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Table 2 Descriptive summary of the included studies

From: Impact of school policies on non-communicable disease risk factors – a systematic review

S/No

Study

Year

Country

Study Design

Sample size (n)

Participant Inclusion Criteria

Policy/ Policy Intervention

Outcome/s measured

Quality

1

Anthamatten et al.

2011

USA

Observational study; case-control

n = 3688

Participation in Learning Landscape Program; recent schoolyard renovation, the size of the school, and the social and demographic characteristics of the school population.

Physical Activity (learning landscape program)(Renovation of school grounds)

Utilization of school yards for Physical Activity

Weak

2

Blum et al.

2008

USA

Quasi-experimental

n = 456 students from 7 schools;

Students from grade 9-11

Elimination from SSB (Diet) and other junk food in schools food policy

Change in students beverage servings/day

Weak

3

Covelli et al.

2008

USA

Quasi-experimental - Repeated Measures

n = 48 (Intervention = 31; control = 17)

(1) be of African-American ethnicity, (2) be between 14 and 17 years old, (3) be able to read and write in English, (4) have obtained a signed parental/guardian consent form, and (5) have signed a participant assent form.

Integration of health promotion in existing curriculum (Provision of cognitive behavioral components of health knowledge, health promotion concepts, nutrition, and exercise).

Health promotion knowledge, behaviors related to fruit and vegetable intake and exercise; blood pressure

Weak

4

Evans-Whipp et al.

2010

USA

Cross-sectional

n = 3466 from 285 schools

One class per school was invited to take part in the study. Selected classes were from three-year levels: Grade 5 (age 10), Year 7 (age 12) and Year 9 (age 14).

Existing School tobacco policies (Washington and Victoria) - Comprehensive smoking bans, policy orientation towards abstinence and harm minimization principles, possession of tobacco products among students

Current tobacco use; daily tobacco use; students perception about school smoking

Moderate

5

Evans-Whipp et al.

2013

USA and Australia

Cross-sectional

n = 1848

Students from grade 5,7 or 9

School alcohol policies (IYDS)

Current alcohol use; alcohol use in schools ground

Moderate

6

Foster et al.

2008

USA

RCT

n = 10 schools; n = 1349 students

Not mentioned

School self-assessment; nutrition education; nutrition policy; social marketing; and parent outreach.

Sales of lower-fat à la carte foods; lower fat food choices; fruit and vegetable intake; Environmental and behavioral perceptions

Strong

7

French et al.

2004

USA

RCT

n = 20 schools

Presence of an à la carte area in the school cafeteria operated by the school food service; a food service director and principal willing to take part in the study for two school years; an informed consent

School nutrition policy initiative

BMI-SD, height, overweight, obese

Weak

8

Fung et al.

2013

Canada

Cross-sectional

n = 5215(in 2003); n = 5508(in 2011)

All public schools were invited to participate

School food and nutrition policy (Children’s Lifestyle and School Performance Study-CLASS)

Dietary Status, Nutrient Intake, and Weight Status

Moderate

9

Gibson et al.

2008

USA

RCT

n = 4905 children (Intervention = 2505 and control = 2400)

Not mentioned

Physical Activity Across the Curriculum(PACC) - 90 mins moderate intensity physical activity delivered as part of academic instruction

Physical activity level

Weak

10

Hamilton et al.

2005

Australia

RCT

n = 4636 adolescents from 30 government high schools

Not mentioned

School-based smoking intervention(The Smoking Cessation for Youth Project-SCYP) - Curricular, parent, nurse counselling cessation support and policy components

The primary outcome variable was regular smoking(smoking on 4 or more days in the previous week) and the more traditional measure of ‘current smoking’ within the last 30 days was used for secondary analyses

Strong

11

Llargues et al.

2011

Spain

RCT

509 (Control: 237, Intervention: 272)

All the children born in 2000 who attended any of the schools in Granollers were eligible to participate

Teacher Training, Develop activities related to food habits and/or physical activity

Primary outcome: Difference in BMI progression Secondary outcomes: changes in eating habits and in physical activity

Strong

12

Knox et al.

2012

Australia

Quasi-experimental

182 pupils attending year (n = 115 Inter; 77 control)

Not mentioned

Physical Activity - Brisk Walking Lessons

Adiposity variables, BP, lipids, lipoproteins, glucose, insulin, high sensitivity C-reactive protein, high molecular weight adenopectin, aerobic fitness, physical activity behavior and diet

Weak

13

Jhonson et al.

2009

USA

Cross-sectional

n = 9151 students from 64 middle schools

All public schools that enroll seventh-grade students and participate in USDA school meal programs were eligible to participate

School district SSB policies

exposure of SSB and student consumption of SSB during the school days; school district policies about SSB and exposure to SSB in schools

Moderate

14

Lovato et al.

2006

USA

Cross-sectional

n = 522,318 students from 81 secondary schools

Not mentioned

School/ District tobacco control policies - scale for prohibition, strength, and characteristics of enforcement. Seven policy components: developing, overseeing and communicating the policy, purpose, and goals, prohibition, strength of enforcement, tobacco use prevention education and assistance to overcome tobacco addictions (Perception of policy)

Student smoking

Weak

15

Manios et al.

1999

Greece

RCT

n = 4171 students (Intervention); n = 1510 students (control)

All students in the first grade of selected schools

Multicomponent workbooks covering dietary issues, physical activity and fitness, dental health hygiene, smoking and accident prevention

Health Knowledge, Dietary, Physical Activity, Fitness, Anthropometric Measurements, Biochemical Indices

Moderate

16

Moore and Tapper

2008

UK

Randomized controlled trial

43 primary schools

The school was excluded if existing tuck shop, selling any food

Fruit Truck Shops

Purchase and Intake of Fruits

Moderate

17

Murnaghan et al.

2008

Canada

Cross-Sectional

n = 4709 grade 10 students

Not mentioned

Policy banning smoking in school property participated in provincially directed school-based smoking prevention program

Occasional and Current Smoking

Weak

18

O Brien et al.

2010

USA

Cross-Sectional

n = 80,428 students in 328 schools across the state of Maine. n = 123 intervention;205 non-intervention schools

Not mentioned

Comprehensive school health education, physical education and physical activity, school nutrition and food services, health promotion and wellness, school counselling physical and behavioral health services, school climate, physical environment, youth, parent, family and community involvement

Behavior change: physical activity, nutrition, and tobacco use

Weak

19

Paek et al.

2013

USA

Cross-Sectional

n = 983; 14 schools

All regular public schools containing grades 9, 10, 11, or 12 were included in the sampling frame

Tobacco-free school policy

Frequency of smoking

Weak

20

Patel et al.

2012

India

Cross-Sectional

n = 172 students from 2 schools

Male adolescents (aged 13-15 yrs.) not meeting the age criteria were excluded

Tobacco promotion and availability around schools

Current smoking and smokeless tobacco use

Weak

21

Schwartz et al.

2009

USA

Quasi- Experimental

 

Not mentioned

Removal of snacks of low nutritional value

Intake of beverages, salty snacks and sweet snacks

Weak

22

Spence et al.

2013

UK

Natural Experiment

n = 385 [2003–4]; n = 632 [2008–9]

Not mentioned

Nutrient-based standards

Mean daily intakes of macro & micro nutrients in school lunch packed lunch and total diet

Weak

23

Vandongen et al.

1995

USA

Cross-Sectional

1147 students from 30 schools

Not mentioned

Fitness, fitness + school nutrition, school-based nutrition, school + home nutrition, home-based nutrition

BP, Dietary Intake, 1.6 km run and Leger shuttle run, anthropometric measurements (subscapular skinfold) BMI, percentage fat

Weak

24

Raczynski et al.

2009

Australia

RCT

n = 2202

Not mentioned

Comprehensive legislation to combat obesity

BMI

Weak

25

Harris et al.

1997

USA

Quasi- Experimental

n = 170

Not mentioned

Modified school lunches, Enhanced nutrition education and increased opportunities for physical activities

Calorie intake, Physical fitness assessment, Knowledge, skills and attitudes related to nutrition and physical fitness

Weak

26

Holt et al.

2013

USA

Quasi- Experimental

Four elementary schools(grade k-5; 68 classroom teachers; 1284 students

Not mentioned

District mandated Physical Activity Policy (20 min)

The level of intensity of physical activity

Weak

27

Jaenke et al.

2012

Australia

Quasi- Experimental

n = 127 children (11-12 years)

Eligibility for participation in the study was for students to be enrolled in school Grades 5 or 6.

Nutrition education, gardening program

Food preference assessment, fruit and vegetable intake

Weak