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PEDIATRICS Vol. 102 No. 2 August 1998, pp. 371-380

School-based Interventions Improve Heart Health in Children With Multiple Cardiovascular Disease Risk Factors

Received Sep 25, 1997; accepted Jan 12, 1998.

Joanne S. Harrell*, Stuart A. GanskyDagger , Robert G. McMurray§, Shrikant I. Bangdiwalaparallel , Annette C. Frauman, and Chyrise B. Bradley*

From the * University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina; the Dagger  University of California, San Francisco, Department of Dental Public Health and Hygiene, San Francisco, California; the § Department of Physical Education, Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the parallel  Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and  Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.

Objective.  To determine the immediate effects of two types of elementary school-based interventions on children with multiple cardiovascular disease (CVD) risk factors.

Design.  Randomized, controlled field trial.

Setting.  Conducted in 18 randomly selected elementary schools across North Carolina.

Study Participants.  Four hundred twenty-two children age 9 ± 0.8 years with at least two risk factors at baseline: low aerobic power and either high serum cholesterol or obesity.

Intervention.  Both 8-week interventions consisted of a knowledge and attitude program and an adaptation of physical education. The classroom-based intervention was given by regular teachers to all children in the 3rd and 4th grades. The risk-based intervention was given in small groups only to children with identified risk factors. Children in the control group received usual teaching and physical education.

Outcome Measures.  The primary outcome measure was cholesterol; additional measures were blood pressure, body mass index, body fat, eating and activity habits, and health knowledge.

Results.  Both interventions produced large reductions in cholesterol (-10.1 mg/dL and -11.7 mg/dL) compared with a small drop (-2.3 mg/dL) in the controls. There was a trend for systolic blood pressure to increase less in both intervention groups than in the controls. Both intervention groups had a small reduction in body fat and higher health knowledge than the control group.

Conclusions.  Both brief interventions can improve the CVD risk profile of children with multiple risk factors. The classroom-based approach was easier to implement and used fewer resources. This population approach should be considered as one means of early primary prevention of CVD.

Key words: child, cardiovascular disease, risk factors, cholesterol, intervention, blood pressure, obesity, exercise.




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