Disclosures: The authors report no relevant financial disclosures.
January 18, 2022
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Lessons learned: Preschool heart health program could yield long-term community benefits

Disclosures: The authors report no relevant financial disclosures.
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A global healthy lifestyle intervention initiated in preschool settings was associated with improved health knowledge, attitude and habits and could potentially reduce CVD risk across the life span, data from a 10-year review show.

In a review of the Salud Integral-Comprehensive Health (SI!) program for CV health promotion, an early childhood health intervention focusing on nutrition, fitness, body awareness and emotional well-being, researchers highlighted lessons learned on how to achieve long-term success promoting and retaining lessons on CV health in the school setting. The review, published in the Journal of the American College of Cardiology, also noted important pillars of the preschool program’s success: establishing multidisciplinary teams; multidimensional educational programs; multilevel interventions; local program coordination and community engagement, along with scientific evaluation through randomized clinical trials.

Graphical depiction of data presented in article
Valentin Fuster, MD, PhD, director and principal investigator of the program and director of Mount Sinai Heart in New York.

“This is a research program based on the concept of SHE — science, health and education — and it is focused on children,” Valentin Fuster, MD, PhD, director and principal investigator of the program and director of Mount Sinai Heart in New York, told Healio. “We believe that the best thing we can do for health in the future is to educate the children. At this early age, 3 to 6 years, they capture everything you tell them.”

Engaging children, teachers and families

As Healio previously reported, the SI! Program, first initiated in 2009, consisted of interventions in two countries: one in Colombia with 2,000 children, and a second in Spain with 2,062 children, later expanding to New York City. Researchers randomly assigned schools to an intensive education intervention of approximately 60 hours over 5 months promoting a healthy diet, exercise, understanding the human body and managing emotions, or to a control group. After the intervention, students were assessed on how their knowledge, attitudes and habits changed toward a healthy lifestyle. The intervention in Spain was expanded to include measurements of body weight, height, waist circumference, skinfold thickness and BMI.

The SI! Program also featured a heart-shaped mascot, named Cardio, and used Sesame Street characters such as Dr. Ruster, a Muppet doctor character based on Fuster. Simple messages on posters or flyers about healthy habits were also distributed throughout the intervention schools. Follow-up of the students is ongoing.

“The program aims to generate positive habits and attitudes related to body self-care and health-related matters,” the researchers wrote. “These positive attitudes are generated through knowledge acquisition, motivation and content reinforcement by using animated characters, which help to make abstract concepts concrete and provide the children with a role model.”

‘Repeatability is critical’

The study found that, in the first year, children who received the intervention had 5.5% higher knowledge, attitudes and habits scores compared with those not receiving the intervention; after the second year, the scores were 7.7% higher; and after the third year, the scores were 4.9% higher. However, the SI! Program has not consistently shown a sustained improvement in relevant CV health metrics across the life span of a child beginning at age 3 to 5 years.

“There are moments of frustration,” Fuster, also the study’s principal investigator and the editor-in-chief of JACC, said in an interview. “It is frustrating when you find these children lose what you told them later, but we are excited again, because we are seeing the second time around, it is geometric. You need to redo it again. This is human. The repeatability is critical.”

The most important takeaway from the program at 10 years: Reintervention at a later age is key, according to Fuster.

“We have learned so many things that are meaningful,” Fuster said. “No. 1, the results in the short term are magnificent. There is tremendous success, but it drops with time, to the point that we are now starting a new project, called Sustainability. When these children reach age 10 to 12 years, they might forget parts of what we told them, so we do a reintervention. We are dealing with 50,000 children now. If a child received an intervention for the first time, we intervene with them again. Our hypothesis is the reintervention will be exponential in terms of benefit compared with the children who only receive the intervention once.”

In the review, the researchers wrote that effective health promotion interventions early in life, like the SI! Program, may induce long-lasting healthy behaviors. Ideally, such habits could curb the CVD epidemic, they wrote.

“A core challenge in global health is translating scientific evidence into educational and community practices,” the researchers wrote. “This challenge becomes more complex when it requires individual, organizational and systemic behavior change. By matching rigorous scientific impact studies with implementation framework analysis, we can help bridge the divide between science and educational practice.”

Creating healthy communities

Fuster said the SI! Program is currently expanding across the five boroughs of New York City through a new project called the Children’s Health and Socioeconomic Implications Project. There are also plans to launch a more family-centered education program this summer, he said.

“After you teach these children for 60 hours, they spend time at home, and we are finding these children have more of an impact on the parents because they teach the parents what they are learning — to exercise, to have dinner as a family,” Fuster told Healio. “We are now developing a project, starting in July, in which we take the four aspects of our program into the family. You cannot think that individually you can be successful. You need a successful environment. That is why healthy communities are so important.”

For more information:

Valentin Fuster, MD, PhD, can be reached at valentin.fuster@mssm.edu.