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个月的多成分干预，旨在增加身体活动，减少久坐不动的习惯，并促进接受正畸治疗的青春期前儿童的健康饮食。干预是基于行为生态模型（BEM），其中相互作用的生理，环境和文化偶然性选择行为。本研究将需要5年的时间招募50个正牙诊所和2100名青少年，并实施一项全诊所范围的干预措施，以促进8-13岁青少年的健康饮食和身体活动。我们的主要目的是检测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、高SES的干预效果差异；男性和女性的对比也是如此；通过与“黄金标准”进行对比来验证我们的主要结果变量；并确定家庭和同伴对久坐和高热量饮食的鼓励在多大程度上增加了正畸医生干预的相对效果。办公室将被随机分配到条件生产2（实验组）2层（低与高SES） 2层（男与女）4（重复测量）实验设计。那些在实验条件下的人将受到办公室范围内的饮食和活动干预；控制条件下的人员将接受办公室范围内的预防吸烟干预。干预措施将包括培训正畸医生和办公室工作人员提供适当的社会提示、加强和咨询，以及修改办公室，为患者和家长提供支持性的物质和社会资源。将在基线、12、24和36个月对饮食、身体活动、身体组成、烟草使用、健康以及家庭和同伴鼓励进行测量。微分随时间的变化将使用随机效应多变量模型进行分析。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的主效应、实验组的时间相互作用和调节效应的分析，通过包括实验条件和其他可能的调节因素的易感性的相互作用项来调节效应。相关性：如果研究成功，这项研究可能会促进所有专家（医生，普通牙医）提供关于饮食和体育活动的简短咨询。这样做可能会产生影响和维持很大一部分青春期前人口变化所必需的累积接触。公共卫生相关性：如果成功，这项研究可能会为政策提供信息，以促进所有专家（医生、普通牙医）提供有关饮食和体育活动的简短咨询。这样做可能会产生影响和维持很大一部分青春期前人口变化所必需的累积接触。

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.