ACTION PAC: Adolescents Committed to Improvement of Nutrition & Physical Activity

ACTION PAC：致力于改善青少年营养

• 批准号: 8503868
• 负责人: Alberta Sum-Yu Kong
• 金额: $ 71.87万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-12 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8503868
• 关键词: Accounting; Address; Adolescent; Adopted; Adoption; Affect; Age; American Indians; Behavior; Body mass index; Cardiovascular Diseases; Cardiovascular system; Central obesity; Child; Child Rearing; Clinical; Clinical Trials Design; Commit; Consumption; Counseling; Data; Development; Diet; Dietary Fiber; Dietary intake; Dyslipidemias; Eating; Eating Behavior; Environment; Epidemic; Fatty acid glycerol esters; Feedback; Funding; Future; Goals; Health; Health Care Visit; Health Personnel; Health Services; Healthcare; Healthy People 2020; Hispanics; Home environment; Homeostasis; Hypertension; Incidence; Insulin Resistance; Intake; Intervention; Intervention Studies; Intervention Trial; Left; Life; Life Cycle Stages; Low income; Measures; Medical; Metabolic; Metabolic syndrome; Methods; Minority; Modeling; National Heart, Lung, and Blood Institute; New Mexico; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Outcomes Research; Overweight; Parents; Participant; Patients; Physical activity; Population; Prediabetes syndrome; Pregnancy; Prevalence; Prevention; Prevention program; Preventive Intervention; Primary Health Care; Provider; Randomized; Randomized Controlled Trials; Research; Risk; Schools; Students; Syndrome; Testing; Treatment Efficacy; Underrepresented Minority; Uninsured; United States National Institutes of Health; Visit; Weight; Weight Gain; Weight maintenance regimen; Work; Youth; base; college; community based participatory research; comparison group; efficacy testing; eleventh grade; experience; fruits and vegetables; group intervention; health disparity; high school; improved; insulin sensitivity; intervention program; motivational enhancement therapy; ninth grade; nutrition; obesity in children; obesity prevention; prevent; programs; public health relevance; response; screening; sugar; sweetened beverage; tenth grade; treatment as usual; twelfth grade; young adult

DESCRIPTION (provided by applicant): The childhood obesity epidemic has led to the rising prevalence of cardiometabolic risks in adolescents. These risks include abdominal obesity, hypertension, dyslipidemia and pre-diabetes, the clustering of which is known as metabolic (or insulin resistance) syndrome. Longitudinal data show that children and adolescents with metabolic syndrome are more likely to develop cardiovascular disease and type-2 diabetes. This is especially worrisome for youth in New Mexico, a culturally diverse state with 44.9% Hispanics and 9.7% American Indians, because obesity disproportionately affects these populations. School-based health centers (SBHCs) offer an important venue to expand healthcare access for adolescents, who are traditionally hard-to- reach. SBHCs provide health services to all students, with a focus on the uninsured and underserved and may be the only point of intervention for low-income and minority youth. The proposed R01 study will build upon significant findings from a NIH/NHLBI funded R21 study that utilized a community-based participatory research approach to develop and pilot-test a SBHC weight management program called Adolescents Committed to Improvement of Nutrition and Physical Activity (ACTION) with two high schools. ACTION was based on the use of motivational interviewing (MI) to support adoption of healthier eating and physical activity behaviors. In this current proposal (ACTION PAC), we propose to collaborate with eight high schools that have SBHCs to evaluate the broader reach and efficacy of using MI-based approaches to prevent and treat overweight/obesity and to decrease the risk of metabolic syndrome development. Specifically, our goals are to 1) prevent the development of overweight and obesity among students with BMI <85th percentile, 2) reduce BMI z score and insulin resistance in students with BMI >=85th percentile, and 3) obtain student and parent feedback on their experience with school-based BMI screening and weight management. To test the efficacy of these MI-based approaches, we will employ a cluster randomized control trial design in which four of the eight high schools will be randomized to an intervention group and the other four high schools will be randomized to a usual care comparison group. 960 participants in the 9th and 10th grades between the ages of 14-17 years will be followed annually for two years (until their 11th and 12th grade, respectively). Analyses will be conducted in a multilevel framework to account for clustering within schools. Baseline and 2nd year comparisons within group and comparison of change between the intervention and comparison groups will be assessed. The collective impact of these research outcomes will advance the field of school-based obesity intervention studies and take a significant step towards identifying sustainable prevention and treatment approaches for adolescent obesity and metabolic syndrome through the use of SBHCs.

描述（由申请人提供）：儿童肥胖流行导致青少年心脏代谢风险患病率上升。这些风险包括腹部肥胖、高血压、血脂异常和糖尿病前期，这些风险被称为代谢（或胰岛素抵抗）综合征。纵向数据显示，患有代谢综合征的儿童和青少年更容易患心血管疾病和2型糖尿病。这对于新墨西哥州的年轻人来说尤其令人担忧，这个文化多元化的州有 44.9% 的西班牙裔和 9.7% 的美洲印第安人，因为肥胖对这些人群的影响尤为严重。学校健康中心 (SBHC) 为扩大传统上难以接触到的青少年提供医疗服务提供了重要场所。 SBHC 为所有学生提供健康服务，重点关注未投保和服务不足的学生，可能是低收入和少数族裔青年的唯一干预点。拟议的 R01 研究将建立在 NIH/NHLBI 资助的 R21 研究的重要发现的基础上，该研究利用基于社区的参与性研究方法与两所高中一起开发和试点测试名为“青少年致力于改善营养和身体活动”(ACTION) 的 SBHC 体重管理计划。 ACTION 基于动机访谈 (MI) 的使用来支持采用更健康的饮食和身体活动行为。在当前的提案 (ACTION PAC) 中，我们建议与八所拥有 SBHC 的高中合作，评估使用基于 MI 的方法预防和治疗超重/肥胖并降低代谢综合征发生风险的更广泛范围和功效。具体来说，我们的目标是 1) 防止 BMI <85% 的学生出现超重和肥胖，2) 降低 BMI >=85% 的学生的 BMI z 评分和胰岛素抵抗，3) 获取学生和家长对学校 BMI 筛查和体重管理体验的反馈。为了测试这些基于 MI 的方法的有效性，我们将采用整群随机对照试验设计，其中八所高中中的四所将被随机分配到干预组，其他四所高中将被随机分配到常规护理对照组。每年将对 960 名年龄在 14 至 17 岁之间的 9 年级和 10 年级参与者进行为期两年的跟踪（分别直至他们的 11 年级和 12 年级）。分析将在多层次框架中进行，以考虑学校内的聚类情况。将评估组内基线和第二年的比较以及干预组和对照组之间的变化比较。这些研究成果的集体影响将推动以学校为基础的肥胖干预研究领域的发展，并在通过使用 SBHC 确定青少年肥胖和代谢综合征的可持续预防和治疗方法方面迈出重要一步。