Should the primary prevention of coronary heart disease commence in childhood?

Clustering of health-related behaviors among 18-year-old Australians

BACKGROUND

Few studies among young adults have examined clustering of health behaviors affecting risk for lifestyle diseases.

METHODS

Smoking, alcohol consumption, physical activity, and diet were examined among Australian 18-year-olds (301 males, 282 females) initially recruited at the age of 9 years from 26 schools. Association analysis was used to recognize behavior clustering.

RESULTS

Fat intake was greater among male smokers than nonsmokers (36% energy vs 34% energy). Women smokers ate less fiber (14.1 g/day) than did nonsmokers (17.8 g/day). Smoking was significantly related, among males, to unsafe drinking (odds ratio 2.38) and higher fat intake (odds ratio 1.06) and, among females, to unsafe drinking (odds ratio 1.59), lower dietary fiber (odds ratio 0.93), and less physical activity (odds ratio 0.36). Cluster analysis defined separate behavior clusters for men and women with smoking status identifying further subgroups. Smoking, drinking alcohol to excess, and adverse dietary choices clustered among men and women, with physical inactivity also clustering among women.

CONCLUSION

Smoking among adolescents is an important indicator of behaviors influencing risk for later cardiovascular disease and other medical disorders. Multimodal approaches allowing for gender differences in health-related behaviors are likely to be more successful than targeting a single behavior in this age group.

School heart health promotion: the National Heart Foundation (Western Australian) approach

The National Heart Foundation of Australia's commitment to school health promotion expanded progressively since 1983. Following establishment of health education curriculum documents by the state Ministries of Education, the Foundation targeted schoolchildren with primary prevention programs and resources. The Foundation looked beyond instructional settings to examine the influence of the school environment on the health of students and school personnel. This paper describes a school heart health promotion model implemented by the Western Australian Division of the National Heart Foundation, serving one of Australia's eight states and territories. The model incorporates elements of policy, curriculum, environment, health services, and community interaction. Though similar to comprehensive models of school health education, this model limits its application to heart health. The program operates in a nongovernment agency with unmatched potential for national reach.

Assessing school health education programs

This review focuses on the component of health education directed at achieving changes in health behavior. Much of the work in this field has centered on health behavior that has a role in preventing future disease. Because the evidence is strongest in relation to coronary heart disease (17), considerable effort has been devoted to this area. Walter et al. (34) indicated that the most relevant forms of health behavior to be considered in school-based programs on heart disease are those relating to diet, physical activity, and smoking. Programs relating to each of these behaviors are addressed here.

Death of a child as a result of familial hypercholesterolaemia

A 10-year-old boy died of a myocardial infarction; he had homozygous familial hypercholesterolaemia. Unrecognized tendon xanthomas previously had been removed. His parents and siblings were found to have elevated cholesterol levels. The screening of at-risk children allows the early recognition of hypercholesterolaemia and intervention in the development of atherosclerosis.