Traumatic brain injury and long-term associations with work, divorce and academic achievement.

OBJECTIVE: Traumatic brain injuries (TBI), irrespective of severity, may have long-term social implications. This study explores the relationships between TBI severity and outcomes related to work stability, divorce, and academic achievement. METHODS: Using a Danish nationwide sample of persons with and without TBI, we employed case-control and longitudinal cohort designs. The case-control design utilized individuals aged 18 to 60 years and examined work stability. Each case, employed at time of TBI, was compared with 10 matched controls. The cohort design utilized individuals alive from 1980 to 2016 with and without TBI and assessed the likelihood of 1) divorce and 2) higher-level education. TBI exposures included concussion, skull fractures, or confirmed TBI. RESULTS: TBI cases exhibited higher odds ratios (OR) for work instability at all follow-ups compared to controls. Increased TBI severity was associated with a higher risk of work instability at 2-year follow-up (concussion: OR = 1.83; skull fracture: OR = 2.22; confirmed TBI: OR = 4.55), and with a higher risk of not working at 10-year follow-up (confirmed TBI: OR = 2.82; concussion: OR = 1.63). The divorce incidence rate ratio (IRR) was elevated in individuals with TBI (males: IRR = 1.52; females: IRR = 1.48) compared to those without TBI. Individuals with childhood TBI had reduced chances of attaining high school degree or higher (males: IRR = 0.79; females: IRR = 0.85) compared to those without TBI. CONCLUSION: TBI is associated with an increased long-term risk of social consequences, including work instability, divorce, and diminished chances of higher education, even in cases with concussion.

Psychological and Academic Adaptation Through Universal Ethnic Studies Classes: Results of a Natural Experiment.

Schools in the United States are increasingly offering ethnic studies classes, which focus on exploring students' ethnic-racial identities (ERI) and critical analysis of systemic racism, to their diverse student bodies, yet scant research exists on their effectiveness for students of different ethnic-racial backgrounds in multiracial classrooms. A policy change to require all high school students in one school district to take an ethnic studies class facilitated a natural experiment for comparing the effects of quasi-random assignment to an ethnic studies class (treatment) relative to a traditional social studies class (control; e.g., U.S. Government, Human Geography). Student surveys and school administrative data were used to compare students' ERI development, well-being, and academic outcomes across ethnic studies and control classes. Participants (N = 535 9th graders; 66.1% ethnic studies) had diverse ethnic-racial (33.5% non-Latine White, 29.5% Black, 21.1% Latine, 10.7% biracial, 2.8% Asian, 2.2% Native American) and gender identities (44.7% female, 7.1% non-binary). Ethnic studies students reported marginally higher ERI exploration and resolution than controls, and sensitivity analyses showed a statistically significant effect on ERI among participants with complete midpoint surveys. Higher resolution was associated with better psychological well-being for all students and higher attendance for White students. Students with low middle school grades (GPA < 2.0) had better high school grades in core subjects when enrolled in ethnic studies than the control class. Overall, the results of this natural experiment provide preliminary support for ethnic studies classes as a method for promoting ERI development, well-being, attendance, and academic achievement for students from diverse ethnic-racial backgrounds.

Association between grit and depressive symptoms among medical students, moderated by academic performance.

Depression amongst medical students is a crucial matter. Grit, which is a potentially modifiable psychological factor, has been inversely linked to depressive symptoms. However, it remains unclear how grit is associated with depression. This study aims to examine the relationship between grit and depressive symptoms and to further investigate the potential effect modification by academic performance on the association between grit and depression among medical students. We focus on the total grit score and its subscales, namely perseverance of effort and consistency of interest. A cross-sectional study was conducted using data from second-year medical students at Tokyo Medical and Dental University in Japan from 2020 to 2023. The participants responded to questionnaire surveys comprising the Center for Epidemiologic Studies Depression Scale and the Short Grit Scale. Linear regression analysis was performed to assess the association between grit and depressive symptoms. We also tested for effect modification by first-year Grade Point Average (GPA) on the association between grit and depression. The total grit score and its subscales, perseverance of effort and consistency of interest, were all inversely associated with depressive symptoms (b = -4.7 [95%CI - 6.7 to - 2.6], b = -3.7 [95%CI - 5.3 to - 2.1], b = -1.8 [95%CI - 3.5 to - 0.2], respectively). While the interaction term for the total grit score and GPA was not significant, the interaction term for perseverance of effort and GPA was significant, indicating that the association between perseverance of effort and depression was stronger among the higher-achieving students. The interaction term for consistency of interest and GPA was also significant, indicating that the association was stronger among the lower-achieving students. We reveal a novel aspect of the association between grit and depressive symptoms in light of academic performance. The findings will contribute to future research on depression amongst medical students.

Perinatal influences on academic achievement and the developing brain: a scoping systematic review.

Introduction and methods: In this PRISMA-compliant systematic review, we identify and synthesize the findings of research in which neuroimaging and assessments of achievement have been used to examine the relationships among aspects of developmental programming, neurodevelopment, and achievement in reading and mathematics. Results: Forty-seven studies met inclusion criteria. The majority examined the impact of prematurity (n = 32) and prenatal alcohol exposure (n = 13). Several prematurity studies reported a positive correlation between white-matter integrity of callosal fibers and executive functioning and/or achievement, and white matter properties were consistently associated with cognitive and academic performance in preterm and full-term children. Volumetric studies reported positive associations between academic and cognitive abilities and white and gray matter volume in regions such as the insula, putamen, and prefrontal lobes. Functional MRI studies demonstrated increased right-hemispheric language processing among preterm children. Altered activation of the frontoparietal network related to numerical abilities was also reported. Prenatal alcohol exposure studies reported alterations in white matter microstructure linked to deficits in cognitive functioning and academic achievement, including mathematics, reading, and vocabulary skills. Volumetric studies reported reductions in cerebral, cerebellar, and subcortical gray matter volumes associated with decreased scores on measures of executive functioning, attention, working memory, and academic performance. Functional MRI studies demonstrated broad, diffuse activation, reduced activation in canonical regions, and increased activation in non-canonical regions during numeric tasks. Discussion: A preponderance of studies linked prematurity and prenatal alcohol exposure to altered neurodevelopmental processes and suboptimal academic achievement. Limitations and recommendations for future research are discussed. Systematic review registration: Identifier: DOI 10.17605/OSF.IO/ZAN67.

Learning in context: Undergraduate students' knowledge and the content retention of anatomy between discipline-specific and integrated course approaches.

Undergraduate introductory human anatomy and human physiology courses are either taught as discipline-specific or integrated anatomy and physiology (A&P) sequences. An institution underwent a curricular revision to change the course approach from discipline-specific Human Anatomy and Human Physiology to an integrated A&P I and II sequence, allowing the unique opportunity to explore the potential role of contextual learning in academic achievement and content retention. Mediation and moderation analysis was used to evaluate lecture examinations, laboratory practical examinations, and anatomical content retention between the different course approaches. Undergraduate students in the integrated A&P I course approach performed significantly better on lecture assessments and had a higher anatomy content retention rate at the end of the year than students enrolled in the standalone Human Anatomy course. The lecture examination averages between Human Physiology and A&P II (the second course in the sequence), as well as the anatomy laboratory practical examinations, were not significantly different between discipline-specific and integrated course approaches. The results suggest contextual learning-providing physiological context to anatomical structures-increases the anatomical content retention and academic achievement overall.

Beyond School Climate: Conceptualizing the School as a Protective Factor Approach.

BACKGROUND: The school climate concept has been promising, but has long-standing critiques that have not been adequately addressed to date. The School as a Protective Factor approach represents one attempt to offer a new approach that builds on and extends beyond the concept of school climate while addressing previously identified limitations. CONTRIBUTIONS TO THEORY: The School as a Protective Factor approach offers a new framework for conceptualizing, measuring, and establishing protective school social and learning environments that co-promote academic achievement and student health in schools, especially student mental health and substance use/abuse prevention. This new framework includes clear definitions, explicit goals, firmly established constructs, validated measures, and an intentionally parsimonious approach that prioritizes the implementation of well-established, high-impact constructs. CONCLUSIONS AND IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The School as a Protective Factor approach presents a simple, easy-to-use means of ensuring a school social environment that meets the developmental, academic, and health needs of all children and adolescents while maximizing protection across a range of desired outcomes. Perhaps most importantly, it does so in a manner that is manageable and easily integrated into every aspect of schooling, resonates with the practical experience of school personnel, and includes brief, effective, and free measurement tools.

Dynamics of a dynamic interrelationship: Exploring whether bidirectional learning behaviors-achievement relations differ across student-teacher relationship profiles.

Children who engage more in classroom instruction tend to also have higher levels of academic achievement relative to their peers who engage less. Although research has clearly established an association between such learning behaviors and academic achievement, the directionality of this relationship, and the possibility of bidirectional relations, remain unclear. It is possible that this lack of clarity stems from the fact that interrelationships between achievement and learning behaviors may differ across student-teacher relationship contexts. We evaluated this possibility using a large nationally representative sample of kindergarten to third grade students (N = 2010) from the Early Childhood Longitudinal Study-Kindergarten Cohort of 2011. Using latent profile moderation analyses, we identified three profiles of student-teacher relationships across kindergarten through third grade students: (a) Close (68%), (b) Conflictual (16%), and (c) Uninvolved (16%). Our follow-up models identified bidirectional relations that differed across these profiles, indicating more robust bidirectional learning behavior-achievement interrelationships in the Close profile and more unidirectional achievement to learning behavior relations in the Conflictual and Uninvolved profiles. These findings illustrate how differences in environmental contexts impact the relationship between students' learning behaviors and their achievement. Future studies should consider contextual influences when investigating children's academic growth processes and developing interventions.

Mediating role of inhibitory control in relationships between cardiovascular fitness and academic achievement in preadolescents.

Cardiovascular fitness (CRF) has been consistently linked to cognitive performance and academic achievement, and inhibitory control has been recognized as a key predictor of academic success. However, few studies have explored whether inhibitory control mediates the relationship between CRF and academic performance in children, and the existing findings are inconclusive because of certain limitations. This study investigated the mediating role of inhibitory control in the association between CRF and academic achievement among preadolescents while also addressing the related limitations. This study enrolled a total of 175 elementary school students (70 girls, mean age=11.17years, standard deviation=0.7), who participated in a half-mile test for assessing their CRF level. Additionally, inhibitory control was measured using the Stroop Color and Word Test (Stroop test), and language and mathematics tests were administered to measure their academic performance. The results revealed that the participants with higher CRF levels achieved superior performance in tasks requiring a high level of inhibitory control (r=0.291, P<0.001) and in Chinese language (r=-0.415, P<0.001) and mathematics (r=-0.366, P<0.001) tests even when gender, age, and body fat were considered. Furthermore, a mediation analysis revealed that inhibitory control, as measured through the incongruent trials of the Stroop test, partially mediated the relationship between CRF and academic performance (language: indirect effect=-0.013, 95% CI [-0.019, -0.008]; math: indirect effect=-0.013, 95% CI [-0.021, -0.009]). These findings have major implications for child development, emphasizing the key role of inhibitory control in the beneficial effects of CRF on academic achievement.

Assessing stress causing factors and language related challenges among first year students in higher institutions in Pakistan.

This mixed-methods study delves into stress factors among first-year undergraduate students in universities across Punjab, Pakistan. Five hundred students underwent evaluation for stress levels and academic achievement, with 10 selected for further analysis. The Perceived Stress Scale (Cohen et al., 1983) and demographic sheets were utilized for data collection. Analysis revealed a significant negative correlation between perceived stress and academic achievement. While women exhibited higher stress levels but better academic performance, students from public sector universities reported greater stress and lower academic success. In-depth interviews identified key stressors including heavy academic workload, financial constraints, limited support systems, competitive academic environments, and language-related challenges, notably weak English-speaking skills. These findings underscore the urgent need for enhanced support services, increased financial aid accessibility, a balanced academic culture, and the implementation of language support programs in Southern Punjab's higher education institutions. Addressing these stressors is crucial for fostering the well-being and academic success of first-year students, emphasizing the importance of creating a supportive learning environment during this transitional phase. The study offers insights into the multifaceted nature of stress experienced by first-year students and highlights the imperative of addressing these stressors to promote a nurturing learning environment conducive to academic success. Future research should explore the effectiveness of interventions aimed at reducing stress among first-year students and investigate additional factors that may contribute to stress in this population.

Is higher adherence to the mediterranean diet associated with greater academic performance in children and adolescents? A systematic review and meta-analysis.

OBJECTIVE: The aim of the present study was to synthesize the available evidence from the relationship between adherence to the Mediterranean diet (MedDiet) and academic performance in children and adolescents. METHODS: A systematic review and meta-analysis was conducted, which adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Scopus, Web of Science, and the Cochrane Library) were examined from inception to April 8th, 2024. RESULTS: Eighteen studies were included in the current systematic review and sixteen in the meta-analysis. The relationship between adherence to the MedDiet and academic performance among children and adolescents was statistically significant (Pearson's correlation coefficient [r] = 0.17, 95% confidence interval [CI]: 0.14 to 0.21, p < 0.001; inconsistency index [I2] = 56.7%). The influence analysis revealed that removing individual studies one at a time did not result in any changes to the overall results (p < 0.05 in all cases). CONCLUSIONS: A higher adherence to the MedDiet could play a relevant role in academic performance among children and adolescents.

The effects of diet quality, eating behavior, and sleep on the academic performance among elementary school students.

The academic success of children contributes to their income, social status, and public health. This study was conducted with 217 elementary school students from western China. Scores on the Chinese Children Dietary Index (CCDI), Dietary Approaches to Stop Hypertension (DASH), adjusted DASH, and KIDMED index were calculated to evaluate diet quality. Eating behavior and sleep quality were assessed using the Children's Eating Behavior Questionnaire (CEBQ) and Children's Sleep Habits Questionnaire (CHSQ), respectively. Academic achievement was measured using school-provided average grades. Higher CCDI scores, longer sleep time, lower total CHSQ scores, and lower subscores on "satiety responsiveness," "slowness in eating," "emotional undereating," and "food fussiness" dimensions of the CEBQ were associated with high academic achievement. In conclusion, good diet quality, sleep quality, healthy eating behaviors, and adequate sleep duration were associated with better academic performance. Interventions are recommended to be developed in education system to improve healthy diets and lifestyles, enhancing academic achievement.

Association between paediatric eye injuries, later academic success and social performance.

Aim: To investigate an association between eye injury and later academic and social performance. Materials: A retrospective longitudinal study of taking measurements multiple times was conducted including all severe eye injuries admitted during 2011-2017 at the main regional clinic to investigate changes in academic success and social inclusion before and after an injury. Parents/caregivers were surveyed asking questions on academic performance, and community/social involvement. In 2023 data on employment status were obtained. Kappa (ĸ) and non-parametric Wilcox-on signed-rank test for multiple comparisons were used. For association of employment status and post-injury visual acuity Fisher score was tested. Results: The total sample for assessing social inclusion and academic success was 36 and 25 children, respectively. In the following academic year ĸ agreements decreased from 0.88 (p<0.001) comparing pre-injury with a one-year post to 0.5106 (p<.0001) in the second year and 0.4750 (p=0.003) in the third, suggesting a deteriorating trend. A comparison of academic success before injury to two and three years after injury showed the trend significantly worsening with time (p=0.005, and 0.003, respectively). No association between an eye injury and social inclusion, as well as between employment and final visual acuity was noticed. Conclusion: Our findings suggest no association between social inclusion, employment, and eye trauma, while in later years academic success may be more impacted by the eye injury. Due to eye injury unpredictability in childhood age, both an informed and supportive climate environment at home and school is essential to minimize deleterious responses to eye trauma.

Do Wechsler intelligence scales predict academic achievement in children with ADHD or autism? A systematic review and meta-analysis.

Intelligence tests predict academic achievement in typically developed children, however if this is the case also in children with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) is not clear. This systematic review and meta-analysis examined if Wechsler intelligence scales predict academic achievement and/or grades in children, ages 6-16 years, with ADHD and/or ASD. We searched the databases PubMed, PsycINFO and Education Research Complete for studies published between 2000 and 2023. We used the Newcastle-Ottawa Scale to assess risk of bias. Narrative synthesis and meta-analysis were performed. Twelve studies (ADHD n = 1,834, ASD n = 176) were included in the review, and six samples (ADHD n = 1,112) of those were included in the meta-analyses. The results of the meta-analyses showed moderate overall weighted correlations between IQ and word reading, written language, and mathematics respectively. Similarly, the overall weighted correlations between processing speed and the aforementioned domains of academic achievement were moderate. Meta-analysis with additional Wechsler scales composite scores could not be conducted. In the narrative synthesis, Full Scale IQ was associated with academic achievement in both ADHD and ASD, and grades in ADHD. The limited number of ASD participants and the heterogeneity of the samples need to be considered when interpreting results. Generally, the results indicate that Wechsler scales are valuable in predicting academic achievement in children with ADHD or ASD. Motivation and other factors related with academic achievement need to be further explored in these groups.

Education and employment outcomes in pediatric chronic kidney disease.

As outcomes and survival for children with chronic kidney disease (CKD) have improved over the last 30 years, there is an emerging need to characterize and understand later educational and employment outcomes across the spectrum of pediatric CKD severity-ranging from mild CKD to requirement for dialysis and kidney transplantation. Although large-scale research on the topic of long-term educational and employment outcomes in the pediatric CKD population is relatively scarce, the existing literature does support that children across the spectrum of CKD severity are at risk for education-related difficulties including chronic school absenteeism. These education-related difficulties are compounded by well-described neurocognitive deficits-particularly in the domain of executive functioning-that may potentially perpetuate the risk for academic underachievement. This is particularly concerning given that data from the general pediatric population suggest that childhood academic underachievement is associated with higher likelihood of un-/underemployment in adulthood. This review highlights what is known about educational and employment outcomes among persons with a history of childhood CKD, as well as suggestions for interventions to improve educational outcomes for this population.

The impact of family socioeconomic status on parental involvement and student engagement during COVID-19 in promoting academic achievement: A longitudinal study in Chinese children.

With a three-wave longitudinal design, the current study examined the impact of family socioeconomic status (SES) on parental involvement and student engagement in promoting children's academic achievement during the coronavirus disease 2019 (COVID-19) pandemic. We recruited data from 246 mother-primary school student dyads, and the mean age of children at Wave 1 was 10.57 ± 0.97 years (range = 9-13 years). The academic achievement of these children was measured both before and after school closures. Family SES, parental involvement, and student engagement were assessed during the school closures. The results indicated that family SES could predict children's later academic achievement after accounting for their prior academic achievement and other demographics (i.e., the significant total effect in the model). Moreover, parental involvement and student engagement played chain-mediating roles in the effect of family SES on children's later academic achievement. Neither parent involvement nor student involvement alone mediated the relationships between family SES and subsequent academic achievement. Suggestions are provided to minimize the negative impact of low family SES on children's academic achievement during pandemics.

The relationship of preterm and small for gestational age with child cognition during school-age years.

BACKGROUND: Children born preterm and/or small for gestational age (SGA) are at increased risk of poor cognitive outcomes, particularly in low and middle-income countries (LMICs). OBJECTIVES: This study examined the cognitive and academic deficits during the school age years in children born preterm or SGA compared to term adequate for gestational age (AGA) in rural Vietnam. METHOD: Children born to women in a preconception micronutrient supplementation trial in Vietnam were classified into three groups: preterm AGA (n =138), term SGA (n =169) and term AGA (n= 1134). Cognitive abilities were assessed using the Wechsler Intelligence Scale for Children, measuring four domains (verbal comprehension -VCI, perceptual reasoning -PRI, working memory -WMI, and processing speed Index scores - PSI) and full-scale intelligence quotient (FSIQ) at 6-7y and 10-11y. Academic achievement was assessed with math and language tests. ANOVA and multiple regression models were used to analyze differences in cognitive function and academic achievement at 6-7y and 10-11y by birth phenotypes. RESULTS: Compared to term AGA children, those born SGA had lower cognitive scores at both 6-7y (-2.3 VCI, -3.7 PRI, -2.1 PSI and -2.9 FSIQ) and 10-11y (-3.7 VCI, -3.5 PRI, -2.7 WMI, -1.9 PSI and -3.9 FSIQ). Children born SGA also had poorer academic achievement with lower language (5.3) and math (2.5) scores. Adjustments for maternal factors and home environment attenuated the associations, but the differences in VCI, PRI, FSIQ and language at 10-11y remained significant. There were no differences in cognitive function and academic achievement between children born preterm and AGA. CONCLUSIONS: Our findings highlight the enduring association of birth phenotype on cognitive functioning and academic achievement during the school years, despite adjustments for maternal education and family environment. Further research is needed to implement effective interventions to improve birth outcomes and optimize child health and development in LMICs. CLINICAL TRIAL REGISTRY: The trial was registered at ClinicalTrials.Gov as NCT01665378, URL: https://clinicaltrials.gov/ct2/show/NCT01665378.

Beyond School Climate: Validating the School as a Protective Factor-Brief Survey.

BACKGROUND: The conceptual framework for School as a Protective Factor approach was presented in a companion article in this issue of the journal. The current article describes the validation of the School as a Protective Factor-Brief (SPF-Brief), a 13-item survey measuring the 3 core constructs and 13 defining characteristics of this framework. METHODS: The SPF-Brief was validated through 2 studies. The developmental study used a longitudinal design including 1349 participants who completed surveys over 5 semesters, while the validation study used a cross-sectional design with 2775 participants. Both studies included middle and high school students. Factor analysis, growth model analysis, criterion-related validation, and outcome analysis were employed. RESULTS: Analyses provided strong evidence supporting the reliability and validity of the instrument and conceptual framework. Higher SPF-Brief scores were associated with higher math grades, English grades, and quality of life, as well as lower rates of anxiety, depression, conduct disorder, alcohol, e-cigarette, tobacco, and cannabis use. Effect size estimates ranged from moderate to strong. CONCLUSIONS: These findings suggest the utility of the SPF-Brief instrument and the School as a Protective Factor framework. Together, they may offer advantages to the traditional school climate approach.

The moderating role of psychological capital in the relationship between school-related stress and outcomes of academic achievement and behavior problems among students with health impairments.

Numerous researches have examined the relationship between school-related stress and outcomes of academic achievement and behavior problems; however, a very few studies were conducted to assess the moderating role of psychological capital in this relat.ionship, especially focusing on students with health impairments. The current study was carried out to investigate the association of school-related stress and psychological capital with academic achievement and behavior problems in students with health impairments, as well as the possible moderating influence of psychological capital in the school-related stress and outcomes relationships. The study involved 233 students with health impairments in Addis Ababa. Instruments used for the study include the Demographic Questionnaire, Perceived School-Related Stress Scale, Psychological Capital Questionnaire, Strengths and Difficulties Questionnaire, and school record reviews. Descriptive statistics, structural equation modeling, and multi-group structural equation modeling were utilized to analyze the data. Results revealed that school-related stress was significantly and negatively associated with academic achievement and positively with behavior problems. Psychological capital was significantly and positively associated with academic achievement and negatively with behavior problems. Higher levels of psychological capital had a significant moderating role in the relationships between school-related stress and both outcomes of academic achievement and behavior problems. The finding suggests that PsyCap is a positive resource to counteract the detrimental impacts of school-related stress on the academic achievement and behavior problems of students with health impairments.

Harmonious passion and academic achievement in higher education: The mediating influence of exploratory and exploitative learning strategies.

Harmonious passion refers to engaging in an activity out of personal volition and sense of meaning, which motivates individuals to devote substantial time and energy while internalizing the activity as part of their identity, and it underpins the promotion of sustainable behaviors and mindsets. The present study aimed to investigate the relationship between harmonious passion and academic achievement among university students in higher education, as well as the mediating role of exploratory and exploitative learning behaviors in this association. Exploratory learning involves seeking new knowledge and skills, whereas exploitative learning involves refining and applying existing knowledge and skills. Data were collected from 528 university students across multiple institutions in China. Using structural equation modeling and multiple regression analysis, results revealed that harmonious passion had a significant positive effect on academic achievement. Furthermore, exploratory and exploitative learning played a chain-mediated role in the relationship. These findings provide insights into how harmonious passion could promote students' academic success in the context of innovation-driven and socially sustainable development, via the facilitation of sustainable learning strategies. Therefore, this study has broader implications for personal and societal sustainability, by emphasizing the role of harmonious passion and sustainable learning strategies in enhancing academic achievement and, ultimately, contributing to a more sustainable society.

In-classroom physical activity breaks program among school children in Sri Lanka: study protocol for a randomized controlled trial.

Background: The problem of sedentary behavior among primary school children is alarming, with numbers gradually increasing worldwide, including Sri Lanka. Physical activity interventions within classroom settings have been acknowledged as a critical strategy to increase students' movement behaviors while enhancing their academic achievement and health. Yet, the busy curriculum and challenging educational demands encourage more sedentary classroom behavior. Hence, this study aims to develop and evaluate an in-classroom physical activity breaks (IcPAB) intervention among fifth graders in Sri Lanka. Methods: The study will adopt a randomized controlled trial (RCT), comprising an in-classroom physical activity breaks program group and a control group to evaluate the effects of IcPAB on academic achievement, movement behaviors and health outcomes. The intervention design is based on the capability (C), opportunity (O) and motivation (M) behavior (B) (COM-B) model. A least 198 fifth graders will be recruited from two schools in Uva province, Sri Lanka. The recruitment process will start in late 2022. Class teachers of the intervention group will implement 5-min activity breaks at least three times a day after completing a training session. The primary variables include mathematics and reading achievement. The secondary variables include physical activity levels, steps count, sedentary behavior, body mass index, aerobic fitness, and perceived stress. Data collection will be implemented at pre-test and post-test, respectively. Intervention fidelity and the process will also be evaluated. Discussion: The IcPAB is designed to prevent pure educational time loss by introducing curriculum-integrated short bouts of physical active breaks into the classroom routine. If the IcPAB is effective, it can (1) improve the mathematics and reading achievement of fifth-grade girls and boys, which is a significant factor determining the performance at the Grade Five National Scholarship Examination in Sri Lanka; (2) improve movement behaviors as well as physical and mental health outcomes among primary school students. Sequentially, the IcPAB will enrich school-based physical activity intervention approaches which can in turn bring academic and health benefits to primary school children in Sri Lanka. Trial registration: The first version of the trial was registered with the ISRCTN registry (Ref: ISRCTN52180050) on 20/07/2022.