Hoelscher 2010.

Methods	Trial name: Travis County Coordinated Approach To Child Health (CATCH) Trial. Study design: Non‐randomised. Intervention duration: 4 years. Length of follow‐up from baseline: 1 year. Differences in baseline characteristics: Not reported. Unit of allocation: Schools (elementary). Unit of analysis: Classroom and students (elementary).
Participants	School type: Schools (elementary). Region: Four school districts in Travis County, Texas, USA. Demographic/socioeconomic characteristics: 53% female; 61% Hispanic, and 14% African American; and mean age of 9.9 years. Inclusion/exclusion criteria: ‐ Schools that include 4th grade classes. ‐ ≥ 60% of school composition of economically disadvantaged students. Number of schools allocated: 30. Numbers by trial group: n (controls baseline) = 15 (CATCH BasicPlus (BP) Group). n (controls follow‐up) = 15 (CATCH BP group). n (interventions baseline) = 15 (CATCH BasicPlus and Community (BPC) group). n (interventions follow‐up) = 15 (CATCH BPC group). Recruitment: Not reported. Recruitment rate: Not reported.
Interventions	Number of experimental conditions: 2 (1 intervention, 1 control). Policies, practices or programs targeted by the intervention: The objective of this CATCH program was to target multiple aspects of the school environment, including the classroom, nutrition services and the cafeteria environment, physical education (PE) activities, family and home environment, and, via school health promotion messages and events, the broader school community. This trial compared two versions of the CATCH program, the CATCH BP and the CATCH BPC. The CATCH BPC included all components of the BP program however schools were provided with additional support for building school and community partnerships and local decision making and capacity building related to physical activity (PA) and healthy eating promotion. Implementation strategies: CATCH BP: EPOC: Educational meetings: ‐ Coordinated school health CATCH training and booster training sessions. EPOC: Educational materials: ‐ CATCH program materials, CATCH component coordination kit and supplemental health promotion resources. EPOC: Local consensus process: ‐ CATCH Committee Meetings. EPOC: Pay for performance: ‐ CATCH Awards Program (recognition and funds for CATCH). EPOC: The use of information and communication technology: ‐ School social marketing efforts. EPOC: Educational outreach visits: ‐ CATCH facilitator support visits (1 visit/4–6 weeks). EPOC: Other: ‐ Family Fun night activities/events. CATCH BPC: All the above strategies plus: EPOC: Educational outreach visits: ‐ Additional CATCH facilitator visits (2–3 visits/4–6 weeks). EPOC: Educational meetings: ‐ CATCH Community “Best Practices” workshops (3/year). EPOC: Local consensus process: ‐ Community member required on CATCH Committee and CATCH Community “Best Practices” workshops (3/year). EPOC: Other: ‐ CDC School Health Index used as planning tool. EPOC: Educational materials: ‐ School program and community health promotion activity guide. Theoretical underpinning: Elements of Social Ecological Theory and Social Cognitive Theory. Description of control: Low‐income schools. They received the CATCH BP intervention. Alternate active implementation strategy.
Outcomes	Outcome relating to the implementation of school service policies, practices or programs: Continuous ‐ CATCH parent and extracurricular activities ‐ CATCH coordinated healthy eating–related activities ‐ CATCH coordinated physical activity–related activities ‐ Number of CATCH lessons taught ‐ Number of health lessons taught Dichotomous ‐ % Reporting CATCH lessons in schoolroom ‐ % Reporting that fruit usually served at lunch Data collection method: Structured interview with CATCH Champion, self‐administered questionnaire for 4th grade classroom teachers and CATCH SPAN student questionnaire. Validity of measures: Not reported/self‐report methods. However the authors comment that the teacher and Champion measurement tools were based on previous instruments used to measure the dissemination of the CATCH program. The student survey used was modified from the SPAN study. The dietary intake, activity, and process measures were self‐reported, all of the measures were adopted from previous work by the study investigators and have demonstrated face validity, and have been evaluated for reproducibility. Outcome relating to staff knowledge, skills or attitudes: Not reported. Outcome relating to cost: Not reported. Outcome relating to adverse consequences: Not reported. Outcome relating to child diet, physical activity or weight status: Height, weight and BMI measurements along with student‐level dietary intake concerning their unhealthy food intake, food index score, fruit and vegetable intake and sweetened beverage consumption, sedentary behaviour and physical activity. Data collection method: Weight status: Weight measurements were collected using a Tanita BWB‐800S scale; a Perspectives Enterprise stadiometer was used to measure height. BMI was calculated using the standard formula, and BMI percentiles were calculated using the CDC 2000 growth charts. Dietary intake: Student questionnaire. Activity behaviours: Student questionnaire. Physical Activity: SOFIT. Validity of measures used: Weight Status: Validated: Standard protocols were followed by trained and certified research staff. Dietary Intake: The student survey used was modified from the SPAN study. Activity Behaviours: The student survey used was modified from the SPAN study. Physical Activity: Valid.
Notes	Research funding: Supported by funding from Michael & Susan Dell Foundation. Conflicts of interest: Some authors received funding from Flaghouse, Inc. and the Michael & Susan Dell Foundation for development, dissemination and evaluation of the CATCH program. The University of Texas School of Public Health receives royalties based on sale of CATCH curriculum, of which 100% goes back into further research and development. The University of Minnesota receives royalties from Flaghouse, Inc. based on sale of CATCH curriculum materials, of which a portion is paid as royalties to the investigators. The remaining authors declared no conflict of interest.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Non‐randomised trial as it does not appear that the schools were randomised to experimental group. 15 CATCH BPC schools were matched to 15 similar low‐income CATCH BP schools by ethnicity and percentage economic disadvantaged.
Allocation concealment (selection bias)	High risk	Non‐randomised trial and there is no mention that allocation was concealed and therefore at high risk of selection bias.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Outcome group: There is no mention that participants or personnel were blinded to experimental group allocation and therefore risk of performance bias is high.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Outcome group: School‐level observations and teacher and student surveys provided process measures. It is not reported that observers or participants were blinded to group allocation and therefore the risk of detection bias is high.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Outcome group: There was no school dropout reported.
Selective reporting (reporting bias)	Unclear risk	There is no study protocol therefore it is unclear if there was selective outcome reporting.
Potential confounding	Unclear risk	CATCH BP and CATCH BPC schools were matched by ethnicity and percentage economic disadvantaged but it is unknown if there were other potential confounders that were not measured.