Different Lifestyle Interventions in Adults From Underserved Communities: The FAMILIA Trial

Rodrigo Fernandez-Jimenez, Risa Jaslow, Sameer Bansilal, Raquel Diaz-Munoz, Monali Fatterpekar, Maribel Santana, Andrea Clarke-Littman, Jacqueline Latina, Ana V. Soto, Christopher A. Hill, Mohamed Al-Kazaz, Rajeev Samtani, Rajesh Vedanthan, Chiara Giannarelli, Jason C. Kovacic, Emilia Bagiella, Andrew Kasarskis, Zahi A. Fayad, Valentin Fuster*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: The current trends of unhealthy lifestyle behaviors in underserved communities are disturbing. Thus, effective health promotion strategies constitute an unmet need. Objectives: The purpose of this study was to assess the impact of 2 different lifestyle interventions on parents/caregivers of children attending preschools in a socioeconomically disadvantaged community. Methods: The FAMILIA (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health) study is a cluster-randomized trial involving 15 Head Start preschools in Harlem, New York. Schools, and their children's parents/caregivers, were randomized to receive either an “individual-focused” or “peer-to-peer–based” lifestyle intervention program for 12 months or control. The primary outcome was the change from baseline to 12 months in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT Score [FBS]), ranging from 0 to 15 (ideal health = 15). To assess the sustainability of the intervention, this study evaluated the change of FBS at 24 months. Main pre-specified secondary outcomes included changes in FBS subcomponents and the effect of the knowledge of presence of atherosclerosis as assessed by bilateral carotid/femoral vascular ultrasound. Mixed-effects models were used to test for intervention effects. Results: A total of 635 parents/caregivers were enrolled: mean age 38 ± 11 years, 83% women, 57% Hispanic/Latino, 31% African American, and a baseline FBS of 9.3 ± 2.4 points. The mean within-group change in FBS from baseline to 12 months was ∼0.20 points in all groups, with no overall between-group differences. However, high-adherence participants to the intervention exhibited a greater change in FBS than their low-adherence counterparts: 0.30 points (95% confidence interval: 0.03 to 0.57; p = 0.027) versus 0.00 points (95% confidence interval: −0.43 to 0.43; p = 1.0), respectively. Furthermore, the knowledge by the participant of the presence of atherosclerosis significantly boosted the intervention effects. Similar results were sustained at 24 months. Conclusions: Although overall significant differences were not observed between intervention and control groups, the FAMILIA trial highlights that high adherence rates to lifestyle interventions may improve health outcomes. It also suggests a potential contributory role of the presentation of atherosclerosis pictures, providing helpful information to improve future lifestyle interventions in adults.

Original languageEnglish (US)
Pages (from-to)42-56
Number of pages15
JournalJournal of the American College of Cardiology
Volume75
Issue number1
DOIs
StatePublished - Jan 7 2020
Externally publishedYes

Keywords

  • caregivers
  • health promotion
  • lifestyle
  • parents
  • vulnerable populations

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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