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Child Health Promotion in Underserved Communities
Study Questions:
What is the impact of a preschool-based health promotion educational intervention in an underserved community?
Methods:
A cluster-randomized controlled study was performed at 15 Head Start preschools in Harlem, NY. Schools and their children were randomized in a 3:2 ratio to receive either a 4-month (50 hours) educational program directed at both children (37 hours) and parents (12 hours) or their standard curriculum. The educational program aimed to instill health behaviors in relation to diet, physical activity, body/heart awareness, and emotion management. The primary outcome was the change in baseline in the overall knowledge, attitudes, and habits (KAH) score of the children at 5 months. Secondary outcomes included change in Test of Emotion Comprehension (TEC) score and body mass index (BMI).
Results:
A total of 562 children were enrolled, of which 398 received the intervention and 164 received the standard curriculum. The median age was 4.1 ± 0.6 years (51% female) with 5% Hispanic/Latino and 37% African American children. For children receiving the intervention, the mean relative change from baseline KAH score was approximately 2.2-fold higher (average absolute difference of 2.86 points, 95% confidence interval, 0.58-5.14; p = 0.014) in the intervention group as compared with those in the control group. A dose-response effect was seen, with maximal effect seen in children who received >75% of the curriculum. No difference was seen between groups in the BMI z-score or TEC score over the course of the follow-up period.
Conclusions:
This school-based educational intervention may be an effective strategy for establishing healthy behaviors among preschoolers from a diverse and socioeconomically disadvantaged community.
Perspective:
Previous studies have demonstrated that cardiac risk factors in children predispose individuals to cardiovascular risk in adulthood. This study investigated the role of a very early intervention program administered to preschool-aged children in a socially disadvantaged community. The study demonstrated improvement in knowledge, attitudes, and habits related to healthy behaviors in those children receiving the 4-month intervention as opposed to controls. The strongest effect was seen in children with lower baseline KAH scores. The positive impact was primarily related to improvement in the physical activity and understanding of the human body and heart components of the study instrument. The authors speculate that this may be explained by students in the study receiving healthy meals and snacks through the Head Start program, which may have blunted the effect of the dietary intervention. Further study is underway to determine the sustainability of the intervention effect. Finally, it is unknown as to whether improvements in KAH scores will translate into reduction in cardiovascular risk factors or cardiac events later in life.
Keywords: Attitude, Body Mass Index, Child, Preschool, Comprehension, Diet, Early Intervention, Educational, Emotions, Exercise, Habits, Health Behavior, Health Promotion, Hispanic Americans, Pediatrics, Primary Prevention, Risk Factors, Snacks, Students, Vulnerable Populations
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