Established Evidence Results

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

Intervention Description: A cross-sectional study was conducted of 4790 children aged 4-15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z-score [BMIz]) and nutrition measures, adjusting for child and community-level covariates.

Intervention Results: Children had lower BMI z-scores (-0.11, 95% confidence interval [CI]: -0.19, -0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02-0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy-dense foods (p = .0004), lower sugar intake from sugar-sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district.

Conclusion: A more active wellness committee was associated with lower BMI z-scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Telephone Support COMMUNITY Community Health Services Policy Distribution of Promotional Items (Classroom/School) Distribution of Promotional Items (Community) Educational Material

Intervention Description: The intervention consists of three mailings and one brief coaching call delivered by 2-1-1 staff over 6 weeks. Emphasizes establishing a smoke-free home rather than smoking cessation.

Intervention Results: Overall, 40.1% reported creating a full household smoking ban. Among the nonsmoking adults reached at follow-up, days of SHS exposure in the past week decreased from 4.9 to 1.2. Among the 1148 smokers reached for follow-up, 211 people quit, an absolute reduction in smoking of 18.4% (p < .0001), with no differences by gender. Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies.

Conclusion: Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies.

Study Design: RCTs; 1st was efficacy trial, 2nd was effectiveness trial, 3rd was a generalizability trial, [4th-5th not described in article]

Setting: Telephone counseling for an educational intervention

Population of Focus: 5 2-1-1 centers chosen via competitive applications for a national grants program

Data Source: Participant reports; Tracking Tool for programs to record process of project

Sample Size: 2345 households at five 2-1-1 organizations

Age Range: Not specified

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): Policy (Community) Food Programs

Intervention Description: Over 2011-2013, the SEBTC demonstrations were evaluated by using a random assignment design. Households were randomly assigned a monthly $60-per-child benefit, a monthly $30-per-child benefit, or no benefit, depending on the study year.

Intervention Results: SEBTC reduced the prevalence of very low food security among children by one-third. It also had positive impacts on 6 of the 8 child nutrition outcomes measured (amounts of fruits and vegetables; whole grains; dairy foods; and added sugars).

Conclusion: SEBTC is a promising model to improve food security and the dietary quality of low-income school-aged children in the summer months.

Study Design: Random assignment design

Setting: Community-based

Population of Focus: Households with school-aged children

Sample Size: 52000

Age Range: n/a

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

Intervention Description: Wellness policies were evaluated using the validated Wellness School Assessment Tool (WellSAT). Concurrently, schools completed the validated Alliance for a Healthier Generation’s Healthy Schools Program (HSP) self-assessment to evaluate physical activity practices. Overall, 13 of 20 physical activity measures from WellSAT and 12 of 13 physical activity measures from HSP were aligned to match policy with practice.

Intervention Results: Most policy items scored 0 or 1, indicating either ‘no mention in the policy’ or ‘containing weak or vague language’. Corresponding HSP results indicated that school physical activity practices are ‘not in place’ or ‘under development’. A strong, positive, correlation (r = 0.92, P < 0.001) indicated that a significant relationship exists between policy and implementation.

Conclusion: Results indicate that most districts currently have weak policies regarding physical activity, limiting the potential to positively influence school-based physical activity.

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

Intervention Description: Evaluation and enhancement of district wellness policies - Intervention: Implementation of InPACT (Interrupting Prolonged sitting with ACTivity) program - Frequency: Two classroom PA breaks per day (five breaks encouraged) - Duration: Integrated into curriculum guide for the 2022-2023 academic school year - Components: Integration into curriculum guide, restructuring of school improvement plan to focus on whole child approach, teacher evaluations and observations

Intervention Results: - The initial evaluation of district wellness policies showed low strength and comprehensiveness scores, indicating weak and non-specific language. - Aligning policies with current practices resulted in a 100% increase in strength and a 132% increase in comprehensiveness. - Despite policy improvements, barriers led to integrating PA into curriculum guides and school improvement plans, with accountability measures such as teacher evaluations.

Conclusion: - The study evaluated and enhanced district wellness policies for physical activity programming, finding initial policies to be weak and not comprehensive. - The pilot process improved policy strength and comprehensiveness, but barriers prevented adoption, leading to alternative strategies. - Alternative strategies such as integrating PA into curriculum guides and school improvement plans may enhance accountability and sustainment. - Future research should examine the effectiveness of these strategies and identify ways to overcome implementation barriers.

Study Design: Observational study; non-controlled; single-site study

Setting: - Geographical Setting: Central Michigan intermediate school district (ISD) - Social Context: Low-resource, low-active county - Population: 25,784 K-12 students in the ISD; 1847 students in the pilot district - Experimental Context: Pilot school district implementing the InPACT program - Time Period: Policy evaluation completed in December 2020

Population of Focus: - Students (1847 students in the pilot school district) - District leadership (superintendent, athletic director, human resources administrator, food services director, ISD lead nutrition facilitator, ISD director of instructional services, assistant principals, principals, special education teacher, curriculum director)

Sample Size: Not mentioned (the paper does not specify the number of individuals participating in the research study)

Age Range: K-12 (approximately 5 to 18 years)

Intervention Components (click on component to see a list of all articles that use that intervention): Policy (Community) Social Supports Family-Based Interventions Housing Programs

Intervention Description: Rapid Rehousing Program

Intervention Results: Participants expressed feelings of insecurity in emergency shelters due to lack of privacy, theft, unsanitary conditions, and safety concerns. Families noted improvements in children's behavior and academic performance after moving into their own homes. Participants reported feeling safer and more secure once they had their own space and autonomy. Families expressed a sense of security and belonging after being housed, leading to improved relationships with family and friends and a sense of hope for the future.

Conclusion: The study highlighted the importance of the Rapid Rehousing Program in improving the security and well-being of families experiencing homelessness. Moving from emergency shelters to their own homes provided a sense of security, autonomy, and hope for the future. Recommendations included providing clear expectations about housing subsidies, offering financial education, and enhancing case management to support long-term housing security for families

Setting: Salt Lake City, UT

Population of Focus: policymakers, social service providers, researchers

Sample Size: n=31

Age Range: average age 37.5 yrs of age

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education HOSPITAL Quality Improvement Policy/Guideline (Hospital) Crib Card Sleep Environment Modification Promotional Event POPULATION-BASED SYSTEMS COMMUNITY Social Media CAREGIVER Education/Training (caregiver) Educational Material (caregiver) Visual Display (Community)

Intervention Description: To improve sleep environment safety for inpatient infants.

Intervention Results: The proportion of infant cribs without loose objects in them increased (32-72%, p = .025), and safe sleep positioning remained stable (82% vs. 95%, p = .183).

Conclusion: Staff education, swaddle sleep sacks, and bedside storage containers were associated with improved sleep safety among pediatric inpatients at our institution and may help at other institutions.

Study Design: QE: pretest-posttest

Setting: University of Iowa Children’s Hospital

Population of Focus: Infants less than 1 year of age developmentally ready for a crib and asleep

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=22) Follow-up 1 (not reported) Follow-up 2 (n=37) Follow-up 3 (n=18)

Age Range: Not specified

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

Intervention Description: The Healthy, Hunger-Free Kids Act of 2010 strengthened nutrition standards for meals and beverages provided through the National School Lunch, Breakfast, and Smart Snacks Programs, affecting fifty million children daily at 99,000 schools. The legislation's impact on childhood obesity is unknown. We tested whether the legislation was associated with reductions in child obesity risk over time using an interrupted time series design for 2003-18 among 173,013 youth in the National Survey of Children's Health.

Intervention Results: We found no significant association between the legislation and childhood obesity trends overall. For children in poverty, however, the risk of obesity declined substantially each year after the act's implementation, translating to a 47 percent reduction in obesity prevalence in 2018 from what would have been expected without the legislation.

Conclusion: These results suggest that the Healthy, Hunger-Free Kids Act's science-based nutritional standards should be maintained to support healthy growth, especially among children living in poverty.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy (Community) Food Programs

Intervention Description: The intervention in this study was the increase in Supplemental Nutrition Assistance Program (SNAP) benefit levels resulting from the re-evaluation of the Thrifty Food Plan (TFP). The TFP serves as the basis for determining SNAP benefit allotments, and in 2021, there was a 21% monthly benefit increase for SNAP participants due to the updated TFP. This increase in SNAP benefits was a critical and permanent change implemented by the USDA amidst the COVID-19 pandemic.

Intervention Results: Prior to the policy change, SNAP participants had significantly worse food insecurity, lower diet quality scores, and higher perceived stress and anxiety/ depression when compared to non-participants (all Ps < 0.05). After adjustment for differences in sociodemographic characteristics, there were no significant effects of the TFP re-evaluation on food insecurity, diet quality, and mental health outcomes among SNAP participants relative to non-participants (all Ps > 0.05). Qualitative responses suggested that rising food prices and growing inflation potentially negated the benefits of the policy change; however, most SNAP participants described the added benefits as helpful in purchasing additional food supplies and offsetting other household costs during this period.

Conclusion: The TFP benefit increase may have helped to prevent inflation-related disparities in food insecurity and health outcomes from widening among SNAP participants and non-participants. Further research is needed to determine the long-term impacts of this policy change.

Study Design: Longitudinal and web-based

Setting: Community-based

Population of Focus: US adults with incomes at or below 65,000

Sample Size: 1776

Age Range: 18-60

Intervention Components (click on component to see a list of all articles that use that intervention): Policy (Community) Social Supports Housing Supports

Intervention Description: tested relationships between three domains of housing - quality, stability, and affordability – with three types of child maltreatment – psychological abuse, physical abuse, and neglect

Intervention Results: Housing affordability was associated with reduced psychological and physical abuse (β = −1.10, p < 0.05 and β = −0.66, p < 0.05 respectively), but not with neglect. Neither housing quality nor stability had any significant association with any maltreatment type. The only significant predictor of neglect was maternal depression.

Conclusion: Housing affordability in particular may protect against maltreatment, but other domains of housing insecurity appear to have little to no effect controlling for other household factors. Findings highlight the need for increased affordable housing supply, as well as mental health supports for families cost-burdened by meeting basic needs.

Study Design: longitudinal survey

Setting: 20 U.S. Cities

Population of Focus: policy makers, social workers, public health, medical staff

Sample Size: N=1804

Age Range: Mothers with children aged 5 and 9

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): Social Supports Policy (Community) Housing Supports

Intervention Description: Through a series of logistic regressions and generalized estimating equations, we tested the temporal associations of emergency/transitional housing and child protection involvement as well as how both experiences affected school attendance and mobility.

Intervention Results: Experiences of emergency or transitional housing often proceeded or occurred concurrently with child protection involvement and increased the likelihood of child protection services. Emergency or transitional housing and child protection involvement posed risks for lower school attendance and greater school mobility.

Conclusion: A multisystem approach to assist families across social services may be important for stabilizing children's housing and bolstering their success at school. A two-generation approach focused on residential and school stability and enhancing family resources could boost adaptive success of family members across contexts.

Study Design: logistic regression

Setting: Hennepin and Ramsey County of Minnesota

Sample Size: 3278 children (ages 4 to 15) whose families used emergency or transitional housing; comparison group of 2613 children who did not use emergency or transitional housing.

Age Range: children aged 4-15 yrs old

Intervention Components (click on component to see a list of all articles that use that intervention): Policy (Community) School-Based Family Intervention Social Supports

Intervention Description: Schools often struggle to build partnerships with homeless and highly mobile (HHM) families. These families are not homogeneous; they live in and engage with schools from diverse residential contexts. Using Epstein’s theory and framework and drawing from 132 interviews with HHM parents, school personnel, and community stakeholders in an urban district,

Intervention Results: results suggest that (a) interviewees had divergent experiences with family, school, and community partnerships; (b) some school actors were better positioned to engage HHM families than others; and (c) the diverse residential context of HHM families molded partnership building in unique ways.

Conclusion: Although partnerships were not always shaped by the residential context, in a number of ways, living in shelter, doubling up, or residing in housing first molded the opportunities to engage in their children’s education (Table 2). In this section, findings are connected to the literature and tied back to Epstein’s concept of “family-like schools” and “school-like families.” I also suggest some theoretical implications and recommendations for practice and policy

Setting: urban school distric

Sample Size: 132 parents

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

Intervention Description: The study focused on evaluating the association between the presence and strength of local smoke-free ordinances and cigarette and smokeless tobacco use among high school students in Kentucky. The researchers examined the impact of smoke-free laws on youth tobacco use, particularly focusing on the differences in tobacco use prevalence based on the strength of these laws and the urban/rural location of the students.

Intervention Results: Students in counties with a comprehensive smoke-free law were 23% less likely to smoke cigarettes and 16% less likely to use smokeless, compared to those in counties without a law. Students in counties with moderate/weak laws did not differ in likelihood of use for either product, compared to those in counties without a law. Students in urban counties were 14% less likely to smoke, but there was no difference in likelihood of smokeless use by urban/rural location.

Conclusion: Comprehensive smoke-free laws are associated with a lower likelihood of youth cigarette and smokeless use. Rural youth may be at increased risk of cigarette smoking relative to youth in urban areas.

Study Design: Longitudinal cohort design

Setting: Kentucky

Population of Focus: Organizations and advocates for smoke-free policies, public health professionals, policymakers, adolescent health workers

Sample Size: 353502 10th and 12th grade students

Age Range: ages 15-18

Intervention Components (click on component to see a list of all articles that use that intervention): COMMUNITY Environment Enhancements Policy (Community)

Intervention Description: - Intervention: Mixed-methods online survey - Duration: Less than 10 minutes to complete - Frequency: Conducted over 2 weeks from May 25 to June 7, 2022 - Components: Quantitative (binomial logistic regression) and qualitative (thematic analysis) components

Intervention Results: - Road safety perceptions predicted active school travel (ATS), unlike distance to school and stranger danger. - The design of routes to school, particularly controlled pedestrian crossings and protected bike paths, was crucial for facilitating ATS. - Practical implications include the need for more controlled crossings, protected bike paths, speed limit reductions, and longer crossing times to improve road safety and encourage ATS.

Conclusion: The study concludes that the design of routes to school is crucial for facilitating active school travel (ATS), with a focus on addressing road danger fears.1 Practical implications include the need for more controlled pedestrian crossings and protected bike paths.2 Both parents and children desire improvements in active transport infrastructure, such as safer crossings and connected routes.3 Recommendations include speed limit reductions and longer crossing times to enhance walkability and cycle-friendliness.4 The study suggests providing controlled crossings frequently and avoiding uncontrolled crossings where speed limits are high.5 Future research should link active transport to public health, environmental health, and economic benefits, and evaluate the impact of infrastructure upgrades on ATS over time.6

Study Design: Mixed-methods survey; Cross-sectional; Online survey; Quantitative and qualitative questions; Binomial logistic regression; Generalized Linear Mixed Model; Thematic analysis

Setting: - Location: Sunshine Coast, Queensland, Australia - Institutions: Chancellor College Primary School and Chancellor College Secondary School - Time period: May 25 to June 7, 2022 - Population: 91 parents and 337 school pupils (year levels 7-12) - Environmental factors: Most participants live within 4 km from school

Population of Focus: Children (aged 12-18) and parents from Chancellor College Primary School and Chancellor College Secondary School in Australia.

Sample Size: 428 (91 parents, 337 school pupils)

Age Range: Students: 12-18 years old; Parents: Not specified