Sleep Duration, Mental Health, and Increased Difficulty Doing Schoolwork Among High School Students During the COVID-19 Pandemic.

We estimated the prevalence of short sleep duration (<8 h/average school night) among high school students (grades 9-12) during the COVID-19 pandemic by using data from the Adolescent Behaviors and Experiences Survey (January-June 2021; N = 7,705). An adjusted logistic regression model predicted prevalence ratios for more difficulty doing schoolwork during the pandemic compared with before the pandemic. Most (76.5%) students experienced short sleep duration, and two-thirds perceived more difficulty doing schoolwork. Students who slept less than 7 hours per school night or experienced poor mental health were more likely to report increased difficulty doing schoolwork. Addressing students' sleep duration could complement efforts to bolster their mental health and learning.

COVID-19 Trends Among School-Aged Children - United States, March 1-September 19, 2020.

Approximately 56 million school-aged children (aged 5-17 years) resumed education in the United States in fall 2020.* Analysis of demographic characteristics, underlying conditions, clinical outcomes, and trends in weekly coronavirus disease 2019 (COVID-19) incidence during March 1-September 19, 2020 among 277,285 laboratory-confirmed cases in school-aged children in the United States might inform decisions about in-person learning and the timing and scaling of community mitigation measures. During May-September 2020, average weekly incidence (cases per 100,000 children) among adolescents aged 12-17 years (37.4) was approximately twice that of children aged 5-11 years (19.0). In addition, among school-aged children, COVID-19 indicators peaked during July 2020: weekly percentage of positive SARS-CoV-2 test results increased from 10% on May 31 to 14% on July 5; SARS-CoV-2 test volume increased from 100,081 tests on May 31 to 322,227 on July 12, and COVID-19 incidence increased from 13.8 per 100,000 on May 31 to 37.9 on July 19. During July and August, test volume and incidence decreased then plateaued; incidence decreased further during early September and might be increasing. Percentage of positive test results decreased during August and plateaued during September. Underlying conditions were more common among school-aged children with severe outcomes related to COVID-19: among school-aged children who were hospitalized, admitted to an intensive care unit (ICU), or who died, 16%, 27%, and 28%, respectively, had at least one underlying medical condition. Schools and communities can implement multiple, concurrent mitigation strategies and tailor communications to promote mitigation strategies to prevent COVID-19 spread. These results can provide a baseline for monitoring trends and evaluating mitigation strategies.

Prevalence of children walking to school and related barriers-United States, 2017.

Children and adolescents can engage in an active lifestyle by walking to school; however, several barriers may limit this behavior. This study estimates the prevalence of walking to school and related barriers as reported by U.S. parents. Data from the 2017 SummerStyles, a Web-based survey conducted on a nationwide sample of U.S. adults, were analyzed in 2017. Parents of children aged 5-18 years (n = 1137) were asked whether their youngest child walked to or from school during a usual school week and what barriers make this difficult. Frequencies are presented overall and by parent characteristics. About 1 in 6 parents (16.5%) reported their youngest child walks to or from school at least once during a usual week. Prevalence differed by parental race/ethnicity, marital status, region, and distance from school. The most common barrier was living too far away (51.3%), followed by traffic-related danger (46.2%), weather (16.6%), "other" barrier (14.7%), crime (11.3%), and school policy (4.7%). The frequency at which parents reported certain barriers varied by their child's walking status, distance to school, age of youngest child, race/ethnicity, education level, household income, and metropolitan statistical area status. However, the relative ranking of barriers did not differ by these characteristics. Prevalence of walking to school is low in the U.S., and living too far away and traffic-related danger are common barriers reported by parents. Implementing Safe Routes to School programs and other initiatives that utilize strategies to overcome locally-relevant barriers could help increase the prevalence of children walking to school.

Do Schools That Screen for Body Mass Index Have Recommended Safeguards in Place?

The Centers for Disease Control and Prevention recommends that schools adopt 10 safeguards before launching a body mass index (BMI) screening program; however, little is known about schools' safeguard adoption. Authors identified questions from the 2014 School Health Policies and Practices Study that aligned with 4 of the 10 safeguards to estimate safeguard prevalence among schools that screened students for BMI (40.7%, N = 223). Among these schools, 3.1% had all four safeguards and 56.5% had none or one. The most prevalent safeguard was having reliable and accurate equipment (54.1%, 95% confidence interval [CI] = [46.1, 62.1]). Providing staff with appropriate expertise and training was the least prevalent; respondents in 26.4% (95% CI [17.1, 35.6]) of schools received recent training on weight status assessment, weight management, and eating disorder identification. School-based BMI screening is common, but adopting multiple recommended safeguards is not. Absent these safeguards, BMI screening programs may fall short of intended outcomes and potentially incur unintended consequences.

Evaluation of Let's Move! active schools activation grants.

Let's Move! Active Schools (LMAS), now Active Schools, is a national initiative in the United States (US) that aims to engage schools to increase students' opportunities to be physically active. This evaluation describes changes in school-level practices related to physical education (PE) and physical activity (PA) among schools that received an LMAS-partner grant from ChildObesity180 or Fuel Up to Play 60 (FUTP60). ChildObesity180 and FUTP60 asked grantee schools to complete nine common questions, between October 2013 and August 2014, before and after receiving the grants to assess progress in implementing practices for PE and PA. "Yes" responses indicated presence of PE/PA-supportive practices. For schools with complete pre and post data (n=972), frequencies of "yes" responses were calculated for each practice at pre/post. Schools receiving a FUTP60 partner grant reported statistically significant improvements from pre to post across five practices for PE and PA, and ChildObesity180 grantees reported significant increases on all practices except daily recess, which was already in place at 95% of schools at pre-survey. Schools across both grant programs reported the largest increases for promoting PA via messaging, implementing classroom PA breaks, and providing PA before and after school. Schools in both programs reported smaller, but statistically significant, increases in requiring the recommended minutes of PE. This study illustrates the feasibility of offering small grants, at a national scale, for schools to make changes that support PA throughout the day. Results suggest that schools can shift PA policies and practices over the course of a school year.

Trends in Beverage Consumption Among High School Students - United States, 2007-2015.

Beverages play an important role in the diets of adolescents because they help to maintain hydration and can provide important nutrients, such as calcium, vitamin D, and vitamin C (1). However, some beverages, such as sugar-sweetened beverages (SSBs) (e.g., soda or pop), provide calories with no beneficial nutrients. Beverage consumption patterns among American youth have changed over time; however, little is known about differences in consumption of various beverages by demographic characteristics such as grade in school, free/reduced price lunch eligibility, and race/ethnicity (2). CDC analyzed data from the 2007-2015 national Youth Risk Behavior Surveys (YRBS) to assess whether the prevalence of drinking non-diet soda or pop (soda), milk, and 100% fruit juice (juice) has significantly changed over time among U.S. high school students. During 2007-2015, daily soda consumption decreased significantly from 33.8% to 20.5%. During 2007-2011, daily milk and juice consumption did not significantly change, but during 2011-2015 daily milk and juice consumption decreased from 44.3% to 37.4% and from 27.2% to 21.6%, respectively. Although a decrease in daily soda consumption is a positive change, soda consumption remains high. Although there is not a specific recommendation for sugar-sweetened beverage consumption, the Dietary Guidelines for Americans 2015-2020 recommend that U.S. residents reduce sugar-sweetened beverage and sweet consumption to reduce intake of added sugars to less than 10% of calories per day. The Dietary Guidelines for Americans 2015-2020 recommend that persons choose beverages with no added sugars, such as water, in place of sugar-sweetened beverages, as one strategy for achieving the added sugars recommendation. Adolescents might need additional support in choosing more healthful beverages, such as low-fat milk, in place of SSBs.

Shared use agreements between municipalities and public schools in the United States, 2014.

Shared use agreements allow public use of school facilities during non-school hours. Such agreements can cover outdoor facilities alone or may be more comprehensive by also including indoor facilities. Our aim was to: 1) estimate the prevalence of shared use agreements and facility types covered among U.S. municipalities and 2) identify differences in prevalence by municipality characteristics. The 2014 National Survey of Community-based Policy and Environmental Supports for Healthy Eating and Active Living is a representative survey of US municipalities (n=2029). Data were analyzed using survey weights to create national estimates. Logistic and multinomial regression models determined odds ratios adjusting for municipality characteristics. Among 1930 municipalities with a school, 41.6% had a shared use agreement as reported by a local official, 45.6% did not, and 12.8% did not know. Significant differences in prevalence existed by population size, rural/urban status, poverty prevalence, median education level, and census region; however, after adjustment for other municipality characteristics significant differences remained only by population size, median education level, and census region. Among municipalities with a shared use agreement, 59.6% covered both outdoor and indoor facilities, 5.5% covered indoor facilities only, and 34.9% covered outdoor facilities only. Opportunities exist to expand the use of shared use agreements particularly in municipalities with small populations, lower education levels, and in the South, and to promote more comprehensive shared use agreements that include both indoor and outdoor facilities.

Depressive Symptoms and Weight Status Among Women Recently Immigrating to the US.

Objectives Depressive symptoms have been associated with obesity. Little is known about this relationship among immigrants. We examined relationships between depressive symptoms and weight status in immigrant women from three ethnic groups. Methods Participants were Brazilian, Haitian, and Latina women (n = 345) enrolled in Live Well, a community-based, randomized intervention designed to prevent weight gain in recent immigrants. Study data are from baseline when participants completed the Center for Epidemiological Studies Depression Scale (CES-D), Perceived Stress Scale, a physical activity questionnaire, and socio-demographic questions; BMI was calculated from measured height and weight. Results Forty-four percent of participants (36 % of Brazilians, 66 % of Haitians, 30 % of Latinas) had high depressive symptoms (CES-D ≥ 16), and 38 % (26 % of Brazilians, 49 % of Haitians, 42 % of Latinas) were obese (BMI ≥ 30.0). Those reporting more depressive symptoms were more likely to be obese (Wald Chi square = 4.82, p < .05). An interaction between depressive symptoms, ethnic group, and income was revealed (F(4,340) = 2.91, p < .05), such that higher depressive symptoms were associated with higher BMI among Brazilians earning ≥$30,000 per year and with lower BMI among Brazilians earning <$30,000. The relationship between depressive symptoms and obesity did not differ by income among Haitians or Latinas. Conclusions Depressive symptoms and obesity were highly prevalent among these recently-immigrated women. Positive relationships between these variables were consistent across ethnic and income groups, with the exception of lower-income Brazilians. While these findings suggest similar patterns and health needs across several groups of immigrants, cultural differences should be considered when addressing these health conditions.

School Factors Associated With the Percentage of Students Who Walk or Bike to School, School Health Policies and Practices Study, 2014.

INTRODUCTION: Active school transport, such as by walking or biking, increases physical activity levels, which has health and academic benefits for children. We examined school demographic and other characteristics to determine their association with the percentage of students who walk or bike to school. METHODS: We analyzed data from the Centers for Disease Control and Prevention's 2014 School Health Policies and Practices Study. The response rate for the module containing questions about transportation was 70% (N = 577). Multivariate logistic regression models examined whether certain school characteristics were associated with a school having 26% or more of students who walk or bike to school in the morning on an average school day. RESULTS: In most (61.5%) schools, 10% or fewer students walked or biked to school in the morning on an average school day; in 22.7% of schools, 26% or more students did so. Although having crossing guards (adjusted odds ratio [AOR] = 3.3; 95% confidence interval [CI], 1.9-6.0), having bicycle racks (AOR = 2.7; 95% CI, 1.2-5.8), and providing promotional materials to students or families on walking or biking to school (AOR = 2.9; 95% CI, 1.7-5.1) were associated with having 26% or more students who walk or bike to school, only 47.7% of schools had crossing guards, 62.4% had bicycle racks, and 33.3% provided promotional materials. CONCLUSION: Several low-cost or no-cost strategies were associated with having 26% or more students who walked or biked to school, but these strategies are not commonly used in schools.

Maternal employment, acculturation, and time spent in food-related behaviors among Hispanic mothers in the United States. Evidence from the American Time Use Survey.

Employment is a major factor underlying im/migration patterns. Unfortunately, lower diet quality and higher rates of obesity appear to be unintended consequences of moving to the US. Changes in food preparation practices may be a factor underlying dietary acculturation. The relationships between employment, acculturation, and food-related time use in Hispanic families have received relatively little attention. We used cross-sectional data collected from Hispanic mothers (ages 18-65) with at least one child <13 years old participating in the 2003-2011 American Time Use Survey (n = 3622) to estimate the relationship between employment, acculturation (US-born vs. im/migrant), and time spent in food preparation and family dinner. Regression models were estimated separately for the employed and the non-working and were adjusted for Hispanic origin group, socio-demographic and household characteristics. Working an eight-hour day was associated with spending 38 fewer minutes in food preparation (-38.0 ± SE 4.8, p < 001). Although being US-born was associated with spending fewer minutes in food preparation, this relationship varied by origin group. Acculturation did not appear to modify the relationship between hours worked and time spent in food preparation or family dinner. Mothers who worked late hours spent less time eating the evening meal with their families (-9.8 ± SE 1.3). Although an eight-hour workday was associated with a significant reduction in food preparation time, an unexpected result is that, for working mothers, additional time spent in paid work is not associated with the duration of family dinner later that day.

Vital signs: sodium intake among U.S. school-aged children - 2009-2010.

BACKGROUND: A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts. METHODS: Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6­18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009­2010. RESULTS: U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school­aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14­18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6­10 years or 11­13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%). IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%­50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75­150 mg per day and about 220­440 mg on days children consume school meals.

Healthier side dishes at restaurants: an analysis of children's perspectives, menu content, and energy impacts.

BACKGROUND: Children consume restaurant-prepared foods at high rates, suggesting that interventions and policies targeting consumption of these foods have the potential to improve diet quality and attenuate excess energy intake. One approach to encouraging healthier dietary intake in restaurants is to offer fruits and vegetables (FV) as side dishes, as opposed to traditional, energy-dense accompaniments like French fries. The aims of the current study were to examine: children's views about healthier side dishes at restaurants; current side dish offerings on children's menus at leading restaurants; and potential energy reductions when substituting FV side dishes in place of French fries. METHODS: To investigate children's attitudes, a survey was administered to a nationally representative sample of U.S. 8- to 18-year-olds (n = 1178). To examine current side dish offerings, children's menus from leading quick service (QSR; n = 10) and full service restaurant chains (FSR; n = 10) were analyzed. Energy reductions that could result from substituting commonly-offered FV side dishes for French fries were estimated using nutrition information corresponding to the children's menu items. RESULTS: Two-thirds of children reported that they would not feel negatively about receiving FV sides instead of French fries with kids' meals. Liking/taste was the most common reason that children gave to explain their attitudes about FV side dishes. Nearly all restaurants offered at least 1 FV side dish option, but at most restaurants (60% of QSR; 70% of FSR), FV sides were never served by default. Substituting FV side dishes for French fries yielded an average estimated energy reduction of at least 170 calories. CONCLUSIONS: Results highlight some healthy trends in the restaurant context, including the majority of children reporting non-negative attitudes about FV side dishes and the consistent availability of FV side dish options at leading QSR and FSR. Yet the minority of restaurants offer these FV sides by default. Promoting creative, appealing FV side dishes can result in healthier, less energy-dense meals for children. Substituting or displacing energy-dense default side dishes with such FV dishes show promise as part of continued, comprehensive efforts to increase the healthfulness of meals consumed by children in restaurant settings.

Healthy kids out of school: using mixed methods to develop principles for promoting healthy eating and physical activity in out-of-school settings in the United States.

INTRODUCTION: Widespread practices supporting availability of healthful foods, beverages, and physical activity in out-of-school-time (OST) settings would further obesity prevention efforts. The objective of this article was to describe principles to guide policy development in support of healthy eating and physical activity practices in out-of-school settings to promote obesity prevention. METHODS: The Institute of Medicine's L.E.A.D. framework (Locate Evidence, Evaluate it, Assemble it, and Inform Decisions) was used to identify practices relevant to children's healthful eating in most OST settings: 1) locate and evaluate information from a national survey of children's perceptions of healthful-food access; published research, reports, policies and guidelines; and roundtables with OST organizations' administrators; 2) assemble information to prioritize actionable practices; and 3) inform programmatic direction. RESULTS: Three evidence-informed guiding principles for short-duration OST resulted: 1) drink right: choose water instead of sugar-sweetened beverages; 2) move more: boost movement and physical activity in all programs; and 3) snack smart: fuel up on fruits and vegetables. CONCLUSION: Healthy Kids Out of School was launched to support the dissemination and implementation of these guiding principles in short-duration OST settings, complementing efforts in other OST settings to shift norms around eating and physical activity.

Association Between Adolescent Self-Reported Physical Activity Behaviors and Feeling Close to People at School During the COVID-19 Pandemic.

The disruption of school operations and routines caused by the COVID-19 pandemic affected students' physical and emotional well-being. Providing physical activity opportunities in schools can encourage students to positively engage with each other. Using a nationally representative sample of U.S. high school students from the Adolescent Behaviors and Experiences Survey (January to June 2021), we examined the association between physical activity behaviors and feeling close to people at school using sex-stratified and race/ethnicity-stratified multiple linear regressions models. Participating in team sports, being more physically active, and attending physical education (PE) during an average week were all associated with higher levels of feeling close to people at school, with variation by sex and race/ethnicity. These associations were also significant when the physical activity behavior variables were categorized to reflect national recommendations. Daily physical activity (i.e., ≥60 minutes all 7 days), daily PE (i.e., attended all 5 days), and the number of Comprehensive School Physical Activity Program (CSPAP) components implemented were associated with higher levels of feeling close to people at school. These findings suggest that opportunities for physical activity before, during, and after school are associated with increased levels of feeling close to people at school during crises like COVID-19.

School Poverty Level Moderates the Effectiveness of a Physical Activity Intervention.

PURPOSE: To explore whether school poverty level and funding modified the effectiveness of an evidence-based Comprehensive School Physical Activity Program called Health Empowers You! implemented in elementary schools in Georgia. DESIGN: Secondary data analysis of a multi-level, cluster-randomized controlled trial. SETTING: 40 elementary schools in Georgia in 2018-2019. SUBJECTS: 4th grade students in Georgia. MEASURES: Intervention schools implemented the Health Empowers You! program to increase school-day physical activity. The outcome was average daily moderate-to-vigorous physical activity, school free-reduced price lunch (FRPL) percentage and per pupil expenditures were effect modifiers. ANALYSIS: Separate linear mixed regression models estimated the effect of the intervention on average daily moderate-to-vigorous physical activity, with interaction terms between intervention status and (1) school FRPL percentage or (2) per pupil expenditures. RESULTS: The effect of the intervention was significantly higher in schools with higher FRPL percentage (intervention*school % FRPL ß (95% CI): .06 (.01, .12)), and was modestly, but not statistically significantly, higher in schools with lower per pupil expenditures. CONCLUSION: Findings support the use of the Health Empowers You! intervention, which was effective in lower income schools, and may potentially reduce disparities in students' physical activity levels.

Adolescent Health Risk Behaviors, Adverse Experiences, and Self-reported Hunger: Analysis of 10 States from the 2019 Youth Risk Behavior Surveys.

We examined associations between adolescent self-reported hunger, health risk behaviors, and adverse experiences during the 2018-2019 school year. Youth Risk Behavior Survey data were pooled from 10 states. Prevalence ratios were calculated, and we assessed effect measure modification by sex. The prevalence of self-reported hunger was 13%. Self-reported hunger was associated with a higher prevalence of every health risk behavior/adverse experience analyzed, even after adjusting for sex, grade, and race/ethnicity. Sex did not modify associations. Findings underscore needs for longitudinal research with more robust measures of adolescent food insecurity to clarify the temporality of relationships.

Feeding styles and evening family meals among recent immigrants.

The protective effect of family meals on unhealthy weight gain and diet has been shown across multiple age groups; however, it is unknown whether a similar effect is present among diverse immigrant populations. In addition, little research has focused on factors associated with the frequency of evening family meals, such as feeding styles (how parents interact with their child around feeding). Therefore the goals of this paper are to explore the 1) association between the frequency of evening family meals and child weight status among new immigrant families, and 2) influence of immigrant mothers' feeding styles on the frequency of evening family meals. Baseline self-reported socio-demographic information and measured heights and weights were collected for both mother and child (age range: 3­12 years) among 387 mother-child dyads enrolled in Live Well, a community-based, participatory-research, randomized controlled lifestyle intervention to prevent excessive weight gain in recent (<10 years in the U.S.) immigrant mothers and children. For children, height and weight measurements were transformed into BMI z-scores using age-and sex-specific CDC standards and categorized as overweight (85th­94th percentile) and obese (≥95th percentile); mothers' BMI was calculated. Frequency of evening family meals, eating dinner in front of the TV, acculturation and responses to the Caregiver's Feeding Styles Questionnaire (CFSQ) were also obtained from the mother. Children were categorized as "eating evening family meals regularly" if they had an evening family meal ≥5 times per week. Overall, 20% of children were overweight and 25% were obese. Less than half (40.9%) of families had regular evening family meals. In multivariate analyses, adjusting for covariates, children who were overweight/obese were significantly less likely to have ≥5 evening family meals/week compared with normal weight children (OR = 0.51, 95% CI 0.32-0.82) . Mothers who had a low demanding/high responsive or a low demanding/low responsive feeding style, were less likely to have ≥5 evening family meals/week compared to mothers with a high demanding/high responsive feeding style (OR = 0.41, 95% CI 0.18-0.0.96, OR = 0.33, 95% CI 0.13-0.87, respectively). Future interventions and programs that seek to help parents establish healthy household routines, such as family meals, may consider tailoring to specific maternal feeding styles.

Opportunities in the Extended Day: Approaches for Promoting Physical Activity and Healthy Eating During Out-of-School Time.

BACKGROUND: This systematic review aims to identify out-of-school time (OST) interventions (eg, programming, policies) that increased opportunities for physical activity (PA) and healthy eating and/or improved youth PA and dietary behaviors. METHODS: We searched for articles within systematic reviews that met our criteria (2010-2018) and for individual articles (2010-2020). Reviewer pairs screened articles, double-extracted data, assessed risk of bias (RoB), and achieved consensus. We included 71 articles (55 studies, 60 intervention arms). RESULTS: Health (n = 3) and nutrition education (n = 7) interventions showed promising results, but most used weak designs and had high RoB. PA-focused interventions (n = 23) were largely consistent in improving fitness and moderate to vigorous PA during programming. Programmatic interventions that improved both PA and nutrition outcomes engaged family or community members (n = 4/13). Most organizational policy interventions improved the nutrition environment and student PA during OST. CONCLUSIONS: Organization-level policy and programmatic interventions can improve environmental supports and youth behaviors during OST programming, complementing school-day efforts to address student PA and dietary intake. To maximize their potential impact, OST programs need to be accessible to families. Administrators can consider actions to reduce participation barriers.

Coordinated Approach: Comprehensive Policy and Action Planning.

BACKGROUND: Schools play a vital role in student health, and a collaborative approach may affect health factors such as physical activity (PA) and nutrition. There is a lack of recent literature synthesizing collaborative approaches in K-12 settings. We present updated evidence about interventions that used a coordinated school health approach to support K-12 student PA and nutrition in the United States. METHODS: A 2-phase literature review search included a search of systematic reviews for individual qualifying studies (2010-2018), followed by a search for individual articles (2010-2020) that evaluated a coordinated approach or use of school wellness councils, committees, or teams to address PA and/or nutrition. RESULTS: We identified 35 articles describing 30 studies and grouped them by intervention type. Interventions demonstrated promising findings for environmental changes and student dietary and PA behaviors. IMPLICATIONS: Coordinated and multicomponent interventions demonstrated significant improvements or null results, indicating that implementation of programs and/or policies to promote healthier eating and PA practices may support and do not appear to hinder environmental or behavioral outcomes. CONCLUSIONS: Schools can use a coordinated approach to implement opportunities for PA and nutrition; this may influence students' PA and dietary behaviors.