Author + information
- Received December 17, 2018
- Revision received January 24, 2019
- Accepted January 28, 2019
- Published online April 22, 2019.
- Rodrigo Fernandez-Jimenez, MD, PhDa,b,c@rodrigo_fjez,
- Risa Jaslow, MS, RDNa,
- Sameer Bansilal, MD, MSa,
- Maribel Santana, BSa,
- Raquel Diaz-Munoz, RN, MSa,
- Jacqueline Latina, MD, MSa,
- Ana V. Soto, MDd,
- Rajesh Vedanthan, MD, MPHe,
- Mohamed Al-Kazaz, MDa,
- Chiara Giannarelli, MD, PhDa,
- Jason C. Kovacic, MD, PhDa,
- Emilia Bagiella, PhDf,
- Andrew Kasarskis, PhDa,
- Zahi A. Fayad, PhDa,
- Roger J. Hajjar, MDa and
- Valentin Fuster, MD, PhDa,b,∗ (, )@IcahnMountSinai@MountSinaiHeart@CNIC_CARDIO@MSCActions
- aZena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- bCentro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- cCIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- dMount Sinai Medical Center, Miami Beach, Florida
- eDepartment of Population Health, NYU School of Medicine, New York, New York
- fCenter for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Valentin Fuster, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, New York 10029.
Background Preschool-based interventions offer promise to instill healthy behaviors in children, which can be a strategy to reduce the burden of cardiovascular disease later. However, their efficacy in underserved communities is not well established.
Objectives The purpose of this study was to assess the impact of a preschool-based health promotion educational intervention in an underserved community.
Methods This cluster-randomized controlled study involved 15 Head Start preschools in Harlem, New York. Schools and their children were randomized 3:2 to receive either a 4-month (50 h) educational intervention to instill healthy behaviors in relation to diet, physical activity, body/heart awareness, and emotion management; or their standard curriculum (control). The primary outcome was the change from baseline in the overall knowledge, attitudes, and habits (KAH) score of the children at 5 months. As secondary outcomes, we evaluated the changes in KAH subcomponents and emotion comprehension. Linear mixed-effects models were used to test for intervention effects.
Results The authors enrolled 562 preschool children age 3 to 5 years, 51% female, 54% Hispanic/Latino, and 37% African-American. Compared with the control group, the mean relative change from baseline in the overall KAH score was ∼2.2 fold higher in the intervention group (average absolute difference of 2.86 points; 95% confidence interval: 0.58 to 5.14; p = 0.014). The maximal effect was observed in children who received >75% of the curriculum. Physical activity and body/heart awareness components, and knowledge and attitudes domains, were the main drivers of the effect (p values <0.05). Changes in emotion comprehension trended toward favoring intervened children.
Conclusions This multidimensional school-based educational intervention may be an effective strategy for establishing healthy behaviors among preschoolers from a diverse and socioeconomically disadvantaged community. Early primordial prevention strategies may contribute to reducing the global burden of cardiovascular disease. (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health [FAMILIA]; NCT02343341)
This study is funded by the American Heart Association under grant No. 14SFRN20490315. The CNIC is supported by the Ministerio de Ciencia, Innovación y Universidades and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505). Dr. Fernandez-Jimenez is a recipient of funding from the European Union Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 707642. Dr. Bansilal is an employee of Bayer Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Fatima Rodriguez, MD, MPH, served as Guest Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received December 17, 2018.
- Revision received January 24, 2019.
- Accepted January 28, 2019.
- 2019 The Authors