The Child and Adolesent Trial for Cardiovascular Health (CATCH) is likely the most extensively implemented and evaluated example of a multicomponent, school-based program that includes an educational curriculum along with a behavioral component and school environmental change (Luepker, et al., 1996; Nader, et al., 1999). Although the program was implemented during elementary school, behavioral effects were sustained to a follow-up three years after the intervention's completion, when the participants were pre- and young adolescents in the 6th, 7th, and 8th grades. Ninety-six schools in California, Louisiana, Minnesota, and Texas were randomized to the CATCH intervention (56 schools) or control group (40 schools). CATCH schools received school food service modifications and food service personnel training to improve the nutrition of school meals, PE interventions and teacher training to increase the amount of fun moderate-to-vigorous physical activity during PE classes, and classroom curricula to address eating habits, physical activity, and smoking. Control schools received their usual food service, PE classes, and health curricula. Three years later, data were collected for 3,714 middle-school students (73% of the initial cohort), who were 69% white, 14% Hispanic, 13% African American, and 4% other. The experimental group differences observed in dietary behaviors at the end of the intervention were maintained over the transition to middle school.

When compared with the control group at the three-year follow up, the CATCH intervention group, on average, obtained a smaller proportion of dietary energy from total fat (30.6% vs. 31.6%) and from saturated fat (11.3% vs. 11.8%). Nader and colleagues (1999) note that, although these differences appear small in magnitude, they actually correspond to a practically relevant difference of one less dish of ice cream daily or a switch from regular to skim milk for a given student. Students from intervention schools also tended to consume less sodium than did students in the control group. While the intervention group advantage with respect to physical activity behavior narrowed over time, the intervention group continued to average more minutes of daily vigorous activity. The narrowest difference was among 8th graders, with intervention group students averaging 30.2 minutes per day, compared with just 22.1 minutes among students in the control group. (Note: There were no significant program effects on smoking; the smoking component of the program was purely classroom-based.) These findings suggest that a program that combines health education with behavioral components and school environmental modifications can improve physical activity and nutrition-related behaviors over three years after the end of the intervention. While the dissipating effects on physical activity behavior suggest that continued health promotion during junior and senior high school is warranted, further research is needed to identify the most effective programs to target these older adolescents (Nader, et al., 1999).