A Coordinated Approach To Child Health Center for Health Promotion and Prevention Research University of Texas-Houston School of Public Health

“Schools have more influence on the lives of youth than any other social institution except the family, and provide a setting in which, friendship networks develop, socialization occurs and norms that govern behavior are developed and reinforced.” Healthy People

Why is this important? Some facts about health status of children in the U.S. Some facts about the health status of children in the U.S.

Obesity Now affects 1 in 3 Americans; 63% of men & 55% of women have BMI > 25 Growing problem in youth; % overweight has tripled since 1970

Actual Causes of Death in the United States, 1990 Source: McGinnis JM, Foege WH. JAMA 1993;270: , , ,000 90,000 30,000 20, , , , , ,000 TobaccoDiet/ActivityAlcoholMicrobial agents Sexual behavior Illicit use of drugs

Percentage of U.S. Youth Who Were Overweight*, by Age * >95th percentile for BMI by age and sex based on NHANES I reference data Source: Troiano RP, Flegal KM. Pediatrics 1998;101(3): NHANES 1999, National Center for Health Statistics

Type 2 Diabetes Type 2 Diabetes was formerly known as “adult onset diabetes”, but there has been an increasing incidence of type 2 diabetes in youth. Rosenbloom et al., 1999 Approximately 85% of children diagnosed with type 2 diabetes are overweight or obese. American Diabetes Association As the US population becomes increasingly overweight, researchers expect type 2 diabetes to appear more frequently in younger children. American Diabetes Association Higher prevalence in Hispanics (1.9x) & African Americans (1.7x). NIDDK, 2000

Adverse CVD Risk Factor Levels in Children Percent of children, aged 5-10, with 1 or more adverse CVD risk factor levels: 27.1% Source: Freedman DS et al. Pediatrics 1999; 103: ` Percent of overweight children, aged 5-10, with 1 or more adverse CVD risk factor levels 60.6%

Physical Inactivity Increase in TV, Internet, Computer Use Physical activity declines steadily during adolescence. – MMWR, CDC Guidelines, 1997 Only 36% of kids in the US have daily PE class Only ½ of all American youth regularly participate in vigorous physical activity – Youth Risk Behavior Survey

Super Size It!! Portion sizes are getting bigger and bigger! McDonald’s now has the “Mighty Kids” Happy Meal – A regular size happy meal with a cheeseburger, fries, and a coke would have 690 calories, 24 grams of fat, and 980 mg of sodium – A mighty kids happy meal with a double cheeseburger, fries and a coke would have 820 calories, 34 grams of fat, and 1400 mg of sodium – remember, this is ONE MEAL!!

Soda Consumption Recently, researchers found that consumption of sugar-sweetened drinks is associated with increased obesity – For each additional serving of a sugar-sweetened beverage, BMI and frequency of obesity increased Ludwig DS, et al. Lancet 2001;357:

How can we combat this “obesity epidemic?” We know the problem – what is the solution? Prevention is the key! – Teaching our kids to eat nutritiously and to get regular physical activity – Changing the school environment – Changing family norms – Coordinated School Health

What is CATCH? CATCH stands for Coordinated Approach To Child Health (formerly known as the Child and Adolescent Trial for Cardiovascular Health) It is part of a Coordinated School Health Program designed to prevent sedentary behavior, poor dietary choices, and tobacco use through changes at the elementary school level

Rationale High prevalence of CVD and early onset among adults Prevent risk factors for type 2 diabetes in children Lifestyle related risk factors potentially modifiable: – Diet – Physical Activity – Smoking

Unique Features First trial to integrate school, child & family Ethnically diverse population Four geographic areas of the U.S. – California – Louisiana – Minnesota – Texas Large number of schools (N=96)

How Is CATCH a Coordinated School Health Program?

CATCH Components Classroom Curriculum Food Service Physical Education Family It’s All About Healthier Kids

Physical Education Students will be involved in MVPA for 50% of class time Students are provided many opportunities to participate and practice skills Students enjoy physical activity Students are encouraged to be physically active outside of school

Classroom Curricula 3-5th grades (15-24 sessions/year) Objectives are for students to be able to: – Identify, Practice, & Adopt healthy eating & physical activity behaviors Focus on: – Knowledge – Modeling by cartoon and peers – Skills training & Self-monitoring – Social skills (tobacco refusal) – Social norm setting

Family Program Homework done by child with parent/grown-up assistance – Focus on skills development & changing family norms – Complements the curricula Family fun nights – health fairs with parent/child & community participation

Eat Smart Program (School Food Service) The vision for CATCH Eat Smart is to provide children with tasty lower fat, saturated fat, and sodium school meals while maintaining required levels of essential nutrients and student participation. Daily throughout the school year.

Four Target Areas of Eat Smart Menu Planning Food Purchasing Food Production Promotion

Does CATCH Work? Reduced total fat and saturated fat content of school lunches. Increased moderate-to-vigorous physical activity (MVPA) during P.E. classes. Improved students’ self-reported eating and physical activity behaviors. Effects persisted over three years without continued intervention. Luepker RV, et al (1996). JAMA, 275(10), Nader PR, et al (1999). Arch Pediatr Adolesc Med, 153(7),

Moderate to Vigorous PA (Percent of Lesson Time) Healthy People 2000 Objective 1.9 Semester

8 th Grade Follow-up Min/day of Vigorous Physical Activity* School Grade Intervention Control Vigorous Activity Min. * Not measured at baseline

8 th Grade Follow-up Dietary Fat Intake School Grade _______ Intervention Control Dietary Fat, % of Energy

Advantages: Well studied, well documented. Approved by State Board of Education & TDH Minority Council as culturally compatible for all race/ethnic groups. Other schools are using it, endorsed by colleagues and professional associations (e.g. TMA, TAHPERD, PTA, etc.). Compatibility: Most schools have PE and food service and health education requirements. CATCH meets CDC and State guidelines. Parents, teachers, and students like the program. Complexity: IT’S NOT – CATCH modifies rather than replaces. Trialability: Program costs little to implement. CATCH staff conducts training, which is supported by the TDH – Diabetes Program/Council. Observability: Visible school environmental changes. Principal receives positive reinforcement, school health apparent. Assist in accountability. Why are schools adopting CATCH?

Conclusions and Recommendations CSHP enhance school connectedness, student health, staff and family wellness, and educational outcomes. CATCH demonstrated that behaviors such as eating foods high in saturated fat and physical inactivity can be changed. A coordinated school health program can be implemented in schools & it is possible to broadly disseminate a coordinated program.

Handy Resources Contact the CATCH Office: Peter Cribb, Program Director phone (512) or fax (512) CATCH website: