Armed with this insight, more and more physicians, educators, and parents are expressing serious concern over the health and fitness of the nation's children, and justifiably so. Kids today are smoking younger, exercising less, and eating more salt and saturated fats than ever before - unhealthy habits that can increase the risk of heart disease, according to Philip R. Nader, M.D., UCSD Professor of Pediatrics, Emeritus.

Dr. Nader continues to be active as a research professor after official retirement and recall to active duty part time in research in physical activity and obesity of children, with active NIH grants in this area.

"Thirty to 60 percent of children in the United States exhibit at least one risk factor for cardiovascular disease by the age of twelve," he says. "We can no longer wait until mid-life to worry about the damaging effects of an unhealthy lifestyle."

Nader directs child and family health studies at UCSD and with his UCSD colleagues, is in the midst of leading a national, multiyear, four-center clinical trial designed to engage schools and families in activities that emphasize the importance of good nutrition, regular exercise, and abstention from smoking.

Funded by the National Heart, Lung, and Blood Institute, the Child and Adolescent Trial for Cardiovascular Health (CATCH) focuses on children in third through sixth grades. Students are served low-fat, low-salt meals by their school cafeterias; study cartoon characters such as "Dynamite Diet" and "Salt Sleuth" in class; and attend health fairs designed especially for them and their parents. Parents are offered a "Home Team" curriculum, which gives them the tools to modify the family diet, integrate exercise programs into home life, and read health-related stories.

Several of the schools participating in CATCH have gone "smoke-free," prohibiting employees, students, and visitors from smoking anywhere on school grounds. More schools are slated to adopt the healthful policy in the coming months.

Each child is given a cardiovascular profile at the beginning and end of the CATCH program that measures height and weight, blood cholesterol level, blood pressure, and percent of body fat.

"The rationale is to see what works and develop a program all schools can use," says Nader, who has been medical consultant to the San Diego Unified School District since 1983. "We want to learn the best ways schools and families can help." The CATCH study is now in a dissemination phase with over 1000 schools around the nation adopting the CATCH program.

Nader has been involved in school health activities since 1968 when he initiated one of the earliest school-based demonstration projects in school health at the University of Rochester. It was there he pioneered bringing educators into the medical school setting and, at the same time, providing community-school training opportunities for medical students and pediatric residents.

It was also in that setting where an early urban school health service project was developed and evaluated. A collaborative effort between the school's health service providers and a neighborhood health center served the same children in the Rochester inner-city area. This was one of many early projects that prompted the U.S. Office of Education to promote and fund health and nutrition projects around the country.

Nader integrated similar school health programs for the University of Texas as well.

Nader has also learned to promote health habits in many cultures and environments. Other projects of child and family health studies include neighborhood-based intervention in the Mexican-American and African-American communities, using churches and organizations as focal points for involving families in developing better health habits. These efforts take into account cultural characteristics that affect health habits and attitudes toward health and diet.

"We need to consider all systems that affect the child - community, health care, family, school - to improve scientific rigor in school health research and commit to multi-disciplinary research that is truly collaborative. These are the guiding principles that will lead to better health in future generations."