Study on Intervention Effect of Heat-related Health Risk Early Warning Digital Technology for School-age Children

This cluster randomized trial is conducted in Beijing primary schools to evaluate the efficacy of a WeChat mini-program-based high-temperature early warning intervention on the physical and cognitive health of school-age children. Six participating schools are randomly assigned to two parallel groups. The intervention group receives tiered heat alerts and guided self-health monitoring via the mini-program. The control group follows standard daily school and family routines, with no dedicated digital high-temperature early-warning intervention. The primary outcome is children's executive function after a 2.5-month follow-up. A range of secondary indicators related to physical status, mental health and health behaviors are assessed concurrently to quantify the intervention's benefits in mitigating adverse health outcomes caused by high temperatures.

Study Overview

• Status: Not yet recruiting
• Conditions: Cardiovascular Diseases; Heat Illness; Respiratory Diseases; Mental Health Disorders; Neurocognitive Impairment
• Intervention / Treatment: Other: WeChat Mini-program Based Heat Health Risk Early Warning Intervention

Detailed Description

This pilot study is conducted in Beijing, with 6 primary schools selected as research sites. A stratified cluster randomized controlled design is adopted, with schools as the unit of randomization. Eligible primary schools are randomly assigned to the intervention group and the control group, with 3 schools in each group.

A total of 5 Wisconsin Card Sorting Tests (WCST), 2 health examinations, 2 children's high-temperature protection themed drawing activities, and 5 mini-program questionnaire surveys will be conducted in this study.

The intervention group receives a digital intervention of high-temperature health risk early warning. The research team uses a WeChat mini-program to release corresponding high-temperature health risk level information, health tips, protection science popularization information and other early warning content when the high-temperature health risk level reaches yellow, orange or red, and simultaneously pushes them to head teachers and parents.

The monitoring and survey schedule for the intervention group during the study period is as follows: at baseline and endpoint, unified offline WCST and health examinations will be conducted for children once each, accompanied by one online mini-program questionnaire survey each time. One children's high-temperature protection themed drawing activity will be organized at baseline and at the end of the 3rd month after the intervention, and the works will be uploaded to the mini-program for check-in. At the end of the 1st, 2nd and 3rd months after the intervention, one online follow-up questionnaire and WCST will be completed each month, together with check-in. Meanwhile, blood pressure will be monitored once a week, and daily blood pressure monitoring and check-in will be carried out after each high-temperature health risk early warning release. In addition, after the release of high-temperature health risk early warnings, the intervention group is required to complete check-in for reading and transmitting early warning information, health tips and protection science popularization content, as well as online mini-program surveys on children's awareness of high-temperature health risk early warning information and short-term behavioral patterns. The above WCST and questionnaire surveys will be completed by children with parental assistance; blood pressure monitoring and check-in are the responsibility of head teachers during non-summer vacations and parents during summer vacations.

The control group does not receive the high-temperature health risk early warning intervention and will only complete the corresponding WCST, health examinations, questionnaire surveys and blood pressure monitoring.

• Study Type: Interventional
• Enrollment (Estimated): 200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tiantian Li, PhD; Phone Number: 010-50930213; Email: litiantian@nieh.chinacdc.cn
• Study Contact Backup: Name: TianTian LI, Study Director; Phone Number: 010-50930213; Email: litiantian@nieh.chinacdc.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

School inclusion criteria

1. Willing to participate in the study.
2. Possess adequate facilities and qualified teaching staff.
3. The school and teachers maintain good cooperation.
4. Class size is no less than 35 students.
5. All participating classrooms are equipped with air conditioners.

Participant inclusion criteria

1. Fourth-grade primary school students aged 9 to 11, of all genders.
2. Voluntary participation by students and their parents, good compliance, and signed informed consent.
3. At least one adult family member has an internet-enabled mobile device.
4. Good general health with no history of severe physical or mental disorders.
5. Local permanent residents with a residency of no less than 6 months.

Participant exclusion criteria

1. Participants who are unable or refuse to complete required examinations.
2. Students receiving psychological or psychiatric treatment that may confound the study results.
3. Those currently enrolled in other interventional clinical studies that may affect outcome assessment.
4. Any other conditions deemed ineligible by the research team. Any participant meeting any of the above exclusion criteria will be excluded from the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Group; The control group does not receive the mini-program-based high-temperature health risk early warning intervention.
Experimental: WeChat Mini-program Heat Health Early Warning Intervention Group; Participants receive tiered yellow, orange and red heat risk alerts and heat protection guidance via the WeChat Mini Program once alerts are issued due to high temperatures. Teachers and parents share health promotion tips with enrolled children. Mandatory mini-program check-ins and routine health monitoring are implemented throughout the 2.5-month intervention.	Other: WeChat Mini-program Based Heat Health Risk Early Warning Intervention; This study implements a digital early warning intervention targeting children's high-temperature health risks. During the intervention period, when the high-temperature health risk level reaches yellow, orange or red, relevant risk information, health tips and heat protection education materials are released to parents and head teachers via the WeChat mini-program. Parents or teachers pass on the warning information to participating children. During non-summer periods, Beijing's high-temperature early warning information is pushed to head teachers and parents via the WeChat mini-program; during summer vacation, location-specific early warning information is sent to parents. All recipients are required to pass on the information to children promptly upon receipt.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The primary outcome is the comprehensive total score of children's executive function constructed based on the Wisconsin Card Sorting Test (WCST)	The only primary outcome of this study is the composite score of cognitive executive function derived from the Wisconsin Card Sorting Test (WCST) via the TOPSIS method. All WCST absolute indicators and sub-dimensions are sub-indicators instead of independent outcomes. The WCST indicators are grouped into three sub-dimensions: conceptual thinking (Total Correct, Total Errors, Nonperseverative Errors, Conceptual Level Responses, Categories Completed), perseveration (Perseverative Responses, Perseverative Errors), and set maintenance (Failure to Maintain Set). Negative indicators are converted using the formula (x' = Max(x) - x). After Z-score normalization, the decision matrix is established, positive and negative ideal solutions are identified, and Euclidean distances and relative closeness are computed. The resulting relative closeness value is taken as the final composite score of cognitive executive function, the single primary outcome of this study.	at 2.5 months of intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Systolic Blood Pressure	Systolic Blood Pressure measured in mmHg	at 2.5 months of intervention
Diastolic Blood Pressure	Diastolic blood pressure measured in mmHg	at 2.5 months of intervention
Heart Rate	Resting heart rate measured in beats per minute (bpm)	at 2.5 months of intervention
Forced Expiratory Volume in 1 second (FEV1)	Pulmonary function indicator measured in liters (L)	at 2.5 months of intervention
Forced Vital Capacity (FVC)	Pulmonary function indicator measured in liters (L)	at 2.5 months of intervention
Peak Expiratory Flow (PEF)	Pulmonary function indicator measured in liters per second (L/s)	at 2.5 months of intervention
Forced Expiratory Flow 25-75% (FEF25-75%)	Mid-expiratory flow measured in liters per second (L/s)	at 2.5 months of intervention
Fractional Exhaled Nitric Oxide (FeNO50)	Exhaled nitric oxide level at 50 mL/s flow rate, measured in parts per billion (ppb)	at 2.5 months of intervention
Fractional Exhaled Nitric Oxide (FeNO200)	Exhaled nitric oxide level at 200 mL/s flow rate, measured in parts per billion (ppb)	at 2.5 months of intervention
Calcium Nitric Oxide (CaNO)	Airway nitric oxide parameter measured in ppb	at 2.5 months of intervention
Fractional Expiratory Carbon Monoxide (FeCO)	Exhaled carbon monoxide level measured in parts per million (ppm)	at 2.5 months of intervention
Body Fat Percentage	Body fat percentage measured by bioelectrical impedance analysis	at 2.5 months of intervention
Total Body Water	Total body water measured in liters (L)	at 2.5 months of intervention
Inorganic Salts	Inorganic salt content measured in kilograms (kg)	at 2.5 months of intervention
Basal Metabolic Rate (BMR)	Basal metabolic rate measured in kilocalories per day (kcal/day)	at 2.5 months of intervention
Body Weight	Body weight measured in kilograms (kg)	at 2.5 months of intervention
High-Temperature Health KAP Score	Knowledge, Attitude, and Practice (KAP) score on high-temperature health	at 2.5 months of intervention
High-Temperature Health Cognition and Protection Behavior Drawing Score	Drawing-based score of children's cognition and protective behaviors for high-temperature health	at 2.5 months of intervention
Short-Term Behavioral Pattern Score	Score of children's short-term behavioral patterns related to heat health	at 2.5 months of intervention
SAS Anxiety Scale Score	Self-rating Anxiety Scale (SAS) score for children's anxiety symptoms	at 2.5 months of intervention
CDI Children's Depression Scale Score	Children's Depression Inventory (CDI) score for depressive symptoms	at 2.5 months of intervention
SGRQ Respiratory Symptom Scale Score	St. George's Respiratory Questionnaire (SGRQ) score for respiratory symptoms	at 2.5 months of intervention
School Absenteeism Days	Number of school absenteeism days during the study period	at 2.5 months of intervention
Academic Performance	Scores of children's academic examinations	at 2.5 months of intervention
Heat-Related Illness Incidence	Occurrence frequency of heat-related illnesses in children	at 2.5 months of intervention
Gastrointestinal Diseases Incidence	Occurrence frequency of gastrointestinal diseases in children	at 2.5 months of intervention
Respiratory Diseases Incidence	Occurrence frequency of respiratory diseases in children	at 2.5 months of intervention
Allergies Incidence	Occurrence frequency of allergies in children	at 2.5 months of intervention
Accidental Injuries Incidence	Occurrence frequency of accidental injuries in children	at 2.5 months of intervention
Early Warning Information Check-in Rate	Check-in rate of early warning information received by the intervention group	at 2.5 months of intervention

Collaborators and Investigators

• Sponsor: Centers for Disease Control and Prevention, China

Publications and helpful links

General Publications

• He M, Xiang F, Zeng Y, Mai J, Chen Q, Zhang J, Smith W, Rose K, Morgan IG. Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial. JAMA. 2015 Sep 15;314(11):1142-8. doi: 10.1001/jama.2015.10803.
• Lei J, Sun Q, Chen R, Zhu Y, Zhou L, Xue X, Fang J, Du Y, Wang Y, Li T, Kan H. Respiratory Benefits of Multisetting Air Purification in Children: A Cluster Randomized Crossover Trial. JAMA Pediatr. 2025 Feb 1;179(2):122-128. doi: 10.1001/jamapediatrics.2024.5049.
• Wang Y, Sun Y, Ban J, Fang J, Sun Q, Du Y, Liu Y, Dong H, Wang Q, Chen C, Zhang Y, Ma R, Chen R, Kan H, Li T. Cognitive benefits of air purification among schoolchildren: A randomized, double-blind, crossover trial. Innovation (Camb). 2026 Feb 5;7(5):101304. doi: 10.1016/j.xinn.2026.101304. eCollection 2026 May 4.
• Pan CY, Tsai CL, Chu CH, Sung MC, Huang CY, Ma WY. Effects of Physical Exercise Intervention on Motor Skills and Executive Functions in Children With ADHD: A Pilot Study. J Atten Disord. 2019 Feb;23(4):384-397. doi: 10.1177/1087054715569282. Epub 2015 Feb 2.
• Assari S, Zare H. Extreme Heat Exposure is Associated with Lower Learning, General Cognitive Ability, and Memory among US Children. Open J Neurosci. 2025;3(1):10-22. doi: 10.31586/ojn.2025.1277. Epub 2025 Jan 10.
• Perera F, Nadeau K. Climate Change, Fossil-Fuel Pollution, and Children's Health. N Engl J Med. 2022 Jun 16;386(24):2303-2314. doi: 10.1056/NEJMra2117706. No abstract available.
• Romanello M, Napoli CD, Green C, Kennard H, Lampard P, Scamman D, Walawender M, Ali Z, Ameli N, Ayeb-Karlsson S, Beggs PJ, Belesova K, Berrang Ford L, Bowen K, Cai W, Callaghan M, Campbell-Lendrum D, Chambers J, Cross TJ, van Daalen KR, Dalin C, Dasandi N, Dasgupta S, Davies M, Dominguez-Salas P, Dubrow R, Ebi KL, Eckelman M, Ekins P, Freyberg C, Gasparyan O, Gordon-Strachan G, Graham H, Gunther SH, Hamilton I, Hang Y, Hanninen R, Hartinger S, He K, Heidecke J, Hess JJ, Hsu SC, Jamart L, Jankin S, Jay O, Kelman I, Kiesewetter G, Kinney P, Kniveton D, Kouznetsov R, Larosa F, Lee JKW, Lemke B, Liu Y, Liu Z, Lott M, Lotto Batista M, Lowe R, Odhiambo Sewe M, Martinez-Urtaza J, Maslin M, McAllister L, McMichael C, Mi Z, Milner J, Minor K, Minx JC, Mohajeri N, Momen NC, Moradi-Lakeh M, Morrissey K, Munzert S, Murray KA, Neville T, Nilsson M, Obradovich N, O'Hare MB, Oliveira C, Oreszczyn T, Otto M, Owfi F, Pearman O, Pega F, Pershing A, Rabbaniha M, Rickman J, Robinson EJZ, Rocklov J, Salas RN, Semenza JC, Sherman JD, Shumake-Guillemot J, Silbert G, Sofiev M, Springmann M, Stowell JD, Tabatabaei M, Taylor J, Thompson R, Tonne C, Treskova M, Trinanes JA, Wagner F, Warnecke L, Whitcombe H, Winning M, Wyns A, Yglesias-Gonzalez M, Zhang S, Zhang Y, Zhu Q, Gong P, Montgomery H, Costello A. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. Lancet. 2023 Dec 16;402(10419):2346-2394. doi: 10.1016/S0140-6736(23)01859-7. Epub 2023 Nov 14.
• Ebi KL, Capon A, Berry P, Broderick C, de Dear R, Havenith G, Honda Y, Kovats RS, Ma W, Malik A, Morris NB, Nybo L, Seneviratne SI, Vanos J, Jay O. Hot weather and heat extremes: health risks. Lancet. 2021 Aug 21;398(10301):698-708. doi: 10.1016/S0140-6736(21)01208-3.
• Liu Z, Gao P, Gao AY, Lin Y, Feng XX, Zhang F, Xu LQ, Niu WY, Fang H, Zhou S, Li WH, Yuan JH, Xu CX, Wu N, Li HJ, Wen LM, Patton GC, Wang HJ, Wu YF. Effectiveness of a Multifaceted Intervention for Prevention of Obesity in Primary School Children in China: A Cluster Randomized Clinical Trial. JAMA Pediatr. 2022 Jan 1;176(1):e214375. doi: 10.1001/jamapediatrics.2021.4375. Epub 2022 Jan 4.
• Shinde S, Weiss HA, Varghese B, Khandeparkar P, Pereira B, Sharma A, Gupta R, Ross DA, Patton G, Patel V. Promoting school climate and health outcomes with the SEHER multi-component secondary school intervention in Bihar, India: a cluster-randomised controlled trial. Lancet. 2018 Dec 8;392(10163):2465-2477. doi: 10.1016/S0140-6736(18)31615-5. Epub 2018 Nov 22.

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: June 3, 2026
• First Submitted That Met QC Criteria: June 9, 2026
• First Posted (Actual): June 11, 2026

Study Record Updates

• Last Update Posted (Actual): June 11, 2026
• Last Update Submitted That Met QC Criteria: June 9, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: cognitive function; digital intervention; executive function; cluster randomized controlled trial; school-age children; Heat stress; climate change; heat early warning; WeChat mini-program; Wisconsin Card Sorting Test; children's physical health; heat-related disease
• Additional Relevant MeSH Terms: Wounds and Injuries; Cardiovascular Diseases; Respiratory Tract Diseases; Heat Stress Disorders
• Other Study ID Numbers: NIEH202643

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No