TARGETING OBESITY AND BLOOD PRESSURE IN URBAN YOUTH

该提案的重点是干预治疗肥胖和降低超重/肥胖城市青年的血压。虽然儿童肥胖是多因素的起源与贡献者在儿童家庭，学校社区和政策环境，很少有研究针对多个环境，并检查创新的行为干预，可能是有益的弱势青年。该提案解决了这些不足，重点是通过儿童-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措施对BMI和BP的不同影响是什么？(2)一个丰富的学校-社区环境（响应干预措施的信息并提供实施场所）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）通过既定的筛选程序招募。参与者将来自两个学校社区环境（“丰富”和“非丰富”）; 25 CMSD学校。丰富的学校将参加一个创新的基督教青年会的伙伴关系，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。使用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，一种有前途的新行为方法，侧重于对家庭环境和日常生活进行系统重新设计（基于生态和个人过程改进理论），2）HealthyCHANGE，一种注重培养技能和增加内在动机的行为方法（主要基于认知行为理论），以及3）仅教育（注意力控制）。在6个月的强化干预和6个月的强化治疗后，受试者将再随访一年。主要结局为BMI和BP z评分。还将评估其他心血管风险指数、成本和生活质量，以及干预效果的潜在介导者和调节者。该项目结合了几项创新，并有可能建立一个可复制的系统，对儿童肥胖症有重大影响的对齐程序。相关性：儿童肥胖，通常与血压升高有关，导致发病，并可能导致过早死亡。因此，找到有效治疗儿童肥胖的方法是健康的首要任务。本研究（a）评估三种行为方法治疗城市青少年肥胖和降低血压，（B）检查学校-社区环境对干预效果的影响。

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.