Established Evidence Results

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

Intervention Description: The Virginia 365 Project, provided two sets of benefits to the treatment schools. The first set of benefits expanded free school-based nutrition assistance programs to all children in treatment schools, offering free breakfast, lunch, and supper each school day, as well as a food backpack on weekends and school breaks. The second set of benefits involved loosening restrictions in the Child and Adult Care Food Program (CACFP) and strengthening school backpack programs

Intervention Results: At follow-up, 1,393 treatment households and 1,243 control households completed a survey sufficiently to be included in the analysis. The rate of FI-C in treatment households was higher at 25.9% compared with 23.9% in control households, a difference of 2 percentage points (95% CI 0.1 to 3.9). The rate of very low food security among children in treatment households was lower at 3.2% compared with 3.9% in control households, a difference of -0.7 percentage points (95% CI -1.3 to -0.10).

Conclusion: Although the distinction in nutrition assistance benefits between treatment and control schools was less than planned, providing a suite of school-based nutrition assistance programs targeted broadly to low-income households with children has both positive and negative impacts on child and household food insecurity.

Study Design: cluster-randomized trial

Setting: School -based

Population of Focus: Children attending low-income schools

Sample Size: 2596

Age Range: 5/18/2024

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Family Intervention, Care Coordination, Collaboration with Local Agencies (State),

Intervention Description: Asthma imposes tremendous burden on children, families, and society. Successful management requires coordinated care among children, families, health providers, and schools. Building Bridges for Asthma Care Program, a school-centered program to coordinate care for successful asthma management, was developed, implemented, and evaluated. The program consists of five steps: (1) identify students with asthma; (2) assess asthma risk/control; (3) engage the family and student at risk; (4) provide case management and care coordination, including engagement of health-care providers; and (5) prepare for next school year. Implementation occurred in 28 schools from two large urban school districts in Colorado and Connecticut.

Intervention Results: Significant improvements were noted in the proportions of students with completed School Asthma Care Plans, a quick-relief inhaler at school, Home Asthma Action/Treatment Plans and inhaler technique (p < .01 for all variables).

Conclusion: Building Bridges for Asthma Care was successfully implemented extending asthma care to at-risk children with asthma through engagement of schools, health providers, and families.

Study Design: Program evaluation

Setting: Twenty-eight schools from two large urban school districts in Colorado and Connecticut

Population of Focus: Students with asthma in the participating schools; Families of the at-risk students; School nurses who led the program; Health-care providers engaged in the care coordination activities; Implementation teams in the two urban school districts of Colorado and Connecticut; Asthma champions within the school districts who provided guidance and support for program implementation at individual schools

Sample Size: 463 students

Age Range: Children 5 to 12 years old

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

Intervention Description: We sought to understand the experiences of community integration among homeless-experienced veteran families. We used a two-stage, community-partnered approach. First, we analysed 16 interviews with homeless-experienced veteran parents (parents who served in the military; n = 9) living in permanent housing and providers of homeless services (n = 7), conducted from February to September 2016, for themes of community integration. Second, we developed a workgroup of nine homeless-experienced veteran parents living in a permanent housing facility, who met four times from December 2016 to July 2017 to further understand community integration. We audio-recorded, transcribed and analysed the interviews and workgroups for community integration themes.

Intervention Results: We describe our findings across three stages of community integration: (a) first housed, (b) adjusting to housing and the community, and (c) housing maintenance and community integration. We found that parents tended to isolate after transitioning into permanent housing. After this, families encountered new challenges and were guarded about losing housing. One facilitator to community integration was connecting through children to other parents and community institutions (e.g. schools). Although parents felt safe around other veterans, many felt judged by non-veterans. Parents and providers reported a need for resources and advocacy after obtaining housing. We share implications for improving community integration among homeless-experienced veteran families, including providing resources after obtaining housing, involving schools in facilitating social connections, and combating stigma.

Conclusion: Parents tended to isolate after transitioning into permanent housing. After this, families encountered new challenges and were guarded about losing housing. One facilitator to community integration was connecting through children to other parents and community institutions (e.g. schools). Although parents felt safe around other veterans, many felt judged by non-veterans. Parents and providers reported a need for resources and advocacy after obtaining housing.

Study Design: two-stage, community-partnered approach

Setting: United States

Population of Focus: researchers, public health specialists

Sample Size: n=16 parents

Age Range: N/A

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

Intervention Description: The "Healthy and Ready to Learn" (HRL) program was a school-based health insurance outreach initiative that aimed to identify and enroll uninsured kindergarten-aged children in areas of high economic need in 16 counties in North Carolina . The program worked with school nurses and staff by providing regional trainings on how to use a required health assessment form, submitted at school entry, to identify uninsured children who could be eligible but not enrolled in North Carolina’s public health insurance programs . The program also provided families with information about the importance of insurance and preventive care for their children . The intervention was implemented over a period of 3 years, from 2009 to 2011 .

Intervention Results: The initiative increased enrollment rates by 12.2% points and increased well-child exam rates by 8.6% points in the RD models, but not differences-in-differences, and did not significantly increase well-child visits.

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: Mixed methods (quasi-experimental)

Setting: Community (16 counties in North Carolina)

Population of Focus: Uninsured kindergareners in areas of high economic need

Sample Size: 300 kindergarteners

Age Range: 4-6 years

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

Intervention Description: The intervention is the implementation of the Community Eligibility Provision (CEP) for free school meals in the United States. CEP allows high-poverty schools to offer free breakfast and lunch to all students without the need for individual household applications. By providing universal access to nutritious meals at school, CEP aims to reduce food insecurity, improve dietary quality, and alleviate financial burdens on low-income families.

Intervention Results: Researchers found access to universal free school meals through the Community Eligibility Provision (CEP) had a meaningful impact on grocery spending for households with children, with monthly food purchases declining by about $11, or 5 percent. For households in zip codes with higher exposure, the decline is as high as $39 per month, or 19 percent. The composition of food purchases also changes after CEP, with low income households experiencing a 3 percent improvement in dietary quality. Finally, CEP exposure is associated with an almost 5 percent decline in households classified as food insecure.

Conclusion: Results on the heterogeneous effects of CEP exposure by prior free/reduced price lunch eligibility reveal benefits in terms of both spending, dietary composition, and food insecurity for previously eligible low-income families, suggesting that the stigma of free school meals may be declining after universal access.

Study Design: Quasi-experimental approach

Setting: Households with school-age children

Population of Focus: School-age students

Sample Size: 40,000 households

Age Range: N/A

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

Intervention Description: Overall, the intervention focused on evaluating and enhancing emergency meal distribution strategies in large urban school districts to address food insecurity and promote equitable access to nutrition programs during the COVID-19 pandemic.

Intervention Results: The study on addressing food insecurity through a health equity lens in large urban school districts during the COVID-19 pandemic yielded several key results: Emergency Meal Distribution Strategies: The study evaluated the emergency school meal service strategies adopted by four of the largest school districts in the USA (Chicago Public Schools, Houston Independent School District, Los Angeles Unified School District, and New York City Department of Education) at the onset of the pandemic . Equitable Access: The degree to which districts promoted equitable access to emergency nutrition programming during the pandemic was assessed through a health equity lens . Guidelines for Equitable Meal Distribution: The study developed evidence-based guidelines for establishing an equitable emergency meal distribution system during a pandemic, filling a gap in evaluating equity in emergency meal distribution systems . Mixed-Methods Approach: The research employed a rigorous mixed methodology for document analysis and geo-spatial mapping to analyze school districts' efforts during the unprecedented pandemic . Availability of Meal Sites: The focus was on the availability of meal sites, with acknowledgment that other dimensions of food access may also be influential and should be examined in future studies . Relevance and Implications: The findings are relevant for school meal and nutrition assistance providers, given the persistent threat of COVID-19, and can inform future plans for public health emergencies . Limitations: The study acknowledged limitations such as recommendations to social distance and time constraints during the public health emergency, reliance on publicly available data, and the need for follow-up research to further explore emergency school meal strategies

Conclusion: This study identifies strategies that have the potential to increase equitable access to nutrition assistance programs. Our findings can support (1) ongoing efforts to address child food insecurity during the pandemic and (2) future meal provision through programs like the Summer Food Service Program and Seamless Summer Option. Future research should further examine the rationale behind meal site placement and how site availability changed over time.

Study Design: Mixed methods design

Setting: School -based

Population of Focus: School-age students

Sample Size: Not provided

Age Range: n/a

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): School-Based Family Intervention, Food Supports

Intervention Description: The Oregon Farm to Table intervention teaches Oregon students about Oregon grown & processed food. Typical projects include activities such as tasting tables, classroom instruction, farm field trips, video lesson production, etc.

Intervention Results: We conducted descriptive analyses for quantitative data. For qualitative data, we coded repeated concepts and identified themes using grounded theory approach. Education grants reached more than 20,000 students in 30 districts, including 25 low-income districts. The most reported activities were nutrition and food-based lessons, school gardens, and farm field trips. Thematic results included students eating fruits and vegetables, trying new foods because of gardens, and learning about growing produce.

Conclusion: Oregon's Farm to School Education Grant Program reached the targeted low-income students, encouraged districts to implement educational activities, and allowed low-income children to learn about produce. Education is a core element of farm-to-school success and can help achieve the behavior change in youth needed for increased acceptance of school meals, better health outcomes, and improved food security.

Study Design: Mixed methods design

Setting: School -based

Population of Focus: Children in low-income school districts

Sample Size: 20000

Age Range: n/a

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

Intervention Description: The intervention involved school-located vaccination events targeting middle school students at the recommended ages, bundling the HPV vaccine with other recommended vaccines, addressing identified barriers, and extending the study area for school-based vaccinations to multiple school districts

Intervention Results: The HPV vaccination data was collected and stratified by gender, age of initiation, and vaccination year. The study achieved 80% power to detect a small effect size using statistical analyses. there was an increase in HPV vaccine uptake among middle school students in the Rio Grande Valley (RGV) through the community-based education and school-based vaccination program. The study found that initiating the HPV vaccine at age ≤11 years increased completion of the HPV vaccine series, and the overall HPV UTD rate was 59.7%. The intervention program provided the HPV vaccine in an alternative setting (schools), increased access and support through education and outreach, and encouraged on-time HPV vaccination and completion.

Conclusion: The study aimed to accelerate HPV vaccine uptake and prevent cancer, emphasizing the urgency for action to improve vaccination rates

Study Design: The study utilized a school-based vaccination program and collected data on HPV vaccination rates, with statistical analyses conducted using Chi-Square Test and Power Analysis and Sample Size

Setting: The setting of the study includes pediatric care settings in Texas, specifically targeting middle school students in various school districts

Population of Focus: The target audience consists of female and male middle school students at the recommended ages of 11-12 years old

Sample Size: The sample size was 786, with the data collected from the vaccine vendor and school immunization records and reconciled with the Texas Immunization Registry

Age Range: The study focused on the age range of initiation, including 9, 10, 11, 12, 13, and 14+ years old

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): Family-Based Interventions, School-Based Family Intervention, Access to Provider through Hotline,

Intervention Description: To identify whether there were differential patterns of children's school attendance and stability, we employed a repeated measures latent class analysis (RMLCA; Collins & Lanza, 2009). Latent class analysis is a person-centered technique that is used to identify mutually exclusive and exhaustive subgroups of participants within the population of interest based on similar patterns of responses to indicator variables (i.e., similar experiences with school attendance and stability).

Intervention Results: The results of the current study have important implications for young children who experience homelessness and suggest promoting school attendance as one avenue to support academic achievement.

Conclusion: Preventing homelessness, especially for families, will take coordination across disciplines and systems, including addressing the cost of housing, extreme poverty, educational disparities, and lack of support for mental health and drug abuse, to name only a few of the complicated issues that contribute to homelessness across the country.

Study Design: person-centered analytic technique

Setting: Massachusetts

Population of Focus: Teachers, public health professionals

Sample Size: N/A

Age Range: Kindergarten through 3rd grade (5-9 yr olds)

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

Intervention Description: The study "Evaluation of Educational Interventions to Enhance Adolescent Specific Vaccination Coverage" by Natasha Underwood implemented two types of educational interventions: one targeted at parents only (P only) and the other a multicomponent intervention for both parents and adolescents (P + A). The interventions aimed to increase the coverage of three vaccines recommended during adolescence: tetanus diphtheria pertussis (Tdap), meningococcal (MenACWY), and human papillomavirus (HPV) vaccines. The specific details of the interventions were not provided in the available information. However, it can be inferred that the interventions likely included educational materials, such as brochures, pamphlets, or presentations, aimed at increasing awareness and knowledge about the importance of adolescent vaccination among the targeted audience. The multicomponent intervention for parents and adolescents may have involved tailored educational content for each group, as well as strategies to facilitate communication and decision-making regarding vaccination within families. For more detailed information on the specific content and delivery of the interventions, referring to the original study by Natasha Underwood would be necessary.

Intervention Results: The study "Evaluation of Educational Interventions to Enhance Adolescent Specific Vaccination Coverage" by Natasha Underwood found that both the parent-only (P only) and multicomponent parent and adolescent (P + A) interventions were effective in increasing vaccination coverage among middle and high school students in Georgia. The study found that the P only intervention resulted in a statistically significant increase in Tdap vaccination coverage among students, from 85.5% at baseline to 91.5% at follow-up. The P + A intervention resulted in a statistically significant increase in Tdap and MenACWY vaccination coverage among students, from 85.5% to 92.5% and from 85.5% to 91.5%, respectively. The study also found that the P + A intervention was more effective than the P only intervention in increasing HPV vaccination coverage among students. The P + A intervention resulted in a statistically significant increase in HPV vaccination coverage among students, from 47.5% to 57.5%, while the P only intervention did not result in a statistically significant increase. Overall, the study suggests that educational interventions targeting parents and adolescents can be effective in increasing adolescent vaccination coverage.

Conclusion: The study "Evaluation of Educational Interventions to Enhance Adolescent Specific Vaccination Coverage" by Natasha Underwood concluded that both the parent-only (P only) and multicomponent parent and adolescent (P + A) educational interventions were effective in increasing vaccination coverage among middle and high school students in Georgia. The findings suggest that targeted educational interventions can positively impact adolescent vaccination rates, particularly for vaccines such as Tdap, MenACWY, and HPV. The study's results support the importance of implementing educational interventions that involve both parents and adolescents to enhance vaccination coverage. The multicomponent approach, which included both parents and adolescents, demonstrated greater effectiveness in increasing vaccination coverage compared to the parent-only intervention for certain vaccines. These conclusions highlight the potential of educational interventions to address vaccination disparities and improve overall vaccination rates among adolescents, emphasizing the significance of engaging both parents and adolescents in vaccination promotion efforts.

Study Design: The study "Evaluation of Educational Interventions to Enhance Adolescent Specific Vaccination Coverage" by Natasha Underwood used a randomized controlled trial design. The 11 middle and high schools in Georgia were randomized into three arms: control, educational intervention for parents only (P only), and multicomponent educational intervention for parents and adolescents (P + A). The study assessed the impact of these interventions on increasing the coverage of three vaccines recommended during adolescence among middle and high school students in the specific setting. The study collected data through surveys administered to students and parents at baseline and follow-up.

Setting: The setting for the study "Evaluation of Educational Interventions to Enhance Adolescent Specific Vaccination Coverage" by Natasha Underwood was conducted in 11 middle and high schools within one school district in Georgia. The study focused on assessing the impact of educational interventions on increasing the coverage of three vaccines recommended during adolescence among middle and high school students in this specific setting.

Population of Focus: The target audience for the study "Evaluation of Educational Interventions to Enhance Adolescent Specific Vaccination Coverage" by Natasha Underwood was middle and high school students in Georgia, specifically those who were recommended to receive three vaccines during adolescence: tetanus diphtheria pertussis (Tdap), meningococcal (MenACWY), and human papillomavirus (HPV) vaccines. The study also targeted parents of these students, as one of the interventions was designed specifically for parents.

Sample Size: The study "Evaluation of Educational Interventions to Enhance Adolescent Specific Vaccination Coverage" by Natasha Underwood had a sample size of 11 middle and high schools in Georgia. The schools were randomized into three arms: control, educational intervention for parents only (P only), and multicomponent educational intervention for parents and adolescents (P + A). The study did not provide information on the number of students or parents included in the sample.

Age Range: The study "Evaluation of Educational Interventions to Enhance Adolescent Specific Vaccination Coverage" by Natasha Underwood focused on middle and high school students in Georgia, who are typically between the ages of 11-18 years old. The study targeted students who were recommended to receive three vaccines during adolescence: tetanus diphtheria pertussis (Tdap), meningococcal (MenACWY), and human papillomavirus (HPV) vaccines. Therefore, the age range of the participants in the study was likely between 11-18 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Family Intervention, Peer-led Mentoring/Support Counseling, Comprehensive School-Based PA Program,

Intervention Description: The intervention involved embedding whole-school and classroom-level prevention/promotion programs alongside small group and individual services for selected youth.

Intervention Results: Students participating in early intervention had significantly improved social-emotional competencies and coping skills (particularly those students at highest risk), and students with mental health disorders who participated in clinical treatment had significantly improved symptoms and functioning. Schools significantly enhanced their capacity to provide mental health services across prevention/promotion, early identification/intervention, and crisis management domains. These findings were replicated across 3 consecutive years of program implementation.

Conclusion: A school-hospital partnership using an MTSS model was found to be feasible, valued, and effective in improving students' mental health status and schools' capacities to provide mental health services.

Study Design: The study utilized a school-hospital partnership to implement a multitiered system of support (MTSS) model over 3 consecutive academic years.

Setting: The study was conducted in 6 urban public schools.

Population of Focus: The target audience for the study was elementary through high-school students enrolled in the 6 urban public schools.

Sample Size: 2700 students

Age Range: The schools included high (52% of total students), middle (21%), and elementary (27%) level classrooms.