Table 3.
Group B: Classroom-based interventions that trained cross-age peers.
| Author, Year |
Intervention Name or Description | Population Characteristics: Grade Level/Age (Sample Size), Location |
Group Receiving Training | Training Design | Intervention Frequency and Duration | Evaluation Indicators and Notable Results |
|---|---|---|---|---|---|---|
| Arlinghaus, 2017 1 [21] |
School-based obesity prevention program with compañeros | 6th and 7th grade (n = 506), Houston, TX |
High school students—“Compañeros” (based on the “promotoras” model of using peer health workers in the Hispanic community. |
Cross-age peer leaders were trained daily for two weeks on intervention activities. In addition to the curriculum, they were trained to be able to identify strengths and weaknesses in their own eating habits and given ideas for how to engage in conversation with middle school students about healthy diet and activity habits. Training included opportunities to practice initiating conversations about the curriculum using different scenarios. They were also trained in providing praise and modeling healthy behavior. Throughout the intervention, they discussed the topic of focus with the PE teacher (see Group A) prior to each class and received regular feedback and support from the PE teacher. |
Intervention was delivered during middle school students’ regularly scheduled PE class period for 6 months; 50 min a day, 5 days a week. One day each week focused specifically on healthy eating. | Outcome: change in anthropometrics; only students with BMI percentile at or above 85% at baseline (n = 189) were included in the analysis. Process: fidelity of implementation and a random assessment of 10% of classes to record frequency of positive reinforcement and constructive feedback. |
| El Rayess, 2017 [35] |
Mark, Set, Go! | 5th and 6th grade (n = 954), Providence, RI |
High school students in an experiential learning program that includes community internships | Cross-peers received an orientation and weekly training session. Training covered classroom management, small group teaching strategies, and a review of the material. | 9-week program (frequency of lessons not specified) |
Outcome: changes in knowledge, dietary behaviors, anthropometrics, and physical activity Results: There was a significant decrease in the percentage of students reporting drinking soft drinks and juice at least once a day. In subgroup analysis, there was a significant decrease in both categories for girls and for students with overweight or obesity. |
| Foley, 2017 [38] |
Students As LifeStyle Activists (SALSA) | Year 8 (same as U.S. 8th grade) *Focus of the study was the cross-age peers; subject number for year 8 students not available. Western Sydney, Australia |
Year 10 students (n = 415) |
Cross-age peers were trained by university students from health and education disciplines who worked themselves had received educator training from the project staff. The Year 10 students were trained to deliver the intervention in a one-day workshop and were given a scripted manual to use as a guide for delivering the intervention. As part of the training, students practiced delivering the lessons in front of one another. |
Four 70-min lessons delivered to a Year 8 class by a small group of 4–6 cross-age peer educators. Length of time between first and fourth lesson varied (mean 25 days +/- 15.9) | Outcomes for cross-age peers: changes in dietary behaviors, physical activity, screen time and intention to change. Results: At follow-up, a significantly higher proportion was meeting recommendations for daily fruit and vegetable intake and drinking less than 1 cup of sugary beverages daily. Process: acceptability among cross-age peers Results: 91% would recommend the program to their peers; goal setting, leadership and teaching emerged as important themes, and 42% discussed program themes at home. |
| Lo, 2008 2 [59] |
Fluids Used Effectively for Living (FUEL) | Grade 9 (n = 113), Saskatchewan, Canada |
University students (worked with same-age peers from the target population, see Group C) | Two-week training intensive that oriented the cross-age peers to the content and also aimed to build teamwork among them. Cross-age peers also provided leadership for the same-age peers. | Six-week program, one 45-min session each week | Outcome: changes in beverage intake, knowledge, and attitudes. Results: Significant decrease in SSB intake post-intervention, sustained through 3-month follow up among group with cross-age and same-age peers (three other comparison groups without peer educators did not show significant change). Process: participant satisfaction with content and delivery of the program. Results: 71% enjoyed the intervention and 77% would suggest it to others. |
1 Also included in Group A. 2 Also included in Group C.