A School Nurse-Delivered Intervention for Overweight and At Risk Adolescents

描述（由申请人提供）：在过去的二十年中，青少年超重几乎增加了两倍，在青春期和成年期都有严重的身体和心理社会后果。学校护士在识别、预防和治疗这一人群的超重方面具有巨大的潜力，因为每年超过95%的儿童和青少年与学校卫生系统有联系，学校护士有信誉和技能提供有关体重、饮食和体育活动的指导。然而，据我们所知，还没有随机对照的学校为基础的试验，利用学校护士提供体重相关的干预青少年。在研究人员进行的一项随机对照试验中，我们发现学校护士提供的戒烟干预成功地帮助青少年吸烟者戒烟，在学校健康环境中提供可行的戒烟干预，并受到青少年的欢迎。这项为期两年的探索性研究将采用这种创新的，基于理论的学校护士提供的干预模式来治疗青少年超重，并测试其在降低BMI，改善饮食，增加体力活动和减少久坐行为方面的可行性和潜在功效。干预的内容将基于目前治疗青少年超重的临床指南和社会认知理论（SCT），采用认知行为技术来促进一系列非常集中的自我管理行为的改变：饮食（每天至少5种水果和蔬菜;避免苏打水和含糖饮料），体力活动（大多数日子至少1小时）和久坐行为（每天少于2小时的电视，视频和电脑时间）。马萨诸塞州的四所高中将在人口统计学、学校规模和低收入百分比方面配对，并随机分配到以下两种情况之一：（1）咨询干预（CI），包括由学校护士在2个月内提供的6次30分钟的以学生为中心的个别咨询会议（第1个月每周一次，第2个月每两周一次）;或（2）信息干预（II）注意力控制比较条件，包括与学校护士在2个月内进行的6次单独会议（第1个月每周一次，第2个月每两周一次），检查体重和行为变化的状况，并提供一系列关于体重和体重管理的标准化小册子。将从四所学校招募9至12年级有超重风险（体重指数（BMI）在年龄和性别的第85和第94百分位数之间）或超重（BMI等于或大于第95百分位数）的青少年（n=84）。将在基线以及3个月和6个月随访时进行评估。如果该探索性研究的结果证明有希望，则将在大规模RCT中评价干预的有效性。如果被发现是有效的，这样的学校护士提供的青少年超重的干预将有巨大的潜力，大规模的传播。在过去二十年中，青少年超重的情况几乎增加了两倍，在青少年时期和成年后都产生了严重的生理和心理后果。学校护士在预防和治疗这一人群的超重方面具有巨大的潜力，因为每年超过95%的青少年与学校卫生系统有联系，学校护士有信誉和技能提供有关体重，饮食和体育活动的指导。本研究的目的是探索一种创新的、基于理论的学校护士提供的咨询干预模式，用于有效地戒烟治疗青少年超重，并测试其在降低BMI、改善饮食、增加体力活动和减少久坐行为方面的可行性和潜在功效。如果这项探索性研究的结果证明是有希望的，干预的有效性将在一个大规模的随机对照试验中进行评估。

DESCRIPTION (provided by applicant): Overweight in adolescents has nearly tripled in the past two decades and has serious physical and psychosocial consequences, both during adolescence and into adulthood. School nurses have tremendous potential to identify, prevent, and treat overweight in this population, as over 95% of children and adolescents have contact with the school health system each year and school nurses have the credibility and skills to provide guidance regarding weight, diet and physical activity. However, to our knowledge there have been no randomized controlled school-based trials that have utilized the school nurse to deliver weight-related intervention to adolescents. In a RCT conducted by the investigators, we found a school nurse-delivered smoking cessation intervention was successful in assisting adolescent smokers to quit, being both feasible to deliver in the school health setting and very well received by adolescents. This two-year exploratory study will adapt this innovative, theory-based school nurse-delivered intervention model for the treatment of adolescent overweight, and test its feasibility and potential efficacy in reducing BMI, improving diet, increasing physical activity and decreasing sedentary behavior. The content of the intervention will be based on current clinical guidelines for the treatment of overweight in adolescents and Social Cognitive Theory (SCT), employing cognitive-behavioral techniques to facilitate changes in a set of very focused self- management behaviors: diet (at least 5 fruits vegetables a day; avoid soda and sugar sweetened drinks), physical activity (at least 1 hour on most days), and sedentary behavior (less than 2 hours of TV, video, and computer time a day). Four high schools in Massachusetts will be pair matched on demographics, school size, and percent low income and randomly assigned to one of two conditions: (1) Counseling Intervention (CI) consisting of six 30-minute individual student-centered counseling sessions delivered by school nurses over 2 months (weekly in month 1, biweekly in month 2); or (2) Information Intervention (II) attention-control comparison condition consisting of six individual sessions with the school nurse over 2 months (weekly in month 1, biweekly in month 2) to check status regarding weight and behavior changes and deliver a series of standardized pamphlets on weight and weight management. Adolescents (n=84) enrolled in grades 9 through 12 at-risk for overweight (body mass index (BMI) between the 85th and 94th percentile for age and gender) or overweight (BMI at or greater than the 95th percentile) will be recruited from the four schools. Assessments will be conducted at baseline and at 3-and 6-month follow-up. Should the results of this exploratory study prove promising the efficacy of the intervention will be evaluated in a large scale RCT. If found to be effective, such a school nurse-delivered intervention for adolescent overweight would have tremendous potential for wide-scale dissemination. Overweight in adolescents has nearly tripled in the past two decades and has serious physical and psychosocial consequences, both during adolescence and into adulthood. School nurses have tremendous potential to prevent and treat overweight in this population, as over 95% of adolescents have contact with the school health system each year and school nurses have the credibility and skills to provide guidance regarding weight, diet and physical activity. The goals of the proposed exploratory study are to adapt an innovative, theory-based school nurse-delivered counseling intervention model used effectively for smoking cessation for the treatment of adolescent overweight, and test its feasibility and potential efficacy in reducing BMI, improving diet, increasing physical activity and decreasing sedentary behavior. If the results of this exploratory study prove promising, the efficacy of the intervention will be evaluated in a large scale randomized controlled trial.