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

描述（由申请人提供）：儿童肥胖症的流行导致青少年心脏代谢风险的患病率上升。这些风险包括腹部肥胖、高血压、血脂异常和糖尿病前期，这些风险的聚集被称为代谢（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。这对新墨西哥州的年轻人来说尤其令人担忧，新墨西哥州是一个文化多样的州，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不成比例。以学校为基础的健康中心（SBHC）为扩大传统上难以接触的青少年的医疗保健提供了一个重要的场所。SBHC向所有学生提供保健服务，重点是没有保险和服务不足的学生，可能是低收入和少数民族青年的唯一干预点。拟议的R 01研究将建立在NIH/NHLBI资助的R21研究的重大发现的基础上，该研究利用基于社区的参与性研究方法开发和试点测试SBHC体重管理计划，称为青少年致力于改善营养和身体活动（行动）与两所高中。行动是基于使用动机访谈（MI），以支持采用健康的饮食和体育活动行为。在目前的提案（行动PAC）中，我们建议与八所拥有SBHC的高中合作，以评估使用基于MI的方法预防和治疗超重/肥胖以及降低代谢综合征发展风险的更广泛范围和有效性。具体来说，我们的目标是1）预防BMI <85百分位数的学生超重和肥胖的发展，2）降低BMI >= 85百分位数的学生的BMI z评分和胰岛素抵抗，3）获得学生和家长对他们在学校进行BMI筛查和体重管理的经验的反馈。为了测试这些MI为基础的方法的有效性，我们将采用一个集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一个干预组，其他四所高中将被随机分配到一个常规护理对照组。960名年龄在14-17岁之间的9年级和10年级的参与者将每年接受两年的随访（分别直到他们的11年级和12年级）。分析将在一个多层次的框架内进行，以说明学校内的集群。将评估组内基线和第2年比较以及干预组和对照组之间变化的比较。这些研究成果的集体影响将推进以学校为基础的肥胖干预研究领域，并通过使用SBHC为青少年肥胖和代谢综合征确定可持续的预防和治疗方法迈出重要一步。

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.