Objective: We reviewed studies pertaining to randomized controlled universal/Tier 1, teacherled 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. [ABSTRACT FROM AUTHOR]