A trial involving nearly 100 elementary schools in four states has proved that young children can be taught behaviors that could help protect them against heart disease later in life.
Furthermore, the study showed that such eating and activity behaviors can be taught through a cost-effective program and with only minimal training of school personnel. And the interventions worked equally well among ethnically diverse public schools.
The Child and Adolescent Trial for Cardiovascular Health (CATCH) is the largest school-based health promotion study ever done in the U.S. and was supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, located in Bethesda, MD. Results of the 3-year, multi-center trial appear in the March 13, 1996, issue of the Journal of the American Medical Association.
"The results of this trial are important because behaviors that increase the risk of cardiovascular disease are often established by young adulthood," notes NHLBI Director Dr. Claude Lenfant. "These behaviors, such as physical inactivity and diets high in saturated fat, form the basis of the atherosclerosis process."
"Schools are an ideal site for prevention programs like CATCH," adds Dr. Russell V. Luepker, head of the Division of Epidemiology at the University of Minnesota School of Public Health in Minneapolis. "Schools have access to virtually all of the children and adolescents in the country, and they have trained staff and the kinds of organizational structures and policies that can support healthy behaviors."
CATCH's health promotion efforts targeted both the children's behaviors and the school environment. CATCH worked with administrators, teachers, physical education specialists, and food-service and other staff to change cafeteria offerings, physical education practices, and classroom curricula. The trial also used family fun nights and activities in the home to involve parents.
The trial involved 96 public elementary schools in California, Louisiana, Minnesota, and Texas. The interventions were done at 56 of the schools, while the other 40 served as controls. Children started the trial in grade 3 and were in grade 5 at its completion.
Altogether, more than 5,000 children participated in the trial.
The interventions were of four main types--food service, physical education, classroom curricula, and family involvement.
The food-service intervention helped food-service staff plan healthier menus and prepare meals with reduced total fat and saturated fat. To improve physical education, teachers were given instruction on how to increase students' enjoyment of and participation in moderate to vigorous activity. Classroom curricula taught students to engage in behaviors and skills for choosing healthful foods and increasing physical activity. The classroom teachers were trained to use such techniques as goal setting, role modeling, and skill-building. Additionally, a classroom intervention for fifth graders focused on avoiding tobacco use, including how to resist social pressures to start smoking. Schools also were given guidance on how to establish smoke-free policies.
Results showed that students in the CATCH intervention schools had a lower daily calorie intake from total fat and saturated fat than students in the control schools. The CATCH interventions successfully improved school lunches to meet Federal guidelines of 30 percent of each day's total calories from fat and 10 percent from saturated fat. Moreover, the changes were seen in the intervention students' home eating patterns too. Blood cholesterol measures, however, did not differ significantly between children in the control and intervention schools.
The CATCH interventions also exceeded the Federal Year 2000 goal of having students spend at least 50 percent of their time in physical education classes being moderately to vigorously active. And the improvement extended beyond the classroom--students in the intervention schools reported significantly higher levels of vigorous activity throughout the day than those in the control schools.
Vitamins and other micronutrients stayed at recommended levels in both intervention and control groups and there were no adverse effects on students' growth or development from the CATCH interventions.