Selected chronic disease 'risk factors' in two elementary school populations. A pilot study

Healthy Start: a comprehensive health education program for preschool children

BACKGROUND

Healthy Start is a 3-year demonstration and education research project designed to evaluate the effectiveness of a multidimensional cardiovascular (CV) risk reduction intervention in preschool centers over a 3-year period of time.

METHODS

Two primary interventions are employed. The first is the preschool food service intervention program designed to reduce the total fat in preschool meals and snacks to less than 30% of calories and reduce the saturated fat to less than 10% of calories. The second major intervention is a comprehensive preschool health education curriculum, focused heavily on nutrition.

RESULTS

Effectiveness of the intervention will be determined through evaluation of changes in dietary intake of preschool children at school meals and snacks, especially with respect to intake of total and saturated fat. Evaluation of the education component will include assessment of program implementation by teachers, assessment of changes in nutrition knowledge by preschool children, and assessment of changes in home meals that children consume (total and saturated fat content). Blood cholesterol will be evaluated semiannually to evaluate changes that may be due to modification of dietary intake. Growth and body fatness will also be assessed.

CONCLUSIONS

While substantial efforts have targeted CV risk reduction and health education for elementary school children, similar efforts aimed at preschool children have been lacking. The rationale for beginning CV risk reduction programs for preschool children is based upon the premise that risk factors for heart disease are prevalent by 3 years of age and tend to track over time, most commonly hypercholesterolemia and obesity, both related to nutrition. Since the behavioral antecedents for nutritional risk factors begin to be established very early in life, it is important to develop and evaluate new educational initiatives such as Healthy Start, aimed at the primary prevention of cardiovascular risk factors in preschool children. The purpose of this publication is to describe the rationale and methods for the Healthy Start project.

Primary prevention of chronic disease among children: the school-based "Know Your Body" intervention trials

The "Know Your Body" project, initiated in 1975 with funding from the National Heart, Lung, and Blood and the National Cancer Institutes, was developed in response to the empirically-validated suggestion that the primary prevention of chronic disease should begin in childhood. The aim of the program is to favorably modify the population distributions of risk factors for these diseases through changes in their behavioral antecedents. The program is classroom-based and teacher-delivered, and consists of three primary intervention foci: diet, physical activity, and cigarette smoking prevention. The program was subjected to a field trial among two demographically dissimilar populations of schoolchildren in the New York City area. After five years of intervention in one of the populations, the program was associated with significant favorable changes in blood total cholesterol levels and dietary intake of total fat and carbohydrate. In both populations, the program was associated with significant favorable changes in knowledge. After six years of intervention, the program was associated with a significant net reduction in the rate of initiation of cigarette smoking. If these findings can be replicated among diverse populations of schoolchildren, they suggest that such programs may be effective in reducing the population risk for the future development of chronic disease.

Cardiovascular risk factors among black schoolchildren: comparisons among four Know Your Body studies

Baseline cardiovascular risk factor variables were obtained from 1,041 black District of Columbia children in Grades 4-6 as part of a Know Your Body evaluation project. Screening included height, weight, triceps skinfold measurements, systolic and diastolic blood pressures, step-test for fitness, serum cholesterol, high-density lipoprotein cholesterol and thiocyanate. Results were compared with those in three other Know Your Body studies, Bronx, New York, Westchester, New York, and Los Angeles, and indicated that District of Columbia black children are more likely to have high cholesterol levels and to fail the fitness test than black children in the other studies. In the District of Columbia, obese children had significantly higher total serum cholesterol, systolic, diastolic, and high-density lipoprotein levels, and were less fit than other District of Columbia children; almost three-fourths of all of the children had one or more risk factors. Socioeconomic status was negatively correlated with diastolic blood pressure, skinfold thickness, and cholesterol levels and was positively correlated with high-density lipoprotein cholesterol. Rates of obesity and diastolic blood pressure were consistent with Bronx and Westchester comparisons suggesting that socioeconomic status interacts with ethnicity to determine risk factor levels. The existence of children with multiple risk factors in all of the Know Your Body studies supports the need for early intervention.

Determinants of blood pressure in Jerusalem schoolchildren

In 1982, 113 first- and second-graders attending an elementary school in West Jerusalem had their blood pressure (BP), height, weight, and resting pulse measured. Three successive BP readings were taken. The mean of the second and third readings was used for data analysis. Mean systolic blood pressure (SBP) was 98.30 +/- 8.51 mm Hg and mean diastolic blood pressure (DBP) was 67.63 +/- 6.85 mm Hg. An analysis of covariance was performed in order to determine the contribution of each independent variable (height, weight-for-height, sex, age, and resting pulse) to the variance in BP, while adjusting for all other independent variables. Height, weight-for-height, and resting pulse were all found to be significantly associated with both SBP and DBP. Children in the upper quartile of weight-for-height had a mean adjusted SBP that was 10.2 mm Hg higher than those in the lower quartile and a mean adjusted DBP that was 7.9 mm Hg higher. Children in the upper quartile of height (for age) had mean adjusted SBP and DBP that were 6.1 and 4.7 mm Hg higher, respectively, than those of children in the lower quartile. Sex and age showed no significant association with SBP. The associations between DBP and both sex and age were not statistically significant (P less than 0.10), but there was a trend for girls and older children to have a slightly higher DBP. In a subsample of 93 children who had both resting pulse and recovery index measured (using the Modified Harvard Step Test for children).(ABSTRACT TRUNCATED AT 250 WORDS)

Menkes's syndrome

Menkes's syndrome (trichopoliodystrophy) is an x-linked, recessive genodermatosis characterized by hair defects, severe retardation, convulsions, progressive neurologic deterioration, and early death. Recent studies in copper metabolism suggest that Menkes's syndrome may be a storage disease in which copper is irreversibly trapped in some tissues by metallothionein, a heavy-metal-binding protein. This then gives rise to a deficiency elsewhere, particularly in the brain, causing irreversible damage in the fetus. We present a patient with Menkes's syndrome and review the clinical and metabolic aspects of this disease.

Baseline chronic disease risk factors in a racially heterogeneous elementary school population: The "Know Your Body" program, Los Angeles

The Los Angeles "Know Your Body" (KYB) program is an organized health education activity for children designed to encourage positive health behavior and discourage or interrupt behavioral patterns that are linked to illness, injury, disability, or death. Components of KYB include a 20-week curriculum; a survey of health knowledge, attitudes, and behaviors; in-service training for elementary school teachers; and a clinical screening that provides feedback to students on selected indices. As part of a KYB field demonstration in Los Angeles conducted by the UCLA Division of Cancer Control, Jonsson Comprehensive Cancer Center, 1,503 Los Angeles and Santa Monica-Malibu children ages 9-11 in grades 4 and 5 underwent baseline health screening evaluations in March 1981, measuring height, weight, triceps skinfold thickness, serum cholesterol, pulse rate recovery following exercise, and blood pressure. The population mean for serum cholesterol was 182.6 mg/dl, with no significant racial/ethnic, sex, or age differences. Significant racial/ethnic differences were found in obesity, with Hispanics having the highest prevalence, Asians the lowest. Black students scored significantly higher in pulse rate recovery following exercise, suggesting better relative cardiovascular fitness, and Asians scored lowest. Blacks were more likely to exceed the 95th percentile in diastolic and systolic blood pressure. Overall, 48% of the children had one or more chronic disease risk factors.

Assessing potential predisposition of elementary school children to heart disease

Physical well-being has been designated a top priority for the children in the Clovis (California) Unified School District. In an effort to diminish coronary risk factors and encourage a healthy life style, a health assessment battery was developed for students in grades 1 through 6. The battery included measurements in height, weight, blood pressure, sit and reach flexibility, and skin-fold test for body fat composition. More than 5000 students were administered the tests by a health assessment team consisting of two nurses, three physical education resource teachers, and two clerical staff members. A random sample of 100 males and 100 females at each grade level was utilized for the statistical analysis. The correlation between body fat and weight was .80 (p v .05) in the fifth and sixth grades. Body fat was positively correlated with both systolic and diastolic measures of blood pressure. The coefficient averaged .21 (p v .05) over the 6 grades for systolic and .22 (p .05) over the 6 grades for diastolic blood pressure. Future plans call for the development of a longitudinal profile of students, as well as establishing district norms for the test battery.

The influence of a family history of CHD risk factors on serum lipoprotein levels in black children and adolescents

This study evaluated the influence of a family history of coronary heart disease (CHD) and CHD risk factors on the total serum cholesterol/high density lipoprotein (TChol/HDL) and the low density lipoprotein/HDL (LDL/HDL) ratios of 84 black children (ages 7-11 years) and adolescents (ages 12-15 years). Fasting lipid determinations were measured on all subjects. A questionnaire was administered to each subject's parent to determine the frequency of myocardial infarction, heart disease, hypertension, stroke, atherosclerosis, diabetes, and obesity in first- and second-degree blood relatives. Based on three-way analysis of variance tests, significant stroke and age, diabetes and age, and obesity and age interactions in TChol/HDL and LDL/HDL were found. There was also an obesity and age and sex interaction effect on T.Chol/HDL. The results indicated that a family history of stroke, diabetes, or obesity can have an unfavorable effect on the TChol/HDL and LDL/HDL ratios in black adolescents.

Teaching children self-care for chronic disease prevention: obesity reduction and smoking prevention

A general health education program was developed for 1,252 students in six New York city area school districts. The purpose of the three-year project was to reduce the prevalence of risk factors associated with increased cardiovascular and cancer risk in adults. The curriculum included nutrition, antitobacco, and hypertension-control materials. A smaller, experimental intensive health behavior program was also developed for obese children (weight greater than or equal to 120% ideal for height, age, and sex). A smoking prevention program was offered to children with the aim of discouraging new smokers. Findings show that: 1) such a school-based primary disease prevention program is feasible and highly acceptable; and 2) reduction of obesity and new cigarette smoking occurred with intensive intervention involving small groups of students. On the other hand, a general health education itself had little effect in the total population in reducing the incidence of extreme clinical values (such as physical inactivity, high blood pressure, as well as smoking and obesity) for their age and sex. It is recommended that future programs for higher risk children concentrate on behavioral change rather than on general education.