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. 1999 Oct;89(10):1529–1535. doi: 10.2105/ajph.89.10.1529

A public health vs a risk-based intervention to improve cardiovascular health in elementary school children: the Cardiovascular Health in Children Study.

J S Harrell 1, R G McMurray 1, S A Gansky 1, S I Bangdiwala 1, C B Bradley 1
PMCID: PMC1508806  PMID: 10511835

Abstract

OBJECTIVES: This study sought to determine the population effects of both classroom-based and risk-based interventions designed to reduce cardiovascular disease risk factors in children. METHODS: Elementary school children (n = 2109; age range: 7-12 years) were randomized by school to a classroom-based intervention for all third and fourth graders, a risk-based intervention only for those with 1 or more cardiovascular disease risk factors, or a control group. The 8-week interventions involved both knowledge--attitude and physical activity components. RESULTS: School-level analyses showed that physical activity in the risk-based group and posttest knowledge in the classroom-based group were significantly higher than in the control group. With regard to trends shown by individual-level analyses, cholesterol dropped more in the classroom-based than in the control group, and 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). CONCLUSIONS: Both classroom-based and risk-based interventions had positive effects on physical activity and knowledge, with trends toward reduced body fat and cholesterol. However, the classroom-based approach was easier to implement and evidenced stronger results than the risk-based intervention.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arbeit M. L., Johnson C. C., Mott D. S., Harsha D. W., Nicklas T. A., Webber L. S., Berenson G. S. The Heart Smart cardiovascular school health promotion: behavior correlates of risk factor change. Prev Med. 1992 Jan;21(1):18–32. doi: 10.1016/0091-7435(92)90003-z. [DOI] [PubMed] [Google Scholar]
  2. Bao W., Srinivasan S. R., Valdez R., Greenlund K. J., Wattigney W. A., Berenson G. S. Longitudinal changes in cardiovascular risk from childhood to young adulthood in offspring of parents with coronary artery disease: the Bogalusa Heart Study. JAMA. 1997 Dec 3;278(21):1749–1754. [PubMed] [Google Scholar]
  3. Berenson G. S., Srinivasan S. R., Bao W., Newman W. P., 3rd, Tracy R. E., Wattigney W. A. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998 Jun 4;338(23):1650–1656. doi: 10.1056/NEJM199806043382302. [DOI] [PubMed] [Google Scholar]
  4. Bieler G. S., Williams R. L. Cluster sampling techniques in quantal response teratology and developmental toxicity studies. Biometrics. 1995 Jun;51(2):764–776. [PubMed] [Google Scholar]
  5. Clarke W. R., Lauer R. M. Does childhood obesity track into adulthood? Crit Rev Food Sci Nutr. 1993;33(4-5):423–430. doi: 10.1080/10408399309527641. [DOI] [PubMed] [Google Scholar]
  6. Clarke W. R., Schrott H. G., Leaverton P. E., Connor W. E., Lauer R. M. Tracking of blood lipids and blood pressures in school age children: the Muscatine study. Circulation. 1978 Oct;58(4):626–634. doi: 10.1161/01.cir.58.4.626. [DOI] [PubMed] [Google Scholar]
  7. Franklin F. A., Jr, Dashti N., Franklin C. C. Evaluation and management of dyslipoproteinemia in children. Endocrinol Metab Clin North Am. 1998 Sep;27(3):641–654. doi: 10.1016/s0889-8529(05)70031-1. [DOI] [PubMed] [Google Scholar]
  8. Haines A. P., Imeson J. D., Meade T. W. Skinfold thickness and cardiovascular risk factors. Am J Epidemiol. 1987 Jul;126(1):86–94. doi: 10.1093/oxfordjournals.aje.a114665. [DOI] [PubMed] [Google Scholar]
  9. Kottke T. E., Gatewood L. C., Wu S. C., Park H. A. Preventing heart disease: is treating the high risk sufficient? J Clin Epidemiol. 1988;41(11):1083–1093. doi: 10.1016/0895-4356(88)90078-9. [DOI] [PubMed] [Google Scholar]
  10. Luepker R. V., Perry C. L., McKinlay S. M., Nader P. R., Parcel G. S., Stone E. J., Webber L. S., Elder J. P., Feldman H. A., Johnson C. C. Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. JAMA. 1996 Mar 13;275(10):768–776. doi: 10.1001/jama.1996.03530340032026. [DOI] [PubMed] [Google Scholar]
  11. Morrison J. A., Payne G., Barton B. A., Khoury P. R., Crawford P. Mother-daughter correlations of obesity and cardiovascular disease risk factors in black and white households: the NHLBI Growth and Health Study. Am J Public Health. 1994 Nov;84(11):1761–1767. doi: 10.2105/ajph.84.11.1761. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Myers L., Coughlin S. S., Webber L. S., Srinivasan S. R., Berenson G. S. Prediction of adult cardiovascular multifactorial risk status from childhood risk factor levels. The Bogalusa Heart Study. Am J Epidemiol. 1995 Nov 1;142(9):918–924. doi: 10.1093/oxfordjournals.aje.a117739. [DOI] [PubMed] [Google Scholar]
  13. Nader P. R., Sallis J. F., Patterson T. L., Abramson I. S., Rupp J. W., Senn K. L., Atkins C. J., Roppe B. E., Morris J. A., Wallace J. P. A family approach to cardiovascular risk reduction: results from the San Diego Family Health Project. Health Educ Q. 1989 Summer;16(2):229–244. doi: 10.1177/109019818901600207. [DOI] [PubMed] [Google Scholar]
  14. Oaks J., Warren B., Harsha D. Cardiovascular health knowledge of children and school personnel in Louisiana public schools. J Sch Health. 1987 Jan;57(1):23–27. doi: 10.1111/j.1746-1561.1987.tb00517.x. [DOI] [PubMed] [Google Scholar]
  15. Report of the Second Task Force on Blood Pressure Control in Children--1987. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics. 1987 Jan;79(1):1–25. [PubMed] [Google Scholar]
  16. Revicki D. A., Israel R. G. Relationship between body mass indices and measures of body adiposity. Am J Public Health. 1986 Aug;76(8):992–994. doi: 10.2105/ajph.76.8.992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Simpson J. M., Klar N., Donnor A. Accounting for cluster randomization: a review of primary prevention trials, 1990 through 1993. Am J Public Health. 1995 Oct;85(10):1378–1383. doi: 10.2105/ajph.85.10.1378. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Srinivasan S. R., Bao W., Wattigney W. A., Berenson G. S. Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study. Metabolism. 1996 Feb;45(2):235–240. doi: 10.1016/s0026-0495(96)90060-8. [DOI] [PubMed] [Google Scholar]
  19. Stone E. J., Perry C. L., Luepker R. V. Synthesis of cardiovascular behavioral research for youth health promotion. Health Educ Q. 1989 Summer;16(2):155–169. doi: 10.1177/109019818901600202. [DOI] [PubMed] [Google Scholar]
  20. Strong J. P., Malcom G. T., McMahan C. A., Tracy R. E., Newman W. P., 3rd, Herderick E. E., Cornhill J. F. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA. 1999 Feb 24;281(8):727–735. doi: 10.1001/jama.281.8.727. [DOI] [PubMed] [Google Scholar]
  21. Strong W. B., Deckelbaum R. J., Gidding S. S., Kavey R. E., Washington R., Wilmore J. H., Perry C. L. Integrated cardiovascular health promotion in childhood. A statement for health professionals from the Subcommittee on Atherosclerosis and Hypertension in Childhood of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 1992 Apr;85(4):1638–1650. doi: 10.1161/01.cir.85.4.1638. [DOI] [PubMed] [Google Scholar]
  22. Telama R., Yang X., Laakso L., Viikari J. Physical activity in childhood and adolescence as predictor of physical activity in young adulthood. Am J Prev Med. 1997 Jul-Aug;13(4):317–323. [PubMed] [Google Scholar]
  23. Tracy R. E., Newman W. P., 3rd, Wattigney W. A., Berenson G. S. Risk factors and atherosclerosis in youth autopsy findings of the Bogalusa Heart Study. Am J Med Sci. 1995 Dec;310 (Suppl 1):S37–S41. doi: 10.1097/00000441-199512000-00007. [DOI] [PubMed] [Google Scholar]
  24. Walter H. J., Hofman A., Connelly P. A., Barrett L. T., Kost K. L. Primary prevention of chronic disease in childhood: changes in risk factors after one year of intervention. Am J Epidemiol. 1985 Nov;122(5):772–781. doi: 10.1093/oxfordjournals.aje.a114160. [DOI] [PubMed] [Google Scholar]
  25. Walter H. J., Hofman A., Vaughan R. D., Wynder E. L. Modification of risk factors for coronary heart disease. Five-year results of a school-based intervention trial. N Engl J Med. 1988 Apr 28;318(17):1093–1100. doi: 10.1056/NEJM198804283181704. [DOI] [PubMed] [Google Scholar]
  26. Webber L. S., Osganian V., Luepker R. V., Feldman H. A., Stone E. J., Elder J. P., Perry C. L., Nader P. R., Parcel G. S., Broyles S. L. Cardiovascular risk factors among third grade children in four regions of the United States. The CATCH Study. Child and Adolescent Trial for Cardiovascular Health. Am J Epidemiol. 1995 Mar 1;141(5):428–439. doi: 10.1093/oxfordjournals.aje.a117445. [DOI] [PubMed] [Google Scholar]
  27. Webber L. S., Srinivasan S. R., Wattigney W. A., Berenson G. S. Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa Heart Study. Am J Epidemiol. 1991 May 1;133(9):884–899. doi: 10.1093/oxfordjournals.aje.a115968. [DOI] [PubMed] [Google Scholar]
  28. Williams C. L., Carter B. J., Arnold C. B., Wynder E. L. Chronic disease risk factors among children. The 'Know Your Body' study. J Chronic Dis. 1979;32(7):505–513. doi: 10.1016/0021-9681(79)90112-7. [DOI] [PubMed] [Google Scholar]
  29. Williams C. L., Carter B. J., Eng A. The "Know Your Body" program: a developmental approach to health education and disease prevention. Prev Med. 1980 May;9(3):371–383. doi: 10.1016/0091-7435(80)90231-5. [DOI] [PubMed] [Google Scholar]

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