Family based approaches, particularly those targeting communication as well as structural and environmental conditions, are the most effective in promoting cardiovascular health, according to a state-of-the-art review published April 4 in the Journal of the American College of Cardiology.

Rates of incident cardiovascular disease continue to rise in the U.S., largely due to modifiable behavior. Habits learned during childhood largely influence behaviors as an adult, leading to a need for continuous cardiovascular health promotion and disease prevention throughout the lifespan. In the review paper, Rajesh Vedanthan, MD, MPH, FACC, et al., examine the impact of the family on cardiovascular health throughout life, focusing on mutual interdependence of the family system, shared environment, parenting style, caregiver perceptions and genomics.

The authors explain that within the family system, cohesion, communication and stress can all influence the development of healthy behaviors. Families with a healthy blend of individuality and independence are more likely to practice healthy behaviors. Additionally, stressors faced by a family can affect behaviors such as meal planning and physical activity. The shared environment of a family – made up of the physical environment, which includes the accessibility of food and physical activity, and the behavioral environment, which includes issues such as self-regulation, self-efficacy, role modeling and feeding practices – is where children develop their health habits.

According to the authors, there are four distinct family styles that shape the future habits of a child – authoritative, authoritarian, permissive and neglectful – with authoritative style being regarded as the ideal. Children who grow up with this style are more likely to eat fruits, less likely to be overweight, be more active and less sedentary, and have a lower rate of smoking.  Additionally, a caregiver’s perceptions of obesity, diet and physical activity influence a child’s weight. Caregivers tend to under estimate their child’s weight status while over estimating the quality of their diet and level of physical activity. They note that it is important for health care providers to discuss these issues with caregivers while being mindful of the sociocultural and demographic construct of the family.

They further explain that cardiovascular disease is influenced by a combination of genetic, genomic, and environmental factors. According to the authors, leveraging a systems genetic approach will influence the study of how shared environment and lifestyle affects the heritability of coronary artery disease.

The authors write that the implications for caregivers of family-based interventions include optimization of parenting skills, modification of the family environment to promote healthy behaviors, modeling healthy lifestyle behaviors, and encouraging self-efficacy of both caregivers and children. Moving forward, policy and structural approaches also need to be promoted at the community and political levels in order to create better surrounding environments for the family system.

“Family-communicated attitudes, knowledge, and behaviors substantially affect an individual’s health behaviors,” explain Vedanthan, et al. “’Nature’ (genomics), ‘nurture’ (parenting styles, perceptions), the surrounding environment, as well as the interaction among these factors all play a crucial role in the promotion of cardiovascular health of children, caregivers, and families. Family-based approaches that target both caregivers and children, as well as encourage communication among the family unit, are likely to be the most effective approach to promote cardiovascular health.”

Keywords: Adult, Attitude, Caregivers, Child, Coronary Artery Disease, Demography, Diet, Fruit, Genomics, Habits, Health Behavior, Health Promotion, Individuality, Life Style, Motor Activity, Obesity, Overweight, Parenting, Smoking, United States

< Back to Listings