**6. Strategies to tackle CVD among adolescents and youths in Nigeria (the health-promoting school approach)**

Compared to developed nations, developing countries have seen an increase in CVD and associated risk factors, as well as a high death rate among young people. This can be due to the lack of information and practical preventive measures, which is also connected to the high levels of poverty in these nations [81]. Adequate knowledge of CVD risk factors is the first step toward an effective preventive mechanism against the burden of CVD among any population. Studies have identified children, adolescents, and young adults as the target population for the prevention program. Seven essential health conditions and habits, according to the American Heart Association, raise the risk of heart disease and stroke, such as dietary factors, smoking, being overweight or obese, being inactive, uncontrolled blood pressure, high cholesterol, and high blood sugar [95]. Ideal cardiovascular health is in line with the principle of

primordial prevention, which refers to the prevention of risk factor development. Additionally, important is primary prevention, which is the management of risk factors in patients who have not yet manifested clinical CVD. The AHA considers persons with risk factors who have received optimal treatment to have intermediate cardiovascular health [96].

Primordial prevention looks to be the higher selection in addressing CVD, and this involves preventing risk factors from occurring by optimizing lifestyles related to smart management of vital signs, low levels of cholesterol, optimum body weight, physical activities and exercise, and elimination of tobacco use. Associate degree intervention of this type involves promoting positive health behaviors, effecting healthy lifestyle policies, and establishing a physical setting that ends up in incorporating and sustaining lifelong heart-healthy lifestyles, from infancy to old age. The American Heart Association guide for improving cardiovascular health at the community level provides a comprehensive list of goals, strategies, and recommendations that may be adopted and domesticated by both developed and developing countries to control cardiovascular diseases. The guide targets not solely health professionals but also government parastatals, nonprofit organizations, community-based organizations, institutions, public health practitioners, and the community [97].

The following strategies could be used to mitigate cardiovascular diseases among adolescents and youths in Nigeria.

#### **6.1 Health promotion and education strategies**

Action on the determinants of health is the prime focus of health promotion. It intends to promote efficient and involved public engagement. It integrates a number of different, yet complementary strategies. Included in this are community development, communication, education, legislation, organizational and community improvements, and unscheduled local health hazard prevention actions. Government, both at the provincial and federal levels, and different sectors, all have a part to play, by enhancing CVD prevention efforts through health promotion, environmental change, dietary treatments, and behavioral and lifestyle adjustments [98].

Health education is designed to enhance health literacy through communication to boost knowledge and develop life skills. Health education on the risk factors of CVDs and the ways to improve the health determinants ought to be advocated for. This includes information on the implications of tobacco use, alcohol, unhealthy diet, and lack of physical activities among others. This can be done through mass media campaigns, media adverts, radio chat show programs, bulk SMS, and alternative social networks including social media. This additional could be done by mobilizing communities through advocacy to community leaders and stakeholders and community sensitization meetings. Additionally, public campaigns and social-promoting initiatives to educate and encourage the target audience about healthy dietary habits should be conducted from the states down to the communities using appropriate and acceptable cultural methods. The benefits of physical activity should be taught, and various methods of undertaking them should be demonstrated [99].

#### **6.2 Health-promoting schools**

Schools at the primary, secondary, and tertiary levels should be mandated to have research-based, comprehensive, and age-appropriate curricula about cardiovascular health and ways in which to boost health behaviors and scale down CVD risk factors. *Prevalence and Risk Factors of Cardiovascular Diseases among the Nigerian Population: A New… DOI: http://dx.doi.org/10.5772/intechopen.108180*

The school curriculum should include lessons on the risk factors for CVD and stroke and also the extent of cardiopathy and stroke in the community. Research-based curriculum regarding effective ways of changing health behaviors can be implemented. Students should learn skills needed to achieve the regular practice of healthful behaviors, and parents should learn how to support their children's healthful behaviors. All schools should be mandated to implement an age-appropriate curriculum on changing dietary, physical activity, and smoking behaviors [97].

#### **6.3 Environmental modifications**

Strategies to address occupational risks should be primary to the establishment of any workplace. The government should also enact and implement policies that promote smoke-free environments in all work sites, institutions, indoor public places, and other public places. More importantly, policy measures on the creation of health-promoting environments should be implemented before the licencing of any establishment, and means to effectively monitor the adoption of these policies should be put in place [100].

#### **6.4 Nutritional interventions**

The effective implementation of WHO recommendations on the marketing of foods and nonalcoholic beverages to children should be a top priority, including adequate mechanisms for monitoring. Effective guidelines should be developed with policy measures that engage different relevant sectors, such as food producers and processors and other relevant commercial operators to produce foods and drinks according to the appropriate terms. The government should effectively collaborate with the agricultural sector to supply policies and reforms for improvement within the provision of fruits and vegetables such that affordability is ensured. Promotion and provision of healthy food and food products should be encouraged by all public institutions including schools and workplaces [101].

#### **6.5 Quality health care delivery**

The National Academic Press (US), in 2010, recommends that along with select population-based approaches, a key step in addressing CVD is to strengthen health systems to deliver high-quality, responsive care for the prevention and management of CVD. This can be achieved by implementing provider-level strategies, health financing, and integration of care, workforce development, and access to essential medical products [102].

#### **6.6 Policy change/reform**

The primary population approach for the control of CVDs among adolescents and youths is largely dependent on the development and effective implementation of policies and regulations, especially those related to food, physical inactivity, and tobacco. These policy changes may include taxation and regulations on tobacco production and sales; regulations on tobacco and food marketing and labeling; and alterations in subsidies for foods and other food and agricultural policies. Implementation on a sufficient scale and adequate resources for evaluation is highly recommended [103].
