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Objective. The aim of this study was to assess the safety and efficacy of lowering dietary intake of total fat, saturated fat, and cholesterol in growing children and adolescents with severe hyperlipidemia. Study Design. This is a 3-year follow-up study conducted on a sample of convenience at three pediatric referral centers in New York City and its suburbs. Subjects were 138 children and adolescents 2 to 15 years of age (54% male), who had been referred with a diagnosis of hyperlipidemia. Those selected had total serum cholesterol values greater than the 95th percentile for age and had at least three visits over 3 years. They were placed on diets restricting total fat content to 30% of total calories and saturated fat to 10% of total calories (National Cholesterol Education Program Step I diet). Anthropometric measures, lipid profiles, and dietary assessment were obtained at each visit. Anthropometric data were analyzed by sex and age. Z scores for height and weight were calculated from NHANES II data and were compared by paired t tests (Hamill et al., 1979, Am J Clin Nutr 32:607–29). Results. Total serum cholesterol dropped from 262 mg/dL at baseline to 249 mg/dL at 3-year follow-up ( P = 0.003). There was no significant change in height or weight percentile, expressed as Z score, from baseline to 3-year follow up. Conclusions. In this population the supervised dietary interventions resulted in a sustained improvement of the lipid profile, with no demonstable adverse effect on growth.

Background. Healthy Start is a 3-year demonstration and education research project designed to evaluate the effectiveness of a multidimensional cardiovascular (CV) risk reduction intervention in preschool centers over a 3-year period of time. Methods. Two primary interventions are employed. The first is the preschool food service intervention program designed to reduce the total fat in preschool meals and snacks to less than 30% of calories and reduce the saturated fat to less than 10% of calories. The second major intervention is a comprehensive preschool health education curriculum, focused heavily on nutrition. Results. Effectiveness of the intervention will be determined through evaluation of changes in dietary intake of preschool children at school meals and snacks, especially with respect to intake of total and saturated fat. Evaluation of the education component will include assessment of program implementation by teachers, assessment of changes in nutrition knowledge by preschool children, and assessment of changes in home meals that children consume (total and saturated fat content). Blood cholesterol will be evaluated semiannually to evaluate changes that may be due to modification of dietary intake. Growth and body fatness will also be assessed. Conclusions. While substantial efforts have targeted CV risk reduction and health education for elementary school children, similar efforts aimed at preschool children have been lacking. The rationale for beginning CV risk reduction programs for preschool children is based upon the premise that risk factors for heart disease are prevalent by 3 years of age and tend to track over time, most commonly hypercholesterolemia and obesity, both related to nutrition. Since the behavioral antecedents for nutritional risk factors begin to be established very early in life, it is important to develop and evaluate new educational initiatives such as Healthy Start , aimed at the primary prevention of cardiovascular risk factors in preschool children. The purpose of this publication is to describe the rationale and methods for the Healthy Start project.

The care of infants and toddlers in nursery school and day-care centers in increasingly large numbers over the past decade poses special problems with respect to communicable disease control. This age group is particularly susceptible to those infectious agents (bacterial, viral, and parasitic) spread by close personal contact. This study describes an outbreak of Haemophilus influenzae type b meningitis in a large nursery school in Westchester County, New York. Organized efforts to control the outbreak through recommendation of rifampin prophylaxis were undertaken and evaluated. Compliance following the first case of meningitis was unacceptably low (45% of children and 33% of staff). Following the second case, however, compliance rose to 90% among child attendees and 79% among staff. Recommended procedures for implementation of control measures are described.

A controlled study is described for chronic disease risk factor identification and intervention among 3000 (of 4600 eligible) school children, 11 to 14

The goal of health education is to motivate society to adopt health behaviors that will reduce premature morbidity and mortality from known preventable causes, including major chronic disease (heart disease, cancer, and stroke) and accidents. This motivation can be effective only within the framework of an action-oriented school health education program with a high degree of personal involvement. This paper describes the foundations of a new school health education system combining health screening, a “Health Passport,” a behavior-oriented health curriculum, and special interventions for high-risk students. We suggest that effective health education programs such as Know Your Body (KYB) become as important in our schools as reading, writing, and arithmetic, and that these be taught each year on a developmentally progressive scale, much in the same fashion as the three Rs.

The effectiveness of a 10-session social psychological approach to the prevention of cigarette smoking was tested on 8th, 9th, and 10th graders (N = 281) in suburban New York. The program was designed to address both the social and psychological factors promoting the onset of smoking by attempting to: (a) increase students' ability to cope with direct pressures to smoke, (b) decrease their susceptibility to indirect pro-smoking social influences, and (c) improve their ability to cope with anxiety. The program was conducted by allied health professionals and utilized group discussion, modeling, and behavior rehearsal. Results indicate significant differences between the experimental and control groups in terms of the proportion of new “experimental smokers” (P < 0.01). Furthermore, there were significantly greater pretest—post-test changes for the experimental group on several of the knowledge and psychological measures, suggesting that the decrease in the onset of smoking behavior among the experimental subjects did occur for the hypothesized reasons.

There is evidence suggesting that a large proportion of adult morbidity and mortality from major chronic disease, particularly cancer and atherosclerosis, might be prevented through educational strategies designed to motivate adoption of a healthier lifestyle beginning in childhood. The “Know Your Body” project is a behaviorally oriented prototype chronic disease prevention education program, based on developmental capabilities and focused on facilitating appropriate personal health decisions at each age.

The “Know Your Body” health education program attempts to reduce children's risk for future disease through a multidimensional approach that combines health screening, a Health Passport that provides feedback to students on their results, teacher training, and curriculum materials on behavior-oriented learning activities, and special activities for high-risk students. As part of an international collaborative project with 14 other nations, more than 3,600 New York City area children age 12 to 15 years underwent health screening evaluations consisting of height, weight, triceps skinfold thickness, blood pressure, plasma total cholesterol and HDL cholesterol, pulse rate recovery index after exercise, and cigarette smoking history. This report provides mean, standard deviations, 90th and 95th percentiles for these measurements by age and sex of the child. These values could be useful in evaluating risk factor levels in childhood.

An international collaborative health screening project was undertaken to stimulate interest in child health education, to study feasibility of health screening in young children from diverse cultures, and to compare the distribution of chronic disease risk factors among 15 countries. Data for the 13-year-old participants showed that risk factors defined by cholesterol greater than 180 mg/dl, systolic blood pressure greater than 130 mm Hg, and daily or occasional smoking were present, to varying degrees, in children from each country. We found no relationship between obesity and cholesterol or blood pressure for these children. The acceptability of the screening, the children's enjoyment in participation, and the prevalence of risk factors at this young age lead to the conclusion that school-based health education programs should be initiated during childhood.