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

描述（由申请人提供）：儿童肥胖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，这些风险聚集在一起被称为代谢（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，因为肥胖对这些人群的影响不成比例。新墨西哥州是一个文化多元化的州，有44.9%的西班牙裔和9.7%的美洲印第安人。以学校为基础的保健中心（shhcs）为扩大传统上难以接触到的青少年的保健机会提供了一个重要场所。中小企业健康中心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族裔青年的唯一干预点。拟议的R01研究将建立在美国国立卫生研究院/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式研究方法，与两所高中一起开发和试点了一项名为青少年致力于改善营养和体育活动（ACTION）的shbhc体重管理计划。行动是基于使用动机访谈（MI）来支持采用更健康的饮食和身体活动行为。在目前的提案（ACTION PAC）中，我们建议与8所拥有shbhcs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 <85百分位学生超重和肥胖的发展；2)降低BMI b> =85百分位学生的BMI z分数和胰岛素抵抗；3)获得学生和家长对学校BMI筛查和体重管理经验的反馈。为了测试这些基于mi的方法的有效性，我们将采用聚类随机对照试验设计，其中8所高中中的4所将被随机分配到干预组，其他4所高中将被随机分配到常规护理对照组。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为期两年的随访（分别到11年级和12年级）。分析将在多层框架下进行，以解释学校内部的群集。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。这些研究成果的共同影响将推动以学校为基础的肥胖干预研究领域，并通过使用shbhcs，为确定青少年肥胖和代谢综合征的可持续预防和治疗方法迈出重要的一步。

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.