Impact of a CBPR School Program on Obesity-Related Outcomes in Underserved Youth

描述（由申请人提供）：在过去的20年里，美国儿童和青少年的肥胖率直线上升。全国性的研究表明，在种族/少数民族和低收入人群超重或肥胖的风险更高的地方，存在着差异。设计、实施和传播有效的以学校为基础的预防项目对于解决肥胖流行的这些差异至关重要，然而成功的模式却很少。由社区合作伙伴使用CBPR方法提供信息的综合性干预措施，以及包括个人（身体活动行为）、社会（体育教师课程培训活动）和环境（改善学校体育设备）因素的综合干预措施，在对儿童肥胖相关行为和认知表现产生长期影响方面取得了更大的成功，特别是在医疗服务不足的地区/人群中（MUA/P）。通过与加州大学洛杉矶分校护理学院、洛杉矶联合学区（LAUSD）的合作，我们建议评估基于中学的环境和课程干预对MUA/P青少年体育活动和健身行为以及标准化成就测试成绩的影响。这项研究还考察了干预的效果是否因性别和种族而异。拟议的环境和课程协调学校健康计划将由三个部分组成：（1)SPARK中学体育教育和营养（M-SPAN）计划，2）体育教师的专业发展（PD）和课程培训；3)提供优质的体育器材。本研究在LAUSD的24所MUA/P中学采用集群随机对照试验设计，重复测量（计划前，计划中，计划后）并随机分配干预措施。M-SPAN是一个基于证据的项目，被美国疾病控制与预防中心推荐用于减少儿童肥胖。为了加强M-SPAN， SPARK创建了与M-SPAN活动相匹配的体育设备。课程干预包括SPARK Active Recreation和LAUSD PE标准课程的结合，将在两个干预年（共22个月）的11个月内每月提供一次。项目设计将分两阶段实施。第一阶段（每个研究条件下有6个地点）将从1-3年级开始，第二阶段（每个研究条件下有6个地点）；将从2-4年级开始。研究目标将通过客观和主观的活动测量来评估，包括SOPLAY（青年计划和休闲活动观察系统），通过FitnessGram评估的身体健康，通过身体成分（BMI下降和皮褶厚度），有氧健身（一英里跑），肌肉力量/耐力（卷腹和引体向上）以及标准化成就测试分数来衡量。来自干预学校的一小部分青少年样本（n=3,960）也将通过修改后的青少年风险行为调查（YRBSS）、干预前、干预中期和干预后立即进行身体活动评估。对于第一波，第1、2、3年，对于第二波，第2、3、4年。

DESCRIPTION (provided by applicant): Over the past 20 years, obesity rates in U.S. children and youth have skyrocketed. National studies show that disparities exist where racial/ethnic minorities and those from a low-income are at higher risk for being overweight or obese. Design, implementation and dissemination of effective school-based prevention programs are critical to addressing these disparities in the obesity epidemic, however few successful models exist. Interventions that are both informed by community partners using a CBPR approach and are comprehensive, and those that include the integration of individual (physical activity behaviors), social (PE teacher curriculum training activities) and environmental (improved school PE equipment) factors have greater success in achieving long-term effects on children's obesity-related behaviors and cognitive performance, especially among medically underserved areas/populations (MUA/P). Resulting from a partnership with the UCLA School of Nursing, the Los Angeles Unified School District (LAUSD) we propose to assess the impact of a middle-school based environmental and curriculum intervention on physical activity and fitness behaviors and standardized achievement test scores among MUA/P youth. This research also examines whether the effects of the intervention vary by gender and ethnicity. The proposed environment and curriculum, coordinated school health program will consist of three components: (1) the SPARK Middle School Physical Education and Nutrition (M-SPAN) Program, 2) professional development (PD) and curriculum training for PE teachers; and 3) provision of quality PE equipment. This study uses a cluster randomized controlled trial design at 24 MUA/P middle schools in the LAUSD with repeated measures (pre-program, mid-program, immediate post-program) and random assignment to the intervention. M-SPAN is an evidenced-based program and is recommended by the CDC to decrease childhood obesity. In order to enhance M-SPAN, SPARK has created PE equipment to match the activities in M-SPAN. The curriculum intervention entails the combination of SPARK Active Recreation and LAUSD PE Standards curricula and will be delivered once a month over 11 months of each of the two intervention years (total 22 months). The project design will be implemented in two waves. Wave I (with 6 sites from each study condition) will run from Years 1-3 and Wave II (with 6 sites from each study condition); will run from Years 2-4. The study aims will be evaluated with objective and subjective activity measures including SOPLAY (System for Observing Plan and Leisure Activity in Youth), physical fitness via the FitnessGram assessment, measured by body composition (decreased BMI and skinfold thickness), aerobic fitness (one mile run), and muscular strength/endurance (curl-up and pull-up) as well as standardized achievement test scores. A small subsample of youth from intervention schools (n=3,960) will also be assessed for physical activity via a modified Youth Risk Behavior Survey (YRBSS), pre-intervention, mid- intervention and immediate post-intervention. For Wave I years 1, 2, and 3 and for Wave II, years 2, 3 and 4.