School-based Interventions:

Two school-based interventions have been implemented as part of the CHIC studies: One to third and fourth graders and one to sixth, seventh and eighth graders. Both interventions had classroom and physical activity components. Both interventions lasted 8 weeks. Students were tested prior to starting the interventions and immediately after finishing the interventions. Yearly follow-up testing has been done on each group as funding has allowed.

3rd/4th Grade intervention:

The first intervention, given to 3rd and 4th graders, was actually testing two different types of interventions. The 18 participating elementary schools were assigned to one of three "intervention" groups:

  1.  a Risk-based, small group intervention;
  2.  a Population-based, large group intervention; and
  3.  no intervention (control group).
Risk-based (small group) intervention: The small group intervention, also called a risk-based intervention, was delivered to groups of 6 to 8 children at a time. Students with risk factors left their regular classroom to spend 30 minutes, two times per week with a nurse educator. Students may also have spent 30 minutes three times per week with a certified physical educator.

Students who were identified as having high cholesterol, obesity, low physical fitness or who were at risk for starting to smoke received the special sessions. The nurse educators delivered an investigator-designed set of lesson plans on the appropriate nutritional needs for healthy lifestyle, the dangers of smoking, and a one-class session on what having a family with heart disease means. Lessons were obtained from existing elementary health curricula and tailored to meet the goals of the study. Nurse educators were oriented to the lesson plans by the pediatric nurse practitioner co-investigator. The certified physical educators delivered a modified PE curricula to groups of 6 to 8 children during their usual PE time or during another time arranged with the school if PE was not offered 3 times per week. The PE curricula was comprised of non-competitive, group activities that were aerobic in nature. Students had 5 minutes of warm-up, 20 minutes of activity, and 5 minutes of cool-down. Physical educators were oriented to the lesson plans by the exercise physiologist co-investigator who compiled them.

Students who had high cholesterol and/or were obese received the nutrition sessions. Students who were not physically fit received the PE sessions. Students at risk for starting to smoke received the anti-smoking sessions. Some students received only one set of lessons whereas other students received two or even all three. [Risks are defined elsewhere]  Although high blood pressure is a risk factor for CVD, we elected not to target an intervention at this risk because we did not expect to find many subjects with hypertension. 23% of the students in these schools received no intervention. Any student who had a parent or grandparent with heart disease received the one session on the meaning of family history of heart disease. Most of the students received this session.

Large group intervention:

The large group intervention, also considered a classroom-based or population-based intervention, was delivered to all students in the classroom by the regular teacher. The classroom teachers used a condensed version of the American Heart Association Lower and Upper Elementary School Site kits available at that time (school year 1990-91). An elementary educator was hired by the study to select the necessary lessons and adapt them to the study goals. She also visited each participating school and oriented the teachers to the lesson plans and was available to help them during the course of the intervention. [Note: We had our elementary educator review the recent AHA elementary school site kit, Heart Power. She found it comparable in content and focus to the ones we used for this intervention.] Certified physical educators taught the same PE curricula as delivered in the small group intervention but to the entire class rather than to small groups. Most schools had to adapt their PE schedules to meet the required three sessions per week.

3rd/4th Grade results summary:

Both interventions were successful in reducing total cholesterol, reducing body fat and improving aerobic fitness, physical activity, and health knowledge. However, the large group intervention was somewhat more successful and was easier to implement and less costly than the small group intervention. In addition, the large group intervention was more effective in rural than in urban areas.

6th-8th Grade Intervention:

Given that the initial intervention was more effective in rural areas and that the population-based approach was more feasible in the schools, our second intervention built on those findings. The second intervention, given to 6th through 8th graders in only rural areas, was a variation on the population-based (Large group) approach used with 3rd and 4th graders. It was designed to determine whether the classroom or physical education or combination of the components is most important in reducing risk factors.


The classroom lesson plans were compiled by the project manager and an experienced middle grades health educator who was also a certified health trainer for the state. Lessons were taken from existing health texts and materials available from various health agencies across the country. The health educator visited the participating schools and oriented the teachers to the lesson plans. In addition, all supplemental, audio-visual materials were supplied and all hand-outs that were part of the curriculum were copied by the study and provided to the teachers. The PE lesson plans were compiled from available PE texts by the exercise physiologist co-investigator and an experienced middle grades physical educator. The middle grades physical educator oriented the PE teachers to the lesson plans and made site visits to all schools during the intervention to see that both health and PE lessons were being used as designed.

[NOTE: Rather than doing fingerstick cholesterol screening on all subjects, we drew blood for lipid profiles on about half of these subjects.]


**By choice, this school did not offer physical education activity during the 8 weeks of the intervention.


**Two small schools were combined to represent one site for this intervention. Usual health education was taught.

Classroom plus PE:

6th-8th grade results summary:

Both the classroom and the physical education components show some positive effects but the combination of the two produces the most significant results. Results of this intervention have not yet been published. Further updates will become available as publication warrants.

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