Objective: Cardiovascular disease is the leading cause of death in the United States for both men and women among all racial and ethnic groups (U.S. Department of Health and Human Services, 2000a). The prevalence of risk factors (smoking, overweight, physically inactive, hypertensive, elevated cholesterol, diabetic) explains about 60% of the variance in coronary heart disease mortality between the states in the United States (Byers et al., 1998). Three health-related behaviors that contribute to cardiovascular disease are the top three Leading Health Indicators in Healthy People 2010: physical activity, overweight and obesity, and tobacco use (U.S. Department of Health and Human Services, 2000b). The purpose of this study was to describe specific risk factors and nursing diagnoses associated with cardiovascular disease and the specific interventions being carried out with preschool children in order to identify those at risk.
Design: A prospective, descriptive design was used.
Population, Sample, Setting, Years: Low-income preschool children, aged 3-5 years, who presented for well-child care at one of four faculty practice sites were invited to participate. In addition, well children from Head Start and Child Find facilities associated with faculty practice sites were also recruited for participation.
Concept and Variables Studied Together: The concept of interest was early identification of modifiable and non-modifiable cardiovascular risks of preschool children. Variables studied were: family history of cardiovascular disease, percent calories from fat, hours of inactivity, exposure to environmental tobacco smoke, cholesterol level, blood pressure, body mass index, nursing diagnosis, nursing intervention, problem rating scale for outcomes
Methods: Parents who consented to participate completed a multi-generational cardiovascular health history form and a 24-hour dietary recall for themselves and their child. Parents were offered a free total cholesterol screen if they were unaware of their own cholesterol level. Data for height, weight, and blood pressure were obtained from the child within the context of the health exam. If risk factors were present, parents were asked permission to perform a fingerstick cholesterol test on their child.
Findings: Of the 79 child participants to date, 35.4% reported ethnicity as Latino/Hispanic (of all races), 43.04% white, 2.53% black, 3.8% Asian and 15.9% mixed race. Most of the children were boys (58.3%). Only 6 children (7.6%) showed no risk factors. Two additional children (2.5%) presented with a non-modifiable (i.e., family history) risk factor. At least one modifiable risk factor was present in 71 (89.9 %) children. There were 26 (32.9%) children with a body mass index over the 85th percentile; 20 (25.3%) children with a systolic or diastolic blood pressure over the 90th percentile for gender, age and height; 41 (51.9%) children with a dietary fat intake of >30%; 28 (35.4%) children who watched TV or played video games more than 2 hours per day; and 19 (24.1%) children were exposed to passive tobacco smoke. The most frequent nursing diagnoses (patient problem in the Omaha System) assigned to subjects were in the domain of health related behaviors (n=19) and included nutrition, physical activity, and substance use (associated with ETS). Environmental problems were second most frequent (n=14) and included income (due to no health insurance) and communication with community resources due to parental difficulties with navigating systems to obtain needed care for their child. No physiological problems related to cardiovascular risk were recorded using the Omaha System.
Conclusions: The presence of cardiovascular risk factors in almost 90% of presumably healthy preschoolers has important implications for the delivery of well-child care to vulnerable populations. It provides evidence to support testing of interventions that are capable of effecting a change in health behaviors.
Implications: The prevalence of cardiovascular risk factors among a low-income preschool population suggests abundant opportunity for early intervention in an attempt to reduce health disparities. There are continuing life span, public health, and economic implications regarding the morbidity and mortality of cardiovascular disease in the United States.
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