Natalia Leal and her son Gabriel are participants in FAMILIA, which instructs preschoolers and their families on cardiovascular health.

Children will listen. That is the simple premise underlying FAMILIA, a trial developed by Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, to promote cardiovascular health among children while reducing their chances of developing risk factors for heart disease.

The “Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health” (FAMILIA) trial enrolled 600 families in Harlem, including 562 children ages 3 to 5, over the last four years. It has demonstrated that a school-based education intervention is an effective strategy for instilling healthy behaviors among preschoolers, according to an abstract that Dr. Fuster presented in November 2018 at the American Heart Association Scientific Sessions in Chicago.

Dr. Fuster is a pioneer in the study of atherosclerotic disease—the build-up of fats, cholesterol, and other substances in and on artery walls—which is the leading cause of death in the United States. It develops slowly over a lifetime and is often caused by such factors as an unhealthy diet, lack of exercise, and tobacco use.

“There is good data showing that part of our behavior as adults develops between ages 3 and 5,” Dr. Fuster says. “If this age is so important, why wouldn’t we use this window of opportunity to teach children to make health a priority for the rest of their lives?”

Funded by a $3.8 million grant from the American Heart Association, FAMILIA is based on successful health interventions that Dr. Fuster developed in Bogota, Colombia, and Spain. Like those programs, FAMILIA is exploring how a child’s behavior, environment, and genetics may lead to heart disease, with the goal of reducing the future risk of obesity, heart attack, stroke, and type 2 diabetes by creating a family-based “culture of health.”

The specific objective of the FAMILIA trial was to “assess the impact of a preschool-based health promotion education intervention in an underserved community.” It enrolled children in 15 Head Start preschools, forming a cohort that was 51 percent female, 54 percent Hispanic/Latino, and 37 percent African American. Children were randomly assigned to either a control group that received their school’s normal curriculum or a group that received 50 hours of heart-health education over four months.

At the start, each child was interviewed by a team member with experience in early childhood education, using tools that were pictorial and structured like an interactive game. Based on the results, each child was given a KAH (knowledge, attitudes, and habits) score. The children who received intervention learned lessons, including: how the heart works; how to select healthy foods; how to regulate their emotions; and how to stay physically active and encourage their families to be active, too. After four months, researchers interviewed the preschoolers again and measured the change in KAH from the baseline.

Researchers found that the overall KAH score rose 11.8 percent from the baseline in the intervention group, compared with 5.5 percent in the control group. Based on the children’s responses, their attitudes about staying active and their understanding of the human body and heart were the biggest drivers of the higher KAH scores, researchers said. The team is planning to conduct a long-term follow-up at five and ten years to assess the sustainability of the intervention effects.

FAMILIA also includes a parallel program for the parents and caregivers of children in the trial. Some adults meet in small groups to help each other get healthier through peer support, while others receive individualized lifestyle counseling and a personal activity-monitoring device. Results from that program are expected in late 2019.

“What we are finding is a significant benefit in all respects,” Dr. Fuster says of both adults and children in FAMILIA. “Their knowledge, their attitudes, and their habits are quite positive, and this is very exciting.”