Child Health Promotion in Underserved Communities: The FAMILIA Trial

• Published in: Journal of the American College of Cardiology Vol. 73; no. 16; pp. 2011 - 2021
• Main Authors: Fernandez-Jimenez, Rodrigo, Jaslow, Risa, Bansilal, Sameer, Santana, Maribel, Diaz-Munoz, Raquel, Latina, Jacqueline, Soto, Ana V, Vedanthan, Rajesh, Al-Kazaz, Mohamed, Giannarelli, Chiara, Kovacic, Jason C, Bagiella, Emilia, Kasarskis, Andrew, Fayad, Zahi A, Hajjar, Roger J, Fuster, Valentin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 30.04.2019
• Subjects: Attitudes; Cardiology; Cardiovascular diseases; Cardiovascular Diseases - prevention & control; Caregivers; Child Welfare; Child, Preschool; Children; Children & youth; Childrens health; Cluster Analysis; Confidence intervals; Control methods; Curricula; Diet; Domains; Education; Families & family life; Female; Head Start project; Health Behavior; Health care; Health Education - organization & administration; Health promotion; Health Promotion - organization & administration; Hispanic Americans; Humans; Intervention; Lifestyles; Linear Models; Male; Medically Underserved Area; New York City; Parents & parenting; Physical activity; Poverty - statistics & numerical data; Preschool children; Primary Prevention - methods; Program Development; Program Evaluation; Questionnaires; Randomization; Schools; Schools - organization & administration; Teachers; New York City; Colombia; Spain; exercise; health promotion; emotions; diet; vulnerable populations; attitude
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2019.01.057

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. The purpose of this study was to assess the impact of a preschool-based health promotion educational intervention in an underserved community. 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. 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. 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).