TARGETING OBESITY AND BLOOD PRESSURE IN URBAN YOUTH

针对城市青年的肥胖和血压问题

• 批准号: 7952286
• 负责人: ELAINE A. BORAWSKI
• 金额: $ 109.9万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-17 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7952286
• 关键词: Address; Attention; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Blood Vessels; Body Composition; Cessation of life; Characteristics; Child; Childhood; Clinical Trials Design; Cognitive; Communities; Demographic Factors; Diet; Disadvantaged; Distal; Education; Educational Intervention; Effectiveness of Interventions; Environment; Environmental Risk Factor; Family; Health Priorities; Informal Social Control; Intervention; Life Style; Lipids; Mediating; Mediator of activation protein; Methods; Modeling; Morbidity - disease rate; Motivation; Obesity; Outcome; Overweight; Parents; Participant; Physical activity; Policies; Principal Investigator; Problem Solving; Process; Protocols documentation; Quality of life; Randomized; Recruitment Activity; Research; Schools; Screening procedure; Self Efficacy; Social Marketing; Social support; Students; System; Target Populations; Testing; Thinking; Work; Youth; arm; base; cardiovascular risk factor; cost; cost effectiveness; fitness; indexing; innovation; insulin sensitivity; interest; intervention effect; metropolitan; normotensive; nutrition education; obesity in children; primary outcome; programs; randomized trial; secondary outcome; sedentary; skills; socioeconomics; theories

This proposal focuses on interventions to treat obesity and reduce BP in overweight/obese urban youth. Although childhood obesity is multi-factorial in origin with contributors at the child-family, school-community, and policy environments, few studies have targeted multiple environments and examined innovative behavioral interventions that may be beneficial to disadvantaged youth. This proposal addresses these deficits, focusing on lifestyle change through both child-family and school-community environments. It asks two main questions: (1) What is the differential impact on BMI and BP of three distinct psycho-educational interventions targeting the child-family environment? (2) Will an enriched school-community environment (echoing the interventions' messages and providing a venue for their implementation) influence the interventions' impact? Our target population is Cleveland Metropolitan School District students (6th-8th grade; n=450) recruited via an established screening program. Participants will be drawn from two school-community environments ("enriched" and "non-enriched"); 25 CMSD schools each. Enriched schools will participate in an innovative YMCA partnership to increase students' physical activity, and have supplemental nutrition education programs, social marketing, and navigators. Using a 3-group stratified randomized trial design, participants in each enriched and non-enriched school will be randomized into 3 intervention arms: 1) SystemCHANGE, a promising new behavioral approach focusing on system redesign of the family environment and daily routines (based on ecological and personal process improvement theory), 2) HealthyCHANGE, a behavioral approach focusing on building skills and increasing intrinsic motivation (based mainly on cognitive behavioral theory), and 3) education only (attention control). Following 6 months of intensive intervention and 6 months of boosters, subjects will be followed for another year. Primary outcomes will be BMI and BP z scores. Other cardiovascular risk indices, costs, and quality of life will also be assessed, as will potential mediators and moderators of the interventions' effects. This project incorporates several innovations and has the potential to establish a replicable system of aligned programs that have major impact on pediatric obesity. RELEVANCE: Childhood obesity, often associated with elevated blood pressure, causes morbidity and may cause early death. Finding ways to effectively treat childhood obesity is therefore a top health priority. This research (a) assesses three behavioral approaches to treating obesity and reducing blood pressure in urban youth, and (b) examines the influence of the school-community environment on the interventions' impact.

本建议的重点是干预治疗肥胖和降低血压超重/肥胖的城市青年。虽然儿童肥胖是由儿童-家庭、学校-社区和政策环境的多因素因素引起的，但很少有研究针对多种环境，并检查可能对弱势青少年有益的创新行为干预措施。该提案解决了这些缺陷，重点关注通过儿童-家庭和学校-社区环境改变生活方式。它提出了两个主要问题：(1)针对儿童-家庭环境的三种不同的心理教育干预对BMI和BP的差异影响是什么？(2)丰富的学校-社区环境（呼应干预措施的信息并为其实施提供场所）是否会影响干预措施的效果？我们的目标人群是克利夫兰大都会学区的学生（6 -8年级；n=450），他们是通过一个既定的筛选项目招募的。参与者将从两种学校社区环境中抽取（“丰富”和“非丰富”）；各25所CMSD学校。富裕学校将参与一个创新的基督教青年会伙伴关系，以增加学生的体育活动，并有补充营养教育计划，社会营销和导航。采用3组分层随机试验设计，每个强化和非强化学校的参与者将随机分为3个干预组：1) SystemCHANGE，关注家庭环境和日常生活的系统重新设计（基于生态和个人过程改进理论）；2)HealthyCHANGE，关注技能培养和内在动机的行为方法（主要基于认知行为理论）；3)仅教育（注意控制）。经过6个月的强化干预和6个月的强化治疗后，受试者将被随访一年。主要结果将是BMI和BP z评分。还将评估其他心血管风险指标、成本和生活质量，以及干预措施效果的潜在调节因子和调节因子。该项目结合了几项创新，并有可能建立一个可复制的协调项目系统，对儿童肥胖产生重大影响。相关性：儿童肥胖通常与血压升高有关，可引起发病并可能导致早期死亡。因此，寻找有效治疗儿童肥胖的方法是卫生工作的重中之重。本研究(a)评估了城市青少年治疗肥胖和降低血压的三种行为方法，(b)考察了学校-社区环境对干预效果的影响。