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

描述(申请人提供)：这项研究将测试一项为期24个月的多成分干预措施，旨在增加体力活动，减少久坐练习，并在获得正畸护理的青少年中促进健康饮食。干预基于行为生态模型(BEM)，在该模型中，生理、环境和文化的交互作用选择行为。这项研究将需要五年时间招募50名正畸医生办公室和2100名青少年，并在全办公室范围内实施干预措施，以促进8-13岁青少年的健康饮食和体育活动。我们的主要目标是检测与烟草预防控制组相比，我们的试验组在饮食、体力活动和BMI方面的不同变化；观察低SES和高SES之间的干预效果的差异；以及男性和女性类似的干预效果；通过将我们的主要结果变量与“黄金标准”进行对比来验证我们的主要结果变量；并确定在多大程度上家庭和同伴鼓励在基线时久坐不动和高热量饮食增加正畸医生干预的相对效果。办公室将随机分配到2层(试验组)、2层(低SES与高SES)、2层(男性与女性)的条件下，采用4(重复措施)实验设计。那些处于实验状态的人将接受全办公室范围的饮食和活动干预；那些处于对照条件的人将接受全办公室的烟草预防干预。干预措施将包括对正畸医生和办公室工作人员进行培训，以提供适当的社交提示，加强和咨询，并对办公室进行改造，为患者和父母提供支持性的物质和社会资源。饮食、体力活动、身体成分、烟草使用、健康以及家庭和同伴鼓励的测量将在基线、12、24和36个月进行。将使用随机效应多变量建模来分析随时间的差异变化。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性主效应、按时间分组的试验组相互作用的分析，以及通过包括按试验条件和其他可能的主持人的敏感度的交互作用项来调节效应。相关性：如果成功，这项研究可能会为促进所有专家(内科医生、普通牙医)提供关于饮食和体力活动的简短咨询的政策提供参考。这样做可能会产生在很大一部分青春期前人口中产生和维持变化所需的累积暴露。公共卫生相关性：如果成功，这项研究可能会为促进所有专家(医生、普通牙医)提供关于饮食和体力活动的简短咨询的政策提供参考。这样做可能会产生在很大一部分青春期前人口中产生和维持变化所需的累积暴露。

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. PUBLIC HEALTH 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.