Clinical trial NCT06715358: The SI! Program Reintervention for Elementary Schools Trial
Official title: Cluster Randomized Trial for the SI! Program Reintervention for Elementary Schools
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Cardiovascular Health
Obesity
Keywords: Cardiovascular health
Health promotion
School-based intervention
Children
Lead sponsor: Foundation for Science, Health and Education, Spain
Sponsor class: OTHER
Collaborators: name: La Caixa Foundation
name: Centro Nacional de Investigaciones Cardiovasculares Carlos III
First posted: 2024-12-04
Enrollment: 840
Sex: ALL
Minimum age (years): 5
Maximum age (years): 8
Standard ages: CHILD
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: Background and objectives:

The SI! Program is a multilevel school-based intervention that has been previously evaluated in different ages in three countries. Schools were randomized to the SI! Program intervention or the control group, and prior to and after the intervention several questionnaires and direct measures were used to assess changes in lifestyle and cardiovascular health indicators. In the SI! Program for Preschool, children in the intervention group increased significantly more their knowledge, attitudes and habits after 4 months of the implementation of the SI! Program compared to children in the control group. However, until now, results have shown that improvements in cardiovascular health between 3 and 5 years old do not sustain overtime. For this reason, the new project of the SI! Program proposes a reinforcement of the children's environment to boost the effect of the intervention and a reinforcement in the classroom after 2 years to favor the sustainability of the effect. The main objective of this study is to assess the effect of the reintervention of the SI! Program in the SI!-Child health score in Elementary school children (7-12 years old) and compare its effect with a single late exposure to the SI! Program.

Methodology:

A cluster-randomized trial involving 50 elementary schools in Spain will be carried out. Schools will be 1:1 randomized to either implement the SI! Program from 2nd grade throughout the whole Elementary Education (5 years) with two classroom interventions (one at 2nd grade and one at 5th grade) or to implement the SI! Program from 5th grade throughout the rest of the Elementary Education (2 years) with only one classroom intervention at 5th grade. Children in the first year of Elementary education at the beginning of the trial will be recruited. Participants will be evaluated at baseline, and after 3, 5 and 6 years using a battery of measurements on cardiovascular health parameters (anthropometry, bioimpedance, blood analysis, accelerometers, questionnaires). The primary endpoint will be the change in the SI!-Child score after 5 years. The SI! Child score includes sleep, diet, physical activity and nutritional status, and ranges from 0 to 100, with higher scores indicating better cardiovascular profiles. Secondary outcomes include the change in individual components of the SI!-Child score and other cardiovascular health indicators such as sedentarism, tobacco exposure, adiposity, blood pressure, lipid profile and blood glucose, and to assess the effect of the SI! Program reintervention to maintain or improve all cardiovascular health indicators previously mentioned one year after the reintervention.

Expected results:

The investigators expect to show that a school-based educational intervention with a reinforcement in the classroom after 2 years in addition to a school environment intervention will induce favorable and sustainable lifestyle changes in health behaviors among Spanish children. If successful, this strategy could be widely adopted having a meaningful effect on cardiovascular health promotion.


Eligibility criteria: Inclusion Criteria:

* Schools from the Madrid Region or Catalonia.
* Public or charter schools
* Schools having from 1st to 6th grades and at least one classroom in 1st grade.
* Schools having a canteen
* Children in the 1st grade.

Exclusion Criteria:

* None

Primary outcomes:
measure: Change in the SI!-Child health score at the end of the intervention
timeFrame: From baseline assessment to the end of the intervention, an average of 5 years
Secondary outcomes:
measure: Effect of the SI! Program reintervention in the individual components of the SI!-Child health score
timeFrame: From baseline assessment to the end of the intervention, an average of 5 years
Other outcomes:
measure: Effect of the SI! Program reintervention in sedentary time
timeFrame: From baseline assessment to the end of the intervention, an average of 5 years
measure: Effect of the SI! Program reintervention in screen time
timeFrame: From baseline assessment to the end of the intervention, an average of 5 years
measure: Effect of the SI! Program reintervention in tobacco exposure
timeFrame: From baseline assessment to the end of the intervention, an average of 5 years
measure: Effect of the SI! Program reintervention in body mass index
timeFrame: From baseline assessment to the end of the intervention, an average of 5 years
measure: Effect of the SI! Program reintervention in waist circumference
timeFrame: From baseline assessment to the end of the intervention, an average of 5 years
measure: Effect of the SI! Program reintervention in blood pressure
timeFrame: From baseline assessment to the end of the intervention, an average of 5 years
measure: Effect of the SI! Program reintervention in the lipid profile and blood glucose levels
timeFrame: From baseline assessment to the end of the intervention, an average of 5 years
measure: Change in the SI!-Child score one year after the intervention
timeFrame: From baseline assessment to the end of the trial, an average of 6 years
Locations:
city: Madrid
country: Spain
facility: Foundation for Science, Health and Education
Study officials:
affiliation: Mount Sinaí Hospital
name: Valentin Fuster
role: PRINCIPAL_INVESTIGATOR
References:
citation: Penalvo JL, Sotos-Prieto M, Santos-Beneit G, Pocock S, Redondo J, Fuster V. The Program SI! intervention for enhancing a healthy lifestyle in preschoolers: first results from a cluster randomized trial. BMC Public Health. 2013 Dec 20;13:1208. doi: 10.1186/1471-2458-13-1208.
citation: Penalvo JL, Santos-Beneit G, Sotos-Prieto M, Martinez R, Rodriguez C, Franco M, Lopez-Romero P, Pocock S, Redondo J, Fuster V. A cluster randomized trial to evaluate the efficacy of a school-based behavioral intervention for health promotion among children aged 3 to 5. BMC Public Health. 2013 Jul 15;13:656. doi: 10.1186/1471-2458-13-656.
citation: Penalvo JL, Santos-Beneit G, Sotos-Prieto M, Bodega P, Oliva B, Orrit X, Rodriguez C, Fernandez-Alvira JM, Redondo J, Vedanthan R, Bansilal S, Gomez E, Fuster V. The SI! Program for Cardiovascular Health Promotion in Early Childhood: A Cluster-Randomized Trial. J Am Coll Cardiol. 2015 Oct 6;66(14):1525-1534. doi: 10.1016/j.jacc.2015.08.014.
citation: Santos-Beneit G, Bodega P, de Miguel M, Rodriguez C, Carral V, Orrit X, Haro D, Carvajal I, de Cos-Gandoy A, Penalvo JL, Gomez-Pardo E, Oliva B, Ibanez B, Fernandez-Alvira JM, Fernandez-Jimenez R, Fuster V. Rationale and design of the SI! Program for health promotion in elementary students aged 6 to 11 years: A cluster randomized trial. Am Heart J. 2019 Apr;210:9-17. doi: 10.1016/j.ahj.2018.12.011. Epub 2019 Jan 8.
citation: Fernandez-Jimenez R, Santos-Beneit G, Tresserra-Rimbau A, Bodega P, de Miguel M, de Cos-Gandoy A, Rodriguez C, Carral V, Orrit X, Haro D, Carvajal I, Ibanez B, Storniolo C, Domenech M, Estruch R, Fernandez-Alvira JM, Lamuela-Raventos RM, Fuster V. Rationale and design of the school-based SI! Program to face obesity and promote health among Spanish adolescents: A cluster-randomized controlled trial. Am Heart J. 2019 Sep;215:27-40. doi: 10.1016/j.ahj.2019.03.014. Epub 2019 Apr 10.
citation: Santos-Beneit G, Fernandez-Jimenez R, de Cos-Gandoy A, Rodriguez C, Carral V, Bodega P, de Miguel M, Orrit X, Haro D, Penalvo JL, Fernandez-Alvira JM, Peyra C, Cespedes JA, Turco A, Hunn M, Jaslow R, Baxter J, Carvajal I, Fuster V. Lessons Learned From 10 Years of Preschool Intervention for Health Promotion: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022 Jan 25;79(3):283-298. doi: 10.1016/j.jacc.2021.10.046.
citation: Santos-Beneit G, Fernandez-Alvira JM, Tresserra-Rimbau A, Bodega P, de Cos-Gandoy A, de Miguel M, Ramirez-Garza SL, Laveriano-Santos EP, Arancibia-Riveros C, Carral V, Orrit X, Rodriguez C, Carvajal I, Haro D, Peyra C, Martinez-Gomez J, Alvarez-Benavides A, Estruch R, Lamuela-Raventos RM, Fernandez-Jimenez R, Fuster V. School-Based Cardiovascular Health Promotion in Adolescents: A Cluster Randomized Clinical Trial. JAMA Cardiol. 2023 Sep 1;8(9):816-824. doi: 10.1001/jamacardio.2023.2231.
citation: Santos-Beneit G, Bodega P, de Cos-Gandoy A, de Miguel M, Rodriguez C, Orrit X, Carral V, Haro D, Carvajal I, Peyra C, Martinez-Gomez J, Fernandez-Alvira JM, Fernandez-Jimenez R, Fuster V. Effect of Time-Varying Exposure to School-Based Health Promotion on Adiposity in Childhood. J Am Coll Cardiol. 2024 Aug 6;84(6):499-508. doi: 10.1016/j.jacc.2024.04.065.