Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: The Cardiovascular Health in Children (CHIC) Study

doi:10.1016/S0022-3476(96)70332-3

The Journal of Pediatrics

Volume 128, Issue 6, June 1996, Pages 797-805

https://doi.org/10.1016/S0022-3476(96)70332-3 Get rights and content

Abstract

OBJECTIVE: To test a classroom-based intervention to reduce cardiovascular disease risk factors in elementary school children. STUDY DESIGN: This was a randomized, controlled field trial in 12 schools across North Carolina, stratified by geographic region and urban/rural setting. Subjects were 1274 third and fourth graders (48% boys). The intervention, taught by regular classroom and physical education teachers, provided all children an 8-week exercise program and 8 weeks of classes on nutrition and smoking. Data were analyzed at the school level with survey regression models and at the individual level with multivariate analysis of variance and analysis of covariance models; 95% confidence intervals were computed. RESULTS: Children in the intervention group had significantly greater knowledge (7.9% more correct) and a significant increase in self-reported physical activity than children in the control group. Trends for the intervention group were a reduction in total cholesterol level (–5.27 mg/dl), an increase in aerobic power, a reduction in body fat, and smaller rise in diastolic blood pressure than control children. CONCLUSIONS: This classroom-based, public health approach improved children's cardiovascular disease risk profiles; it is practical and fairly easy to incorporate into the school day. All children directly receive the potential benefits of the intervention without a risk of labeling. This program can improve health knowledge, habits, and health outcomes of young children at a time when health habits are being formed. (J PEDIATR 1996;128:797-805)

Section snippets

Setting and sample

This segment of the Cardiovascular Health in Children study was conducted in 12 schools in North Carolina, a state in the top quintile for deaths in the United States as a result of stroke and CVD.²⁴ Half the schools were in rural areas and half in urban areas. Urban schools were located in cities with a population of at least 50,000. Rural schools were located in counties that did not include any cities of more than 50,000, and in towns with populations of less than 2500. Because the heart

Sample

The sample included 1274 children, 616 (48.4%) boys and 658 (51.6%) girls, aged 7 to 11 years (mean ± SD = 8.9 ± 0.8 years). Socioeconomic status data were obtained from 80% of the fathers and 96% of the mothers. Half of the children were third graders (51.2%). Geographic distribution was as follows: eastern coastal plain 32.3%, central piedmont 35.4%, and western mountains 32.3%; 49.4% of the subjects lived in rural areas and 50.6% in urban areas. Racial/ethnic composition was 74.3% white,

DISCUSSION

This study tested an 8-week school-based intervention for third and fourth graders. The classroom-based intervention incorporated health education and regular supervised physical activity; both components were given to all children in the schools assigned to the intervention group. When compared with the control group at posttest, children in the intervention group had lower total serum cholesterol, decreased body fat, increased aerobic power, greater heart health knowledge, and higher

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^☆: From the School of Nursing, Department of Physical Education, Exercise and Sport Science, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

^☆☆: Supported by the National Institute for Nursing Research, National Institutes of Health, grant No. R01-1837, and the Veterans Affairs Office of Academic Affairs Predoctoral Fellowship in Health Services Research (Mr. Gansky).

^★: Reprint requests: Joanne S. Harrell, PhD, CB No. 7460, 506 Carrington, University of North Carolina, Chapel Hill, NC 27599-7460.

^★★: 0022-3476/96/$5.00 + 0 9/20/72463

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Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: The Cardiovascular Health in Children (CHIC) Study☆,☆☆,★,★★

Abstract

Section snippets

Setting and sample

Sample

DISCUSSION

Am J Cardiol

Prev Med

Prev Med

Controlled Clinical Trials

J Adolesc Health

Prevention of coronary disease starting in childhood: What risk factors should be identified and treated?

Coronary Artery Disease

Coronary heart disease prevention in childhood part I: background and rationale

Medicine, Exercise, Nutrition and Health

Tracking of serum lipids and lipoproteins from childhood to adulthood

Am J Epidemiol

Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis: the Bogalusa Heart Study

N Engl J Med

Natural history of aortic and coronary atherosclerotic lesions in youth

Arterioscler Thromb

Relationship of atherosclerosis in young men to serum lipoprotein cholesterol concentration and smoking

JAMA

Statement on cholesterol

Pediatrics

Cholesterol screening by primary care pediatricians: a study of attitudes and practices in Minneapolis-St. Paul Metropolitan area

Pediatrics

Preventive practices for adult cardiovascular disease in children

J Fam Pract

Adult heart disease prevention in childhood: a national survey of pediatricians' practices and attitudes

Pediatrics

Prevention of adult heart disease beginning in childhood: intervention programs

Cardiovasc Clin

Primary prevention of cardiovascular disease: communitywide strategies for youth

J Consult Clin Psychol

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 [Special report]

Circulation

Modification of risk factors for coronary heart disease: five-year results of a school-based intervention trial

N Engl J Med

A family approach to cardiovascular risk reduction: results from the San Diego Family Health Project

Health Educ Q

School-based health research funded by the National Heart, Lung, and Blood Institute

J Sch Health

Synthesis of cardiovascul ar behavioral research for youth health promotion

Health Educ Q

School-based cardiovascular health promotion: the child and adolescent trial for cardiovascular health (CATCH)

J Sch Health

Promoting physical activity and a healthful diet among children: results of a school-based intervention study

Am J Public Health