The study, published in the August issue of Health Education & Behavior, examines a school program called CATCH in the U.S.-Mexico border city of El Paso, Texas, in an area where low-income families and Mexican cultural influences are both dominant.
"For most intervention schools, El Paso CATCH significantly increased moderate to vigorous physical activity during physical education classes, decreased fat in school meals, and decreased sodium in school breakfasts," report investigators Edward M. Heath, Ph.D., from Utah State University and Karen J. Coleman, Ph.D., from the University of Texas at El Paso.
CATCH -- which stands for the Coordinated Approach to Child Health -- is "the most comprehensive and ambitious approach" aimed at promoting healthy behaviors among school children to be implemented in the past 15 years, Heath and Coleman say. Previous testing at 96 schools nationwide has demonstrated that CATCH can produce significant and lasting improvements in physical activity and dietary behaviors.
Such changes, the authors note, are extremely desirable in light of their ability to reduce risk of costly diseases that are in large part lifestyle-related, such as obesity, Type 2 diabetes and heart disease.
The present study examined the first effort to disseminate the CATCH program to elementary schools throughout the country. "Although the national CATCH [trial] included a large representation of Hispanics … these sites were not dominated by the Mexican culture like the El Paso border region" selected as the implementation site, Heath and Coleman note. They cite previous research indicating that physical inactivity and being overweight or obese are especially prevalent among children and adults in this region, and make a major contribution to the high area's high incidence of Type 2 diabetes.
The researchers conducted a three-year outcome and process evaluation of the first two CATCH components to be widely implemented in El Paso elementary schools, targeting physical education classes and meals served in school cafeterias. Trained observers gathered data at 20 CATCH schools and four non-CATCH schools between 1998 and 2000.
Although the results from the CATCH schools were somewhat inconsistent, observations of physical education classes for children in grades three through five revealed substantial increases in time spent engaged in moderate to vigorous physical activity at most schools. Many schools eventually met the program target of 50 percent of class time. Large-percentage increases in vigorous physical activity were also evident at many schools, but final levels invariably fell short of the program target of 20 percent of class time.
Observations during school breakfast and lunch service also revealed improvement, with a trend toward reduced fat and sodium content of meals served. Most schools eventually met or closely approximated the program target of no more than 30 percent of calories from fat at both meals, and kept the sodium content in the desired range of 600-1,000 milligrams for a breakfast meal.
At least two study limitations prevent the authors from being able to state absolutely that CATCH was responsible for the observed improvements. Baseline data were missing from some schools, they note, and other influences could have been at work. Nevertheless, they said the lack of improvement in physical activity levels and increase in fat content of school meals at the non-CATCH schools during the same time period suggest a direct effect of the program.
As successful as El Paso CATCH appears to be, Heath and Coleman found evidence that its effects could be even more profound. "Most of the classroom and physical education teachers, cafeteria staff and administrators were ardent supporters of El Paso CATCH," they observed. Yet physical education instructors, cafeteria staff and classroom teachers said they faced numerous surmountable barriers to implementation, including low priority for physical education relative to other subjects, lack of indoor activity facilities, inflexible cafeteria menus, lack of the right ingredients, lack of materials in Spanish and inadequate staff training.
The study was funded by the Patient Care and Outcomes Research Award program from the American Heart Association and the Paso del Norte Health Foundation.
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Health Education & Behavior