title: School-based health education programs can be maintained over time: results from the CATCH Institutionalization study.
abstract: 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. Macronutrient content of 5 days of school lunch menus, amount and type of physical education (PE) classes, and health instruction practices in the classroom were assessed. An institutionalization score for schools was developed, using program maintenance variables: % kcal from fat and saturated fat in school lunches, % PE class spent in vigorous and moderate-to-vigorous physical activity, and class time devoted to CATCH topics.
  
  
  RESULTS
  Menus from 50% of former intervention cafeterias met the Eat Smart guidelines for fat, compared to 10% of former control cafeterias and 17% of unexposed school cafeterias (P < 0.005). There were no significant differences in implementation of CATCH PE goals between conditions. Although the total time spent teaching CATCH was low in former CATCH schools, the former intervention schools spent significantly more time teaching CATCH and taught more lessons as compared to former comparison schools. Former intervention schools had a higher mean institutionalization score than former comparison schools (P < 0.001). Training had the greatest impact on maintenance of CATCH.
  
  
  CONCLUSIONS
  Results from this study suggest that changes in the school environment to support healthful behaviors can be maintained over time. Staff training is an important factor in achieving institutionalization of these programs.
authors.affiliation: Center for Health Promotion and Prevention Research, The University of Texas-Houston School of Public Health, Houston, TX 77030, USA. Deanna.M.Hoelscher@uth.tmc.edu
authors.forename: Deanna M
authors.initials: DM
authors.lastname: Hoelscher
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Johnson
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Lytle
authors.forename: Stavroula K
authors.initials: SK
authors.lastname: Osganian
authors.forename: Guy S
authors.initials: GS
authors.lastname: Parcel
authors.forename: Steven H
authors.initials: SH
authors.lastname: Kelder
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Stone
authors.forename: Philip R
authors.initials: PR
authors.lastname: Nader
mesh_terms: D000293:Adolescent; D003479:Curriculum; D004032:Diet; D015444:Exercise; D005522:Food Services; D017408:Guidelines as Topic; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D015397:Program Evaluation; D012572:School Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014481:United States