Cardiovascular Diseases, Heat Illness, Mental Health Disorders, Neurocognitive Impairment, Respiratory Diseases
Conditions
Keywords
Heat stress, heat early warning, digital intervention, WeChat mini-program, school-age children, executive function, Wisconsin Card Sorting Test, cognitive function, cluster randomized controlled trial, children's physical health, heat-related disease, climate change
Brief summary
This cluster randomized trial is conducted in Beijing primary schools to evaluate the efficacy of a WeChat mini-program-based high-temperature early warning intervention on the physical and cognitive health of school-age children. Six participating schools are randomly assigned to two parallel groups. The intervention group receives tiered heat alerts and guided self-health monitoring via the mini-program. The control group follows standard daily school and family routines, with no dedicated digital high-temperature early-warning intervention. The primary outcome is children's executive function after a 2.5-month follow-up. A range of secondary indicators related to physical status, mental health and health behaviors are assessed concurrently to quantify the intervention's benefits in mitigating adverse health outcomes caused by high temperatures.
Detailed description
This pilot study is conducted in Beijing, with 6 primary schools selected as research sites. A stratified cluster randomized controlled design is adopted, with schools as the unit of randomization. Eligible primary schools are randomly assigned to the intervention group and the control group, with 3 schools in each group. A total of 5 Wisconsin Card Sorting Tests (WCST), 2 health examinations, 2 children's high-temperature protection themed drawing activities, and 5 mini-program questionnaire surveys will be conducted in this study. The intervention group receives a digital intervention of high-temperature health risk early warning. The research team uses a WeChat mini-program to release corresponding high-temperature health risk level information, health tips, protection science popularization information and other early warning content when the high-temperature health risk level reaches yellow, orange or red, and simultaneously pushes them to head teachers and parents. The monitoring and survey schedule for the intervention group during the study period is as follows: at baseline and endpoint, unified offline WCST and health examinations will be conducted for children once each, accompanied by one online mini-program questionnaire survey each time. One children's high-temperature protection themed drawing activity will be organized at baseline and at the end of the 3rd month after the intervention, and the works will be uploaded to the mini-program for check-in. At the end of the 1st, 2nd and 3rd months after the intervention, one online follow-up questionnaire and WCST will be completed each month, together with check-in. Meanwhile, blood pressure will be monitored once a week, and daily blood pressure monitoring and check-in will be carried out after each high-temperature health risk early warning release. In addition, after the release of high-temperature health risk early warnings, the intervention group is required to complete check-in for reading and transmitting early warning information, health tips and protection science popularization content, as well as online mini-program surveys on children's awareness of high-temperature health risk early warning information and short-term behavioral patterns. The above WCST and questionnaire surveys will be completed by children with parental assistance; blood pressure monitoring and check-in are the responsibility of head teachers during non-summer vacations and parents during summer vacations. The control group does not receive the high-temperature health risk early warning intervention and will only complete the corresponding WCST, health examinations, questionnaire surveys and blood pressure monitoring.
Interventions
OTHERWeChat Mini-program Based Heat Health Risk Early Warning Intervention
This study implements a digital early warning intervention targeting children's high-temperature health risks. During the intervention period, when the high-temperature health risk level reaches yellow, orange or red, relevant risk information, health tips and heat protection education materials are released to parents and head teachers via the WeChat mini-program. Parents or teachers pass on the warning information to participating children. During non-summer periods, Beijing's high-temperature early warning information is pushed to head teachers and parents via the WeChat mini-program; during summer vacation, location-specific early warning information is sent to parents. All recipients are required to pass on the information to children promptly upon receipt.
Sponsors
Centers for Disease Control and Prevention, China
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
9 Years to 11 Years
Healthy volunteers
Yes
Inclusion criteria
School inclusion criteria 1. Willing to participate in the study. 2. Possess adequate facilities and qualified teaching staff. 3. The school and teachers maintain good cooperation. 4. Class size is no less than 35 students. 5. All participating classrooms are equipped with air conditioners. Participant inclusion criteria 1. Fourth-grade primary school students aged 9 to 11, of all genders. 2. Voluntary participation by students and their parents, good compliance, and signed informed consent. 3. At least one adult family member has an internet-enabled mobile device. 4. Good general health with no history of severe physical or mental disorders. 5. Local permanent residents with a residency of no less than 6 months. Participant
Exclusion criteria
1. Participants who are unable or refuse to complete required examinations. 2. Students receiving psychological or psychiatric treatment that may confound the study results. 3. Those currently enrolled in other interventional clinical studies that may affect outcome assessment. 4. Any other conditions deemed ineligible by the research team. Any participant meeting any of the above
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The primary outcome is the comprehensive total score of children's executive function constructed based on the Wisconsin Card Sorting Test (WCST) | at 2.5 months of intervention. | The only primary outcome of this study is the composite score of cognitive executive function derived from the Wisconsin Card Sorting Test (WCST) via the TOPSIS method. All WCST absolute indicators and sub-dimensions are sub-indicators instead of independent outcomes. The WCST indicators are grouped into three sub-dimensions: conceptual thinking (Total Correct, Total Errors, Nonperseverative Errors, Conceptual Level Responses, Categories Completed), perseveration (Perseverative Responses, Perseverative Errors), and set maintenance (Failure to Maintain Set). Negative indicators are converted using the formula (x' = Max(x) - x). After Z-score normalization, the decision matrix is established, positive and negative ideal solutions are identified, and Euclidean distances and relative closeness are computed. The resulting relative closeness value is taken as the final composite score of cognitive executive function, the single primary outcome of this study. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Systolic Blood Pressure | at 2.5 months of intervention | Systolic Blood Pressure measured in mmHg |
| Diastolic Blood Pressure | at 2.5 months of intervention | Diastolic blood pressure measured in mmHg |
| Heart Rate | at 2.5 months of intervention | Resting heart rate measured in beats per minute (bpm) |
| Forced Expiratory Volume in 1 second (FEV1) | at 2.5 months of intervention | Pulmonary function indicator measured in liters (L) |
| Forced Vital Capacity (FVC) | at 2.5 months of intervention | Pulmonary function indicator measured in liters (L) |
| Peak Expiratory Flow (PEF) | at 2.5 months of intervention | Pulmonary function indicator measured in liters per second (L/s) |
| Forced Expiratory Flow 25-75% (FEF25-75%) | at 2.5 months of intervention | Mid-expiratory flow measured in liters per second (L/s) |
| Fractional Exhaled Nitric Oxide (FeNO50) | at 2.5 months of intervention | Exhaled nitric oxide level at 50 mL/s flow rate, measured in parts per billion (ppb) |
| Fractional Exhaled Nitric Oxide (FeNO200) | at 2.5 months of intervention | Exhaled nitric oxide level at 200 mL/s flow rate, measured in parts per billion (ppb) |
| Calcium Nitric Oxide (CaNO) | at 2.5 months of intervention | Airway nitric oxide parameter measured in ppb |
| Fractional Expiratory Carbon Monoxide (FeCO) | at 2.5 months of intervention | Exhaled carbon monoxide level measured in parts per million (ppm) |
| Body Fat Percentage | at 2.5 months of intervention | Body fat percentage measured by bioelectrical impedance analysis |
| Total Body Water | at 2.5 months of intervention | Total body water measured in liters (L) |
| Inorganic Salts | at 2.5 months of intervention | Inorganic salt content measured in kilograms (kg) |
| Basal Metabolic Rate (BMR) | at 2.5 months of intervention | Basal metabolic rate measured in kilocalories per day (kcal/day) |
| Body Weight | at 2.5 months of intervention | Body weight measured in kilograms (kg) |
| High-Temperature Health KAP Score | at 2.5 months of intervention | Knowledge, Attitude, and Practice (KAP) score on high-temperature health |
| High-Temperature Health Cognition and Protection Behavior Drawing Score | at 2.5 months of intervention | Drawing-based score of children's cognition and protective behaviors for high-temperature health |
| Short-Term Behavioral Pattern Score | at 2.5 months of intervention | Score of children's short-term behavioral patterns related to heat health |
| SAS Anxiety Scale Score | at 2.5 months of intervention | Self-rating Anxiety Scale (SAS) score for children's anxiety symptoms |
| CDI Children's Depression Scale Score | at 2.5 months of intervention | Children's Depression Inventory (CDI) score for depressive symptoms |
| SGRQ Respiratory Symptom Scale Score | at 2.5 months of intervention | St. George's Respiratory Questionnaire (SGRQ) score for respiratory symptoms |
| School Absenteeism Days | at 2.5 months of intervention | Number of school absenteeism days during the study period |
| Academic Performance | at 2.5 months of intervention | Scores of children's academic examinations |
| Heat-Related Illness Incidence | at 2.5 months of intervention | Occurrence frequency of heat-related illnesses in children |
| Gastrointestinal Diseases Incidence | at 2.5 months of intervention | Occurrence frequency of gastrointestinal diseases in children |
| Respiratory Diseases Incidence | at 2.5 months of intervention | Occurrence frequency of respiratory diseases in children |
| Allergies Incidence | at 2.5 months of intervention | Occurrence frequency of allergies in children |
| Accidental Injuries Incidence | at 2.5 months of intervention | Occurrence frequency of accidental injuries in children |
| Early Warning Information Check-in Rate | at 2.5 months of intervention | Check-in rate of early warning information received by the intervention group |
Contacts
CONTACTTiantian Li, PhD
CONTACTTianTian LI, Study Director
Outcome results
None listed