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): 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): 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): Multicomponent School-Based Program

Intervention Description: This study examined variation in the effects of SWPBIS based on children’s baseline pattern of behavior problems and social–emotional skills using data from a randomized controlled effectiveness trial

Intervention Results: This study used data from a 4-year RCT to examine variation in the impact of SWPBIS based on the children’s baseline risk profile. LPA identified four latent classes of baseline risk, including two adaptive classes we labeled normative (36.5%), because they scored at or near the sample mean on all four TOCA–C subscales, and socially–emotionally skilled (33.6%), because they scored higher than the mean for the two adaptive scales and below the mean on the two problem scales. A relatively small high-risk class (6.6%) was identified, as was a larger at-risk (23.3%) class; each of these classes demonstrated baseline TOCA–C scores that suggested elevated levels of risk relative to their peers in the normative and the socially–emotionally skilled classes. The covariates were functionally related to the class membership, thereby providing further validation of the latent classes. As hypothesized, there were significant differences in the SWPBIS outcomes based on the children’s baseline risk class. Generally, we found that children in the at-risk and high-risk classes in the SWPBIS schools demonstrated the greatest effects relative to their at-risk and high-risk peers in the comparison schools. Specifically, both at-risk and high-risk children in the SWPBIS schools were significantly less likely to receive an ODR than their peers in the comparison schools. A similar pattern emerged for receipt of counseling services and referral to special education, which are indicators of the need for more intensive services ( Bradshaw, Waasdorp, et al., 2012). The socially– emotionally skilled children in the SWPBIS schools were less likely to receive counseling services for social skills development and less likely to experience grade retention. We are cautious in our interpretation of the large effect size for the grade retention finding due to the relatively low base rate of grade retention across the sample. Although the overall proportion of children retained was low for the socially–emotionally skilled children, these find- ings suggest that the heterogeneity in SWPBIS outcomes does apply to archival academic outcome data

Conclusion: Consistent with previous research (e.g., Kellam et al., 1994 , 1998 ; Spilt et al., 2013 ; van Lier et al., 2005 ), children’s baseline risk profile moderated the effects of SWPBIS. These findings suggest that at-risk and high-risk children may benefit most from exposure to SWPBIS. This is the first study to systematically explore the heterogeneity in the impacts of SWPBIS, with a particular interest in response to intervention based on baseline risk profiles and using reliable and well-validated teacher-report measures collected over multiple years. Our approach to examin- ing heterogeneity in program responsiveness is consistent with recent calls for greater attention to and precision with which researchers examine these issues ( Lanza & Rhodes, 2013; Schochet et al., 2014 ; Supplee et al., 2013 ). We believe the use of LPA within the context of a longitudinal group randomized con- trolled effectiveness trial represents an important contribution, not only to the literature on SWPBIS, but also to the broader literature on subgroup effects in school-based prevention programs.

Study Design: RCT

Setting: Public Elementary Schools

Data Source: Data came from a group randomized controlled effectiveness trial (Flay et al., 2005 ; Murray, 1998) of the universal SWPBIS model in public elementary schools; all schools recruited for participation enrolled.

Sample Size: 12,344 elementary school children

Age Range: Elementary School Children

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): Multicomponent School-Based Program,

Intervention Description: The intervention described in the provided PDF was an educational intervention on sexually transmitted diseases (STDs), HPV infection, and preventive strategies. The intervention involved a set of slides relating to STD prevention with a particular focus on HPV infection, related diseases, and vaccination, which were presented in plenary sessions to all students for which the consent form signed by parents was obtained. The intervention was conducted by medical doctors and researchers of the Department of Health Promotion, Maternal and Infant Care, Internal Medicine, and Excellence Specialties of the University of Palermo. The intervention was followed by an on-site HPV vaccination offer in five schools in a dedicated and fully equipped caravan of the Local Health Agency (LHA), parked in the courtyards inside the schools ,[object Object],,[object Object],.

Intervention Results: The study described in the provided PDF found that the educational intervention on STDs, HPV infection, and preventive strategies was strongly associated with HPV vaccination knowledge and uptake among preadolescents aged 11-14 years in the province of Palermo, Italy. The study found that the intervention led to a statistically significant 6% increase in the willingness to receive HPV vaccination among the study participants. The study also found that students attending schools in more deprived areas or students with poor socio-economic conditions were least informed about STDs or the opportunity to protect themselves with vaccination. However, the study demonstrated the high efficacy of school-based formative intervention and a vaccination offer, as 188 preadolescent students of five schools (69.1% of the susceptible sample) not already immunized against HPV were vaccinated during the study duration. The study concluded that the large-scale organization of school-based educational interventions on STDs, HPV-related diseases, and preventive strategies should probably be standardized and extended to improve awareness and willingness of students on the importance of HPV vaccination ,[object Object],,[object Object],.

Conclusion: HPV vaccination represents a clear example of under-use of a practice with a very high scientific value [7]. In Italy, vaccination coverage rates among preadolescents remain considerably low [8]. Of note, the future role of parents and of school educational intervention could represent a solution to improve vaccination attitudes and knowledge of preadolescents, that represents the primary target of HPV vaccination [34]. The large-scale organization of school-based educational interventions on STDs, HPV-related diseases and preventive strategies should probably be standardized and extended in order to improve awareness and willingness of students on the importance of HPV vaccination.

Study Design: The study described in the provided PDF had a pre-post interventional design. The study was conducted in two consecutive school years (2017/2018 and 2018/2019) in 18 first-grade secondary schools located in Palermo, Italy. The schools were sampled through cluster sampling based on urban location and were divided into three levels, according to the deprivation index of the neighborhood or municipality in which they arose. The study involved administering two questionnaires, before and after carrying out an educational intervention on sexually transmitted diseases (STDs), HPV infection, and preventive strategies. The study also included an on-site HPV vaccination offered after the intervention in five schools in a dedicated and fully equipped caravan of the Local Health Agency (LHA), parked in the courtyards inside the schools ,[object Object],,[object Object],.

Setting: The setting described in the provided PDF is a multicenter project conducted in four Italian regions (Liguria, Veneto, Apulia, Sicily) with the main objective of evaluating the offer of vaccination, coverage rates, and determinants associated with HPV vaccination uptake or refusal in different age classes and target groups ,[object Object],. Specifically, the study was conducted in Sicily, a southern Italian region with about five million inhabitants, divided into nine Local Health Agencies (LHAs) corresponding to nine provinces, including Palermo ,[object Object],. Additionally, the intervention took place in five schools in Palermo, where a dedicated and fully equipped caravan of the Local Health Agency (LHA) was parked in the courtyards inside the schools ,[object Object],.

Population of Focus: The target audience for the study described in the provided PDF is preadolescents attending first-grade secondary schools in the province of Palermo, Italy. A total of 1702 students were enrolled in the study, with a response rate of 68.9% ,[object Object],. The study aimed to assess knowledge and attitudes regarding HPV infection and vaccination among this specific group of preadolescents ,[object Object],. Additionally, the study focused on evaluating the offer of vaccination, coverage rates, and determinants associated with HPV vaccination uptake or refusal in different age classes and target groups, including preadolescents aged 11–14 years in the province of Palermo ,[object Object],.

Sample Size: The sample size for the study described in the provided PDF was 1702 students attending first-grade secondary schools in the province of Palermo, Italy ,[object Object],. This sample size was considered representative of the population of preadolescents aged 11–14 years in the province of Palermo, which was reported to be 51,888 ,[object Object],.

Age Range: The study in the provided PDF focused on preadolescents aged 11–14 years in the province of Palermo, Italy ,[object Object],. Therefore, the age range of the target audience for this study was 11 to 14 years old.

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): 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, 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): 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): Multicomponent School-Based Program, Outreach (School Staff), Care Coordination,

Intervention Description: N/A

Intervention Results: Based on a sample of 64,710 children, 0.5% identified school-based providers as their primary source of health care. Children who were older, uninsured, or living in the Northeast were significantly more likely to report school-based providers as their usual source of care. Children whose usual source of care was a school-based provider were less likely to receive care meeting medical home criteria than children who usually received care at a doctor's office.

Conclusion: While SBHCs improve access to care, our findings indicate potential challenges with establishing a medical home for children who usually receive health care from a school-based provider.

Study Design: Using data from the 2016-2018 National Survey of Children's Health (NSCH), we analyzed children's usual source of care (school-based provider, doctor's office or clinic, other location, or none), and whether they received care meeting medical home criteria.

Setting: 2016-2018 National Survey of Children's Health; United States

Population of Focus: Children and adolescents, particularly those that use SBHCs

Sample Size: 64710

Age Range: 0-17

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, 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): 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, 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): 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): Multicomponent School-Based Program,

Intervention Description: The California Tobacco-Use Prevention Education (TUPE) program promotes the use of evidence-based tobacco-specific prevention and cessation programs for adolescents within the school setting. Through a competitive grant process, schools are funded to provide programs for grades 6–12. This research evaluates the association between TUPE funding and tobacco prevention activities and tobacco use prevalence.

Intervention Results: This study found that TUPE-funded schools were more likely to provide tobacco-specific health education programs, to place a priority on tobacco-prevention efforts, and to prepare educators to address tobacco use than non-TUPE schools. Educators at both types of schools felt better prepared to talk with students about traditional tobacco products than about emerging products such as e-cigarettes. Overall, students at TUPE-funded schools were more likely to report receiving anti-tobacco messages from school-based programs than those at non-TUPE schools. The former were also less likely to use tobacco products, even when the analysis controlled for demographics and school-level characteristics (OR = 0.82 [95% CI = 0.70–0.96]).

Conclusion: TUPE funding was associated with an increase in schools’ tobacco-specific prevention activities and these enhanced activities were associated with lower tobacco use among students. This study also found that education and prevention efforts regarding emerging tobacco products need to be strengthened across all schools.

Study Design: Cross-sectional survey analysis

Setting: California, USA

Population of Focus: Researchers, public health professionals, policymakers

Sample Size: 3564 students from 691 schools

Age Range: ages 11-18

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

Intervention Description: 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, 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): 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): 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): 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): 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, 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): Multicomponent School-Based Program

Intervention Description: For this study, an experimental pre-test/post-test design was used which included a control group. Three groups were established. The first group, Treatment with Support, involved students from schools that implemented a school-based anti-bullying intervention with additional support from the research group. The second group, Treatment without Support, also involved students from schools that implemented a school-based anti-bullying programme. However, in contrast with those falling under the first condition, this group of schools could not appeal to the research group for additional help. The last group involved students from schools that did not implement the anti-bullying programme and served as a Control condition. Repeated measures analyses of variance were carried out.

Intervention Results: The findings regarding the effects of the school-based anti-bullying intervention programme on the extent of bullying and victimisation showed a mixed pattern of positive changes in primary schools and zero outcomes in secondary schools. The findings regarding the effects of external support revealed limited outcomes.

Conclusion: The outcomes of the evaluation study confirm that a school-based anti-bullying intervention strategy can be effective in reducing problems with bullying, especially within primary schools. It was argued that the developmental characteristics of secondary school students interfered with the programme outcomes. In addition, the findings revealed no extra effects of specific training sessions.

Study Design: experimental pre-test/post-test design

Setting: 18 primary and secondary schools

Data Source: N/A

Sample Size: 1104 primary and secondary school children

Age Range: Students ranged in age from 10 to 16 years

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): Multicomponent School-Based Program

Intervention Description: A randomized controlled effectiveness trial of SWPBIS.

Intervention Results: Analyses indicated that children in schools that implemented SWPBIS displayed lower rates of teacher-reported bullying and peer rejection than those in schools without SWPBIS. A significant interaction also emerged between grade level of first exposure to SWPBIS and intervention status, suggesting that the effects of SWPBIS on rejection were strongest among children who were first exposed to SWPBIS at a younger age.

Conclusion: The results indicated that SWPBIS has a significant effect on teachers' reports of children's involvement in bullying as victims and perpetrators. The findings were considered in light of other outcomes for students, staff, and the school environment, and they suggest that SWPBIS may help address the increasing national concerns related to school bullying by improving school climate.

Study Design: Three-level models were fit using hierarchical linear modeling to determine the effect of SWPBIS on children's involvement in bullying.

Setting: Thirty-seven Maryland public elementary schools

Data Source: N/A

Sample Size: 12 344 children

Age Range: Elementary School Children