Targeting Preschool Children to Promote Cardiovascular Health: Cluster Randomized Trial

Study Questions:

Do educational interventions in preschool change children’s knowledge, attitudes, and habits towards healthy eating and physical activity?


This study used cluster randomization to assign 14 preschool facilities in Bogotá, Colombia to an educational intervention or usual curriculum between May and November 2009. The intervention focused on education and play to teach healthy diet and physical activity over a 5-month period. All children were between 3-5 years old. Children, parents, and teacher were excluded if they had received formal training in healthy habits in the prior 6 months. Educational activities included Sesame Workshop Healthy Habits story books, posters, videos, games and songs, a healthy family day, and weekly health notes. Parents participated in three workshops and the weekly notes. Teachers participated in three centralized training sessions and personalized working sessions. Questionnaires were developed to measure knowledge, attitudes, and habits regarding health behaviors at baseline, and 5 and 12 months.


A total of 1,216 children, 928 parents, and 120 teachers participated in this study. No significant differences were noted between the groups who received the intervention and the control group. After adjustment for cluster, children’s sex, age, and weight, and teacher’s educational level, children who received the intervention had larger mean increases in the overall improvement in knowledge, attitudes, and habits for a healthy lifestyle. The absolute adjusted difference was 3.90 units (95% confidence interval [CI], 1.64-6.16; p < 0.001). Significant improvements in attitudes toward healthy behaviors were noted as well. Both parents and teachers who received the intervention also had larger improvements in the questionnaire than those in the control group (absolute difference, 4.08 units; 95% CI, 2.03-6.12; p < 0.001 for the parents, and absolute difference 5.36 units; 95% CI, -0.29 to +11.01; p < 0.06). The improvement in knowledge, attitudes, and habits was still larger among the intervention group at 1 year.


The investigators concluded that a preschool intervention aimed at improving knowledge, attitudes, and habits related to healthy diet and active lifestyle is feasible, efficacious, and sustainable in very young children.


Educational interventions to improve healthy habits may be a critical component of prevention of obesity and cardiovascular risk factors. Evaluation of these interventions is paramount to truly successful efforts to improve and sustain healthy behaviors among children and adolescents.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Diet

Keywords: Attitude, Food Habits, Risk Factors, Colombia, Health Behavior, Child, Preschool, Motor Activity, Cardiovascular Diseases, Obesity, Questionnaires, Confidence Intervals, Diet, Curriculum

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