Table 1.
Summary of included papers
| Reference | Study type |
Setting | N° Children (schools) |
Age | Environmental measures a |
Outcome | Results |
|---|---|---|---|---|---|---|---|
| School Neighbourhood: Physical activity | |||||||
| Dalton et al 2011 |
CS | US | 1552 (45) |
7th-11th Grades (12-17y) |
Residential density, land use mix and network measures of school buffer |
AT (SR) | Sidewalks, residential density, and building continuity increased the odds of AT and (for latter two) frequency of AT. Frequency also positively related to intersection density, food outlets, curbs, on-street parking, small setbacks and building height |
| Jones (2010) | CS | UK | 1868 (92) |
Year 5 (9-10y) |
AT/PA provision around school |
PA (M) | Comparing best and worst, girls and boys both spent more commuting time in MVPA at schools with best walking and cycling provision. Boys did more MVPA at lunchtime at schools with the best sports/play facilities scores, and girls were more active with better designed grounds |
| Panter (2010) | CS | UK | 2012 (92) |
Year 5 (9-10y) |
Route measures, policies and facilities |
AT (SR) | Odds of both cycling and walking to school were decreased by route length >1km, lower route directness, and having a main road on the route |
| Schlossberg (2006) | CS | USA | 287 (4) | 6th-8th Grades (11-14y) |
Route measures |
AT (SR) | Greater route length decreased odds of AT to and from school. Lower intersection density decreased odds of AT to school while higher dead-end density decreased odds |
| Timperio (2006) | CS | Australia | 912 (19) | 5-6y and 10-12y |
Route measures |
AT (SR) | Odds of AT increased by shorter (both), direct (older) route and decreased by a main road (both) and a steep road (younger) |
| Trilk et al 2011 | CS | US | 1394 (22) |
12th Grade (17-18y) |
PA facilities near schools |
PA (SR) | Girls with ≥ 5 facilities near their school were more active than those with <5. Significant interaction between facilities and urban/rural location. Girls in rural areas with ≥ 5 facilities did 12% more PA than those in rural areas with <5. |
| School Neighbourhood: Food | |||||||
| Davis (2009) | CS | USA | 500000 (ng) |
Grades 6- 10 (11-16y) |
Fast food restaurants around schools |
Adiposity, diet (SR) |
Students with fast-food restaurants within 0.5 mile of their schools consumed fewer servings of fruits and vegetables, were more likely to drink soda, and be OW or obs |
| Laska et al 2010 |
CS | USA | 349 (ng) | 10-17y | Food outlets around homes and schools |
Adiposity (M) Diet (SR) |
Few, inconsistent, associations between school neighbourhood measures and diet and adiposity measures. Of the 105 test, 3 showed significant associations. |
| New (2003) | CS | UK | 504 (3) | 11-15y | Mode of travel to school |
Diet (SR) | Average rank of confectionary consumption of children travelling to school by car was 185. Walking = 217, cycling = 216 |
| Seliske (2009) | CS | Canada | 7987 (178) |
Grades 6- 10 (11-16y) |
Food retailers around schools |
Adiposity (SR) |
At 1km having any food retailer associated with decreased OR of OW, and at 5km access to any retailer decreased odds of OW |
| School Grounds: Physical activity | |||||||
| Cardon (2008) | CS | Belgium | 783 (39) | 4-5y | Grounds size and facilities |
PA (M) | Fewer children per m2 was associated with increased step counts in boys and girls. Presence of hard surface play areas increase step counts for boys |
| Cohen (2008) | CS | USA | 1566 (36) |
6th Grade (11-12y) Girls |
Grounds size and facilities |
PA (M) | More facilities associated with increased MVPA - an average increase of 3.88 minutes per additional facility |
| Cradock (2007) | CS | USA | 248 (10) | 7th-8th Grade (12-14y) |
Grounds size | PA (M) | Campus area, playground area and building area (all per child) associated with increase in vector magnitude equated to 20-30% over range of data |
| Dyment (2008) | CS | Canada | na (59) | Elementary schools (5-14y) |
“greening” of grounds |
PA (SR) | Highest proportion of children engaged in VPA in turf and asphalt areas. Greened areas supported more LPA. Teacher perception that PA levels increased after greening. |
| Fernandes (2009) | L | USA | 8935 (ng) |
5th Grade (10-11y) |
Grounds components |
PA (M) | Having a gymnasium associated with 8.29 minutes more PE per week. No associations between school facilities and BMI trajectory |
| Fjørtoft et al 2010 |
CS | Norway | 81 (2) | 14y | Landscape elements/areas |
PA (M) | GPS showed most break-time movement (of generally low intensity PA) close to school buildings. Highest intensity PA clustered around the ball game areas |
| Lanningham-Foster (2008) | I | USA | 40 (1) | 4th Grade (9-10y) |
Class-room design |
PA (M) | Mean activity significantly higher in The Neighbourhood than in either traditional classroom (mean activity = 115 (neighborhood), and 71 in both traditional classrooms. |
| Nichol (2009) | CS | Canada | 7638 (154) |
Grades 6- 10 (11-16y) |
Grounds components |
PA (SR) | Odds of being active increased at school with a playing field (boys), a poor quality gym (junior schools), poor or good quality gym (boys), poor or good quality field (girls), and good quality field (elementary schools). |
| Ridgers (2007) | I | UK | 470 (26) | Elementary schools (5-11) |
Intervention: grounds re- design |
PA (M) | Post-intervention increase seen in MVPA and MPA at intervention schools - increasing by 4.5% and 2.3% respectively. Intervention effect was larger among younger children |
| Sallis (2001) | CS | USA | ng (24) | Middle schools (11-14y) |
Grounds components |
PA (OB) | Environmental characteristics explained 59% (boys) and 42% (girls) of the variation in proportion engaging in MVPA. Most boys active in courts with high supervision, higher proportion of girls active were high levels of equipment and supervision |
| Willenberg (2010) | MM | Australia | 3006 (23) |
Primary schools (5-12y) |
Grounds components |
PA (OB) | More VPA observed in areas with loose equipment and teacher supervision. MPA highest in areas with fixed play equipment. Children identified soft surfaces as most suitable for more intense PA due to safety concerns |
| School Facilities: Physical activity | |||||||
| Durrant (2009) | CS | USA | 165 (ng) | 12-18y | PA facilities | PA, Adiposity (SR) |
No associations between school factors and TV viewing nor BMI. School equipment index not associated with overall PA nor school-based PA |
| Haerens (2006) | I | Belgium | 2287 (15) |
11-15y | Adiposity (M) |
Significant intervention effect seen for girls in intervention plus parental support group only; BMI and BMI z-score increased less in this group than control or intervention alone. No effect seen for boys. | |
| Haerens (2007) | I | Belgium | 258 (15) | 11-15y | PA facilities added |
PA (M) | Significant intervention effect seen for intervention plus parental support group only. |
| Haug (2008) | CS | Norway | 1347 (68) |
Grade 8 (12-13y) |
PA facilities | PA (SR) | Odds of daily activity increased at schools with more facilities, and by having open field, Outdoor obstacle course, playground equipment and a cardio/weight equipment room |
| Haug (2010) | CS | Norway | 16471 (130) |
Grades 4- 10 (8-15y) |
PA facilities | PA (SR) | For older boys odds of PA were increased by presence of: soccer field, areas for hopscotch/skipping, playground equipment, a sledding hill and more facilities generally. Last two significant for older girls |
| McKenzie et al 2010 |
CS | USA | ng (13) | Elementary schools (4-11y) |
PA facilities | PA (OB) | Odds of engaging in MVPA were higher in areas with loose play equipment. Greater participation in MVPA was also observed in unsupervised areas compared to supervised ones. |
| Nielsen et al 2010 |
CS | New Zealand |
417 (7) | 5-12y | Playground area and PA facilities |
PA (M) | School-time and overall PA (average cpm) increased with increasing number of facilities. No relationship seen with grounds size after adjustment for number of facilities. |
| Stratton (2000) | I | UK | 60 (2) | 5-7y | playground markings added |
PA (M) | % recess time in MVPA increased in the intervention group and decreased in the control group. Intervention effect significant for MVPA and VPA, but no main effect differences |
| Stratton (2005) | I | UK | 99 (8) | 4-11y | playground markings added |
PA (M) | MVPA and VPA increased significantly at intervention schools. No significant age or gender interactions with the intervention |
| Taylor et al 2011 |
CS | New Zealand |
441 (16) | Years 2 and 4 (6- 9y) |
PA facilities | PA (M) | Positive association between number of facilities and both total PA (cpm) and MVPA |
| Thompson (2001) | Q | USA | 180 (9) | 3rd-5th grades (8-11y) |
PA facilities | PA (OB) | Staff identify lack of facilities as a barrier to children’s PA. |
| van Sluijs (2010) | CS | UK | 1908 (92) |
Year 5 (9-10y) |
PA facilities and policies |
PA (M) | Less SA at schools with ‘Park & Stride’, more MPA at schools with lollypop person and better walking provision. More VPA at schools with more medium/good quality PA facilities and pedestrian training, lower VPA at schools with policy promoting PA |
| Verstraete (2006) | I | Belgium | 235 (7) | 5th-6th grades (10-12y) |
PA facilities added |
PA (M) | Significant increases seen in intervention group in % time spent in MPA, but not in VPA nor LPA. Interactions showed intervention effect only significant among girls. |
| School Facilities: Food | |||||||
| Caballero (2003) | I | USA | 1409 (41) |
2nd Grade (7-8y) |
Food service (and policy/ed) changes |
Adiposity, diet (M) |
No intervention effects observed in adiposity measures. Observer-measured % energy from fat decreased significantly in the intervention, and not control schools. |
| Carson (1999) | I | USA | ng (1) | Kindergarten (5-6y) |
Veg garden with/without nutrition ed |
Diet (M) | Increase in willingness to taste and identification of fruit and veg as ‘best snacks’, and increases in fruit and veg recognition. |
| Cullen (2004) | L | USA | 581 (5) | 4th-5th Grades (9-11y) |
Move from elementary to middle school |
Diet (SR) | For those moving to middle school consumption of fruit, veg and milk decreased, and high fat veg and sweetened drinks increased. For those at middle school throughout high-fat veg and milk consumption increased and veg and sweetened drinks decreased |
| Davee (2005) | I | USA | na (7) | High schools (14-18y) |
n/a | Diet (OB) | Changes to VM contents widely accepted, but resistance from staff and students to changes in ALC programs. No results reported on adiposity nor diet measures |
| Fox (2009) | CS | USA | 2228 (287) |
1st-12th Grades (6-18y) |
Food availability and outlets |
Adiposity (SR) |
No significant associations with BMI/weight status in high schools. In middle schools LNED foods in ALC associated with lower BMI but LNED from VMs associated with higher BMI. In elementary schools serving french fries and desserts ≥ once a week associated with higher odds of obesity. |
| French (2001) | I | USA | na (20) | High schools (14-18y) |
VM promotion and pricing changes |
Diet (OB) | Increase in price reductions of low-fat snacks associated with increases in sales. Promotional signage was weakly associated with increases in low-fat snack sales. |
| Haerens (2007) | I | Belgium | 2840 (15) |
11-15y | Increased fruit accessibility (plus ed) |
Diet (SR) | For girls only fat intake and % energy from fat decreased in all three groups, but significantly more in the intervention plus parent input group. |
| Kubik (2003) | CS | USA | 598 (16) | 7th -8th Grades (12-14y) |
Food availability and outlets |
Diet (SR) | At schools with ALC programs, pupils ate fewer servings of fruit and fruit and veg, and had higher percentage energy intake from total fat and saturated fat. Increasing numbers of VMs were associated with decreased fruit consumption |
| Luepker (1996) | I | USA | 5106 (96) |
3rd Grade (8-9y) |
Food service (and policy/ed) changes |
Adiposity, diet (OB) |
Greater increase in energy consumption among control schools. Energy from fat decreased at intervention schools, but not at control schools. Dietary cholesterol decreased at interventions and increased at controls. No intervention effects seen for adiposity measures. |
| McAleese (2007) | I | USA | 122 (3) | 10-13y | Veg garden with/without nutrition ed |
Diet (SR) | Significant intervention effect seen for ed plus gardening group. This group saw greatest increase in fruit and vegetable consumption (increasing by over one portion of each a day) as well as vitamin A and Fibre. |
| McKinley (2005) | Q | UK | 106 (11) | Year 7 (11-12y) |
Diet (SR) | Cost, time and effort, and choice/availability all identified as barriers to healthy eating. Foods identified as ‘healthy’ seen to be not as filling, tasty or good value as ‘unhealthy’ foods | |
| Morris (2002) | I | USA | 213 (3) | 4th Grade (9-10y) |
Veg garden with/without nutrition ed |
Diet (M) | Significant intervention effect for nutritional knowledge and veg preference scores. Veg preference scores varied by type of vegetable |
| Morris (2001) | I | USA | 97 (2) | 1st Grade (6-7y) |
Veg garden with nutrition ed |
Diet (M) | No significant intervention effect on nutritional knowledge nor vegetable preference, but students at intervention school more likely to be willing to taste different veg after intervention |
| Neumark-Sztainer (2005) | CS | USA | 1088 (20) |
9th-12th Grades (14-18) |
Food availability and outlets |
Diet (SR) | Children allowed off site at lunch time ate significantly more at fast food restaurants and snack food consumption increased with increasing numbers of snack VMs |
| Prell (2005) | I | Sweden | 228 (3) | 8th Grade (14-15y) |
Food service (with/without ed) changes |
Diet (OB) | The % of children eating fish at lunchtime increased in both intervention groups, and decreased in the control, however the effect was only significant among the SL + HE group. |
| Wiecha (2006) | CS | USA | 1684 (10) |
6th -7th Grades (11-13) |
Food availability and outlets |
Diet (SR) | Children reporting using VMs reported consuming more sugar sweetened beverages. |
Abbreviations: ALC = a la carte program, AT = active travel, CS = cross-sectional, ed = education, I = Intervention, L = Longitudinal, LNED = Low nutrient energy dense (food), M = Measured, MM = Mixed-methods, MPA = Moderate physical activity, MVPA = moderate-to-vigorous physical activity, na = not applicable, ng = not given, OB = Observed, Obs = obese, OR = odds ratio, OW = overweight, PA = physical activity, Q = Qualitative, SA = sedentary activity, SES = socio-economic status, SR = self-reported, VM = Vending machine, VPA = vigorous physical activity
a
Measures of the school environment. Some papers also investigated home environments, which are not included here.