The Journal of School Nursing2025, Vol. 41(1) 5–35© The Author(s) 2024Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405241288538journals.sagepub.com/home/jsn
Overweight and obesity are common in school-age children. Policy, system, and environmental (PSE) approaches—which entail making upstream changes to a school’s context—can be leveraged to reduce childhood obesity. Nurses can advance PSE approaches in schools to promote healthy living habits. This review examines the effect of nurse-involved PSE interventions globally to promote healthy nutrition and reduce obesity in schools. We conducted a literature search using multiple databases from 2010 to 2023 for nurse-involved studies that implemented interventions focused on PSE change related to promoting healthy nutrition or reducing obesity in school settings. Twenty interventions globally were included in the systematic review synthesis. Improvements in anthropometrics, health and nutrition knowledge, attitudes, and beliefs were observed. PSE interventions can be leveraged to promote healthy nutrition and reduce obesity in school settings. Nurses in varying roles are uniquely qualified to advocate for and implement school-based interventions focused on PSE change.
child, body mass index, child health services, diet, exercise, health education, health policy, obesity, public health practice, school health services, systematic review
Poor nutrition and resulting obesity are major public health concerns for children and adolescents, with both widespread prevalence and harmful health implications (Centers for Disease Control and Prevention, 2024). The prevalence of obesity in children and adolescents aged 5–19 years old globally was 8.24% (World Health Organization, 2022), and in the United States, 19.7% (14.7 million) of children aged 2 to 19 years have obesity (Centers for Disease Control and Prevention, 2024). Children and adolescents with obesity have an increased risk for poor cardiometabolic health, including hypertension and type 2 diabetes (Chung et al., 2023). Historically, efforts for childhood obesity prevention and reduction often focused on education for individual health behavior change (e.g., teaching children and families to choose healthier foods). However, the obesity field has demonstrated a growing need for recognizing how macrolevel physical, social, and policy environments contribute to obesity risk. For example, poor childhood nutrition can be deeply rooted in individuals’ social determinants of health, including poverty, poor living environments, lack of access to quality education and food, and parental unemployment (Agurs-Collins et al., 2024). Thus, an increasing number of childhood obesity prevention and reduction efforts now focus on changing the context in which youth make nutrition and obesity-related choices and engage in obesity-related behaviors. Upstream approaches such as these have been termed as a policy, systems, and environmental (PSE) approach.
A PSE approach provides a useful framework to address barriers to health promotion interventions by recognizing the need to go beyond solely individual-level approaches and address environmental, organizational, community, and policy factors that impact child health (United States Department of Agriculture, 2023). PSE approaches entail changing the PSEs in which chronic disease risk manifests to support better health. Policy changes entail modifying the rules, protocols, or regulations that govern procedures within a system. For example, federal and local school policies related to improving food security and increasing the healthfulness of food provided in school, in-class physical activity (PA) breaks, and health class content can influence children’s nutrition and obesity risks. System changes involve efforts that shift an organization’s context in a way that changes service use for most users. System changes can entail a breadth of initiatives that impact how students, families, school nurses, teachers, and school staff interact with one another and school resources. For example, systems factors related to nutrition and obesity can include whether school nurses are provided with protected time to engage in health promotion activities with students, how teachers are trained at professional development events to support health promotion, and if school PA areas such as playgrounds are unlocked and open to students outside school hours (e.g., weekends, summer breaks). Environmental changes include modifications to the physical, person-made environment in which health behaviors occur. Related to childhood obesity in schools, this can include factors such as whether water fountains versus soda machines are more readily available, the presence of visual cues to promote health (e.g., posters in the cafeteria highlighting fruit and vegetables), and the space and quality of school sports facilities. Environmental changes could also include optimizing the social environment by increasing social support and awareness among parents through nutrition-related parent engagement.
PSE approaches may be particularly well-suited to address childhood nutrition and obesity in school settings because a child’s obesity risk is influenced by numerous upstream factors—beyond individual health behavior, genetic risk, and physiology—in the school setting. For example, school staff and student social norms, the predominant school population’s cultural values, access to green space or healthy foods in the school neighborhood environments, and availability of school health resources can all influence obesity risk. With 54.2 million children across the United States consuming up to 40% of their daily nutrition at school, the school setting provides opportunities for PSE efforts to support health promotion and obesity risk reduction activities (American Academy of Pediatrics, 2021).
Nurses in varying roles (i.e., school nurses, academic/research nurses, community health nurses) are well-suited to lead school-based PSE efforts for childhood obesity prevention and reduction for several reasons. First, the nursing paradigm is grounded in the interaction between person, environment, and health, meaning that PSE’s focus on macro-level factors naturally aligns with the nursing paradigm. Second, one of the nurses’ key roles is to serve as a patient (i.e., student) advocate. Given that children often do not hold the power to tailor the context of school systems, nurses can serve as a student’s advocate—guided by the nurse’s clinical expertise—in promoting healthier school contexts. Third, the Framework for 21st Century School Nursing Practice defines the principles of professional school nursing, including care coordination, leadership, quality improvement, community/public health, and standards of practice (National Association of School Nurses et al., 2024). These principles make a school nurse (the most common type of nurse practicing in schools) uniquely qualified to play a role in PSE-focused school nutrition and obesity prevention and reduction efforts (National Association of School Nurses et al., 2024). Fourth, prior research demonstrates that school nurse-led obesity interventions effectively reduce obesity (Schroeder et al., 2016), that school nurses are well-suited to address upstream determinants of health (Francis et al., 2021; Schroeder et al., 2018), and that school nurses’ services are cost-effective ways to promote child health (Wang et al., 2014). These suggest that nurse involvement in PSE obesity prevention and reduction interventions merits more attention.
While PSE interventions have gained increasing attention in childhood obesity realms and while nurses and school nurses’ roles in school-based obesity interventions have been explored, to our knowledge, no review has yet synergized the two; thus, it is unknown whether school-based interventions that involve nurses and focus on PSE are effective in promoting child nutrition and preventing or reducing obesity. Systematic and environmental barriers may prevent school health leaders from fully implementing school wellness policies, making understanding PSE approaches particularly important (Turgeon, 2013). Nurses with varying roles and capacities may be uniquely positioned to overcome such barriers (Bejster et al., 2020) by providing student-centered care and developing policies, systems, and environments that optimize health. However, this has not been examined (National Association of School Nurses, 2024). To fill that gap, this systematic review examines the effect of nurseinvolved, school-based PSE interventions to promote healthy nutrition and reduce obesity in schools.
We used the Johanna Briggs Institute’s guide for systematic reviews (Lizarondo et al., 2020) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Page et al., 2021) standards for reporting the results of this systematic review. Collaborating with an experienced clinical informationist and librarian, our team of nurse scholars built a search strategy. We retrieved citations from the following databases: PubMed, EMBASE, CINAHL, Cochrane, Web of Science, SCOPUS, Education Source, and ERIC. The search was completed on November 3, 2023. The detailed search strategy is included in Appendix A. As an example, we included MESH terms and keywords that included “Nurses” or “nursing” Or “nurse directed” OR “nurse led” or “nurse managed” AND “School Health Services” OR “primary school” OR “elementary school” OR “middle school” AND “Nutrition” OR “Healthy Eating” OR “Nutrition Policy” AND “obesity.” The search results were imported into COVIDENCE software to facilitate the conduct of the systematic review (Veritas Health Innovation, 2020).
We included studies from the U.S. and international settings and published in English from 2010 to 2023 in peerreviewed journals. The publication start date was selected to coincide with the initial onset of the Healthy Hunger-Free Kids Act of 2010 (Prokop & Galon, 2011), which improved access to healthy nutrition in schools. Children were defined as ages five to 18 years in kindergarten through 12th grade. Exclusion criteria included no full text available in English, theoretical papers, gray literature, systematic or other reviews, nonschool settings, interventions that did not include a PSE approach or individual-level only interventions, and solely PA interventions. Our primary focus was on nutrition, but we accepted papers with nutrition and PA-related outcomes. We defined nurse involvement as nurse participation in authorship or the intervention’s design, implementation, or evaluation to capture various degrees of nursing contributions. Nurses were defined broadly as nurse researchers, school nurses, public health/community nurses, or nurses working in health settings that partner with schools. This criterion was verified during the full-text review. We defined school-based interventions as those that occurred in school settings, including afterschool programs. Interventions targeted to parents and children were also included if the child portion of the intervention was delivered in a school setting.
COVIDENCE was used to conduct the screening and review process (Veritas Health Innovation, 2020). Two independent reviewers (ML and JP) conducted title and abstract screening to determine eligibility for full-text review. Differences between the two reviewers were resolved through discussion. Articles eligible for full-text review were retrieved in pdf format and imported into COVIDENCE. Three independent reviews (EEI, LF, and JP) conducted a full-text review to identify articles for inclusion in the review. Disagreements were resolved through group discussion.
The methodological rigor of the full-text review articles was assessed using the Mixed Methods Appraisal Tool (MMAT) because it is a consistent quality assessment tool when various quantitative, qualitative, mixed-methods, and multimethod designs are being evaluated (Hong et al., 2018). The MMAT consists of two screening questions common to all types of study designs, followed by four specific questions to each type of study design, with possible answers of “yes,” “no,” or “can’t tell.” A numerical score is not generated, but the specific feedback for each included article is outlined in Table 2 (Appendix). We integrated the SQUIRE 2.0 checklist for one quality improvement report (Ogrinc et al., 2016). Finally, we included two additional questions to examine if a theoretical or conceptual framework guided the study and to document the funding source for the study. Any questions or disagreements generated from full-text reviews between the reviewers were resolved through group discussion.
Two of the articles selected for inclusion were reviewed and abstracted by each of the three authors (EEI, LF, and JP) to establish interrater reliability. The remaining articles were divided into thirds for data abstraction, performed independently by three authors (EEI, LF, and JP). The group met weekly to discuss progress and resolve questions about specific articles. The abstracted data included citation information, setting, study demographics, intervention description, and results. Interventions were also categorized as related to one or more of the following: policy (written or formalized policy or regulation), systems (organizational or operational changes in processes), and environment (physical or social environmental changes related to promoting healthy nutrition or obesity prevention or management). After the results were discussed, the data was synthesized. We developed an organizing framework for data abstraction, including the study design, intervention description, PSE category, demographics, and outcomes.
See Figure 1 for a PRISMA flow diagram of search results. The final synthesis included twenty studies (Başçı et al., 2023; Boyle & Anderson, 2014; Davis et al., 2017; Eanes et al., 2019; Gowland-Ella et al., 2022; Greve & Heinesen, 2015; Ilgaz, 2022; Kubik et al., 2021; Lovell, 2018; Ospina Romero et al., 2021; Pbert et al., 2013; Phaitrakoon et al., 2014; Robbins et al., 2020; Toruner & Savaser, 2010; Tucker et al., 2011; Tucker & Lanningham-Foster, 2015; Vitale et al., 2021; Wong & Cheng, 2013; Woodgate & Sigurdson, 2015; Wright et al., 2013), 10 from the United States and Canada (Davis et al., 2017; Eanes et al., 2019; Kubik et al., 2021; Lovell, 2018; Pbert et al., 2013; Robbins et al., 2020; Tucker et al., 2011; Tucker & Lanningham-Foster, 2015; Woodgate & Sigurdson, 2015; Wright et al., 2013), and 10 from outside the United States and Canada, including five from Europe (Başçı et al., 2023; Boyle & Anderson, 2014; Gowland-Ella et al., 2022; Greve & Heinesen, 2015; Vitale et al., 2021), two from Asia (Phaitrakoon et al., 2014; Wong & Cheng, 2013), two from Turkey (Europe/Asia; Ilgaz, 2022; Toruner & Savaser, 2010), and one from South America (Ospina Romero et al., 2021). See Table 1 for details of the extracted data. The synthesized studies methods included five randomized controlled trials (Greve & Heinesen, 2015; Kubik et al., 2021; Pbert et al., 2013; Toruner & Savaser, 2010; Wright et al., 2013), 12 quasi-experimental studies (Başçı et al., 2023; Boyle & Anderson, 2014; Eanes et al., 2019; Gowland-Ella et al., 2022; Ilgaz, 2022; Ospina Romero et al., 2021; Phaitrakoon et al., 2014; Robbins et al., 2020; Tucker et al., 2011; Tucker & Lanningham-Foster, 2015; Vitale et al., 2021; Wong & Cheng, 2013), two mixed-methods studies (Davis et al., 2017; Woodgate & Sigurdson, 2015), and one quality improvement study (Lovell, 2018). Interventions were targeted to students across all grades in two studies (Greve & Heinesen, 2015; Wright et al., 2013), kindergarten through grade school in 13 studies (Başçı et al., 2023; Boyle & Anderson, 2014; Davis et al., 2017; Eanes et al., 2019; Ilgaz, 2022; Kubik et al., 2021; Lovell, 2018; Phaitrakoon et al., 2014; Toruner & Savaser, 2010; Tucker et al., 2011; Tucker & Lanningham-Foster, 2015; Vitale et al., 2021; Wong & Cheng, 2013), and middle or high school in four studies (Gowland-Ella et al., 2022; Pbert et al., 2013; Robbins et al., 2020; Woodgate & Sigurdson, 2015). The quality of the extracted studies was analyzed using the MMAT and SQUIRE 2.0 (see Table 2 in Appendix.)
The interventions included various PSE approaches, which mainly served as an addition to individual-level strategies such as nutrition or health education, counseling sessions, workshops focusing on nutrition and PA, and motivational interviewing (see Figure 2). A study could include one or more of the PSE strategies. Five interventions included a physical environmental approach involving community/school/home gardens (Eanes et al., 2019; Ospina Romero et al., 2021), adding posters in school to educate about the sugar content in chocolate milk (Lovell, 2018), modifying the environment by adding a chilled water station (Gowland-Ella et al., 2022), and removing chocolate milk from the cafeteria and replacing with water and 1% milk—the only study that used a sole environmental approach to address healthy behaviors (Davis et al., 2017). Thirteen interventions addressed improving the social environment through the lens of social support by increasing awareness and support among parents and teachers on nutrition, PA, and screen time (Başçı et al., 2023; Boyle & Anderson, 2014; Kubik et al., 2021; Ospina Romero et al., 2021; Phaitrakoon et al., 2014; Robbins et al., 2020; Toruner & Savaser, 2010; Tucker & Lanningham-Foster, 2015; Vitale et al., 2021; Wong & Cheng, 2013; Wright et al., 2013). For example, the Kids N Fitness intervention is a familycentered educational program in which nutrition and PA-related parent engagement is an important part of their health promotion activities (Wright et al., 2013). Seven interventions included a systems approach whereby partnerships were forged between schools, public health, and communitybased organizations to support the aims of the studies (Greve & Heinesen, 2015; Pbert et al., 2013; Tucker et al., 2011; Tucker & Lanningham-Foster, 2015; Woodgate & Sigurdson, 2015; Wright et al., 2013), and one study developed an electronic health recording system to support documentation of screening, intervention participation, and surveillance activities related to obesity prevention efforts (Ilgaz, 2022). Only one study included all three categories, PSE, where a school wellness policy was set in place in addition to a systems and environment approach to support dietary changes needed to prevent obesity (Wright et al., 2013).
Less than half of the articles (9/20) stated a theoretical or conceptual framework that guided the PSE interventions’ development and/or implementation (see Table 2 in Appendix). Some used behavior change theories and frameworks such as the Social Cognitive Theory, the Social-Ecological Framework, the Healthy Lerner Model for Student Chronic Condition Management, the Health Behavior Interaction Model, and the Self-determination theory to guide their studies.
Primary obesity prevention studies focus on preventing obesity from occurring, especially among those who may be at risk of becoming obese. Secondary obesity prevention studies focus on weight loss among people with obesity to prevent worsening outcomes such as developing hypertension and type 2 diabetes. In this review, we identified 13 of 20 studies that address primary prevention of overweight or obesity (Başçı et al., 2023; Davis et al., 2017; Eanes et al., 2019; Gowland-Ella et al., 2022; Greve & Heinesen, 2015; Ilgaz, 2022; Lovell, 2018; Ospina Romero et al., 2021; Robbins et al., 2020; Tucker et al., 2011; Tucker & Lanningham-Foster, 2015; Vitale et al., 2021; Woodgate & Sigurdson, 2015). Seven studies implemented secondary prevention programs geared toward children already overweight or obese (Boyle & Anderson, 2014; Kubik et al., 2021; Pbert et al., 2013; Phaitrakoon et al., 2014; Toruner & Savaser, 2010; Wong & Cheng, 2013; Wright et al., 2013).
Ten studies included body mass index (BMI), BMI percentile, BMI z-scores, or weight for height percentile as an outcome (Boyle & Anderson, 2014; Greve & Heinesen, 2015; Kubik et al., 2021; Pbert et al., 2013; Toruner & Savaser, 2010; Tucker et al., 2011; Tucker & Lanningham-Foster, 2015; Vitale et al., 2021; Wong & Cheng, 2013; Wright et al., 2013). Four of the 10 studies reported significant reductions in BMI, BMI z-scores, BMI percentiles, or weight percentiles (Toruner & Savaser, 2010; Tucker et al., 2011; Wong & Cheng, 2013; Wright et al., 2013). Two of the four studies that reported significant results were RCTs (Toruner & Savaser, 2010; Wright et al., 2013), and one was a primary prevention intervention (Tucker et al., 2011). One study using all three PSE strategies found significant reductions in BMI but only for females (Wright et al., 2013).
Seven studies reported significant improvements in healthy food consumption and increased PA (Boyle & Anderson, 2014; Davis et al., 2017; Lovell, 2018; Phaitrakoon et al., 2014; Tucker et al., 2011; Tucker & Lanningham-Foster, 2015; Wright et al., 2013). Specifically, there were significant increases in daily fruit and vegetable intake (Tucker & Lanningham-Foster, 2015), exercise steps (Tucker & Lanningham-Foster, 2015), and a decrease in chocolate milk and juice consumption (Davis et al., 2017; Lovell, 2018; Tucker et al., 2011; Tucker & Lanningham-Foster, 2015).
Ten studies report outcomes related to knowledge, attitudes, and perceptions. Across varying study designs and interventions, five studies reported significant improvements in knowledge of healthy eating, nutrition, or PA, including improved knowledge about the harmful effects of sweetened sugary beverages and cardiovascular disease risk factors (Boyle & Anderson, 2014; Eanes et al., 2019; Gowland-Ella et al., 2022; Ilgaz, 2022; Toruner & Savaser, 2010). Five studies reported outcomes on perceptions of health, healthy eating and exercise, and perceptions of self-efficacy (Başçı et al., 2023; Pbert et al., 2013; Phaitrakoon et al., 2014; Robbins et al., 2020; Woodgate & Sigurdson, 2015). Two of the five report significant improvement in positive perceptions of healthy habits, life perspectives, self-efficacy, and self-esteem. In addition to perceptions, one study also reported improved attitudes toward healthy habits postintervention (Başçı et al., 2023).
This review identified 20 nurse-involved studies detailing the effects of PSE interventions implemented in schools to address obesity and support student health. Collectively, results demonstrated that global body literature has examined nurse-involved school-based obesity interventions focused on PSE. Most of those interventions focused on the “e” of PSE, though several concentrated on policy and systems. Many demonstrated positive effects on student outcomes, including knowledge/perceptions/attitudes, diverse health behaviors, and anthropometric outcomes. While evidence gaps remain, findings suggest that nurse-involved interventions can contribute to school-based obesity prevention and reduction efforts focused on PSE.
Childhood obesity is a complex and multifaceted global issue that will require developing culturally sensitive, multilevel solutions that include approaches to the individual and all the systems that impact children’s health, namely PSE factors. Results from prior systematic reviews (including but not limited to nurse-involved interventions) have shown that PSE approaches implemented in the early care and education setting effectively address early childhood obesity (Kracht et al., 2023). Nonetheless, more PSE components in intervention work are needed. Only 40% of the PSE papers in this review were published within the past 5 years, demonstrating a need for more recent data—especially given shifts in the school environment and child well-being since the onset of the COVID-19 pandemic. Among the studies included in this review, some reported positive anthropometric, dietary quality, or attitudes related to healthy habits outcomes. It is important to note that none of the studies addressed food insecurity, a critical PSE determinant of poor nutrition, childhood obesity, and obesity inequities (St Pierre et al., 2022).
Nurses with varying roles are instrumental in supporting children’s health in school settings, given their role as student advocates, researchers, and clinical experts, and they know macrolevel influences on health. They also position themselves as (often the only) health experts in the school setting. A prior review demonstrates the effectiveness of school nurses, specifically, in addressing childhood obesity in schools (Schroeder et al., 2016). For this review, we expanded the nursing scope to include nurses who work in various capacities (i.e., a research capacity, academic nurses, public health nurses, community health nurses, or nurses who work in healthcare settings that partner with schools), which captures the breadth of roles nurses can and do play related to school-based obesity efforts. Nurse-led solutions to address childhood obesity in school settings will require “all hands on deck” to develop and implement robust and innovative PSE approaches leveraging the skills and expertise of nurses in chronic disease prevention and management, providing psychosocial support, care coordination, and family and community engagement (Francis et al., 2021). Additionally, formal support and buy-in from school leadership and parents to bolster school nurses’ role in reducing obesity is key (Schroeder & Smaldone, 2017). Doing so, however, will additionally require substantial and sustainable funding to support nurse-led, school-based, evidence-based programming—especially given that PSE approaches often necessitate costly and time-consuming initial investments. Of the 20 studies identified in this review, only eleven cited funding support: six federal/government, one foundation, and one school/institutional support, and three received both federal and foundation support. Expanding the capacity for nurses in the United States to bill payers like the Children’s Health Insurance Program and School Medicaid for their services to include obesity prevention programming, mental health care, and care coordination to address unmet social needs could prove to be a sustainable model of care for the United States and globally that can improve both child health and learning outcomes (Francis et al., 2018). Additionally, building school nurses’ capacity for collaboration with individuals with grant writing and management expertise could support these efforts. This systematic review contributes significantly to current knowledge regarding nurse-involved, school-based interventions to address the growing global problem of poor nutrition and obesity in school children. It can serve as evidence to advocate for resources to support nurse-led PSE obesity interventions.
This literature review has several implications for school nursing and school health services. First, it suggests that nurses in diverse roles can play an important role in PSE-level obesity prevention and reduction. Guided by the Framework for 21st Century School Nursing Practice, nurses can advocate for PSE efforts in their capacities as student advocates. For example, nurses can use evidence such as that in this review to ask school administrators and district school health offices to devote resources (e.g., school staff time, school space, and school budget) to schoolbased PSE efforts to reduce obesity. Second, school health services and administrators can support and advocate for school nurses’ roles as individuals who deliver clinical care to individual children and as population and public health experts who can play a key role in supporting healthier school systems. This can be concretely operationalized by ensuring school nurses are included in communications (e.g., emails, meetings) and involved with decisional authority in making choices that affect school PSE. Third, nurses involved in school nursing but not in direct student care (e.g., school nurse administrators and nurse scientists who do school nursing research) can apply for external funding to support school-based PSE efforts. Lastly, expert groups can provide training and support to increase school nurses’ self-efficacy in leading nutrition and obesity PSE efforts. Such efforts would align with the breadth of existing highquality resources (e.g., webinars, conference presentations) provided by the National Association of School Nurses.
Some limitations noted in these reviewed studies include relatively small sample sizes associated with predominately single-site interventions (Başçı et al., 2023; Davis et al., 2017; Robbins et al., 2020; Vitale et al., 2021; Woodgate & Sigurdson, 2015), which limits generalizability. Study measurement tools sometimes lacked reliability and validity documentation, limiting the rigor of the study results (Boyle & Anderson, 2014; Tucker et al., 2011; Wong & Cheng, 2013). One important limitation noted was a significant loss to follow-up or poor participation in after-school activities (Boyle & Anderson, 2014; Robbins et al., 2020; Wright et al., 2013). After-school responsibilities such as sibling care, work, sports clubs, or other activities may be essential in timing school-based interventions for healthy nutrition or obesity prevention, especially in older children and adolescents. Finally, we should note that some nurses work in obesity prevention in schools but work outside of nursing schools, did not use nurse in the indexing process, or may not necessarily label themselves as nurse researchers.
While tackling childhood obesity requires a multidisciplinary approach, globally, nurses are well-positioned to address childhood obesity in schools via PSE approaches. Nurses with varying capacities can, for example, secure funding to support the development and implementation of PSE interventions for students at risk for or who are experiencing overweight or obesity. Nurses can also leverage their community-building and advocacy skills to develop and implement PSE approaches grounded in theory that are proven effective in supporting positive health outcomes. To advance nurses’ role as unique contributors to schoolbased obesity prevention and reduction efforts, future studies should examine the impact of nurse-involved obesity prevention and reduction interventions on long-term health and learning outcomes.
The authors would like to gratefully acknowledge Margaret Li for assisting with screening phase of the review. We would also like to thank Stella M. Seal, MLS, Lead Informationist, Johns Hopkins University for her assistance in the literature search.
Lucine Francis: Conceptualization; Data curation; Formal analysis; Methodology; Project administration; Supervision; Writing – original draft; Writing – review & editing.
Jennifer K. Peterson: Conceptualization; Data curation; Formal analysis; Methodology; Writing – original draft; Writing – review & editing.
Alexandra Peary: Investigation; Writing – original draft; Writing – review & editing.
Nancy G. Russell: Formal analysis; Investigation; Writing – original draft; Writing – review & editing
Erika Estrada-Ibarra: Formal analysis; Investigation; Writing – original draft; Writing – review & editing.
Krista Schroeder: Formal analysis; Writing – review & editing.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:: This review was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number T32NR020315 (Ms. Erika Estrada-Ibarra). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health..
Lucine Francis https://orcid.org/0000-0002-0063-9934
Jennifer K. Peterson https://orcid.org/0000-0001-7628-567X
Alexandra Peary https://orcid.org/0000-0002-1426-028X
Nancy G. Russell https://orcid.org/0000-0003-1085-765X
Krista Schroeder https://orcid.org/0000-0002-2034-7525
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Lucine Francis is an Assistant Professor at Johns Hopkins School of Nursing and a core faculty member of the Johns Hopkins Center for School Health (formerly known as the Johns Hopkins Consortium for School-Based Health Solutions).
Jennifer K. Peterson is an Assistant Professor at Johns Hopkins School of Nursing and a board-certified clinical nurse specialist with advance practice roles focusing on the care of infants, children, and young adults and their families affected by heart disease.
Alexandra Peary is a PhD student at Johns Hopkins School of Nursing.
Erika Estrada-Ibarra is a DNP/PhD student at Johns Hopkins School of Nursing.
Nancy G. Russell is an Assistant Professor at Johns Hopkins School of Nursing and a family nurse practitioner at Johns Hopkins University Student Health & Wellbeing.
Krista Schroeder is an Associate Professor of Nursing at Temple University College of Public Health.
1 Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
2 Johns Hopkins University Center for School Health, Baltimore, Maryland, USA
3 Johns Hopkins University Student Health & Well-Being, Baltimore, Maryland, USA
4 Department of Nursing, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
Corresponding Author:Lucine Francis, Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21212, USA.Email: lfranc12@jhu.edu
