Teaching preschoolers healthy habits lowers their heart disease risk later on

WASHINGTON — For future generations to be happy and healthy, a new study finds it’s never too early to start instilling some positive lifestyle habits. Researchers from Mount Sinai Heart report that implementing school-based programs teaching healthy cardiovascular habits as early as preschool can help students live healthier and avoid heart disease for the rest of their lives.

Prior research reveals that a worrying percentage of modern children and adolescents already practice unhealthy lifestyle habits such as smoking, eating fatty foods, and staying largely stagnant all day. Additional research also reports an association between poor cardiovascular health in childhood and poor cardiometabolic health in adults.

“The SI! Program (Salud Integral – Comprehensive Health) was developed as a multilevel and multicomponent school-based program for the promotion of cardiovascular health and achieving lasting lifestyle changes in children from preschool age. It was implemented in three countries from year 2009 onwards,” says principal investigator Valentin Fuster, MD, PhD, director of Mount Sinai Heart, in a media release.

“The school environment is a great area to introduce lifestyle interventions, because children are spending so much of their time there,” adds Rodrigo Fernández-Jiménez, MD, PhD, group leader of the cardiovascular health and imaging lab at general director at Centro Nacional de Investigaciones Cardiovasculares (CNIC). “There are specific times in a child’s life when improvements can be made to enhance long-term cardiovascular health status. Our review, and previous studies, suggest that 4-5 years of age is the most favorable time to start a school-based intervention focused on healthy habits.”

The more kids learn, the healthier they are

Researchers analyzed the decade-long results of the SI! Program. The project encompassed 3,800 children between the ages of three and five from 50 schools across Colombia, Spain, and the United States. The team closely examined each child to determine if their knowledge, attitudes, or habits shifted at all toward a healthy lifestyle. Sure enough, kids enrolled in SI! displayed big jumps in knowledge, attitudes, and healthy habits following the four-month health program.

After tracking health habits and outcomes well into adulthood and assessing those habits via a series of country-specific surveys, researchers conclude kids who attended more than 75 percent of the SI! program displayed significant positive changes in overall knowledge, attitudes, and habits. Others who only attended less than 50 percent of the program showed considerably fewer habit adjustments.

More specifically, study authors assessed the success of the program for each child according to a complex formula. To start, researchers analyzed dissemination (conveying information about the program to the school). From there, they graded adoption (initial decision by the school to implement the program), implementation, and evaluation (did the program achieve its goals?). Finally, the team measured institutionalization, or whether or not the child incorporated the program’s teachings into their life for the long haul.

“Most preschool interventions focus solely on physical activity and diet. The SI! Program breaks down cardiovascular health into four components. Through the first two components, children are learning how a well-balanced diet and physically active life are directly connected to a healthy heart. Next, they learn about emotion management, which seeks to instill behavior mechanisms against substance abuse – mainly smoking – and dietary decisions later in life. Finally, the children are taught about how the human body works and how it is affected by behavior and lifestyle,” explains lead study author Gloria Santos-Beneit, PhD, scientific coordinator of the SHE-la Caixa Foundation.

Help from a Muppet

To ensure the program worked for preschool aged children, researchers used a heart-shaped mascot named “Cardio” to help convey their healthy messages. Additionally, the “Sesame Street” character Dr. Ruster (a Muppet based on Dr. Fuster) introduced children to new healthy activities. Study authors utilized various videos and printed materials (a colorful storybook, an interactive board game, and flash cards) as well.

Researchers specially designed the messages and activities depending on the country of implementation. So, children in the U.S. received different instructions and activities than others living in Spain or Columbia.

“Further research is needed to identify specific socioeconomic status factors that influence child health and effectiveness of intervention in the long term, and the issue of sustainability or need for re-intervention,” Dr. Fuster concludes. The SI! Program has expanded across the five boroughs of New York City through the Children’s Health and Socioeconomic Implications (CHSEI) project.

“The diverse ethnic and socioeconomic backgrounds in New York City offer a unique opportunity to explore which socioeconomic factors, at both the family and borough level, may eventually affect children’s health, how they are implicated in the intervention’s effectiveness, and how they can be addressed to reduce the gap in health inequalities.”

The study is published in the Journal of the American College of Cardiology.

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