Clinician Promotion of Healthy Diet and Activity to Reduce Obesity Among Adolesce

描述（由申请人提供）：本研究将测试一项为期24个月的多组分干预，旨在增加体力活动，减少久坐不动的做法，并促进获得厌食症护理的青少年前健康饮食。干预是基于行为生态模型（BEM），其中相互作用的生理，环境和文化的偶然性选择行为。这项研究将需要五年的时间来招募50个健康诊所和2100名青少年，并在8-13岁的青少年中实施全办公室的干预措施，以促进健康饮食和体育活动。我们的主要目的是检测我们的实验组与烟草预防对照组相比在饮食、身体活动和BMI方面的差异变化;观察低SES与高SES之间干预的差异效应;以及男性与女性之间的差异效应;通过将我们的主要结果变量与“金标准”进行对比来验证它们;并确定家庭和同伴鼓励久坐和高热量饮食在基线时增加减肥干预的相对效果的程度。办公室将被随机分配到产生2（实验组）× 2层（低SES与高SES）× 2层（男性与女性）× 4（重复测量）实验设计的条件下。那些在实验条件下将暴露于办公室范围内的饮食和活动干预;那些在控制条件下将暴露于办公室范围内的烟草预防干预。干预措施将包括培训康复医生和办公室工作人员，以提供适当的社会提示，加强和咨询，并修改办公室，为其患者和父母提供支持性的物质和社会资源。将在基线、12、24和36个月时测量饮食、身体活动、身体成分、烟草使用、健身以及家庭和同伴鼓励。将使用随机效应多变量建模分析随时间推移的差异变化。分析将包括对办公室集群效应的控制，多变量模型将包括对假设主要效应、实验组与时间相互作用的分析，以及通过纳入实验条件和其他可能的调节因子对易感性的相互作用项的调节效应。相关性：如果成功，这项研究可能会为促进所有专家（医生，普通牙医）提供饮食和体育活动的简短咨询的政策提供信息。这样做可能会产生必要的累积暴露，以影响和维持大部分青春期前人口的变化。

DESCRIPTION (provided by applicant): This study will test a 24-month multi-component intervention designed to increase physical activity, reduce sedentary practices and promote healthy diets among preteens who obtain orthodontia care. The intervention is based on the Behavioral Ecological Model (BEM), where interacting physiological, environmental, and cultural contingencies select behavior. This study will require five years to recruit 50 orthodontist offices, and 2100 youth, and implement an office-wide intervention for promoting healthy diet and physical activity among 8-13 yr old youth. Our primary aims are to detect a differential change in diet, physical activity and BMI in our experimental group compared to the tobacco prevention control group; to observe differential effects of the intervention between low vs. high SES; and similarly for males vs. females; to validate our primary outcome variables by contrasting them with a "gold standard"; and determine the degree to which family and peer encouragement for sedentary and high caloric diet at baseline increases the relative effect of the orthodontist intervention. Offices will be assigned at random to condition producing a 2 (experimental group) by 2 strata (low vs. high SES) by 2 strata (male vs. female) by 4 (repeated measures) experimental design. Those in the experimental condition will be exposed to the office-wide intervention for diet and activity; those in the control condition will be exposed to an office-wide intervention for tobacco prevention. The intervention will consist of training of orthodontists and office staff to provide appropriate social prompts, reinforcement and counseling, and modification of the offices to provide supportive physical and social resources for their patients and parents. Measures of diet, physical activity, body composition, tobacco use, fitness and family and peer encouragement will occur at baseline, 12, 24, and 36 months. Differential change over time will be analyzed using Random Effects Multivariate modeling. Analyses will include control for office cluster effects and multivariate models will include analyses of hypothetical main effects, experimental group by time interactions, and moderating effects by inclusion of interaction terms for susceptibility by experimental condition and other possible moderators. Relevance: If successful, this study may inform policies that would promote all specialists (physicians, general dentists) to deliver brief counseling for diet and physical activity. Doing so might yield the cumulative exposure necessary to effect and sustain change in a large proportion of the preteen population.