COPE/Healthy Lifestyles for Teens: A School-Based RCT

描述(由申请人提供)： 预防和治疗青春期肥胖和精神健康障碍是美国的两大公共卫生问题。今天。在过去的20年里，青少年超重或肥胖的发生率急剧上升，目前约有17.1%的青少年超重或肥胖。此外，在美国，大约有1500万儿童和青少年(25%)有心理健康问题，这干扰了他们在家中或在学校的功能，但只有不到25%的受影响儿童和青少年接受了这些疾病的治疗。在西班牙裔青少年中，肥胖和心理健康问题的患病率甚至更高，研究表明，这两种情况往往在许多年轻人中共存。然而，尽管这两种公共卫生问题及其相关的健康差距和不良健康结果的发生率迅速上升，但针对高中青少年进行的以理论为基础的干预研究一直很少，以改善他们的健康生活方式行为以及他们的身心健康结果。不幸的是，身体和心理健康服务在很大程度上仍然是分开的，而不是整合到国家的医疗体系中，这往往导致对这些严重的青少年健康问题的识别和治疗不足。因此，拟议的随机对照试验的目标是测试COPE(为个人赋权创造机会)/健康生活方式青少年(思维、感觉、情绪和锻炼)计划的有效性，该计划是一种以认知行为理论为指导的教育和认知-行为技能培养干预措施，对亚利桑那州凤凰城800名不同文化背景的青少年的健康生活方式行为和抑郁症状进行测试。这项研究的具体目的是：(1)使用随机对照试验来测试COPE青少年计划对包括健康生活方式行为、抑郁症状和体重指数百分比在内的关键结果的短期和长期有效性；(2)考察认知信念和在领导健康生活方式方面的感知困难在COPE对健康生活方式行为和抑郁症状的影响中的作用；以及(3)探索可能缓和干预对健康生活方式行为和抑郁症状影响的变量，包括种族/民族、性别、社会经济地位、文化适应以及父母健康的生活方式信念和行为。之前的六项试点研究支持需要进行这项全面的临床试验，并使用认知-行为技能培养来促进青少年的健康生活方式、信念、行为和最佳心理健康。这项研究符合美国国立卫生研究院的路线图和目标，即改善人们的健康，预防疾病和残疾的发生，并促进弱势群体的最高健康水平。 公共卫生相关性： 预防和治疗青春期肥胖和精神健康障碍是当今美国的两大公共卫生问题。为了应对与肥胖和心理健康问题相关的发病率增加和不良健康后果，将在高中健康课程中提供基于理论的15节干预计划，题为COPE(为个人赋权创造机会)/健康生活方式青少年(思维、感觉、情感和锻炼)，以改善800名不同文化背景的青少年(14至16岁)的身心健康结果。

DESCRIPTION (provided by applicant): The prevention and treatment of obesity and mental health disorders in adolescence are two major public health problems in the United States (U.S.) today. The incidence of adolescents who are overweight or obese has increased dramatically over the past 20 years, with approximately 17.1 percent of teens now being overweight or obese. Furthermore, approximately 15 million children and adolescents (25 percent) in the U.S. have a mental health problem that is interfering with their functioning at home or at school, but less than 25 percent of those affected receive any treatment for these disorders. The prevalence rates of obesity and mental health problems are even higher in Hispanic teens, with studies suggesting that the two conditions often coexist in many youth. However, despite the rapidly increasing incidence of these two public health problems with their related health disparities and adverse health outcomes, there has been a paucity of theory- based intervention studies conducted with adolescents in high schools to improve their healthy lifestyle behaviors as well as their physical and mental health outcomes. Unfortunately, physical and mental health services continue to be largely separated instead of integrated in the nation's healthcare system, which often leads to inadequate identification and treatment of these significant adolescent health problems. Therefore, the goal of the proposed randomized controlled trial is to test the efficacy of the COPE (Creating Opportunities for Personal Empowerment)/Healthy Lifestyles TEEN (Thinking, Feeling, Emotions & Exercise) Program, an educational and cognitive-behavioral skills building intervention guided by cognitive behavior theory, on the healthy lifestyle behaviors and depressive symptoms of 800 culturally diverse adolescents enrolled in Phoenix, Arizona high schools. The specific aims of the study are to: (1) Use a randomized controlled trial to test the short- and more long-term efficacy of the COPE TEEN Program on key outcomes, including healthy lifestyles behaviors, depressive symptoms and body mass index percentage, (2) Examine the role of cognitive beliefs and perceived difficulty in leading a healthy lifestyle in mediating the effects of COPE on healthy lifestyle behaviors and depressive symptoms; and (3) Explore variables that may moderate the effects of the intervention on healthy lifestyle behaviors and depressive symptoms, including race/ethnicity, gender, SES, acculturation, and parental healthy lifestyle beliefs and behaviors. Six prior pilot studies support the need for this full scale clinical trial and the use of cognitive-behavioral skills building in promoting healthy lifestyles beliefs, behaviors and optimal mental health in teens. This study is consistent with the NIH roadmap and goals of improving people's health and preventing the onset of disease and disability as well as promoting the highest level of health in a vulnerable population. PUBLIC HEALTH RELEVANCE: The prevention and treatment of obesity and mental health disorders in adolescence are two major public health problems in the United States today. To address the increasing incidence and adverse health outcomes associated with both obesity and mental health problems, a theory-based 15 session intervention program entitled COPE (Creating Opportunities for Personal Empowerment)/Healthy Lifestyles TEEN (Thinking, Feeling, Emotions & Exercise), will be delivered within high school health classes in order to improve the physical and mental health outcomes of 800 culturally diverse adolescents (14 to 16 years of age).