A Coordinated Approach A Coordinated Approach To Child HealthTo Child Health

Center for Health Promotion and Prevention Research

University of Texas-HoustonSchool 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 2010

http://web.health.gov/healthypeople

Why is this important?Why is this important?

Some facts about Some facts about the health status health status of children in the U.S.of children in the U.S.

ObesityObesity

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 Actual Causes of Death in the United States, 1990United States, 1990

Source: McGinnis JM, Foege WH. JAMA 1993;270:2207-12.

400,000

300,000

100,000 90,000

30,000 20,000

0

100,000

200,000

300,000

400,000

500,000

Tobacco Diet/Activity Alcohol Microbialagents

Sexualbehavior

Illicit use ofdrugs

Percentage of U.S. Youth Who Percentage of U.S. Youth Who Were Overweight*, by AgeWere Overweight*, by Age

13%

10.7%

4.1%

14.0%

10.7%

4.6%

0

2

4

6

8

10

12

14

16

1963-70 1971-74 1976-80 1988-94 1999

Percent

Ages 6-11 Ages 12-17* >95th percentile for BMI by age and sex based on NHANES I reference data

Source: Troiano RP, Flegal KM. Pediatrics 1998;101(3):497-504. NHANES 1999, National Center for Health Statistics

Type 2 DiabetesType 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 Adverse CVD Risk Factor Levels in ChildrenLevels 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; 103:1175-82`

Percent of overweight children, aged 5-10, with 1 or more adverse CVD risk factor levels

60.6%

Physical InactivityPhysical 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!!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 ConsumptionSoda 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;357:505-08.

How can we combat this How can we combat this “obesity epidemic?”“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 & familyEthnically diverse populationFour 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 KidsIt’s All About Healthier KidsIt’s All About Healthier KidsIt’s All About Healthier Kids

Physical EducationStudents will be involved in

MVPA for 50% of class timeStudents are provided many

opportunities to participate and practice skills

Students enjoy physical activityStudents 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 ProgramHomework 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), 768-76.Nader PR, et al (1999). Arch Pediatr Adolesc Med, 153(7), 695-704.

Moderate to Vigorous PA(Percent of Lesson Time)

30

35

40

45

50

55

60

0 1 2 3 4 5 6

Intervention Control

Healthy People 2000 Objective 1.9

Semester

8th Grade Follow-up Min/day of Vigorous Physical Activity*

3 4 5 6 7 8

School Grade

Intervention

Control

60

40

20

0

Vig

oro

us A

cti

vit

y

Min

.

* Not measured at baseline

8th Grade Follow-up Dietary Fat Intake

3 4 5 6 7 8

School Grade

_______ Intervention

- - - - - - Control

34

32

30

0Die

tary

Fat,

% o

f En

erg

y

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

cribb@uts.cc.utexas.edu

phone (512) 346-6163 or fax (512) 346-6802

CATCH website:http://www.sph.uth.tmc.edu/chppr/catch