Health promotion programs targeting preschoolers in underserved communities can effectively improve their knowledge and attitude toward a healthy lifestyle, according to study results published in the Journal of the American College of Cardiology.

The investigators of this cluster-randomized controlled study sought to assess the effect of early-life educational intervention programs designed to instill healthy behaviors, specifically focused on heart health, in underserved, high-burden communities.

The study included 448 preschool children, age 3-5 years, recruited from 15 Head Start preschools in Harlem, New York. Schools and their children were randomly assigned in a 3:2 ratio to receive a 4-month educational intervention (9 schools; 304 children) or standard curriculum (6 schools; 144 children). The intervention group participated in a minimum of 37 hours of age-appropriate educational activities designed around strategies to develop healthy behaviors, including components of diet, physical activity, body/heart awareness, and emotion management. The primary study outcome was the change from baseline in overall knowledge, attitudes, and habits (KAH) score; secondary outcomes were changes in KAH subcomponent scores and emotion comprehension scores. The investigators applied a mixed-effects model to test for adjusted intervention effects.

Compared with the control group, the mean percentage relative change in overall KAH score was >2 times higher in the intervention group (11.8% vs 5.5%); the absolute difference in overall KAH score between the groups was 2.86 points; 95% CI, 0.58-5.14; P =.014. Comparing KAH subcomponent scores, the greatest changes between the intervention and control arms were observed in physical activity and in understanding how the body and heart work. The investigators reported the biggest benefit in children who completed >75% of the intervention curriculum. Knowledge and attitude toward a healthy lifestyle were the leading factors in evoking the greatest effect on change. Both groups improved their emotion comprehension scores, but a greater change was seen in children of the intervention arm.

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Limitations to the study include the inability of the investigators to translate KAH improvement into a reduction of cardiovascular risk factors and poor retention, as ~20% of participants were lost to follow-up mostly because they aged out or moved to other schools.

The investigators suggest that early-life educational intervention may be an effective strategy to establish healthy behaviors among young children, especially from socioeconomically disadvantaged communities. A wider adoption of school-based health promotion curricula may further help reduce the global burden of cardiovascular disease.


Fernandez-Jimenez R, Jaslow R, Bansilal S, et al. Child health promotion in underserved communities: the FAMILIA trial. J Am Coll Cardiol. 2019;73(16):2011-2021.