Students In Intervention Schools Research Articles

“Water First” School Water Promotion and Access Intervention: A Cost Analysis Study

BackgroundAdequate water intake is associated with improved cognitive and physical performance, prevention of dental caries, and overweight and obesity. However, access to free drinking water in schools remains inadequate. Water First, a school-based intervention promoting water consumption, was shown effective in preventing overweight, yet its costs have not been quantified. ObjectiveTo evaluate the costs of Water First from the school's perspective over one academic year. DesignSecondary analysis of a cluster-randomized clinical trial assessing the cost of Water First. Participants/SettingSix public schools in the San Francisco Bay Area in the 2018-2019 academic year, with an average of 578±69 students per school and 110±2 fourth-grade students in intervention schools, and 508±190 students per school and 101±5 fourth-grade students in control schools. InterventionSchools were randomized to receive water dispensers and stations in cafeterias and high-traffic areas and a schoolwide water promotion campaign (school-level intervention). Fourth-grade students and teachers received reusable water bottles, lessons, and materials for school and home (class-level intervention). Main outcome measuresActivities, resources, and the value needed to implement the school- and classroom-level intervention were systematically captured over one academic year, including labor, materials, and utilities costs. Statistical analysisThe intervention costs per school and per student were estimated by summing the component-specific costs. Results are presented for both school- and classroom-level interventions in 2023 USD. ResultsThe Water First intervention costs $20 per student for the school- and $131 per student for the classroom-level intervention over one academic year. Accounting for the useful life of the installed water stations and dispensers beyond one year, the annualized cost of the school-level intervention was $11 per student. ConclusionsThese cost estimates provide useful insights for schools and stakeholders to plan and implement effective school-based interventions that promote access to drinking water.

Effects of the informed health choices secondary school intervention after 1 year: a prospective meta-analysis using individual participant data

BackgroundCritical thinking about health choices is essential to avoid being misled by unreliable information and to use reliable information appropriately. The aim of this prospective meta-analysis was to synthesize the results of 1-year follow-up data from three cluster-randomized trials of an intervention designed to teach lower secondary school students to think critically about health choices. Only one other randomized trial has evaluated a school-based intervention to teach adolescents to think critically about health choices. That trial compared two teaching strategies to teach statistical reasoning. It did not assess long-term learning-retention.MethodsWe conducted the trials in Kenya, Rwanda, and Uganda. The intervention included providing a 2–3-day teacher training workshop and digital resources for ten lessons. The intervention focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥ 9 of 18 multiple-choice questions answered correctly). We performed random effects meta-analyses to estimate the overall intervention effects. We calculated learning retention as the test results in the intervention schools after 1 year relative to just after the intervention, adjusted for chance.ResultsAltogether, 244 schools (11,344 students) took part in the three trials. Follow-up data was collected for 8298 students (73%). The overall odds ratio for the primary outcome after 1 year was 3.6 (95% CI: 1.9–7.1; p = 0.0001) in favor of the intervention, whereas it was 5.5 (95% CI: 3.0–10.2) just after the intervention. This corresponds to 25.6% (95% CI: 21.1–30.0%) more students in the intervention schools passing the test after 1 year versus 33.3% (95% CI: 28.7–37.8%) just after the intervention. Overall, 2273 (52.6%) of 4324 students in intervention schools had a passing score after 1 year compared to 3397 (58.1%) of 5846 students just after the intervention, indicating 88.3% learning retention.ConclusionsOne year after the intervention, we still found a positive effect on the ability of students to think critically about health choices, but 5.5% fewer students in the intervention schools had a passing score. The certainty of the evidence was also lower due to 27% of students being lost to follow-up.Trial registrationThe protocol for this prospective meta-analysis was registered with PROSPERO May 31, 2022, ID 336580. The three randomized trials were registered in the Pan African Clinical Trial Registry February 15, 2022, PACTR202203880375077; April 5, 2022, PACTR20220488391731; and April 14, 2022, PACTR202204861458660.

Encouraging STEM Careers among Minoritized High School Students: The Interplay between Socio-Environmental Factors and Other Social Cognitive Career Constructs

Performance in math, particularly algebra, is a major barrier to student success and participation in STEM among under-represented minoritized students, particularly Black U.S. high school students. This research applies social cognitive career theory (SCCT) to measure the impacts of an afterschool algebra for engineering program on math self-efficacy and interest in STEM among high school students in a large urban district. To study the program’s effects, a mixed methods research design was used where schools were assigned to either treatment or control conditions. Students in treatment schools accessed algebra for engineering modules, STEM professional role model videos, and field trips, while students in control schools accessed role model videos and field trips only. Surveys measuring math self-efficacy and STEM interest, outcome expectations, and choice goals were completed by participants in both conditions at the beginning and end of two separate program years, 2021–2022 and 2022–2023. Across both years, quantitative results suggest some positive effects of participation, particularly for STEM choice goals, but benefits depend upon student participation levels. Qualitative data offer student voice around prior experiences in math and science and the development of postsecondary plans in STEM. In combination, the results suggest that for students who do not initially identify as STEM career-bound, afterschool programming may not necessarily promote preparation for STEM careers due to an accumulation of weak math and science school experiences and other socio-environmental influences.

Incentivising Textbooks for Self-Study: Experimental Evidence from the Democratic Republic of the Congo

Abstract We designed and randomly evaluated the impact of textbooks for a self-study scheme in eastern areas of the Democratic Republic of the Congo targeting student achievement in primary schools. Students in treatment schools were 7 percentage points more likely to pass the national exam, and those who passed obtained higher scores. We also evidence higher scores on a French language test. The effects are primarily driven by student interest in textbooks, frequency of doing homework and motivation to go to school and continue education. Student achievement can thus be improved by intensified and diversified use of existing learning materials in poor and fragile settings.

Assessing the Pragmatic Effectiveness and Implementation of Click City: Tobacco: A School-Based Prevention Program Targeting Youth Cigarette and E-cigarette Use.

Given the rapid increase in the prevalence of e-cigarette use among youth, we updated Click City: Tobacco, an existing, efficacious, online tobacco prevention program for 5th graders with a 6th-grade booster, to also target e-cigarette use. To evaluate the effectiveness of the updated 5th-grade program within a "real world" setting, we conducted a pragmatic randomized trial with 5th-grade students in 43 schools across Arizona and Oregon, assessing change in intentions and willingness to use e-cigarettes/cigarettes, from baseline to one-week post-intervention. Students in intervention schools (n = 1327) received the updated version of Click City: Tobacco; students in control schools (n = 1346) received their usual tobacco prevention curriculum. Students in intervention schools significantly decreased their intentions and willingness to use e-cigarettes and cigarettes, compared to students in control schools. The intervention also significantly changed all targeted etiological mechanisms predictive of intentions and willingness. The intervention was more effective for at-risk students, as defined by student's previous tobacco use, current family use of tobacco, and/or high in sensation-seeking. The effects of the intervention on all outcomes were similar as a function of state, gender, ethnicity, and historical timing (before COVID-19 pandemic school closures vs. after schools re-opened). Close to 90% of the students in the intervention condition completed the entire program, supporting fidelity of implementation, and teachers reported satisfaction with the program. Findings suggest that Click City: Tobacco is effective for all 5th-grade students and can be delivered with fidelity across school settings. The results of a randomized pragmatic effectiveness trial showed that the updated Click City: Tobacco program decreased intentions and willingness to both vape e-cigarettes and smoke cigarettes among 5th-grade students, particularly for those at high risk. Program effectiveness and lack of differences because of factors such as state, gender, ethnicity, and historical timing have universal implications, suggesting that all students can benefit from this program. Click City: Tobacco received high ratings of program satisfaction from teachers and was implemented with fidelity. Findings suggest that Click City: Tobacco is effective and can be easily implemented in schools.

Effects of the Informed Health Choices secondary school intervention: A prospective meta-analysis.

The aim of this prospective meta-analysis was to synthesize the results of three cluster-randomized trials of an intervention designed to teach lower-secondary school students (age 14-16) to think critically about health choices. We conducted the trials in Kenya, Rwanda, and Uganda. The intervention included a 2- to 3-day teacher training workshop, digital resources, and ten 40-min lessons. The lessons focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥9 of 18 multiple-choice questions answered correctly). We performed random effects meta-analyses to estimate the overall adjusted odds ratios. Secondary outcomes included effects of the intervention on teachers. Altogether, 244 schools (11,344 students) took part in the three trials. The overall adjusted odds ratio was 5.5 (95% CI: 3.0-10.2; p<0.0001) in favor of the intervention (high certainty evidence). This corresponds to 33% (95% CI: 25-40%) more students in the intervention schools passing the test. Overall, 3397 (58%) of 5846 students in intervention schools had a passing score. The overall adjusted odds ratio for teachers was 13.7(95% CI: 4.6-40.4; p<0.0001), corresponding to 32% (95% CI: 6%-57%) more teachers in the intervention schools passing the test (moderate certainty evidence). Overall, 118 (97%) of 122 teachers in intervention schools had a passing score. The intervention led to a large improvement in the ability of students and teachers to think critically about health choices, but 42% of students in the intervention schools did not achieve a passing score.

Peer learning can modify the reciprocal relationship between peer support and victimization in middle school.

This research investigated how peer victimization and support are reciprocally related and how Cooperative Learning (CL) can reverse the progressive cascade that, unchecked, can culminate in youth mental health problems. The sample (N = 1890; 53% male) was derived from a randomized trial of CL in 15 middle schools in the United States. Students were recruited in the 7th grade. Structural Equation Modeling (SEM) was used to fit our cross-lag difference score model across four waves of data. The results indicated a reciprocal relationship between peer support and victimization across time, suggesting the potential for negative experiences with peers to become amplified over time in a "vicious cycle," negatively impacting mental health. Students in intervention schools reported significantly higher levels of peer support and lower levels of victimization, suggesting that CL can intervene in this cycle, with salutary effects on mental health; CL also demonstrated direct effects on mental health. The present study indicates that low peer support can be both a precursor to and an outcome of victimization, serving to maintain a vicious cycle that compounds negative effects on student mental health. Further, results demonstrate how CL can reverse this cycle. We conclude that CL can be of particular importance to the prevention field as a universal mental health program that does not require the associated stigma of identifying youth at elevated risk for referral to treatment programs.

Efficacy of the Virtual Reality Intervention VR FestLab on Alcohol Refusal Self-Efficacy: A Cluster-Randomized Controlled Trial.

It is currently unknown whether a virtual social environment can support young people in building their skills to overcome peer pressure when offered alcohol. This study evaluated the efficacy of the newly developed virtual reality simulation game VR FestLab on the refusal self-efficacy regarding social pressures to drink of Danish male and female students aged 15–18. VR FestLab features a party setting where adolescents can “steer” their own party experience. Eleven schools were included in a cluster-randomized controlled trial and allocated to either the intervention (n = 181) or the active control group (n = 191). Students in intervention schools played VR FestLab, while those in the control group played the VR game Oculus Quest—First Steps. The primary outcome measure was the social pressure subscale of the drinking refusal self-efficacy scale (DRSEQ-RA). The intervention effects were measured immediately after the intervention/control session (T1) and after a 6-week follow-up (T2). Data were examined using linear mixed regression models. Our study did not demonstrate a significant effect of drinking refusal self-efficacy at T1. For all secondary outcomes, we observed no substantial differences between the intervention and control groups. This study provides new insights into the feasibility and effectiveness of an innovative virtual reality alcohol prevention tool. VR FestLab can be an innovative and promising contribution to complement existing school-based alcohol prevention, but more research is needed to improve its effectiveness.

Bystander Program to Reduce Sexual Violence by Witnessing Parental Intimate Partner Violence Status

Youth who witness parental intimate partner violence are at increased risk for sexual violence. Existing data from a cluster RCT were used to determine the effectiveness of Green Dot bystander intervention to reduce sexual violence among high-school students who did and did not witness parental intimate partner violence. A secondary analysis was conducted in 2021 of extant data from a 5-year cluster RCT. A total of 26 high schools in Kentucky were randomized to intervention or control condition in 2010. A total of 15,863 surveys were analyzed from baseline, 30,014 from partial intervention implementation (Years 1 and 2), and 25,907 from full implementation (Years 3 and 4). The sample was stratified to include students who witnessed or did not witness parental intimate partner violence. The bystander intervention program was delivered in 2 stages. During partial implementation, a persuasive speech describing rates, risk factors, and bystander-based approaches to violence prevention was provided to most students in schools randomized to the intervention. During full implementation, an in-depth 5-hour skill-based bystander training was provided to popular opinion leaders among the students in intervention schools (10%-15%). The primary outcome was sexual assault measured as perpetration and victimization. Secondary outcomes included sexual harassment and stalking, measured as victimization and perpetration. During full implementation, among students who witnessed parental intimate partner violence, the intervention was associated with significant reductions in sexual assault perpetration (β= -0.21, p<0.01), sexual harassment perpetration (β= -0.29, p<0.001), sexual assault victimization (β= -0.25, p<0.01), and sexual harassment victimization (β= -0.45, p<0.001). For students who did not witness parental intimate partner violence, the intervention was only associated with reductions in sexual harassment (β= -0.19, p<0.001) and stalking (β= -0.09, p<0.01) victimization. As implemented in the parent RCT, the bystander training was more effective at reducing violent outcomes among those who witnessed parental intimate partner violence than in those who did not witness parental intimate partner violence. This study is registered at www. gov, under identifier NCT01878097.

The role of students’ interests during computer-assisted learning: A field experiment

The present paper examined the effect of adjusting learning material to the out-of-school interests of students. In particular, using a field experiment involving 1449 secondary school students in 31 Flemish schools, we evaluated the effectiveness of the instructional method “example choice” in a computer-assisted financial education program. Example choice allowed students to choose between contexts potentially more aligned with their out-of-school interest, which in turn determined the backdrop examples for exercises in the computer-assisted program. Schools were randomly assigned to a control or treatment condition. While students in both the control and treatment schools received the computer-assisted program, example choice was added only to the program for students in treatment schools. Results show that example choice did not increase students' financial knowledge. Despite the well-established psychological belief that students’ interest in an academic topic can be instilled by the educator or the learning environment, example choice did not affect the interest of the average student in the financial topic. Moreover, example choice even led to significant motivational deficits for students with low perceived competence.

O5 Seeing the “Bigger Picture”: Impact of an Arts-Focused Type II Diabetes Education Program

<h3>Background</h3> Traditional health education efforts rarely align with youth social justice values. The Bigger Picture (TBP), a public health literacy campaign that uses spoken word art to promote health, leverages a social justice approach to activate youth around the social determinants of type 2 diabetes (T2D). <h3>Objective</h3> We examine the impact of TBP on health-related mindsets and expectations; sense of belonging; and civic engagement among youth in urban, low-income high schools. <h3>Study Design, Setting, Participants</h3> In this cluster-randomized study students from 3 high schools received a T2D-related arts-based program and students from 3 comparison schools received a non-health related arts-based program. Both programs were delivered in classrooms and extracurricular clubs over the course of 3 semesters (with the final semester modified due to coronavirus-related school closures). <h3>Measurable Outcome/Analysis</h3> We conducted interviews with adults (n = 32; 27 unique participants) and youth (n = 15) from both intervention and comparison schools who participated in programming. In addition, we performed a content analysis of student poems (n = 10) related to T2D in intervention schools. <h3>Results</h3> Students in both intervention and comparison schools listed factors like genetics, sugar consumption, diet, income, and neighborhood access to nutrition and physical activity as contributors to T2D. In more cases, however, students in intervention schools were able to draw connections between race/ ethnicity and poor access to basic health-promoting resources. Students in both programs had a high sense of belonging at school and confidence in civic engagement. One instance of T2D-related civic engagement was reported in intervention schools. Content analysis of TBP students' poems revealed youth's detailed understanding the role that government and corporate influence, access, individual behavior, and sociocultural factors play in developing T2D. <h3>Conclusion</h3> Future studies might explore program scalability, and how the integration of civic engagement opportunities into TBP curriculum might impact student's capacity to actively participate in creating social positive change around the social determinants of T2D.

Bystander Intervention Efficacy to Reduce Teen Dating Violence Among High School Youth Who Did and Did Not Witness Parental Partner Violence: A Path Analysis of A Cluster RCT

Youth who witness parental intimate partner violence (IPV) are at increased risk of teen dating violence (DV). This analysis of secondary data investigated whether a bystander intervention program, Green Dot, was effective at reducing physical and psychological DV victimization and perpetration among youth who had and had not previously witnessed parental IPV. The parent RCT assigned 13 schools to control and 13 schools to the Green Dot intervention. Responses from 71,797 individual surveys that were completed by high school students were analyzed across three phases of a 5-year cluster randomized control trial. Multigroup path analyses revealed that students in intervention schools who witnessed parental IPV had a reduction in psychological (p < .001) and physical DV (p < .01) perpetration and psychological DV victimization (p < .01) in Phase 2 of the intervention, while those who did not witness parental IPV had a significant reduction in psychological DV victimization (p < .01). Individuals in the intervention received more training (p < .001), which was associated with lower levels of violence acceptance (p < .001). Violence acceptance was positively associated with DV victimization and perpetration (p < .001), especially for individuals who previously witnessed parental IPV. Green Dot is an effective program at reducing DV victimization and perpetration among the high-risk group of youth who previously witnessed parental IPV, largely operating through violence acceptance norms. This underscores the bystander intervention approach as both a targeted and universal prevention program.

The development and impact of team-based school technology leadership

PurposeThe authors tested the efficacy of a team-based instructional leadership intervention designed to increase middle school mathematics and science teachers' use of educational technologies for multiple representations of content to foster students' conceptual understandings. Each school's leadership team comprised an administrator, a technology instructional specialist role, and a mathematics and a science teacher leader.Design/methodology/approachThe authors tested the intervention in a quasi-experimental design with five treatment and five matched comparison schools. Participants included 48 leadership team members and 100 grade 6–8 teachers and their students. The authors analyzed data using two-level, nested multiple regressions to determine the effect of treatment on leaders' practices; leaders' practices on teachers' learning and integration; and teachers' learning and integration on students' learning. Leaders and teachers completed monthly self-reports of practices; students completed pre- and post-tests of knowledge in science and math.FindingsSignificant treatment effects at the leader, teacher and student levels establish the efficacy of this team-based approach to school leadership of an educational technology integration innovation. Leaders at treatment schools participated in a significantly higher total frequency and a wider variety of leadership activities, with large effect sizes. Teachers participated in a significantly wider variety of learning modes focused on technology integration and integrated technology significantly more frequently, with a wider variety of technologies, all with moderate effect sizes. Students in treatment schools significantly outperformed students in comparison schools in terms of science achievement but not in mathematics.Research limitations/implicationsThe overall sample size is small and the approach to participant recruitment did not allow for randomized assignment to the treatment condition. The authors tested the influence of treatment on leader practices, on teacher practices, and on student achievement. Future work is needed to identify the core components of treatment that influence practice and investigate the causal relationships between specific leaders' practices, teacher practices and student achievement.Originality/valueThis study establishes the efficacy of a replicable approach to developing team-based instructional leaders addressing educational technology. It contributes to the knowledge base about how district leaders and leadership educators might foster school leaders' instructional leadership, and more specifically technology leadership capacity.

Centrality-Based Spillover Effects

We study the role of social network structure in peer-to-peer educational spillovers by leveraging a two-year field experiment in primary schools in rural Bangladesh. We implement a randomized educational intervention--the provision of free after-school tutoring--offered to a random subsample of students in treatment schools. We exploit the experimentally induced across-classroom variation in the centrality of treated students to provide the first causal evidence of centrality-based spillover effects. We find that a one standard deviation (SD) increase in the average centrality of treated students within a classroom leads to improvements in the test scores of their untreated classmates of 0.57 SD in English and 0.62 SD in math. Further evidence indicates that more central students have higher academic ability, better social skills, and interact more with classmates on matters related to learning, which suggests that they can be more influential for their peers. In addition, we offer the private tutoring intervention to the most central students on a separate group of schools. We find that this targeted approach provides larger educational benefits both for treated and untreated students than the policy that treats a random subset of students. We conclude that targeting the most central students in a network to offer an intervention can be a cost-effective way to improve the educational outcomes of all students in a classroom.

Post-secondary education and information on labor market prospects: A randomized field experiment

We examine the impact of an information intervention offered to 97 randomly chosen high schools on post-secondary education applications and enrollment in Finland. Graduating students in treatment schools were surveyed and given information on the labor market prospects associated with detailed post-secondary programs. We find that students who were the most likely to update their beliefs due to the intervention started to apply to programs associated with higher earnings. However, this subgroup is too small to give rise to a statistically or economically significant impact on the overall application or enrollment patterns.

Longer Term Impact of Bystander Training to Reduce Violence Acceptance and Sexism

ABSTRACT Many bystander programs to prevent violence have been developed and evaluated in college populations. An exception is the randomized controlled trial of Green Dot, found effective in reducing violence rates and violence acceptance in 26 high-schools (2010–2014). In ‘Life’s Snapshot’, 10,727 seniors were recruited from these same schools with the goal of determining the longer-term efficacy of bystander training. Students in intervention schools could have up to three years of Green Dot exposure. Seniors from intervention versus control schools had significantly lower scores (p <.01) indicating less violence acceptance or sexism for two of five measures. Seniors’ self-reports of bystander training received confirmed these findings. These cross-sectional analyses suggest that some reductions in violence acceptance associated with bystander programming may be maintained into early adulthood.

The Toll of Turnover: Network Instability, Well-Being, and Academic Effort in 56 Middle Schools

This article examines whether network instability—namely, the extent of turnover in a person’s social network over time—is a distinct social process that affects individual well-being. Using a unique two-wave network data set collected in a field experiment that involved more than 21,100 students across 56 middle schools, we find a strong negative association between network instability and well-being and academic effort at the individual level, independent of other types of network change effects. We assess whether the negative effect of network instability remains when the source of instability is exogenous, the result of participation in the randomized intervention. Network instability leads to negative consequences even in this context, negatively impacting students who directly participated in the intervention. For nonintervention students in treatment schools, the intervention stabilized their social networks. We discuss the implications of these findings for studies of social networks and collective action.

Effectiveness of the GoActive intervention to increase physical activity in adolescents aged 13–14 years: a cluster randomised controlled trial

BackgroundAdolescent physical activity levels are low and are associated with rising disease risk and social disadvantage at increasingly early ages. We aimed to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) in adolescents. MethodsIn this cluster randomised controlled trial, non-fee-paying, co-educational schools including Year 9 students (aged 13–14 years) in Cambridgeshire or Essex, UK, were eligible for inclusion; within participating schools, all Year 9 students were eligible. Schools were computer-randomised (1:1) to either the control or intervention group, stratified by school-level pupil premium (below vs above county-specific median) and county (Cambridgeshire vs Essex). Measurement staff were masked to allocation; investigators were not masked because of necessary school contact. The iteratively developed, feasibility-tested and refined 12-week intervention trained older adolescents (mentors) and in-class peer leaders to encourage classes to undertake two new weekly activities. Training sessions consisted of an initial session between facilitators and mentors lasting at least 1 h followed by six 30 min meetings every week during the first six weeks and meetings approximately every 2 weeks thereafter. Mentors met with peer leaders weekly. Students and classes gained points and rewards for activity in and out of school. The primary outcome was mean daily minutes of accelerometer-assessed MVPA at 10 months post-intervention, assessed in the complete case population (ie, all students who had a 10-month post-intervention measurement and [in the intervention group] wore the accelerometer) under the intention-to-treat principle, and in the per-protocol population (ie, students who also reported weekly class activities and logged points). Ethical approval was granted from the University of Cambridge Psychology Ethics Committee (PRE.126.2016). This study is registered with the International Standard Randomised Controlled Trials registry, number ISRCTN31583496. FindingsOf 103 eligible schools, 16 enrolled in the study. 2862 Year 9 students were eligible, of whom 1319 were in the eight control schools (mean of 165 [SD 62] students per school) and 1543 were in the eight intervention schools (mean 193 [SD 43] per school; intraclass correlation coefficient=0·03 for school-level MVPA). 2167 (76%) of 2862 students had a 10-month post-intervention measurement; we analysed the primary outcome in 1874 participants (65%) due to expected low levels of accelerometer wear (871 [66%] in control schools; 1003 [65%] in intervention schools); analyses were adequately powered to detect an effect. At 10 months, time spent doing MVPA did not differ significantly between adolescents at intervention schools versus those at control schools (mean difference –1·91 min [95% CI –5·53 to 1·70]; p=0·32). In the per protocol population (285 students in intervention schools and 871 in control schools at 10 months), results were similar (mean difference –1·87 min [–6·80 to 3·06]; p=0·47]). InterpretationThe rigorously developed school-based GoActive intervention was no more effective than standard school practice at increasing adolescent physical activity. Authorities should be cautious about commissioning and proliferating school-based health promotion strategies and realistic about expectations of effect. FundingUK National Institute for Health Research (NIHR) Public Health Research Programme (13/90/18).

An Efficacy Study of a Ninth-Grade Early Warning Indicator Intervention

Building on previous research showing how well ninth-grade student behaviors predict on-time high school graduation, this experimental study investigates the impact of a ninth-grade intervention on student attendance and course passing. The study, conducted in 41 geographically and demographically diverse high schools within a single state, evaluates the effects of placing a half-time staff member in high schools to implement the Early Warning Intervention (EWI) Team model designed to monitor ninth-grade early warning indicators and provide timely interventions. Analyses based on the pre-specified student outcomes of attendance rate and percentage of ninth-grade course credits earned indicated no statistically significant impact of the intervention. On secondary outcome variables, results indicated that students in treatment schools were significantly less likely than control school students to be chronically absent. The difference between treatment and control school students on dichotomous measures of course failure were not statistically significant. The widespread dissemination of research and best practices related to early warning systems and ninth-grade interventions likely accounted for low levels of contrast between treatment and control school practices and outcomes.

Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children

BackgroundStudies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV’s cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV’s cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue.MethodsWe performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015–2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses.ResultsThe overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8%) and secondary schools (48.2%) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2%) and secondary schools (2.5%). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and $86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools -- decreasing substantially in secondary schools. (to $53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean = $45.48). Also, these estimates were higher than our 2009–2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015–2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness.ConclusionsSLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination.Trial RegistrationClinicalTrials.govNCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017).