TEEN JOIN: A Scalable Weight Control Intervention for Adolescents

说明(申请人提供)：儿童和青少年超重/肥胖的流行率仍然是一个公共卫生优先事项。对目前正在与超重作斗争的儿童和青少年进行干预，对于防止肥胖进入成年期至关重要。越来越多的证据支持对青少年进行综合生活方式干预的有效性。尽管出现了这样的治疗方法，但很少有青少年受益，因为这些干预措施主要是通过严格控制的临床试验或在附属于学术医疗中心的专门/三级临床环境中提供的。2010年，美国预防服务工作组(USPSTF)为临床医生提供了B级建议(即，以中等/高度肯定的益处推荐该服务)，以筛查6-17岁的儿童肥胖，并将确定的青少年推荐给综合行为计划。实现这一目标的挑战是缺乏以社区为基础的肥胖治疗方法，特别是针对青少年的。JOIN计划是由United HealthGroup和Y-USA合作开发的，是一种儿科体重控制干预措施，目标是6-17岁的广泛年龄段的年轻人，即：1)基于公认的和基于证据的原则；2)由基督教青年会促进者在社区环境中提供：3)可能在全国范围内推广。一项为期6个月的先导性研究检验了JOIN的有效性，结果显示学龄儿童的体重状况发生了令人印象深刻的变化，但对青少年的影响较小。拟议研究的目标是修改JOIN计划，以提高其对青少年的有效性，同时保持其可伸缩性的潜力。总共{120}名青少年(13-17岁)，BMI；85%和&lt；{50}将被随机分配到为期16周的增强型JOIN计划(青少年JOIN)，或传统的JOIN干预，随后每月进行6次维护。将在基线、4个月和10个月获得青少年身高、体重、群体凝聚力、目标体力活动、{饮食摄入量}和心理社会结果的评估。其他结果将包括治疗的可行性，包括出席，完成饮食和体力活动监测记录，以及就干预措施与青少年和父母进行离职访谈。我们还将获得成本效益的初步指标。据推测，与随机加入的青少年相比，随机加入青少年的青少年在4个月和10个月时BMI的下降幅度更大。进一步的假设是，与接受标准加入条件的青少年相比，随机加入青少年的青少年在中等强度体育活动中的参与度更高，在自我概念、与体育活动相关的自我效能感和群体凝聚力方面也有更大的改善。这一研究的下一个目标是进行一项大规模的传播试验(R18)，以评估青少年加入对青少年体重控制的有效性。

DESCRIPTION (provided by applicant): The prevalence of overweight/obesity among children and adolescents remains a public health priority. Interventions to treat children and adolescents currently struggling with excess weight are critical for prevention of obesity into adulthood. There is increasing evidence to support the efficacy of comprehensive lifestyle interventions for adolescents. Despite the emergence of such treatments, few adolescents benefit because these interventions are available primarily through carefully controlled clinical trials or delivered in specialized/tertiary clinical settings affiliated with academic medical centers. In 2010, the U.S. Preventive Services Task Force (USPSTF) provided a Grade recommendation B (i.e. the service is recommended with moderate/high certainty of benefit) for clinicians to screen children ages 6-17 years for obesity and refer identified youth to comprehensive behavioral programs. The challenge in meeting this objective is the lack of community-based obesity treatments to which to refer, particularly for adolescents. The JOIN program, developed as a collaboration between United HealthGroup and Y-USA is a pediatric weight control intervention targeted toward a broad age range of youth from 6-17 years that is: 1) based on well established and evidence based principles; 2) delivered by YMCA facilitators within a community setting: and 3) potentially scalable nationally. Findings from a 6-month pilot study examining the effectiveness of JOIN demonstrated impressive changes in weight status for school age children, but more modest results for adolescents. The goal of the proposed study is to modify the JOIN program to increase its effectiveness with adolescents while retaining its potential for scalability A tota of {120} adolescents (ages 13-17) with BMI > 85th% and < {50} will be randomly assigned to a 16-week enhanced JOIN program (TEEN JOIN), or the traditional JOIN intervention, followed by 6 monthly maintenance sessions. Evaluation of adolescent height, weight, group cohesion, objective physical activity, {dietary intake} and psychosocial outcomes will be obtained at baseline, 4 months, and 10 months. Additional outcomes will include treatment feasibility, including attendance, completion of diet and physical activity monitoring logs, and exit interviews with adolescents and parents regarding the intervention. We will also obtain preliminary indicators of cost effectiveness. It is hypothesized that adolescents who are randomized to TEEN JOIN will demonstrate greater decrease in BMI at 4 and 10 months than those randomized to JOIN. It is further hypothesized that adolescents randomized to TEEN JOIN will demonstrate greater increases in participation in moderate-vigorous physical activity and greater improvements in self-concept, self-efficacy related to physical activity, and group cohesion than adolescents who receive the standard JOIN condition. The next objective in this line of research is to conduct a large scale dissemination trial (R18) to evaluate the effectiveness of TEEN JOIN for adolescent weight control.