Hoelscher 2010.

Study characteristics
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: elementary schools Region: 4 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 included fourth 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 programmes targeted by the intervention The objective of this CATCH programme was to target multiple aspects of the school environment, including the classroom, nutrition services and the cafeteria environment, PE activities, family and home environment, and, via school health promotion messages and events, the broader school community. This trial compared 2 versions of the CATCH programme, the CATCH BP and the CATCH BPC. The CATCH BPC included all components of the BP programme; however, schools were provided with additional support for building school and community partnerships and local decision‐making and capacity building related to PA and healthy eating promotion. Implementation strategies CATCH BP: EPOC: educational meetings ‐ Co‐ordinated school health CATCH training and booster training sessions. EPOC: educational materials ‐ CATCH programme materials, CATCH component co‐ordination 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 included all of 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 programme 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 programmes Continuous ‐ CATCH parent and extracurricular activities ‐ CATCH co‐ordinated healthy eating‐related activities ‐ CATCH co‐ordinated PA‐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 fourth grade classroom teachers and CATCH SPAN student questionnaire. Validity of measures used: not reported/self‐report methods. However, the authors commented that the teacher and Champion measurement tools were based on previous instruments used to measure the dissemination of the CATCH programme. The student survey used was modified from the SPAN study. The dietary intake, activity and process measures were self‐reported, all the measures were adopted from previous work by the study investigators and had demonstrated face validity, and had been evaluated for reproducibility. Outcome relating to cost: not reported Outcome relating to adverse consequences: not reported Outcome relating to child diet, PA 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 PA. 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 PA:SOFIT Validity of measures used Weight status: validated: standard protocols were followed by trained and certified research staff. Dietary intake: student survey used was modified from the SPAN study. Activity behaviours: student survey used was modified from the SPAN study. PA:valid
Notes	Research funding: 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 programme. 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 did 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 was no mention that allocation was concealed and, therefore, were at high risk of selection bias.
Blinding of participants and personnel (performance bias) Implementation outcome	High risk	Outcome group: there was 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) Implementation outcome	High risk	Outcome group: school‐level observations and teacher and student surveys provided process measures. It was 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) Implementation outcome	Low risk	Outcome group: there were no school dropouts reported.
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	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.
Overall risk of bias assessment	High risk	Most domains were at low or unclear risk of bias.