School-based cardiovascular health promotion program trial had neutral effect on adolescent cardiovascular health

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1. There was no difference in cardiovascular health between adolescents who received a 2 or 4-year-long school-based health promotion intervention compared to those who received the standard curriculum.

2. Despite the neutral statistical effect, adolescents reported positive experiences following this comprehensive program that involved individual empowerment in making healthy life decisions.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Adolescence represents a pivotal phase when foundational lifestyle patterns take root, offering a window of opportunity for preventive measures against modifiable risk factors affecting cardiovascular health (CVH), such as diet, physical activity and tobacco use. Addressing this critical juncture, the Salud Integral (SI!) Program is a school-based intervention that promotes CVH by fostering health-conscious behaviors. Compared to previous interventions in adolescents that focused on weight loss, this program included comprehensive teaching on health literacy, and emotional and behavioral management to make healthy life decisions. This cluster randomized clinical trial aimed to assess the efficacy of this educational health intervention, delivered in a 2-year and 4-year format, on the CVH of adolescents. From baseline to follow-up, the study found no difference in the adolescents’ CVH between the intervention and control groups. There was a marginal beneficial difference for the group that received the 4-year intervention at the halfway follow-up, however, this was not maintained at the end of the 4 years. A noteworthy constraint of the study was the unforeseen disruption caused by the COVID-19 pandemic. The need for adaptation to remote learning and the discontinuation of specific physical activities inevitably introduced limitations, and the results at follow-up may have underestimated the effect of the intervention. Nonetheless, further research on adolescent health promotion strategies is necessary to discover effective interventions for CVH.

Click to read the study in JAMA Cardiology

Click to read an accompanying editorial in JAMA Cardiology

Relevant Reading: Lessons learned from 10 years of preschool interventions for health promotion: JACC state-of-the-art review

In-Depth [randomized clinical trial]: This cluster randomized clinical intervention trial involved 24 public secondary schools in Spain from September 2017 to July 2021. A total of 1326 adolescents aged 12 to 16 were enrolled at the start of secondary school. Participating schools were randomized to three groups: (1) 4-year long-term health promotion intervention, (2) 2-year short-term health promotion intervention, and (3) control group. The main outcome was the between-group differences in change of CVH scores from baseline to 2-year and 4-year follow-up. The American Heart Association defined the CVH score (0-14, higher is healthier), which measures the following health metrics: smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol level, and blood glucose level. At 2 years, there was a statistically beneficial effect for the long-term intervention group compared to control (0.44 points, p<0.04). However, there was no significant difference between either intervention group and control at 4 years. Secondary analysis revealed no statistically different within-group changes or changes in individual CVH metrics. Following the intervention, qualitative analysis was performed through online focus group discussions and revealed the program was well-received and raised awareness of healthy living.

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