Table 5.

Applicability reporting of observational school audit tool studies.

ID		Does tool relate to a policy, program or ongoing intervention study?	Are tool limitations described?	Are future/potential uses of the tool described?	Are results or analyses reported to schools or districts?	Do authors provide a “call to action” for schools based on findings?	Total Items Reported
1	ACTION! Staff Audit	Formative research for ACTION! (group randomized staff wellness study)					1
2	Adachi et al, 2013		Some information cannot be described, including: calorie content, comparing water to flavored water, replacement frequency, or sold out status			Be aware that vending machines are still prevalent, and a potent source of both energy-dense, low-nutrient calories as well as advertising to students	2
3	Belansky et al, 2013	School Environment Project (pair randomized study to test two strategies for wellness environment and policy changes through a university-school partnership in Colorado)	May lack generalizability (only used in rural schools)			Appoint staff champions to coordinate/monitor changes; involve administrator in school-university-partnership, support changes that will improve student behavior	3
4	Branding Checklist		Small sample size			Provides six strategies for schools/districts to develop school nutrition brand personality; school professionals should be trained to implement strategies	2
5	Co-SEA	COMPASS (longitudinal, quasi-experimental study of how changes in programs, policies, and built environments relate to child behaviors and health in Canada)	Measurement error may have occurred when assessing condition of facilities	Photo-taking aspect can inform future methods; Could harmonize data collection across school based studies for generalizability	All schools receive School Health Profiles, which include school-specific data, evidence-based recommendations, and contact information to take action		4
5.1	Co-SEA (Unadapted)		Should have been adapted with unique consideration of Guatemalan school culture	Can use in other countries; recommend adaptation and translation due to school differences across countries	All schools receive School Health Profiles, which include school-specific data, evidence-based recommendations, and contact information to take action	Increase availability of free drinking water, and decrease access, restrict marketing, and enforce sale legislation on sale of sugar-sweetened beverages	4
6	EAPRS	School Grounds as Community Parks study (quasi-experimental study of schoolyard renovations in Cleveland, Ohio)	Some confusion with scale items; subjective items had poor reliability; dynamic items not captured; lack variability; may lack generalizability	Could be adapted for parks or playgrounds in other regions to create more user-friendly PA spaces at school; establish predictors of park use			3
7	ENDORSE	ENDORSE (Environmental Determinants of Obesity in Rotterdam Schoolchildren, prospective 2-year study in adolescents)	Crude constructs of availability; cross-section; possible non-sensitive categorization; no gold standard to test validity				2
8	Food Decision Environment Tool		As a result of tailoring, it may lack generalizability to other settings where choice points may be different	Useful approach to identify targets for research and intervention planning that is aimed toward improving quality of children’s food choices			2
9	GRF-OT	Aligned with Playworks (nonprofit organization aiming to help schools create recess and play environments for all children)	Framework represents an adult view of recess quality and does not get child perspective; reliability data limited to one large urban public school district.	Could be used to evaluate CDC and SHAPE America recess initiatives nationwide, to ensure consistency and inclusivity of key context variables			3
10	Hecht et al, 2017						0
11	ISAT	International Study of Childhood Obesity, Lifestyle, Environment (ISCOLE) (cross-sectional, lifestyle correlates of childhood obesity in 12 countries)	Possible “ceiling effect” with amount of equipment; tool does not record aesthetic qualities; inter-rater only reliability measure	Use of single tool across many countries can facilitate global work to promote healthy school environments		Shift focus from increasing facilities and sports to addressing other drivers of PA (e.g., PE and fitness programs, active breaks and curriculum, etc)	4
12	Laurie et al, 2017	South African National School Nutrition Program’s Sustainable Food Production in Schools (SFPS) pillar				Seek outside support to sustain gardens, and links should be created to improve consistency and training, increase garden size, production, equipment, management	2
13	LCFO	Healthy Communities Study (longitudinal study of associations between community programs and policies and child/adolescent behaviors and health across USA)	Single day of observation may not fully reflect whether school meets USDA meal standards				2
14	PARA (Adapted)	Healthy Communities Study (longitudinal study of associations between community programs and policies and child/adolescent behaviors and health across USA)					1
14.1	PARA (unadapted)	Mixed methods cross-sectional study to identify environmental influences on children’s physical activity and diet in rural communities/schools	Small sample size, only in rural schools	Also used for other neighborhood physical activity resources (e.g., parks, trails, etc)		Consider low-cost ways to make environment health-promoting (e.g., walking school bus, exercise breaks); provide age-appropriate and fun games at recess	4
15	Patel et al, 2009	Community-academic partnership’s evaluation of Los Angeles School District’s 2005 Cafeteria Improvement Motion (aims to increase NSLP participation, improve school meal marketing)	Qualitative analysis limits quantification of results; small sample size	Other community-academic teams, including school policy stakeholders, should conduct similar site visits to assess policies are implemented as intended	Enabled community-academic partnership to determine priorities for program to help LAUSD translate Cafeteria Improvement Motion into practice	School-specific actions taken as a result of the findings include: creating larger signs to display menu, ordering pre-sliced fruit, offering free, chilled water	5
16	School Food Environment Scan	Let’s Move Salad Bars to Schools Initiative	May lack generalizability (only used in schools with high concentration of African American students)			Consider promotion and placement to increase salad bar use; Address individual factors that may lead to use	3
17	School Lunchroom Audits	National School Lunch Program requirements and Smarter Lunchroom strategies	Single point-in-time audit			To better implement Smarter Lunchrooms, schools need to improve provider engagement and buy-in	3
18	SF-EAT	Think&EatGreen @School Alliance (community-university research alliance), provincial guidelines for food and beverage sales in British Columbia, Canada	May lack generalizability (only Vancouver public schools); scoring process not designed to track small differences; cross-sectional	Schools could use as a needs assessment to understand engagement in each domain and/or determine future actions; Could modify for other local or national contexts or priorities using similar development process		School stakeholders should communicate frequently about a clear definition of sustainable food, and develop policies that incentivize and train food service workers to promote sustainable food use	4
19	SNDA-III	2004 Child Nutrition and WIC Reauthorization Act (federal act require schools to have local wellness policies)	Did not investigate the hours when vending machines were accessible to students			Districts should include specific policy language to prohibit certain foods/beverages in all school areas, and work with food and nutrition professionals	3
20	SNEO	Louisiana Health (randomized controlled trial to test efficacy of two multi-component, school-based childhood obesity prevention interventions)	Small sample size	Methods can be useful in developing future process evaluation measures, and expanding to include dose and reach			3
21	SPACE Checklist	Active Living (study encouraging PA in primary school children in Southern Limburg, Netherlands)	Limited variation was found for schoolyard characteristics			Ensure presence of fixed equipment and opportunities to use that equipment, consider amount/type of green space to incorporate, expand open hours	3
22	SPAN-ET	Federal policies, best practices, and SNAP-Ed priorities	May lack generalizability (small rural sample); not able to correlate findings with actual child behavior	Could repeat beyond Oregon to assess ability to detect change between schools; could pair with annual behavioral surveillance data to help schools meet national agendas	Tailored results were presented to school stakeholders by extension educators in various formats, including best practice resources specific to “poor” categories	Tailored calls-to-action (and accompanying resources) were provided for each school depending on their scores	5
23	SPEEDY	SPEEDY (Sport, Physical Activity and Eating Behavior: Environment Determinants in Young People, cohort study to understand patterns of influence on diet/PA among children)	Not sensitive to between-school variability; some subjectivity; hard to differentiate sports; no loose equipment captured; Kappa not good for binary items				3
23.1	SPEEDY (Adapted; Dias et al, 2017)s		Only addresses one factor related to environment (structures), only cross-sectional			Schools should have spaces with good structural conditions to favor planned activities, which can increase student PA	2
23.2	SPEEDY (Adapted; Harrison et al, 2016)	SPEEDY study (4-year follow-up)	No reliability or validity for middle school, (items may be less relevant and others may be missed); no loose equipment or access policies captured				2
23.3	SPEEDY (Adapted; Tarun et al, 2017)		May lack generalizability (only private schools); no focus on indoor areas; reliability/validity not re-tested for Indian schools			Need multi-pronged policy approach to promot PA, including schools supporting curricula with PA time, investing in and maintaining grounds equipment and space	2
23.4	SPEEDY (Unadapted; Chalkley et al, 2018)	Marathon Kids UK (primary school-based running program delivered by Kids Run Free and Nike)			Protocol indicates that findings will be shared with schools and other stakeholders at a joint dissemination event		3
23.5	SPEEDY (Unadapted; Hyndman and Chancellor, 2017)		No loose equipment captured; school leaders knew of the visit so may have prepared outdoor areas			Schools should address differences between primary and secondary, provide opportunities for social and non-competitive active play, update garden features, facilities, surface type	2