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Tissot H, Pfarrwaller E, Haller DM Primary care prevention of cardiovascular risk behaviors in adolescents: A systematic review. Prev Med. 2021 Jan;142:106346. doi: 10.1016/j.ypmed.2020.106346. Epub 2020 Dec 1. (Systematic review)
Abstract

Adolescence is associated with behavioral changes offering opportunities for prevention of cardiovascular risk behaviors. Primary care physicians are ideally placed to deliver preventive interventions to adolescents. The objective was to systematically review the evidence about effectiveness of primary care-led interventions addressing the main cardiovascular risk behaviors in adolescents: physical activity, sedentary behaviors, diet and smoking. PubMed, Embase, PsycINFO, CINAHL, Cochrane, ClinicalTrials.gov, and ISRCTN registry were searched from January 1990 to April 2020. Randomized controlled trials of interventions in primary care contexts on at least one of the cardiovascular behaviors were included, targeting 10-19-year old adolescents, according to the World Health Organization's definition. Two authors independently assessed risk of bias. Twenty-two papers were included in the narrative synthesis, reporting on 18 different studies. Interventions targeting smoking uptake seemed more effective than interventions targeting established smoking or the three other risk behaviors. Intervention components or intensity were not clearly associated with effectiveness. Risk of bias was mostly unclear for most studies. There is little evidence for specific interventions on adolescents' cardiovascular risk behaviors in primary care, mainly due to studies' methodological limitations. Further research should investigate the effectiveness of opportunistic primary care-based interventions as compared to more complex interventions, and address the methodological shortcomings identified in this review.

Ratings
Discipline Area Score
Nurse 6 / 7
Physician 5 / 7
Comments from MORE raters

Nurse rater

The study results warrants consideration since cardiovascular diseases are still the leading cause of death in many countries regardless of Covid-19. The target population is also very critical for observation.

Nurse rater

It is a necessary review to know the next strategic lines of investigation.

Nurse rater

As a Public Health Practitioner, I view this article as very important as I shall advice other Public Health Practitioners at District Health Offices to adopt the methodologies in this systematic reviews while trying to change adolescents' risk behaviours on drug, alcohol, substance use and sedentary life styles.

Nurse rater

I appreciated the icons in the table as a means to engage my community partners potentially in systematic reviews.

Nurse rater

Most striking is the focus on prevention of cardiovascular risk behaviors in adolescents. Most PCPs/Pediatricians I work with are not actually focusing on potential or future cardiovascular risk and tend to address the 4 aspects of this risk as independent or perhaps lumped into life style behaviors--obesity, physical activity/sedentary behavior and smoking. I was disappointed that consumption of "energy drinks" e.g., red bull, monster, etc. was not studied as high levels of caffeine and sugar can definitely impact cardiovascular health. As with adults, smoking and vaping education may be more effective in preventing utilization and achieving cessation in established smokers was less effective. I believe that when the information is presented to adolescents during a routine visit and identified in a non-judgmental focus of preventive health agenda instead of a life style lecture, the outcomes will be more effective-KUDOS!

Nurse rater

As a pediatric nurse practitioner, researcher, and faculty in a school of nursing, I conducted similar research in an elementary school where children identified as obese were able to add physical exercise of dance each morning prior to the start of the school day for an academic year. Another local school did not have the dance exercise program and provided a comparison group. I was unable to randomize the groups. However, since I was present each school day, I was able to observe the dance activity and measure outcomes of BMI change and weight change as well as cardiovascular status with vital signs. I found this review very pertinent as the outcomes were CV risk. The addition of smoking behaviors was certainly pertinent to that risk and that was valuable. I found the reviews very meaningful and the different approaches to behavioral interventions were important to the outcomes.

Nurse rater

This is an interesting systematic review of randomized controlled studies of primary care interventions to promote healthy lifestyle in 10 to 19 year olds. The main result suggests that there is little effect of primary care interventions on healthy lifestyle in this group. An interesting point that suggests primary care may have a stronger influence on preventing the uptake of smoking, versus smoking cessation, speaks to the importance of public health interventions that start in middle childhood and are incorporated in parenting education and school curricula. This review is limited by inclusion of only randomized controlled studies, which strip away context required to evaluate interventions for complex health problems. The lack of contribution of theory to results was discouraging. While these results may be discouraging for primary care providers, they suggest that an integrated and comprehensive effort for younger children and their families may have merit.

Nurse rater

While this systematic review raises the value of primary care physicians instigating preventive interventions related to cardiovascular risk in adolescents, such work maybe more effective when offered by health professionals working in education settings with large adolescent populations.

Physician rater

Good habits start early in life; the earlier the better.

Physician rater

The review found that there is no good evidence, so there doesn't follow much from reading the paper than just this.
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