Cardiovascular Disease Prevention ECHOS Program

Date: April 4, 2023

To:

From:

Subject: Funding for the Early Cardiovascular Health Outreach SMS (ECHOS) Program

I write in relation to your proposal to fund the ECHOS program implemented by the University of California, Los Angeles (UCLA). The ECHOS program seeks to promote health awareness and encourage healthy lifestyles among college students by using text messaging to increase preventive knowledge on cardiovascular health. Past studies have shown that text messaging programs provide an effective and convenient platform to communicate with large audiences and improve health awareness among target populations (Glowacki et al., 2018). However, as Glowacki et al. (2018) point out, their use in college populations is limited and hence, it may be important to assess the feasibility of the ECHOS program among the target group as the organization considers the funding possibilities.

The Health Problem

The CDC identifies cardiovascular disease (CVD) as a leading cause of death among adults in the US (Tran et al., 2022). It is estimated that one in every four deaths occurring in the US is attributable to CVD, and that every year, 610,000 adults in America die of CVD (Tran et al., 2022). Multiple interventions have been implemented at the community, state, and federal levels to reduce the incidence of CVD among American adults in general (Tran et al., 2022). However, college students have been conspicuously underestimated in most of these programs despite presenting a significantly high prevalence of CVD risk factors.

As they establish their adult identities and gain independence, college students often engage in unhealthy behaviours such as poor sleeping habits, tobacco use, alcohol consumption, unhealthy diets, and physical inactivity - all of which increase the risk of CVD (Tran et al., 2022). A study by Nair et al. (as cited in Tran et al., 2022) involving 970 college students found that 45 percent of college students did not engage in any form of physical activity, 71 percent had fried foods in their diets (daily), 38 percent were binge drinkers, and 40 percent were regular tobacco smokers. Unfortunately, 50 percent of college students are unaware that such lifestyle behaviours place them at risk of developing CVD in the future. Common risk factors for CVD include diabetes, hyperlipidemia, physical inactivity, obesity, and smoking (Tran et al., 2022). It would be prudent to note that studies have found that 73 percent of college students have lipoprotein cholesterol, 47 percent have hypertension, 20 percent have high blood glucose, and 33 percent are either obese or overweight (Tran et al., 2022). Generally, however, 75 percent of these students are unaware that they have these risk factors (Makaroff et al., 2021).

Programs that help college students gain knowledge about CVD risk factors and general heart health would go a long way towards shaping their future health outcomes and enhancing their self-efficacy around healthy lifestyle choices. Ultimately, this would make them less likely to engage in behaviours that increase the risk of developing CVD later on in life.

The ECHOS Program Offers a Valuable Opportunity

The UCLA’s Department of Medicine has implemented the ECHOS Program, which seeks to increase students’ knowledge and awareness about heart-healthy behaviours and general heart health (Makaroff et al., 2021). The impact of the program in the long-term is to reduce the incidence of CVD in the community. The idea is that once students understand the risks posed by their lifestyle choices while in college, they are more likely to embrace positive choices, which would ultimately minimize their risk of developing CVD. The program realizes this by sending regular texts to students on the risk factors of CVD and strategies or habits of preventing the same (Makaroff et al., 2021). To enhance relevance among the target group, the messages are developed by undergraduate students within the department of medicine, with the input of cardiologists from among the faculty (Makaroff et al., 2021).

The texts are delivered three times a week via a web-based application. This was preferred to the basic SMS as it allows the texts to include links to external websites and articles from which students could obtain additional information. The texts encourage students to practice simple behaviours that would help reduce their risk of CVD later on in life. The program is based on the nudge theory, which postulates that indirect suggestions and positive reinforcement can effectively influence human behaviour (Makaroff et al., 2021). Hence, the program works by nudging students to assess how their lifestyles compare with an ideally healthy lifestyle, and to take action to correct poor lifestyle choices as a means to enhance their cardiovascular health (Makaroff et al., 2021).

The ECHOS Program will Effectively Enhance College Students’ Awareness about CVD and Influence more Positive Lifestyle Choices

An evaluation by Makaroff et al. (2021) assessed the effectiveness of the ECHOS program in increasing students’ knowledge about CVD risk factors and driving positive lifestyle changes. The researchers administered a survey to a sample of 195 students before and after three months of receiving weekly texts to assess the change in knowledge around heart health. A comparison of participants’ pre and post-intervention survey responses showed that participation in the ECHOS program increased knowledge of heart health by 16 percent and increased (by 21 percent) the perception that CVD is preventable (Makaroff et al., 2021). As a result of the program, participants reported a 21 percent increase in the frequency of taking a low cholesterol diet and a 19 percent increase in how often they thought about food portions (Makaroff et al., 2021). The program did not significantly affect the motivation to engage in physical exercises, sleep patterns, and stress levels (Makaroff et al., 2021). As such, the evaluation concluded that there would be need to complement the ECHOS program with other interventions that have proven beneficial in these areas so as to increase its overall efficacy.

It would be prudent to note that this evaluation was conducted using data collected from UCLA students and the results may, therefore, vary if the study were to be replicated in a different context. A more accurate evaluation of the program would involve students from different universities to determine whether environmental factors have any effect on the results.

All the same, this evaluation suggests that the ECHOS program significantly improved college students’ knowledge on heart disease and strategies for preventing it, and also influenced the adoption of healthy lifestyle choices, particularly with regard to nutrition (Makaroff et al., 2021). It is possible that the program will significantly improve more young people’s lifestyle choices if implemented extensively, thus helping minimize the future incidence of CVD on a larger scale.

Let us Fund the ECHOES Program and Prevent CVD-Related Deaths in our Community

Approximately 50 percent of college students in the US have one or more CVD risk factors, yet 75 percent are unaware of this and, thus, do not take any action to address their poor lifestyle choices. This increases their risk of developing CVD later on in life. Failure to address the current lack of awareness and knowledge among college students places our community at risk of reporting even higher incidences of CVD among younger cohorts of the population in the future. This will ultimately increase the economic burden of CVD, i.e. as a consequence of increased healthcare costs, thereby robbing the country of crucial human resources.

A short-term impact of the ECHOS program would be increased knowledge and awareness of CVD among young people, leading to positive lifestyle choices. An intermediate impact would be an increase in the number of young people volunteering to pass the knowledge they have gained from the program to their peers to help them improve their lifestyle choices as well. The long-term impact would be a decrease in the overall incidence of CVD in the community and the US population in general.