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Table 1 Description of the interventions in the review

From: The sustainability of public health interventions in schools: a systematic review

Study #Intervention name; country; author(s) and yearHealth outcome(s) targeted; length of interventionCountry-specific education phase; grade (age); universal or targeted approachHPS elementsDescription of componentsEvaluation of effectiveness which preceded assessment of sustainabilityTime between effectiveness evaluation and evaluation of sustainabilitya
CurriculumEthos/environmentFamily/communityStudy designEvidence of effects on outcomes
1Project Salsa; United States; Elder et al., 1998 [57]Nutrition; 3 years (for school-based components)Primary; not stated; universalXXX• Nutrition education for parents, food service staff, teachers (e.g. health fairs)
• Classroom curriculum/learning activities
• Links with community institutions
• Student advisory committees
• Changes to school menus
Non-experimental pilot evaluation.
6 intervention schools. Evaluation report was not available.
Not known.2–5 years
2Adolescent Suicide Awareness Program (ASAP); US; Kalafat and Ryerson 1999 [53]Suicidal feelings; flexible, minimum delivery 3 monthsSecondary; grade 10 (15–16 years old); universalXXX• Classroom curriculum/learning activities
• Links with community gatekeepers
• Organisational consultation and policies
• Educator training
• Parent training
N/A—non-evaluated pilot initiative.Not known.5–10 years
3–9Child and Adolescent Trial for Cardiovascular Health (CATCH); US; Johnson et al. 2003 [52]
Kelder et al. 2003 [49]
Lytle et al. 2003 [48]
McKenzie et al. 2003 [51]
Osganian et al. 2003 [55]
Parcel et al. 2003 [60]
Hoelscher et al. 2004 [56]
Cardiovascular health; 3 yearsPrimary; Grades 3–5 (8–11 years old); universalXXX• Classroom curriculum/learning activities—changes to PE classes
• Classroom curriculum/learning activities—health education lessons
• Nutrition programme—changes to school menus, food purchasing and preparation
• Family activities and event
• No-smoking policy
cRCT [67]
Schools unit of allocation
56 intervention schools and 40 control
Effective for primary outcomes
• % of energy intake from total fat in school meals sig. Reduced in intervention schools compared with controls.
• Intensity of physical activity (PA) in PE classes increased sig. More in intervention compared with controls.
• Dietary knowledge and intentions, and self-reported food choice changes were sig. Greater for intervention schools.
• 24-h food recall showed increased total daily energy intake among children in both intervention and control schools with ageing, but increase was greater in control schools. Fat intake was sig. Reduced among children in intervention schools.
5 years
10Project ALERT; US; St Pierre and Kaltreider 2004 [58]Substance abuse; 2 yearsSecondary; grades 7 and 8 (12–14 years old); universalX  • Classroom curriculum/learning activitiesRCT [68]
8 schools, 6 classes per school randomly assigned to 1 of 3 conditions: experimental groups × 2 and 1 control group.
No effect on primary outcome, harmful effect for one treatment condition
• No evidence of beneficial effects on substance use.
• Harmful effects were found for the teen-assisted intervention condition on marijuana use in the past year, and future expected marijuana use.
< 1 year
11School Fruit Programme and the Fruit and Vegetables Make the Marks (FVMM); Norway; Bere 2006 [61]Fruit and vegetable consumption; 1 yearPrimary; grade 6 (11 years old); universalXXX• Subscription to the national fruit and vegetable programme (free in trial phase)
• Classroom curriculum/learning activities
• Parent newsletters
RCT [61]
9 intervention schools, 10 control schools.
Effective for primary outcome
• Strong intervention effects were observed for fruit and vegetables (F&V) eaten at school and all day.
• Average F&V intake was 0.6 portions higher in the intervention group than controls at school & all day.
1 year
12Untitled - intervention focused on water consumption; Germany; Muckelbauer et al. 2009 [66]Overweight; 2 yearsPrimary; grades 2 and 3 (7–9 years old); universalXX • Installation of school water fountain
• Classroom curriculum/learning activities
cRCT [69]
City unit of allocation
17 intervention schools, 16 control schools.
Effective for some but not all primary outcomes
• The risk of being overweight was sig. Reduced in the intervention group compared with controls.
• No sig. Differences for BMI. There was no general weight-reducing effect.
• Changes in water consumption higher in the intervention group compared with controls. No effects on juice or soft drink consumption.
< 1 year
13European Network of Health-Promoting Schools; Norway; Tjomsland et al. 2009 [43]Healthy lifestyles; 3 yearsPrimary and secondary; grades 5–10 (10–16 years old); universalXXX• Health integrated into school policies
• Needs assessment
• A variety of activities e.g. curriculum, meals, school environment, parent-involvement (differed by school)
• National, regional, and international conferences
Non-experimental pilot evaluation
10 intervention schools. Evaluation report on outcomes not available.
Not known.9 years
14Winning with Wellness; US; Schetzina et al. 2009 [50]Nutrition, physical activity, obesity; 1 yearPrimary; grades 3 and 4 (8–10 years old) universalXX • 5 min desk-side exercises
• 2 x classroom curriculum—nutrition and health education
• Changes to school menus and vending machines.
• Snack preparation demonstrations
• Walking trails
• School health services
• Health promotion for staff
Non-experimental pilot evaluation [50]
1 school
Effective for some but not all primary outcomes
• No sig. Changes in BMI.
• Students were sig. More active at school after intervention implementation than before, with an increase of approx. 886 steps per day.
• Sig. fewer unhealthy foods were being offered & purchased/served to students after implementation than before.
< 1 year
15First Step to Success; US; Loman et al. 2010 [59]Anti-social behaviour; 18 monthsPrimary; grades K to 2 (5–8 years old); targeted XX• Universal screening
• Consultant-based behavioural intervention with teacher, child and peers
• Parent training
Non-randomised controlled trial [70]
No. of schools not stated.
Effective for primary outcome
• Sig. pre-post behavioural changes—adaptive, aggression, maladaptive, academic engaged time—for the intervention group.
• No sig. Difference in teachers’ perception of how positively or negatively other children in the class viewed the target child.
4–10 years
16GreatFun2Run; England; Gorely et al. 2011 [65]Physical activity and fruit and vegetable consumption; 10 monthsPrimary; grade not stated (7–11 years old); universalXXX• Classroom curriculum/learning activities
• Participation in two running events
• An interactive website
• A local media campaign
Non-randomised controlled trial [71]
4 intervention schools, 4 control schools
Effective for some but not all primary outcomes
• Sig. increase in students’ daily steps & total time in MVPA in intervention compared to control schools.
• Older participants in intervention schools showed a sig. Slowing in the rate of increase in estimated % body fat, BMI, & waistline.
• No difference between groups in F&V consumption, aerobic fitness, knowledge of healthy lifestyles, perceived competence, enjoyment of PA, or intrinsic motivation.
1 year 9 months
17Fourth R program; Canada; Crooks et al. 2013 [64]Peer and dating violence; 1 yearSecondary; grade 9 (14–15 years old); universalX X• Classroom curriculum/learning activities
• Parent newsletters
cRCT [72]
Schools unit of allocation
10 intervention schools, 10 control schools
Effective for some but not all primary outcomes
• Physical dating violence (PDV) was sig. Higher for students in control schools than for those in intervention schools.
• Boys in intervention schools were less likely than boys in control schools to engage in dating violence. However, girls had similar rates of PDV in both groups.
• Differences between control & intervention groups were not sig. For physical peer violence, substance use, or condom use.
2 or more years, range not stated.
18New Moves; US; Friend et al. 2014 [47]Obesity, physical activity, eating behaviours, body image; 1 yearSecondary; grade not stated (14–16 years old); targetedXXX• 3 x classroom curriculum/learning activities—all-girls physical education class, nutrition, and social support
• Individual counselling sessions
• Lunch get-togethers
• Parent postcards and event
cRCT [73]
Schools unit of allocation
6 intervention schools, 6 control schools
Effective for some but not all primary outcomes
• Sig. differences between intervention & control students in changes in: stage of change for PA, goal setting for PA and self-efficacy to overcome barriers to PA; total non-sedentary activity; stage of change for F&V, & goal setting for healthy eating; portion control; unhealthy weight control behaviours; body satisfaction; athletic competence & self-worth.
• Changes were non-significant in: body fat & BMI, total PA and MVPA, TV time, & stage of change TV, F&V intake & sugar-sweetened beverages, and breakfast, binge eating, appearance
1–2 years
19Youth@work: Talking Safety; US; Rauscher et al. 2015 [54]Workplace safety and health; not specified—6 sessions.Secondary; grade not stated (age not stated); universalX  • Classroom curriculum/learning activitiesNon-experimental pilot evaluation. Evaluation report was not available.Not known1–9 years
20Cognitive Behavioral Intervention for Trauma in Schools (CBITS); US; Nadeem and Ringle 2016 [46]Post-traumatic stress disorder, anxiety and depression; 1 yearSecondary; grade 6 (11 years old); targeted XX• 10 group sessions
• 1–3 individual sessions
• Parent and teacher education
Non-experimental pilot evaluation [74]
30 intervention schools.
Effective for primary outcome
• There was a sig. Pre- to post-intervention decline in PTSD symptoms.
2 years
21Good Behavior Game (GBG); The Netherlands; Dijkman et al. 2017 [63]Anti-social behaviour; 1 yearPrimary; grade 2 (6–7 years old); universal X • Behavioural approach in classroomN/A—non-evaluated pilot initiativeNot known1 year 9 months
22TAKE 10!; US; Goh et al. 2017 [44]Physical activity and on-task behaviour; 8 weeksPrimary; grades 3–5 (8–11 years old); universal X • Classroom activityNon-experimental pilot evaluation [42, 85]
1 intervention school.
Effective for some but not all primary outcomes
• No sig. Effect on mean daily in-school steps.
• No sig. Effect on average daily in-school moderate intensity PA levels of students.
• Sig. effect on MVPA levels and vigorous intensity PA.
• There was a mean % decrease of on-task behaviour by 7.7% during the baseline period & a mean percentage increase of on-task behaviour by 7.2% during the intervention period.
< 1 year
23School outdoor smoking ban; The Netherlands; Rozema et al. 2018 [62]Tobacco use; unspecified/continuousSecondary; grades n/a (12–18 years old); universal X • Smoking ban everywhere on school grounds for everyoneN/A—non-evaluated pilot initiativeNot known1–40 years
However, 64% of schools had implemented the ban in the last 3 years.
24Health Optimizing PE (HOPE); US; Egan et al. 2019 [45]Physical activity; 2 yearsSecondary (middle); grades 6–7 (11–13 years old); universalXXX• Provision of technology resources
• Before and after school activities
• Classroom curriculum/learning activities
• Family event
• Parent education event
Non-experimental pilot evaluation [86]
1 intervention school.
Effective for primary outcome
• Sig. difference between baseline & end of year 2 for various fitness activities & amount of PA time in class.
• There was a sig. Improvement on test of knowledge of PA and healthy eating between baseline & year 1, & baseline & year 2.
• The mean number of MVPA minutes (daily) declined steadily over the course of the study.
< 1 year
  1. aEstimated as the time between the last year of the effectiveness evaluation (or the end of the implementation period for non-evaluated initiatives) and the last year of the sustainability phase evaluation