• Research Review
• Journal Review

Authors: I Harrabi, J Maatoug, M Gaha, R Kebaili, et al.

Reference: Indian J Community Med 2010; 35:94-99
http://www.ijcm.org.in/article.asp?issn=0970-0218;year=2010;volume=35;issue=1;spage=94;epage=99;aulast=Harrabi;type=0

Reviewer: Carlos Mendoza Montano, PhD, ProCor contributing editor; President, Guatemalan Association for the Prevention of Heart Diseases (APRECOR), Guatemala City, Guatemala

Reviewer comments: Integrated actions against smoking, physical inactivity and unhealthy diet can lead to the reduction of cardiovascular disease (CVD) and other chronic diseases. These interventions should take place early in childhood. The need for early intervention to promote cardiovascular health in children is recognized because children exhibit risk factors for CVD that often persist into adulthood. This pilot study has demonstrated the potential of schools as suitable settings for the promotion of healthy lifestyles in children. The study resulted in substantial improvements concerning knowledge, behaviors, and intentions in the intervention group. However, similar to previous intervention studies with children, no significant changes were observed in body mass index (BMI). The authors of the study did not comment on the reasons for the absence of differences in overweight/obesity between their groups, but other researchers have previously discussed that BMI might not be the most appropriate indicator of obesity to assess the impact of interventions targeting children.

Purpose of study: To implement and evaluate a school-based intervention program to prevent CVD risk factors among children.

Location of study: Sousse, Tunisia

Study design: The study comprised 1189 pupils of four secondary public schools in Sousse, aged 12-16 years. This investigation adopted a pre-post quasi-experimental design, and divided the subjects into two groups. The intervention group was subject to classroom-based CVD risk factors prevention curriculum, while the control group received no intervention. One month before the intervention began, and, separately, a month after it ended, the intervention group and the control group were tested, so that effects of the intervention could be ascertained.

Results: After one year of intervention, the program showed to be acceptable to school administrators, teachers, parents, and children. Knowledge, behaviors, and intentions concerning smoking improved in both the intervention and the control groups between baseline and the end of the study, particularly in the intervention group. Nutrition knowledge, behaviors, and intentions improved in both groups between baseline and final stage, particularly in the intervention group. At the final stage, there was an increase in the proportion of children walking to and from school in the intervention group. There was also an increase in the percentage of children with intention of practicing sport in the future particularly in the intervention group. There were no significant differences in BMI after the intervention neither in intervention nor in control groups. At the end of the study, the incidence of overweight and obesity was similar to that at baseline.

Additional references:
Nader P, Sallis J, Patterson T, Abramson I, et al. A family approach to cardiovascular risk reduction: results from the San Diego Family Health Project. Health Educ Q 1989; 16:229-44. http://www.ncbi.nlm.nih.gov/pubmed/2732065

Walter H, Wynder E. The development, implementation, evaluation, and future directions of a chronic disease prevention program for children: The "Know Your Body" studies. Prev Med 1989; 18:59-71. http://www.ncbi.nlm.nih.gov/pubmed/2710763