Table 5.

Group D: Community, afterschool, or extracurricular interventions that trained adults.

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
Dubuy, 2014 1 [33]	Health Scores!	10–14 years old (n = 605), Flanders, Belgium	Professional football players hosted a start clinic and end clinic prior to and at the conclusion of the classroom-based portion of the intervention (see Group A)	While the professional athletes did not receive formal training from the research staff, the football clubs were responsible for organizing the start and end clinics, and athlete promotion of healthy behaviors was a key part of the intervention. At the clinics, the professional athletes participated in activities with the youth that encouraged a healthy diet and physical activity and handed out lifestyle contracts that youth signed. Athletes also filmed two video messages that were shown to the youth at school and sent two letters reminding students of the importance of eating healthy and being active.	4 month in-school curriculum bookended by the start and end clinics with a professional football team	Outcome: changes in dietary habits, frequency of breakfast consumption, eating attitudes and self-efficacy, and physical activity levels. Process: youth satisfaction with professional athlete clinics, response to videos and letters and overall satisfaction with the program See Table 1 for results
Gittelsohn, 2013 2 [40]	Baltimore Healthy Eating Zones	10–14 years old (n = 242), Baltimore, MD	Public health graduate students	2-day initial training with periodic booster sessions. Once trained, they visited rec centers and corner stores participating in the intervention at least weekly and offered cooking classes at rec centers. Also worked with cross-peer educators at each rec center site (see Group E).	Four phases, each 10 weeks long. Interventionists and cross-age peers were to hold one session per week at rec centers.	Process: reach and dose measured against implementation standards developed by the research team.
Irwin, 2012 1 [46] +1 paper [47]	Get Fit with the Grizzlies	4th and 5th grade (n = 888), Memphis, TN	Memphis Grizzlies players and staff	While athletes did not receive formal training, they participated as role models in the intervention by making visits to assemblies in participating schools and hosting an achievement day for youth who completed the program.	6-week mini-unit incorporated into PE curriculum; one lesson taught per week. Players, dancers and/or the mascot for the Memphis Grizzlies visited the schools for an assembly, and there was a district-wide Get Fit with the Grizzlies Achievement Day at Grizzlies home arena at the end of the program.	Outcome: changes in knowledge, eating behaviors, and physical activity habits. See Table 1 for results
Kohlstatdt, 2016 2 [52] +1 paper [53]	NutriBee	4th–7th grade (n = 179), New Mexico, Michigan, Maryland and Guam	School teachers and health professionals. Intervention was conducted in afterschool or weekend clubs, or in camp settings	Received 1–3 h of experiential in-person instruction designed to parallel the format of the intervention itself, including a culminating game show. Also received an instructor training manual and informational video. After completion of the intervention, instructors received a stipend and certificate	10 2-h modules delivered across varying time frames ranging from 4 days (in camp settings) to 1 month (club that met once/week)	Outcome: changes in dietary knowledge, intentions, outcome expectations, self-efficacy, and dietary intake. Results: Selection of dried and fresh fruit and bottled water increased, and consumption of sugary sports drinks decreased. Process: measured dose, fidelity, and acceptability. Results: Acceptability was based on appropriateness of difficulty and appropriateness of length. Scores ranged from 1.5 to 1.8 out of a maximum of 2.
Linton, 2014 [58]	Youth Engagement and Action for Health (YEAH!)	Age range was 9–22 years across all groups: 6 middle school, 6 high school, 8 community center groups and 1 church youth group (n = 136), San Diego, CA	Adult mentors/ leaders of youth groups in a variety of settings (after-school programs, community organizations, religious organizations) who are interested in nutrition or physical activity- related community advocacy projects.	Training is a half-day session that covers gathering necessary resources for the project, conducting a community assessment of factors related to healthy eating and/or active living, identifying community decision makers, and advocacy. Adult leaders receive the YEAH! manual as part of the training and have access to ongoing technical support from the Sand Diego County Childhood Obesity Initiative throughout their projects.	Groups are run independently, and length varies by project; average was 9 sessions over a 10-week period. With guidance from an adult mentor, youth groups assess their food and built environment, prioritize problems identified in the assessment, and develop and implement an action plan to advocate with decision makers for change in their community.	Outcome: changes in attitude, perception of control, self-efficacy, readiness to act as social change advocates and health behavior. Process: retention of youth throughout project, number of meetings with decision makers. Results: 73% of youth participants across all groups remained engaged throughout their group’s project. 19 of 20 groups in the evaluation had in-person meetings or presentations with decision makers. 11 groups reported changes in the community as a result of their work, and 4 reported pending changes.
Luesse, 2019 [60]	In Defense of Food afterschool curriculum	6th–8th grade (n = 32), New York, NY	Afterschool program teachers	Before the start of the intervention, afterschool teachers received a 2-h professional development training on the curriculum. Two weeks into the intervention, teachers received an additional 1-h follow-up training. They also had access to support as needed throughout the intervention period.	10 weeks, one 2-h afterschool session each week. The curriculum is divided into 3 units of 3 lessons each and a final culminating lesson.	Outcome: changes in dietary intake, outcome expectations, self-efficacy, self-regulation skills and autonomous motivation. Results: There was a significant increase in fruit and vegetable intake post- intervention. Qualitative: assessment of student understanding and ability to apply “food rules” from each lesson and semi-structured interviews with youth to better understand target outcomes. Results: Youth best understood “rules” related to drinking water and moderation. In interviews, youth noted that the social and physical environment made it difficult to decrease consumption of processed foods even when they desired to do so.
Molaison, 2005 [62]	Qualitative study that examined factors that mediate fruit and vegetable consumption among southern, low-income black adolescents to aid in planning an intervention	10–13 years old (n = 42), 2 counties in the lower Delta region of Mississippi	Graduate students and research staff who were of the same ethnic or racial background as the youth.	3-day workshop provided training in standardized focus group methods.	Focus groups were conducted with youth enrolled in the 5-week National Youth Sports Program. Groups were segmented by gender and age: 10–11, 12, and 13, for 6 groups total. Each focus group met once during the 5-week summer program session.	Qualitative: focus group transcripts were coded, and themes were identified. Results: Taste and method of preparation were major factors limiting fruit and vegetable consumption, especially for vegetables. Additional limiting factors were lack of availability of fruits and vegetables at home or in neighborhood stores and limited control over their food options. Most had family support for fruit and vegetable consumption, but not peer support.
Tucker, 2015 1 [70]	Let’s Go 5-2–1-0 childhood obesity prevention intervention delivered by school nurses plus 1:1 or small group coaching by nursing students	4th and 5th grade (n = 72), Location not specified; corresponding author affiliated with University of Iowa	Nursing students Intervention also included classroom component with school nurses (see Group A)	Training was provided in the 5-2–1-0 curriculum, basic motivational interviewing (MI) principles for behavior change, and role modeling healthy behavior. Training included a didactic portion, role playing, and use of videos. At one nursing school, training consisted of an initial 4-h session followed by weekly sessions of practice and role plays. At the other nursing school, a 2-h training session was provided.	The intervention ran from September to April in one school and January to April in the other school. School nurses delivered the Let’s Go 5-2–1-0 curriculum weekly during classroom instructional time in 10–15 increments. Dosage varied from 14–21 sessions. Nursing students had lunch with their assigned student/students once a week to discuss curriculum content and set goals for intervention topics.	Outcome: changes in anthropometric measurements, physical activity levels, nutrition, family eating patterns, and screen time. See Table 1 for results
Wright, 2012 [71]	Kids Nutrition and Fitness	8–12 years old (n = 251), Los Angeles, CA	An advanced practice nurse, registered nurses, a physical education specialist, and community health workers (some of whom were parent volunteers)	Training took place in a full-day, in-person session that covered all intervention protocols, including culturally relevant information and examples for the nutrition education component. Retraining was provided on an as-needed basis if instructors were not following the intervention protocol during session observations.	6-week afterschool program with weekly 90-min sessions. Students were recruited and went through the program in waves of 14–28 at a time. Beyond the curriculum, the intervention also included school and community-level activities, including physical and mental health services through local clinics.	Outcome: changes in anthropometrics, dietary behaviors, food preferences, knowledge, and self-efficacy Results: Self-reported intake of fruit, vegetables and 100% fruit juice increased significantly at post-intervention and was sustained at 12-month follow-up. Process: intervention fidelity assessed by session observations, focus groups with parents.
Zhou, 2019 1 [72] +1 paper [73]	Chinese Childhood Health, Activity and Motor Performance Study (Chinese CHAMPS) with both in-school and afterschool components	7th grade (n = 680), Beijing, Wuhu, and Weifang, China	Afterschool program staff Intervention also included classroom component with PE teachers (see Group A)	1-day training focusing on adolescent growth and development, designing age-appropriate physical activities, and instructional methods. Training facilitators demonstrated activities, and staff then had the opportunity to practice.	8-month intervention. The afterschool portion of the intervention added 45 min of moderate to vigorous physical activity (MVPA) 2 days a week, provided fitness and nutrition education, and bi-weekly text messages to students.	Outcome: Changes in physical fitness, anthropometrics, cognitive function, food habits and preferences, knowledge, and physical activity. Process: fidelity and dose received through periodic monitoring of sessions by research staff.

¹ Also included in Group A. ² Also included in Group E.