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March 13, 1996

Outcomes of a Field Trial to Improve Children's Dietary Patterns and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH)

Russell V. Luepker, MD; Cheryl L. Perry, PhD; Sonja M. McKinlay, PhD; et al Philip R. Nader, MD; Guy S. Parcel, PhD; Elaine J. Stone, PhD, MPH; Larry S. Webber, PhD; John P. Elder, PhD; Henry A. Feldman, PhD; Carolyn C. Johnson, PhD; Steve H. Kelder, PhD, MPH; Margaret Wu, PhD; Philip Nader, MD; John Elder, PhD; Thom McKenzie, PhD; Kathryn Bachman, MS, EdS; Shelia Broyles, PhD; Ellen Busch, RD; Steve Danna; Todd Galati, MA; Karen Haye; Christine Hayes, MA; Michael McGreevy; B. J. Williston, MEd; Michelle Zive, MS, RD.; Cheryl Perry, PhD; Leslie Lytle, RD, PhD; Russell Luepker, MD; Beth Davidann, MPH; Pat Brothen; Virginia Dahlstrom, MA; Maxine Dammen; Sally Ehlinger, PhD; Tawny Greene; Barbara Hann; Jean Heberle; Tom Hofflander, MEd; Colleen Kelder; Pat Kelliher; Therese Kunz; Bonnie Manning; Donna McDuffie; Todd Morrow; Margie Miller; Jennifer Mrosala; Gretchen Newman, MA; Mellanie Pusateri; Margaret Reinhardt, RD, MPH; Renee Sieving, MSN; Jennifer Smisson; Mary Smyth; Pat Snyder, MA, RD; Mike Staufacker, MA; Janelle Traut; Tracy Wick.; Guy Parcel, PhD; Steve Kelder, PhD, MPH; Deanna Montgomery, PhD, RD; Milton Nichaman, MD, ScD; Wendell Taylor, PhD, MPH; Kathleen (Wambsgans) Cook, MEd; Elvira Barrera, SpMFT, LPC; Larry Berry; Janet Carbonneau, MEd, RD; Karen Chemycz, MA; Peter Cribb, MEd; Sandra Evans, MPH; Rebecca Gordon; Jenifer Gwinn; Susan Luton, MA; Barbara Scaife, MS, RD; Sue Sharkey; Sharon Snider; Sema Spigner; Kay Wilson, MPH, RD; Sherry Woods, EdD; Edmundson, PhD; Jack Wilmore, PhD; Larry Webber, PhD; Carolyn Johnson, PhD; Theresa Nicklas, DrPH, MPH, LDN; Vincent Anthony; Nancy Baker, MS, RD; Kathryn Barnwell; Stacy Belou; Gerald Berenson, MD; Susan Bonura, MPA; Keith Bordelon; Sandra Cameron, RN; Ann Clesi, MEd; Lisa Crochet, MEd; Amy Cunningham, MS, RD; Didara Franklin; Anwarul Haque, MBBS; David Harsha, PhD; Javed Joy, MPH; Saundra M. Hunter, PhD; Daniel Kuras; Pam Lambie; Ann Layman, MA; Sharon Little-Christian, MEd; Sheryl Pedersen, MPH; Jacqueline Reeds-Epping, MEd; Rochelle Rice, MPH; Kelly Romero, MEd; Cynthia Pitcher-Smith; Patricia Strikmiller, MS; Marion White, MS, RD.; Sonja McKinlay, PhD; Stavroula Osganian, MD, MPH; Henry Feldman, PhD; Herman Mitchell, PhD; Susan Budman, MSW; Patty Connell; Michael Koehler; Paul Mitchell, MS; Christine Kannler; Glenn Rennie; Debbie Sellers, PhD; Moira Walsh; Minhua Yang, MS.; Johanna Dwyer, DSc, RD; Mary Kay Ebzery, MS, RD; Anne Garceau, MS, RD; Lynn Hewes, MS, RD; Caitlin Hosmer, MS, RD; Debra Raizman, MPH, RD.; Linda Bausserman, Ph; Elaine Stone, PhD, MPH; Marguerite Evans, MS, RD; Jeffrey Cutler, MD, MPH.; Ronald Lauer, MD; Thomas Coates, PhD; William Haskell, PhD; C. Anderson Johnson, PhD; Ronald Prineas, MD, PhD; Linda Van Horn, PhD, RD; Joel Verter, PhD
Author Affiliations

From the Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis (Drs Luepker and Perry); New England Research Institutes, Watertown, Mass (Drs McKinlay and Feldman); Department of Pediatrics, Community Pediatrics Division, University of California at San Diego, La Jolla (Drs Nader and Elder); Center for Health Promotion Research and Development, University of Texas Health Science Center, Houston (Drs Parcel and Kelder); Project Office, National Heart, Lung, and Blood Institute, Bethesda, Md (Drs Stone and Wu); and Tulane University School of Public Health and Tropical Medicine, New Orleans, La (Drs Webber and Johnson).

JAMA. 1996;275(10):768-776. doi:10.1001/jama.1996.03530340032026

Objective.  —To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease.

Design.  —A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994).

Participants.  —A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas.

Intervention.  —Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education.

Main Outcome Measures.  —At the school level, the two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychosocial factors, recall measures of eating and physical activity patterns, and other physiologic measures.

Results.  —In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001 ). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%) (P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed.

Conclusion.  —The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.(JAMA. 1996;275:768-776)