Social Determinants of Health: Expanded In-School Learning Time

The CPSTF finding is based on evidence from a systematic review of 11 studies. Five of the included studies were identified from reference lists of 2 existing systematic reviews (Patall et al., 2010, search period 1960 2009; Redd et al., 2012, search period not reported). The remaining 6 studies were identified through a Community Guide search for evidence (search period 2010 February 2015).

This review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to the use of educational interventions for the promotion of health equity.

More details about study results are available in the CPSTF Finding and Rationale Statement [PDF – 299 kB].

• Included studies reported the number of hours added to school, but provided little information on how the added time was used. This made it difficult to draw a useful conclusion.
• Effect sizes for students’ test scores were small and inconsistent.
• Three studies examined public charter schools that implemented other program changes in addition to expanded in-school time (Angrist et al., 2013; Dobbie et al., 2013; Hoxby et al., 2009).
  • Some of the schools provided teachers with feedback, used data to guide instruction, offered high intensity tutoring, or cultivated a culture of high expectations.
  • Taken together, these policies improved student achievement.
  • When authors looked at the effects of expanded in-school time alone, however, they found small effects.

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How is added school time used?
  • Is time added as allocated school time, allocated class time, instructional time, or academic learning time?
  • Is added time used for a specific subject or across subjects?
  • Are there other changes to make use of added time, such as curriculum changes, or offers of tutoring for students in need?
• How does this intervention apply to private schools or schools in high income communities?

• Studies examined the effects of expanded school years and days (5 studies), expanded school years (1 study), and lengthened school days (5 studies).
• Studies reported students’ scores on standardized tests administered at national or state levels or tests developed for the research study.
• Studies were from the United States (9 studies), Chile (1 study), and Israel (1 study).
• One study was conducted in a rural area.
• Programs were implemented in public charter (5 studies), traditional (5 studies), or magnet (1 study) schools and encompassed grades K-12.
• Programs varied in the number of hours added per school year (9 studies reporting), ranging from 90 to 300 or more hours.
• Five of the evaluated programs were implemented in schools or school districts with high percentages of students who were black (median of 50%) or Hispanic (median 27%). The majority of students in these studies qualified for free or reduced price lunch (median 82%).

Peng Y, Finnie RKC, Hahn RA, et al. Expanded in-school instructional time and the advancement of health equity: a Community Guide systematic review. Journal of Public Health Management and Practice 2018:online.

effectiveness Review

Analytics Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table

Inclusion Criteria

To be included in this review, a study had to do the following

• be published in a journal or government report
• evaluate the effect of increased in-school learning time alone (independent of other intervention components)
• evaluate interventions implemented in K-12 schools
• not evaluate full vs. half-day kindergarten (topic previously reviewed)
• not assess an exclusively special needs population
• have a concurrent comparison group or before-after comparison; cross-sectional studies and post-intervention only studies were excluded
• include comparison groups that were either exposed to routine school time or to lesser amounts of expanded time than the intervention group
• report >1 outcome of interest: academic achievement, cognition, social or emotional skills, delinquent behaviors
• be published in English; and
• be conducted in a high-income nation (World Bank List)

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications)..

Effectiveness Review

Angrist JD, Pathak PA, Walters CR. Explaining charter school effectiveness. Am Econ J: Appl Econ 2013:5(4):1 27.

Bellei C. Does lengthening the school day increase students’ academic achievement? Results from a natural experiment in Chile. Econ Educ Rev 2009: 29: 629 40.

Bishop J, Worner W, Weber L. Evaluation Studies, extending the school day: an evaluation study of a seven-period class schedule. Studies in Educational Eval 1988:14:361 80.

Checkoway A, Gamse B, Velez M, Caven M, de la Cruz R et al. Evaluation of the Massachusetts Expanded Learning Time (ELT) Initiative, year five final report, 2010-2011, Volume I. Cambridge: Abt Associates, 2012.

Dobbie W, Fryer RG. Getting beneath the veil of effective schools: evidence from New York City. Am Econ J: Appl Econ 2013:5(4):28 60.

Eren, O and Millimet DL. Time to learn? The organizational structure of schools and student achievement. Empirical Econ 2007:32:301 32.

Frazier JA, Morrison FJ. The influence of extended-year schooling on growth of achievement and perceived competence in early elementary school. Child Devel 1998:69(2):495 517.

Hoxby CM, Murarka S, Kang J. How New York City’s charter schools affect achievement, August 2009 report. Second report in series. Cambridge, MA: New York City Charter Schools Evaluation Project, September 2009.

Gleason P, Clark M, Clark Tuttle C, Dwoyer E. The evaluation of charter school impacts, final report (NCEE 2010-4029). Washington (DC): National Center for Education Evaluation and Regional Assistance, Institute of Education Sciences, U.S. Department of Education, 2010.

Kraft MA. How to make additional time matter: integrating individualized tutorials into an extended day. Educ Finance and Pol 2015:81 116. doi:10.1162/EDFP_a_00152.

Lavy V. Expanding school resources and increasing time on task: effects on student’s academic and non-cognitive outcomes. Cambridge (MA): National Bureau of Economic Research. Working paper 18369, 2012.

Assessing and Summarizing the Evidence on Effectiveness

Study Abstraction and Quality Assessment

Two reviewers independently evaluated each study meeting our inclusion criteria, including studies from the two existing systematic reviews and those found in the update search. Information on study methods, results, and interpretation was abstracted using standard Community Guide criteria. Disagreements between reviewers were resolved by consensus. Using Community Guide methods [PDF – 240 kB], each study was assessed for study design and threats to internal and external validity, including inadequate descriptions of the intervention, population, and sampling frame; inadequate measurement of exposure or outcome; inappropriate analytic methods; high attrition; or failure to control for confounding. Study quality of execution was characterized as good (0 1 threats to validity), fair (2 4 threats), or limited (>4 threats). Studies of limited quality of execution were excluded from analysis.

Primary and Secondary Outcomes of Interest

Education achievement is counted as an indicator of long term health benefit in this review since it is an established determinant of long term health outcomes. Intervention impact on educational achievement was assessed by changes in standardized test scores or grade point average. Changes in other outcomes were qualitatively assessed.

Statistical Analysis and Synthesis of Results

We present results separately for studies that examined lengthened school day, those that examined lengthened school year, and those that examined both changes combined; no studies examined lengthened school week. Depending on data provided in each study, effect estimates were calculated using relative percent change, absolute percentage point change, or standardized mean difference (SMD). When metrics allowed, effect estimates from individual studies were pooled to calculate a median. When at least five individual effect estimates were available, interquartile intervals (IQIs) were calculated to provide a measure of variation; otherwise, the range of estimates was indicated. Studies without metrics or data to allow direct comparison with other studies were narratively summarized. Some studies reported multiple effect estimates per outcome (e.g., language, math, or science scores); mean effects were calculated to prevent counting studies more than once. When relevant data were available, we transformed increased time reported into hours per year. Analyses were performed in 2016 2017.

The CPSTF findings are based on evidence from a systematic review with 11 included studies (search period through February 2015). Studies that met inclusion criteria published prior to 2010 were identified from two high quality existing systematic reviews identified through the search (Patall et al., 2010; Redd et al., 2012). Included studies published after 2010 were identified using the search strategy listed below.

Effectiveness Review

The following databases were searched for English-language papers that evaluated the impact of modified school time programs:

• CAB Abstracts
• CINAHL
• EconLit
• ERIC
• Federal Research in Progress
• Global Health
• Medline
• NEA
• PsycINFO
• PsycCritiques
• Scopus
• Sociological Abstracts

The literature search covered interventions modifying school time by either expanding school time or rearranging school calendar without expanding school time. For the review on expanded in-school learning time, Community Guide staff screened search results twice to identify papers specific to this intervention.

Following are the search strategies used for this review.

Databases: [all on EBSCOHost] CINAHL, EconLit, Federal Research in Progress
Date Searched: 2/20/2015

S8 TI 12 month school* OR twelve month school*

S7 TI year round schooling

S6 TI year round education

S5 TI year round education

S4 TI all year school

S3 TI all year school AND TI ( “school day” or “school days” or “school hours” or “instructional hours” or “instructional time” or “class time” or “classroom time” or “classroom hours” )

S2 TI increase* AND TI (“school day” or “school days” or “school hours” or “instructional hours” or “instructional time” or “class time” or “classroom time” or “classroom hours”)

S1 TI “saturday school” OR TI “longer school week”

TI (longer or lengthen* or extended or extending or extend or expand* ) AND TI ( school day* or school week or school time or school hours or school year or instructional hours or school calendar or learning time )

Databases: [all on OVID] Medline, Global Health, PsycINFO, PsycCritiques, CAB Abstracts
Date Searched: 2/20, 23/2015

1. ((longer or lengthen* or extended or extending or extend or expand*) and (school day* or school week or school time or school hours or school year or instructional hours or school calendar or learning time)).ti.
2. ((longer or lengthen* or extended or extending or extend or expand*) and (school day* or school week or school time or school hours or school year or instructional hours or school calendar or learning time)).su,kw.
3. ((longer or lengthen* or extended or extending or extend or expand*) and (school day* or school week or school time or school hours or school year or instructional hours or school calendar or learning time)).sh,kf,kw.
4. year round school.ti,kf,kw,sh.
5. (year round school or 12 month school or twelve month school).ti,sh,kw.
6. 5 not 4
7. (saturday school or saturday classes).ti,sh,kw.
8. ((longer or lengthen* or extended or extending or extend or expand*) and (school day* or school week or school time or school hours or school year or instructional hours or school calendar or learning time)).ab.
9. ((longer or lengthen* or extended or extending or extend or expand*) and (classroom time or classroom hours or instructional time or learning hours)).ti,sh,kw.
10. (classroom hours and academic achievement).mp.
11. ((school day or school time or classroom time or classroom hours) and academic achievement).mp.
12. from 1 keep 1-29
13. from 4 keep 1-7
14. from 7 keep 1-5
15. from 9 keep 1
16. from 11 keep 18, 110, 121, 123, 148, 151…

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1. (length* adj2 school day*).ab.
2. saturday school.ab.
3. longer school week*.ab.
4. ((extend* adj2 school day*) or (extend* adj2 school week) or (extend* adj2 instruction* hours)).ab.
5. ((expand* adj2 school day*) or (expand* adj2 school week) or (expand* adj2 instruction* hours) or (extend* adj2 school calendar*) or (expand* adj2 school calendar*) or year round school).ab. ear round education.ab.
6. ((increase* adj2 school day*) or (increas* adj2 school week) or (increas* adj2 instruction* hours) or (increas* adj2 school calendar*) or (increas* adj2 school year) or (increas* adj2 school week)).ab.
7. ((increase* adj2 school day*) or (increas* adj2 school week) or (increas* adj2 instruction* hours) or (increas* adj2 school calendar*) or (increas* adj2 school year) or (increas* adj2 school week)).ab.
8. ((increase* adj2 school day*) or (increas* adj2 school week) or (increas* adj2 instruction* hours) or (increas* adj2 school calendar*) or (increas* adj2 school year) or (increas* adj2 school week)).ab.
9. (increas* adj2 instruction* hours).ab.
10. (longer adj2 (instruction* hours or school day* or school week or school hours or school year* or school term* or learning time* or school calendar)).ab.
11. year round schooling.ti,ab,kw.
12. (length* adj2 (school hour* or school day* or school year or school calendar or school schedul* or school term*)).ti,ab,kw.
13. or/1-13

Databases: [all on Proquest] ERIC, Social Services Abstracts (1979 – current), Sociological Abstracts? (1952 – current), ProQuest Family Health, ProQuest Health & Medical Complete, ProQuest Psychology Journals, ProQuest Research Library, ProQuest Social Science Journals, ProQuest Sociology (1985 current)
Date Searched: 2/20/2015

S36 ti(“year round education”)

S35 ti(“expanded instructional time”)

S34 ti(“expanded instructional hours”)

S33 ti(“twelve month school”)

S32 ti(“12 month school”)

S31 ti(“12 month school”)

S30 ti(“year round school”)

S29 ti(“longer school calendar”)

S28 ti(“longer school calendars”)

S27 ti(“extended school calendars”)

S26 ti(“extended school calendar”)

S25 ti(“extended school year”)Limits applied

S24 ti(“extended school year”)Limits applied

S23 ti(“extended school year”)

S22 ti(“extended instructional”)

S21 ti(“extended school time”)

S20 ti(“extended school days”)

S19 ti(“extended school day”) or ti(“extendeded school days”)

S18 ti(“longer school day”) or ti(“lengthened school days”)

S17 ti(“longer the school day”) or ti(“longer school days”)

S16 ti(“expanded school day”)

S15 ti(“lengthening the school day”)

S14 (“lengthening the school day”)Limits applied

S13 (“lengthening the school day”)

S12 (“longer school day”)Limits applied

S11 (“longer school day”)

S10 (“lengthen school day”)

S9 ti(“increase* school day”)

S8 ti(extended OR extending OR expand OR expanded OR expanding OR increase OR increased OR increasing OR lengthen OR lengthened OR lengthening or longer or Saturday*) AND ti((school* OR instructional or learning))Limits applied

S7 ti(extended OR extending OR expand OR expanded OR expanding OR increase OR increased OR increasing OR lengthen OR lengthened OR lengthening or longer or Saturday*) AND ti((school* OR instructional or learning))

S6 “year round school” OR (“school all year round” OR “12 month school year”) OR (“twelve month school year” OR “year round education”)

S5 ti(extended OR extending OR expand OR expanded OR expanding OR increase OR increased OR increasing OR lengthen OR lengthened OR lengthening or longer or Saturday*) AND ti((school* OR instructional or learning or day or days))

S4 ti(extended OR extending OR expand OR expanded OR expanding OR increase OR increased OR increasing OR lengthen OR lengthened OR lengthening or longer or Saturday*) AND ti((school* OR instructional or learning or day or days))

S3 ti(extended OR extending OR expand OR expanded OR expanding OR increase OR increased OR increasing OR lengthen OR lengthened OR lengthening) AND ti((school* OR instructional or learning or day or days))

S2 ti(extended OR extending OR expand OR expanded OR expanding OR increase OR increased OR increasing OR lengthen OR lengthened OR lengtheneding) AND ti((school* OR instructional or learning or day or days))

S1 (extended or extending or expand or expanded or expanding or increase or increased or increasing or lengthen or lengthened or lengtheneding) AND (school* OR instructional or learning or day or days)
ti(“extended school week”) or ti(“Saturday school”)Limits applied

---

S4 ti(“extended school week”) or ti(“Saturday school”)

S3 ti(“longer school week”)

S2 ti(“year round schooling”)

S1 ti(“year round schooling”
ti(“longer school week”)

---

S3 su(saturday school programs)or su(“Saturday school programs”)

S2 su(saturday school effectiveness)

S1 su(extended school year)Limits applied

Database: Scopus
Date Searched: 2/20/2015

( TITLE-ABS-KEY ( “extended school day” ) ) OR ( TITLE-ABS-KEY ( “extended school hours” ) ) OR ( TITLE-ABS-KEY ( “length of school day” ) ) OR ( TITLE-ABS-KEY ( “year round school” OR “12 month school” OR “twelve month school” ) ) OR ( TITLE-ABS-KEY ( “saturday classes” OR “saturday school” OR “longer school week” OR “lengthened school week” OR “expanded school week” OR “increased school hours” OR “increased school week” ) ) OR ( TITLE-ABS-KEY ( “extending the school day” OR “extending the school year” OR “lengthening the school day” OR “lengthening the school year” ) )

Angrist JD, Pathak PA, and Walters CR. Explaining charter school effectiveness. American Economic Journal: Applied Economics 2013:5(4):1-27.

Dobbie W and Fryer RG. Getting beneath the veil of effective schools: evidence from New York City. American Economic Journal: Applied Economics 2013:5(4):28 60.

Hahn RA, Truman BI. Education improves public health and promotes health equity. International Journal of Health Services 2015;45(4):657-78.

Hoxby CM, Murarka S, and Kang J. How New York City’s Charter Schools Affect Achievement, August 2009 Report (second report in series). Cambridge (MA): New York City Charter Schools Evaluation Project, September 2009.

Knopf JA, Hahn RA, Proia KK, Truman BI, Johnson RL, et al. Out-of-school-time academic programs to improve school achievement: a Community Guide health equity review. Journal of Public Health Management & Practice 2015;21(6):594 608.

Patall EA, Cooper H, and Allen AB. Extending the school day or school year: a systematic review of research (1985-2009). Review of Educational Research 2010;80(3):401-36.

Redd Z, Boccanfuso C, Walker K, Princiotta D, Knewstub D, and Moore K. Expanding Time for Learning Both Inside and Outside the Classroom: A Review of the Evidence Base. New York (NY): The Wallace Foundation, August 2012.

Despite the finding of insufficient evidence, the following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

• In 2013, the Community Preventive Services Task Force recommended out-of-school time academic programs (reading-focused, math-focused, and general) to improve students’ academic achievement. They noted, however, that programs were not as effective as they might have been because some students who would have benefitted did not participate and overall attendance was poor (Knopf et al., 2015). Because expanded in-school time programs affect all students, it is possible that adding academic programs during the extended time could improve students’ test scores.
• Time may not be a good measure of teaching quality or learning experience. Within the same amount of time, more skilled teachers are likely to accomplish more than their less skilled peers.
• Potential benefits of longer school days and years
  • Reduced need and cost for child-care
  • Increased opportunities for parental employment
  • Decreased student involvement in violence after school
• Potential harms of longer school days and years
  • Reduced opportunities for additional employment for teachers or school staff
  • Decreased family and play time