of childhood obesity would be prevented in 2029. Besides promoting a healthy weight, this strategy may also benefit children in other ways. Providing children and their families with strategies to move away from their screens allows for more time for activities like reading and active play.
By training and equipping 119 community health workers annually by ensuring that everyone has access to what they need to grow up healthy and strong, this strategy could help reach those families and children that may be at higher risk of having or developing obesity. Children in households with low income could see greater health benefits from this strategy.1
To learn more about this strategy, read the research brief.
References
1. Epstein LH, Roemmich JN, Robinson JL, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. Mar 2008;162(3):239-45. doi:10.1001/archpediatrics.2007.45
Movement Breaks in the Classroom
Movement breaks in the classroom is a strategy to promote physical activity during the school day by incorporating five-to-10-minute movement breaks in K-5 public elementary school classrooms. To implement the movement breaks strategy in Boston, teachers, Wellness Champions, and staff would receive training, equipment, and materials to incorporate short activity breaks in the classroom to help children move more.1,2
This aligns with Boston Public School’s (BPS) Physical Education and Physical Activity Policy that requires schools to offer physical activity opportunities during the school day,3 as well as BPS’ Whole School, Whole Community, Whole Child approach, which supports students’ holistic health by promoting positive classroom environments that foster physical activity and learning.
Additional Key Findings
If movement breaks were incorporated into classrooms in Boston, 37 cases of childhood obesity would be prevented in 2029 and save $35,300 in health care costs related to excess weight over 10 years.
By training and equipping over 600 teachers and other school staff yearly to incorporate movement breaks in the classroom, this strategy could help all Boston Public Schools cultivate a positive school climate and improve social emotional learning.4 Participation in movement breaks are associated with students spending more time on task,5 and teachers report that students are more engaged, supportive of each other, and responsive to teacher instructions after participating in a movement break.6
To learn more about this strategy, read the research brief.
References
1. Erwin HE, Beighle A, Morgan CF, Noland M. Effect of a low-cost, teacher-directed classroom intervention on elementary students’ physical activity. J Sch Health. 2011;81(8):455-461.
2. Murtagh E, Mulvihill M, Markey O. Bizzy Break! The effect of a classroom-based activity break on in-school physical activity levels of primary school children. Pediatr Exerc Sci. 2013;25(2):300-307.
3. Boston Public Schools. Physical Education & Physical Activity Policy. 2020:8. Superintendent’s Circular. https://drive.google.com/file/d/1rSGwpFaa4LsPKxjhdsHxz2IaXg3ZFVtE/view?usp=embed_facebook
4. School-Based Physical Activity Improves the Social and Emotional Climate for Learning. Centers for Disease Control and Prevention,. Accessed March 9, 2022. https://www.cdc.gov/healthyschools/school_based_pa_se_sel.htm
5. The Community Preventive Services Task Force. Physical Activity: Classroom-based Physical Activity Break Interventions. The Community Guide. 2021:8.
Campbell AL, Lassiter JW. Teacher perceptions of facilitators and barriers to implementing classroom physical activity breaks. J Educ Res. 2020;113(2):108-119
Creating Healthier Afterschool Environments (OSNAP)
The Out of School Nutrition and Physical Activity (OSNAP) initiative helps afterschool programs improve practices and policies that increase physical activity and consumption of healthy snacks.
To implement this initiative, the Boston Public Health Commission would provide professional development opportunities for afterschool program leaders serving students in grades K-5. Afterschool staff leaders would participate in three learning collaborative sessions and receive technical assistance to assess1 and modify their programs’ practices and policies2 to meet the OSNAP nutrition and physical activity goals.
Additional Key Findings
If the OSNAP initiative was implemented in Boston, 37 cases of obesity would be prevented in 2029. It is also projected to be cost-effective at commonly accepted thresholds3 based on net population health improvement related to excess weight ($72,100 per quality-adjusted life year gained).
This strategy may also support children’s health in a variety of other ways. Regular physical activity, healthy eating, and adequate hydration can improve children’s mental and emotional well-being and their heart, lung, and bone health.4 These healthy behaviors can also strengthen students’ attention, memory,5,6 and cognitive functioning,5 all important components for learning and academic performance.
To learn more about this strategy, read the research brief.
References
1. Lee RM, Emmons KM, Okechukwu CA, Barrett JL, Kenney EL, Cradock AL, Giles CM, deBlois ME, Gortmaker SL. Validity of a practitioner-administered observational tool to measure physical activity, nutrition, and screen time in school-age programs. Int J Behav Nutr Phys Act. 2014 Nov 28;11:145. doi: 10.1186/s12966-014-0145-5.
2. Kenney EL, Giles CM, deBlois ME, Gortmaker SL, Chinfatt S, Cradock AL. Improving nutrition and physical activity policies in afterschool programs: results from a group-randomized controlled trial. Prev Med. 2014;66:159-166. doi:10.1016/j.ypmed.2014.06.011
3. Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness–the curious resilience of the $50,000-per-QALY threshold. New England Journal of Medicine. 2014 Aug 28;371(9):796-7. DOI: 10.1056/NEJMp1405158. PMID: 25162885.
4. Health Benefits of Physical Activity for Children. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/adults/health-benefits-of-physical-activity-for-children.html. Published Jan 12, 2022. Updated 2022-01-12T05:06:09Z. Accessed Dec 7, 2022.
5. Childhood Nutrition Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyschools/nutrition/facts.htm. Published 2022. Updated 2022-08-05T03:49:26Z. Accessed Dec 12, 2022.
6. Blanding N. Afterschool Programs in Boston, MA, Expand Opportunities for Obesity Prevention. Centers for Disease Control and Prevention; 2016. http://nccd.cdc.gov/nccdsuccessstories
The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.
This document was developed at the Harvard T.H. Chan School of Public Health through the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This document is intended for educational use only. This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.
Coffee Chat: Using Local Data to Improve Health and Advance Health Equity
In this coffee chat hosted by the CHOICES Community of Practice, guest speakers Dr. Susan Carlson and Magdalena Pankowska highlighted the resources and data available through PLACES — a collaboration between the CDC, Robert Wood Johnson Foundation, and the CDC Foundation that provides local data estimates for all U.S. counties, places, census tracts, and ZIP Code tabulation areas — showcased the 2023 data release, and shared how these resources can be used to inform work around healthy eating, active living, and advancing health equity.
Strategy Profile: New Opportunities for Healthy Afterschool Programs
The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.
- Providing school-age children in grades K-5 attending Title I public schools with free state-administered afterschool programs that include 80 minutes of physical activity, a healthy snack, academic enrichment, and homework assistance.
What population benefits?
Children in grades K-5 who experience low income and are not currently participating in afterschool programs but would if programs were available.
What are the estimated benefits?
Relative to not implementing the strategy
Increase moderate-to-vigorous physical activity and, in turn, promote healthy child weight.
What are the additional benefits?
Relative to not implementing the strategy
The costs of implementing this strategy could be offset by savings from…
↓ Decrease in time cost of parent, relative, and non-relative caregivers to provide care for children newly attending afterschool programming
What activities and resources are needed?
| Activities | Resources | Who Leads? |
| Administer funding and coordinate afterschool programming | • Time of federal and state directors to lead administration and funding of afterschool programs in each state • Time of federal, state, and district coordinators to coordinate afterschool programming and funding |
Federal and state directors |
| Coordinate transportation for children attending afterschool programs | • Time of district transportation coordinator | District transportation coordinator |
| Train afterschool program site directors and staff and school district food service directors to operate the afterschool programs | Time of state physical activity training facilitator to lead annual trainings • Time for afterschool program site directors and staff (teachers and paraprofessionals) to attend annual trainings • Time for school district food service directors to attend annual trainings on operating a healthy afterschool snack program |
State physical activity training facilitator |
| Purchase physical activity curricula, equipment, and materials for operating afterschool programs | • Cost of physical activity curricula and equipment • Cost of afterschool program handbook provided to families |
District coordinator |
| Provide afterschool snacks that meet USDA afterschool snack program guidelines from the National School Lunch Program or the Child and Adult Care Food Program | • Cost of snacks | School district food service director |
| Provide afterschool programming | • Time of afterschool program site director • Time of afterschool program staff (teachers and paraprofessionals) • Time of school custodial staff to clean afterschool program space |
Afterschool program site director |
| Provide transportation home from afterschool programs | • Cost of bus transportation | District transportation coordinator |
FOR ADDITIONAL INFORMATION
Cradock AL, Barrett JL, Kenney EL, Giles CM, Ward ZJ, Long MW, Resch SC, Pipito AA, Wei ER, Gortmaker SL. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Prev Med. 2017 Feb;95 Suppl: S17-S27. doi: 10.1016/j.ypmed.2016.10.017. Supplemental Appendix with strategy details available at: https://ars.els-cdn.com/content/image/1- s2.0-S0091743516303395-mmc1.docx
- Browse more CHOICES research briefs & reports in the CHOICES Resource Library.
- Explore and compare this strategy with other strategies on the CHOICES National Action Kit.
Suggested Citation
CHOICES Strategy Profile: New Opportunities for Healthy Afterschool Programs. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2023.
Funding
This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.
Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist
©2015 President and Fellows of Harvard College. All rights reserved. The CHOICES name, acronym and logo are marks of the President and Fellows of Harvard College.
Strategy Profile: Creating Healthier Early Care and Education Environments
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.
- Improving nutrition, physical activity, & screen time policies & practices for children ages 3-5 by incorporating the Nutrition & Physical Activity Self-Assessment for Child Care (NAP SACC) Program into state’s Quality Rating and Improvement Systems (QRIS) for early care and education programs.
What population benefits?
Children ages 3-5 attending licensed early care and education programs that participate in their state’s Quality Rating and Improvement Systems (QRIS).
What are the estimated benefits?
Relative to not implementing the strategy
Promote healthy child weight.
What activities and resources are needed?
| Activities | Resources | Who Leads? |
| Train early care and education health professionals to work with early care and education programs | • Time of state training consultant to train early care and education health professionals • Time of early care and education health professionals to be trained |
State QRIS administrators |
| Provide consultation to early care and education program directors and staff for conducting self-assessments of program policies and practices, completing action plans, and implementing changes to improve nutrition, physical activity, and screen time environments in programs | • Time of early care and education health professionals to provide consultation to early care and education programs • Time of early care and education program directors and staff to participate in consultation |
Early care and education health professionals |
| Provide materials and equipment for implementing NAP SACC program | • Cost for GO NAP SACC online license • Physical activity equipment costs |
State QRIS administrators |
| Implement changes in early care and education programs to improve nutrition, physical activity, and screen time environments | • Time of early care and education program directors to implement changes | Early care and education program directors |
| Improve nutritional quality of meals served in early care and education programs | • Food costs for improving nutritional quality of meals | Early care and education program directors |
| Monitor compliance with NAP SACC program | • Time of state-level QRIS Administrators to monitor compliance | State QRIS administrators |
Strategy Modification
In states where NAP SACC is already being implemented, the strategy could be modified to focus on increasing the number of early care and education programs that participate in NAP SACC. With this modification, the cost for the GO NAP SACC online license would not be needed, since it is a fixed annual cost paid per state (i.e., it does not depend on the number of participating programs). With this modification, the impact on health is expected to be similar, and the impact on reach and cost would vary according to the number of programs reached.
FOR ADDITIONAL INFORMATION
Gortmaker SL, Wang YC, Long MW, Giles CM, Ward ZJ, Barrett JL, Kenney EL, Sonneville KR, Afzal AS, Resch SC, Cradock AL. Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Aff (Millwood). 2015 Nov;34(11):1932-9. doi: 10.1377/hlthaff.2015.0631. Supplemental Appendix with strategy details available at: https://www.healthaffairs.org/doi/suppl/10.1377/hlthaff.2015.0631/ suppl_file/2015-0631_gortmaker_appendix.pdf
Selected CHOICES research brief including cost-effectiveness metrics:
Adams B, Sutphin B, Betancourt K, Balamurugan A, Kim H, Bolton A, Barrett J, Reiner J, Cradock AL. Arkansas: Creating Healthier Child Care Environments: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) in the Quality Rating Improvement System (QRIS) {Issue Brief}. Arkansas Department of Health, Little Rock, AR, 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-napsacc-arkansas
Kenney EL, Giles CM, Flax CN, Gortmaker SL, Cradock AL, Ward ZJ, Foster S, Hammond W. New Hampshire: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) Intervention {Issue Brief}. New Hampshire Department of Health and Human Services, Concord, NH, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2017. Available at: https:// choicesproject.org/publications/brief-napsacc-intervention-new-hampshire
- Browse more CHOICES research briefs & reports in the CHOICES Resource Library.
- Explore and compare this strategy with other strategies on the CHOICES National Action Kit.
Suggested Citation
CHOICES Strategy Profile: Creating Healthier Early Care and Education Environments. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023.
Funding
This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.
Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist
©2015 President and Fellows of Harvard College. All rights reserved. The CHOICES name, acronym and logo are marks of the President and Fellows of Harvard College.
Strategy Profile: More Movement in Early Care and Education Settings
The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.
- Policy to promote physical activity among children ages 3-5 in licensed early care and education (ECE) programs by requiring training for early care educators in the provision of structured physical activity opportunities using an evidence-based curriculum.
What population benefits?
Children ages 3-5 who attend licensed early care and education programs.
What are the estimated benefits?
Relative to not implementing the strategy
Increase children’s moderate-to-vigorous physical activity levels and, in turn, promote healthy child weight.
What activities and resources are needed?
| Activities | Resources | Who Leads? |
| Train early care and education program directors and staff on evidence-based strategies and curricula (Hip Hop to Health Jr.) to provide physical activity instruction | • Time for State Early Care and Education Agency Training Consultant to prepare for and lead training • Time for early care and education program directors and staff to attend training • Travel costs |
State early care and education training consultant |
| Provide materials and equipment for promoting physical activity (such as CDs with activity-promoting music and templates for parent newsletters) | • Cost of materials and equipment | Early care and education programs (or local government) |
| Assess compliance with new policy to provide training and physical activity opportunities | • Time for state licensor to assess compliance with policy during monitoring visit | State early care and education agency monitoring and compliance staff |
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
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- Explore and compare this strategy with other strategies on the CHOICES National Action Kit.
Suggested Citation
CHOICES Strategy Profile: More Movement in Early Care and Education Settings. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023.
Funding
This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.
Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist
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