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:
Risk-based (small group) intervention:
a Risk-based, small group intervention;
a Population-based, large group intervention; and
no intervention (control group).
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.
Delivered only to those with risk factors for future heart disease [Risks
are defined elsewhere]
Delivered in groups of 6 to 8 children by nurse educators or certified
Groups met 2 times per week for "education" sessions but 3 times per week
for physical activity
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
Delivered to all students in 3rd and 4th grade at participating schools
Delivered by either the regular classroom teacher or a certified physical
"Education" components were delivered 2 times per week and physical activitiy
components given 3 times 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.
Classroom-only school received our health education,
PE-only school received our PE but received their usual health
Classroom plus PE school received both our classroom and
our PE curricula and
Control school followed their usual health and PE curricula.
[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.
Our lesson plans were delivered by regular health teacher
Classes met for about 45 minutes, 2 times per week for 8 weeks
**Two small schools were combined to represent one site for this intervention.
Usual health education was taught.
Our lesson plans were delivered by regular physical education teacher
Classes were active for at least 30 minutes, 3 times per week for 8 weeks
Classroom plus PE:
6th-8th grade results summary:
Our health and PE lesson plans were delivered by the regular health and
Health lesson plans were given on alternate days with PE lessons following
the same time schedule as the other schools
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.