INTERNET ENHANCED HEALTH PROMOTION FOR OBESE ETHNIC MINORITY ADOLESCENTS

A.1.概述。儿童和青少年肥胖率正在以惊人的速度增长。这个 从1980年到2004年，12至19岁青少年超重的流行率增加了两倍(Ogden等人， 2006)。非洲裔美国人和西班牙裔青年的肥胖率最高(国家疾病中心)。 统计数据，2004年)。在肥胖的年轻人中，包括胰岛素抵抗在内的共病情况越来越多， 2糖尿病、高血压、阻塞性睡眠呼吸暂停、自尊心差、与健康相关的生活质量降低(拉希德 和Roberts，2000；RosenBloom，2002；Sorof，Lai，Turner，Poffenbarger和Portman，2004；Wing等人，2003)。 此外，80%的肥胖青年(惠特克、赖特、佩佩、 Siedel和Dietz，1997)。鉴于青少年肥胖率的快速增长，制定基于证据的 减肥疗法不仅能达到减肥效果，还能促进健康体重的可持续性 需要，特别是对于低收入、种族和族裔多样化的人口，那里的发病率 超重是最严重的。通过行为促进持续健康体重控制的新方法 促进青少年充分参与体育活动的战略是 尚未通过良好对照试验进行充分检验的研究。我们将测试如何使用 综合面对面和基于互联网的计划，目标是增加体力活动和减少 波士顿地区超重男孩和女孩的久坐行为。该计划将利用行为 包括自我监控、目标设定、社会支持、解决问题和其他促进的策略 青少年持续的健康行为改变。技术可能是一种特别有效的工具 这样的干预是因为互动技术：1)大多数人在日常生活中经常使用 例如，2004年波士顿青年调查显示，76%的男孩和72%的女孩来自 不同族裔和种族的样本可以在家中上网(Bys，2004)，2) 关于增加青少年和成年人健康行为改变的初步研究(参见，Williamson等人，2005年)，以及 3)可以以经济高效的方式交付给大量参与者。 几篇关于以技术为基础的干预措施来解决青少年体重控制的文献综述如下 确定了若干限制，包括1)样本量小，2)身体测量不足 成分，3)在分析中不注意身体发展的影响，4)未能分解 分别针对男孩和女孩的结果，以及5)缺乏后续行动(Atlantis，Barnes，Fiatarone，&Singh，2006；Boon 和Clydesdale，2005；Sneten，Broome，&Cashin，2006)。哪些研究专门测试了基于互联网的 除两项研究外，所有研究都是准实验设计，两项研究都随机分配到组中。 此外，理论在这些研究中的使用也受到限制，这是一个重要的组成部分。最后，结果是 在以前的研究中，测量是自我报告的，样本量通常很小。因此，虽然 初步结果显示，利用科技进行身体活动和促进营养是有希望的。 在青少年项目中，迫切需要严格测试基于互联网的项目的有效性，以帮助 在设计良好、有客观结果衡量标准的试验中采用和维持减肥， 有足够的能量，有理论基础，这对更大范围的减肥有意义。 我们建议设计一个创新的减肥计划，通过增加体力活动和 减少了久坐的时间。具体地说，我们打算测试一项为期3个月的监督锻炼计划，该计划还 包括全面的、基于理论的、面对面和互联网行为指导，以促进身体健康 减肥活动(锻炼+互联网辅导)与为期3个月的标准监督锻炼计划 (练习)。通过这种方式，我们将能够测试是否添加了面对面和互联网 行为训练有助于实现和维持身体脂肪的减少 体力活动和久坐时间的减少。

A.1. Overview. The prevalence of childhood and adolescent obesity is increasing at alarming rates. The prevalence of overweight among adolescents aged 12 to 19 has tripled between 1980 and 2004 (Ogden et al., 2006). The obesity rates are highest among African American and Hispanic youth (National Center for Disease. Statistics, 2004). Co-morbid conditions are increasingly seen in obese youth, including insulin resistance, type 2 diabetes, hypertension, obstructive sleep apnea, poor self-esteem, lower health-related quality of life (Rashid & Roberts, 2000; Rosenbloom, 2002; Sorof, Lai, Turner, Poffenbarger, & Portman, 2004; Wing et al., 2003). Moreover, these conditions tend to track into adulthood for 80% of obese youth (Whitaker, Wright, Pepe, Siedel, & Dietz, 1997). Given the rapidly growing prevalence of obesity in youths, developing evidence-based weight loss treatments that not only achieve weight loss but facilitate sustainability of healthy weight are needed, particularly for low income racially and ethnically diverse populations where the prevalence of overweight is highest. Novel approaches to promoting sustained healthy weight control through behavioral strategies that lead to improvements in adequate physical activity participation in youths are a critical area of research that has not been adequately tested through well-controlled trials. We will test the use of an integrated in-person and Internet-based program that will target increased physical activity and decreased sedentary behavior in overweight boys and girls from the Boston area. The program will utilize behavioral strategies including self-monitoring, goal setting, social support, problem solving and others to promote sustained health behavior change in adolescents. Technology may be a particularly effective tool for delivering such interventions because interactive technologies: 1) are routinely used throughout daily life by most adolescents, for example, the 2004 Boston Youth Survey indicated that 76% of boys and 72% of girls from a ethnically and racially diverse sample have access to the Internet at home (BYS, 2004), 2) have been shown in preliminary studies to increase health behavior change in youth and adults (c.f.., Williamson et al., 2005), and 3) can be delivered in a cost efficient way to large numbers of participants. Several reviews of the literature on technology-based intervention to address adolescent weight control have identified a number of limitations including 1) small sample sizes, 2) inadequate measures of body composition, 3) inattention to the impact of physical development in the analyses, 4) failure to disaggregate results for boys and girls separately , and 5) lack of follow-up (Atlantis, Barnes, Fiatarone, & Singh, 2006; Boon & Clydesdale, 2005; Snethen, Broome, & Cashin, 2006). Of the studies that specifically tested Internet-based programs, all but two studies were quasi-experimental in design, both had random assignment to groups. Moreover, the use of theory was limited in these studies, an important component. Finally, the outcome measures in previous studies were self-report and the sample sizes were typically small. Thus, while preliminary results are promising for the use of technology for physical activity and nutrition promotion programs in youth, there is a critical need to rigorously test the efficacy of an Internet-based program to aid in the adoption and maintenance of weight loss in a trial that is well-designed, with objective outcome measures, adequately powered, theoretically-based, and that has implications for weight loss on a larger-scale. We propose to design an innovative program for weight loss by targeting increased physical activity and decreased sedentary time. Specifically, we intend to test a 3-month supervised exercise program that also includes comprehensive, theoretically-based, in-person and Internet behavioral coaching to promote physical activity for weight loss (Exercise + Internet Coaching) versus a 3-month standard supervised exercise program (Exercise). In this way, we will be able to test whether or not the addition of the in-person and Internet behavioral coaching assists in the achievement and maintenance of a reduction in body fat via promotion of physical activity and a reduction in sedentary time.