Table 1 Description of the interventions in the review

1

Project Salsa; United States; Elder et al., 1998 [57]

Nutrition; 3 years (for school-based components)

Primary; not stated; universal

X

X

X

• 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

2

Adolescent Suicide Awareness Program (ASAP); US; Kalafat and Ryerson 1999 [53]

Suicidal feelings; flexible, minimum delivery 3 months

Secondary; grade 10 (15–16 years old); universal

X

X

X

• 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

3–9

Child 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 years

Primary; Grades 3–5 (8–11 years old); universal

X

X

X

• 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

10

Project ALERT; US; St Pierre and Kaltreider 2004 [58]

Substance abuse; 2 years

Secondary; grades 7 and 8 (12–14 years old); universal

X

• Classroom curriculum/learning activities

RCT [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

11

School Fruit Programme and the Fruit and Vegetables Make the Marks (FVMM); Norway; Bere 2006 [61]

Fruit and vegetable consumption; 1 year

Primary; grade 6 (11 years old); universal

X

X

X

• 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

12

Untitled - intervention focused on water consumption; Germany; Muckelbauer et al. 2009 [66]

Overweight; 2 years

Primary; grades 2 and 3 (7–9 years old); universal

X

X

• 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

13

European Network of Health-Promoting Schools; Norway; Tjomsland et al. 2009 [43]

Healthy lifestyles; 3 years

Primary and secondary; grades 5–10 (10–16 years old); universal

X

X

X

• 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

14

Winning with Wellness; US; Schetzina et al. 2009 [50]

Nutrition, physical activity, obesity; 1 year

Primary; grades 3 and 4 (8–10 years old) universal

X

X

• 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

15

First Step to Success; US; Loman et al. 2010 [59]

Anti-social behaviour; 18 months

Primary; grades K to 2 (5–8 years old); targeted

X

X

• 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

16

GreatFun2Run; England; Gorely et al. 2011 [65]

Physical activity and fruit and vegetable consumption; 10 months

Primary; grade not stated (7–11 years old); universal

X

X

X

• 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

17

Fourth R program; Canada; Crooks et al. 2013 [64]

Peer and dating violence; 1 year

Secondary; grade 9 (14–15 years old); universal

X

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.

18

New Moves; US; Friend et al. 2014 [47]

Obesity, physical activity, eating behaviours, body image; 1 year

Secondary; grade not stated (14–16 years old); targeted

X

X

X

• 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

19

Youth@work: Talking Safety; US; Rauscher et al. 2015 [54]

Workplace safety and health; not specified—6 sessions.

Secondary; grade not stated (age not stated); universal

X

• Classroom curriculum/learning activities

Non-experimental pilot evaluation. Evaluation report was not available.

Not known

1–9 years

20

Cognitive Behavioral Intervention for Trauma in Schools (CBITS); US; Nadeem and Ringle 2016 [46]

Post-traumatic stress disorder, anxiety and depression; 1 year

Secondary; grade 6 (11 years old); targeted

X

X

• 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

21

Good Behavior Game (GBG); The Netherlands; Dijkman et al. 2017 [63]

Anti-social behaviour; 1 year

Primary; grade 2 (6–7 years old); universal

X

• Behavioural approach in classroom

N/A—non-evaluated pilot initiative

Not known

1 year 9 months

22

TAKE 10!; US; Goh et al. 2017 [44]

Physical activity and on-task behaviour; 8 weeks

Primary; grades 3–5 (8–11 years old); universal

X

• Classroom activity

Non-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

23

School outdoor smoking ban; The Netherlands; Rozema et al. 2018 [62]

Tobacco use; unspecified/continuous

Secondary; grades n/a (12–18 years old); universal

X

• Smoking ban everywhere on school grounds for everyone

N/A—non-evaluated pilot initiative

Not known

1–40 years

However, 64% of schools had implemented the ban in the last 3 years.

24

Health Optimizing PE (HOPE); US; Egan et al. 2019 [45]

Physical activity; 2 years

Secondary (middle); grades 6–7 (11–13 years old); universal

X

X

X

• 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