Elementary School Program Improves Children's Physical Activity and Diet

Addresses CDC Winnable Battle: Obesity
Case Study

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Coordinated Approach To Child Health (CATCH)

 

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Background

During the past 2 decades, childhood obesity has steadily increased in the United States, and the increase in childhood diabetes is alarming. These changes have highlighted the importance of developing and disseminating effective programs to increase physical activity and improve diet among children and to coordinate health messages in schools and communities.

Context

The Coordinated Approach To Child Health (CATCH) program* was designed in the 1980s to improve physical activity and diet and to prevent the onset of tobacco use (Perry et al., 1990). Researchers at The University of Texas Health Science Center at Houston (UTHealth), in conjunction with experts from Tulane University, the University of California at San Diego, and the University of Minnesota, developed an interdisciplinary program for elementary schools, under the auspices of the National Institutes of Health (NIH). The intent is to improve a whole set of environmental influences to support behavior change, both inside and outside of school. 

In recent years, researchers at the Michael & Susan Dell Center for Health Living at UTHealth School of Public Health have designed and evaluated additional elements for the CATCH program to address new at-risk populations and additional behaviors: CATCH Early Childhood (children ages 3-5); CATCH K- 2^nd grade; CATCH Middle School; CATCH After School; CATCH My Breath, a middle school e-cigarette program; CATCH sunscreen protection program for young children, and CATCH Healthy Smiles, an oral health program for K-3rd graders.  The five main components of CATCH are (1) Pre K-8 classroom curricula focusing on food, nutrition, physical activity, sun safety, oral health, and e-cigarette prevention; (2) physical education activities; (3) child nutrition services; (4) family involvement; and (5) community involvement. CATCH is also aligned with the Centers for Disease Control and Prevention’s coordinated school health and the Whole School, Whole Community, Whole Child (WSCC) models.  CATCH augments existing school health programming by inviting local community youth organizations to participate in the process of creating a healthier school environment.

Methods & Results

An evidence base supports the program’s efficacy in improving diet and increasing physical activity and preventing the onset of obesity in children. In 1992, a 3-year randomized controlled trial* of the CATCH program in 56 intervention and 40 control elementary schools in 4 states (Texas, Minnesota, California, and Louisiana) resulted in children significantly increasing time (from 40% to 50%) spent in moderate to vigorous physical activity within physical education classes, as well as significantly decreasing consumption of fat (from 39% to 32%) in school meals. According to follow-up surveys, the significantly increased physical activity and reduced fat intake persisted over 3 consecutive years without additional intervention.

In 1999, results of long-term CATCH follow-up study indicate that changes in diet and physical activity in the original cohort were maintained 3 years post intervention, until the children were in eighth grade.

CATCH has been proven effective in promoting health among inner-city, border, rural, privileged, and underprivileged children. A school randomized replication study of CATCH in El Paso, Texas found significant effects in reducing the rate of increase of overweight and risk of overweight among a cohort of children in grades 3-5. By fifth grade, the rate of increase was 2 percent for girls and 1 percent for boys in intervention schools, compared with 13 and 9 percent, respectively, in control schools.  Based on positive results, the El Paso region, with funding from Paso del Norte Health Foundation, conducted a community-wide implementation of CATCH; data from the School Physical Activity and Nutrition (SPAN) survey found a 7 percent reduction in child obesity prevalence in the El Paso region from 2000-2002 (prior to CATCH implementation) to 2004-2005 (after CATCH implementation) (Hoelscher et al., 2010a.)

In 2010, a demonstration study of CATCH with low-income Hispanic and African American students in the Travis County area showed an 8 percent reduction in overweight and obesity among fourth graders (Hoelscher et al., 2010b).  According to a 2007 cost-effectiveness study of CATCH, the program’s cost effectiveness ratio was approximately $900 (representing the intervention cost per quality-adjusted life-year saved), and the net benefit was $68,125 (based on a comparison of the present value of averted future costs due to obesity with the cost of the CATCH intervention) (Brown et al., 2007).

Consequences

With support from CDC, in the 1990’s, the UTHealth Prevention Research Center (PRC) endeavored to disseminate, implement, and institutionalize the CATCH program in Texas schools. Staff were hired to dedicate their time to foster and sustain partnerships and to develop and conduct training for school personnel. Partnerships to disseminate CATCH at that time included the Texas Department of Health; Texas Education Agency; Paso del Norte Health Foundation; National Heart, Lung, and Blood Institute; American Heart Association; Texas Medical Association; Bexar County Community Health Collaborative; and many other organizations. Dedicated dissemination staff proved invaluable in coordinating partnerships, maintaining momentum, and ensuring quality control as the program grows.

The CATCH collaboration became motivated to educate policymakers in Texas, which resulted in the development and passage of Senate Bill 19 in 2001 mandating that all elementary schools have a coordinated school health program by 2007 and Senate Bill 42, extending SB19 to include middle schools (grades 6-8).

Impact And Potential Impact

CATCH is proving to be sustainable and feasible in a wide variety of settings. The program provides hands-on training and is designed to minimize the burden on teachers and school staff. The program has been adapted for low-income communities in the United States and dissemination is well underway - interest continues to grow.

In 2014, the CATCH Global Foundation was formed to assume the maintenance and distribution of the CATCH platform, lead future program development, and support greater dissemination in economically disadvantaged communities. The Foundation is a 501(c)3 public charity and provides CATCH schools and communities with implementation training, technical support, evaluation assistance, assistance with locating and writing grants, community publicity, and other services. Since its inception, the Foundation has guided more than 100 new CATCH implementations, impacting over 150,000 children.

Updates:

• Approximately 50% of Texas elementary schools have adopted CATCH as their coordinated school health program as part of Texas requirements for school health.
• Over the years, CATCH has been updated to align with current research and best practices and has been expanded for use in middle school, afterschool, and preschool settings.
• Schools in 38 states use CATCH programs and CATCH is beginning to be disseminated internationally, including a recent implementation in Ecuador.

An estimated 10,000 educational sites use CATCH programs, reaching approximately 1.7 million children.

References

Barroso, C., Kelder, S. H., Springer, A., Ledingham, C., Hoelscher, D. M., & Ranjit, R. (2009). Senate Bill 42: Implementation and Impact on Physical Activity in Middle Schools. Jounral Adolescent Health Care, S82-S90.

Brown, H. S., Rivera, R., Kelder, S., Hoelscher, D., Li, Y. P., & Perez, A. (2007). The Cost-Effectiveness of a School-Based Overweight Program. International Journal of Behavioral Nutrition and Physical Activity, 4(1), 47.

Coleman, K. J., Tiller, C. L., Sanchez, J., Heath, E. M., Sy, O., Milliken, G., & Dzewaltowski, D. A. (2005). Prevention of the Epidemic Increase in Child Risk of Overweight in Low-Income Schools: the El Paso Coordinated Approach to Child Health. Archives of Pediatrics and Adolescent Medicine, 159, 217-224.

Franks, A., Kelder, S. H., Dino, G., Horn, K., Gortmaker, S., Wiecha, J., & Simoes, E. (2007). School-Based Programs: Lessons Learned from CATCH, Planet Health, and Not-On-Tobacco. Preventing Chronic Disease: Public Health, Research, and Policy, 4, A33. Retrieved from http://www.cdc.gov/pcd/issues/2007/apr/06_0105.htm

Hoelscher, D. M., Kelder, S. H., Perez, A., Day, R. S., Benoit, J. S., Frankowski, R. F., . . . Lee, E. S. (2010a). Changes in the Regional Prevalence of Child Obesity in 4th, 8th, and 11th Grade Students in Texas from 2000-2002 to 2004-2005. Obesity, 18(7), 1360-1368.

Hoelscher, D. M., Springer, A. E., Menedez, T., Cribb, P. W., & Kelder, S. H. (n.d.). From NIH to Texas Schools: Policy Impact of the Coordinated Approach to Child Health (CATCH) Program in Texas. Active Living Research.

Hoelscher, D., Springer, A., Ranjit, N., Perry, S., Evans, A., Stigler, M., & Kelder, S. (2010b). Reductions in Child Obesity among Disadvantaged School Children with Community Involvement: The Travis County CATCH trial. Obesity, 18(1), S36-S44.

Kelder, S. H., Springer, A., Barroso, C., Smith, C., Sanchez, E., Ranjit, N., & Hoelscher, D. M. (2009). Implementation of Texas Senate Bill 19 to Increase Physical Activity in Elementary Schools. Journal of Public Health Policy, 30(1), S221-S247.

Luepker, R. V., Perry, C. L., McKinlay, S. M., Nader, P. R., Parcel, G. S., Stone, E. J., . . . Wu, M. (1996). Outcomes of a Field Trial to Improve Children's Dietary Patterns and Physical Activity: the Child and Adolescent Trial for Cardiovascular Health (CATCH). Journal of the American Medical Association, 275, 768-776.