Hoelscher Deanna M, Feldman Henry A, Johnson Carolyn C, Lytle Leslie A, Osganian Stavroula K, Parcel Guy S, Kelder Steven H, Stone Elaine J, Nader Philip R
Center for Health Promotion and Prevention Research, The University of Texas-Houston School of Public Health, Houston, TX 77030, USA.
Prev Med. 2004 May;38(5):594-606. doi: 10.1016/j.ypmed.2003.11.017.
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.
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.
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.
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.
开发和评估旨在影响学生做出健康选择机会的干预措施一直是学校健康促进研究的重点；然而，很少有研究考察这些项目的可持续性以及组织持续实施的可行性。
本研究的目的是确定在干预后5年，前干预学校（n = 56）和前对照学校（n = 20）中儿童和青少年心血管健康试验（CATCH）在学校层面的变化是否得以维持。将12所未接触过CATCH的学校作为对照进行测量。评估了5天学校午餐菜单的宏量营养素含量、体育课的数量和类型以及课堂上的健康指导实践。利用项目维持变量制定了学校的制度化评分：学校午餐中来自脂肪和饱和脂肪的千卡百分比、体育课中用于剧烈和中度至剧烈身体活动的百分比以及用于CATCH主题的课堂时间。
前干预食堂中有50%的菜单符合“明智饮食”的脂肪指南，相比之下，前对照食堂为10%，未接触学校食堂为17%（P < 0.005）。不同条件下在实现CATCH体育目标方面没有显著差异。虽然在前CATCH学校中教授CATCH的总时间较少，但与前对照学校相比，前干预学校教授CATCH的时间明显更多，且授课节数更多。前干预学校的平均制度化评分高于前对照学校（P < 0.001）。培训对CATCH的维持影响最大。
本研究结果表明，支持健康行为的学校环境变化可以随着时间的推移得以维持。员工培训是实现这些项目制度化的一个重要因素。
