A Public Health vs a Risk-Based Intervention to Improve Cardiovascular Health in Elementary School Children: The Cardiovascular Health in Children Study.

A Public Health vs a Risk-Based Intervention to Improve Cardiovascular Health in Elementary School Children: The Cardiovascular Health in Children Study Harrell JS, McMurray RG, Gansky SA, et al (School of Nursing and Departments of Biostatistics and Physical Education, Exercise, and Sport Science, University of North Carolina, Chapel Hill, NC; Department of Dental Public Health and Hygiene, University of California at San Francisco, San Francisco, Calif), Am J Public Health. 1999;89: 1529-1535.

The purpose of this controlled, randomized study was to compare a large-group, classroom-based intervention with a small-group, risk-based approach to improving cardiovascular health in third- and fourth-grade children.

The researchers randomized 2,109 elementary school children (range = 7-12 years of age) by school into 1 of 3 groups: (1) a classroom-based intervention for all third and fourth graders, (2) a risk-based intervention only for those children with one or more cardiovascular disease risk factors (ie, high serum cholesterol, obesity, physical inactivity, risk for future smoking), (3) or a control group.

The classroom-based intervention consisted of educational programs (how to select "heart healthy" foods, dangers of smoking, how to combat pressure to smoke, and importance of regular exercise) 2 times a week for 8 weeks and physical activity 3 times per week. The risk-based approach used the following 3 interventions: (1) nutrition classes that were attended by children at risk because of high cholesterol levels or obesity (n = 393), (2) physical activity classes that were attended by children with low aerobic capacity (n = 213), and (3) "don't start smoking" classes attended by those children with an increased risk of smoking (ie, at least one parent smoked or had stopped smoking within the previous 2 years) (n = 455). Most children (n = 645; 77.2%) received at least 1 intervention, 26.8% (n = 224) received 2 interventions, and 11.5% (n = 96) received 3 interventions. The control group did not receive any type of intervention.

School-based analyses revealed that, compared with the control group schools, the posttest knowledge scores (as measured with a 25-item questionnaire) were significantly greater in the classroom-based intervention schools, and the physical activity scores on a revised form of the Know Your Body Health Habits Survey improved significantly in the risk-based schools. The individual-level intervention effects revealed that cholesterol decreased more in the classroom-based group than in the control group and that the skinfold thickness decreased 2.9% in the classroom-based group and 3.2% in the risk-based group as compared with a 1.1% increase in the control group.

The authors concluded that both the classroom-based and the risk-based interventions had positive effects on knowledge and physical activity, with trends toward reduced cholesterol and body fat. However, they said that the results from the classroom-based approach showed stronger trends and were much easier to implement in the school system.

Janna Beling, PT, PhD California State University, Northridge Northridge, Calif