Heath 2002.

Study characteristics
Methods	Trial name: El Paso Coordinated Approach to Child Health (El Paso CATCH) Study design: non‐randomised Intervention duration: 1997–2000 Length of follow‐up from baseline: 3 years Differences in baseline characteristics: not reported Unit of allocation: schools Unit of analysis: schools
Participants	School type: elementary schools Region: participants were 24 elementary schools from 5 school districts in West Texas and Eastern New Mexico. Demographic/socioeconomic characteristics: El Paso, Texas, a region dominated by the Mexican culture and low‐income families. Inclusion/exclusion criteria: not reported Number of schools allocated: 24 (20 intervention, 4 control) 4 schools served as controls, with the remaining 20 schools enrolled in the El Paso CATCH programme. 16 schools had baseline PA measures and 12 had baseline school meal assessments. PA behaviour during PE classes was assessed in third, fourth and fifth grades for 16 intervention schools and in third grade only for 4 intervention and the 4 control schools. Grades 3, 4 and 5 were reflected in school meal assessments for all schools. All but 2 schools (1 control and 1 intervention school) had PE with certified PE instructors. In these 2 schools, classroom teachers conducted PE for third grade only. Numbers by trial group n (controls baseline) = 4 n (controls follow‐up) = 4 n (interventions baseline) = 20 n (interventions follow‐up) = 20 Recruitment: not reported Recruitment rate: not reported
Interventions	Number of experimental conditions: 2 (1 intervention, 1 control) Policies, practices or programmes targeted by the intervention CATCH intervention was delivered at school level to: Food service: ‐ To reduce the total fat content of food served to 30% ‐ To reduce the total sodium content to 600–1000 mg per serving Implementation strategies EPOC: educational meetings ‐ Staff received training sessions to deliver CATCH EPOC: educational outreach visits ‐ Staff received ongoing support visits to implement EATSMART/CATCH PE EPOC: educational materials ‐ Educational materials were provided to staff/schools. Smart choices manual was provided to all schools. Theoretical underpinning: Social Learning Theory and Organisational Change Description of control: not reported but assume usual practice
Outcomes	Outcome relating to the implementation of school service policies, practices or programmes ‐ % fat in breakfast ‐ Sodium (mg) in breakfast ‐ % fat in lunch ‐ Sodium (mg) in lunch Data collection method: for both control and CATCH schools, school breakfast and lunch menus and their recipes were collected for 5 consecutive days during each semester in every year of the study. Recipes for these menus were obtained by interviewing cooks and kitchen managers in school cafeterias and by reviewing the cafeteria production sheets for each meal. Foods from the menus, production sheets and recipes were entered into a nutritional database that is especially useful for ethnic foods (ESHA Research Inc, Salem, Ore). Once the nutrient content of the meals was analysed, means of breakfast and lunch values across the 5 days of data collection were obtained. Validity of measures used: not reported/self‐report methods Outcome relating to cost: cost‐effectiveness analysis reported Outcome relating to adverse consequences: not reported Outcome relating to child diet, PA or weight status: BMI, waist‐to‐hip ratio and weight Data collection method: anthropometry was conducted in the late autumn or early spring semester (November, December, January or February) of each year of the project. ≥ 3 people were trained to collect these measurements. Validity of measures used: anthropometry was valid. Each person's measurements were compared with an experienced technician's values (the trainer), and reliability was established at a minimum of r = 0.90 for all measures before data collection.
Notes	Note: this trial also contained a PA component as part of their policy, practice or programmes implemented; however, the trial was downgraded to a nutrition trial only as it did not report implementation outcomes for PA or in some instances, the direction and magnitude of effect was not known. Research funding: Patient Care and Outcomes Research Award programme from the American Heart Association (9970182N) and the Paso del Norte Health Foundation, El Paso, Texas. Conflicts of interest: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Non‐randomised. 4 schools that were beginning the CATCH programme in 1999 were randomly selected and then 4 control schools that were not in the CATCH programme were selected by matching them to the intervention schools for district, relative location, number of PE teachers, number of cafeteria staff, size of third‐grade classes and size of school overall.
Allocation concealment (selection bias)	High risk	Non‐randomised. Intervention schools were in the CATCH programme while control schools were not in the CATCH programme. High risk of bias as no concealment of allocation.
Blinding of participants and personnel (performance bias) Implementation outcome	High risk	Outcome group: there was no blinding of participants or personnel described and performance is likely to be influenced by knowledge of group allocation.
Blinding of outcome assessment (detection bias) Implementation outcome	High risk	Outcome group: questionnaires were used to survey PE teachers, cafeteria staff and classroom teachers about the implementation of CATCH. There was no blinding of participants described and the outcome was likely to be influenced by the use of self‐reported questionnaires.
Incomplete outcome data (attrition bias) Implementation outcome	Low risk	Outcome group: no schools appeared to dropout.
Selective reporting (reporting bias)	Unclear risk	No study protocol, therefore, it was unclear if there was selective outcome reporting.
Other bias	Low risk	Appeared free from other bias.
Potential confounding	Unclear risk	Matched intervention and control schools for district, relative location, number of PE teachers, number of cafeteria staff, size of third‐grade classes and size of school overall. However, it is unknown whether all potential confounders were measured.
Overall risk of bias assessment	High risk	Most domains were at high risk of bias.