CATCH Study Hopes to Nip Children's Bad Nutritional and Behavior Habits in the Bud

TARRYTOWN, NY--A nationwide study to test whether a multidimensionalapproach can change schoolchildren's nutritional habits and behaviorfor the better is nearing its final stage, Elaine Stone, PhD,of the National Heart, Lung and Blood Institute said at a symposiummarking the 25th anniversary of the American Health Foundation.

The study, called CATCH, for Child and Adolescent Trial of CardiovascularHealth, is trying new methods to spur children to eat better andavoid smoking and other unhealthy habits, said Dr. Stone, programadministrator for the study.

Until the 1970s, school health instruction was heavy-handed andhad little or no impact on health behavior of children, Dr. Stonesaid. That situation began to change in the 1980s, when psychologicalinformation on complex behaviors such as smoking began to be appliedto in-school programs.

The 1990s have brought the realization that health-affecting behaviorssuch as eating, smoking, and exercise have to be looked at together,and that family factors also influence those habits, she said.CATCH, which attempts to integrate behavior modification effortsboth in school and out, thus represents a third generation ofinterventional efforts.

The program starts with nutrition in the third grade, with exerciseadded in the fourth grade, and smoking in the fifth grade. CATCHuses the methodology of clinical trials, with a control groupand an intervention group, she said.

The NHLBI-funded study is trying to change children's behaviorby focusing not only on them as individuals but also on the influencesof family and schools. The approach is "integrated behaviormodification at multiple levels," Dr. Stone said, with databeing gathered on both behavioral and physiological outcomes.

CATCH started with a field trial in four schools, in Minneapolis,New Orleans, Houston and San Diego, and since has been expandedto 96 schools nationwide. Children in those schools are randomizedinto two groups: One receives instruction in the school whilethe other has family intervention added. Children in other districtschools who are not in the program also serve as controls.

In the dietary area, the researchers do a continuing analysisof the children's menu and of school food services. Children fillout a behavior questionnaire that includes a record of food intake,and they are tested for urinary levels of sodium and potassium.

Interim results indicate that fat intake in the fourth grade hasbeen reduced for participants in CATCH, Dr. Stone said, whilefor smoking, "there is a very low onset rate now."

CATCH, which has been going on for more than 3 years, is in itsfinal data collection process now, she said. Children will befollowed up to the eighth grade after the formal data collectionportion of the study ends.

The study is a preview of coming attractions, she said. One ofits outcomes will be creation of a database to help guide futurebehavior modification studies, which are planned by the Centersfor Disease Control, Department of Agriculture, and National Instituteon Drug Abuse, among others. The idea is to "synthesize whatwe know to pinpoint where our resources should go," she said.

One aim will be to determine whether school-sponsored programswill be more effective if coupled with commercial behavior modificationprograms. Since eating, smoking, and exercise habits are majordeterminants of future health, "we need more multidisciplinaryteams for programs in the field," she said.

Nutrition and Cancer

Ernst Wynder, MD, founder and president of the American HealthFoundation, called the CATCH program a precursor of efforts toreduce the incidence not only of cardiovascular disease but alsoof cancer. Dr. Wynder, who was one of the first to warn aboutcigarette smoking when he was at the Memorial Sloan-KetteringCancer Center, now advocates the belief that nutrition is a majorfactor in a number of forms of cancer.

Smoking still plays a role in that area, since it is associatedwith a high intake of fat and a low intake of fruits and vegetables,Dr. Wynder said. But the best information comes from Japanesestudies, which indicate that those nutrients are related to bothbreast cancer and prostate cancer, he said.

For example, the Japanese have much lower intakes of total caloriesand fat than Americans, he said. Breast cancer is rare in Japan,and the prostate cancer rate in Japan is only 10% of that in theUnited States. "If I can't explain a 10-fold difference,I'm not very smart," he said.

Nutrition is so important that treatment of breast cancer shouldinclude dietary modification to reduce total calorie and fat intake,Dr. Wynder said.