Themes in Train-the-Trainer Nutrition Education Interventions Targeting Middle School Students: A Systematic Review.

Context-appropriate nutrition education interventions targeting middle school students have the potential to promote healthy dietary patters that may help prevent unnecessary weight gain at a point in childhood development when youth experience increasing agency over their food choices. The aim of this review was to identify and synthesize themes in train-the-trainer approaches, intervention content and delivery, and youth receptivity across teacher, mentor, and peer-led nutrition education interventions that targeted middle school-age youth in urban, primarily low-income settings. A systematic, electronic literature search was conducted in seven electronic databases, PubMed/Medline, CINAHL, ERIC, PsycINFO, Scopus, SPORTDiscus, and Cochrane CENTRAL, using fixed inclusion and exclusion criteria. A total of 53 papers representing 39 unique interventions were selected for data extraction and quality assessment. A framework synthesis approach was used to organize the interventions into six categories and identify themes according to whether the intervention was classroom-based or out-of-school-based and whether adults, cross-age peers or same-age peers delivered the intervention. Ten of the interventions contained multiple components such that they were included in two of the categories. The review findings indicated that trainings should be interactive, include opportunities to role-play intervention scenarios and provide follow-up support throughout intervention delivery. Interventions targeting middle school youth should include positive messaging and empower youth to make healthy choices within their specific food environment context.