A School Nurse-Delivered Intervention for Overweight and At Risk Adolescents

描述（由申请人提供）：在过去的二十年中，青少年的超重几乎增加了两倍，并且在青春期和成年期都有严重的身体和心理后果。学校护士在识别、预防和治疗这一人群中的超重方面具有巨大的潜力，因为每年有95%以上的儿童和青少年与学校卫生系统接触，学校护士在提供有关体重、饮食和身体活动的指导方面具有信誉和技能。然而，据我们所知，还没有随机对照的以学校为基础的试验，利用学校护士向青少年提供与体重相关的干预。在调查人员进行的一项随机对照试验中，我们发现学校护士提供的戒烟干预在帮助青少年吸烟者戒烟方面是成功的，在学校健康环境中既可行，又受到青少年的欢迎。这项为期两年的探索性研究将采用这一创新的、基于理论的学校护士干预模式来治疗青少年超重，并测试其在降低BMI、改善饮食、增加身体活动和减少久坐行为方面的可行性和潜在功效。干预的内容将基于当前治疗青少年超重的临床指南和社会认知理论（SCT），采用认知行为技术促进一系列非常集中的自我管理行为的改变：饮食（每天至少5个水果蔬菜；避免苏打水和含糖饮料），体育活动（大多数天至少1小时），和久坐行为（每天看电视，视频和电脑的时间少于2小时）。马萨诸塞州的四所高中将根据人口统计学、学校规模和低收入比例进行配对，并随机分配到以下两种情况之一：(1)咨询干预（CI），由学校护士在两个月内（第一个月每周一次，第二个月每两周）提供6次30分钟的以学生为中心的个人咨询会议；(2)信息干预（II）注意控制比较条件，由学校护士在2个月内（第1个月每周一次，第2个月两周一次）进行6次单独会话组成，检查体重和行为变化状况，并发放一系列标准化的体重和体重管理小册子。从四所学校招募9至12年级有超重风险（体重指数（BMI）在年龄和性别的第85至94百分位之间）或超重风险（BMI等于或大于第95百分位）的青少年（n=84）。评估将在基线和3个月和6个月随访时进行。如果这项探索性研究的结果证明是有希望的，干预的效果将在大规模的随机对照试验中进行评估。如果被发现是有效的，这种由学校护士提供的针对青少年超重的干预措施将具有广泛推广的巨大潜力。青少年超重在过去二十年中几乎增加了两倍，并在青春期和成年期造成严重的身体和心理后果。学校护士在预防和治疗这一人群中的超重方面具有巨大潜力，因为每年有95%以上的青少年与学校卫生系统接触，而且学校护士具有信誉和技能，可以提供有关体重、饮食和身体活动的指导。本探索性研究的目的是将一种创新的、基于理论的、有效用于戒烟的学校护士辅导干预模式应用于青少年超重的治疗，并检验其在降低BMI、改善饮食、增加身体活动和减少久坐行为方面的可行性和潜在功效。如果这项探索性研究的结果证明是有希望的，将在大规模的随机对照试验中评估干预的效果。

DESCRIPTION (provided by applicant): Overweight in adolescents has nearly tripled in the past two decades and has serious physical and psychosocial consequences, both during adolescence and into adulthood. School nurses have tremendous potential to identify, prevent, and treat overweight in this population, as over 95% of children and adolescents have contact with the school health system each year and school nurses have the credibility and skills to provide guidance regarding weight, diet and physical activity. However, to our knowledge there have been no randomized controlled school-based trials that have utilized the school nurse to deliver weight-related intervention to adolescents. In a RCT conducted by the investigators, we found a school nurse-delivered smoking cessation intervention was successful in assisting adolescent smokers to quit, being both feasible to deliver in the school health setting and very well received by adolescents. This two-year exploratory study will adapt this innovative, theory-based school nurse-delivered intervention model for the treatment of adolescent overweight, and test its feasibility and potential efficacy in reducing BMI, improving diet, increasing physical activity and decreasing sedentary behavior. The content of the intervention will be based on current clinical guidelines for the treatment of overweight in adolescents and Social Cognitive Theory (SCT), employing cognitive-behavioral techniques to facilitate changes in a set of very focused self- management behaviors: diet (at least 5 fruits vegetables a day; avoid soda and sugar sweetened drinks), physical activity (at least 1 hour on most days), and sedentary behavior (less than 2 hours of TV, video, and computer time a day). Four high schools in Massachusetts will be pair matched on demographics, school size, and percent low income and randomly assigned to one of two conditions: (1) Counseling Intervention (CI) consisting of six 30-minute individual student-centered counseling sessions delivered by school nurses over 2 months (weekly in month 1, biweekly in month 2); or (2) Information Intervention (II) attention-control comparison condition consisting of six individual sessions with the school nurse over 2 months (weekly in month 1, biweekly in month 2) to check status regarding weight and behavior changes and deliver a series of standardized pamphlets on weight and weight management. Adolescents (n=84) enrolled in grades 9 through 12 at-risk for overweight (body mass index (BMI) between the 85th and 94th percentile for age and gender) or overweight (BMI at or greater than the 95th percentile) will be recruited from the four schools. Assessments will be conducted at baseline and at 3-and 6-month follow-up. Should the results of this exploratory study prove promising the efficacy of the intervention will be evaluated in a large scale RCT. If found to be effective, such a school nurse-delivered intervention for adolescent overweight would have tremendous potential for wide-scale dissemination. Overweight in adolescents has nearly tripled in the past two decades and has serious physical and psychosocial consequences, both during adolescence and into adulthood. School nurses have tremendous potential to prevent and treat overweight in this population, as over 95% of adolescents have contact with the school health system each year and school nurses have the credibility and skills to provide guidance regarding weight, diet and physical activity. The goals of the proposed exploratory study are to adapt an innovative, theory-based school nurse-delivered counseling intervention model used effectively for smoking cessation for the treatment of adolescent overweight, and test its feasibility and potential efficacy in reducing BMI, improving diet, increasing physical activity and decreasing sedentary behavior. If the results of this exploratory study prove promising, the efficacy of the intervention will be evaluated in a large scale randomized controlled trial.