One of three demonstration sites of the Canadian Heart Health Initiative in Quebec, Coeur en sante St. Louis du Parc was a school-based heart health promotion program for children in grades 4-6 attending eight elementary schools in St. Louis du Parc. This low income, low education multiethnic community located in central Montreal, was selected for intervention because of its high morbidity and mortality related to cardiovascular disease. In addition, surveys of elementary schoolchildren in this area showed markedly high levels of obesity, smoking and physical inactivity among these youth.

The purpose of this five-year research and demonstration project was to promote the adoption and maintenance of heart healthy behaviors among preadolescent children, including non-smoking, physically active lifestyles, and healthy dietary habits. The program was conceived and developed based on current health behavior change theories including Azjen and Fishbeinís Theory of Reasoned Action, Green and Kreuterís Precede-Proceed Model, and Banduraís Social Learning Theory. The Ottawa Charter for Health Promotion provided the framework for development of program activities. Among the more novel aspects of this project is that the target population comprised representation of children from many diverse ethnic groups including Portuguese, Italian, Chinese, Vietnamese, Cambodian, South Asian, Arabic-speaking, Central American and Caribbean children, as well as Canadian children of Francophone and Anglophone origin. In addition, although the primary target group comprised students in grades 4 to 6, program activities were also targeted to parents, teachers, and local community groups, in recognition that the social environment is a powerful influence on childrenís behavior.

Activities for children included: (i) development and implementation of a classroom-based, 20 hour/year school curriculum adapted specifically for each grade, to increase knowledge and to improve attitudes and behaviors related to heart health; (ii) an after-school physical activity club for girls; (iii) development of a heart health board game called "Leaving the Moon"; (iv) a healthy muffin baking workshop for children and their parents; (v) multiethnic dinners for children and their parents; (vi) a "Healthy School" initiative which engages children in identifying and finding solutions for problems within their school; and (vii) healthy lunch box activities. Activities for teachers and other school personnel included: (i) training teachers to deliver the curriculum; (ii) yearly CVD risk factor screening; (iii) physical fitness assessments; and (iv) development and distribution of a monthly heart health newsletter. Activities for parents included workshops on CVD prevention and collective kitchens. In addition to activities directed to these target groups, the program comprised ecological interventions such as beautifying the school yard and making it "safe for play", and creation of a committee to explore enforcing the law prohibiting the sale of cigarettes to minors in local depanneurs.

To date, results of a variety of implementation and impact evaluations suggest, among other findings, that: (i) screening school personnel for CVD risk factors not only results in increased levels of physical activity among those screened, but also increases teachersí awareness of their role in promoting heart healthy behaviors among their students; (ii) training teachers how to implement the heart health curriculum, as well as providing direction on what their role is with respect to the heart health of their students, is essential. Provision of ongoing (external) support is also necessary to enhance skill-building and support teacher efforts; and (iii) an effective method to encourage parental participation in heart health activities is to invite them to attend school functions which feature their children.

When the Coeur en sante project funding ended in 1997, three of the eight participating schools formed a coalition with the local public health department and several local recreational and sports facilities to seek financial support for continuing the project. In addition, more funding was obtained, and approximately 20 teachers from across Montreal were trained to deliver the curriculum.

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