United Kingdom - Boost Better Breaks - A School based Public Health Programme in Northern Ireland


Boost Better Breaks (BBB), a school break-time programme, was launched in 1994 specifically to address the issue of unhealthy snacks and drinks consumed by children during breaks in primary and pre-schools. The programme was developed through a team of dieticians, school meal advisors, teachers, health promotion officers and local suppliers of school milk located within the rural community of the Southern Health and Social Services Board (SHSSB).

Background and rationale

Children and adolescents of Northern Ireland have the highest prevalence of caries in the UK. It is also evident that children in Northern Ireland from low-income households attending disadvantaged schools (classified by the proportion of children entitled to free school meals) have more caries, consume foods higher in sugar and fats and are more likely to take candy and sugar based drinks at break than other children. With one in three children in the UK living in poverty there is a need to promote oral health where wealth inequalities exist. Keeping these in mind Boost Better Breaks (BBB) project was conceived which introduces a healthy snacking policy within the school environment helping empower children to make the "healthy choice is the easy choice".

Project Outline

The BBB programme was launched in 1994 by the SHSSB and the Southern Education and Library Board. The main objective of this programme was to introduce a healthy snacking scheme in schools.

Community-based dental practitioners develop the break-time strategy with parents, teachers and governors of the primary and pre-schools. They encourage parents and teachers to appreciate the need for BBB and invite schools, teachers, parents and children to participate. The participating school must have a written policy, approved by the board of Governors permitting the consumption of only milk and/or fruit at breaks. Schools must not sell snacks high in fat or sugar in the school environment; teachers must not reward children with candy. Community-based practitioners and the Community Dental Services monitored the school activities, compliance with the scheme and adherence to the policy.


Since 2001, more than 80% of primary and pre-school groups in the SHSSB region have taken part in the BBB programme.

Findings of the evaluation of the first 2 years of the programme showed no dramatic improvement in caries development though demonstrated a positive effect in increasing the mean number of sound teeth in children attending schools in areas in which socio-economic conditions were poor.


The BBB initiative demonstrates the importance of collaboration with-in a research-practice-community partnership. This programme has the potential to reduce disparities in oral health in communities like in Northern Ireland.


Freeman R et al. Addressing Children's Oral Health Inequalities in Northern Ireland: A Research-Practice-Community Partnership Initiative, Public Health Rep 2001; 116:617-625.