This article is more than 5 years old. Information may no longer be current.
FAMILIA: Health education in preschool may reduce CVD burden later in life
Preschoolers from an underserved community who received a multidimensional school-based educational intervention improved overall knowledge, attitudes and habits about healthy lifestyles, which may potentially reduce the global burden of CVD, according to results from the FAMILIA Project published in the Journal of the American College of Cardiology.
“This is a very scientific-oriented project, but the main concept is that at a young age is what we believe is the window of opportunity. That’s basically what this study was about,” Valentin Fuster, MD, PhD, principal investigator and director of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital, told Cardiology Today. He noted the project was funded by a $3.8 million grant from the American Heart Association.
Intervention in preschools
Rodrigo Fernandez-Jimenez, MD, PhD, researcher at the National Centre for Cardiovascular Research in Madrid, and colleagues analyzed data from 562 children (mean age, 4 years; 51% girls; 37% non-Hispanic black; 54% Hispanic/Latino) from 15 preschools in Harlem in New York City.
“We feel the best age is between 3 and 5,” Fuster said in an interview. “At that age, the number of centers in the brain is relatively small and they do not connect with each other. Later in life, they connect with each other and there are many more centers. So what you learn at this age is easily retained and can be applied in later years. When the children reach puberty and older, the number of centers in the brain and the connections are much more complex and more difficult to retain deep concepts.”
The schools and children were assigned the intervention (9 schools; 398 children) or the control (6 schools; 164 children). The intervention consisted of approximately 50 hours of age-appropriate educational activity during a 4-month period, including a minimum of 37 hours for children and 12 hours for parents and caregivers. The education program promoted the benefits of increasing physical activity, a healthy diet, managing emotions and understanding the human body. Parents and caregivers learned strategies on how to develop and instill healthy behaviors in children.
The primary outcome of interest was a change in the overall composite knowledge, attitudes and habits score in children from baseline to 5 months. Secondary outcomes of interest were changes in the Test of Emotion Comprehension score and BMI.
Changes in health beliefs
During a median follow-up of 5.4 months, the mean relative change in the overall knowledge, attitudes and habits score was approximately 2.2-fold higher in children assigned the intervention vs. those assigned the control (average absolute difference = 2.86 points; 95% CI, 0.58-5.14).
“It is nice that we have good results in an underserved community,” Fuster told Cardiology Today.
The largest benefit from the intervention was seen in children who highly adhered to the program (P for trend = .029).
The greatest changes between both groups were seen for attitudes (mean difference = 1.66; 95% CI, 0.26-3.05) and knowledge (difference = 1.62; 95% CI, 0.41-2.82). Other substantial changes were seen in understanding how the human body and heart work (mean difference = 1.16; 95% CI, 0.15-2.17) and physical activity (mean difference = 1.1; 95% CI, 0.13-2.06).
Children assigned the intervention had a higher change in their Test of Emotion Comprehension score, although it was not statistically significant.
“What we will try to answer soon ... is how you motivate the teachers,” Fuster said in an interview. “In other words, this is a lot of hard work, but not for people who love it. We have been very lucky in all the classes we have been involved by having people very motivated. This is a critical issue. ... The thing we have to do is see how we motivate society and the people who have the possibility to teach these children, and then it would be much easier to understand.”
‘Important milestone’
“Childhood, including in the preschool years, is a critical period for preventing obesity and CVD risk,” Keith C. Ferdinand, MD, professor of medicine at Tulane University School of Medicine and Cardiology Today Editorial Board Member, wrote in a related editorial. “Despite the need for evidence of long-term follow-up and sustainability, the FAMILIA trial is an important milestone for establishing healthy behaviors among preschoolers from a diverse and socioeconomically disadvantaged community. The time is now for primordial CVD prevention, which is even more critical in minorities and children from families with the lowest incomes and educational attainment.” – by Darlene Dobkowski
For more information:
Valentin Fuster, MD, PhD, can be reached at The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029; email: valentin.fuster@mountsinai.org.
Disclosures: Fuster and Fernandez-Jimenez report no relevant financial disclosures. Ferdinand reports he served as a consultant for Amgen, Boehringer Ingelheim, Janssen, Novartis, Quantum Genomics and Sanofi. Please see the study for all other authors’ relevant financial disclosures.