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

描述(申请人提供)：在过去的二十年里，青少年的超重几乎增加了两倍，在青春期和成年期都有严重的身体和心理社会后果。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，因为超过95%的儿童和青少年每年都与学校卫生系统有联系，学校护士有信誉和技能来提供关于体重、饮食和体力活动的指导。然而，据我们所知，还没有利用学校护士为青少年提供与体重相关的干预的随机对照学校试验。在调查人员进行的随机对照研究中，我们发现由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，既可以在学校卫生环境中提供，也非常受青少年欢迎。这项为期两年的探索性研究将采用这种创新的、基于理论的学校护士提供的干预模式来治疗青少年超重，并测试其在减少BMI、改善饮食、增加体力活动和减少久坐行为方面的可行性和潜在疗效。干预的内容将基于当前青少年超重治疗的临床指南和社会认知理论(SCT)，使用认知行为技术来促进一系列非常专注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(大多数日子至少1小时)和久坐行为(每天看电视、看视频和玩电脑的时间少于2小时)。马萨诸塞州的四所高中将在人口统计学、学校规模和低收入百分比方面进行配对，并随机分配到两种情况之一：(1)咨询干预(CI)，由学校护士在两个月内提供六次30分钟的以学生为中心的咨询会议(第一个月每周，第二个月两周)；或(2)信息干预(II)，由学校护士在两个月内(第一个月每周，第二个月两周)与学校护士进行六次个人会议，以检查有关体重和行为变化的状况，并提供一系列关于体重和体重管理的标准化小册子。将从这四所学校招募有超重风险(年龄和性别的身体质量指数(BMI)在第85至94个百分位数之间)或超重(BMI在第95个百分位数或以上)的9至12年级的青少年(n=84)。将在基线以及3个月和6个月的后续行动中进行评估。如果这项探索性研究的结果被证明是有希望的，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将具有广泛传播的巨大潜力。在过去的二十年里，青少年的超重几乎增加了两倍，在青春期和成年期都产生了严重的身体和心理社会后果。在这一人群中，学校护士在预防和治疗超重方面具有巨大潜力，因为95%以上的青少年每年都与学校卫生系统有联系，学校护士有信誉和技能提供有关体重、饮食和体力活动的指导。这项探索性研究的目标是将一种创新的、基于理论的学校护士提供的咨询干预模式应用于青少年超重的治疗，并测试其在减少BMI、改善饮食、增加体力活动和减少久坐行为方面的可行性和潜在效果。如果这项探索性研究的结果被证明是有希望的，干预的效果将在一项大规模的随机对照试验中进行评估。

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.