Formative research in school and community-based health programs and studies: "state of the art" and the TAAG approach.

Formative research uses qualitative and quantitative methods to provide information for researchers to plan intervention programs. Gaps in the formative research literature include how to define goals, implementation plans, and research questions; select methods; analyze data; and develop interventions. The National Heart, Lung, and Blood Institute funded the Trial of Activity for Adolescent Girls (TAAG), a randomized, multicenter field trial, to reduce the decline in physical activity in adolescent girls.

School-based health education programs can be maintained over time: results from the CATCH Institutionalization study.

Background: Developing and evaluating interventions to influence students' opportunities for healthful choices has been a focus of school-based health promotion research; however, few studies have examined the sustainability of these programs and viability of continued organizational implementation.

Methods: The purpose of this study was to determine the maintenance of Child and Adolescent Trial for Cardiovascular Health (CATCH) school-level changes in former intervention (n = 56) and former comparison (n = 20) schools 5 years post-intervention. Twelve schools unexposed to CATCH were measured as controls.

School climate and implementation of the Pathways study.

Background: Pathways was a multisite school-based study to prevent obesity in American Indian school children by encouraging healthy eating and physical activity.

Methods: Over the 3-year study, a total of 290 in-depth interviews were conducted with school administrators, food service managers, classroom teachers, and physical education instructors in all 21 intervention schools to examine support and barriers for Pathways. Analysis included qualitative assessment of key themes using NUD*IST and quantitative modeling of the impact of a school climate score on implementation of intervention components.

Changes in the nutrient content of school lunches: results from the Pathways study.

Background: Pathways, a randomized trial, evaluated the effectiveness of a school-based multicomponent intervention to reduce fatness in American-Indian schoolchildren. The goal of the Pathways food service intervention component was to reduce the fat in school lunches to no more than 30% of energy from fat while maintaining recommended levels of calories and key nutrients.

Methods: The intervention was implemented by school food service staff in intervention schools over a 3-year period.

Pathways curriculum and family interventions to promote healthful eating and physical activity in American Indian schoolchildren.

Background: Pathways, a multisite school-based study aimed at promoting healthful eating and increasing physical activity, was a randomized field trial including 1704 American Indian third to fifth grade students from 41 schools (21 intervention, 20 controls) in seven American Indian communities.

Methods: The intervention schools received four integrated components: a classroom curriculum, food service, physical activity, and family modules. The curriculum and family components were based on Social Learning Theory, American Indian concepts, and results from formative research.

Design, implementation, and quality control in the Pathways American-Indian multicenter trial.

Background: Pathways was the first multicenter American-Indian school-based study to test the effectiveness of an obesity prevention program promoting healthy eating and physical activity.

Methods: Pathways employed a nested cohort design in which 41 schools were randomized to intervention or control conditions and students within these schools were followed as a cohort (1,704 third graders at baseline). The study's primary endpoint was percent body fat.

Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren.

Background: Childhood obesity is a major public health problem in the United States, particularly among American Indian communities.

Objective: The objective was to evaluate the effectiveness of a school-based, multicomponent intervention for reducing percentage body fat in American Indian schoolchildren.

Design: This study was a randomized, controlled, school-based trial involving 1704 children in 41 schools and was conducted over 3 consecutive years, from 3rd to 5th grades, in schools serving American Indian communities in Arizona, New Mexico, and South Dakota.

School climate and the institutionalization of the CATCH program.

School climate refers to various physical and psychosocial structures that shape schools' social and physical environments. The Child and Adolescent Trial for Cardiovascular Health (CATCH) study provided an opportunity to study how aspects of school climate are associated with continued implementation of the CATCH program. Nutrient analysis of menus, observations of physical education (PE) classes, and teacher and staff self-reports were used to measure CATCH program components.

Long-term implementation of the CATCH physical education program.

To test the effectiveness of the Child and Adolescent Trial for Cardiovascular Health (CATCH) program, a randomized trial was conducted in 96 elementary schools in four regions of the United States. Results from the original trial indicated a significant positive effect on the delivery of physical education (PE). All 56 former intervention schools (FI), 20 randomly selected former control schools (FC), and 12 newly selected unexposed control schools (UC) were assessed 5 years postintervention.

Institutionalization of a school health promotion program: background and rationale of the CATCH-ON study.

Research is lacking on how to make effective programs available on a large scale and how to maintain levels of implementation. CATCH: A Study of Institutionalization (CATCH-ON) was designed to help us understand the conditions under which such programs are institutionalized after the trial has ended. The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the largest field trial of school-based health promotion in the United States conducted in 96 schools in four geographic areas of the United States: California, Louisiana, Minnesota.

The effectiveness of interventions to increase physical activity. A systematic review.

The Guide to Community Preventive Service's methods for systematic reviews were used to evaluate the effectiveness of various approaches to increasing physical activity: informational, behavioral and social, and environmental and policy approaches. Changes in physical activity behavior and aerobic capacity were used to assess effectiveness. Two informational interventions ("point-of-decision" prompts to encourage stair use and community-wide campaigns) were effective, as were three behavioral and social interventions (school-based physical education, social support in community settings, and individually-adapted health behavior change) and one environmental and policy intervention (creation of or enhanced access to places for physical activity combined with informational outreach activities).

Sociodemographic differences in exposure to health information.

Objective: Baseline data from the Heart Attack REACT Study provided the opportunity to explore population subgroup differences in exposure to health information in an ethnically diverse sample from 5 regions across the United States.

Methods: During the 4-month baseline period of the REACT study, some 1,200 residents from the 20 study communities were surveyed using random digit dial telephone methods. Respondents were asked to recall health messages seen and/or heard recently, and the sources of these messages.

Fifth through eighth grade longitudinal predictors of tobacco use among a racially diverse cohort: CATCH.

CATCH provides multiethnic cohort data from third to eighth grades from four US geographic regions. This study examined smoking behaviors and predictors from fifth and eighth grades by ethnicity, gender, and geographic location through self-report data obtained from the cohort (N = 3,654). Overall, eighth grade prevalence for ever smoked was about 44%, 30-day prevalence was about 20%, 7-day prevalence 13.