The development of CVD risk factors carries a behavioral component that may be corrected at an early age, when behaviors are first formed, by effective health promotion initiatives. School-based interventions are an effective way to promote healthy behaviors, specially when they also reach out to the children’s most proximal environment: their families, teachers and the school itself. Within this framework, the first phase of the long-term Program SI! intervention targets children from 3 to 5 years of age aiming to establish appropriate lifestyle behaviors early in life. The intervention entails a comprehensive approach including four lifestyle-related components: correct dietary habits, promotion of physical activity, understanding how the human body and heart work, and emotion’s management. To evaluate the efficacy of the Program SI! to instill healthy behaviors in children aged 3-5, a cluster-randomized controlled trial in public schools in the city of Madrid (Spain) was initiated in 2011. A total 24 schools were selected on the basis of socio-demographic characteristics. These included 2062 children (3-5 years), 1949 families, and 125 teachers at baseline. Schools were randomized (1:1) to follow their usual school curriculum or to engage in the intervention. The primary outcome of this report is the 2-years differential change from baseline in scores for knowledge, attitudes and habits (KAH) in the four components of the intervention between intervention and control. Children were interviewed by trained psychologists and scored on overall and component-specific KAH questionnaires. The Test for Emotional Comprehension (TEC) was used to assess children’s ability to recognize emotions. Mixed linear models accounting for the cluster-randomized design were used to test for intervention effects. Fixed effects in each model were the corresponding baseline score, the class year, and the treatment group. Schools were handled as random effects. After 2 years, the Program SI! intervention increased children’s overall KAH score (5.6, 95%CI, 4.1-7.1, p<0.001) corresponding to an additional 7% improvement in the intervened children. KAH assessing improved Physical activity contributed the most (3.39, 95%CI, 2.35-4.43, p<0.001) to the difference between groups, followed by KAH relating Dietary habits (1.78, 95%CI, 0.94-2.62, p<0.001). A weak, non-significant improvement in KAH score for Human body (0.37, 95%CI, -0.14-0.89) was also found. Regarding emotion’s management, this component also increased after the intervention (0.50, 95%CI, 0.02-0.97, p<0.040), with greater improvements in older children (5 years old). The Program SI! is demonstrated as an effective and feasible strategy for improving lifestyle behaviors among very young children that may eventually impact in lower rates of development of CVD risk factors.
Lessons from Studies in Middle-Aged and Older Adults Living in Mediterranean Islands: The Role of Dietary Habits and Nutrition Services
