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## Complete Summary

#### GUIDELINE TITLE

Cardiovascular health promotion in the schools: a statement for health
and education professionals and child health advocates from the
Committee on Atherosclerosis, Hypertension, and Obesity in Youth (AHOY)
of the Council on Cardiovascular Disease in the Young, American Heart
Association.

#### BIBLIOGRAPHIC SOURCE(S)

Hayman LL, Williams CL, Daniels SR, Steinberger J, Paridon S, Dennison
BA, McCrindle BW. Cardiovascular health promotion in the schools: a
statement for health and education professionals and child health
advocates from the Committee on Atherosclerosis, Hypertension, and
Obesity in Youth (AHOY) \[trunc\]. Circulation 2004 Oct
12;110(15):2266-75. \[66 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15477426)

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Cardiovascular diseases (CVD)

#### GUIDELINE CATEGORY

Prevention

#### CLINICAL SPECIALTY

Cardiology\
Family Practice\
Pediatrics

#### INTENDED USERS

Health Care Providers\
Public Health Departments

#### GUIDELINE OBJECTIVE(S)

To optimize the school environment as an integral part of
population-based strategies designed to promote cardiovascular health
for all US children and youth and reduce the risk and public health
burden of cardiovascular disease (CVD)

#### TARGET POPULATION

School-age children (kindergarten through grade 12)

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  School-based (including preschools and after-school programs)
    educational programs aimed at promoting cardiovascular health for
    children and youth emphasizing:

    -   Healthy dietary intake

    -   Physical activity

    -   Smoking behavior

    -   Education about risk factors for cardiovascular disease

2.  Establishment of school policies that promote physical activity and
    healthy patterns of nutrition including:

    -   Heart-healthy school lunches and snacks

    -   Physical education programs

    -   Tobacco-free environments in schools

    -   School-community links to promote cardiovascular health

#### MAJOR OUTCOMES CONSIDERED

-   Cardiovascular disease (CVD) risk factor knowledge

-   Total fat intake

-   Salt/sodium intake

-   Total/high density lipoprotein (HDL) cholesterol

-   Systolic/diastolic blood pressure

-   Indices of obesity

-   Pulse rate

-   Total fat content of school lunch menus

-   Saturated fat content of school lunch menus

-   Amount of moderate-to-vigorous physical activity (MVPA) in physical
    education (PE) programs

-   Changes in fat content of food lunch offerings

-   Body mass index (BMI)

-   PV~O2~max

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

This statement was approved by the American Heart Association Science
Advisory and Coordinating Committee on July 19, 2004.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**[Recommendations]{.underline}**

The American Heart Association\'s (AHA\'s) Council on Cardiovascular
Disease in the Young (CVDY) supports the need for both high-risk and
population-based approaches to cardiovascular health promotion and risk
reduction beginning in early childhood. Consistent with the AHA\'s
*Guide for Improving Cardiovascular Health at the Community Level*, CVDY
endorses the role of schools and school health programs as central and
essential components of population-based strategies. To this end, goals
and recommendations that are designed to optimize the school environment
(including preschools and after-school programs) in promoting
cardiovascular health for children and youth are listed below.
Information that is relevant to these recommendations is included in the
Guidelines and School Health Objectives portion of the Suggested Reading
section.

**Heart Health Education and Health Behaviors**

*Goals*

-   All schools should implement evidence-based, comprehensive,
    age-appropriate curricula about cardiovascular health, methods for
    improving health behaviors, and the reduction of cardiovascular
    disease (CVD) risk.

-   All schools should implement age-appropriate and culturally
    sensitive curricula on changing students\' patterns of dietary
    intake, physical activity, and smoking behaviors.

*Recommendations*

-   School curricula should include general content about the major risk
    factors for cardiovascular disease and content specific to the
    sociodemographic, ethnic, and cultural characteristics of the school
    and the community.

-   School curricula should include research-based content about the
    effective methods of changing cardiovascular disease-related health
    behaviors.

-   Schools should provide the behavioral skill training necessary for
    students to achieve the regular practice of healthy behaviors.

-   Physical education (PE) class should be required at least 3 times
    per week from kindergarten through grade 12, with an emphasis on
    increasing the participation of all students in age-appropriate
    moderate-to-vigorous physical activity (MVPA). The American Heart
    Association advocates 150 minutes of PE during each school week for
    elementary school students and at least 225 minutes per week for
    middle school students.

-   Meals provided in schools should be conducive to cardiovascular
    health and conform to current recommendations for macronutrient and
    micronutrient content.

-   School buildings and surrounding environments should be designated
    tobacco-free settings.

**School Policies**

*Goals*

-   All schools should institute policies that enforce the
    implementation of the current national recommendations for physical
    activity and nutrition for children and youth, including the
    modification of food services and physical education programs.

-   All schools should institute policies that they be maintained as
    tobacco-free environments.

*Recommendations*

-   School policies should address all foods and snacks consumed on- and
    off-premises during school hours.

-   After-school programs should institute policies that are conducive
    to the consumption of nutritious healthy snacks and an appropriate
    level of physical activity for all children in their programs. These
    policies should take into account the stocking of vending machines
    and the marketing of foods.

**School and Community Linkages**

*Goal*

-   All schools should establish links with the community resources and
    infrastructures necessary to support cardiovascular health promotion
    and risk reduction for children and youth.

*Recommendation*

-   As community thought leaders, schools should make the promotion of
    healthy patterns of dietary intake and physical activity behaviors
    in their community a priority.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting each recommendation is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

School health programs initiated in preschool and extending through high
school have the potential to influence the cardiovascular health of the
majority of US children and youth.

#### POTENTIAL HARMS

Not stated

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Hayman LL, Williams CL, Daniels SR, Steinberger J, Paridon S, Dennison
BA, McCrindle BW. Cardiovascular health promotion in the schools: a
statement for health and education professionals and child health
advocates from the Committee on Atherosclerosis, Hypertension, and
Obesity in Youth (AHOY) \[trunc\]. Circulation 2004 Oct
12;110(15):2266-75. \[66 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15477426)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2004 Oct 12

#### GUIDELINE DEVELOPER(S)

American Heart Association - Professional Association

#### SOURCE(S) OF FUNDING

American Heart Association

#### GUIDELINE COMMITTEE

Working Groups of the American Heart Association Committee on
Atherosclerosis, Hypertension

Obesity in Youth (AHOY) of the Council on Cardiovascular Disease in the
Young, American Heart Association

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee Members*: Laura L. Hayman, PhD, RN (Cochair); Christine L.
Williams, MD, MPH (Cochair); Stephen R. Daniels, MD, PhD; Julia
Steinberger, MD, MS; Steve Paridon, MD; Barbara A. Dennison, MD; Brian
W. McCrindle, MD, MPH

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The American Heart Association makes every effort to avoid any actual or
potential conflicts of interest that may arise as a result of an outside
relationship or a personal, professional, or business interest of a
member of the writing panel. Specifically, all members of the writing
group are required to complete and submit a Disclosure Questionnaire
showing all such relationships that might be perceived as real or
potential conflicts of interest.

**Disclosure**

-   Dr Laura L. Hayman reported no financial relationships to disclose.

-   Dr Christine L. Williams reported no financial relationships to
    disclose.

-   Dr Stephen R. Daniels reported no financial relationships to
    disclose.

-   Dr Julia Steinberger reported serving as a consultant for American
    Phytotherapy Research Laboratory, Inc.

-   Dr Steve Paridon reported no financial relationships to disclose.

-   Dr Barbara A. Dennison reported no financial relationships to
    disclose.

-   Dr Brian W. McCrindle reported no financial relationships to
    disclose.

This represents the relationships of writing group members that may be
perceived as actual or reasonably perceived conflicts of interest as
reported on the Disclosure Questionnaire, which all members of the
writing group are required to complete and submit.

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Heart Association Web
site](http://circ.ahajournals.org/cgi/content/full/110/15/2266).

Print copies: Available from the American Heart Association, Public
Information, 7272 Greenville Ave, Dallas, TX 75231-4596; Phone:
800-242-8721

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on January 21, 2005.

#### COPYRIGHT STATEMENT

Copyright to the original guideline is owned by the American Heart
Association, Inc. (AHA). Reproduction of the AHA Guideline without
permission is prohibited. Single reprint is available by calling
800-242-8721 (US only) or writing the American Heart Association, Public
Information, 7272 Greenville Ave., Dallas, TX 75231-4596. Ask for
reprint No. 71-0276. To purchase additional reprints: up to 999 copies,
call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies,
call 410-528-4121, fax 410-528-4264, or email kgray@lww.com. To make
photocopies for personal or educational use, call the Copyright
Clearance Center, 978-750-8400.

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008