title: Protocol for a systematic review of the effects of schools and school-environment interventions on health: evidence mapping and syntheses.
abstract: BACKGROUND
  Schools may have important effects on students' and staff's health. Rather than treating schools merely as sites for health education, 'school-environment' interventions treat schools as settings which influence health. Evidence concerning the effects of such interventions has not been recently synthesised.
  
  
  METHODS
  Systematic review aiming to map and synthesise evidence on what theories and conceptual frameworks are most commonly used to inform school-environment interventions or explain school-level influences on health; what effects school-environment interventions have on health/health inequalities; how feasible and acceptable are school-environment interventions; what effects other school-level factors have on health; and through what processes school-level influences affect health.We will examine interventions aiming to promote health by modifying schools' physical, social or cultural environment via actions focused on school policies and practices relating to education, pastoral care and other aspects of schools beyond merely providing health education. Participants are staff and students age 4-18 years.We will review published research unrestricted by language, year or source. Searching will involve electronic databases including Embase, ERIC, PubMed, PsycInfo and Social Science Citation Index using natural-language phrases plus reference/citation checking.Stage 1 will map studies descriptively by focus and methods. Stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by two reviewers in parallel. Evidence will be synthesised narratively and statistically where appropriate (undertaking subgroup analyses and meta-regression and where no significant heterogeneity of effect sizes is found, pooling these to calculate a final effect size).
  
  
  CONCLUSIONS
  We anticipate: finding a large number of studies missed by previous reviews; that non-intervention studies of school effects examine a greater breadth of determinants than are addressed by intervention studies; and that intervention effect estimates are greater than for school-based health curriculum interventions without school-environment components.
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. chris.bonell@lshtm.ac.uk
authors.forename: Chris
authors.initials: C
authors.lastname: Bonell
authors.forename: Angela
authors.initials: A
authors.lastname: Harden
authors.forename: Helene
authors.initials: H
authors.lastname: Wells
authors.forename: Farah
authors.initials: F
authors.lastname: Jamal
authors.forename: Adam
authors.initials: A
authors.lastname: Fletcher
authors.forename: Mark
authors.initials: M
authors.lastname: Petticrew
authors.forename: James
authors.initials: J
authors.lastname: Thomas
authors.forename: Margaret
authors.initials: M
authors.lastname: Whitehead
authors.forename: Rona
authors.initials: R
authors.lastname: Campbell
authors.forename: Simon
authors.initials: S
authors.lastname: Murphy
authors.forename: Laurence
authors.initials: L
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004777:Environment; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D016032:Randomized Controlled Trials as Topic; D012574:Schools; D000078202:Systematic Reviews as Topic