title: The SI! Program for Cardiovascular Health Promotion in Early Childhood: A Cluster-Randomized Trial.
abstract: BACKGROUND
  The preschool years offer a unique window of opportunity to instill healthy life-style behaviors and promote cardiovascular health.
  
  
  OBJECTIVE
  This study sought to evaluate the effect of a 3-year multidimensional school-based intervention to improve life-style-related behaviors.
  
  
  METHODS
  We performed a cluster-randomized controlled intervention trial involving 24 public schools in Madrid, Spain, that were assigned to either the SI! Program intervention or the usual curriculum and followed for 3 years. The SI! Program aimed to instill and develop healthy behaviors in relation to diet, physical activity, and understanding how the human body and heart work. The primary outcome was change in the overall knowledge, attitudes, and habits (KAH) score (range 0 to 80). The intervention's effect on adiposity markers was also evaluated.
  
  
  RESULTS
  A total of 2,062 children from 3 to 5 years of age were randomized. After 3 years of follow-up, the overall KAH score was 4.9% higher in children in the intervention group compared with the control group (21.7 vs. 16.4; p < 0.001). A peak effect was observed at the second year (improvement 7.1% higher than in the control group; p < 0.001). Physical activity was the main driver of the change in KAH at all evaluation times. Children in the intervention group for 2 years and 1 year showed greater improvement than control subjects (5.9%; p < 0.001 and 2.9%; p = 0.002, respectively). After 3 years, the intervention group showed a higher probability than the control group of reducing the triceps skinfold z-score by at least 0.1 (hazard ratio: 1.40, 95% confidence interval: 1.04 to 1.89; p = 0.027).
  
  
  CONCLUSIONS
  The SI! Program is an effective strategy for instilling healthy habits among preschoolers, translating into a beneficial effect on adiposity, with maximal effect when started at the earliest age and maintained over 3 years. Wider adoption may have a meaningful effect on cardiovascular health promotion. (Evaluation of the Program SI! for Preschool Education: A School-Based Randomized Controlled Trial [Preschool_PSI!]; NCT01579708).
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
authors.forename: José L
authors.initials: JL
authors.lastname: Peñalvo
authors.affiliation: Fundación SHE, Barcelona, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Santos-Beneit
authors.affiliation: Fundación SHE, Barcelona, Spain; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Sotos-Prieto
authors.affiliation: Fundación SHE, Barcelona, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Bodega
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Oliva
authors.affiliation: Fundación SHE, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Orrit
authors.affiliation: Fundación SHE, Barcelona, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Rodríguez
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Fernández-Alvira
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.
authors.forename: Juliana
authors.initials: J
authors.lastname: Redondo
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vedanthan
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Sameer
authors.initials: S
authors.lastname: Bansilal
authors.affiliation: Fundación SHE, Barcelona, Spain.
authors.forename: Emilia
authors.initials: E
authors.lastname: Gómez
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: valentin.fuster@mountsinai.org.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
mesh_terms: D050154:Adiposity; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002675:Child, Preschool; D016000:Cluster Analysis; D004032:Diet; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008019:Life Style; D008297:Male; D012572:School Health Services / Q000458:organization & administration*; D013030:Spain
keywords: adiposity; attitudes; behavior; education; knowledge; preschool