Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: We monitored children's PA levels over 4 consecutive school days at 6 rural Oregon elementary schools with Walk4Life pedometers. During the same week, teachers recorded all student PA opportunities (recess, PE, and CBPA breaks) and answered a 26-item questionnaire about factors influencing their use of CBPA breaks. Mixed-effects models were used to associate teacher-level factors and PA opportunities with children's moderate to vigorous PA (MVPA; in minutes per day), controlling for child-level covariates.

Intervention Results: When teachers valued PA, students accumulated more MVPA (1.07 min/d; P < .01) than students of teachers reporting low PA value. Students did more MVPA (1 min/d; P < .001) when teachers agreed the school operating conditions posed barriers to providing PA than when teachers disagreed that barriers existed. PE classes contributed significantly to student's PA levels.

Conclusion: Provision of PE, increasing teacher value for PA, and further investigation of how teacher-level factors relate to students' MVPA levels during CBPA breaks at rural elementary schools are warranted.

Study Design: RCT

Setting: Rural elementary schools

Population of Focus: Children in rural elementary schools

Data Source: Pedometers and teacher selfreport

Sample Size: 1,739 children

Age Range: Ages 6-11

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent School-Based Program, CLASSROOM_SCHOOL

Intervention Description: This study fills a gap in research on multi-level school-based approaches to promoting positive youth development and reducing bullying, in particular cyberbullying, among middle school youth.

Intervention Results: The intervention did not yield significant changes in the treatment schools. However, student self-reported experience with restorative practices significantly predicted improved school climate and connectedness, peer attachment, and social skills, and reduced cyberbullying victimization.

Conclusion: While more work is needed on how interventions can reliably produce restorative experiences, this study suggests that the restorative model can be useful in promoting positive behaviors and addressing bullying.

Intervention Components (click on component to see a list of all articles that use that intervention): Comprehensive School-Based PA Program, CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: The 12 month intervention encouraged healthy eating and physical activity, including a daily additional 30 minute school time physical activity opportunity, a six week interactive skill based programme in conjunction with Aston Villa football club, signposting of local family physical activity opportunities through mail-outs every six months, and termly school led family workshops on healthy cooking skills.

Intervention Results: Data for primary outcome analyses were: baseline, 54 schools: 1392 pupils (732 controls); first follow-up (15 months post-baseline), 53 schools: 1249 pupils (675 controls); second follow-up (30 months post-baseline), 53 schools: 1145 pupils (621 controls). The mean BMI z score was non-significantly lower in the intervention arm compared with the control arm at 15 months (mean difference -0.075 (95% confidence interval -0.183 to 0.033, P=0.18) in the baseline adjusted models. At 30 months the mean difference was -0.027 (-0.137 to 0.083, P=0.63). There was no statistically significant difference between groups for other anthropometric, dietary, physical activity, or psychological measurements (including assessment of harm).

Conclusion: The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments.

Study Design: Cluster RCT

Setting: 53 schools

Population of Focus: Ages 5-6

Data Source: Actiheart worn continuously for 5 days

Sample Size: 1467 children

Age Range: Ages 5-6

Intervention Components (click on component to see a list of all articles that use that intervention): Presentation/meeting/information Session (Classroom), CLASSROOM_SCHOOL, Extra-Curricular Activities

Intervention Description: This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students' receptiveness to the intervention.

Intervention Results: Intervention fidelity was uniformly excellent (>96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants' social-emotional competence. The intervention's impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution.

Conclusion: This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school.

Intervention Components (click on component to see a list of all articles that use that intervention): Extra-Curricular Activities, CLASSROOM_SCHOOL

Intervention Description: an intervention that provides children and their parent more time to interact positively could impact children's PA. We examined the efficacy of a 12-week mother-daughter intervention on African-American girls' PA levels. In Spring of 2013 and 2014, mother-daughter dyads (n = 76) from Springfield, MA, were randomly assigned to one of three groups [child-mother (CH-M, n = 28), child alone (CH, n = 25), or control (CON, n = 23)] that participated in an afterschool culturally-tailored dance intervention (60 min/day, 3 days/week, 12 weeks). Girls in the CH-M group participated in the intervention with their maternal figure, while girls in the CH group participated in the intervention alone. CON group participants received weekly health-related newsletters.

Intervention Results: During the afterschool intervention time, girls in the CH-M group displayed a significantly steeper rate of increase in their percent time spent in vigorous PA compared to both the CON (γ = 0.80, p < 0.001) and the CH group (χ2 (1)=13.01, p < 0.001). Mothers in the CH-M group displayed a significantly steeper rate of increase in their percent time spent in total daily moderate-to-vigorous PA compared to CH group's mothers (γ = 0.07, p = 0.01).

Conclusion: This culturally-tailored mother-daughter afterschool intervention influenced African-American girls' afterschool hour PA levels, but not total daily PA.

Study Design: Random assignment to one of 3 groups; comparison of change

Setting: After-school dance intervention

Population of Focus: African American girls ages 7-10

Data Source: Accelerometers

Sample Size: 76 mother-daughter dyads

Age Range: Ages 7-10

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), CLASSROOM_SCHOOL, PROFESSIONAL_CAREGIVER, Outreach (caregiver), Communication Tools, Distribution of Promotional Items (Classroom/School)

Intervention Description: In Michigan, a school-based outreach effort was piloted using existing school communication tools to identify children who are currently uninsured and may be eligible for state-subsidized health insurance. School districts were provided with two health insurance status collection forms to be included with the free and reduced school lunch application, and as part of the student registration packet and welcome materials for school. Completed forms were sent to a state registered application-assisting agency to ensure families can access the coverage and services they need. A final step in the process is outreach to eligible respondents by the Michigan Primary Care Association to help ensure that they receive information and access to the healthcare coverage and services they need.

Intervention Results: As a result of the survey, 156 children were identified as not having health insurance. This represents more than 44% of the 358 children who are eligible for State subsidized health insurance, in the participating school districts, but are uninsured. Integrating the collection of health insurance status into routine school communication channels is an effective way to identify children who do not have health insurance and may be eligible for state subsidized benefits.

Conclusion: 1. The Michigan Department of Community Health should lead the effort to work with the Michigan Department of Education to modify the Free and Reduced Lunch Application to capture whether or not the applicant has health insurance. 2. The Michigan Department of Community Health should lead the effort to incorporate into the direct certified free and reduced lunch eligibility process a systematic check as to whether or not the applicant has State subsidized health insurance. 3. The Michigan Department of Community Health should provide resources from the expected performance bonus to work with schools across the State to implement these changes.

Study Design: Cross-sectional pilot study

Setting: Schools (School districts in Van Buren County, Michigan)

Population of Focus: Uninsured children

Data Source: Survey data

Sample Size: 8,999 children

Age Range: School-aged children

Intervention Components (click on component to see a list of all articles that use that intervention): SCHOOL, School-Based Health Centers, CLASSROOM_SCHOOL

Intervention Description: We sought to compare visit rates, emergency care use, and markers of quality of care between adolescents who use school-based health centers and those who use other community centers within a safety-net health care system for low-income and uninsured patients.

Intervention Results: Although school-based health center users (n = 790) were less likely than other users (n = 925) to be insured (37% vs 73%), they were more likely to have made > or = 3 primary care visits (52% vs 34%), less likely to have used emergency care (17% vs 34%), and more likely to have received a health maintenance visit (47% vs 33%), an influenza vaccine (45% vs 18%), a tetanus booster (33% vs 21%), and a hepatitis B vaccine (46% vs 20%).

Conclusion: These findings suggest that, within a safety-net system, school-based health centers augment access to care and quality of care for underserved adolescents compared with traditional outpatient care sites.

Study Design: Retrospective cohort design

Setting: Denver, Colorado Health safety-net system

Population of Focus: Adolescents ages 14-17 within Denver Health safety-net system (study population was limited to uninsured or insured by Medicaid or SCHIP)

Data Source: Administrative databases maintained by Denver Health and Denver Public Schools

Sample Size: Total (N=3599)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Extra-Curricular Activities, Comprehensive School-Based PA Program, CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: This research incorporated data from a subsample of after-school care enrollees above the 90th BMI percentile (Mage=10.1 years) who participated in either 4-day/week (n = 21) or 3-day/week (n = 24) versions of a 45 min/session, cognitive-behaviorally based physical activity/health behavior-change program over a full school year, or a control condition of usual care (n = 14).

Intervention Results: For the cognitive-behavioral groups only, significant improvements were found in self-regulation, mood, and physical activity. Their BMI increases of 0.12 and 0.11 kg/m2, respectively, were significantly less than the 0.90 kg/m2 rise expected through maturation. Theory-based regression models uniformly confirmed significant associations of changes in self-regulation and physical activity (R2s = .22–.25). However, within separate analyses, entry of changes in (a) self-efficacy and mood into a multiple regression equation, (b) self-efficacy as a mediator, and (c) mood as a moderator, did not increase predictive accuracies. The significant association of changes in physical activity and BMI was stronger in the heavier children. Findings will be useful for large-scale intervention applications and refinements.

Conclusion: Even given the stated limitations, the present research advanced the development of palatable behavioral treatments for young children with overweight and obesity. Theory and related research were also progressed through decomposing effects associated with Physical Activity and BMI Change in after-School Care 7 psychological changes over a full school year. Although challenging internal validity, the study’s field setting advantageously facilitated generalization of findings to community-based settings capable of helping large numbers of children in need (Green et al., 2013). Based on the present findings, it is hoped that practitioners consider the importance of facilitating behavioral (i.e., self-management) skills to enable even children of high weights to feel successful at physical activity pursuits. Additionally, factors such as the mood-enhancing effects of physical activity and the value of building feelings of ability (i.e., self-efficacy) should be considered in their program development. It is hoped that continued related research is able to affect large-scale change applied to the increasing problem of high weight in children.

Study Design: Multi-level research design

Setting: After-school program sites managed by a communitybased organization

Population of Focus: Elementary school aged children

Data Source: Student self-report and study staff physical assessments

Sample Size: 190 students

Age Range: Ages 8-11

Intervention Components (click on component to see a list of all articles that use that intervention): PE Enhancements, Adult-led Curricular Activities/Training, CLASSROOM_SCHOOL

Intervention Description: In this randomized control trial, we examined Moderate-to-vigorous physical activity (MVPA) in a physical activity intervention compared to physical education (PE) class as usual (TAU), stratified by sex and weight classification. Standardized BMI (zBMI) overtime was also examined.

Intervention Results: Participants were 12.10 ± 0.63 years old and 53% were girls. Overall those in intervention increased weekday MVPA more than TAU (F(1,190) = 7.03, p < .01). Intervention girls increased weekday MVPA; whereas TAU girls decreased weekday MVPA (F(1,99) = 7.36, p < .01). Among those with obesity, there was no difference in MVPA between conditions (F(1, 56) = 0.33, p = .57), but Intervention decreased zBMI significantly more than TAU (F(1, 56) = 6.16, p < .05).

Conclusion: Structured PE classes grounded in behavioral theory may be an important strategy to prevent typical decreases in MVPA during adolescence, particularly among girls and for youth with obesity.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Dental Screening

Intervention Description: Researchers identified and searched multiple databases to search for randomized control trials that evaluated school dental screening compared with no intervention or with one type of screening compared with another.

Intervention Results: Researchers found very low-certainty evidence that did not allow for conclusions to be drawn about whether there is a role for traditional school dental screening in improving dental attendance. For criteriabased screening, researchers found low-certainty evidence thatit may improve dental attendance when compared to no screening. However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low-certainty evidence).

Conclusion: The trials included in this review evaluated short‐term effects of screening. We found very low‐certainty evidence that is insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria‐based screening, we found low‐certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low‐certainty evidence). We found low‐certainty evidence to conclude that personalised or specific referral letters may improve dental attendance when compared to non‐specific counterparts. We also found low‐certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) may improve dental attendance in comparison to screening alone. For children requiring treatment, we found very‐low certainty evidence that was inconclusive regarding whether or not a referral letter based on the 'common‐sense model of self‐regulation' was better than a standard referral letter. We did not find any trials addressing possible adverse effects of school dental screening or evaluating its effectiveness for improving oral health.

Setting: School/preschool

Population of Focus: Children and adolescents ages 4 to 15

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Dental Services, CLASSROOM_SCHOOL

Intervention Description: To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services.

Intervention Results: This trial evaluated a post screening referral letter based on the common-sense model of self-regulation (a theoretical framework that explains how people understand and respond to threats to their health), with or without a dental information guide, compared to a standard referral letter. The findings were inconclusive. Due to high risk of bias, indirectness and imprecision, we assessed the evidence as very low certainty.

Conclusion: The trials included in this review evaluated short-term effects of screening. We found very low-certainty evidence that is insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters may improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) may improve dental attendance in comparison to screening alone. For children requiring treatment, we found very-low certainty evidence that was inconclusive regarding whether or not a referral letter based on the 'common-sense model of self-regulation' was better than a standard referral letter. We did not find any trials addressing possible adverse effects of school dental screening or evaluating its effectiveness for improving oral health.

Intervention Components (click on component to see a list of all articles that use that intervention): Comprehensive School-Based PA Program, CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: This study aimed to assess the impact of a 7-month, intensive, city-wide intervention ("Life of Health") on tackling youth inactivity and sedentary behavior in an entire Latin-American city (Jaguariuna, Brazil). For youth, a program focused on tackling inactivity/sedentary behavior was delivered at every school (n = 18). Plausibility assessments (pre-to-post design) were performed with 3,592 youth (out of 8,300 individuals at school age in the city) to test the effectiveness of the intervention. Primary outcomes were physical activity and sedentary behavior. Secondary outcome was BMI z-score.

Intervention Results: Physical activity did not change (0; 95%CI:-2.7-2.8 min/day; p = 0.976), although physically inactive sub-group increased physical activity levels (11.2; 95%CI:8.8-13.6 min/day; p < 0.001). Weekday television and videogame time decreased, whereas computer time increased. Participants with overweight and obesity decreased BMI z-score (-0.08; 95%CI:-0.11-0.05; p < 0.001; -0.15; 95%CI:-0.19-0.11; p < 0.001). This intervention was not able to change the proportion of physical inactivity and sedentary behavior in youth at a city level. Nonetheless, physically inactive individuals increased PA levels and participants with overweight and obesity experienced a reduction in BMI z-score, evidencing the relevance of the intervention.

Conclusion: Education-based lifestyle programs should be supplemented with environmental changes to better tackle inactivity/sedentary behavior in the real-world.

Study Design: Quasi-experimental design

Setting: Schools in an entire Latin American city (teacher-led)

Population of Focus: Children and adolescents

Data Source: Student self-report

Sample Size: 3, 592 students

Age Range: Ages 6-17

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Teacher/Staff Training, Comprehensive School-Based PA Program

Intervention Description: The four-month intervention included strategies focused on training teachers, new opportunities for physical activity in the school environment, and health education strategies for the school community (including parents). Moderate- to-vigorous physical activity level (≥420 min/week), TV watching and computer use/gaming (<2 h/day), daily consumption of fruit juice, fruit, vegetables, soft drinks, savory foods and sweets, and current alcohol and tobacco use were measured before and after intervention.

Intervention Results: McNemar's test and logistic regression (odds ratio [OR] and a 95% confidence interval [95% CI]) were used, considering p < 0.05. In the intervention schools, a significant increase occurred in the number of adolescents who met physical activity guidelines (5.3%; 95% CI = 0.8; 9.8) and who reported using computer for <2 h a day (8.6%; 95% CI = 3.8; 13.4) after intervention. No changes were observed in the control schools. At the end of the intervention, adolescents from intervention schools were more likely to practice physical activity at recommended levels (OR = 1.44; 95% CI = 1.00; 2.08) than adolescents from control schools. No significant change was observed for the other lifestyle factors.

Conclusion: In conclusion, this multicomponent intervention was effective in promoting physical activity among adolescents from vulnerable areas. However, other lifestyle factors showed no significant change after intervention.

Study Design: Cluster RCT

Setting: 6 schools in the public education system

Population of Focus: Adolescents in grades 7-9

Data Source: Physical activity list and Youth Risk Behavior Survey Questionnaire

Sample Size: 548 adolescents in intervention group; 537 in the control group

Age Range: Ages 11-18

Intervention Components (click on component to see a list of all articles that use that intervention): Comprehensive School-Based PA Program, CLASSROOM_SCHOOL

Intervention Description: The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum.

Intervention Results: Mixed-model analyses showed significant favourable effects for the full HPSF versus control schools for, among others, school water consumption (effect size (ES) = 1.03 (T1), 1.14 (T2)), lunch intake of vegetables (odds ratio (OR) = 3.17 (T1), 4.39 (T2)) and dairy products (OR = 4.43 (T1), 4.52 (T2)), sedentary time (ES = -0.23 (T2)) and light PA (ES = 0.22 (T2)). Almost no significant favourable effects were found for partial HPSF compared to control schools.

Conclusion: We conclude that the full HPSF is effective in promoting children's health behaviours at T1 and T2 compared with control schools. Focusing on both nutrition and PA components seems to be more effective in promoting healthy behaviours than focusing exclusively on PA.

Study Design: Quasi-experimental longitudinal study

Setting: 4 control and 4 intervention pilot schools in the ‘Healthy Primary School of the Future’ project in Parkstad region of the Netherlands

Population of Focus: Children aged 4-12 enrolled in HPSF project schools

Data Source: Accelerometers, questionnaires,

Sample Size: 2,326 students

Age Range: Ages 4-12

Intervention Components (click on component to see a list of all articles that use that intervention): Physically Active Classrooms, CLASSROOM_SCHOOL

Intervention Description: Given the need to find more opportunities for physical activity within the elementary school day, this study was designed to asses the impact of I-CAN!, active lessons on: 1) student physical activity (PA) outcomes via accelerometry; and 2) socioeconomic status (SES), race, sex, body mass index (BMI), or fitness as moderators of this impact.

Intervention Results: Students in treatment schools took significantly more steps than those in control schools (β = 125.267, SE = 41.327, p = .002, d = .44). I-CAN! had a significant effect on MVPA with treatment schools realizing 80% (β = 0.796, SE =0.251, p = .001; d = .38) more MVPA than the control schools. There were no significant school-level differences on sedentary behavior (β = -0.177, SE = 0.824, p = .83). SES, race, sex, BMI, and fitness level did not moderate the impact of active learning on step count and MVPA.

Conclusion: Active learning increases PA within elementary students, and does so consistently across demographic sub-groups. This is important as these sub-groups represent harder to reach populations for PA interventions. While these lessons may not be enough to help children reach daily recommendations of PA, they can supplement other opportunities for PA. This speaks to the potential of schools to adopt policy change to require active learning.

Study Design: Multilevel regression model

Setting: 28 central Texas elementary schools

Population of Focus: Fourth grade students across different schools in Texas

Data Source: Accelerometer

Sample Size: 2,493 students

Age Range: Ages 9-10 (4th grade)

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Curricular Activities/Training, Physically Active Classrooms, CLASSROOM_SCHOOL

Intervention Description: Nine third- through sixth-grade classrooms (n = 292 students) in one elementary-middle school in Detroit, Michigan (49% female, 95% nonwhite; 80% qualified for free/reduced lunch) participated in this 20-week intervention where teachers implemented 5 × 4 min moderate-to-vigorous activity breaks per day. Gamification of activity breaks occurred during weeks 13-20 of the intervention and included the use of game design elements and classroom goals for activity break intensity. Moderate-to-vigorous physical activity (MVPA) during activity breaks was measured via direct observation.

Intervention Results: There was a significant effect of intervention with a 27% increase in student MVPA participation during the gamified intervention weeks compared with the standard intervention weeks (p = 0.03). Gamification of activity breaks resulted in 55% (compared with 25% during the standard intervention) of students accumulating approximately 20 min of health-enhancing physical activity per day in their classroom.

Conclusion: These findings provide preliminary evidence that gamifying activity breaks may be an important strategy for increasing student participation in classroom activity breaks.

Study Design: Cohort design

Setting: One elementary-middle school in Detroit, MI, where at least 40% of students qualified for free/reduced priced lunch

Population of Focus: Students who were able to participate in physical education classes from 9 3rd through 6th grade classrooms

Data Source: System for Observing Play and Leisure Activity in Youth (SOPLAY)

Sample Size: 292 students

Age Range: Ages 8-13

Intervention Components (click on component to see a list of all articles that use that intervention): Comprehensive School-Based PA Program, CLASSROOM_SCHOOL

Intervention Description: This study evaluated a multi-component school-based intervention (Y-PATH: Youth-Physical Activity Towards Health), focused on halting the age-related decline in physical activity of youth in early adolescence. A cluster randomized controlled trial in 20 post primary schools (10 control, 10 intervention) was conducted. Data were collected from all 20 schools at baseline (2013), and 12 months (2014), and from 10 of these schools (5 intervention) at 24 months (2015). The setting was mixed gender post primary schools residing in the greater area of Dublin, Ireland. Principals from each school were asked to nominate one first year class group attending their school in September 2013 to participate in the study (N = 564). Intervention schools implemented the Y-PATH whole school intervention, comprising teacher component, parent component, and PE component; while control schools continued with usual care. The main outcome measure was accelerometer derived average minutes of daily moderate to vigorous physical activity (MVPA).

Intervention Results: Results of the multilevel regression analysis confirmed that there was a significant time intervention effect, and this was predominantly contributed by the difference between control and intervention groups within females.

Conclusion: Findings support the case for national dissemination of the Y-PATH intervention so that the knowledge learned can be translated to routine practice in schools.

Study Design: Cluster RCT

Setting: Greater Dublin area primary schools

Population of Focus: First year post primary students

Data Source: Accelerometer

Sample Size: 564 students

Age Range: Ages 12-13

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Reporting & Response System, CLASSROOM_SCHOOL, PATIENT_CONSUMER, Feedback

Intervention Description: This study evaluated whether immediate feedback in response to poor indoor air quality in children’s bedrooms can reduce the potential for SHS exposure, as measured by adherence to a World Health Organization (WHO) indoor air standard.

Intervention Results: The likelihood that a child’s bedroom met the WHO indoor air quality standard on a given day increased such that the baseline versus post-baseline odds ratio (OR) of maintaining indoor PM2.5 levels below the WHO guideline was 2.38 times larger for participants who received the intervention. Similarly, the baseline versus post-baseline OR associated with achieving an SFH was 3.49 times larger for participants in the intervention group.

Conclusion: The real-time intervention successfully drove clinically meaningful changes in smoking behavior that mitigated indoor PM2.5 levels in children’s bedrooms and thereby reduced SHS exposure. These results demonstrate the effectiveness of targeting sensitive microenvironments by giving caregivers actionable information about children’s SHS risks. Future extensions should examine additional microenvironments and focus on identifying the potential for SHS exposure before it occurs.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Curricular Activities/Training, CLASSROOM_SCHOOL

Intervention Description: This study utilized a randomized control trial (RCT) design to evaluate the knowledge acquisition of children who received the Monique Burr Foundation's Child Safety Matters curriculum, a program designed to educate kindergarten to Grade 5 children about bullying, cyberbullying, four types of abuse (physical, sexual, emotional, and neglect), and digital dangers.

Intervention Results: The interaction of treatment and time was significant, F(2, 90) = 17.024, p < .000. Children who received the curriculum increased their knowledge about potentially risky situations, and this knowledge was sustained over 7 months to the follow-up assessment. Children in the control schools did not have similar gains.

Conclusion: The current classroom-based child maltreatment prevention education is a promising strategy to address children's vulnerability to abuse and its consequences.

Intervention Components (click on component to see a list of all articles that use that intervention): Training (Parent/Family), Extra-Curricular Activities, PARENT_FAMILY, CLASSROOM_SCHOOL, Family-Based Interventions

Intervention Description: This was an 11-week, two group, randomized feasibility study. Participants were children and their parents at one OOSP on a rural American Indian reservation. Children, ages 6–9, were randomized to receive the Generations Health (GH) intervention or comparison condition. The GH group received daily activities focused on physical activity (PA), nutrition, sleep, and reducing TV/screen time, and frequently engaged parents. The comparison group received usual OOSP activities. To assess intervention feasibility, we measured recruitment and participation rates and program satisfaction. We assessed pre- to posttest changes in body composition, PA and sleep patterns, dietary intake and Healthy Eating Index-2010 (HEI-2010) scores, TV/screen time, and nutrition knowledge. We report recruitment and participation rates as percentages and participants’ program satisfaction as means. Two-tailed paired t tests and 95% confidence intervals were used to detect changes in behavioral and health outcome variables.

Intervention Results: Forty-six children met age eligibility criteria; following screening, 52% (24/46) met the inclusion criteria and 96% (23/24) were randomized to the study. Overall, 91% of the children participated in the intervention and 100% participated in at least some of the posttest assessments. Parents reported high program satisfaction (mean rating of 4, on a 1–5 scale). Our outcome measure for child adiposity, zBMI, was reduced by 0.15 in the GH group, but increased by 0.13 in the comparison condition. Meaningful changes were evident for total kilocalories, HEI-2010 scores, PA, TV/screen time, and nutrition knowledge.

Conclusion: High recruitment, participation and program satisfaction and positive health and behavioral outcomes at 11 weeks provide encouraging indications of the feasibility and potential effectiveness of the intervention.

Study Design: Feasibility RCT

Setting: American Indian Reservation

Population of Focus: Rural students

Data Source: Activity monitors (PA levels), questionnaire (sedentary/screen activity)

Sample Size: 24 students

Age Range: Ages 6-9

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: 116 fifth-graders were assigned to one intervention group (n = 31) participating in daily physical activity engaging the brain with Fitbit Challenge (PAEB-C), another intervention group (n = 29) wearing Fitbits only (Fitbit-O) daily, five days per week, or the comparison group (n = 56). Four-week real-time PA data were collected from the intervention students via Fitbase. Three groups were pre- and post-tested aerobic fitness.

Intervention Results: The PAEB-C students showed significantly higher steps and minutes of being very active and fairly active (F = 7.999, p = 0.014, ŋ = 0.121; F = 5.667, p = 0.021, ŋ = 0.089; F = 10.572, p = 0.002, ŋ = 0.154) and lower minutes of being sedentary daily (F = 4.639, p = 0.035, ŋ = 0.074) than the Fitbit-O group. Both Fitbit groups exhibited significantly greater increases in aerobic fitness scores than the comparison group over time (F = 21.946, p = 0.001, ŋ = 0.303). Boys were more physically active and fit than girls.

Conclusion: Technology-enhanced PA intervention was effective for improving real-time PA and aerobic fitness.

Study Design: RCT

Setting: 2 elementary schools

Population of Focus: Elementary school students

Data Source: FitBit, Fitbase, PACER test

Sample Size: 116 students

Age Range: Ages 10-11 (5th grade)

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Early Head Start

Intervention Description: Authors performed a quasi-experimental study, interviewing 479 EHS and 699 non-EHS parent-child dyads at baseline (2010-2012) and at a 24-month follow-up (2012-2014). Researchers estimated the effects of EHS participation on the probability of having a dental care visit after controlling for baseline dental care need and use and a propensity score covariate; random effects to account for EHS program clustering were included.

Intervention Results: The odds of having a dental care visit of any type (adjusted odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.74, 3.48) and having a preventive dental visit (adjusted OR = 2.6;95% CI = 1.84, 3.63) were higher among EHS children than among non-EHS children. In addition, the adjusted mean number of dental care visits among EHS children was 1.3 times (95% CI = 1.17, 1.55) the mean number among non-EHS children.

Conclusion: This study is the first, to our knowledge, to demonstrate that EHS participation increases dental care use among disadvantaged young children.

Setting: Community

Population of Focus: Low-income children younger than 3 years and their families

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Early Head Start

Intervention Description: Researchers compared children enrolled in North Carolina EHS programs with similar children enrolled in Medicaid but not EHS on the use of preventive oral health services (POHS). They analyzed 4 dependent variables (oral assessment by medical health care provider, oral assessment by oral health care provider, fluoride application by medical health care provider, fluoride application by oral health care provider) by using multivariate logistic regression that controlled for covariates.

Intervention Results: Primary caregivers of children enrolled in EHS (n = 479) and Medicaid (n = 699) were interviewed when children were approximately 10 and 36 months of age. An average of 81% of EHS and non-EHS children received POHS from an oral or medical health care provider at follow-up. EHS children had greater odds of receiving an oral health assessment (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.74 to 3.13) and fluoride (OR, 1.53; 95% CI, 1.16 to 2.03) from an oral health care provider than children not enrolled. EHS children had decreased odds (OR, 0.73; 95% CI, 0.54 to 0.99) of receiving fluoride from a medical health care provider.

Conclusion: Both children enrolled in EHS and community control participants had high rates of POHS, but the source of services differed. EHS children had greater odds of receiving POHS from oral health care providers than non-EHS children. EHS and non-EHS children had equal rates for fluoride overall because of the greater percentage of non-EHS children with medical fluoride visits. The integration of POHS in early education and Medicaid medical benefits combined with existing dental resources in the community greatly improves access to POHS.

Setting: Community

Population of Focus: Children between 10 and 36 months of age

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: The intervention was performed in a sample of 47 children attending a primary school in the south of Italy and it was structured in two sessions of classroom active breaks (CABs) in three school days a week, shared with and supervised by the teachers.

Intervention Results: CABs showed an overall potential positive effect on the reduction of inactivity of ∼12 min and an equivalent increase in PA levels, of which 5 min were of moderate/vigorous intensity. Girls showed lower time spent in light and moderate PA and higher amount of inactivity than boys and responded better to the intervention. The satisfaction of children and teachers was high.

Conclusion: CABs program is a safe tool to reduce inactivity and increase moderate/vigorous PA. Designing structured exercise breaks adapted in a flexible way to meet the needs of the school curriculum program may increase the feasibility of such PA program in the schools.

Study Design: Non-randomized feasibility study

Setting: Elementary schools (teacher-led)

Population of Focus: 3rd grade school children

Data Source: Accelerometer data and student self-report

Sample Size: 47 students

Age Range: Ages 8-9

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Adult-led Curricular Activities/Training, Physically Active Classrooms

Intervention Description: Teachers at 5 elementary schools attended training on how to implement CBPA. Data on school-day PA opportunities [physical education (PE), recess, and CBPA] were obtained via calendar and teacher-recorded CBPA logs. Daily step counts were measured via accelerometry in 1346 students across 65 classrooms in first through fifth grades.

Intervention Results: PE, recess, and CBPA contributed significantly to students' daily steps. Males accrued more steps than females over the school day, during PE, and during recess. No gender disparity was seen in the amount of additional steps accrued during CBPA. Overall step counts were lower among fifth-grade students versus first-grade students, but CBPA attenuated this difference such that grade-level differences were not significant in fifth-grade students who received CBPA.

Conclusion: Gender disparities in step totals were present on PE and recess days, but not on CBPA days. CBPA appears to provide equal PA benefits for both genders and to potentially minimize the decline in PA among older students.

Study Design: Quasi-experimental design

Setting: Public elementary schools (teacher-led)

Population of Focus: 1st through 5th grade school children

Data Source: Accelerometer data and teacher self-report

Sample Size: 1,346 students

Age Range: Ages 6-11

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Peer-led Curricular Activities/Training, Extra-Curricular Activities

Intervention Description: Female participants, aged 11-13 years, were recruited from six post-primary schools in Northern Ireland. Participants were randomized by school (cluster) to participate in regular 10-15-min peer-led brisk walks throughout the school week (the WISH study) (n = 101, two schools) or to continue with their usual PA (n = 98, four schools). The primary outcome measure was school-time PA post intervention (week 12), assessed objectively using an Actigraph accelerometer. Secondary outcome measures included anthropometry, cardiorespiratory fitness and psychosocial measures. Changes in PA data between baseline (T0) and end of intervention (week 12) (T1) were analysed using a mixed between-within subjects analysis of variance with one between (group) and one within (time) subjects factor, with two levels.

Intervention Results: Of 199 participants recruited (mean age = 12.4 ± 0.6 years, 27% overweight/obese), 187 had valid accelerometer data for inclusion in subsequent analysis. A significant interaction effect was observed for changes in light intensity PA across the school day (p = 0.003), with those in the intervention increasing their light intensity PA by 8.27 mins/day compared with a decrease of 2.14 mins/day in the control group. No significant interactions were observed for the other PA measures across the intervention. Intervention effects on school-time PA were not sustained four months post intervention.

Conclusion: The intervention increased daily light intensity PA behaviour in these adolescent girls but did not change moderate to vigorous physical activity (MVPA). These findings suggest that a school-based brisk walking intervention may be feasible and can change PA behaviour in the short term, but it is possible that the self-selected walking speeds determined by a peer-leader may not be sufficient to reach MVPA in this age group. Further research is needed to evaluate the potential of school-based brisk walking to contribute to MVPA in adolescent girls.

Study Design: Cluster RCT

Setting: 6 post-primary schools in Northern Ireland

Population of Focus: Girls in participating schools without medical conditions that would limit their participation

Data Source: Accelerometers, BMI, Queens College Step Test (cardiovascular fitness), selfefficacy for PA questionnaire

Sample Size: 6 schools: 101 female students from 2 schools (intervention), 98 female students in 4 schools (control)

Age Range: Ages 11-13

Intervention Components (click on component to see a list of all articles that use that intervention): Physically Active Classrooms, CLASSROOM_SCHOOL, Upgrade of School Facilities

Intervention Description: The aim of this study was to examine the potential impact of an environmental intervention, the addition of sit-stand desks in the classroom, on school children's sitting and physical activity during class time and after school.

Intervention Results: In total 176 children (mean age = 9.3 years) took part in the trial. At baseline, control and intervention groups spent more than 65% of class time sitting, this changed to 71.7% and 59.1% at follow-up, respectively (group effect p < 0.001). The proportion of class time spent standing and stepping, along with the proportion of time in light activity increased in the intervention group and decreased in the control group. There was no evidence of any compensatory effects from the intervention after school.

Conclusion: Incorporating sit-stand desks to change the classroom environment at primary school appears to be an acceptable strategy for reducing children's sedentary behaviour and increasing light activity especially during class time.

Intervention Components (click on component to see a list of all articles that use that intervention): Teacher/Staff Training, CLASSROOM_SCHOOL

Intervention Description: We capitalized on recent methodological advances and integrated self-determination theory with a social-ecological perspective.

Intervention Results: A doubly latent multilevel structural equation model with follow-up mediation tests showed that experimental-group teachers created a substantially more supportive classroom climate, leading student bystanders to embrace the defender role. This classroom-wide (L2) emergence of pro-victim peer bystanders led to sharply reduced victimization (effect size = -.40). Unlike largely unsuccessful past interventions that focused mainly on individual students, our randomized control trial intervention substantially reduced bullying and victimization.

Conclusion: Focusing on individual students is likely to be ineffective (even counterproductive) without first changing the normative climate that reinforces bullying. Accordingly, our intervention focused on the classroom teacher. In the classrooms of these teachers, bystanders supported the victims because the classroom climate supported the bystanders.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: We conducted a quasi-experimental repeated measures pilot study in two primary schools in the Stirling Council area: one school with, and one without, intention to introduce the Daily Mile. Pupils at the control school followed their usual curriculum. Of the 504 children attending the schools, 391 children in primary classes 1-7 (age 4-12 years) at the baseline assessment took part. The follow-up assessment was in the same academic year. Outcomes were accelerometer-assessed average daily moderate to vigorous intensity physical activity (MVPA) and average daily sedentary behaviour, 20-m shuttle run fitness test performance and adiposity assessed by the sum of skinfolds at four sites. Valid data at both time points were collected for 118, 118, 357 and 327 children, respectively, for each outcome.

Intervention Results: After correction for age and gender, significant improvements were observed in the intervention school relative to the control school for MVPA, sedentary time, fitness and body composition. For MVPA, a relative increase of 9.1 min per day (95% confidence interval or 95%CI 5.1-13.2 min, standardised mean difference SMD = 0.407, p = 0.027) was observed. For sedentary time, there was a relative decrease of 18.2 min per day (10.7-25.7 min, SMD = 0.437, p = 0.017). For the shuttle run, there was a relative increase of 39.1 m (21.9-56.3, SMD = 0.236, p = 0.037). For the skinfolds, there was a relative decrease of 1.4 mm (0.8-2.0 mm, SMD = 0.246, p = 0.036). Similar results were obtained when a correction for socioeconomic groupings was included.

Conclusion: The findings show that in primary school children, the Daily Mile intervention is effective at increasing levels of MVPA, reducing sedentary time, increasing physical fitness and improving body composition. These findings have relevance for teachers, policymakers, public health practitioners, and health researchers.

Study Design: QE repeated measures pilot

Setting: 2 primary schools

Population of Focus: Primary school children

Data Source: Accelerometer, bodycomposition

Sample Size: 391 students

Age Range: Ages 4-12

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program, COMMUNITY, Policy (Community)

Intervention Description: Schools signal health priorities through policies. School districts prioritize health and, accordingly, their school health environments through policies that engage parents/guardians, campus educators, staff, and community leaders in the development process. Using a repeated cross-sectional study design, we compare the presence and strength of policies related to four topics—physical activity, nutrition, mental health, and bullying—described in elementary school Campus Improvement Plans (CIPs; also called school improvement plans) within Texas, across four Texas Public Health Regions (PHRs), and between 2016 and 2020. CIPs were collected using a multi-stage probability-based survey approach, scored using an adapted WellSAT tool, and analyzed to determine associations between PHR or year and health topic.

Intervention Results: Across 170 CIPs, bullying was the most frequently addressed topic, followed by mental health, physical activity, and nutrition. On average, schools addressed 2.7 ± 1.3 topics within their CIP; 38.2% of schools addressed all four, 26.5% addressed three, 12.4% addressed two, 15.3% addressed one, and 7.6% addressed none. CIPs in the same district had high levels of clustering (ICCs = 0.28–0.55). The mostly rural Panhandle PHR included the fewest topics in their CIPs and used the weakest policy language.

Conclusion: Between 2016 and 2020, there was a decrease in the proportion of CIPs that addressed nutrition; the strength of language for mental health and bullying also decreased. Regional and time trends reveal opportunities for more robust school health policy interventions.

Study Design: Repeated cross-sectional study

Setting: Elementary Schools in Texas across Texas Public Health Regions

Population of Focus: Elementary aged children, Grades K-5, attending participating schools with Campus Improvement Plans

Sample Size: 170 Campus Improvement Plans/Elementary schools

Age Range: Children ages 5-11 years

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, PE Enhancements

Intervention Description: This school-based feasibility study of a randomised cluster trial recruited adolescents aged 12-14 years (n = 224) from five schools (three intervention; two control) in Belfast, Northern Ireland. The 22-week intervention (The StepSmart Challenge) informed by self-determination theory and incorporating gamification strategies involved a school-based pedometer competition. Outcomes, measured at baseline, and post-intervention (at 22 weeks post-baseline and 52 weeks post-baseline) included daily minutes of moderate to vigorous physical activity (MVPA) (measured using ActiGraph accelerometer), mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale), social support for physical activity, time preference (for delayed and larger rewards or immediate and smaller rewards), pro-social behaviour (Strengths and Difficulties Questionnaire (SDQ)) and the influence of social networks. The intervention's acceptability was explored in focus groups.

Intervention Results: We invited 14 schools to participate; eight showed interest in participating. We recruited the first five who responded; all five completed the trial. Of the 236 pupils invited, 224 participated (94.9%): 84.8% (190/224) provided valid MVPA (minutes/day) at baseline and 57.2% (123/215) at 52 weeks. All other outcomes were well completed apart from the SDQ (65% at baseline). Qualitative data highlighted that participants and teachers found The StepSmart Challenge to be an acceptable intervention.

Conclusion: The level of interest and high recruitment and retention rates provide support for the feasibility of this trial. The intervention, incorporating gamification strategies and the recruitment methods, using parental opt-out procedures, were acceptable to participants and teachers. Teachers also suggested that the implementation of The StepSmart Challenge could be embedded in a lifelong learning approach to health within the school curriculum. As young people's lives become more intertwined with technology, the use of innovative gamified interventions could be one approach to engage and motivate health behavioural change in this population.

Study Design: Feasibility study of a randomized cluster trial

Setting: 5 post-primary schools

Population of Focus: Adolescents aged 12-14 years from 5 schools

Data Source: Accelerometers and questionnaires. Aggregate step counts from Fitbit Zip data were updated weekly for each team on the StepSmart Challenge website leader board

Sample Size: 224 students

Age Range: Ages 12-14

Intervention Components (click on component to see a list of all articles that use that intervention): Teacher/Staff Training, CLASSROOM_SCHOOL

Intervention Description: This study investigates the prevalence of bullying and the short-term effects on students' bullying perceptions of a preventive intervention conducted among teachers of first-grade secondary schools in Palermo, Sicily (Italy).

Intervention Results: A total of 402 students participated in the study (72.7% response rate). A decrease in the number of bullying episodes after the intervention was reported by the students in all types of bullying explored (physical, verbal, and indirect bullying, observers, resiliency, and prosociality), with all three methods. In particular, a statistically significant decrease in all the bullying areas investigated (except for resiliency) was reported for students attending schools of an intermediate socioeconomic level.

Conclusion: Even if many school-based interventions have been implemented to reduce school bullying throughout the world, this is one of the first conducted in Europe and it assesses the effectiveness among students of an anti-bullying intervention tailored for teachers. The encouraging results in reducing the number of bullying episodes together with the low cost in terms of human and economic resources could suggest an extension of this research on a regional/national scale.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, PE Enhancements

Intervention Description: We followed up 228 children who started school in 1998-2000 seven years later, when they had reached a mean age of 14.8. The 152 children (59% boys) at the intervention school did 200 minutes of physical education per week during that period, and the 76 children (50% boys) in the three control schools did the standard 60 minutes. Questionnaires assessed the durations of total and leisure-time physical activity and screen-time activity at baseline and after five and seven years.

Intervention Results: Physical activity and screen-time activity were similar between the two groups before the study started. The intervention group then achieved higher durations of total physical activity than the controls (p < 0.001) and these levels remained in the sex-specific evaluations. There were no differences between the groups in the durations of leisure-time activity (p 0.08-0.77) or screen-time activity (p 0.31-0.91).

Conclusion: A school-based exercise intervention programme increased the total duration of physical activity in both sexes without any compensatory increase in screen-time activity. The findings contradict the activity-stat theory, which stated that the duration of physical activity in children is constant.

Study Design: Comparative study (pre-post test) intervention vs. control schools

Setting: 4 primary schools

Population of Focus: Primary school students

Data Source: Questionnaires assessed the durations of total and leisuretime physical activity and screen-time activity at baseline and after 5 and 7 years

Sample Size: 228 students

Age Range: Ages 6-9 at beginning of study; Ages 13-16 at end of study

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Comprehensive School-Based PA Program, Presentation/meeting/information Session (Classroom), Physically Active Classrooms, Multicomponent School-Based Program

Intervention Description: “GiochiAmo” is an innovative randomized field trial which aims to educate children aged about nutrition, physical activity, smoking and alcohol. Each primary school class worked on a different theme. Particularly, the project is structured in two sequential phases: a lesson for each theme followed by several game sessions during the next three months.

Intervention Results: A total number of 74 and 76 children participated in the physical activity and nutrition interventions. NTs was 4.17 (SD: 2.23) before and 5.03 (SD: 2.79) after the intervention (P = 0.005). PAs was 27.4 (SD: 9.6) before and 30.5 (SD: 10.7) after the intervention (P = 0.003). No significant differences were obtained comparing males and females for all scores. Ds was 0.86 for nutrition and 3.1 for physical activity. Univariate analysis of Delta scores obtained no significant differences.

Conclusion: The present results confirm the effectiveness of 'GiochiAMO' to change nutrition and physical activity behavior.

Study Design: Single arm, cluster field trial (c-RCT)

Setting: Public primary schools

Population of Focus: Second and third grade students in primary school

Data Source: Student self-report

Sample Size: 150 students

Age Range: Ages 6-9

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Homework/Extra Credit, Presentation/meeting/information Session (Classroom), Adult-led Curricular Activities/Training

Intervention Description: A total of 675 children aged 7-10 years from 16 New Zealand primary schools participated in the Healthy Homework study. Schools were randomised into intervention and control groups (1:1 allocation). Intervention schools implemented an 8-week applied homework and in-class teaching module designed to increase physical activity and improve dietary patterns. Physical activity was the primary outcome measure, and was assessed using two sealed pedometers that monitored school- and home-based activity separately. Secondary outcome measures included screen-based sedentary time and selected dietary patterns assessed via parental proxy questionnaire. In addition, height, weight, and waist circumference were measured to obtain body mass index (BMI) and waist-to-height ratio (WHtR). All measurements were taken at baseline (T0), immediately post-intervention (T1), and 6-months post-intervention (T2). Changes in outcome measures over time were estimated using generalised linear mixed models (GLMMs) that adjusted for fixed (group, age, sex, group x time) and random (subjects nested within schools) effects. Intervention effects were also quantified using GLMMs adjusted for baseline values.

Intervention Results: Significant intervention effects were observed for weekday physical activity at home (T1 [P < 0.001] and T2 [P = 0.019]), weekend physical activity (T1 [P < 0.001] and T2 [P < 0.001]), BMI (T2 only [P = 0.020]) and fruit consumption (T1 only [P = 0.036]). Additional analyses revealed that the greatest improvements in physical activity occurred in children from the most socioeconomically deprived schools. No consistent effects on sedentary time, WHtR, or other dietary patterns were observed.

Conclusion: A compulsory health-related homework programme resulted in substantial and consistent increases in children's physical activity - particularly outside of school and on weekends - with limited effects on body size and fruit consumption. Overall, our findings support the integration of compulsory home-focused strategies for improving health behaviours into primary education curricula.

Study Design: Cluster RCT

Setting: Primary schools in Auckland or Dunedin

Population of Focus: 3rd-5th year students

Data Source: Pedometers, questionnaires (diet, television and computer usage), anthropometrics

Sample Size: 675 students from 16 schools

Age Range: Ages 7-10

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: This study examined the effects of a standing desk intervention in a classroom on children's standing and sitting time at school, sedentary and physical activity levels throughout the day (waking hours), and musculoskeletal discomfort. A within-subjects crossover study design was used. Participants used either a standing desk or traditional seated desk for 21 days before swapping desks for another 21 days. Accelerometry and musculoskeletal discomfort data were collected during the last seven days of each 21-day period. Mixed models were used to analyse accelerometry data. Zero-inflated regression models and logistic regression models were used to analyse discomfort data.

Intervention Results: Forty-seven male students (aged 10⁻11 years) participated in the study. Standing time was 21 min/school day higher (p < 0.001) and sitting time was 24 min/school day lower (p = 0.003) when standing desks were used. No significant differences were found in sedentary and physical activity time during waking hours between the standing desk and seated desk conditions. Students were less likely to report musculoskeletal discomfort in the neck, shoulder, elbows and lower back when using standing desks (OR 0.52⁻0.74).

Conclusion: Standing desks significantly increased classroom standing time and decreased musculoskeletal discomfort reports but had no overall effect on daily physical activity levels. Schools should consider moving towards classrooms enabling a variety of postures to potentially improve the long-term health of children.

Study Design: Within-subjects crossover trial

Setting: 1 elementary school

Population of Focus: Male students age 10-11 years

Data Source: Accelerometry and musculoskeletal discomfort data were collected

Sample Size: 47 male students

Age Range: Ages 10-11

Intervention Components (click on component to see a list of all articles that use that intervention): Comprehensive School-Based PA Program, CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: The Shaping Healthy Choices Program is a multi-component, school- based intervention that was developed to improve children’s health. This program integrates activities within four components, all working together to sustain positive health outcomes: Nutrition education and promotion, Family and community partnerships, Foods available on the school campus with an emphasis on regional agriculture, School wellness policies

Intervention Results: Mean minutes of MVPA significantly increased at the intervention school (22.3 + 37.8; p = 0.01) and at the control school (29.1 + 49.5; p = 0.01). There were no significant differences in the change in MVPA between the schools. Youth at the intervention school significantly decreased mean minutes in sedentary activity compared to the controls (p = 0.02).

Conclusion: Youth who participated in the SHCP decreased time spent in sedentary activity and increased very vigorous physical activity from pre- to post-intervention, while these changes were not observed at the control school. The overall small physical activity intensity pattern shift supports that physical activity is an important area to target within a multicomponent nutrition intervention aimed at preventing childhood obesity.

Study Design: Pre and post assessments at intervention and control schools

Setting: 2 schools (one intervention and 1 control)

Population of Focus: 4th graders

Data Source: Accelerometer (Polar Active monitors)

Sample Size: 92 youth

Age Range: Ages 9.5-9.6

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Extra-Curricular Activities

Intervention Description: The aim of this study was to investigate whether a two-year, empowerment-based health-promotion school intervention had any effects on changes in (a) moderate-to-vigorous PA (MVPA), (b) sedentary time (SED), (c) exercise training (ET) frequency, and (d) ET duration, among adolescents.

Intervention Results: No significant differences were measured between the intervention and control groups for any of the measures. There was an increase of MVPA in intervention group by 6.6 minutes and sedentary time showed a decrease in the intervention group but neither statistically significant compared to control group. No differences were found among the groups for exercise training frequency or duration.

Conclusion: Overall, the intervention was unsuccessful at promoting PA and reducing SED.

Study Design: Quasi-experimental, non-randomized, longitudinal pretestposttest design

Setting: Municipal schools in a multicultural, low SES area of Angered of Gothenburg, Sweden

Population of Focus: 7th grade students (followed through 9th grade)

Data Source: Accelerometers, questionnaire (exercise training), anthropometrics

Sample Size: 152 students (1 intervention school, 2 control schools)

Age Range: Ages 12–13 (followed through 14-16 years)

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Active Recess

Intervention Description: Direct observations were conducted during recess before the redesign in May 2014, then again at 6 months and 1 year after the redesign. During each observation, observers scanned the playground and counted how many students were sedentary, engaged in moderate activity, or engaged in vigorous activity. System for Observing Play and Leisure Activity in Youth, a validated instrument for observing physical activity in free play settings, was used to collect observation data.

Intervention Results: Six months from baseline, the percentage of children engaging in moderate to vigorous physical activity during recess increased by 23.3%, and the percentage engaged in vigorous physical activity increased by 26.2%. These increases were sustained at 1 year from baseline, with an increase of 17.2% for moderate to vigorous physical activity and 33.1% for vigorous physical activity. Chi-square tests of independence showed that changes in the proportion of students engaging in moderate to vigorous physical activity and vigorous physical activity were statistically significant (p<0.01).

Conclusion: This evaluation demonstrated that environmental interventions involving the provision of structural and loose play equipment can be implemented in an intermediate school setting, and can create a sustainable increase in physical activity among students during recess. This example also demonstrates that schools and community organizations can evaluate the impact of these interventions using relatively simple, low-cost observational methods.

Study Design: Pre-post design

Setting: 1 elementary school

Population of Focus: Students in 5th and 6th grade

Data Source: Direct observation data were collected using System for Observing Play and Leisure Activity in Youth (SOPLAY)

Sample Size: 148 students

Age Range: Ages 10-12 (5th & 6th grade)

Intervention Components (click on component to see a list of all articles that use that intervention): Teacher/Staff Training, PE Enhancements, CLASSROOM_SCHOOL

Intervention Description: The aim of this study was to evaluate the role of a teacher to implement the Team Pentathlon (TP) in order to improve the PAP in primary children.

Intervention Results: Several teachers noted significant increases in PAP in the IG for both boys and girls (p ≤ 0.05 or p < 0.01), whereas others found only small improvements in PAP. One teacher even observed higher PAP in the CG. Training session records revealed that the teacher himself, how the TP is implemented, and proper resources were the three elements that explained the successful implementation of the TP program.

Conclusion: The implementation of the TP significantly increased the PAP in primary children. Training sessions helped teachers to implement the TP program but personal engagement, motivation, respecting protocol, and an adequate environment are also necessary in improving the PAP of children.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Adult-led Curricular Activities/Training, Multicomponent SchooL-Based Program, Peer-led Curricular Activities/Training

Intervention Description: This study examined the effects of the Finnish anti-bullying program KiVa on changes in self-reported affective and cognitive empathy and tested whether these effects varied depending on students’ gender, initial levels of empathy, peer-reported bullying, and peer-perceived popularity, as well as school type (primary versus secondary school) and classroom bullying norms.

Intervention Results: KiVa had a positive effect on affective empathy, but not cognitive empathy. The effects of the program on both types of empathy did not depend on students' gender, initial levels of empathy, bullying, or popularity, nor on school type or classroom bullying norms.

Conclusion: Findings suggest that KiVa can raise students' affective empathy regardless of students' gender, status, initial empathy, or levels of bullying, and regardless of school type or classroom bullying norms.

Study Design: Pre-post design

Setting: Primary and secondary schools

Population of Focus: Children and adolescents

Sample Size: 15403

Age Range: 8-14

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Social Network/Peer

Intervention Description: Thirty-seven elementary school students participated in a 4-week randomized controlled study (1-week baseline; 2-week intervention [with only the Game group receiving MKMM]; and 1-week follow-up). All participants wore a Tractivity® accelerometer throughout. Linear mixed models were applied to assess sustainability; a second 42-children-based dataset and age-/sex-adjusted linear regression models were used to compare effect across socioeconomic environments.

Intervention Results: In the first week of intervention, the Game group compared to the Control group showed a greater increase in physical activity (of 1,758 steps/day [95% confidence interval, CI = 133-3,385] and 31 active minutes/day [95% CI = 4-59]), relative to baseline (13,986 steps/day; 231 active minutes/day). However, this was not sustained in the second intervention week or follow-up. The school within a lower socioeconomic status environment showed lower baseline activity and the 1-week intervention resulted in a greater increase relative to baseline (3,633 steps/day more [95% CI = 1,281-5,985]).

Conclusion: MKMM could be a useful short-term physical activity promotion tool; however, effectiveness may decrease as novelty diminishes.

Study Design: RCT

Setting: 2 elementary schools with different socioeconomic environments

Population of Focus: Elementary school students (9-13-year-olds)

Data Source: Accelerometer

Sample Size: 79 students in two interventions

Age Range: Ages 9-13

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: A total of 210 3rd to 5th grade (age = 9.1 ± 0.1) students from one U.S. elementary school participated in a 4-week intervention. Students’ physical activity levels were measured using pedometers, quantified by step counts pre- and post-intervention.

Intervention Results: Results from the study indicated that students’ physical activity levels increased after participation in the intervention; male students’ physical activity levels were higher than female students. Additionally, there was an increase in physical activity levels regardless of weight categories, with students of healthy weight exhibiting the most increase following participation in the intervention.

Conclusion: In view of the improvement of children’s physical activity levels following their participation in a classroom-based physical activity curriculum, it is recommended that training and resources be provided for teachers to easily implement the curriculum during the school day.

Study Design: Quasi-experimental design

Setting: Elementary schools (teacher-led)

Population of Focus: Elementary school aged children in grades 3-5

Data Source: Pedometer data, stadiometer (height), medical scale (weight)

Sample Size: 210 students

Age Range: Ages 8-11

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Dental Screening

Intervention Description: Researchers identified and searched multiple databases to search for randomized control trials that evaluated school dental screening compared with no intervention or with another type of screening

Intervention Results: The systematic review found there was very low certainty of evidence to support the role of school screening programmes in improving dental attendance. There was a low certainty of evidence to conclude that criteria-based screening, personalised referral letters or screening supplemented with motivation improve dental attendance.

Conclusion: The systematic review found there was very low certainty of evidence to support the role of school screening programmes in improving dental attendance. There was a low certainty of evidence to conclude that criteria-based screening, personalised referral letters or screening supplemented with motivation improve dental attendance.

Setting: School/preschool

Population of Focus: Children and adolescents ages 4 to 16

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Comprehensive School-Based PA Program

Intervention Description: In this study, we examined the development of children's moderate to vigorous physical activity (MVPA) and physical education (PE) enjoyment through the Physical Activity as Civil Skill Program 2012-2014.

Intervention Results: The proportion of children meeting the current MVPA guidelines declined from 38% to 22% (intervention) and 14% to 9% (control), whereas PE enjoyment was stable in both groups. Boys were more physically active than girls only within control group children. Teachers' feedback indicated that violence and bullying among intervention students reduced during the program, which can be considered as an additional benefit.

Conclusion: It may be that both MVPA and PE enjoyment may require more tailored actions to be increased across a long-term program. It is important to ensure that school-based physical activity programs, especially including transition from elementary to middle school level, provide all children positive experiences, and thus, may improve their motivation, and MVPA participation during school days and leisure time.

Study Design: RCT (Voluntary participation as control/ intervention schools; collected data from random subset)

Setting: Elementary schools in central and northeast Finland

Population of Focus: Elementary school students

Data Source: Accelerometer, online questionnaire

Sample Size: 661 students

Age Range: Ages 11-13

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent School-Based Program, Comprehensive School-Based PA Program, CLASSROOM_SCHOOL

Intervention Description: In this study, we examined the development of children's moderate to vigorous physical activity (MVPA) and physical education (PE) enjoyment through the Physical Activity as Civil Skill Program 2012-2014.

Intervention Results: The proportion of children meeting the current MVPA guidelines declined from 38% to 22% (intervention) and 14% to 9% (control), whereas PE enjoyment was stable in both groups. Boys were more physically active than girls only within control group children. Teachers' feedback indicated that violence and bullying among intervention students reduced during the program, which can be considered as an additional benefit.

Conclusion: It may be that both MVPA and PE enjoyment may require more tailored actions to be increased across a long-term program. It is important to ensure that school-based physical activity programs, especially including transition from elementary to middle school level, provide all children positive experiences, and thus, may improve their motivation, and MVPA participation during school days and leisure time.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: An external fitness specialist was employed to deliver a two-phased PA intervention program during the school PE timetable. Phase 1 included showing an educational DVD during school assembly which featured local sport role models. The DVD highlighted: 1) the importance of PA to improve health, 2) the use of circuit training sessions to demonstrate whole body exercise, and 3) the importance of exercise intensity by increasing breathlessness. This was followed by 10-days of introductory circuit training sessions (CTS) within class PE lessons. Students were encouraged to increase exercise duration on each CTS exercise station by increasing number of repetitions and intensity during each subsequent session. Phase 2 ran over a period of 5 months and had two distinct elements. In the first 4 weeks, students were provided with supervised exercise sessions using children’s sized gym equipment including a ski-walker, stepper, elliptical cross-trainer, bicycle, leg extension/leg curl machine, twister, chest press, shoulder press, and bicep curl/tricep extension machine (Phit-Kidz Range, Beny Sports UK Ltd.; EQ Fitness, Sportwise Ltd., UK) during weekly class PE lessons. Students were also allowed access to the gym equipment during recreational times (e.g., lunch recess, before/after school). The second element of Phase 2, included relocating the children’s gym equipment to local community facilities (e.g. village hall, community churches) in order to increase access and facilitate sustained community 7 participation. Both phases included a reward system using PA diaries in which students received prizes, such as medals and certificates, when they achieved a set number of PA goals. Students were encouraged to complete the PA diaries with parental support to record PA performed at school, home and in the community. Following introduction of the intervention by an external instructor, classroom teachers were then expected to continue the intervention delivery. Classroom teachers were provided a program booklet and 1 hour training session to deliver the CTS and weekly gym equipment sessions. UK schools typically do not have designated PE teachers at elementary level education and the PE curriculum is delivered by classroom teachers.

Intervention Results: CG increased body mass (P > .001), aerobic capacity (P > .001), and push-ups (P = .005), as well as improved attitudinal scores toward health and fitness and vertigo (P < .05) compared to the IG. Process evaluation revealed struggles with implementation and design, including pedagogical issues to facilitate program goals. The intervention did not improve attitudinal outcomes, PA levels, or physical fitness above that of the CG.

Conclusion: As some of the data sets had non-normal distributions, all data was further analysed using class means mixed effect model and Mann-Whitney U test. Table 4 provides the F and p values from the reduced class mean fixed effect model and the adjusted Z and p value from the Mann Whitney U test for further comparison. These analyses revealed increases in the CG for body mass, stature, BMI percentile, aerobic capacity, push-ups, sit and reach left, and the following attitudinal components: health and fitness, social continuation, and vertigo compared to the IG (p <0.05). These findings lend further support that there were no overall effects on attitudinal or physical health outcomes in the IG compared to the CG.

Study Design: Quasi experimental, Mixed methods outcome evaluation

Setting: 72 urban elementary schools in the UK

Population of Focus: Elementary students from 4 UK schools

Data Source: Anthropometrics, physical fitness battery, questionnaires (attitudes and PA)

Sample Size: 694 students (468 intervention, 128 controls) and 19 teachers

Age Range: Ages 7-12

Intervention Components (click on component to see a list of all articles that use that intervention): Teacher/Staff Training, CLASSROOM_SCHOOL

Intervention Description: The present study aimed at implementing the P.E.A.C.E. (Preparation, Education. Action, Coping, Evaluation) pack program, developed in Australia, in Italian high schools.

Intervention Results: After the intervention, severe victims (victimized once/week or more often) showed a significant decrease in victimization and higher scores in self-efficacy, while an increase in victimization was observed in the not involved students. As reported by all the groups after the intervention, classmates were perceived more likely to intervene when a bullying episode occurred. By contrast, occasional and severe victims perceived their teachers as less likely to intervene.

Conclusion: The P.E.A.C.E. pack is a promising program confirming in Italian schools the effectiveness already shown in other countries. This program is very useful for severe victims, supporting their self-confidence with a decrease in the frequency of aggressive episodes.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Active Recess

Intervention Description: Three schools were randomly selected by an intervention group in Bogotá, Colombia, in 2013: Intervention (Active Module of Active Recess - MARA) + Text Messages (SMS) (MARA+SMS group), intervention (MARA group), control (control group). Intervention was implemented for ten weeks. The duration and intensity of physical activity and sedentary behaviors were measured objectively using accelerometers Actigraph-GT3X+. Adiposity was measured by body mass index and fat percentage. We measured at baseline (T0) and during the tenth week of intervention (T1). We evaluated the effect of the intervention using a difference-in-difference analysis (DID).

Intervention Results: We included 120 students (57.5% girls; mean age = 10.5 years; standard deviation [SD] = 0.64). There was a significant increase in the mean daily minutes of moderate to vigorous physical activity in the MARA group (Difference T1-T0 = 6.1 minutes, standard error [SE] = 3.49, p = 0.005) in relation to the control group. There were no significant changes in the minutes of moderate to vigorous physical activity in the MARA+SMS group (Difference T1-T0 = -1.0 minute; SE = 3.06; p = 0.363). The minutes decreased in the control group (Difference T1-T0 = -7.7 minutes; SE = 3.15; p = 0.011). The minutes of sedentary behaviors decreased in the MARA and MARA+SMS groups and increased in the control group (MARA Difference T1-T0 = -15.8 minutes; SE = 10.05; p= 0.279; MARA+SMS Difference T1-T0 = -11.5 minutes; SE = 8.80; p= 0.869; Control Difference T1-T0 = 10.9 minutes; SE = 9.07; p = 0.407). There was a higher participation in the MARA group in relation to the MARA+SMS group (MARA group = 34.4%; MARA+SMS group = 12.1%). There were no significant changes in adiposity at 10 weeks according to difference-in-differences analysis (body mass index p: ΔMARA+SMS group versus Δcontrol group = 0.945, ΔMARA group versus Δcontrol group = 0.847, ΔMARA+SMS group versus ΔMARA group = 0.990; FP p ΔMARA+SMS group versus Δcontrol group = 0.788, ΔMARA group versus Δcontrol group = 0.915, ΔMARA+SMS group versus ΔMARA group = 0.975).

Conclusion: The Active Module of Active Recess is a promising strategy to increase physical activity levels and decrease sedentary behavior in students. The addition of Text Messages was not associated with increased moderate to vigorous physical activity or changes in adiposity.

Study Design: Randomized community trial

Setting: Primary Schools in Bogota, Columbia

Population of Focus: 5th grade students

Data Source: Accelerometers, anthropometrics

Sample Size: 120 students from 3 randomly selected schools that were part of a larger study: International Study of Childhood Obesity, Lifestyles, and the Environment (ISCOLE)

Age Range: Ages 9-11

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, PE Enhancements

Intervention Description: Effective physical activity interventions are needed for children because health behaviors track into adulthood, and risk factors for diseases begin early in life. No study has determined whether an intervention designed using a Community-Based Participatory Research approach can improve moderate to vigorous physical activity (MVPA) and the related psychosocial constructs in underserved children. This study determined whether improvements in MVPA and related psychosocial constructs (self-efficacy, knowledge, beliefs, attitudes, and skills) occurred following a Community-Based Participatory Research intervention in underserved, rural children. It was then determined if these constructs were mediators of MVPA.

Intervention Results: There were no differences at baseline between groups. MVPA (30.0 [4.4] min), knowledge, and skill scores were significantly higher in the intervention group compared with the comparison group at follow-up (P < .05). Knowledge and skills were mediating variables of MVPA.

Conclusion: Priority should be placed on research that determines the sustained impact of similar Community-Based Participatory Research interventions.

Study Design: RCT

Setting: 2 fifth-grade classes in a public school in rural Alabama

Population of Focus: Students in grade 5 (all African American; all on free or reducedpriced lunch)

Data Source: Accelerometer; survey with questions from the Patientcentered Assessment and Counseling for Exercise (PACE) Adolescent Psychosocial Scale

Sample Size: 39 students

Age Range: Ages 10-11-year-olds

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Social Network/Peer

Intervention Description: Girls Active involves teachers reviewing PA, sport and physical education provision, culture and practices in their school; attending training; creating action plans; and effectively working with girls as peer leaders to influence decision-making and to promote PA to their peers. Support from a hub school and the YST is offered.

Intervention Results: Twenty schools and 1752 pupils were recruited; 1211 participants provided complete primary outcome data at 14 months. No difference was found in mean MVPA level between groups at 14 months [1.7 minutes/day, 95% confidence interval (CI) –0.8 to 4.3 minutes/day], but there was a small difference in mean MVPA level at 7 months (2.4 minutes/day, 95% CI 0.1 to 4.7 minutes/day). Significant differences between groups were found at 7 months, but not at 14 months, in some of the objective secondary outcomes: overall PA level represented by average acceleration (1.39 mg, 95% CI 0.1 to 2.2 mg), after-school sedentary time (–4.7 minutes/day, 95% CI –8.9 to –0.6 minutes/day), overall light PA level (5.7 minutes/day, 95% CI 1.0 to 10.5 minutes/day) and light PA level on school days (4.5 minutes/day, 95% CI 0.25 to 8.75 minutes/day). Minor, yet statistically significant, differences in psychosocial measures at 7 months were found in favour of control schools. Significant differences in self-esteem and identified motivation in favour of intervention schools were found at 7 and 14 months, respectively. Subgroup analyses showed a significant effect of the intervention for those schools with higher numbers of pupils at 14 months. Girls Active was well received by teachers, and they reported that implemented strategies and activities were having a positive impact in schools. Barriers to implementation progress included lack of time, competing priorities and the programme flexibility. Implementation costs ranged from £2054 (£23/pupil) to £8545 (£95/pupil) per school. No differences were found between groups for health-related quality-of-life scores or frequencies, or for costs associated with general practitioner, school nurse and school counsellor use.

Conclusion: Girls Active may not have had an effect on the random 90 girls per school included in the evaluation. Although we included a diverse sample of schools, the results may not be generalisable to all schools. Girls Active was viewed positively but teachers did not implement as many aspects of the programme as they wanted. The intervention was unlikely to have a wide impact and did not have an impact on MVPA level at 14 months. Capitalising on the opportunities of a flexible programme like this, while also learning from the stated barriers to and challenges of long-term implementation that teachers face, is a priority for research and practice.

Study Design: Two-arm cluster RCT

Setting: 20 secondary schools

Population of Focus: Girls aged 11-14

Data Source: Wrist-worn accelerometers

Sample Size: 1,752 pupils (Girls)

Age Range: Ages 11-14

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: The Israeli Health Promoting School Network (HPSN) is actively committed to enhancing a healthy lifestyle for the entire school population. This study aimed to explore the contribution of school participation in the HPSN and students' individual characteristics to healthy eating and physical activity habits among Israeli school children aged 10-12 years.

Intervention Results: Multi-level analysis indicated that student's individual characteristic was significantly associated with healthy eating and physical activity habits. The subjective self-reported health education received at school was statistically significant factor associated with students' health behaviors. The school's affiliation with the HPSN was not associated with higher healthy eating and physical activity scores after adjusting for individual factors.

Conclusion: These findings suggest that Israeli HPSN schools do not contribute to children's health behaviors more than other schools. Therefore, health promoting activities in HPSN schools need to be improved to justify their recognition as members of the HPS network and to fulfill their mission.

Study Design: Quasi-experimental design

Setting: 2 elementary schools; 5 classes

Population of Focus: 5th grade students

Data Source: Fitbit data

Sample Size: 116 5th grade students

Age Range: Ages 10-11 (5th grade)

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Dental Screening

Intervention Description: Researchers conducted a review of the literature to understand the differences in dentla attendance rates of children receiving a school based dental screening versus those not receiving it.

Intervention Results: Researchers found very low certainty evidence that was insufficient to allow them to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. In addition, when compared to traditional screening there was no evidence of a difference in dental attendance (very low-certainty evidence).

Conclusion: The trials included in this review evaluated short-term effects of screening, assessing follow-up periods of three to eight months. We found very low certainty evidence that was insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening there was no evidence of a difference in dental attendance (very low-certainty evidence). We found low-certainty evidence to conclude that personalised or specific referral letters improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) improves dental attendance in comparison to screening alone. We did not find any trials addressing cost-effectiveness and adverse effects of school dental screening.

Setting: School/preschool

Population of Focus: Children and adolescents

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Reporting & Response System, YOUTH, CLASSROOM_SCHOOL, PATIENT_CONSUMER, Feedback

Intervention Description: This SHS reduction trial assigned families at random to brief coaching and continuous real-time feedback (intervention) or measurement-only (control) groups.

Intervention Results: PEs were significantly correlated with air nicotine levels (r=0.60) and reported indoor cigarette smoking (r=0.51). Interrupted time-series analyses showed an immediate intervention effect, with reduced PEs the day following intervention initiation. The trajectory of daily PEs over the intervention period declined significantly faster in intervention homes than in control homes. Pretest to post-test, air nicotine levels, cigarette smoking and e-cigarette use decreased more in intervention homes than in control homes.

Conclusion: Results suggest that real-time particle feedback and coaching contingencies reduced PEs generated by cigarette smoking and other sources.

Intervention Components (click on component to see a list of all articles that use that intervention): Class Rules, CLASSROOM_SCHOOL

Intervention Description: The objective of this trial was to investigate the impact, value for money and longer-term outcomes of the Good Behaviour Game.

Intervention Results: There was no evidence that the Good Behaviour Game improved any outcomes (hypothesis 1). The only significant subgroup moderator effect identified was contrary to expectations: at-risk boys in Good Behaviour Game schools reported higher rates of bullying (hypothesis 2). The moderating effect of the amount of time spent playing the Good Behaviour Game was unclear; in the context of both moderate (≥ 1030 minutes over 2 years) and high (≥ 1348 minutes over 2 years) intervention compliance, there were significant reductions in children’s psychological well-being, but also significant reductions in their school absence (hypothesis 3). The only medium-term intervention effect was for peer and social support at 24 months, but this was in a negative direction (hypothesis 4). After disaggregating within- and between-individual effects, we found no temporal within-individual associations between children’s mental health and their academic attainment (hypothesis 5). Last, our cost–consequences analysis indicated that the Good Behaviour Game does not provide value for money (hypothesis 6).

Conclusion: The Good Behaviour Game cannot be recommended based on the findings reported here.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Comprehensive School-Based PA Program

Intervention Description: PA levels from 3294 fourth grade students in 24 intervention schools and 7 control schools in metropolitan Atlanta, Georgia were measured during the 2015-2016 academic year. PA measures included daily steps in school, steps taken in physical education class (PE), and percent of PE class time spent in moderate-to-vigorous physical activity (MVPA). Intervention effectiveness was assessed using generalized estimating equations adjusting for sex and school-level socioeconomic status (SES).

Intervention Results: After adjusting for sex and school-level SES, intervention students had significantly higher increases in average daily steps (p < .05), steps taken in PE (p < .01), and percent of PE class spent in MVPA (p < .01) than control students.

Conclusion: Our findings demonstrate the effectiveness of CSPAPs in increasing PA. Further research using randomized controlled trials of large-scale implementations, longer follow-up periods, and more diverse student sample is warranted.

Study Design: Quasi-experimental design

Setting: Georgia public elementary schools in 3 metropolitan Atlanta counties

Population of Focus: Elementary school aged children

Data Source: Pedometers, and Gopher FITstep Pros

Sample Size: n 3,294 students

Age Range: Ages 9-10

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: We aimed to explore the feasibility and potential effectiveness of a classroom-based intervention on moderate to vigorous PA (MVPA) and total PA. The secondary aim was to assess the acceptability and sustainability of the intervention. In a mixed-methods, non-randomised, exploratory controlled before-and-after study, 152 children (10 ± 0.7 years) were recruited from five schools; two intervention (n = 72) and three control (n = 80) schools. School teachers delivered an 8-week classroom-based intervention, comprising of 10 minutes daily MVPA integrated into the curriculum. The control schools maintained their usual school routine. Mean daily MVPA (min), total PA (mean cpm), physical fitness, and health-related quality of life measurements were taken at baseline, end of intervention, and 4-weeks post-intervention (follow-up).

Intervention Results: Data were analysed using a constrained baseline longitudinal analysis model accounting for the hierarchical data structure. For the primary outcomes (MVPA and total PA) the posterior mean difference and 95% compatibility interval were derived using a semi-Bayesian approach with an explicit prior. The acceptability and sustainability of the intervention was explored via thematic content analysis of focus group discussions with teachers (n = 5) and children (n = 50). The difference in mean daily MVPA (intervention-control) was 2.8 (-12.5 to 18.0) min/day at 8 weeks and 7.0 (-8.8 to 22.8) min/day at follow-up. For total PA, the differences were -2 (-127 to 124) cpm at 8-weeks and 11 (-121 to 143) cpm at follow-up. The interval estimates indicate that meaningful mean effects (both positive and negative) as well as trivial effects are reasonably compatible with the data and design.

Conclusion: The intervention was received positively with continuation reported by the teachers and children. Classroom-based PA could hold promise for increasing average daily MVPA, but a large cluster randomised controlled trial is required.

Study Design: Mixed-methods, non-randomized, exploratory controlled before-and-after study

Setting: 5 schools; all children in years 5 & 6

Population of Focus: Year 5 & 6 students

Data Source: Hip-mounted accelerometer

Sample Size: 195 students

Age Range: Ages 9-11

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Social Network/Peer

Intervention Description: A cluster-randomized controlled trial with preassessment in 2014 and follow-up assessment in 2015 included 29 schools with 1020 students (47.6% girls, mean age = 13.69 years). Intervention students received pedometers and monitored their steps for 12 weeks. Classes with the most steps were awarded. Primary outcomes included moderate-to-vigorous PA, out-of-school sports activities, active transport assessed through questionnaires, as well as cardiorespiratory fitness measured using the 20-m shuttle-run test and anthropometric data (weight, height, body fat, and waist circumference) assessed by study staff.

Intervention Results: Significant interaction terms between group and time were found for all 3 indicators of PA; intervention students showed a higher increase of PA than control students. The same pattern was shown for cardiorespiratory fitness, but the effect missed significance. A more favorable development for the intervention students was shown for body fat and waist-to-height ratio, while there was no effect on body mass index percentile.

Conclusion: An easy way to administer school-based PA program may enhance students' leisure-time PA even 1 year after the intervention has ended.

Study Design: Cluster RCT

Setting: Secondary schools in 6 districts in SchleswigHolstein, Germany

Population of Focus: 8th grade adolescents

Data Source: Pedometers (only used as motivator during the intervention), questionnaires (usual level of activity, out of school sports, active transport), 20-minute shuttle test, anthropometric measures

Sample Size: 29 schools (18 schools, 36 classes in intervention), 1,020 students

Age Range: Ages 12-16

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Extra-Curricular Activities

Intervention Description: We conducted a cluster-randomised feasibility trial of a revised after-school physical activity (PA) programme delivered by trained teaching assistants (TAs) to assess the potential evidence of promise for increasing moderate-to-vigorous physical activity (MVPA). Participants (n = 335) aged 8–10 years were recruited from 12 primary schools in South West England. Six schools were randomised to receive the intervention and six acted as non-intervention controls. In intervention schools, TAs were trained to deliver an after-school programme for 15 weeks.

Intervention Results: There was no evidence for a difference in MVPA at T1 between intervention and control groups. Programme delivery cost was estimated at £2.06 per pupil per session. Existing provision in the 12 schools cost £5.91 per pupil per session. Action 3:30 was feasible to deliver and considerably cheaper than existing after-school provision.

Conclusion: No difference in weekday MVPA was observed at T1 between the two groups, thus progression to a full trial is not warranted.

Study Design: Cluster RCT

Setting: 12 primary schools in south-west England

Population of Focus: Year 4 & 5 students

Data Source: Accelerometers, questionnaires, cost data

Sample Size: 12 schools, 335 students (intervention+ control)

Age Range: Ages 8-10

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Provider Training/Education, Nurse/Nurse Practitioner, CLASSROOM_SCHOOL, Teacher/Staff Training, PROFESSIONAL_CAREGIVER, Outreach (caregiver), Outreach (School Staff)

Intervention Description: Healthy and Ready to Learn is a targeted, school-based CHIP and Medicaid outreach initiative for identifying and enrolling eligible and uninsured children entering kindergarten in North Carolina’s highest need counties. School nurses and administrative staff attend regional trainings on how to use a required health assessment form, submitted at school entry, to identify uninsured children who could be eligible but are not enrolled in public insurance. Continuous community-based outreach (e.g., attending community events, providing outreach materials in various languages, contacting local organizations and leaders to help inform families about CHIP and Medicaid) is also utilized.

Intervention Results: With increased enrollment rates and well-child exam rates, findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for parents from low-income backgrounds. The initiative increased enrollment rates by 12.2% points and increased well-child exam rates by 8.6% points in the regression discontinuity design models, but not differences-in-differences, and did not significantly increase well-child visits. Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low-income parents.

Conclusion: Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low-income parents.

Study Design: Quasi-experimental difference-in-difference and regression discontinuity

Setting: Schools (Elementary schools in North Carolina)

Population of Focus: Uninsured kindergarten-aged children in high economic need counties in North Carolina

Data Source: Medicaid and CHIP administrative data, focus groups, key informant interviews

Sample Size: 300 children; 16 counties were selected as intervention sites that included 278 elementary schools in 22 districts; in the second year, expanded to 32 counties

Age Range: 4-6 years

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Adult-led Curricular Activities/Training, Multicomponent Schoo-Based Program, Peer-led Curricular Activities/Training

Intervention Description: This study examined the extent to which school personnel implementing the KiVa® antibullying program systematically employed the program-recommended approaches (confronting or non-confronting), used one or the other depending on the bullying case (case-specific approach), or used their own adaptation when talking to perpetrators of bullying, and whether they organized follow-up meetings after such discussions. In addition to investigating adherence to program guidelines, researchers tested how effective these different approaches were in stopping bullying. Finally, this study tested the contribution of follow-up meetings and the number of years KiVa had been implemented in a school to the effectiveness of the interventions, using reports from both school personnel and victimized students.

Intervention Results: The school personnel were more likely to use the confronting approach than the non-confronting approach. Over time, rather than sticking to the two program-recommended approaches, they made adaptations (e.g., combining the two; using their own approach). Two-level regression analyses indicated that the discussions were equally effective, according to both personnel and victimized students, when the confronting, non-confronting, or a case-specific approach had been used.

Conclusion: The discussions were less effective when the personnel used their own adaptation or could not specify the method used. Perceived effectiveness was higher in primary school and when follow-up meetings were organized systematically after each intervention, but unrelated to the number of years KiVa had been implemented.

Study Design: Pre-post design with follow-up

Setting: Primary and secondary schools

Population of Focus: School personnel

Sample Size: 1221 primary and secondary schools

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent School-Based Program, Reporting & Response System, CLASSROOM_SCHOOL

Intervention Description: We examined the extent to which school personnel implementing the KiVa® antibullying program in Finland during 2009-2015 systematically employed the program-recommended approaches (confronting or non-confronting), used one or the other depending on the bullying case (case-specific approach), or used their own adaptation when talking to perpetrators of bullying, and whether they organized follow-up meetings after such discussions.

Intervention Results: Two-level regression analyses indicated that the discussions were equally effective, according to both personnel and victimized students, when the confronting, non-confronting, or a case-specific approach had been used. The discussions were less effective when the personnel used their own adaptation or could not specify the method used. Perceived effectiveness was higher in primary school and when follow-up meetings were organized systematically after each intervention, but unrelated to the number of years KiVa had been implemented.

Conclusion: Perceived effectiveness was higher in primary school and when follow-up meetings were organized systematically after each intervention, but unrelated to the number of years KiVa had been implemented.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Active Recess

Intervention Description: The active play intervention consisted of a 1-h outdoor physical activity session per week, incorporating 30 min of facilitated games and 30 min of free play.

Intervention Results: Sixty-six percent of eligible children (n = 137) agreed to participate in the research. No schools withdrew from the study and three participants were lost to follow-up. Compliance to the intervention was high-none of the participants missed more than two of the ten scheduled active play sessions. Data lost to follow-up were minimal; most were lost (14%) for school day physical activity. Active play sessions were shorter than planned on average by 10 min, and participants spent a mean of 39.4% (14.2) of the session time in moderate-to-vigorous intensity physical activity (MVPA). There was preliminary evidence of a small intervention effect on MVPA (d = 0.3), FMS score (d = 0.4), inhibition (fish trial: d = 0.1, arrow trial d = 0.1) and maths fluency (addition: d = 0.3, subtraction: d = 0.1).

Conclusion: The active play intervention was feasible and benefitted from a relatively high MVPA content; however, preliminary findings suggest the intervention had a small effect on the outcomes. Having more active play sessions per week and/or extending the duration of the intervention may increase the effects and these should be tested before a future definitive cluster RCT is undertaken.

Study Design: Feasibility cluster RCT

Setting: Primary schools in Glasgow, Scotland with at least 70% of pupils living in 20% most deprived areas of Scotland

Population of Focus: Year Primary 3 school children

Data Source: Accelerometer, Test of Gross Motor Development-2, NIH toolbox Flanker Test, One Minute Basic Number Facts Test

Sample Size: 8 classes, 207 students

Age Range: Age 7

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Dental Screening

Intervention Description: Researchers conducted a review of the literature to understand the differences in dentla attendance rates of children receiving a school based dental screening versus those not receiving it.

Intervention Results: For an intracluster correlation coefficient of 0.030, there was no statistically significant difference in dental attendance between children who received dental screening and those who did not receive dental screening (RR 1.11, 95% 0.97, 1.27).

Conclusion: There is currently no evidence to support or refute the clinical benefits or harms of dental screening. Routine dental screening may not increase the dental attendance of school children, but there is a lot of uncertainty in this finding because of the quality of evidence.

Setting: School/preschool

Population of Focus: Children aged 3-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: The FIT Game is a low-cost intervention that increases fruit and vegetable consumption in elementary school children. For this study, the FIT Game was adapted into an intervention designed to increase children's physical activity at school. A total of 29 participants were recruited from a sixth-grade classroom. An ABAB reversal design was used. Participants wore an accelerometer while at school during pre/postintervention baseline (A) and intervention (B) phases. During the FIT Game intervention, daily physical activity goals encouraged the class to increase their median daily step count above the 60th percentile of the previous 10 days. When daily goals were met, game-based accomplishments were realized.

Intervention Results: Children met their activity goals 80% of the time during the intervention phases. Physical activity at school increased from a median of 3331 steps per day during the baseline to 4102 steps during the FIT Game phases (P<.001, Friedman test).

Conclusion: Preliminary evidence showed that playing the FIT Game could positively influence children's physical activity at school.

Study Design: Single case, reversal design pilot (ABAB)

Setting: One classroom in Cache County, UT

Population of Focus: 6th grade students

Data Source: Accelerometers

Sample Size: 29 students

Age Range: Ages 11-12

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Comprehensive School-Based PA Program

Intervention Description: We randomly allocated 2 clusters of 2 Catholic middle (grades 6-8) schools/cluster to a 2-week no treatment/4-week intervention crossover trial to determine the effects of a 20-day Lenten-themed PA intervention on 187 students' pedometer steps taken at school. Specifically, students independently progressed through a workbook (Savior's Sandals) that depicted and informed about 11 locations in the Holy Land where Jesus lived, visited, and/or ministered, and included Scripturally-based questions about each place for students to answer. In all, students would accumulate 110,000 steps if they completed the workbook virtual journey. General linear mixed models with restricted maximum likelihood estimation to compensate for missing data were used to compute the intervention effects on mean daily steps.

Intervention Results: There were significant main effects for the intervention overall and by school and grade level. Follow-up tests isolated that a single school (Meandiff = + 2156 steps/day) and grade 6 students (Meandiff = + 1678 steps/day) across all four schools experienced the greatest treatment effects.

Conclusion: Religious-themed PA interventions can be effective; however, specific adjustments may be needed to optimize the intervention's effectiveness for a broader population of students.

Study Design: Crossover controlled design

Setting: Catholic middle schools (teacher-led)

Population of Focus: Catholic middle school aged children grades 6-8

Data Source: Student self-report and pedometer data

Sample Size: 187 students

Age Range: Ages 11-13

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: Youth aged 9-10 years and the main preparer of their meals participated in the 12-week program followed by monthly newsletters and biyearly booster sessions until 24 months.

Intervention Results: There was a significant (P < .05) group × time interaction for LPA (adjusted interaction B estimate, 95% confidence interval; 0.18 [0.05, 0.30]) and ST (-0.15 [-0.26, -0.04]); ST increased and LPA decreased in the treatment group. There were no differences in other accelerometer-derived PA measures, self-report Block Kids Physical Activity Screener measures, or frequency of family actively playing together at any time point.

Conclusion: iCook 4-H was a multicomponent program observing youth aged 9-10 years for 24 months that focused on enhancing cooking skills, mealtime behavior and conversation, and PA through daily family activities. Greater emphasis on developing PA skills, changing environmental factors, and increasing PA both in and after school may be needed.

Study Design: RCT

Setting: 5 states: Maine, Nebraska, South Dakota, Tennessee, West Virginia

Population of Focus: Youth aged 9-10 (and the preparer of their meals)

Data Source: Accelerometer; questionnaire

Sample Size: 155 youth

Age Range: Ages 9-12

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent School-Based Program, Presentation/meeting/information Session (Classroom), CLASSROOM_SCHOOL, Intensive Therapy, PATIENT_CONSUMER

Intervention Description: To examine the secondary effects of a personality-targeted intervention on bullying and harms among adolescent victims and bullies.

Intervention Results: There was no significant intervention effect for bullying victimization or perpetration in the total sample. In the subsample, mixed models showed greater reductions in victimization (b = -0.208, 95% CI -0.4104 to -0.002, p < .05), suicidal ideation (b = -0.130, 95% CI -0.225 to -0.034, p < .01), and emotional symptoms (b = -0.263, 95% CI -0.466 to -0.061, p < .05) among high-risk victims in Preventure versus control schools. Conduct problems (b = -0.292, 95% CI -0.554 to -0.030, p < .05) showed greater reductions among high-risk bullies in Preventure versus control schools, and suicidal ideation showed greater reductions among high-risk female bullies in Preventure versus control schools (b = -0.820, 95% CI -1.198 to -0.442, p < .001).

Conclusion: The findings support targeting personality in bullying prevention.

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, CLASSROOM_SCHOOL

Intervention Description: During October 2008 through March 2009, in 4 Denver public SBHCs, we conducted (1) a demonstration study among 265 girls needing ≥ 1 recommended adolescent vaccine and (2) an RCT among 264 boys needing vaccines, with half randomized to recall and half receiving usual care. Immunization rates for recommended adolescent vaccines were assessed 6 months after recall. First dose costs were assessed by direct observation and examining invoices.

Intervention Results: At the end of the demonstration study, 77% of girls had received ≥ 1 vaccine and 45% had received all needed adolescent vaccines. Rates of receipt among those needing each of the vaccines were 68% (160/236) for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, 57% (142/248) for quadrivalent meningococcal conjugate vaccine, and 59% (149/253) for the first human papillomavirus vaccine. At the end of the RCT, 66% of recalled boys had received ≥ 1 vaccine and 59% had received all study vaccines, compared with 45% and 36%, respectively, of the control group (P < .001). Cost of conducting recall ranged from $1.12 to $6.87 per recalled child immunized.

Conclusion: SBHC-based recall was effective in improving immunization rates for all adolescent vaccines, with effects sizes exceeding those achieved with younger children in practice settings.

Study Design: RCT (for boys)

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: Combined diet and physical activity school-based interventions (rather than only diet or physical activity interventions) are more likely to help prevent children from becoming overweight in the long term. However, such interventions are less prevalent, and therefore, this pilot study aimed to assess the feasibility of a gardening intervention coupled with awareness about plant-based meals among 9-10 year old children in a London primary school. We recruited 60 children from two Year 5 classes, one class participated as an intervention group, and results were compared against another class who acted as the control group.

Intervention Results: Results are inconclusive; however, they indicate some impact on reduction of sedentary behaviour, increase of moderate to vigorous PA, knowledge of nutrition and some level of acceptance in trying new vegetables.

Conclusion: School-based interventions involving gardening show some promise to increase children's PA and improve their attitudes to eating fruits and vegetables.

Study Design: Quasi-experimental mixed-methods pilot

Setting: Primary schools in London, England

Population of Focus: 60 students from two year 5 classes in one school

Data Source: Accelerometers, questionnaires, focus groups (at end of intervention)

Sample Size: 1 school, 2 classes 60 students (1 class of 30 intervention, one class of 30 control)

Age Range: Ages 9-10

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: The purpose of the present study was to examine the effects of height-adjustable standing desks on time-series variation in sedentary behavior (SB) among primary school children. Thirty-eight children aged 11-12 years (22 boys and 16 girls) from two classes at a primary school in Nagano, Japan, participated in this study. One class was allocated as the intervention group and provided with individual standing desks for 6 months, and the other was allocated as the control group. Time spent in SB, light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) was measured using accelerometers (ActiGraph) at baseline and follow-up.

Intervention Results: Time spent in SB was significantly lower by 18.3 min/day on average in the intervention class at follow-up (interaction effects: F(1, 36) = 4.95, p = 0.035, η2 = 0.082). This was accompanied by a significant increase in time spent in MVPA (+19.9 min/day on average). Our time-series analysis showed significant decreases in SB during school time, while no change in SB was found during non-school time.

Conclusion: This result indicates that the use of standing desks promotes an overall reduction in SB with no compensatory increase during non-school time.

Study Design: Quasi-experimental design

Setting: Public primary schools

Population of Focus: 6th grade school children

Data Source: Accelerometer data and student self-report

Sample Size: 43 students

Age Range: Ages 11-12

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Curricular Activities/Training, PE Enhancements, CLASSROOM_SCHOOL

Intervention Description: We analyzed the effect of two school-based PA interventions on daily PA levels, cardiorespiratory fitness (CRF) and muscle strength among adolescents.

Intervention Results: Daily PA and time spent in moderate- to vigorous-intensity PA (MVPA) decreased in all groups throughout the intervention. The mean difference in PA level and MVPA for participants in the PAL-intervention arm was 34.7 cpm (95% CI: 4.1, 65.3) and 4.7 min/day (95% CI: 0.6, 8.8) higher, respectively, compared to the control arm. There were no significant intervention effects on daily PA level, MVPA or time spent sedentary for adolescents in the DWBH-intervention arm. Adolescents in the PAL-intervention arm increased distance covered in the running test compared to controls (19.8 m, 95% CI: 10.4, 29.1), whilst a negative intervention effect was observed among adolescents in the DWBH-intervention arm (- 11.6 m, 95% CI: - 22.0, - 1.1).

Conclusion: The PAL-intervention resulted in a significantly smaller decrease in daily PA level, time spent in MVPA, and increased CRF compared to controls. Our results indicate that a teacher-led intervention, including three unique intervention components, is effective in curbing the decline in PA observed across our cohort and improving CRF.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL

Intervention Description: A total of 21 Latina adolescents (aged 12-18 years) who could read and write in English and were underactive (<90 min/week) participated in a 12-week, theory-informed Web-based physical activity intervention. The intervention website was modified from a previous Web-based intervention for Latina adults. Web content was individually tailored based on the responses to monthly questionnaires. Feasibility was measured by recruitment, retention, and adherence/engagement, and acceptability was measured by satisfaction surveys. Physical activity was measured at baseline and follow-up (12 weeks) using the 7-day physical activity recall (PAR) interview and accelerometers.

Intervention Results: Baseline activity as measured by the 7-day PAR and accelerometers was 24.7 (SD 26.11) and 24.8 (SD 38.3) min/week, respectively. At 12 weeks, 19 participants (90%, 19/21) returned. Adherence and engagement with materials were low, but 72% (15/21) of the participants indicated that they were satisfied with the intervention. Activity at 12 weeks increased by 58.8 (SD 11.33) min/week measured by the 7-day PAR (P<.001). Accelerometer-measured activity did not increase. Activities reported at follow-up were more varied than at baseline, including some activities measured poorly by accelerometers (eg, biking and swimming). Participants suggested simplifying the website and incorporating other technologies.

Conclusion: Good retention and increases in self-reported activity suggest a promising approach to delivering a physical activity intervention to Latina adolescents. Incorporating other technologies, such as smartphone apps, could make the intervention more engaging, acceptable, and effective.

Study Design: Demonstration trial

Setting: Community-based

Population of Focus: Latinx adolescents

Data Source: Parent and student self-report, accelerometers

Sample Size: 21 adolescents

Age Range: Ages 12-18

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: Study participants were 187 students in grades 4 and 5 from 2 Title 1 elementary schools in the Southwest United States. The intervention was a quasi-experimental character modeling and goal setting program. New Lifestyles NL-1000 activity monitors were used to assess number of steps taken and MVPA by the participants. Fruit and vegetable consumption was measured by direct observation. School day steps, MVPA, and FV consumption were recorded at baseline, intervention, and during a 10-week follow-up.

Intervention Results: There were not differences between groups at baseline. Steps and MVPA were statistically significantly (P < .05; Δ = ~2500 steps and ~5 minutes of MVPA) greater in the intervention compared with the control group over time. Fruit and vegetable consumption was not significantly (P = .308) greater in the intervention compared with the control group over time. Students in the intervention school were significantly more active than students in the control school during the intervention phase and at follow-up.

Conclusion: The findings reported here would suggest that character modeling and goal setting can increase PA among elementary aged children but did not increase FV consumption.

Study Design: RCT

Setting: Elementary schools in SW U.S.

Population of Focus: Elementary school students

Data Source: Accelerometer

Sample Size: 187 students

Age Range: Ages 9-10

Intervention Components (click on component to see a list of all articles that use that intervention): Extra-Curricular Activities, CLASSROOM_SCHOOL

Intervention Description: The purpose of this study was to test the effectiveness of an after-school sport sampling intervention among underserved youth in the Midwest.

Intervention Results: The intervention group had significantly better physical literacy (t115=7.57; P=.004) and engaged in more moderate- and vigorous-intensity physical activity minutes per week (t115=4.28; P=.04) and steps per day (t115=4.29; P=.03).

Conclusion: An after-school sport sampling program may be an effective solution for combating youth physical inactivity. Future research should assess the scalability of this intervention with larger populations and in different areas.

Intervention Components (click on component to see a list of all articles that use that intervention): Group Education, PATIENT_CONSUMER, CLASSROOM_SCHOOL, Self-Regulation, YOUTH, Adult-led Support/Counseling/Remediation

Intervention Description: The current study aimed to explore the impact of a school-based mindfulness intervention on bullying behaviors among teenagers

Intervention Results: The results were as follows: (1) the post-test scores of trait mindfulness and self-control in the experimental group significantly increased (p < 0.01) while the scores of bullying behavior significantly decreased (p < 0.01); (2) trait mindfulness was positively associated with self-control (r = 0.13 to 0.63, p < 0.05), whereas trait mindfulness and self-control were both negatively associated with bullying behavior (r = -0.38 to -0.13, p < 0.05); and (3) the mediating effect of self-control accounted for 50% of the overall effect of trait mindfulness on bullying behavior.

Conclusion: These findings demonstrated that the school-based mindfulness intervention distinctly improves trait mindfulness and self-control and reduces bullying behavior among teenagers. Moreover, self-control plays a mediating role between trait mindfulness and bullying behavior.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Self-Regulation

Intervention Description: The purpose of this study was to test the feasibility of a theory-based self-regulation intervention to increase older adolescents' leisure time physical activity (LTPA) behavior. Forty-nine adolescents (M = 15.78 years; SD = 0.52; 31% female) from two schools agreed to participate. Participants were randomly assigned to the experimental or control arm at the school level. The experimental group (n = 24) underwent a brief self-regulation intervention for six weeks. The control group (n = 25) continued with standard classes.

Intervention Results: Intervention fidelity data was collected to assess feasibility. Outcome measures included self-reported LTPA behavior and self-regulation technique use. Intervention sessions were delivered as intended, participant attendance was high and compliance with intervention content was acceptable. The experimental group reported higher levels of LTPA behavior eight weeks post-intervention and increased use of self-regulation techniques.

Conclusion: A brief theory-based self-regulation intervention delivered in a school-setting appears feasible and may increase LTPA behavior and self-regulation in adolescents.

Study Design: Randomized controlled feasibility trial

Setting: 2 schools in Dublin, Ireland

Population of Focus: Older Adolescent students

Data Source: Pedometers, questionnaires

Sample Size: 49 students (24 intervention, 25 control)

Age Range: Ages 14-16 years

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Teacher/Staff Training

Intervention Description: The current study utilized a pre–post design to evaluate a 2-day FPD training as a tool for enhancing teacher knowledge of trauma-informed approaches prior to implementation. The study also examined whether gains in knowledge following the training were associated with teacher perceptions of acceptability of traumainformed approaches and whether perceived alignment of trauma-informed approaches with existing school norms and practices, or system fit, moderated that relationship.

Intervention Results: Results indicated significant knowledge growth following the training. Among teachers who perceived better system fit, knowledge growth was associated with increased acceptability for trauma-informed approaches. However, among teachers perceiving less system fit, knowledge growth was associated with decreased acceptability.

Conclusion: Implications for the installation and implementation of trauma-informed approaches in schools are discussed.

Study Design: Pre-post design

Setting: Six New Orleans public charter schools

Population of Focus: Primary and secondary teachers

Sample Size: 183

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program, COMMUNITY, Policy (Community)

Intervention Description: Schools are critical for developing students' health through didactic health education adn encouraging healthy habits. School health stakeholders recognize the interconnected nature of academic success and school wellness components (i.e., physical and mental health, the school environment, families, and community involvement). Driving this integrated perspective is the Whole School, Whole Community (WSCC) model, a comprehensive framework for school wellness. It is essential to establish the current baseline levels of strength and comprehensiveness of WSCC-aligned policies. Fifty-four Connecticut public school districts' policies were evaluated using the WellSAT WSCC, a new measure of how well district-level policies address topic areas within each domain of the WSCC model. The comprehensiveness and strength of each district's policies were calculated and then averaged across districts to assess areas of strength and need.

Intervention Results: Districts' policies were most comprehensive in the domains of Social and Emotional Climate; Behavioral Supports (Counseling, Psychological, and Social Services); and Family Engagement. Policies were strongest for Safe Environment (Physical Environment); Behavioral Supports; and Health Services.

Conclusion: School district policy coverage of the WSCC model within Connecticut varies by domain and is often fragmented. Comprehensive and coordinated policies modeled from WSCC domains are needed to better support safe, healthy, and supportive school environments.

Study Design: Policy evaluation

Setting: Connecticut Public School Districts

Population of Focus: Policies in public school districts

Sample Size: 54 school districts (30 randomly selected and 24 with administrative reviews in the 2019-2020 school year)

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: NASA's Mission X: Train Like an Astronaut project uses the excitement of exploration to challenge students to set physical fitness and research goals, practice physical fitness activities, and research proper nutrition, to enable each child to become our next generation of fit explorers!

Intervention Results: Girls reported less PA than boys (40.7 vs. 59.0, p < 0.01). Children with a normal body mass index (BMI) were more likely to be active than underweight children (< 10 percentile) or overweight children (⩾ 85 percentile). After the intervention, about one-half of the children had increased their level of PA (49.4%), increased interest in PA (59.1%) and found psychological need satisfaction in exercise (52.6%). The majority of parents became aware of the necessity of childhood PA (94.2%), their child's PA capability (64.3%), and the relationship of PA with their children's self-esteem (79.9%).

Conclusion: The adapted NASA Mission X program was feasible and effective in promoting PA in kindergarteners, and also improved their parents' attitude and beliefs about children's PA in South Korea. This study provided a model for promoting childhood health through child care and educational settings.

Study Design: Pre-post test

Setting: 3 kindergartens in 3 cities

Population of Focus: 5-year-old kindergarten students and their parents

Data Source: Parent questionnaires that included the children’s leisure time activity at home, and the parents’ attitudes and beliefs about the child’s PA at postintervention.

Sample Size: 212 5-year-olds

Age Range: Age 5

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Active Recess

Intervention Description: For schools to consider physical activity (PA) interventions, improvements must be shown in PA and additional educational benefits such as executive function (EF) and academic performance (AP). Over 8800 schools worldwide have implemented The Daily Mile™ (TDM), without any formal assessments of its impact. Rigorous and high-quality studies are needed to explore TDM’s contribution to moderate-to-vigorous PA (MVPA) guidelines and potential impact on EFs and AP.

Intervention Results: Using multi-level modelling, TDM revealed significantly greater MVPA (+10.23 min) and reduced sedentary time (−9.28 min) compared to control (p ≤ 0.001, d = 4.92, 3.61 retrospectively). Maths fluency interacted with condition and time (p = 0.031, d = 0.25); post hocs revealed no significances over time (p > 0.05). No differences in EFs (all p > 0.05).

Conclusion: This study is the first assessing the acute effects of TDM compared to continued academic lessons. TDM revealed no significant improvements in maths fluency or EF. These findings question justifying the widespread adoption of TDM based on enhanced cognition claims. Nonetheless, TDM may provide 10 min of MVPA, achieving a third of the daily in school recommendations to meet overall daily recommendations.

Study Design: RCT using a betweensubjects design

Setting: 14 classes in 11 primary schools

Population of Focus: Primary school-aged children

Data Source: Accelerometers; math fluency test and Executive function test

Sample Size: 303 children

Age Range: Mean age 8.99

Intervention Components (click on component to see a list of all articles that use that intervention): Physically Active Classrooms, CLASSROOM_SCHOOL

Intervention Description: To assess physical activity outcomes of a pedometer-based physically active learning (PAL) intervention in primary school children. Six paired schools were randomly allocated to either a 6-week teacher-led pedometer-based physically active learning intervention or a control (n = 154, female = 60%, age = 9.9 [0.3] y). Accelerometers assessed total daily sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Preintervention mean daily MVPA minutes grouped participants as Low Active (<45 min/d) and High Active (≥45 min/d).

Intervention Results: From the final sample size, the intervention (n = 52) significantly improved LPA versus control (n = 31, P = .04), by reducing sedentary time. More intervention (+10%) than control (+3%) pupils met the 60 minutes per day guidelines. In both intervention subgroups, pupils spent less time in LPA (P < .05) versus control. The greatest nonsignificant increase was found in the Low Active pupils MVPA levels.

Conclusion: Improvements in LPA were statistically significant in the intervention versus control group. In subgroup analysis, Low Active pupils in the intervention showed the greatest beneficial effects and the Most Active pupils may have replaced MVPA and sedentary time with LPA. The intervention group housed clusters of pupils showing variable responsiveness, justifying routine examination of subgroup variability in future studies.

Study Design: RCT

Setting: 6 year five classes across 6 schools

Population of Focus: Elementary school students; 9-10-year-olds

Data Source: Accelerometers

Sample Size: 154 students total; Intervention 82 & control 72

Age Range: Ages 9-10

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: A multicomponent school-based intervention programme, called 'Sigue la Huella' (Follow the Footprint), was developed to reduce sedentary lifestyles and increase PA levels. This programme has proven to be effective in increasing the daily levels of moderate to vigorous PA, in decreasing ST and in improving motivational outcomes in secondary education students, in the city of Huesca (Spain). The study design was quasi-experimental, longitudinal and by cohorts, and it was carried out in four schools, two as an experimental group (n = 368) and two as a control group (n = 314). During the 25 months' intervention, this programme adopted a holistic approach aiming to create favourable environments to engage in PA, and the empowerment of students to get actively involved in the design and execution of the activities, assuming responsibility for managing and optimizing their own PA. The programme is theoretically based on the social-ecological model and self-determination theory, and it provided evidence for four actions or components that can be used in school-based PA promotion: tutorial action, Physical Education at school, dissemination of information and participation in institutional programmes and events

Intervention Results: Data analysis examining the impact of Sigue la Huella on objectively measured MVPA, ST and self-reported motivational variables included multilevel statistical models accounting for random and repeated effects, and capable of handling unbalanced data in a longitudinal design. After adjustment for relevant variables, including student socioeconomic status, the estimated difference between the experimental group and the control group was 13.51 minutes/day of MVPA in favour of the experimental group. Both boys and girls benefited from the intervention, although the former to a greater extent (Murillo et al., 2014a). Regarding ST, Sigue la Huella had a protective effect in two of the three study cohorts, irrespective of gender and socioeconomic status. Although ST increased in the full sample, such tendency was not observed in the experimental group of cohort 2 and the increase was much lower in the experimental group of cohort 3 than the control group (Murillo et al., 2014b). Finally, as expected, the intervention was also effective in improving student motivational outcomes relevant to participation in PA and, particularly, PE. Specifically, compared to the control group, and after adjustment for relevant variables, participants in the experimental group reported greater enjoyment of PA, intrinsic and extrinsic motivation in PE, perceived autonomy in PE, perceived competence in PE and perceived importance of PE over time. Participants in this group reported also lower amotivation in PE over time. In subsequent analyses, perceived importance of physical education predicted MVPA, while perceived autonomy in PE emerged as predictor of ST (Murillo et al., 2016).

Conclusion: This article has described the processes and characteristics of a promising and feasible intervention to address the important and increasing problem of low PAL and sedentary lifestyle in adolescents. A commitment is required as well as the participation of all agents and players involved in the intervention. Hence the importance of multi-component interventions based on the school environment, which will foster the empowerment of the members of the school community. On the other hand, a key element in the development of interventions whose aim is to change behaviour is to consider a diagnostic phase, an implementation phase and a monitoring phase. To assess intervention impact, it is imperative to have a baseline that offers us a point of reference and later on the opportunity to engage in a continuous improvement process in terms of monitoring longitudinally the effects of the intervention and the variables that prove to be more influential. In this regard, the measurement of PA is a key aspect. More specifically, the objective measurement with accelerometers, due to their precision and suitability for monitoring PA. But we must bear in mind that the precision of the instruments is not the only important factor in the measurement of intervention effects. Characteristics of the intervention design are also important in this regard, as this article illustrates.

Study Design: Quasi-experimental, longitudinal and cohort intervention

Setting: Public and private secondary schools

Population of Focus: Adolescents in secondary schools

Data Source: Student self-report, accelerometer data

Sample Size: s 930 adolescents

Age Range: Ages 12-17

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Dental Services, CLASSROOM_SCHOOL, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education

Intervention Description: This community intervention study compared the changes in oral health knowledge, attitude, practices (KAP), and oral health indicators among 12-14-year-old children who received a school based oral health promotion delivered by auxiliaries in a rural setting in India.

Intervention Results: The improvement in total KAP score, oral hygiene, and gingival bleeding from baseline to follow up was higher in the intervention arm (p < 0.05). The prevented fraction for net caries increment were 23.33% and 20.51% for DMFT and DMFS, respectively. Students in the intervention group had a higher dental attendance (OR 2.92, p < 0.001). The change in treatment index, restorative index, and care index were significantly higher in the intervention arm (p < 0.001).

Conclusion: Inclusion of available primary care auxiliaries like school health nurses and teachers in oral health promotion is a novel, effective, and sustainable strategy to improve oral health indicators and utilization in rural areas in low resource settings.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Health Centers

Intervention Description: In 2013, Ronald McDonald House Charities, a non-profit organization, partnered with Children’s Hospital of Erlanger to provide a mobile clinic trademarked Ronald McDonald Care Mobile utilising a large, box-style truck equipped with examination rooms and a telemedicine portal. Initially, starting with three elementary schools in Bradley County, Tennessee, USA, the programme rapidly expanded to include schools in five other participating Tennessee counties. Only three schools in Bradley County have the option of in-person visits. All other schools access care via telemedicine portals. Funding is provided through multiple grants and community partners. If a student does have insurance, the insurance carrier is billed for the visit, but students without insurance are treated free of charge. Prior to the 2018–2019 school year, only limited data were collected.

Intervention Results: Our first goal was to perform physicals for children not attached to a primary care physician. During the 2018–2019 school year, 28 patients presented for a well-child check. However, 16 of these (57%) did not have a primary care physician. Of note, 19% of students presenting for any complaint did not have a primary care physician on file (172 students). All well-child checks were performed in-person on the Care Mobile. Our second goal was to provide medical consultations and treatment for acute illnesses. A total of 1446 persons were seen for sick visits. Of these, 424 were telemedicine visits (352 students and 72 staff), while 1022 were in-person visits. The five most common diagnoses that the nurse practitioner managed during the 2018–2019 school year included acute pharyngitis, acute upper respiratory infection, streptococcal pharyngitis, fever and acute maxillary sinusitis. Finally, our third goal was to lower absenteeism rates. There were 1446 sick person visits (1253 students and 193 staff). Twenty-two per cent of the students (276 persons) returned to class while 74% (142 persons) of staff returned to work.

Conclusion: The mobile/telemedicine health clinic is a novel innovation to increase access to acute care and reduce school absenteeism among both students and staff, potentially saving schools hundreds to thousands of dollars.

Setting: School

Population of Focus: Children in K-12 rural schools in Tennessee)

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Mobile Clinic

Intervention Description: . The objectives of this pilot project were (a) to perform physicals for children not attached to a primary care physician; (b) to provide medical consultations and treatment for acute illnesses of students and staff, and (c) to lower absenteeism rates among students and staff.

Intervention Results: Our first goal was to perform physicals for children not attached to a primary care physician. During the 2018–2019 school year, 28 patients presented for a well-child check. However, 16 of these (57%) did not have a primary care physician. Of note, 19% of students presenting for any complaint did not have a primary care physician on file (172 students). All well-child checks were performed in-person on the Care Mobile. Our second goal was to provide medical consultations and treatment for acute illnesses. A total of 1446 persons were seen for sick visits. Of these, 424 were telemedicine visits (352 students and 72 staff), while 1022 were in-person visits. The five most common diagnoses that the nurse practitioner managed during the 2018–2019 school year included acute pharyngitis, acute upper respiratory infection, streptococcal pharyngitis, fever and acute maxillary sinusitis. Finally, our third goal was to lower absenteeism rates. There were 1446 sick person visits (1253 students and 193 staff). Twenty-two per cent of the students (276 persons) returned to class while 74% (142 persons) of staff returned to work.

Conclusion: The mobile/telemedicine health clinic is a novel innovation to increase access to acute care and reduce school absenteeism among both students and staff, potentially saving schools hundreds to thousands of dollars.

Intervention Components (click on component to see a list of all articles that use that intervention): Active Recess, PE Enhancements, CLASSROOM_SCHOOL

Intervention Description: The purpose of this study was to investigate the effects of schoolyard renovations and a physical activity (PA) recess curriculum alone and in combination on children's PA.

Intervention Results: No meaningful intervention effects were found. Lack of an effect may be due to the brief dose of recess, the curriculum not being integrated within the schoolyard, the LL implementation occurring prior to the study, or the already high levels of PA.

Conclusion: Potential avenues to promote PA include making recess longer, integrating recess into the school curricula, and developing recess PA curricula integrating schoolyards.

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent School-Based Program, CLASSROOM_SCHOOL

Intervention Description: The aim of the outlined study was to evaluate the German version of the Olweus Bullying Prevention Program (OBPP) and to investigate potential moderators of its effectiveness.

Intervention Results: In the group of non-completers, the prevalence of victimization did not change during the observation period of 2 years (χ2(2) = 4.64, p = 0.099). In the group of the completer schools, a significant decrease in bullying between t0 and t1 was found for victims (t0: 9.14%; t1: 6.87%; OR = 0.74; 95% CI 0.62-0.88; p = 0.001) and perpetrators (t0: 6.16%; t1: 4.42%; OR = 0.70; 95% CI 0.55-0.89; p = 0.004). After 24 months (t2), this decrease could be retained (victims: t2: 6.83%; OR = 0.73; 95%CI = 0.61-0.88; p = 0.001; perpetrators: t2: 4.63%; OR = 0.72; 95% CI 0.57-0.92; p = 0.009). Furthermore, we found the following moderators of program effectiveness in the completer schools: (1) gender (with a stronger decrease among victimized girls; p = 0.004) and (2) school grade (with a stronger decrease of victimization among grades 5-7; p = 0.028). The German version of the OBPP significantly reduced the bullying prevalence in the completer schools.

Conclusion: Effective prevention needs time and resources: fulfilling the 18-months implementation period was the basis for positive results.

Intervention Components (click on component to see a list of all articles that use that intervention): Social Network/Peer, CLASSROOM_SCHOOL

Intervention Description: The investigation aimed to evaluate the feasibility of a novel school three-tier peer-led mentoring model designed to improve PA levels and reduce sedentary time (ST) of adolescent girls. Two-hundred and forty-nine Year 9 adolescent girls (13⁻15 years old) from three UK secondary schools were invited to participate in a peer-led mentoring intervention (Girls Peer Activity (G-PACT) project). The peer-led mentoring model was delivered in all three schools. Two of the schools received an additional after-school PA component. PA and ST were assessed through wrist-worn accelerometry.

Intervention Results: Girls who received an exercise class after-school component significantly increased their whole day moderate-to-vigorous PA (MVPA) (3.2 min, p = 0.009, d = 0.33). Girls who received no after-school component significantly decreased their MVPA (3.5 min, p = 0.016, d = 0.36) and increased their ST (17.2 min, p = 0.006, d = 0.43). The G-PACT intervention demonstrated feasibility of recruitment and data collection procedures for adolescent girls.

Conclusion: The peer-led mentoring model shows promise for impacting girls' MVPA levels when combined with an after-school club PA opportunity.

Study Design: Three-arm, parallel group, non-randomized feasibility trial

Setting: Three secondary schools in West Lancashire, England

Population of Focus: Year 9 adolescent girls in 3 secondary schools

Data Source: Accelerometers, anthropometrics, questionnaires

Sample Size: 249 adolescent girls

Age Range: Ages 13-15

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, PE Enhancements

Intervention Description: A seventh-grade mountain biking unit was modified to include instructional activities targeting known correlates of PA behavior following principles of Physical Education Dedicated to Physical Activity for Life (PEDAL). A three-group design (intervention, standard PE, no PE) was employed. Participants completed a survey at baseline, postintervention, and follow-up at 4 weeks.

Intervention Results: A total of 300 seventh graders (girls = 151) from two schools completed the surveys. Data suggest PE may influence certain correlates of and autonomous motivation for PA although results revealed no intervention main effects for continuous and noncontinuous dependent variables. Results also provide evidence of sport-specific skill being improved through physical education.

Conclusion: While results of this study showed no main effects from the intervention, data suggest PE may influence certain correlates of and autonomous motivation for PA. This warrants attention toward autonomy supporting PE environments and instruction sensitive to autonomous motivation. Future studies should examine PEDAL-designed PE programs over an entire year or more.

Study Design: Three-group pre-, post-, and post-experimental design (intervention, standard PE, no PE)

Setting: 7th graders in 2 schools

Population of Focus: 7th grade students

Data Source: Weekly Activity Checklist (Sallis 1993)

Sample Size: 300 students

Age Range: Ages 12-13

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: The study aimed to develop and evaluate a multicomponent school and home based physical activity (PA) intervention in children in grades 3-7 (aged 8-13 years) and determine the psychological variables that influence PA; 10 × 1 h school-based training sessions, a home-based activity program and 4 × 1 h lifestyle workshops for parents. PA was assessed at an intervention and nearby control school using accelerometers and self-report at 3-time points: baseline, post intervention and 10-week follow-up. Self-efficacy, self-management strategies, enjoyment, perceived barriers to PA, outcome-expectancy and social support were evaluated.

Intervention Results: The study showed 73% of the children with complete data sets at the intervention school (n = 27) did not increase device measured moderate to vigorous PA (MVPA) in the after-school period (3 p.m. to 6 p.m.) or over the whole day or during school break time immediately following the intervention or at follow-up, as compared to 70% of children with complete data sets at the control school (n = 35; p > 0.05 for all). Overall, 59% of boys attained more than double the recommended 120 min of MVPA each day compared to 42% of girls (p = 0.013). At the baseline, children's self-reported PA in the intervention school positively correlated with: outcome expectancy (R = 0.240, p = 0.015), enjoyment (R = 0.339, p < 0.001), self-efficacy (R = 0.399, p < 0.001), self-management (R = 0.617, p < 0.001), social support at home (R = 0.406, p < 0.001), and social support at school (R = 0.407, p < 0.001). Similar relationships were observed after the intervention and at follow-up. Focus groups with the children, parents and interviews with teachers identified areas for improvement of the intervention.

Conclusion: In conclusion, while the multifaceted approach to improve PA was ineffective over the time span of the study, important predictors of PA in this sample of disadvantaged children were identified.

Study Design: Multi-component comprehensive school and home-based program

Setting: Children in socially disadvantaged elementary schools

Population of Focus: Children in grades 3-7

Data Source: Student self-report, accelerometers

Sample Size: 98 children

Age Range: Ages 8-13

Intervention Components (click on component to see a list of all articles that use that intervention): Presentation/meeting/information Session (Classroom), Distribution of Promotional Items (Classroom/School), CLASSROOM_SCHOOL

Intervention Description: This study aims to implement and evaluate an educational intervention on bullying prevention among junior high school students in Shantou, China.

Intervention Results: The results showed that the intervention group's awareness of bullying (percentage of the students who knew bullying very well, male: before vs. after intervention: 16.3% vs. 37.6%, P < 0.001; female: before vs. after intervention: 11.8% vs. 38.8%, P < 0.01), and the female students' acceptance of anti-bullying education (before vs. after intervention: 89.3% vs. 97.6%, P < 0.05) was improved after intervention. The incidence of cyber victimization (male: 32.3% vs. 18.5%, P < 0.05; female: 22.4 to 7.0%, P < 0.01) was also reduced in the intervention group, with the reduction in the incidence of social (19.4% vs. 8.7%, P < 0.05), verbal (40.9% vs. 27.2%, P < 0.05) victimization, and peer (36.6% vs. 20.7%, P < 0.05) and social bullying (11.8% vs. 2.2%, P < 0.01) among male students after intervention.

Conclusion: This educational intervention was the first important step to develop effective intervention strategies for bullying prevention among junior high school students in China.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Extra-Curricular Activities

Intervention Description: Following a call for greater gender-relevant physical activity programming, Aggie Play, an after-school physical activity program, engaged female student athletes to serve as active role models who lead girls through high-energy activities twice a week over a school year. The purpose of this study was to explore how Aggie Play affected girls' self-efficacy and expected enjoyment for physical activity, time spent in various physical activity intensities during free play, and fitness, relative to a control group.

Intervention Results: Results revealed that the girls participating in Aggie Play increased ratings of physical activity self-efficacy and enjoyment compared with girls at a control site. Aggie Play girls also demonstrated greater improvements on the muscle-endurance test than girls at a control site.

Conclusion: Results are consistent with prior gender-relevant physical activity and physical education research. This study extends prior results by documenting the benefits of gender-relevant physical activity programming when led by active female role models.

Study Design: RCT

Setting: 2 elementary schools in SE U.S. – Afterschool program

Population of Focus: Female students

Data Source: Accelerometer; Physical Activity Self-Efficacy Scale (questionnaire)

Sample Size: 74 girls

Age Range: Ages 8-11

Intervention Components (click on component to see a list of all articles that use that intervention): Presentation/meeting/information Session (Classroom), Adult-led Support/Counseling/Remediation, CLASSROOM_SCHOOL, YOUTH

Intervention Description: The current effectiveness trial evaluated the combination of a whole-school program designed to prevent bullying perpetration and victimization together with a targeted intervention for at-risk students, teaching them individual and dyadic strategies to reduce their anxiety and manage victimization, allowing schools some latitude to implement programs as they typically would.

Intervention Results: Victimization decreased significantly and similarly across all four conditions at 12 and 24 months following baseline. Similar reductions and failure to discriminate conditions were found on other key constructs: anxiety; bullying perpetration; and depression.

Conclusion: Possible reasons for the failure to demonstrate victimization prevention differences and lessons learned from this large, effectiveness trial are considered.

Intervention Components (click on component to see a list of all articles that use that intervention): SCHOOL, School-Based Health Centers, CLASSROOM_SCHOOL

Intervention Description: We describe the implementation of an "expanded medical home" partnering a primary care practice (the Ypsilanti Health Center [YHC]) with local school-based health centers (the Regional Alliance for Healthy Schools [RAHS]), and to assess whether this model improves access to and quality of care for shared patients.

Intervention Results: At baseline, patients seen at YHC/RAHS had higher compliance with most quality metrics compared with those seen at YHC only. The proportion of shared patients significantly increased because of the intervention (P < .001). Overall, patients seen in the expanded medical home had a higher likelihood of receiving quality metric services than patients in YHC only (odds ratio, 1.8; 95% confidence interval, 1.57-2.05) across all measures.

Conclusion: Thoughtful and intentional implementation of an expanded medical home partnership between primary care physicians and school-based health centers increases the number of shared high-risk adolescent patients. Shared patients have improved compliance with quality measures, which may lead to long-term improved health equity.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Regional Alliance for Healthy Schools (SBHCs) in middle and high schools and UMHS Ypsilanti Health Center

Population of Focus: Middle and high school youth ages 10– 21 years and a part of Michigan “safety net” network

Data Source: The University of Michigan Hospital and Health Systems electronic health records

Sample Size: Total (N=1471 at baseline)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Extra-Curricular Activities

Intervention Description: The intervention included an after-school club for adolescents 2 days/week, parent-adolescent dyad meeting, and parent Facebook group.

Intervention Results: Intervention adolescents had greater autonomous motivation for PA and self-efficacy for healthy eating than control adolescents (both p < .05). Although between-group differences were not significant, close-to-moderate effect sizes resulted for accelerometer-measured moderate-to-vigorous PA and diet quality measured via 24-hr dietary recall (d = .46 and .44, respectively). A trivial effect size occurred for percent body fat (d = -.10). No differences emerged for BMI. Efficacy testing with a larger sample may be warranted.

Conclusion: Efficacy testing with a larger sample may be warranted.

Study Design: Group RCT

Setting: 24 schools in the Midwest U.S.

Population of Focus: Adolescent girls

Data Source: Accelerometer, survey

Sample Size: 1,519 girls

Age Range: Ages 10-14

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: The study was a secondary analysis of data from a group randomized trial, including 12 intervention and 12 control schools in the Midwestern United States. Data were collected in 2012-2016. Girls (fifth- to eighth-grade, N = 1,519) completed surveys on perceived benefits and enjoyment of PA, PA self-efficacy, social support and motivation for PA, and barriers to PA and wore accelerometers.

Intervention Results: The final path model had a good fit: χ(4) = 2.48, p = .648; goodness-of-fit index = 1; comparative fit index = 1; root-mean-square error of approximation = 0; standardized root-mean-square residual = 0.01. For MVPA change from baseline to postintervention, enjoyment (B = 24.48, p < .001) and social support (B = 30.48, p < .001) had a positive direct effect, whereas the intervention had a positive indirect effect through enjoyment and social support (B = 9.13, p < .001). Enjoyment (B = -13.83, p < .001) and social support (B = -17.22, p < .001) had a negative indirect effect on MVPA change from postintervention to follow-up.

Conclusion: Enjoyment of PA and social support for PA may be important mediators of PA in young adolescent girls and warrant consideration when designing interventions.

Study Design: Quasi-experimental pre-post test

Setting: Two K-8 grade schools in a large urban school district in the Midwest, U.S.

Population of Focus: Parent-adolescent (5th-7th grade student) dyads in two schools; Students selected were not attending other regularly scheduled MVPA such as sports, dance lessons

Data Source: Accelerometers, online dietary assessment (log) tool, anthropometrics, questionnaires

Sample Size: 81 parent-adolescent dyads; 38 intervention dyads, 48 control dyads

Age Range: Ages 10-13

Intervention Components (click on component to see a list of all articles that use that intervention): Extra-Curricular Activities, Adult-led Curricular Activities/Training, CLASSROOM_SCHOOL

Intervention Description: This quasi-experimental study aimed to compare the levels of physical activity (PA) during the school day of children in a school intervention programme vs. those in a control group, and to determine compliance with MVPA recommendations.

Intervention Results: The MVPA of the control group was higher than that of the intervention group during the first recess (p < 0.001). None of the groups complied with the recommendations for steps during the PA or PE sessions. During the PA session, sedentary time was lower and MVPA was higher, in the intervention group than in the control group. Fifty percent of the children from the intervention group complied with the MVPA recommendations, vs. 22.7% of those in the control group.

Conclusion: The schoolchildren in the intervention group performed more MVPA than those in the control group. Future interventions could include other periods, such as recess and lunchtime, which are opportunities for improving the MVPA levels of schoolchildren.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Peer-led Curricular Activities/Training, Adult-led Curricular Activities/Training, Multicomponent School-Based Program

Intervention Description: Using active transportation to (or from) school (ATS), or non-motorized modes of travel such as walking ot biking, holds promising potential to increase the health of children and adolescents. Individual- and school-level predictors of ATS were examined using data from parent surveys (N = 11,100) of students in grades 3-8 attending 112 schools in Arizona (United States) administering Safe Routes to School (SRTS) programs between 2007 and 2018. Multilevel logistic models were estimated to predict the likelihood of students using active (walking or biking) versus inactive travel (riding bus or car) to and from school, and across distance and school-level income categories.

Intervention Results: Student grade, parent education, asking permission to use ATS, perceived health and school support for ATS, distance, and school income were predictive of ATS. The impact of demographic factors persisted across distances of ½ mile or less and at low- and medium-income schools but diminished as distance and income increased. Asking permission and perceived school support persisted across levels of distance and income, while perceiving ATS as healthy was significant only for distances under 1 mile.

Conclusion: SRTS programs should continue promoting health benefits and school support for ATS. SRTS may be particularly effective at low- and medium-income schools and among families living within ½ mile distances.

Study Design: Program evaluation

Setting: Schools in Arizona administering Safe Routes to School programs

Population of Focus: Parents of students in grades 3-8 at 112 schools who completed a Safe Routes to School Parent Survey between 2007 and 2018

Sample Size: 11,100 parent surveys

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, PE Enhancements

Intervention Description: SPARK is dedicated to creating, implementing, and evaluating research-based programs that promote lifelong wellness. SPARK strives to improve the health of children, adolescents, and adults by disseminating evidence-based Physical Education, After School, Early Childhood, and Coordinated School Health programs to teachers and recreation leaders serving Pre-K through 12th grade students. Each SPARK program fosters environmental and behavioral change by providing a coordinated package of highly active curriculum, on-site teacher training, extensive follow-up support, and content-matched equipment.

Intervention Results: Although there was no detectable intervention effect on increasing the number of students exercising 60 minutes per day, there was a negative intervention effect detected for muscle-strengthening exercises. A significant positive intervention effect was detected for both PE enjoyment and FitnessGram passing. Deeper analysis of these findings revealed that the positive effect on PE enjoyment occurred only among male students.

Conclusion: The SPARK curriculum had mixed effects on students' PA behavior as well as predisposing, enabling, and reinforcing factors for PA. Incorporating student perspectives into the evaluation of intervention efforts to promote PA can facilitate a better understanding of the ways in which these efforts influence PA behaviors and its determinants.

Study Design: Quasi experimental cohort

Setting: 16 middle schools in Los Angeles, CA

Population of Focus: 7th & 8th grade majority Latinx students in low-income Los Angeles, CA

Data Source: Questionnaires, observation for PE testing

Sample Size: 3,763 students

Age Range: Ages 12-14

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Dental Screening

Intervention Description: Researchers conducted a review of the literature to understand the differences in dental attendance rates of children receiving a school based dental screening versus those not receiving it.

Intervention Results: The review concludes that school based dental screening marginally increases the dental attendance by 16 percent as opposed to a non-screening group (RR 1.16 (95% CI 1.11, 1.21). The quality of evidence was found to be low.

Conclusion: There is evidence of marginally increased dental attendance rate of 16 % following screening. As the quality of evidence was found to be low, the results of this review may be used with caution.

Setting: School/preschool

Population of Focus: Children below 15 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Multicomponent School-Based Program

Intervention Description: Five activity-based sessions. In the first four sessions, the following topics were addressed: thinness culture, myths and realities of dieting and supplements, healthy eating behaviours and healthy menus. At the end of each session, students engaged in an enjoyable physical activity hour. In the fifth session, participants were divided into three parallel workshop groups focusing on: thinness culture, healthy menus, and physical activity. The programme incorporated a variety of dissonance-based interventions using interactive psychoeducational strategies.

Intervention Results: After 6 months, repeated-measures analyses of variance (ANOVAs) revealed a significant reduction in the mean DEB scores in young women. In young men, DEB and DMS mean scores decreased but not significantly. Physical activity frequency and duration showed a significant increase in the total sample over time.

Conclusion: Overall, implementation of the programme had positive effects on young people and important differences were found between the sexes.

Study Design: Non-experimental single group field study with repeated measures

Setting: Public high schools in Hidalgo, Mexico

Population of Focus: High school students; urban setting; mixed SES

Data Source: The short form of the International Physical Activity Questionnaire (IPAQ)

Sample Size: 214 women & 154 men

Age Range: Ages 15-18

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Comprehensive School-Based PA Program

Intervention Description: The core intervention component was physically active academic lessons, a teaching activity that combines physical activity and educational content. The purpose of this study was to investigate the effect of a 10-month, cluster-randomized controlled trial on physical activity level and aerobic fitness conducted in the city of Stavanger, Norway, in 2014-15. The physical activity level during physically active academic lessons was also studied. A total of 447 children (9-10 years) participated. The weekly intervention consisted of physically active academic lessons, physically active homework and physically active recess.

Intervention Results: Intervention effects were found for time in moderate to vigorous physical activity (MVPA) (adjusted mean difference of 8 min/day, 95% CI: 3.4-13, p < 0.001) and total physical activity (60 counts/min, 95% CI: 15-105, p = 0.009). Children with low aerobic fitness increased their running distance compared to controls (d = 0.46; p = 0.001). During physically active academic lessons children spent 26% of the time in MVPA, which was comparable to physical education lessons.

Conclusion: The Active School program successfully increased physical activity for the intervention group and aerobic fitness for the least fit children. The activity level during physically active academic lessons was as high as in physical education lessons.

Study Design: Cluster RCT

Setting: All schools in a municipality in Norway

Population of Focus: Primary school students

Data Source: Accelerometer; interval test

Sample Size: 447 students

Age Range: Ages 9-10

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Curricular Activities/Training, Active Recess, CLASSROOM_SCHOOL

Intervention Description: The purpose of this study was to investigate the effect of a 10-month, cluster-randomized controlled trial on physical activity level and aerobic fitness conducted in the city of Stavanger, Norway, in 2014-15.

Intervention Results: Intervention effects were found for time in moderate to vigorous physical activity (MVPA) (adjusted mean difference of 8 min/day, 95% CI: 3.4-13, p < 0.001) and total physical activity (60 counts/min, 95% CI: 15-105, p = 0.009). Children with low aerobic fitness increased their running distance compared to controls (d = 0.46; p = 0.001). During physically active academic lessons children spent 26% of the time in MVPA, which was comparable to physical education lessons.

Conclusion: The Active School program successfully increased physical activity for the intervention group and aerobic fitness for the least fit children. The activity level during physically active academic lessons was as high as in physical education lessons.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Comprehensive School-Based PA Program

Intervention Description: A mixed factorial two (group) × two (time) wait-list controlled trial was conducted and reported using the TREND guidelines. A total of 155 children (56% females; intervention n = 84, control n = 71) took part and completed measures at baseline (week 0) and post-intervention (week 11). The effect of the intervention on MVPA (model 1) and well-being (model 2) was tested through serial mediation models with three mediators (i.e. autonomy-support, needs satisfaction and intrinsic motivation).

Intervention Results: In comparison to the control group, the intervention was related to increases in MVPA (β = .45) and autonomy-support (β = .17). In model 1, analyses revealed partial mediation of the MVPA change through autonomy-support (β = .14), intrinsic motivation (β = .51) and all three SDT mediators in sequence (total r 2 = .34). In model 2, well-being was indirectly enhanced through autonomy-support (β = .38) and autonomy-support and needs satisfaction in sequence (total r 2 = .21).

Conclusion: The HCP enhanced MVPA and well-being by engendering a needs-supportive physical activity environment. The scientific and practical contribution of this study was the application of SDT in all aspects of the HCP intervention's design and analyses. Practitioners may consider integrating SDT principles, as implemented in the HCP, for health promotion.

Study Design: 2 group, 2 time points RCT

Setting: 2 schools in Northern Ireland

Population of Focus: 8-9-year-old students with low SES

Data Source: Accelerometers, questionnaires

Sample Size: 155 students

Age Range: Ages 8-9

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Family Intervention

Intervention Description: We studied 434 children (10-11 years) in a cluster-randomized setting (8 intervention schools, IG; 7 control schools, CG) over 18 months. The school-based prevention program included weekly lifestyle lessons for children with the aim to increase physical activity in and outside of school, physical fitness as well as health behavior. Anthropometric measurements and blood sampling were conducted using standard protocols, physical activity by use of a questionnaire and physical fitness by a 6-item-test battery. Central retinal arteriolar (CRAE) and venular (CRVE) vessel diameters as early marker of vascular dysfunction, as well as the arteriolar-to-venular diameter ratio (AVR), were investigated with a non-mydriatic vessel analyser.

Intervention Results: School-based physical activity increased in 41% of children in IG (19% in CG, p = 0.038). Improvements in vascular parameters were observed for AVR (increase in 83% of children in IG versus 50% in CG; p < 0.001) and for CRVE (43% of children with retinal venular widening in IG versus 58% in CG, p = 0.019). These vascular improvements were also seen in overweight children for CRAE (p = 0.021) and AVR (p < 0.001).

Conclusion: The school-based prevention program JuvenTUM 3 increased physical activity at school inducing favourable effects on retinal microvasculature function. These findings underline the importance of early lifestyle interventions in children for primary prevention of cardiovascular disease.

Study Design: Cluster RCT

Setting: Intermediate and middle schools in Munich, Germany

Population of Focus: 5th through 6th grade students

Data Source: Anthropometric measures, blood samples, retinal vascular diameters, questionnaires, physical fitness test battery

Sample Size: 15 schools (8 intervention, 7 control), 434 students (243 intervention, 191 control)

Age Range: Not specifiedintermediate and middle school students

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: Two classes (intervention students: n=22 [aged 11.8±0.4years]; control students: n=27 [11.6±0.5years]) from a public school in Lisbon were selected. The intervention involved replacing traditional seated classroom desks for standing desks, for a total duration of 16 weeks, in addition to performing teacher training and holding education/motivation sessions with students and parents. Sedentary behavior (ActivPAL inclinometer) and physical activity (Actigraph GT3X+ accelerometer) were measured for seven days immediately before and after the intervention.

Intervention Results: There were no differences in baseline behaviors between intervention and control groups (p>0.05). At follow-up (16 weeks), it was observed that the intervention group had decreased time spent sitting (total week: -6.8% and at school: -13.0% relative to baseline) and increased standing (total week: 16.5% and at school: 31.0%) based on inclinometer values (p-value for interaction group*time <0.05). No significant differences in activity outcomes were observed outside school time (week or weekend) between groups.

Conclusion: We conclude that a 16 week classroom standing desk intervention successfully reduced sitting time and increase standing time at school, with no observed compensatory effects outside of school time.

Study Design: Cluster non-randomized controlled trial

Setting: Public elementary school

Population of Focus: 6th grade students

Data Source: Micro inclinometer and accelerometers

Sample Size: 49 students

Age Range: Ages 11-13

Intervention Components (click on component to see a list of all articles that use that intervention): Presentation/meeting/information Session (Classroom), CLASSROOM_SCHOOL

Intervention Description: The purpose of this study was to develop a social and emotional competence enhancement (SECE) program as an intervention for adolescents who bully, and to investigate its effects on school bullying behavior and mental health.

Intervention Results: The effects of this program were significant with regard to group-by-time interaction effects on social competence, emotional regulation, empathy, and school bullying behavior at the 1-month follow-up.

Conclusion: The results indicate that the SECE program was effective at reducing school bullying behavior in adolescents who bully. School and community-based mental health professionals can provide feasible interventions that can be used in the short term to reduce school bullying behavior in adolescents who bully.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: The purpose of this pilot study was to examine the feasibility, acceptability, and preliminary efficacy on fitness and cognition of a recess intervention in elementary school children. Two schools were randomized to either a 3-month cardiorespiratory and muscular fitness intervention (15 minutes/weekday during recess) or control condition (standard recess activities). Process evaluation (feasibility and acceptability) measures were recorded daily (research staff questionnaire), weekly (accelerometer and heart rate monitors), and post-intervention (participant and school-staff questionnaires). Preliminary efficacy measures included pre- and post-intervention inhibition/attention, working memory, and cardiorespiratory and muscular fitness scores.

Intervention Results: Some feasibility and acceptability measures were favorable (88% of the lessons were implemented, 78% of the lessons were implemented as planned, and the majority of students and school staff were satisfied with most aspects of the intervention). However, intensity adherence during the intervention sessions based on accelerometry (% of time spent in moderate-to-vigorous activity: 41.7 ± 14.5) and participation (19.4% attendance rate) were lower than expected. Preliminary efficacy of the intervention on cognitive and fitness outcomes was not demonstrated.

Conclusion: This study provided evidence that some aspects of the fitness intervention were acceptable during school recess. However, important implementation factors (i.e., intervention exposure) should be targeted to improve youth fitness programs offered during this school setting.

Study Design: Feasibility RCT Pilot

Setting: 2 elementary schools

Population of Focus: Elementary school students

Data Source: Accelerometer, questionnaire

Sample Size: 53 students

Age Range: Ages 8-9

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent School-Based Program, CLASSROOM_SCHOOL

Intervention Description: We evaluated the impact of the Olweus Bullying Prevention Program (OBPP) in an 8-year study in urban middle schools that served primarily African American students living in low-income areas.

Intervention Results: For teacher ratings of student behavior, we found significant main effects across all subtypes of aggression and victimization, with some variability in the timing of effects. The pattern of findings showed delayed intervention effects for boys and a weaker impact of the OBPP on 6th graders. We found main effects for student-reported cyber aggression and victimization, relational aggression, and a composite of physical, verbal, and relational victimization. Decreases in victimization emerged in the 1st or 2nd year of intervention, and reductions in aggression emerged during the 3rd year. Across all findings, once intervention effects emerged, they remained significant in subsequent intervention years. The OBPP resulted in significant decreases in student- and teacher-reported aggression and victimization. However, this intervention had limited impact on general areas of school climate including teacher support, positive peer interactions, and school safety.

Conclusion: Overall, the findings offer important prevention and research implications.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: The primary aim of this study was to explore the acceptability and feasibility of three brief single-component primary school PA interventions targeting 9⁻10-year-old children. The secondary aim was to examine the effectiveness of the interventions on increasing PA levels and reducing sedentary time. The single-component interventions included active classroom breaks (AB; 3 schools; n = 119 children) Born to Move (BTM) exercise videos (2 schools; n = 50 children), and playground supervisory staff training (2 schools; n = 56 children). Qualitative data from participating children (n = 211), class teachers (n = 6), and playground supervisory staff (n = 8) explored the experiences, acceptability, and feasibility of each intervention component. Accelerometers were worn by 225 children during the last week of implementation.

Intervention Results: Playground staff reported difficulties in implementing activities due to children's age and competing responsibilities on the staffs' time. Children reported that the ABs and BTM videos were enjoyable. During half hour time windows, including the ABs and BTM videos, children engaged in 4.8 min and 8.6 min of moderate to vigorous PA (MVPA) on average, respectively. ABs and BTM videos positively affected MVPA. ABs were feasible to implement; however, teachers faced some barriers in implementing the BTM videos.

Conclusion: Feasibility of playground interventions may be dependent on staff responsibilities and age of the children.

Study Design: Mixed methods pilot

Setting: 7 Primary schools in low-income district (Skelmersdale, West Lancashire, UK)

Population of Focus: Year 5 students

Data Source: Group interviews with students, individual interviews with teachers and playground supervisory staff, accelerometer, teacher recording sheet

Sample Size: 211 students, 6 teachers, 8 playground supervisory staff

Age Range: Ages 9-10

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: The AS:Sk intervention was implemented for eight weeks in four schools with three control schools continuing normal practice. It consisted of eight components: active breaks, bounce at the bell, 'Born To Move' videos, Daily Mile or 100 Mile Club, playground activity challenge cards, physical education teacher training, newsletters, and activity homework. Child-level measures were collected at baseline and follow-up, including objectively measured PA.

Intervention Results: After accounting for confounding variables, the intervention had a significant effect on school day ST which was significantly less for the intervention children by 9 min per day compared to the control group. The AS:Sk pilot intervention was effective in reducing school day ST but significant changes in PA were negligible.

Conclusion: To increase the efficacy of the current and future school-based interventions, authors should focus on implementation and process evaluations to better understand how schools are implementing intervention components.

Study Design: Cluster RCT

Setting: 7 Primary schools in low-income district (Skelmersdale, West Lancashire, UK)

Population of Focus: Year 5 students

Data Source: Accelerometers, shuttle run test, anthropometrics, questionnaire

Sample Size: 232 students, 3 control schools, 4 intervention

Age Range: Ages 9-10

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: This study investigated whether children engaged in more physical activity (PA) on school days that included Forest School (FS) sessions than a regular school day or a school day with a Physical Education (PE) lesson. How FS sessions influenced children's general levels of PA and wellbeing was also explored across gender. A mixed-methods study followed a sample of 59 child participants aged 7 to 9 years old, from four primary schools, whilst taking part in twelve weekly FS sessions.

Intervention Results: Children had significantly greater levels of light PA on a FS day and a PE school day compared to a regular school day and children reported feeling both happier and relaxed as a consequence of the intervention. From the qualitative data, boys and girls reported different likes of the FS interventions, whereas their dislikes of FS were comparable.

Conclusion: Findings from this research provide evidence for such outdoor, nature-based learning within the school curriculum contributing to daily PA in children.

Study Design: Mixed-methods study

Setting: 4 primary schools in NW England

Population of Focus: Primary school students

Data Source: Accelerometer (primary), also questionnaire

Sample Size: 59 students

Age Range: Ages 7-9

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Social Network/Peer

Intervention Description: A total of 190 adolescents (46.32% boys; M age = 12.17, age range: 11-14 years) were randomly allocated to either the intervention or control condition. In the intervention condition, the most influential adolescents (based on peer nominations of classmates) in each classroom were trained to promote physical activity among their classmates. Participants received a research smartphone to complete questionnaires and an accelerometer to measure physical activity (steps per day) at baseline, and during the intervention one month later.

Intervention Results: A multilevel model tested the effectiveness of the intervention, controlling for clustering of data within participants and days. No intervention effect was observed, b = .04, SE = .10, p = .66.

Conclusion: This was one of the first studies to test whether physical activity in adolescents could be promoted via influence agents, and the first social network intervention to use smartphones to do so. Important lessons and implications are discussed concerning the selection criterion of the influence agents, the use of smartphones in social network intervention, and the rigorous analyses used to control for confounding factors.

Study Design: Cluster RCT

Setting: First year students from 15 secondary school classes in Venlo region, Netherlands

Population of Focus: First year secondary school students

Data Source: Accelerometers

Sample Size: 190 adolescents

Age Range: Ages 11-14

Intervention Components (click on component to see a list of all articles that use that intervention): Physically Active Classrooms, CLASSROOM_SCHOOL

Intervention Description: Seventy-seven 4th grade students (41 males) were included in an intervention (Move for Thought program: M4T) group (n = 46) that utilized PA integrated with mathematics or a control group (n = 31). Accelerometer data from each student were collected during five complete school days. M4T and control classroom sessions were identified using teachers' logs. Accelerometer data were extracted, processed separately, and aggregated into a single data set. Minutes and percent time at different PA intensities were obtained using accelerometer minute-by-minute predicted METs.

Intervention Results: One-way ANOVAs on PA levels showed a significant group effect (F = 5.33, p < 0.05) on moderate-to-vigorous PA (MVPA) in favor of the M4T group, but not on sedentary and light PA. The most active integrated PA provided 10.88 min of MVPA (SD = 11.87; 21.38 ± 24.38%) in a 50 min class period.

Conclusion: Integrating PA with mathematics in the classroom can contribute to increasing MVPA levels in children.

Study Design: Intervention and control classrooms

Setting: 1 elementary school in a rural Midwestern state

Population of Focus: 4th grade students

Data Source: Accelerometers

Sample Size: 77 students (41 males; 36 females)

Age Range: Ages 9-10 (4th grade)

Intervention Components (click on component to see a list of all articles that use that intervention): Teacher/Staff Training, Extra-Curricular Activities, CLASSROOM_SCHOOL

Intervention Description: The aim of this study was to examine the efficacy of an embedded after-school intervention, on promoting physical activity and academic achievement in primary-school-aged children.

Intervention Results: A total of 60 children were assessed (7.7 [1.8] y; 50% girls) preintervention and postintervention (77% retention rate). Children in the intervention centers spent significantly more time in moderate to vigorous physical activity (adjusted difference = 2.4%; 95% confidence interval, 0.6 to 4.2; P = .026) and scored higher on cognitive flexibility (adjusted difference = 1.9 units; 95% confidence interval, 0.9 to 3.0; P = .009). About 92% of the intervention sessions were implemented. The participation rates varied between 51% and 94%.

Conclusion: This after-school intervention was successful at increasing moderate to vigorous physical activity and enhancing cognitive flexibility in children. As the intervention was implemented by the center staff and local university students, further testing for effectiveness and scalability in a larger trial is required.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: Year 3 students (n=172, mean age 8.4±0.3 years, 48% male) were recruited from 10 classes across two urban primary schools. Participants were randomly assigned to a seated classroom (Classroom) group or physically-active lessons in the playground (Playground) and crossed over to the alternative condition in the subsequent school term. The 6-week intervention comprised 3×30min sessions/week. Multiplication-tables (teacher-designed test) and general maths (standardised test) were assessed pre- and post-intervention. Aerobic fitness was assessed via the shuttle-run. Pre- to post-intervention change scores were compared for analysis and effect sizes (ES) calculated. Total PA and MVPA were assessed with accelerometers in a subset of participants.

Intervention Results: Multiplication scores improved significantly more in Playground than Classroom groups (ES=0.23; p=0.045), while no significant differences were observed in general numeracy (ES=0.05; p=0.66). Total PA and MVPA were substantially higher during Playground than Classroom lessons (ES: total PA=7.4, MVPA=6.5; p<0.001) but there were no differences in PA/MVPA between the groups throughout the rest of the school day. Aerobic fitness improved more in Playground than Classroom groups (ES=0.3; p<0.001) while the change in BMI was not different between groups (p=0.39).

Conclusion: Physically-active lessons may benefit the learning of maths multiplication-tables while favourably contributing to school-day PA/MVPA.

Study Design: Randomized controlled cross-over trial

Setting: 10 classes across 2 urban primary schools

Population of Focus: Year 3 students age

Data Source: Accelerometers

Sample Size: 172 students

Age Range: Average age 8.4

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Dental Screening, Teledentistry, HEALTH_CARE_PROVIDER_PRACTICE, CLASSROOM_SCHOOL

Intervention Description: The purpose of this paper was to describe how two school-based teledentistry programs increased access to oral health services for children and adolescents living in rural areas.

Intervention Results: Both MCHS and CDS reported that over 99 percent of encounters were successfully completed using telehealth technology. Both grantees reported that 99.4 percent of students received an oral health evaluation/screening, primarily through a dental hygienist traveling to the school site connected to a dentist or advanced dental therapist through telehealth. One half of the students had dental caries (50.6 % MCHS; 48.6% CDS). Both grantees referred all students with dental caries for oral health follow-up care.

Conclusion: By utilizing dental hygienists traveling to school sites and connecting with centrally located dental professionals through telehealth, both grantees increased access to needed oral health care services for rural children. Oral health screening in school settings using dental hygienists with teledentistry can provide an efficient way to identify students at high risk for dental caries and offer a valuable strategy for oral disease prevention and control.

Intervention Components (click on component to see a list of all articles that use that intervention): Physically Active Classrooms, CLASSROOM_SCHOOL

Intervention Description: 374 children in Year 3 and 4 (74% response) were recruited from six schools across Melbourne, Australia. Schools were randomised to the ACTI-BREAK intervention or usual teaching practice. The intervention involved teachers incorporating 3×5min active breaks into their classroom routine daily. Academic achievement was assessed using 1-min tests in reading and mathematics; classroom behaviour at the individual and whole class level was observed by teachers; and physical activity levels were assessed using accelerometers. Multilevel mixed effects linear regression models were conducted using intention to treat (ITT) and per protocol (PP) analyses.

Intervention Results: Significant intervention effects were found for classroom behaviour at the individual level (ITT B=16.17; 95% CI: 6.58, 25.76); effects were stronger for boys (B=21.42; 95% CI: 10.34, 32.49) than girls (B=12.23; 95% CI: 1.52, 22.92). No effect was found for classroom behaviour at the whole class level, reading, math or physical activity. PP findings were similar.

Conclusion: Implementing active breaks during class time may improve classroom behaviour, particularly for boys. There was no evidence to suggest that implementing active breaks had any adverse effect on academic achievement or classroom behaviour, which may encourage classroom teachers to incorporate active breaks into their routine.

Study Design: Pilot cluster RCT

Setting: 6 Elementary Schools in Melbourne, Australia

Population of Focus: Year 3 & 4 students

Data Source: Accelerometers

Sample Size: 374 students

Age Range: Ages 8-10

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Physically Active Classrooms

Intervention Description: The Daily Physical Activity (DPA) policy in British Columbia requires elementary schools to help students achieve 30 min of physical activity during instructional and noninstructional time on school days. The purpose of this study was to determine how elementary teachers implement the DPA policy, and examine differences in children's light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) at school, based on how the teacher implemented the DPA policy during the school day (provision of DPA during instructional time or only noninstructional time). In this observational mixed-methods study, 12 teachers were interviewed on their implementation approaches. Teachers provided DPA opportunities during instructional time (i.e., prescriptive implementers, n = 9) or relied on students to be active during noninstructional times (i.e., nonprescriptive, n = 3). Next, 10 students from each interviewed teacher's classroom were randomly selected to wear accelerometers for one school week.

Intervention Results: Teacher's DPA implementation strategy accounted for a significant proportion of variance in student's activity throughout the school day (p's < .05). The prescriptive group (n = 88) was more active (LPA and MVPA) and spent a greater proportion of their school days in MVPA during instructional time than the nonprescriptive group (n = 23). Heterogeneity in policy implementation creates variations in policy effectiveness.

Conclusion: Students provided with opportunities to be active during instructional time may accumulate more MVPA compared with those who are not given these opportunities.

Study Design: Observational mixedmethod study

Setting: 13 public elementary schools

Population of Focus: Elementary school students

Data Source: Accelerometers

Sample Size: 111 students

Age Range: Ages 9-12

Intervention Components (click on component to see a list of all articles that use that intervention): PE Enhancements, CLASSROOM_SCHOOL

Intervention Description: A total of 823 students (52.8% boys) wore accelerometers at baseline (fall 2015) and outcome (spring 2016) on PE and non-PE days. The System for Observing Fitness Instruction Time+ measured changes in PA promotion practices. Teachers ( n = 9) attended a 90-minute workshop prior to outcome data collection. Mixed-model linear regressions estimated changes in teacher practices and students' MVPA. Three of the nine targeted PA promotion practices changed in the desired direction (i.e., p < .05; increased motor content and lessons taught outdoors, reduced activities with lines), with three more teacher practices trending in the desired direction (i.e., reduced management time and activities with elimination, increased small-sided games).

Intervention Results: During PE, boys and girls increased MVPA by 2.0 (95% confidence interval [1.1, 3.0]), and 1.3 (95% confidence interval [0.5-2.0]) minutes, respectively. However, there were no statistically significant changes in boys' or girls' MVPA during the school day. Greater implementation of promotion practices by the PE teachers was associated with boys', but not girls', MVPA during PE. Girls in high- and low-implementing teachers' lessons experienced increases in MVPA, suggesting that even small changes in PA promotion practices can increase girls' MVPA during PE.

Conclusion: Overall, the workshops were effective at increasing teachers' PA promotion and students' MVPA in PE. Other school-based strategies that complement and extend efforts targeting PE are recommended to increase children's total daily PA.

Study Design: Single group pre-test and multiple post-test repeated cross-sectional study/ Pilot

Setting: Students at 8 elementary schools in one low-income school district in SE state

Population of Focus: 1st grade and 4th grade students

Data Source: Accelerometer

Sample Size: 1,570 students

Age Range: Ages 6, 9

Intervention Components (click on component to see a list of all articles that use that intervention): PE Enhancements, CLASSROOM_SCHOOL

Intervention Description: Participatory-based, experiential, competency-building professional development workshop for physical education and classroom teachers. Baseline was fall 2015, and the intervention was delivered during spring 2016 through spring 2017.

Intervention Results: A total of 1,570 first- and fourth-grade students (49.8% girls, 87.0% African American, 88% free and reduced-price lunch) were measured across the project. Primary analyses indicated that the percentage of girls and boys meeting the 30-minutes/day guideline increased by 9.3% (95% CI=4.7%, 13.9%) and 10.4% (95% CI=5.5%, 15.3%), respectively. A corresponding increase of 1.7 (95% CI=0.5, 2.8) and 2.5 (95% CI=1.1, 3.8) MVPA minutes accumulated during the school day were observed for both girls and boys, respectively. Primary analyses indicated that statistically significant increases in MVPA and total activity for boys and girls were observed across the school day, during classroom time, and during physical education.

Conclusion: Participatory-based, experiential, competency-building professional development is an effective strategy for increasing students' MVPA and total activity in low-income schools. However, data from this study indicate that targeting settings outside of the school day may be more appropriate given that schools were providing more than two thirds of the recommended 30 minutes/day of MVPA prior to intervention.

Study Design: 2-year evaluation, single-group pre/ posttest design Pilot

Setting: 8 rural elementary schools in one school district of a Southeastern state

Population of Focus: Elementary school students

Data Source: Accelerometer; fitness instruction time measured by SOFIT+ systematic observation instrument

Sample Size: 823

Age Range: Ages 6-10 (based on mean/SD ages)

Intervention Components (click on component to see a list of all articles that use that intervention): PE Enhancements, CLASSROOM_SCHOOL

Intervention Description: While the control group continued academic classes as usual, the experimental group participated in cross-training involving resistance training (RT), calisthenics, and stretching twice a week for 10 weeks. Pre- and post-intervention measures included height, mass, ATPA, and PA. BMI was calculated and ATPA and PA levels were assessed via questionnaire.

Intervention Results: The groups did not differ significantly (p > .05) for either pre- or post-intervention regarding BMI, ATPA, and PA. However, BMI and PA levels significantly increased over time for both groups (p ≤ .05).

Conclusion: Overall, cross-training in a school setting may be a safe and enjoyable option for physical activity participation. BMI and PA increases were likely the result of the natural growth process and seasonal weather pattern changes, respectively. Nevertheless, the cross-training did not detract from PA levels and may have led to an overall increase in PA levels. As subdomain analyses revealed decreased attitude toward health and fitness in the experimental group, shorter programs involving RT with various protocols are recommended.

Study Design: RCT

Setting: 1 elementary school (6 classes)

Population of Focus: 4th & 5th graders

Data Source: Measures included height, mass, ATPA, and PA. BMI was calculated, and ATPA and PA levels were assessed via questionnaire

Sample Size: 60 control; 58 experimental

Age Range: Ages 9-11

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Health Centers, Planning for Transition, HEALTH_CARE_PROVIDER_PRACTICE, Pediatric to Adult Transfer Assistance, Care Coordination, Quality Improvement/Practice-Wide Intervention

Intervention Description: This pilot study implemented and assessed the use of a structured HCT process, the Six Core Elements of HCT, in two school-based health centers (SBHCs) in Washington, DC. The pilot study examined the feasibility of incorporating the Six Core Elements into routine care and identified self-care skill gaps among students. Quality improvement methods were used to customize, implement, and measure the Six Core Elements and HCT supports.

Intervention Results: After the pilot, both SBHCs demonstrated improvement in their implementation of the structured HCT process. More than half of the pilot participants reported not knowing how to find their doctor’s phone number and not knowing what a referral is.

Conclusion: These findings indicate the need for incorporating HCT supports into SBHCs to help students build self-care skills necessary for adulthood.

Study Design: Cohort pilot evaluation

Setting: Schools

Population of Focus: High school students

Sample Size: 560

Age Range: Grades 9-12

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Curricular Activities/Training, CLASSROOM_SCHOOL

Intervention Description: This article introduces ABBL, the anti-bullying program for the transition to middle school, which was designed as a free, feasible, and easily applicable solution for teachers who, for any reason, cannot take advantage of comprehensive anti-bullying school-based programs.

Intervention Results: The evaluation of the program effectiveness showed that it reduced bullying in the classroom.

Conclusion: Indications for wider implementations are presented together with the ready-to-use ABBL anti-bullying program

Intervention Components (click on component to see a list of all articles that use that intervention): Physically Active Classrooms, CLASSROOM_SCHOOL

Intervention Description: Active breaks at primary school are feasible, may increase daily moderate to vigorous physical activity (MVPA) and decrease off-task behaviour without adversely affecting cognitive function and learning.

Intervention Results: Children in the intervention group engaged in 15.4 and 10.9 minutes more MVPA per day at 3 and 6 weeks respectively (P < .001). Participation significantly increased the proportion of children who met the Australian 24-Hour Movement Guidelines (P < .001). At pre, middle and end of intervention, 44.4%, 60.8% and 55.1% of intervention children and 46.5%, 45.9% and 45.8% of controls met the guidelines. Significantly fewer students engaged in off-task behaviour in the intervention classes at mid and final weeks of intervention (-1.4 students, P = .003). No significant intervention effects were found for wellbeing, cognitive and maths performance.

Conclusion: Active classroom breaks are an effective way to increase physical activity among primary school children while reducing off-task classroom behaviour. SO WHAT?: Primary school students' health would benefit from active breaks with no detrimental effects on wellbeing, maths and cognitive performance.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, PE Enhancements

Intervention Description: The Chinese Childhood Health; Activity and Motor Performance Study (Chinese CHAMPS) was a cluster randomized controlled trial to modify school physical activity policies and the physical education (PE) curriculum; using teacher training and parent engagement to increase opportunities and support students' physical activity and healthy eating. Using a 2 × 2 factorial design, the study tested the incremental effects of increasing the amount and intensity of physical activity, alongside adding support for healthy eating, on health-related and cognitive function outcomes in Chinese middle school students.

Intervention Results: The intervention was implemented by PE teachers in 12 middle schools in three Chinese cities, with a targeted enrollment of 650 students from August 2015⁻June 2016. The assessment of the outcomes involved a test battery of physical fitness and cognitive functioning at both baseline and at the end of the intervention. Process information on implementation was also collected.

Conclusion: The Chinese CHAMPS is a multi-level intervention that is designed to test the influences of policy and environmental modifications on the physical activity and eating behaviors of middle school students. It also addresses some key weaknesses in school-based physical activity interventions.

Study Design: Cluster RCT using 2 x 2 factorial design

Setting: 12 middle schools in three Chinese cities

Population of Focus: 7th grade students

Data Source: Accelerometers to measure time spent each day in light, moderate, and vigorous activities and sedentary behavior

Sample Size: 650 students

Age Range: Age 12