School Nurse Intervention and After School Exercise Program for Overweight Teens

超重青少年的学校护士干预和课后锻炼计划

• 批准号: 8189550
• 负责人: LORI PBERT
• 金额: $ 26.12万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-18 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8189550
• 关键词: Address; Adherence; Adolescent; Adult; Age; Attention; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Body Weight Changes; Body Weight decreased; Body fat; Body mass index; Child; Childhood; Clinic; Computers; Consumption; Counseling; Effectiveness; Enrollment; Exercise; Health; Hour; Individual; Intervention; Link; Lipids; Low income; Mediating; Mental Depression; Mental Health; Modeling; Obesity; Outcome; Overweight; Pamphlets; Participant; Patient Self-Report; Physical activity; Physiological; Pilot Projects; Positioning Attribute; Protocols documentation; Public Health; Quality of life; Randomized; Recommendation; Recruitment Activity; Reporting; Research Infrastructure; Resources; School Nursing; Schools; Self Efficacy; Self Management; Series; Solutions; Structure; Students; Teenagers; Testing; Time; Translating; United States; United States National Institutes of Health; Visit; Weight; Youth; base; behavior change; clinically significant; combat; cost; cost effective; demographics; follow-up; high school; improved; innovation; insulin sensitivity; intervention effect; medical specialties; nursing intervention; physical conditioning; programs; psychosocial; randomized trial; secondary outcome; sedentary; sex; skills; systematic review; theories; waist circumference

DESCRIPTION (provided by applicant): Adolescent overweight and obesity are of great and increasing concern in the US. Although comprehensive moderate-to-high intensity behavioral programs produce short-term, modest weight reductions in youth, there are no models for practical implementation in readily-accessible settings to translate promising treatment approaches into practice. High schools are well-positioned to deliver such interventions. They have the facilities and staff to deliver a physical activity program, school nurses with the skills to address obesity, and easy access for adolescents. This application builds on a randomized trial (NIH R21HD053371) of a minimal- intensity, 6-session, school nurse-delivered counseling intervention that engaged adolescents and improved key self-reported weight-related behaviors. Having demonstrated feasibility of implementation and short term behavioral improvements from this modest intervention, we now propose an 8-month, expanded intervention that further leverages existing school-based resources to assess longer term behavioral effects as well as key health outcomes, including BMI. This moderate-intensity intervention includes a structured after-school exercise program delivered by school staff, weekly weigh-ins, and school nurse visits across the entire school year. We will test this higher intensity program's feasibility and ability to reduce BMI and to improve dietary quality, physical activity, and sedentary behaviors in overweight and obese adolescents. One in each of four matched pairs of high schools (8 schools in all) will be assigned to either: (1) Lookin' Good Feelin' Good (LGFG) program -- six 30-minute individual student-centered counseling sessions delivered by school nurses during the first two months followed by weekly weigh-ins and monthly visits over the subsequent 6 months, plus a school-based exercise program 3 times weekly for the full 8 months, or (2) Information attention-control (IC) comparison condition - six individual sessions with the school nurse over the first 2 months followed by monthly visits over the remaining 6 months to check weight and behavior changes and provide pamphlets on weight and weight management. We will recruit 136 adolescents (17/school) in grades 9 through 12 who are overweight or obese (>85th percentile for age/sex) and conduct baseline and 8-month assessments. Our primary aim is to determine the feasibility and efficacy of LGFG compared to IC in reducing BMI. Secondary aims include: determining the effect of the LGFG on adherence to behaviors that mediate BMI change (i.e., dietary quality, physical activity, sedentary behavior) and on secondary physiologic (waist circumference, body fat, blood pressure, lipids, and insulin sensitivity) and psychosocial (e.g., self-efficacy, quality of life, and depression) outcomes. Extending the intervention time-frame and adding an accessible exercise program to our previous, well-accepted program should enable us to achieve both statistically and clinically significant weight loss. This school-based weight management intervention, leveraging existing infrastructure in an accessible setting, has tremendous potential for wide-scale dissemination with significant public health impact. PUBLIC HEALTH RELEVANCE: Adolescent overweight and obesity have increased dramatically in the past several decades. High schools are well-positioned to deliver weight loss treatment to overweight and obese adolescents, as they have the facilities and staff to deliver a physical activity program, school nurses with the skills to provide counseling, and are easily accessible by adolescents. This exploratory study will test the feasibility and ability of a school- based intervention, consisting of school nurse counseling and a school-based exercise program, to reduce BMI and improve dietary quality, physical activity, and sedentary behaviors in overweight and obese adolescents. If effective, this could prove to be a cost-effective and relatively easy intervention to disseminate widely for significant public health impact.

描述（由申请人提供）：青少年超重和肥胖在美国受到越来越多的关注。虽然全面的中到高强度的行为计划产生短期的，适度的减轻体重的青年，有没有实际实施的模式，在容易获得的设置转化为实践有前途的治疗方法。高中完全有能力提供这种干预措施。他们有设施和工作人员提供体育活动计划，学校护士的技能，以解决肥胖问题，并方便青少年访问。本申请建立在一项随机试验（NIH R21 HD 053371）的基础上，该试验采用了最低强度、6次会议、由学校护士提供的咨询干预措施，该干预措施使青少年参与并改善了关键的自我报告的体重相关行为。在证明了这种适度干预的实施和短期行为改善的可行性之后，我们现在提出了一种为期8个月的扩展干预，进一步利用现有的学校资源来评估长期行为影响以及关键的健康结果，包括BMI。这种中等强度的干预包括学校工作人员提供的结构化课后锻炼计划，每周称重，以及整个学年的学校护士访问。我们将测试这种高强度计划的可行性和能力，以降低体重指数，并改善超重和肥胖青少年的饮食质量，身体活动和久坐行为。四对配对的高中中每对一个（共8所学校）将被分配到：（1）看起来“感觉好”（LFG）计划-在头两个月由学校护士提供六次30分钟的以学生为中心的个人咨询会议，随后的6个月每周称重，每月访问，加上为期8个月的每周3次的校本锻炼计划，或（2）信息注意力控制（IC）比较条件-在前2个月与学校护士进行6次单独的会议，然后在剩下的6个月内每月进行一次访问，以检查体重和行为并提供有关体重及体重管理的小册子。我们将招募136名超重或肥胖（年龄/性别>第85百分位数）的9至12年级青少年（17/学校），并进行基线和8个月的评估。我们的主要目的是确定LGFG与IC相比在降低BMI方面的可行性和有效性。次要目的包括：确定LFG对坚持介导BMI变化的行为的影响（即，饮食质量、身体活动、久坐行为）和次要生理（腰围、体脂、血压、脂质和胰岛素敏感性）和心理社会（例如，自我效能、生活质量和抑郁）结果。延长干预时间框架，并在我们以前的广泛接受的计划中添加一个可访问的运动计划，应该使我们能够实现统计学和临床显着的减肥。这种以学校为基础的体重管理干预措施，利用现有的基础设施，在一个方便的环境，具有巨大的潜力，大规模传播，具有重大的公共卫生影响。 公共卫生相关性：青少年超重和肥胖在过去几十年中急剧增加。高中有能力为超重和肥胖的青少年提供减肥治疗，因为他们有设施和工作人员提供体育活动计划，学校护士有提供咨询的技能，并且青少年很容易获得。这项探索性研究将测试以学校为基础的干预措施的可行性和能力，包括学校护士咨询和以学校为基础的锻炼计划，以降低超重和肥胖青少年的BMI，改善饮食质量，身体活动和久坐行为。如果有效的话，这可能是一种具有成本效益和相对容易的干预措施，可以广泛传播，产生重大的公共卫生影响。