Table 3 Summary of results on the sustainability of the intervention

1

Project Salsa; Elder et al. 1998 [57]

One school (17%) continued nutrition-related activities for students and parents.

No schools continued student advisory committees and changes to school menus.

Nutrition education classes for adults continued, unknown if this occurred in all schools.

The nutrition information provided by a community institution was discontinued and replaced with a different intervention, delivered by parent volunteers.

2

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

96% of FI schools continued student training, although at a lesser dosage, compared to 100% of CG schools.

67% of schools had written policies and procedures for responding to at-risk students, compared to 86% of CG schools.

8% of schools continued educator training, compared to 0% of CG schools.

All schools retained links with community agencies.

13% of schools continued parent training compared to 0% of CG schools.

3

Child and Adolescent Trial for Cardiovascular Health (CATCH) – health education curriculum; Johnson et al. 2003 [52]

19% of teachers in FI schools used CATCH health education activities, compared to 5% in CG1^a schools and 0% in CG2^b schools.

23% of teachers in FI schools used CATCH health education materials, compared to 11% in CG1 schools and 0% in CG2 schools.

69% of teachers in FI schools taught zero hours of CATCH in the current school year, compared to 84% in CG1 schools, and 99% in CG2 schools.

4

CATCH – PE component; Kelder et al. 2003 [49]

35% of teachers in FI schools had CATCH PE materials available, compared to 19% in CG1^a schools.

32% of teachers in FI schools had used CATCH PE materials, compared to 22% in CG1 schools.

There were no sig. differences between study groups (FI, CG1, or CG2^b) in the amount of physical activity.

5

CATCH – all components; Lytle et al. 2003 [48]

34% of staff from FI schools said they were partially implementing the health education curriculum, compared to 23% of staff from CG1^a schools. 66% said it was not implemented their school, compared to 62% in CG1 schools.

24% of staff from FI schools said they were still implementing CATCH PE. 70% of staff from FI schools said they used elements of it, compared to 93% from CG1 schools. 6% of staff from FI schools said they had discontinued CATCH PE, compared to 7% of staff from CG1 schools.

None of the food service staff from FI schools said they were fully implementing the food service component ‘Eat Smart (ES)’. 27% of the respondents from CG1 schools said ES was not being used at their school.

Most district-level respondents said that some of the ES guidelines were being followed.

Sustainability of the no-smoking policy not reported.

4% of staff from FI schools said they carried out some parts of the family component. All other staff indicated it had been discontinued.

6

CATCH – PE component; McKenzie et al. 2003 [51]

70% of teachers from FI schools who had had CATCH PE training reported using the CATCH PE curriculum, compared to 57% from CG1^a schools.

There were no sig. differences between FI and CG1 schools in the amount of physical activity in PE lessons and class energy expenditure.

7

CATCH – food service component; Osganian et al. 2003 [55]

25% of cooks in FI schools said the ES manual was present in the school kitchen compared to 15% in CG1^a schools. 15% of cooks in FI schools said they used it compared to 3% in CG1 schools.

34% of cooks in FI schools said the recipe box was present in the kitchen compared to 20% in CG1 schools 32% of cooks in FI schools said they used it compared to 12% in CG1 schools.

8

CATCH – school climate; Parcel et al. 2003 [60]

Schools in which principals and teachers were more open were sig. more likely to be teaching more hours of CATCH. ‘Open’ principals were supportive, low on rigid monitoring/control and low on restrictiveness. ‘Open’ teachers were highly collegial, had a network of social support and were engaged with school.

Schools in which principals and teacher were more open, and schools higher in organisational health, were sig. more likely to have a greater percentage of calories from saturated fat in school lunches.

9

CATCH – all components; Hoelscher et al. 2004 [56]

No differences between study groups (FI, CG1^a, CG2^b) and % of class time spent in moderate to vigorous physical activity or vigorous physical activity. All study groups exceeded the CATCH goal of 90 min of PE/week. Teachers reported teaching only about two CATCH lessons during the previous school year, a much lower dosage than the original intervention.

Over 88% of PE teachers and 60% of classroom teachers reported using the CATCH PE activity box in the previous school year.

30% of FI schools achieved the total fat goal of < 30%, compared to 10% of CG1 schools and 17% CG2 schools. 45% of FI schools achieved the saturated fat goal of < 10%, compared to 30% of CG1 schools and 17% of CG2 schools.

Most ES guidelines implemented consistently across all study conditions. No schools met the ES guidelines for sodium.

Sustainability of the no-smoking policy was not reported.

The family component was taught infrequently.

10

Project ALERT; St Pierre and Kaltreider 2004 [58]

38% of schools continued the curriculum.

11

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

Sustainability of the classroom curriculum/learning activities was not reported.

44% of schools continued to participate in the School Fruit Programme (SFP) (paying for it), compared to 30% of CG schools (n = 3).

66% of students subscribed to the School Fruit Programme, compared to 21% of students in CG schools.

Students from FI schools who continued to participate in the SFP ate 0.4 portions more FV at school than students from FI schools that discontinued participation.

Sustainability of the parent newsletters was not reported.

12

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

Sustainability of the classroom curriculum/learning activities was not reported.

65% of schools retained the water fountain.

The mean water flow was highest in the first 3 months of implementation. Afterwards, it decreased by about 35% until the end of the intervention, and remained stable between implementation and sustainability phases.

13

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

Sustainability of specific classroom curriculum/learning activities was not reported.

86% of schools had sustained and developed health promotion practices—specific activities and policies were not reported.

71% of schools referred to aspects of health promotion in their vision statements/priority areas.

Sustainability of the needs assessment and national, regional and international conferences were not reported.

Sustainability of specific family/community activities was not reported.

14

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

50% of teachers reported teaching students the nutrition curriculum.

Sustainability of the health education curriculum was not reported.

100% of teachers reported using the 5 min desk-side exercises.

Sustainability of the changes to school menus and vending machines, snack preparation demonstrations, use of walking trails, school health services and health promotion activities for staff was not reported.

15

First Step to Success (FSS); Loman et al. 2010 [59]

8/13 school districts (62%) reported at least one school was continuing to use the behavioural intervention. 72% of the schools nominated by district administrators reported sustainment (mean duration was 7.1 years). 28% of the schools had discontinued implementation (mean duration was 2.4 years).

Sustainability of the parent-training component was not reported.

16

GreatFun2Run; Gorely et al. 2011 [65]

25% of teachers were currently using any of the intervention resources.

There were no sig. differences between students from FI and CG schools in steps per day or moderate to vigorous physical activity at the time of the sustainability study (in contrast to trial phase).

The sustainability of the use of the summer activity wall planner and website was not reported.

The sustainability of the running events was not reported.

17

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

72% of teachers said they had implemented the intervention in the most recent school year.

During the most recent year of implementation:

40% said they had implemented 81% or more of the programme; 25% said 61–80% of the programme; 18% said 41–60% of the programme; 13% said 21–40% of the programme; 5% said less than 20% of the programme

The sustainability of the parent newsletters was not reported.

18

New Moves; Friend et al. 2014 [47]

83% of schools continued the intervention to some degree. One school closed; one discontinued the intervention. Of schools that remained open (n = 11):

• 91% offered an all-girls PE class 4 times a week. In 9/10 observed classes, most girls met the goal for being active at least 50% of the class.

• 45% of schools continued to implement nutrition and social support classes.

27% of schools offered individual coaching sessions, though less frequently than the intervention specified.

0% of schools continued lunch get-togethers.

Sustainability of the parent postcards and event were not reported.

19

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

81% of teachers had taught the curriculum more than once since being trained in it, with a mean sustainability score of 10.1 (SD = 6.6, maximum score 18). The mean fidelity score was 2.1 (SD 2.2, maximum score 6).

20

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

50% of clinicians implemented the counselling intervention 1 year after the trial phase.

0% of clinicians implemented the intervention 2 years after the trial phase.

Sustainability of parent outreach activities not reported.

21

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

The mean sustainability score was 8.7 (range 2–14, maximum score 20).

22

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

20% of teachers implemented the activities regularly (2 or more times a week; during the trial phase, teachers implemented the intervention on average once a day).

Some teachers (numbers not given) implemented it less regularly (once a week or less). A few teachers (numbers not given) discontinued the intervention.

23

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

The mean sustainability score was 5.70 (SD 0.9, maximum score 7).

24

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

Teachers (numbers not given) were still using the technology resources.

The classroom curriculum was discontinued.

One element of the before and after school activities—‘Intramurals’ was discontinued and then reinstated 2 months later. Another before and after school activity was discontinued.

The family fun run event continued (the event had existed pre-trial phase).

The parent education event was discontinued.