INTERNET ENHANCED HEALTH PROMOTION FOR OBESE ETHNIC MINORITY ADOLESCENTS

A.1.概况.儿童和青少年肥胖症的流行率正在以惊人的速度增加。的 12至19岁的青少年中超重的流行率在1980年至2004年之间增加了两倍（Ogden等人， 2006年）。非裔美国人和西班牙裔青年的肥胖率最高（国家疾病中心）。 统计，2004年）。在肥胖青年中，合并症越来越多，包括胰岛素抵抗、 2糖尿病、高血压、阻塞性睡眠呼吸暂停、自尊心差、健康相关生活质量较低（Rashid & Roberts，2000; Rosenbloom，2002; Sorof，Lai，Turner，Poffenbarger，& Portman，2004; Wing et al.，2003年）。 此外，这些条件往往跟踪到成年的80%的肥胖青年（惠特克，赖特，佩佩， Siedel，& Dietz，1997）。鉴于青少年肥胖症的流行率迅速上升， 减肥治疗，不仅实现减肥，但促进健康体重的可持续性， 需要，特别是对低收入的种族和族裔多样化的人口， 超重是最高的。通过行为干预促进持续健康体重控制的新方法 改善青少年充分参与体育活动的战略是一个关键领域， 没有通过严格控制的试验进行充分测试的研究。我们将测试使用 一个综合的面对面和基于互联网的计划，将针对增加身体活动和减少 波士顿地区超重男孩和女孩的久坐行为。该计划将利用行为 策略包括自我监控，目标设定，社会支持，解决问题和其他促进 青少年健康行为的持续改变。技术可能是一个特别有效的工具， 这些干预措施是因为互动技术：1）大多数人在日常生活中经常使用 例如，2004年波士顿青年调查显示，76%的男孩和72%的女孩来自一个 种族和民族多样化的样本在家里上网（BYS，2004年），2）已经显示， 增加青年和成年人健康行为改变的初步研究（C.F.，威廉姆森等人，2005年），以及 3)可以以成本有效的方式传递给大量参与者。 关于青少年体重控制的技术干预文献的几篇综述， 发现了一些局限性，包括1）样本量小，2）身体测量不足 3）在分析中不注意物理发展的影响，4）未能分解 5）缺乏随访（Atlantis，巴恩斯，Fiatarone，& Singh，2006;布恩 & Clydesdale，2005; Snethen，Broome，& Cashin，2006）.在专门测试基于互联网的 程序，所有的研究，但两个准实验设计，都有随机分配到组。 此外，理论的使用也是这些研究中的一个重要组成部分。最后，结果 以前的研究中的测量是自我报告的，样本量通常很小。因此，虽然 初步结果是有希望的使用技术的身体活动和营养促进 在青年计划，有一个关键需要严格测试的有效性，以互联网为基础的计划，以帮助 在设计良好的试验中采用并维持体重减轻，并采用客观的结局指标， 有足够的动力，有理论基础，这对更大规模的减肥有影响。 我们建议设计一个创新的减肥计划，目标是增加体力活动， 减少久坐时间。具体来说，我们打算测试一个为期3个月的监督锻炼计划， 包括全面的，以理论为基础的，面对面的和互联网的行为教练，以促进身体 活动减肥（运动+互联网教练）与3个月的标准监督运动计划 （Exercise）.这样，我们就可以测试是否加入了人与互联网 行为指导通过促进以下方面来帮助实现和维持体脂减少： 运动和减少久坐时间。

A.1. Overview. The prevalence of childhood and adolescent obesity is increasing at alarming rates. The prevalence of overweight among adolescents aged 12 to 19 has tripled between 1980 and 2004 (Ogden et al., 2006). The obesity rates are highest among African American and Hispanic youth (National Center for Disease. Statistics, 2004). Co-morbid conditions are increasingly seen in obese youth, including insulin resistance, type 2 diabetes, hypertension, obstructive sleep apnea, poor self-esteem, lower health-related quality of life (Rashid & Roberts, 2000; Rosenbloom, 2002; Sorof, Lai, Turner, Poffenbarger, & Portman, 2004; Wing et al., 2003). Moreover, these conditions tend to track into adulthood for 80% of obese youth (Whitaker, Wright, Pepe, Siedel, & Dietz, 1997). Given the rapidly growing prevalence of obesity in youths, developing evidence-based weight loss treatments that not only achieve weight loss but facilitate sustainability of healthy weight are needed, particularly for low income racially and ethnically diverse populations where the prevalence of overweight is highest. Novel approaches to promoting sustained healthy weight control through behavioral strategies that lead to improvements in adequate physical activity participation in youths are a critical area of research that has not been adequately tested through well-controlled trials. We will test the use of an integrated in-person and Internet-based program that will target increased physical activity and decreased sedentary behavior in overweight boys and girls from the Boston area. The program will utilize behavioral strategies including self-monitoring, goal setting, social support, problem solving and others to promote sustained health behavior change in adolescents. Technology may be a particularly effective tool for delivering such interventions because interactive technologies: 1) are routinely used throughout daily life by most adolescents, for example, the 2004 Boston Youth Survey indicated that 76% of boys and 72% of girls from a ethnically and racially diverse sample have access to the Internet at home (BYS, 2004), 2) have been shown in preliminary studies to increase health behavior change in youth and adults (c.f.., Williamson et al., 2005), and 3) can be delivered in a cost efficient way to large numbers of participants. Several reviews of the literature on technology-based intervention to address adolescent weight control have identified a number of limitations including 1) small sample sizes, 2) inadequate measures of body composition, 3) inattention to the impact of physical development in the analyses, 4) failure to disaggregate results for boys and girls separately , and 5) lack of follow-up (Atlantis, Barnes, Fiatarone, & Singh, 2006; Boon & Clydesdale, 2005; Snethen, Broome, & Cashin, 2006). Of the studies that specifically tested Internet-based programs, all but two studies were quasi-experimental in design, both had random assignment to groups. Moreover, the use of theory was limited in these studies, an important component. Finally, the outcome measures in previous studies were self-report and the sample sizes were typically small. Thus, while preliminary results are promising for the use of technology for physical activity and nutrition promotion programs in youth, there is a critical need to rigorously test the efficacy of an Internet-based program to aid in the adoption and maintenance of weight loss in a trial that is well-designed, with objective outcome measures, adequately powered, theoretically-based, and that has implications for weight loss on a larger-scale. We propose to design an innovative program for weight loss by targeting increased physical activity and decreased sedentary time. Specifically, we intend to test a 3-month supervised exercise program that also includes comprehensive, theoretically-based, in-person and Internet behavioral coaching to promote physical activity for weight loss (Exercise + Internet Coaching) versus a 3-month standard supervised exercise program (Exercise). In this way, we will be able to test whether or not the addition of the in-person and Internet behavioral coaching assists in the achievement and maintenance of a reduction in body fat via promotion of physical activity and a reduction in sedentary time.