Different Lifestyle Interventions in Adults From Underserved Communities: The FAMILIA Trial

• Published in: Journal of the American College of Cardiology Vol. 75; no. 1; pp. 42 - 56
• Main Authors: Fernandez-Jimenez, Rodrigo, Jaslow, Risa, Bansilal, Sameer, Diaz-Munoz, Raquel, Fatterpekar, Monali, Santana, Maribel, Clarke-Littman, Andrea, Latina, Jacqueline, Soto, Ana V, Hill, Christopher A, Al-Kazaz, Mohamed, Samtani, Rajeev, Vedanthan, Rajesh, Giannarelli, Chiara, Kovacic, Jason C, Bagiella, Emilia, Kasarskis, Andrew, Fayad, Zahi A, Fuster, Valentin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 07.01.2020
• Subjects: Adults; Arteriosclerosis; Atherosclerosis; Blood pressure; Body mass index; Cardiology; Caregivers; Children; Confidence intervals; Counseling; Curricula; Families & family life; Health promotion; Hispanic Americans; Intervention; Leadership; Lifestyles; Low income groups; Meetings; Parents; Parents & parenting; Pictures; Schools; Sustainability; Tobacco; Ultrasonic imaging; Ultrasound; United States > US; caregivers; health promotion; vulnerable populations; lifestyle; parents
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2019.10.021

The current trends of unhealthy lifestyle behaviors in underserved communities are disturbing. Thus, effective health promotion strategies constitute an unmet need. The purpose of this study was to assess the impact of 2 different lifestyle interventions on parents/caregivers of children attending preschools in a socioeconomically disadvantaged community. The FAMILIA (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health) study is a cluster-randomized trial involving 15 Head Start preschools in Harlem, New York. Schools, and their children's parents/caregivers, were randomized to receive either an "individual-focused" or "peer-to-peer-based" lifestyle intervention program for 12 months or control. The primary outcome was the change from baseline to 12 months in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT Score [FBS]), ranging from 0 to 15 (ideal health = 15). To assess the sustainability of the intervention, this study evaluated the change of FBS at 24 months. Main pre-specified secondary outcomes included changes in FBS subcomponents and the effect of the knowledge of presence of atherosclerosis as assessed by bilateral carotid/femoral vascular ultrasound. Mixed-effects models were used to test for intervention effects. A total of 635 parents/caregivers were enrolled: mean age 38 ± 11 years, 83% women, 57% Hispanic/Latino, 31% African American, and a baseline FBS of 9.3 ± 2.4 points. The mean within-group change in FBS from baseline to 12 months was ∼0.20 points in all groups, with no overall between-group differences. However, high-adherence participants to the intervention exhibited a greater change in FBS than their low-adherence counterparts: 0.30 points (95% confidence interval: 0.03 to 0.57; p = 0.027) versus 0.00 points (95% confidence interval: -0.43 to 0.43; p = 1.0), respectively. Furthermore, the knowledge by the participant of the presence of atherosclerosis significantly boosted the intervention effects. Similar results were sustained at 24 months. Although overall significant differences were not observed between intervention and control groups, the FAMILIA trial highlights that high adherence rates to lifestyle interventions may improve health outcomes. It also suggests a potential contributory role of the presentation of atherosclerosis pictures, providing helpful information to improve future lifestyle interventions in adults.