Reducing Obesity & Diabetes in High Risk Youth

描述（由申请人提供）： 本申请涉及广泛的挑战领域（05），比较有效性研究和特定的挑战主题，05-MD-102，预防慢性疾病的差异人口。基于我们先前对1型糖尿病（T1 D）青少年和2型糖尿病（T2 D）高危少数群体青少年的研究，我们建议开发和评估两种创新和互动的基于网络的高中教育计划的比较有效性，旨在减少肥胖和高危青少年人群中的T2 D风险。目的是：1.修改为减少少数族裔青少年肥胖和T2 D风险而开发的基于课堂的教育和应对技能培训（CST）干预措施（Tween”），以及与青少年、家长、高中教师合作为T1 D青少年开发的互联网CST计划（TeenCope”）我们的信息技术（IT）团队和我们的研究团队。这一修改过程的结果将是两个互动的基于网络的高中教育计划。一个方案将是关于健康饮食和体育活动的综合心理教育课程，以预防肥胖和T2 D（健康-e-teen），另一个方案将提供相同的心理教育课程加上CST部分（健康-e-teen + CST）。2.对与在课堂环境中向高中生提供互联网课程相关的所有流程和程序进行试点测试。3.比较健康e-teen计划和健康e-teen + CST计划对高中生BMI、营养和体育活动行为以及自我效能的影响。还将比较使用情况、满意度和成本。在与西黑文和2纽黑文高中，以及我们建立的IT和研究团队合作，我们将使用相同的方法，我们用来成功地翻译我们的人CST程序与T1 D青少年到互联网上，现在正在测试一个大型临床试验。这一方法将是反复和参与性的，包括在设计、开发和评估阶段的目标用户，以开发两个互动的互联网方案（健康-青少年;健康-青少年+国家技术服务小组）。这些计划将建立在“整个课程的阅读和写作”的倡议，符合当前的教育优先事项。开发完成后，将评估项目交付的可行性，并在第一年年底前完成对项目或流程的最终修订。在第二年，将在西黑文和纽黑文公立高中进行随机比较有效性试验。该计划将在该项目的第二年秋季提供。所有10年级的青少年都有资格参加。这些学校的人口是50%的西班牙裔，58%的非洲裔美国人，40%的白色，和6%的其他。纳入标准包括在适当班级的学生，他们有父母的许可参加。将不排除任何青年参加，因此可能有将近900人参加。将在基线、3个月和6个月时在线收集健康行为、体重和身高数据，以计算BMI、自我效能和满意度。将在整个过程中收集使用和成本数据。分析将包括混合模型ANCOVA，按体重状态分层（BMI <85 th % ile，BMI > 85 th % ile）。这种方法将使我们能够在学校提供一个关键主题的标准课程-健康教育和行为支持，以促进健康饮食和体育活动-以互动的形式吸引青少年。该计划将允许在高风险的少数群体中进行肥胖和T2 D的一级和二级预防。虽然这一人群面临着许多障碍和挑战，包括互联网接入有限，健康素养差，以及肥胖环境，但我们的方法将使我们能够通过学校接触大量青年，在低健康素养水平下提供急需的教育，通过创新地使用媒体和技术，并为青少年提供克服环境挑战和改变行为的技能。此外，我们提出了一个比较有效的试验两个心理教育计划，一个与CST和一个没有CST。通过互联网提供这些程序允许干预提供标准化，这对比较有效性研究很重要，但在行为研究中往往具有挑战性。最重要的是，由于我们与学校的持续关系以及我们在为T1 D青少年开发基于互联网的项目方面的经验，我们可以克服青少年肥胖和T2 D挑战性问题的无数障碍，并成功开发和评估两个创新和互动的互联网项目。肥胖症和2型糖尿病在青年中的流行率以惊人的速度增加。在少数民族社区，这一比例高达近30%。要减少这一流行病，就必须采取对青年有吸引力并能以具有成本效益的方式实施的办法。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05), Comparative Effectiveness Research and Specific Challenge Topic, 05-MD-102, Prevention of Chronic Diseases in Disparity Populations. Building on our previous research in teens with type 1 diabetes (T1D) and in minority teens at high-risk for type 2 diabetes (T2D), we propose to develop and evaluate the comparative effectiveness of two innovative and interactive web-based high school educational programs aimed at reducing obesity and risk for T2D in a population of high risk teens. The aims are to: 1. Modify a classroom-based educational and coping skills training (CST) intervention developed to reduce obesity and T2D risk in minority teens (Tween") and an internet CST program developed for youth with T1D (TeenCope") collaboratively with teens, parents, high school teachers, our Information Technology (IT) team, and our research team. The outcome of this modification process will be two interactive web-based high school educational programs. One program will be a comprehensive psychoeducational curriculum on healthy eating and physical activity to prevent obesity and T2D (health-e-teen) and the other will provide the same psychoeducational curriculum plus a CST component (health-e-teen + CST). 2. Conduct a pilot test of all processes and procedures associated with delivering the internet programs in a classroom setting to high school students. 3. Compare the effect of the health-e-teen program and the health-e-teen + CST program delivered to high school students on BMI, nutrition and physical activity behaviors, and self-efficacy over 6 months. Usage, satisfaction, and costs will also be compared. In collaboration with the West Haven and 2 New Haven high schools, and our established IT and research team, we will use the same approach we used to successfully translate our in-person CST program for teens with T1D to the internet, now being tested in a large clinical trial. This approach will be iterative and participatory, including the targeted users in the design, development, and evaluation phases to develop two interactive internet programs (health-e-teen; health-e-teen + CST). These programs will build on the 'reading and writing across the curriculum' initiatives that fit with current educational priorities. Following development, the feasibility of program delivery will be evaluated and final revisions to the programs or the processes will be completed by the end of year 1. In the second year, a randomized comparative effectiveness trial will be undertaken in the West Haven and New Haven public high schools. The program will be offered in the fall of the second year of the project. All youth in the 10th grade will be eligible to participate. The population of these schools is 50% Hispanic, 58% African American, 40% White, and 6% other. Inclusion criteria include pupils in the appropriate classes who have parental permission to participate. No youth will be excluded from participation, yielding a potential sample size of nearly 900. Data on health behaviors, weight and height to calculate BMI, self efficacy, and satisfaction will be collected online at baseline, 3, and 6 months. Usage and cost data will be collected throughout. Analyses will include mixed model ANCOVA, stratifying by weight status (BMI < 85th %'ile, BMI > 85th%'ile). This approach will allow us to provide a standard curriculum in the schools on a critical topic - health education and behavioral support to promote healthy eating and physical activity - in an interactive format that is appealing to teens. The program will allow for primary and secondary prevention of obesity and T2D in a high risk, minority population. While there are a number of barriers and challenges for this population, including limited internet access, poor health literacy, and the obesogenic environment, our approach will allow us to reach a large number of youth through the schools, provide much needed education at a low health literacy level, engage teens in the content by using media and technology innovatively, and provide teens with the skills to overcome environmental challenges and change behavior. In addition, we propose a comparative effectiveness trial of two psychoeducational programs, one with CST and one without CST. Delivery of these programs over the internet allows for standardization of intervention delivery, which is important to comparative effectiveness research, yet often challenging in behavioral research. Most importantly, because of our ongoing relationship with the schools and our experience in developing an engaging internet-based program for teens with T1D, we can overcome myriad barriers to the challenging problem of obesity and T2D in youth and be successful in the development and evaluation of two innovative and interactive internet programs. Public Health Relevance Obesity and type 2 diabetes have increased in prevalence among youth at an alarming rate. In minority communities, the rates are as high as nearly 30%. Approaches that are appealing to youth and that can be cost-effectively delivered are necessary to reduce this epidemic.