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dc.contributor.authorFernandez-Jimenez, Rodrigo 
dc.contributor.authorBriceño, German
dc.contributor.authorCéspedes, Jaime
dc.contributor.authorVargas, Sarha
dc.contributor.authorGuijarro, Jennifer
dc.contributor.authorBaxter, Jorge
dc.contributor.authorHunn, Marilyn
dc.contributor.authorSantos-Beneit, Gloria 
dc.contributor.authorRodríguez, Carla
dc.contributor.authorCéspedes, Maria Paula
dc.contributor.authorBagiella, Emilia
dc.contributor.authorMoreno, Zorayda
dc.contributor.authorCarvajal, Isabel
dc.contributor.authorFuster, Valentin
dc.identifier.citationJ Am Coll Cardiol. 2020; 75(13):1565-1578es_ES
dc.description.abstractLong-term evaluations of child health promotion programs are required to assess their sustainability and the need for reintervention. This study sought to explore the long-term impact of a preschool health promotion intervention delivered in an urban low-income area of Colombia (phase 1) and to assess the effect of a new community-based intervention (phase 2). In phase 1, a cross-sectional analysis of knowledge, attitudes, and habits (KAH) toward a healthy lifestyle and ideal cardiovascular health (ICH) scores of 1,216 children 9 to 13 years old was performed. Of the total, 596 had previously received a preschool health promotion intervention at 3 to 5 years old, whereas the remaining 620 were not previously intervened (intervention-naive group). In phase 2, all children were cluster randomized 1:1 to receive either a 4-month educational intervention (the SI! Program) to instill healthy behaviors in community centers (24 clusters, 616 children) or to control (24 clusters, 600 children). Previously intervened and intervention-naive children were not mixed in the same cluster. The primary outcomes were the change from baseline in KAH and ICH scores. Intervention effects were tested for with linear mixed-effects models. In phase 1, ∼85% of children had nonideal cardiovascular health, and those who previously received a preschool intervention showed a negligible residual effect compared with intervention-naive children. In phase 2, the between-group (control vs. intervention) differences in the change of the overall KAH and ICH scores were 0.92 points (95% confidence interval [CI]: -0.28 to 2.13; p = 0.133) and -0.20 points (95% CI: -0.43 to 0.03; p = 0.089), respectively. No booster effect was detected. However, a dose-response effect was observed, with maximal benefit in children attending >75% of the scheduled intervention; the difference in the change of KAH between the high- and low-adherence groups was 3.72 points (95% CI: 1.71 to 5.73; p < 0.001). Although overall significant differences between the intervention and control groups were not observed, high adherence rates to health promotion interventions may improve effectiveness and outcomes in children. Reintervention strategies may be required at multiple stages to induce sustained health promotion effects (Salud Integral Colombia [SI! Colombia II]; NCT03119792).es_ES
dc.description.sponsorshipThis study was funded by the Santo Domingo Foundation. Dr. Fuster is the recipient of funding from the American Heart Association under grant no. 14SFRN20490315. Dr. Fernández-Jiménez is the recipient of funding from the Carlos III Institute of Health-Fondo de Investigacion Sanitaria (PI19/01704) and has received funding from the European Union Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement no. 707642. The CNIC is supported by the Instituto de Salud Carlos III (ISCIII), the Ministerio de Ciencia e Innovación and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505).es_ES
dc.publisherElsevier es_ES
dc.titleSustainability of and Adherence to Preschool Health Promotion Among Children 9 to 13 Years Old.es_ES
dc.typejournal articlees_ES
dc.rights.licenseAttribution-NonCommercial-NoDerivatives 4.0 Internacional*
dc.contributor.funderFundación Santo Domingo 
dc.contributor.funderAmerican Heart Association 
dc.contributor.funderInstituto de Salud Carlos III 
dc.contributor.funderUnión Europea. Comisión Europea 
dc.contributor.funderMinisterio de Ciencia e Innovación (España) 
dc.contributor.funderFundación ProCNIC 
dc.identifier.journalJournal of the American College of Cardiologyes_ES
dc.repisalud.orgCNICCNIC::Grupos de investigación::Imagen Cardiovascular y Estudios Poblacionaleses_ES
dc.rights.accessRightsopen accesses_ES

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Attribution-NonCommercial-NoDerivatives 4.0 Internacional
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