Table 1 Summary of study characteristics
Study/location | Study design/sample | Outcome of interest | Exposure measure used | School exposure measure and reported association(s) with student weight outcome (95% CI) (^ = p-value less than 0.05) | QA | ||
|---|---|---|---|---|---|---|---|
Method of data collection | Validity/reliability | ANGELO framework | |||||
Veugelers & Fitzgerald, 2005 [13]/Canada | Cross-sectional/5,200 Yr 5 students from 228 schools | Body Mass Index (BMI) | A written survey was completed by the school principal on the presence of healthy menu alternatives. | Not reported | A Policy-related factor was researched (1) | 1. School provided healthy menu alternatives: Overweight = OR 0.91 (0.77, 1.09) Obesity = OR 0.85 (0.63, 1.15) | 5 |
Fox et al. 2009 [14]/US | Cross-sectional/2,228 Yr 1–12 students from 287 schools | BMI (obesity only) | A written survey was completed by a foodservice manager about the frequency and type of foods made available in the cafeteria. | Not reported | Policy (2–6) | 2. Low-nutrient, energy-dense foods available = OR 1.09 (0.57 – 2.08)^ | 8 |
3. Whole or 2% milk offered = OR 1.17 (0.75 – 1.82)^ | |||||||
4. Fresh fruit/raw vegetables not offered daily = OR 1.13 (0.73 – 1.75)^ | |||||||
5. French fries/ similar products offered regularly = OR 2.70 (1.58 – 4.62)^ | |||||||
6. Dessert offered more than once per week = OR 1.78 (1.13 – 2.80)^ | |||||||
Harrison et al. 2011 [15]/UK | Cross-sectional/1,725 Yr 5 students from 92 schools | Fat Mass Index (FMI) | A written survey was completed by a ‘head teacher’ about school policies. | Not reported | Physical (7) | 7. Lower FMI was found in girls attending schools with more pupils in their age group^ (interquartile analysis) | 4 |
Policy(8–11) | |||||||
Economic (12) | |||||||
A ‘trained assessor’ completed an audit of school grounds. | 8. Better cycle support was associated with higher FMI in girls^ (interquartile analysis) | ||||||
Local council provided general information. | 9. Higher FMI was associated with boys who were allowed to eat any foods at break-time^ (interquartile analysis) | ||||||
Insignificant findings not reported for: | |||||||
10. Food-related learning | |||||||
11. UK Govt ‘healthy school programme’ | |||||||
12. Free school meals. | |||||||
Rundle et al. 2012 [16]/US | Cross-sectional/624,204 Yr K-12 students from 1,276 schools | BMI | Data were extracted from the New York City Department of Education enrolment database. | Not reported | Economic (13) & Socio-cultural (14) | 13. Students received free or reduced-price lunches: Overweight = OR 1.05 (1.00, 1.08)^ and Obesity = OR 1.13 (1.10, 1.18)^ | 5 |
Insignificant findings not reported for: | |||||||
14. Ethnicity of students in school. | |||||||
Leatherdale, 2013 [17]/Canada | Cross-sectional/2,331 Yr 1–4 students from 30 schools | BMI (over-weight only) | A written survey was completed by the ‘senior administrator most knowledgeable about school policies and practices’. | Not reported | Physical (15–16) | 15. Moderate level of student access to a variety of facilities on and off school grounds during school hours = OR 0.39 (0.16, 0.92)^ | 1 |
Policy (17–21) | |||||||
Socio-cultural (22–25) | |||||||
A school built environment survey was completed by a ‘trained assessor’ using the ‘Environmental Points of Interest’ tool. | 16. Good level of student access to a variety of facilities on and off school grounds during school hours = OR 0.32 (0.12, 0.86)^ | ||||||
Insignificant findings not reported for: | |||||||
17. PA used as reward | |||||||
18. Good PA transport to and from school | |||||||
19. Good implementation of daily PA | |||||||
20. Good amount of daily PA | |||||||
21. Good training of PA teachers | |||||||
22. Good consistency of intramural PA | |||||||
23. Good incorporation of PA into other subjects | |||||||
24. Good community feedback on school PA | |||||||
25. Good PA promotion by teachers | |||||||