Healthy Kids Out of School (HKOS)

Healthy Kids Out of School (HKOS) was designed to promote healthy eating and physical activity in volunteer-led, short-duration out-of-school-time (OST) programs. In 2009, HKOS engaged leaders from nine national OST organizations to develop guiding principles to support the health and wellness of the tens of millions of children reached by their programs:

  • Drink Right: Choose water instead of sugar-sweetened beverages
  • Move More: Boost movement and physical activity in all programs
  • Snack Smart: Fuel up on fruits and vegetables

Working in Maine, Massachusetts, and New Hampshire from 2011 to 2014, HKOS developed and refined tailored interventions to support the adoption and implementation of these principles in a variety of OST programs. The initiative also partnered with grocery store chains to create and evaluate Snack It Up, a pilot program to increase access to fruits and vegetables in OST organizations.

From 2014 to 2017, HKOS brought its principles and programs to scale across the U.S. by embedding them at the national and regional levels of a variety of organizations serving demographic groups and communities disproportionately impacted by obesity. HKOS engaged more than a dozen national partners to implement HKOS principles in their programs. Some examples include:

  • The Scout Strong Healthy Unit Award (patch) is administered by the Boy Scouts of America, and the HKOS principles are included in the organization’s national leader handbooks.
  • The 4th H for Health Challenge is distributed by national 4-H and has been adopted by more than 15 states and the District of Columbia.
  • The Coaching Healthy Habits Training has been adopted nationally by eight organizations: YMCA, US Youth Soccer, Pop Warner, US Lacrosse, United States All Star Federation (USASF) for cheer and dance teams, National Council of Youth Sports, Up2Us, and the Positive Coaching Alliance.
  • The Strong Girls Healthy Meeting Patch has been adopted by 40 Girl Scout Councils.

In addition, HKOS developed the Healthy Kids Out of School Curriculum, a set of nutrition and physical activity lesson plans for afterschool and youth programs. Over seven sessions, OST program leaders can  take kids through fun activities to help them drink water, snack on fruits and vegetables, and get more physical activity.


Explore more of our research related to promoting healthy behaviors in out-of-school-time settings

Anzman-Frasca S, Newman MB, Angstrom HM, Sharma S, Nelson ME, Dolan PR, Economos CD. Parent perspectives on nutrition and physical activity during out-of-school time. J Nutr Educ Behav. 2014, 46(3):156-163.

Sliwa SA, Sharma S, Dietz WH, Dolan PR, Nelson ME, Newman MB, Rockeymoore M, Economos CD. Healthy Kids Out of School: Using mixed methods to develop principles for promoting healthy eating and physical activity in out-of-school settings in the United States. Preventing Chronic Disease. 2014; 11.

Anzman-Frasca S, Boulos R, Hofer T, Folta SC, Koomas A, Nelson ME, Sacheck JM, Economos CD. Validation of the Out-of-school-time Snacks, Beverages, and Physical Activity Questionnaire. Childhood Obesity. 2015; 11(4).

Folta SC, Koomas A, Metayer N, Fullerton KJ, Hubbard KL, Anzman-Frasca S, Hofer T, Nelson ME, Newman M, Sacheck JM, Economos CD. Engaging Stakeholders from Volunteer-Led Out-of-School Time Programs in the Dissemination of Guiding Principles for Healthy Snacking and Physical Activity. Preventing Chronic Disease. 2015; 12(E225).

Economos CD, Anzman-Frasca S, Koomas A, Chan G, Folta S, Heck J, Newman M, Sacheck J. Snacks, beverages, and physical activity during volunteer-led out-of-school-time programs: A cross-sectional analysis. BMC Public Health. 2017;17(1):125.