Primary Prevention of Chronic Disease in Childhood: Changes in Risk Factors After One Year of Intervention

Abstract

A five-year intervention study of the feasibility and effectiveness of a program aimed at the primary prevention of chronic disease was initiated in 1980 among children in 22 elementary schools in the Bronx, New York. Schools randomly were assigned either to the intervention program or to a control group. The intervention program consists of a curriculum focusing on nutrition, physical fitness, and cigarette smoking prevention. The study population at baseline comprised 2,283 fourth-graders. Subjects were eligible at baseline and at one-year follow-up for participation in a medical examination in which the following target risk factors were measured: systolic and diastolic blood pressures, plasma total and high-density lipoprotein (HDL) cholesterol, serum thiocyanate, ponderosity index, triceps skinfold thickness, and postexercise pulse recovery rate. After one year of intervention, systolic pressure increased less in the intervention group than among controls. Diastolic pressure decreased in both groups, but more in the intervention subjects than in controls. Total cholesterol decreased in the intervention group while increasing among controls. Significant net changes in the favorable direction also were observed for total cholesterol/HDL cholesterol ratio and for thiocyanate. These observations indicate that it is feasible to implement a school-based program aimed at the primary prevention of chronic disease. The intervention program appears to have had a favorable effect on several target risk factors. Although the effects were relatively small, intervention programs in schools may prove to be effective in lowering chronic disease risk.

School health education programs in Crete: Evaluation of behavioural and health indices a decade after initiation

“…This triggered scientists to try through education programs to reduce the levels or even to eliminate these factors during childhood (Lionis et al, 1991;Kafatos and Mamalakis, 1993;McGraw et al, 2000;Walter et al, 1985;Resnicow et al, 1992;Lytle et al, 1996;McMurray et al, 2002;Sahota et al, 2001;Harrell et al, 1996). These studies, with a shorter duration than the 6 y intervention of the present study, confirm the positive effect that the education program can have on the reduction of lipoprotein levels, arterial blood pressure and obesity indices.…”

“…The rapid increase in morbidity and mortality indices in the population of Greece (Lionis et al, 1991;Voukiklaris et al, 1996) make the initiation of health promotion and prevention programs, starting from early childhood, a necessity (Lionis et al, 1991;Kafatos and Mamalakis, 1993;McGraw et al, 2000;Walter et al, 1985;Resnicow et al, 1992;Lytle et al, 1996;McMurray et al, 2002;Sahota et al, 2001;Harrell et al, 1996).…”

Blood pressure and physical fitness in children.

“…The 1983 median family income was $55,904 in Westchester County and $22,126 in the Bronx. The population in the Bronx, 10 as well as in Westchester County," has been described in detail elsewhere.…”

“…After 1 year of intervention favorable changes in blood pressure, plasma lipid levels, and smoking habits, but not in physical fitness, have been observed. 10 " Because of the absence of an effect on physical fitness, the data were analyzed as if obtained in an observational study. When appropriate, the intervention status was entered as a variable in the analysis.…”

A brief history of the cluster randomised trial design

“…social, for example, families, households or religious congregations; [8][9][10][11] . educational or occupational, for example, schools or school classes; [12][13][14][15][16][17] . hospitals and worksites; [18][19][20] or .…”