Recent prevalence of allergic rhinitis caused by house dust mites among the pediatric population in Fukui, Japan.

Background: Allergic rhinitis (AR) is an IgE-mediated type I allergic chronic nasal disease common among all age groups, including the pediatric population. House dust mites (HDMs) are globally ubiquitous and the most important indoor aeroallergen. However, the recent prevalence of HDM-caused AR (AR-HDM) in Japan remains unknown, especially after the COVID-19 pandemic. Objective: The objective of this study was to investigate the current prevalence of AR-HDM, its clinical features, and the current status of medical examinations in elementary school students. Methods: A survey of 41,000 elementary school students was conducted during July 2021 in Fukui Prefecture, Japan. Parents were asked to complete a questionnaire that examined allergic disease history and clinical background. Results: A total of 17,974 subjects were analyzed in the study. The results showed that the current prevalence of AR-HDM in elementary school children is 18.8%. We found that AR-HDM had already developed before entrance into elementary school in 68.3% of affected subjects. Among these subjects, 82.3% had received some form of treatment, such as prescription medications, whereas 4.2% were treated by allergen immunotherapy. Multiple logistic regression analysis of the onset of AR-HDM revealed that male sex, being the first-born child, comorbidity of bronchial asthma, atopic dermatitis, food allergy, and allergic conjunctivitis are associated with development of AR-HDM. Conclusions: The present study revealed the prevalence of AR-HDM in elementary school children. The results emphasize the importance of appropriate diagnosis and treatment from infancy through early childhood.

Impact of a mindfulness-based intervention on well-being and mental health of elementary school children: results from a randomized cluster trial.

Prevention programs, such as mindfulness-based interventions (MBIs), are often implemented in schools to prevent psychological disorders from emerging in children and to support their mental health. This study used a randomized cluster design to evaluate the impact of a MBI, called Mission Méditation, on the well-being and the mental health of elementary school children's. 13 classrooms of an elementary school were randomly allocated to the experimental condition (7 classrooms, n = 127 students) or the waitlist control condition (6 classrooms, n = 104 students). Participants in the experimental condition received a 10-week MBI. Regression analyses revealed significant differences between conditions for inattention. Participants in the MBI condition reported no change in pre- to post-intervention, whereas participants in the control condition reported pre- to post-intervention increases. Results also showed significant differences in perceived competence. Participants in the MBI condition reported a non-significant decrease in perceive competence, whereas participants in the control condition reported significantly higher perceive competence scores from pre- to post-intervention. Results do not indicate that the MBI had a significant impact on participant's well-being and mental health. This suggests that MBIs may not have an added value when compared to other preventive interventions geared towards well-being and mental health promotion in school settings.

The factorial structure of executive functions in preschool and elementary school children and relations with intelligence.

The timing of structural changes in executive functions (EFs) across development is a matter of controversy; whereas some studies suggest a uniform structure of EFs in early childhood, findings in middle and late childhood are mixed. There are results indicating uniformity of EFs as well as several studies suggesting multidimensionality of the construct. In addition, studies demonstrate an age-related differentiation of the relation between EFs and intelligence. We conducted a comparative analysis of the EF structure and relations with fluid intelligence in two distinct age groups. A sample of n = 145 preschool children (5.2-6.7 years of age) and n = 109 elementary school children (8.8-11.8 years) completed measures of working memory, inhibition, cognitive flexibility, and fluid intelligence. Confirmatory factor analysis (CFA) revealed that a single-factor model best represented performance on EF tasks in both preschool and elementary school children. Multi-group CFA indicated equivalent and strong relations between EFs and intelligence across both age groups (r = .64 in preschool and elementary school children). Our results confirm that EFs are significantly related to fluid intelligence but might not underlie a uniform pattern of successive differentiation into multiple EF components in childhood. We discuss how methodological artifacts such as simultaneous interference might have contributed to previous findings on differentiation in middle and late childhood.

Examining the effectiveness of a social-play-based programme to reduce symptoms of Attention-Deficit/Hyperactivity Disorder in Saudi elementary school children.

BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions in children, and can profoundly affect their social interactions, well-being, and relationships with parents, peers, and teachers. OBJECTIVE: This study investigated the effectiveness of a social-play-based intervention programme in reducing ADHD symptoms in a sample of 67 Saudi boys aged 8-10 diagnosed with ADHD. METHODS: The programme consisted of ten 60-minute sessions of play-based activities, delivered to the experimental group twice weekly for 5 weeks. The control group followed the usual school curriculum. Teachers and parents completed the Conners' Teacher Rating Scale-Revised: Short Form and Conners' Parent Rating Scale-Revised: Short Form for all participants at pre-test, post-test, and follow-up. RESULTS: The experimental group showed a significant reduction in ADHD-associated behavioural problems over time, with moderate to large effect sizes. No significant changes over time were found for the control group. The results were maintained at a 2-month follow-up. CONCLUSIONS: We recommend incorporating social-play-based activities and skill training into the school context. Reducing ADHD symptoms may improve children's academic performance and perspective on school.

Contribution of orthography to vocabulary acquisition in a second language: Evidence of an early word-learning advantage in elementary-school children.

Recent studies have shown that children benefit from orthography when learning new words. This orthographic facilitation can be explained by the fact that written language acts as an anchor device due to the transient nature of spoken language. There is also a close and reciprocal relationship between spoken and written language. Second-language word learning poses specific challenges in terms of orthography-phonology mappings that do not fully overlap with first-language mappings. The current study aimed to investigate whether orthographic information facilitates second-language word learning in developing readers, namely third and fifth graders. In a first experiment French children learned 16 German words, and in a second experiment they learned 24 German words. Word learning was assessed by picture designation, spoken word recognition, and orthographic choice. In both experiments, orthographic facilitation was found in both less and more advanced readers. The theoretical and practical implications of these findings are discussed.

Relationship between the floating toe and the center-of-pressure position in an upright posture among students.

[Purpose] The incidence of floating toes in children is increasing. Although the anteroposterior center of pressure in children is present posteriorly, its relationship with the floating toe is unclear. This study aimed to clarify the relationship between the position of the anteroposterior center of pressure and the floating toe in an upright posture in children. [Participants and Methods] In this cross-sectional study, a Win-Pod (Medicapteurs) platform was used to measure the position of the anteroposterior center of pressure in 208 boys and 195 girls from Japanese elementary schools. Using images of the plantar footprint, floating toes were assessed and the floating toe score was calculated. [Results] The anteroposterior center of pressure position was situated 32.3 ± 8.2% from the heel. The floating toe score of all the participants was 3.5 ± 2.4, with a very high rate of 98%. The floating toe score had a significant, moderate correlation with age, height, weight, and the anteroposterior center-of-pressure position. Multivariate analysis revealed an association between the floating toe score and the anteroposterior center-of-pressure position, height, and weight. [Conclusion] There is significant relationship between the anteroposterior center-of-pressure position and the floating toe score in an upright posture in Japanese elementary school students.

The Effects of Family and School Interpersonal Relationships on Depression in Chinese Elementary School Children: The Mediating Role of Academic Stress and the Moderating Role of Self-Esteem.

This study explores the relative contributions and psychological mechanisms of the effects of family (father-child and mother-child) and school (teacher-student and student-student) interpersonal relationships on depression in elementary school children. The participants (n = 20,629) were elementary school children (48.19% male) aged nine to 13 years from Southwest China during the COVID-19 pandemic. They voluntarily completed questionnaires regarding parent-child, teacher-student, and student-student relationships, as well as academic stress and self-esteem. The results indicate that the effect of family interpersonal relationships on children's depression was stronger than that of school interpersonal relationships. The predictive effects of father-child and mother-child relationships on children's depression did not significantly differ; however, the effect of student-student relationships was significantly stronger than that of teacher-student relationships. Academic stress partially mediated the effect of interpersonal relationships on depression in elementary school children. The effects of family interpersonal relationships and academic stress on depression were moderated by self-esteem. These findings underscore the disparities and mechanisms pertaining to the impacts of diverse interpersonal associations on children's depression, thus signifying significant implications for the advancement of research and intervention strategies aimed at addressing this issue.

"It Is Scary, but Then I Just Do It Anyway": Children's Experiences and Concerns about Risk and Challenge during Loose Parts Play.

Children's risky play opportunities depend on supervising adults' attitudes and the play environment. The possibilities to engage in risk-taking outdoor play for children have seriously decreased over the last few decades, due to safety concerns and adults' preoccupation with protection. In response to this shift, research has increasingly focused on influencing factors on professional attitudes toward risk-taking in children's play. However, children's perspective on risky play is underrepresented in the recent literature. This study generates awareness of children's risky play preferences and interests to help professional caretakers hone their facilitating role. We explored children's notions of risk and challenge in play during a loose parts intervention stimulating risky play and facilitated by after-school childcare practitioners. A thematic analysis examined observations, informal conversations, and roundtable talks with children about their risky play experiences. Children describe their risk-taking in play as experimental and daring. The findings report on children's general views on risky play, their play experiences with loose parts, their real-life risky play experiences, and their opinions on the role of practitioners. By relating the results to risky play research and self-determination theory, this study offers insight into children's innate needs. Taking risks on their own terms gives children a sense of self-confidence and mastery, and forces them into new relationships with other children and guiding adults. Consequently, children fulfill the three universal needs of self-determination theory: autonomy, competence, and relatedness.

Lifestyle Pathways Affecting Children's Mental Health in Japan during the COVID-19 Pandemic.

The recent prolonged COVID-19 pandemic has worsened the daily lives of preschoolers and elementary school children worldwide. Although these changes may have affected their mental health, the full picture still remains unknown. Since March 2020, Japan has intermittently experienced several COVID-19 waves. This survey was conducted between February and March 2022. In this study, we investigated the pathways by which specific lifestyle factors (such as exercise, sleep, diet, and life skills) affect physical/psychosocial health (PPH) in 1183 preschoolers (3-5 years old) and 3156 elementary school children (6-11 years old) in Toyama Prefecture, Japan. These pathways were examined using a path analysis. Consequently, "life skills" was found to be the factor most strongly associated with PPH in both preschoolers and elementary school children (p < 0.001). Furthermore, it was associated with the physical activity score and with PPH via physical activity. Moreover, both boys' and girls' mental health declined with age among elementary school children (p < 0.001). The results of the current study may be helpful for early interventions (around the start of elementary school) at home and at school to improve children's mental health during the COVID-19 pandemic.

Development of an Assessment Tool to Measure Healthy Eating in Navajo Children and Their Families.

Background: To estimate the efficacy of interventions to improve healthy eating, valid measures are essential. Although simple dietary intake tools have been developed with other populations, few have been culturally tailored and assessed for validity and reliability among Navajo. Objectives: This study aimed to develop a simple dietary intake tool tailored to Navajo culture, derive healthy eating indices, and assess their validity and reliability in Navajo children and adults and to describe the process used to develop this tool. Methods: A picture-sort tool using typically consumed foods was developed. Elementary school children and family members provided qualitative feedback in focus groups, used to refine the tool. Next, school-aged children and adults completed assessments at baseline and follow-up. Baseline behavior measures including child self-efficacy for fruits and vegetables (F&V) were examined for internal consistency. Healthy eating indices were derived from intake frequencies from picture sorting. The convergent validity of the indices and behavior measures for children and adults were examined. The reliability of the indices at the 2 time points was derived using Bland-Altman plots. Results: The picture-sort was refined from feedback provided by the focus groups. Baseline measures from 25 children and 18 adults were obtained. In children, a modified Alternative Healthy Eating Index (AHEI) and 2 other indices from the picture-sort were correlated with self-efficacy for eating F&V and had good reliability. In adults, the modified AHEI and 3 other indices from the picture-sort had significant correlations with adult abbreviated food frequency of F&V or obesogenic dietary index and had good reliability. Conclusions: The Navajo foods picture-sort tool developed for Navajo children and adults is proven to be acceptable and feasible to implement. Indices derived from the tool has good convergent validity and repeatability, supporting use in evaluating dietary change interventions in Navajo, with the potential for broader use of the approach in other underserved populations.

Neighborhood Socioeconomic Characteristics Associated with the COVID-19 Incidence in Elementary School Children: An Ecological Study in Osaka City, Japan.

We aimed to determine whether neighborhood socioeconomic characteristics are associated with the coronavirus disease 2019 (COVID-19) incidence in elementary school children and, if so, the associated characteristics. We obtained data on the number of infected children from 282 public elementary schools and the socioeconomic characteristics of each school district in Osaka City, Japan. We examined associations between these variables through negative binomial regression analyses. The proportion of employment in the wholesale and retail trade industry and the college graduation rate were significantly positively and negatively associated, respectively, with the total number of COVID-19-infected children. It was discovered that percentages of employment in the accommodation and food service industries in Wave 2, wholesale and retail trade industries after Wave 3, and healthcare and social assistance industries in Wave 5 were significantly positively associated with the number of infected children; likewise, the college graduation rate in Wave 5 was significantly negatively associated with the number of infected children. Our findings provide insight into the relevant and important areas of focus for public health policymakers and practitioners to ensure reduced disparities in COVID-19 infection rates.

Evaluation of the Prevalence of Refractive Defects and Ocular Function in a Group of 1518 Children Aged 8 Years in Northwestern Poland-A Retrospective Study.

PURPOSE: To determine the prevalence of refractive errors in a group of 8-year-old school children in northwestern Poland. MATERIAL AND METHODS: In 2017-2019, refractive errors were examined in a group of 1518 Caucasian children aged 8 years old with cycloplegia. Refraction was obtained with a hand-held autorefractor (Retinomax 3). The refractive error reading was expressed as the spherical equivalent (SE) as myopia (≤-0.5 D), emmetropia (>-0.5 D to ≤+0.5 D), mild hyperopia (>+0.5 D to ≤+2.0 D) and hyperopia (>+2.0 D), and astigmatism (≤-0.75 DC) and anisometropia (≥1.00 D). Data analysis was performed using Statistica 13.5 software and included Pearson's chi-squared and Mann-Whitney U tests. p-values of <0.05 were considered statistically significant. RESULTS: Mild hyperopia was most common (37.6%), myopia was observed in 16.8% and astigmatism in 10.6% of participants. Pseudomyopia concerned up to 51.91% children. Girls were significantly more likely to have mild hyperopia (p = 0.0144) and were significantly more likely to wear glasses (p = 0.00093). CONCLUSIONS: Screening children for refractive errors after cycloplegia is key for detecting accommodative spasm and refractive errors. The largest group of children presented with mild hyperopia, which is a physiological feature of refraction in 8-year-old children, but myopia and astigmatism were the most common refractive errors.

Emotion regulation as a mediator on the relationship between emotional awareness and depression in elementary school students.

As a cognitive skill, emotional awareness plays a fundamental role in emotional intelligence and significant effect on the development of individuals' social adaptation. However, the role of emotional awareness in children's social adaptation, especially emotional development, remains unclear, the current study sought to determine the significant influence of emotional awareness in children's emotional development. By using cross-sectional and longitudinal study designs, the current study explored the relationship between emotional awareness and children's depression, as well as the mediation effect of emotion regulation on this relationship. The sample comprised 166 Chinese elementary school students (89 girls and 77 boys) ranging from 8 to 12 years old. After adjusting for demographic variables (gender, grade, etc.), the results showed that children with high emotional awareness were less likely to adopt expressive suppression as an emotion regulation strategy and had lower depression levels currently and in the future. In contrast, children with low emotional awareness were more likely to use suppression strategies and showed higher depression levels. Thus, the results indicated that emotional awareness could predict children's current and future depression status. Meanwhile, emotional regulation strategies are an important mediating variable explaining the relationship between emotional awareness and children's depression. Implications and limitations were also discussed.

Protocol for the Open Sky School: a two-arm clustered randomized controlled trial to test the effectiveness of a nature-based intervention on mental health of elementary school children.

BACKGROUND: This article outlines the protocol for a trial to test the effectiveness of a nature-based intervention called Open Sky School to reduce mental health problems among elementary school children. Experimental studies show that contact with nature (e.g. walks in parks) improve mental health. A growing number of teachers have been applying outdoor education within the regular school curriculum and evidence suggests that such teaching methods could improve students' mental health but a randomized controlled trial has never been conducted. METHODS: A two-arm clustered randomized controlled trial will be conducted in elementary schools across Québec, Canada. Following informed consent by teachers, parents and students, schools will be randomly assigned 1:1 to the intervention or the control group with a total of 2500 5-6th grade students and 100 teachers expected to participate. The intervention will take place outdoors in a green-space (2 h per week for 12 weeks) and include a toolkit of 30 activities to foster well-being (e.g. mindfulness) and academic competencies (e.g. mathematics). Questionnaires will be administered to teachers and students before, immediately after and 3 months after the intervention. The primary outcome will be reductions of mental health problems in children from pre-to-post test (Social Behavior Questionnaire: self and teacher reports). Secondary outcomes include depression, positive and negative affect, nature connectedness, and pro-environmental behaviors among children. We will explore, immediate benefits on teacher's well-being and positive and negative affect and sustained benefits among students at 3 months follow-up. For the primary outcome, we will explore moderators including child's sex, child's disability status, the green-space of neighbourhoods, the school's socio-economic position and teacher's experience. DISCUSSION: In conducting the first randomized controlled trial of the Open Sky School, our results could provide empirical evidence on the effectiveness of nature-based interventions in reducing mental health problems among elementary school children. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov: NCT05662436 on December 22, 2022.

Associations Among Parents' Eating Behaviors, Feeding Practices, and Children's Eating Behaviors.

Parental feeding practices influence children's eating behaviors, yet it is not well-understood whether parents' own eating behaviors are associated with their feeding practices. The purpose of this study was to examine associations among parents' eating behaviors, parental feeding practices, and children's eating behaviors. A cross-sectional study was conducted with 76 parents of children from an elementary school in Tampa, FL. Parents completed three questionnaires with topics related to parent eating behaviors, parental feeding practices, and children's eating behaviors. Multiple regression analysis was performed, controlling for demographic covariates. Parents who reported to eat more fruits per day (ß = 0.15), eat more than one kind of fruit each day (ß = 0.33), eat more than one kind of vegetable each day (ß = 0.29), eat 2 or more vegetables at the main meal (ß = 0.36), plan meals (ß = 0.19), and keep vegetables ready for the child to eat (ß = 0.25) indicated that they use more positive reinforcement feeding practices (all p ≤ 0.001). There were significantly positive associations between positive reinforcement and children's eating fruits or vegetables like apples, bananas or carrots as snacks (ß = 1.03) and eating more than one kind of vegetable a day (ß = 1.03; all p < 0.001). No other variables had any significant associations. Findings of this study indicate that there are potential associations among parent's own eating behaviors, feeding practices, and children's eating behaviors. Further research is needed to determine the mechanism of these relationships. Targeting these parental factors may be an effective way to maximize the impact of nutrition interventions on children's dietary behavior changes.

Factors Associated With Media Addiction in Korean Elementary School Children.

The aim of this study was to identify the prevalence of media addiction and its associated factors in elementary school children based on the problem behavior theory. This cross-sectional study was a secondary data analysis using national data from the 10th Panel Study on Korean Children 2017, which included 1,078 families of third-grade students (8-9 years of age). Descriptive statistics were used to examine the prevalence of media addiction, and logistic regression analysis was conducted to identify factors associated with media addiction. Prevalence of media addiction was 22.91% in this sample. Media addiction was significantly associated with general characteristics (gender, education level of mother, and time spent without parents), socialization (media use time), factors in the personal system (happiness), and factors in the perceived-environment system (parenting style). More comprehensive, tailored education may prevent elementary school children's media addiction. In addition, parents should participate in media addiction education with their children.

Teacher and School Concerns and Actions on Elementary School Children Digital Safety.

Elementary school children are spending more time using digital technologies. Teachers and schools are concerned about the student's digital safety. We interviewed ten elementary school teachers virtually to understand their concerns and understand the actions they take regarding elementary school children's digital safety. Using thematic analysis, we identified themes of concerns and actions of teachers and schools on elementary school children's digital safety. Some digital safety concerns discussed by the teachers included content-related concerns such as accessing inappropriate content, contact-related concerns, inappropriate contact with others online, sharing personal information, lack of understanding of danger, conduct-related concerns regarding cyberbullying and digital footprint, contract-related concerns such as digital security and privacy, and home-related concerns. Teachers and schools have taken several actions to address these concerns. Some of the digital safety actions included security measures and limits, monitoring student activities, providing education on digital safety, and support from guidance counselors. This study has implications for elementary school educators, administrators, parents, and students on the safe use of digital technologies. Supplementary Information: The online version contains supplementary material available at 10.1007/s11528-022-00803-z.

The relationships between parents' and children's screen times on body mass index: a cross-sectional path analysis.

BACKGROUND: Understanding factors contributing to an individual reducing screen time is essential for promoting a healthy weight. Parents' behavior affects children by influencing their daily decision-making through modeling, rules or restrictions, social support, and co-participation. We examined how the direct and indirect effects of parents' and children's behaviors regarding screen time influenced body mass index (BMI) among Japanese elementary school children. METHODS: We included 283 Japanese children, one child per household, aged 6-12 years, who were randomly selected from resident registries of two cities. The questionnaires were completed by children and their mothers and fathers. Screen time and sociodemographic attributes, including sex, age, employment status, height, and weight, were assessed using a mail-based survey. Path analyses were conducted to determine associations among children's, fathers', and mothers' variables. It was hypothesized that after controlling for household income and children's sex and age, mothers' and fathers' screen time on weekdays and weekends would be related to children's weekdays and weekend screen time, respectively. In addition, we hypothesized that children's weekday and weekend screen time was related to children's BMI. RESULTS: Both fathers' and mothers' weekday screen times were associated with children's weekday and weekend screen times. BMI was affected by children's weekday screen time (0.117). The path coefficients for the indirect effects of mothers' and fathers' screen time on children's BMI through children's weekday screen time were 0.016 from the fathers' weekday screen time and 0.024 from the mothers' weekday screen time (GFI = .980, AGFI = .953, RMSEA = .030, AIC = 93.030). CONCLUSIONS: Both fathers' and mothers' weekday screen times indirectly affected children's BMI through children's weekday screen time among Japanese elementary school children. The strongest indirect effects could be seen by examining the paths of a mother's weekday screen time through children's screen time to BMI. Mothers who spend much time with their children are role models, and their behavior could affect the child's behavior. The findings imply that intervention strategies to reduce screen time in children should also focus on modeling the mothers' behavior.

Success Rate of Swept-Source Optical Coherence Tomography Biometry of Eyes of Elementary School Students.

Purpose: To determine the success rate of swept-source optical coherence tomography (SS-OCT) biometry (OA-2000) in elementary school students. Methods: This was a prospective observational longitudinal study of 115 right eyes of elementary school students who were 8- to 9-years-old at the initial examination. Biometric measurements of the eyes were performed annually for three years, viz., during the third, fourth, and fifth grades. The success rates of obtaining data from optical biometric measurements of the axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), pupillary diameter (PD), corneal diameter (CD), and corneal curvature (CC) were determined. Results: The AL, CCT, and CC could be measured in all images at the three measurement times in all subjects. The success rate of the measurements of the ACD was 92.2% in the third grade and 100% in the fourth and fifth grade. The LT was successfully measured in 88.7% in the third grade, 99.1% in the fourth grade, and 100% in the fifth grade. The PD was successfully measured in 100% of the third grade, 96.0% of the fourth grade, and 100% in the fifth grade. The CD was successfully measured in 84.3% in the third grade, 66% in the fourth grade, and 100% in the fifth grade. Conclusion: SS-OCT can obtain accurate measures of all ocular parameters in the primary school students with high success rates. However, care should be taken especially in analyzing the ACD, LT, PD, and CD because errors can occur in some cases.

Design for a cluster randomized controlled trial to evaluate the effects of the CATCH Healthy Smiles school-based oral health promotion intervention among elementary school children.

Background: The top two oral diseases (tooth decay and gum disease) are preventable, yet dental caries is the most common childhood disease with 68% of children entering kindergarten having tooth decay. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st, and 2nd grade, and is based on the framework of Coordinated Approach to Child Health (CATCH), an evidence-based coordinated school health program. CATCH has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in incorporating the factors surrounding children, in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children. The aim of this paper is to describe the design of the CATCH Healthy Smiles CRCT to determine the effectiveness of an oral health school-based behavioral intervention in reducing incidence of dental caries among children. Methods: In this CRCT, 30 schools serving low-income, ethnically-diverse children in greater Houston area are recruited and randomized into intervention and comparison groups. From which, 1020 kindergarten children (n = 510 children from 15 schools for each group) will be recruited and followed through 2nd grade. The intervention consists of four components (classroom curriculum, toothbrushing routine, family outreach, and schoolwide coordinated activities) will be implemented for three years in the intervention schools, whereas the control schools will be offered free trainings and materials to implement a sun safety curriculum in the meantime. Outcome evaluation will be conducted at four time points throughout the study period, each consists of three components: dental assessment, child anthropometric measures, and parent survey. The dental assessment will use International Caries Detection and Assessment System (ICDAS) to measures the primary outcome of this study: incidence of dental caries in primary teeth as measured at the tooth surface level (dfs). The parent self-report survey measures secondary outcomes of this study, such as oral health related behavioral and psychosocial factors. A modified crude caries increment (mCCI) will be used to calculate the primary outcome of the CATCH Healthy Smiles CRCT, and a two-tailed test of the null hypothesis will be conducted to evaluate the intervention effect, while considering between- and within-cluster variances through computing the weighted-average of the mCCI ratios by cluster. Conclusion: If found to be effective, a platform for scalability, sustainability and dissemination of CATCH already exists, and opens a new line of research in school oral health. Clinical trials identifier: At ClinicalTrials.gov - NCT04632667.