Document Type : Original Article



BACKGROUND: Cardiovascular disease (CVD) is the number one cause of death in India.
Atherosclerosis begins in the second decade of life; thus, preventive efforts beginning in adolescence
are crucial. Yet, there are no national or regional school‑based educational programs in India for
the prevention of CVD. We aimed to assess the impact of a simple educational intervention on the
awareness regarding CVD among school‑going adolescents in a rural area of Bengaluru.
MATERIALS AND METHODS: This study was conducted using a convenience sample of school‑going
adolescents of classes 8, 9, and 10 in three schools in a rural area of Anekal subdistrict, Bengaluru,
with a sample size of 170. A standardized, validated questionnaire testing CVD awareness was
administered, followed by a simple lecture with audio‑visual aids on key aspects of CVD. Three weeks
later, the same questionnaire was administered to the same students. The results were then analyzed
using appropriate descriptive (mean, percentage) and inferential analyses (Chi‑square, paired t‑test).
RESULTS: The mean (SD) age was 14.5 (1.0) years, and 54% (n = 100) were boys. 75% (139)
belonged to privately funded schools. 23% (43) belonged to class 8, 37% (69) to class 9, and 40% (74)
to class 10. The mean (SD) total score on baseline assessment was 27.4 (9.3) out of 100, with girls
and students of private schools scoring higher. The mean (SD) post‑test total score was 48.5 (15.7),
with significant increases in all domains of awareness, and in all categories of students.
DISCUSSION: Awareness regarding CVD among adolescents from rural Bengaluru was poor,
highlighting the need for educational interventions to aid preventive efforts. A simple educational
intervention resulted in significant improvements in CVD awareness, even after 3 weeks.


1. India State‑Level Disease Burden Initiative CVD Collaborators.
The changing patterns of cardiovascular diseases and their risk
factors in the states of India: The Global Burden of Disease Study
1990‑2016. Lancet Glob Health 2018;6:e1339‑51.
2. Martinez‑Amezcua P, Haque W, Khera R, Kanaya AM, Sattar N,
Lam CSP, et al. The upcoming epidemic of heart failure in South
Asia. Circ Heart Fail 2020;13:e007218.
3. Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in
India: Current epidemiology and future directions. Circulation
4. Pursnani S, Merchant M. South Asian ethnicity as a risk factor for
coronary heart disease. Atherosclerosis 2020;315:126‑30.
5. Ibanez B, Fernández‑Ortiz A, Fernández‑Friera L, García‑LunarI,
Andrés V, Fuster V. Progression of early subclinical
atherosclerosis (PESA) study: JACC focus seminar 7/8. J Am
CollCardiol 2021;78:156‑79.
6. Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE,
McCarthy PM, et al. High prevalence of coronary atherosclerosis
in asymptomatic teenagers and young adults: Evidence from
intravascular ultrasound. Circulation 2001;103:2705‑10.
7. Ray M, Guha S, Ray M, Kundu A, Ray B, Kundu K, et al.
Cardiovascular health awareness and the effect of an educational
intervention on school‑aged children in a rural district of India.
Indian Heart J 2016;68:43‑7.
8. Lindahl B, Norberg M, Johansson H, Lindvall K, Ng N, Nordin M,
et al. Health literacy is independently and inversely associated
with carotid artery plaques and cardiovascular risk. Eur J
PrevCardiol 2020;27:209‑15.
9. Killen JD, Telch MJ, Robinson TN, Maccoby N, Taylor CB,
Farquhar JW.Cardiovascular disease risk reduction for tenth
graders. A multiple‑factor school‑based approach. JAMA
10. Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC,
Gansky SA, Bradley CB. Effects of a school‑based intervention to
reduce cardiovascular disease risk factors in elementary‑school
children: The Cardiovascular Health in Children (CHIC) study.
J Pediatr 1996;128:797‑805.
11. Harrell TK, Davy BM, Stewart JL, King DS. Effectiveness of
a school‑based intervention to increase health knowledge of
cardiovascular disease risk factors among rural Mississippi
middle school children. South Med J 2005;98:1173‑80.
12. Nader PR, Perry C, Maccoby N, Solomon D, Killen J, Telch M, et al.
Adolescent perceptions of family health behavior: A tenth grade
educational activity to increase family awareness of a community
cardiovascular risk reduction program. J Sch Health 1982;52:372‑7.
13. Yadav S, Khokhar A. Effect of information, education, and
communication activity on health literacy of cardiovascular
diseases among school‑going adolescents in Delhi. J Educ Health
Promot 2021;10:71.
14. Zhao D. Epidemiological Features ofCardiovascular Disease in
Asia. JACC: Asia 2021;1:1‑13.
15. The World Bank Data [homepage on the internet].Rural
population (% of total population)‑India. Available from:
ZS?locations=IN. [Last accessed on 2022 Feb 12].
16. Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al.
Cardiovascular risk and events in 17 low‑, middle‑, and
high‑income countries. N Engl J Med 2014;371:818‑27.
17. Khaing W, Vallibhakara SA, Attia J, McEvoy M, Thakkinstian A.
Effects of education and income on cardiovascular outcomes:
A systematic review and meta‑analysis. Eur J PrevCardiol
18. Gupta R, Mohan I, Narula J. Trends in coronary heart disease
epidemiology in India. Ann Glob Health 2016;82:307‑15.
19. Bhatia M, Dixit P, Kumar M, Dwivedi LK. Impending epidemic
of cardiovascular diseases among lower socioeconomic groups
in India. Lancet Healthy Longev 2021;2:e314‑5.
20. Mohebbi B, Tafaghodi B, Sadeghi R, Tol A, Yekanenejad MS.
Factors predicting nutritional knowledge, illness perceptions,
and dietary adherence among hypertensive middle‑aged women:
Application of transtheoretical model. J Edu Health Promot
21. Mohebbi B, Sabouri M, Tol A. Application of health education
and promotion theory‑based interventions on patients with
cardiovascular disease: A systematic review. J Edu Health Promot
22. Sisti LG, Dajko M, Campanella P, Shkurti E, Ricciardi W,
de Waure C. The effect of multifactorial lifestyle interventions on
cardiovascular risk factors: A systematic review and meta‑analysis
of trials conducted in the general population and high risk groups.
Prev Med 2018;109:82‑97.
23. Maruthur NM, Wang NY, Appel LJ. Lifestyle interventions reduce
coronary heart disease risk: Results from the PREMIER Trial.
Circulation 2009;119:2026‑31.
24. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC,
Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease
prevention in clinical practice: Developed by the Task Force
for cardiovascular disease prevention in clinical practice with
representatives of the European Society of Cardiology and 12
medical societies with the special contribution of the European
association of preventive cardiology (EAPC). Eur Heart J
25. Hayman LL, Reineke PR. Preventing coronary heart disease: The
implementation of healthy lifestyle strategies for children and
adolescents. J CardiovascNurs 2003;18:294‑301.
26. Busch V, de Leeuw JR, de Harder A, Schrijvers AJ. Changing
multiple adolescent health behaviors through school‑based
interventions: A review of the literature. J Sch Health
27. Van Cauwenberghe E, Maes L, Spittaels H, van Lenthe FJ, Brug J,
Oppert J‑M, et al. Effectiveness of school‑based interventions in
Europe to promote healthy nutrition in children and adolescents:
Systematic review of published and ‘grey’ literature. Br J Nutr