Child Health Promotion in Underserved Communities: The FAMILIA Trial

Rodrigo Fernandez-Jimenez, Risa Jaslow, Sameer Bansilal, Maribel Santana, Raquel Diaz-Munoz, Jacqueline Latina, Ana V. Soto, Rajesh Vedanthan, Mohamed Al-Kazaz, Chiara Giannarelli, Jason C. Kovacic, Emilia Bagiella, Andrew Kasarskis, Zahi A. Fayad, Roger J. Hajjar, Valentin Fuster

Research output: Contribution to journalArticlepeer-review

35 Citations (Scopus)


Background: Preschool-based interventions offer promise to instill healthy behaviors in children, which can be a strategy to reduce the burden of cardiovascular disease later. However, their efficacy in underserved communities is not well established. Objectives: The purpose of this study was to assess the impact of a preschool-based health promotion educational intervention in an underserved community. Methods: This cluster-randomized controlled study involved 15 Head Start preschools in Harlem, New York. Schools and their children were randomized 3:2 to receive either a 4-month (50 h) educational intervention to instill healthy behaviors in relation to diet, physical activity, body/heart awareness, and emotion management; or their standard curriculum (control). The primary outcome was the change from baseline in the overall knowledge, attitudes, and habits (KAH) score of the children at 5 months. As secondary outcomes, we evaluated the changes in KAH subcomponents and emotion comprehension. Linear mixed-effects models were used to test for intervention effects. Results: The authors enrolled 562 preschool children age 3 to 5 years, 51% female, 54% Hispanic/Latino, and 37% African-American. Compared with the control group, the mean relative change from baseline in the overall KAH score was ∼2.2 fold higher in the intervention group (average absolute difference of 2.86 points; 95% confidence interval: 0.58 to 5.14; p = 0.014). The maximal effect was observed in children who received >75% of the curriculum. Physical activity and body/heart awareness components, and knowledge and attitudes domains, were the main drivers of the effect (p values <0.05). Changes in emotion comprehension trended toward favoring intervened children. Conclusions: This multidimensional school-based educational intervention may be an effective strategy for establishing healthy behaviors among preschoolers from a diverse and socioeconomically disadvantaged community. Early primordial prevention strategies may contribute to reducing the global burden of cardiovascular disease.

Original languageEnglish
Pages (from-to)2011-2021
Number of pages11
JournalJournal of the American College of Cardiology
Issue number16
Publication statusPublished - 30 Apr 2019
Externally publishedYes


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