Topic: Active Living

Strategy Profile: Active School Day

Posted on November 16, 2023

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 opportunities for students to participate in physical activity during the school day for at least 30 minutes a day or 150 minutes a week.

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

Posted on November 13, 2023

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.

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

References

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

More Movement Program in Early Child Care Settings

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

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

Additional Key Findings

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

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

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

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

References

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

Home Visits to Reduce Screen Time

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

Through professional development training opportunities, community health workers would learn ways to support families and children in limiting their screen time. During a home visit, community health workers would share the importance of appropriate screen time limits and provide strategies and tools for families to use, including a screen time management device. Integrating this strategy through existing home visiting programs could help more children manage their screen time and grow up at a healthy weight.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.

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

References

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

Movement Breaks in the Classroom

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

This aligns with Boston Public School’s (BPS) Physical Education and Physical Activity Policy that requires schools to offer physical activity opportunities during the school day,³as 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.

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

References

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

Creating Healthier Afterschool Environments (OSNAP)

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

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

Additional Key Findings

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

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

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

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

References

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

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

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

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Coffee Chat: Using Local Data to Improve Health and Advance Health Equity

Posted on October 24, 2023

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.

View the resource round-up from this coffee chat

Download the October 2023 coffee chat presentation slides

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Strategy Profile: New Opportunities for Healthy Afterschool Programs

Posted on October 19, 2023

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

What population benefits?

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

What are the estimated benefits?

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

What are the additional benefits?

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

What activities and resources are needed?

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

FOR ADDITIONAL INFORMATION

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

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

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Strategy Profile: Creating Healthier Early Care and Education Environments

Posted on September 22, 2023

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

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

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Strategy Profile: More Movement in Early Care and Education Settings

Posted on September 15, 2023

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

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: 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

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

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Brief: Creating Healthier Afterschool Environments (OSNAP) in Boston, MA

Posted on July 28, 2023

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

This brief summarizes a CHOICES Learning Collaborative Partnership model examining the implementation of the Out of School Nutrition and Physical Activity (OSNAP) initiative that helps afterschool programs improve practices and policies that increase physical activity and consumption of healthy snacks.

The Issue

Every child should have opportunities to grow up healthy. Regular physical activity, healthy eating, and adequate hydration can help children maintain a healthy weight. Over 6,000 students in kindergarten to fifth grade participate in afterschool programs in Boston.¹ These educational settings can provide essential opportunities for children to learn healthy eating habits and promote physical activity and wellness. However, not all programs offer the same opportunities for healthy eating and physical activity.² Helping more afterschool programs adopt policies and practices that incorporate more physical activity, healthier snacks, and improved water access during program time can help ensure that all children in Boston’s afterschool programs have opportunities to grow up healthy.

About Creating Healthier Afterschool Environments

OSNAP is a proven initiative implemented in multiple communities that helps afterschool programs create environments that promote increased physical activity and consumption of healthy snacks.^3-6 Creating healthier afterschool environments can contribute to higher quality afterschool programming. 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 assess⁷ and modify their programs’ practices and policies³ to meet the OSNAP nutrition and physical activity goals. The Boston Public Health Commission would supply program leaders with materials to support implementation and offer continuing education units for their participation.

Comparing Costs and Outcomes

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

Creating healthier afterschool environments is an investment in the future. By the end of 2029:

Conclusions and Implications

Opportunities for physical activity and access to healthy foods in afterschool programs are important to parents² and can help enhance the quality of afterschool programing. Over 10 years, this strategy could train more than 600 afterschool teachers and directors. By equipping afterschool leaders with these skills and resources, afterschool programs could adopt healthier practices and policies and we project that 10,800 children would benefit from more physical activity and improved diet. We project that 37 cases of obesity would be prevented and $34,100 in healthcare costs related to excess weight would be saved in 2029. We expect this strategy would cost $18.30 per child per year to implement in Boston and is projected to be cost-effective at commonly accepted thresholds⁸ based on net population health improvement related to excess weight ($72,100 per quality-adjusted life year gained).

In addition to promoting healthy weight, this strategy may also support children’s health in 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.⁹ These healthy behaviors can also strengthen students’ attention, memory,^10,11 and cognitive functioning,¹⁰ all important components for learning and academic performance. Incorporating physical activity and healthy snacks in afterschool programs can help children nurture healthy habits and lay a strong foundation for overall health and well-being.

This strategy builds upon Boston Public Health Commission’s demonstrated success where, in 2015, more than 120 programs took steps to improve their screen time, physical activity, and nutrition practices through OSNAP, creating higher quality afterschool programs across Boston.¹¹ Broader implementation could reach all afterschool programs in Boston, improving practices and policies that promote increased physical activity and consumption of healthy snacks, furthering the Boston Public Health Commission’s goal of creating policy and systems changes in childcare to promote the health of all Boston residents.

References

Boston AfterSchool & Beyond. SY 21-22 Programs. In. Boston, MA: Boston AfterSchool & Beyond; 2021.
Kids on the Move: Afterschool Programs Promoting Healthy Eating and Physical Activity. Washington, D.C.: America After 3pm, Afterschool Alliance; 2015.
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
Cradock AL, Barrett JL, Giles CM, et al. Promoting Physical Activity With the Out of School Nutrition and Physical Activity (OSNAP) Initiative: A Cluster-Randomized Controlled Trial. JAMA Pediatr. 2016;170(2):155-162.
Lee RM, Giles CM, Cradock AL, Emmons KM, Okechukwu C, Kenney EL, Thayer J, Gortmaker SL. Impact of the Out-of-School Nutrition and Physical Activity (OSNAP) Group Randomized Controlled Trial on Children’s Food, Beverage, and Calorie Consumption among Snacks Served. J Acad Nutr Diet. 2018 Aug;118(8):1425-1437. doi: 10.1016/j.jand.2018.04.011.
Lee RM, Barrett JL, Daly JG, Mozaffarian RS, Giles CM, Cradock AL, Gortmaker SL. Assessing the effectiveness of training models for national scale-up of an evidence-based nutrition and physical activity intervention: a group randomized trial. BMC Public Health. 2019 Nov 28;19(1):1587. doi: 10.1186/s12889-019-7902-y.
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.
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.
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.
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.
Blanding N. Afterschool Programs in Boston, MA, Expand Opportunties for Obesity Prevention. Centers for Disease Control and Prevention; 2016. http://nccd.cdc.gov/nccdsuccessstories

Suggested Citation:

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

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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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:

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

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.
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
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
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
School Wellness Initiative for Thriving Community Health (SWITCH). Initiatives: Massachusetts School Wellness Coaching Program. Published 2022. Accessed Oct 5, 2022. https://massschoolwellness.org/initiatives
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
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.
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
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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Use of Evidence-Based Interventions to Promote Healthy Weight, Nutrition, and Physical Activity in Community Health Improvement Plans from Large Local Health Departments

Posted on June 20, 2023

This study identifies evidence-based healthy weight, nutrition, and physical activity strategies related to obesity prevention in large local health department Community Health Improvement Plans.

Dupuis R, Reiner JF, Silver S, Barrett JL, Daly JG, Lee RM, Gortmaker SL, Cradock AL. Use of Evidence-Based Interventions to Promote Healthy Weight, Nutrition, and Physical Activity in Community Health Improvement Plans from Large Local Health Departments. J Public Health Manag Pract. 2023 Sep-Oct 01;29(5):640-645. doi: 10.1097/PHH.0000000000001778. Epub 2023 Jun 20.

Abstract

We sought to identify evidence-based healthy weight, nutrition, and physical activity strategies related to obesity prevention in large local health department (LHD) Community Health Improvement Plans (CHIPs). We analyzed the content of the most recent, publicly available plans from 72 accredited LHDs serving a population of at least 500 000 people. We matched CHIP strategies to the County Health Rankings and Roadmaps’ What Works for Health (WWFH) database of interventions. We identified 739 strategies across 55 plans, 62.5% of which matched a “WWFH intervention” rated for effectiveness on diet and exercise outcomes. Among the 20 most commonly identified WWFH interventions in CHIPs, 10 had the highest evidence for effectiveness while 4 were rated as likely to decrease health disparities according to WWFH. Future prioritization of strategies by health agencies could focus on strategies with the strongest evidence for promoting healthy weight, nutrition, and physical activity outcomes and reducing health disparities.

Funding

This study was supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP001946 and U48DP006376). The findings and conclusions are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or The JPB Foundation.

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