Implementing a health promotion school-based program aimed at teaching healthy cardiovascular health habits as early as preschool may achieve lasting lifestyle changes in children, according to a review paper published Jan. 17 in the Journal of the American College of Cardiology.

The authors reviewed lessons learned from 10 years of the SI! Program, which included more than 3,800 children, aged 3-5 years, from 50 schools across Colombia, Spain and the U.S. Specifically, the authors discuss the program's dissemination, adoption, implementation, evaluation and institutionalization.

The authors note that the activities and messages used in the program were tailored based on the country in which the program was implemented. Among the activities used to accommodate the learning styles of preschool-aged children was a heart-shaped mascot named "Cardio" and the Sesame Street character Dr. Ruster, a Muppet based on Valentin Fuster, MD, PhD, MACC, principal investigator of the project. Other materials included video segments and printed materials.

"The SI! Program breaks down cardiovascular health into four components," explains Gloria Santos-Beneit, PhD, lead author. "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."

To evaluate the success of the program, assessment tools were adapted to the maturation of the children. Questionnaires included simple pictures and were modified to the sociocultural contexts of each country by using names and pictures of local foods, pictures of local playgrounds and images reflecting ethnic diversity.

Results showed that compared to children who received less than 50% of the four-month health promotion program, children who received more than 75% of the program were found to have a significant change from baseline in overall knowledge, attitudes and habits toward a healthy lifestyle.

Some of the challenges to be considered in implementing the program include family involvement, family socioeconomic status, the amount of time dedicated to the program and long-term adherence strategies.

"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," said Fuster. The SI! Program has expanded across the five boroughs of New York City through the Children's Health and Socioeconomic Implications 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."

Clinical Topics: Cardiovascular Care Team, Prevention, Smoking

Keywords: Child Health, Health Status Disparities, Cardiovascular Diseases, Substance-Related Disorders, Smoking, Cardiology, ACC International, Life Style, Healthy Lifestyle, Risk Reduction Behavior

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