School-Based Cardiovascular Health Promotion in Adolescents

Quick Takes

  • No significant difference in adolescent CV health was observed when comparing a 2- and 4-year wellness intervention to no intervention.
  • However, there was evidence of marginal benefit midway through the 4-year wellness intervention, which was not sustained.
  • Further research is warranted into the efficacy of school-based health promotion programs with different intensities and reintervention strategies.

Study Questions:

Does the effect of multicomponent educational health promotion strategy differ by duration or intensity on adolescents’ cardiovascular health (CVH)?


The S! Program for Secondary Schools is a 4-year intervention trial, which used a cluster randomized design to examine a multicomponent wellness intervention among children enrolled in 24 secondary schools from Barcelona and Madrid, Spain between September 7, 2017–July 31, 2021. Participants were enrolled in the first grade of secondary school. Schools were randomized to receive a health promotion intervention (SI! Program), which was delivered as a long-term intervention over 4 years (n = 8 schools) or a short-term intervention over 2 years (n = 8 schools). A third group received a standard curriculum (i.e., usual care). The primary outcome was between-group differences in overall CVH score defined by the American Heart Association (range 0-14) at 2 and 4 years.


A total of 1,326 adolescents were included (51.6% boys, mean age 12.5 years at time of recruitment) with a study completion rate of 86%. Eight schools were randomized to each of the three study arms (long-term intervention, short-term intervention, and control). Baseline overall CVH scores were 10.3 points in the long-term intervention group, 10.6 points in the short-term intervention group, and 10.5 points in the control group. After 2 years, at halfway through the long-term intervention and at the end of the short-term intervention, the difference in the CVH score change was 0.44 points (95% confidence interval [CI], 0.01-0.87; p = 0.04) between the long-term intervention group and the control group, and 0.18 points (95% CI, −0.25 to 0.61; p = 0.39) between the short-term intervention group and the control group. At 4 years, differences for the long-term intervention and short-term intervention groups versus control were 0.12 points (long-term intervention: 95% CI, −0.19 to 0.43; p = 0.42) and 0.13 points (short-term intervention: 95% CI, −0.17 to 0.44; p = 0.38). No adverse events were reported.


The authors concluded that the tested school-based health promotion strategies in this randomized controlled trial had a neutral effect on the CVH of the adolescents, although there was evidence of a marginal beneficial effect for the 4-year intervention midway through the intervention period.


Improving wellness among school age children has been associated with improvements in CV health. However, this study did not report significant improvements in CVH, although a marginal benefit was noted midway through the longer-term intervention. Conducting these types of trials is difficult, with changes in school wellness policies and home environments difficult to assess and control for. Further research, in particular with implementation science methods, is warranted if such interventions are to be successfully implemented and scaled upwards.

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

Keywords: Adolescent, Adolescent Health, Child Health, Curriculum, Health Promotion, Intervention Studies, Pediatrics, Primary Prevention, School Health Services, Schools

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