The HI-5 Interventions

Interventions Changing the Context

School-Based Programs to Increase Physical Activity: The goal of these school-based programs is to increase physical activity during the times children are on school grounds before, during, and after classes. The programs can expand and enhance existing physical education programs and incorporate physical activities into academic classroom settings. Evidence demonstrates that these programs are associated with increases in student physical activity and have positive effects on BMI and obesity prevention.

School-Based Violence Prevention: Universal school-based violence prevention programs provide students and school staff with information about violence, change how youth think and feel about violence, and enhance interpersonal and emotional skills such as communication and problem-solving, empathy, and conflict management. These approaches are typically delivered to all students in a particular grade or school. A systematic review found that universal school-based violence prevention programs were associated with reductions in youth violence in all types of school environments, regardless of grade level, socioeconomic status, crime rate, and predominant race/ethnicity of students. The evidence also shows that specific programs have been associated with reductions in delinquency, alcohol and substance abuse, and improvements in academic performance.

Safe Routes to School (SRTS): SRTS is a comprehensive approach that encourages students and their families to walk, bike, or use other forms of active transportation to commute to and from school. It combines programmatic approaches like bicycle safety education, walking school buses, and increased traffic enforcement with infrastructure improvements such as sidewalks, crosswalks, and lighting to ensure safe conditions for walking and biking. The evidence demonstrates that SRTS is associated with increases in the number of students who walk and bike to and from school. There is also evidence that SRTS reduces the risk of injury from traffic collisions involving pedestrians and bicyclists.   

Motorcycle Injury Prevention: Universal motorcycle helmet laws require all motorcycle riders, both drivers and passengers, to wear a helmet when riding on public roads. States with universal laws consistently experience higher rates of helmet use and lower rates of motorcycle-related deaths and injuries.

Tobacco Control Interventions: Effective tobacco control interventions include tobacco price increases, high-impact anti-tobacco mass media campaigns, and comprehensive smoke-free laws. Evidence has shown a 20 percent increase in the unit price of tobacco can reduce the number of young people who started smoking, can increase quitting among young people and adults ages 30 and older, and can reduce tobacco use and demand. High-impact anti-tobacco mass-media campaigns, which target large audiences through television and radio broadcasts, print media (e.g., newspaper), and digital media to change knowledge, beliefs, attitudes, and behaviors regarding tobacco, have been shown to reduce adult tobacco use and promote tobacco cessation, as well as prevent tobacco use initiation among youth. Comprehensive smoke-free laws that prohibit smoking in all indoor areas of workplaces, bars, and restaurants are associated with reductions in exposure to secondhand smoke and improvements in short and long-term health outcomes, including reduced hospitalizations for asthma and heart attacks.

Access to Clean Syringes: Policies that support access to clean needles and syringes allow pharmacies to sell them without prescriptions and/or public health departments to authorize and conduct programs distributing clean needles and syringes and safely disposing of used ones. Evidence demonstrates that these policies, laws, and regulations are associated with reductions in the prevalence and incidence of HIV and HCV among persons who inject drugs.

Interventions Addressing the Social Determinants of Health

Early Childhood Education: Early Childhood Education (ECE) programs foster socio-emotional, cognitive, and motor skill development for children ages 3 to 4 years. Some programs also include physical activity, nutritious meals, parental support, health care screening and access, and social services. ECE programs may be delivered in a variety of ways and settings: state and district programs (available to all children), the federal Head Start program, and model programs (which focus on at-risk and/or economically disadvantaged children). In addition to improved cognitive development, the evidence shows that ECE programs are associated with reductions in obesity and BMI, child abuse and neglect, youth violence and emergency department visits.

Clean Diesel Bus Fleets: Under these transition programs, fleets of diesel buses are retrofitted to operate using clean diesel technology. The body of scientific evidence demonstrates these reductions are associated with fewer cardiovascular events and respiratory conditions, including asthma, and improved lung function among children.

Public Transportation System Introduction or Expansion: The purpose of introducing or expanding public transportation systems is to increase both access and use of public transit and to reduce traffic. The body of evidence demonstrates this intervention is associated with reductions in traffic crash injuries, fatalities, traffic congestion and associated air pollution as well as increasing levels of physical activity.

Home Improvement Loans and Grants: These financial resources provide funding to low-income families to repair and improve their homes. For example, funds may cover weatherization to improve insulation, air quality, dampness, and energy conservation, as well as removal of health or safety hazards from homes. The evidence demonstrates that these interventions are associated with improving residents’ general health and in reducing asthma symptoms and non-asthma related respiratory problems.

Earned Income Tax Credits: Earned income tax credits are usually implemented as refundable income tax credits levied at the federal, state, and/or local levels that benefit low- and moderate-income working individuals and families. The EITC has been credited with keeping more families and children above the poverty line than any other federal, state, or local program. In addition, the evidence demonstrates that EITC is associated with reductions in infant mortality and preterm births, and improvements in birthweight and maternal mental health.

Water Fluoridation: Community water fluoridation is the process of adjusting fluoride in water in order to improve oral health. Drinking fluoridated water keeps teeth strong and reduces tooth decay by approximately 25 percent in children and adults. By preventing tooth decay, community water fluoridation has been shown to save money, both for families and the health care system.

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