Peer health education to raise cardiovascular risk awareness in schools in a disadvantaged region

Abstract Cardiovascular diseases (CVD) are a leading cause of premature mortality, with socio-economic inequalities in their distribution. An important primary prevention tool of CVD is health education in schools, targeting key risk factors like smoking and alcohol use. We aimed to assess if the Balassagyarmat Health Education Program (BEP) had an effect on adolescents’ awareness of these CVD risk factors in a city of a disadvantaged Hungarian region. The BEP was a universal one-year intervention applying near-peer education, interactivity, and gamification to improve the knowledge of all 9th-grade students (intervention group:IG) of the city (2018-2021). Pre-BEP students served as controls (CG). Awareness was defined as indicating smoking or alcohol as risk factors for CVD in a multiple-choice question. Generalized estimating equations adjusted for gender and school type (providing school leaving exam [SLE] or not) were used to compare awareness between study groups. The interaction between school type and group was tested to check for differences in the effect. Of 1021 IG students, 664 were reached at post-test, while CG had 317 participants (no sig. difference between groups in gender and school type). Based on preliminary results, awareness of smoking being a risk factor for CVD did not differ between groups (p = 0.168). However, CG students were less likely to identify alcohol as a risk factor (p = 0.031; OR = 0.72 [CI95% 0.53-0.97]). Higher awareness of SLE students was measured in both risk factors compared to non-SLE students. School type and study group had no sig. interaction. The BEP was similarly effective in improving awareness of alcohol use as a CVD risk factor independent of school type, and could be scalable to other low-resource settings. However, the marked difference in awareness between school types requires special attention to programs that could decrease inequalities. Further studies are required to assess if awareness changes translate to behavioral changes. Key messages • Universal school-based peer health education programs could help raise awareness of certain CVD risk factors in disadvantaged regions. • Interventions to reduce health awareness gaps between students of different school types should be designed in the future to reduce socioeconomic disparities in premature mortality.