School-Based Cardiovascular Health Promotion: The Child and Adolescent Trial for Cardiovascular Health (CATCH)

Article excerpt

During the past decade, a revolution in school health education occurred, with expanded objectives and demonstrable behavioral outcomes. Before 1980, the goal of school health education was similar to that of other academic subjects: to provide more knowledge about personal and social health. Healthier behavior patterns were expected as a result of greater knowledge and more positive attitudes about health. Lack of change in behavior, particularly cigarette smoking among adolescents in the 1970s--a decade after the Surgeon General's landmark report on the health consequences of smoking--provoked a new look at health education in schools. At that time the need to develop new approaches to promote behavior change through school programs became a mandate.

Guided by behavioral models from social psychology, rather than by medical or educational models, several school-based intervention programs achieved changes in smoking onset rates, eating habits, and physical activity patterns. (1) These programs deemphasized knowledge acquisition and instead emphasized social influences, skill-building, and behavioral competencies related to particular health-related behavior. For cardiovascular health promotion, program outcomes were enhanced when classroom curricula were augmented by parental involvement, school environmental changes, and multiple years of education. (2-6)

The current challenge, then, is to develop programs that are implemented with youth before certain behavior patterns solidify. These programs should address multiple behaviors simultaneously, including classroom, environmental, and family components. Given the overrepresentation of acute and chronic diseases among the lower educational and socioeconomic strata in the U.S., it is essential that such programs be tested among diverse populations, including the poor and less well-educated. (7)

This paper provides a brief overview of the goals and objectives of the Child and Adolescent Trial for Cardiovascular Health (CATCH) study. In addition, it provides the scientific rationale for cardiovascular health promotion with youth. It describes how CATCH should not only test hypotheses on cardiovascular disease (CVD) prevention but should provide data on stages of individual and organizational change that may be necessary for school-based health promotion to be successful.


CATCH was designed as a research study to continue the development of and demonstrate the effectiveness of new approaches for behavioral school health education. It is an outgrowth of progress made in discrete research studies in the 1980s. The overall objective of the trial is to assess the effects of a school-based intervention for promoting healthful behavior in elementary schoolchildren to reduce their subsequent cardiovascular disease risk. Programs developed for CATCH provide skills training in more healthful eating, physical activity, and nonsmoking patterns. These behavioral changes are expected to influence favorably serum lipids and lipoproteins, blood pressure, and physical fitness.

School curricula focus on these health behaviors, and parental involvement programs have been designed so changes promoted in the curricula are reinforced by parents at home. School environmental change programs provide opportunities for students to rehearse and practice these new skills and thereby reduce inconsistencies between what is taught in the classroom and what is practiced by the institution of the school. Table 1 contains a summary of each intervention program planned for Phase II with reference to previous research that serves as the basis for the programs. (8-11)

Table 1
CATCH Phase II Intervention Programs

Grade   Type of           Title/
Level   Program           Reference           Description

3       Classroom         The Adventures of   Eating and
        Curricula         Hearty Heart and    exercise program;
                          Friends (3)         15 sessions over
                                              five weeks; Skills
                                              training, modeling
                                              by cartoon
                                              characters, food
                                              teacher-led. …