With minor adaptations, the COACH program can be pilot tested in rural settings to address key health concerns and behaviors that affect risk for cardiovascular health.

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Objective: We reviewed studies pertaining to randomized controlled universal/Tier 1, teacher-led intervention trials in United States (US) schools, and their impact on anxiety in K-12 students. Methods: We searched 7 databases and one search engine. Anxiety was the main outcome measure. Studies published through July 5, 2018 were appraised using the Cochrane Collaborations tool. Results: We included 4 studies, all indicating efficacy for lowering anxiety symptoms. Internal bias was unclear for 3. Conclusion: Despite a call from the National Institute of Mental Health for population-based, upstream public health interventions, empirical evidence is scarce. Findings from this review are reflected by the absence of such studies from the Healthy People 2020 recommendations for evidence-based resources consumer page. There appears to be a need for development and testing of universal teacher-led anxiety interventions in US schools.