School Nurse Intervention and After School Exercise Program for Overweight Teens

超重青少年的学校护士干预和课后锻炼计划

• 批准号: 8189550
• 负责人: LORI PBERT
• 金额: $ 26.12万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-18 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8189550
• 关键词: Address; Adherence; Adolescent; Adult; Age; Attention; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Body Weight Changes; Body Weight decreased; Body fat; Body mass index; Child; Childhood; Clinic; Computers; Consumption; Counseling; Effectiveness; Enrollment; Exercise; Health; Hour; Individual; Intervention; Link; Lipids; Low income; Mediating; Mental Depression; Mental Health; Modeling; Obesity; Outcome; Overweight; Pamphlets; Participant; Patient Self-Report; Physical activity; Physiological; Pilot Projects; Positioning Attribute; Protocols documentation; Public Health; Quality of life; Randomized; Recommendation; Recruitment Activity; Reporting; Research Infrastructure; Resources; School Nursing; Schools; Self Efficacy; Self Management; Series; Solutions; Structure; Students; Teenagers; Testing; Time; Translating; United States; United States National Institutes of Health; Visit; Weight; Youth; base; behavior change; clinically significant; combat; cost; cost effective; demographics; follow-up; high school; improved; innovation; insulin sensitivity; intervention effect; medical specialties; nursing intervention; physical conditioning; programs; psychosocial; randomized trial; secondary outcome; sedentary; sex; skills; systematic review; theories; waist circumference

DESCRIPTION (provided by applicant): Adolescent overweight and obesity are of great and increasing concern in the US. Although comprehensive moderate-to-high intensity behavioral programs produce short-term, modest weight reductions in youth, there are no models for practical implementation in readily-accessible settings to translate promising treatment approaches into practice. High schools are well-positioned to deliver such interventions. They have the facilities and staff to deliver a physical activity program, school nurses with the skills to address obesity, and easy access for adolescents. This application builds on a randomized trial (NIH R21HD053371) of a minimal- intensity, 6-session, school nurse-delivered counseling intervention that engaged adolescents and improved key self-reported weight-related behaviors. Having demonstrated feasibility of implementation and short term behavioral improvements from this modest intervention, we now propose an 8-month, expanded intervention that further leverages existing school-based resources to assess longer term behavioral effects as well as key health outcomes, including BMI. This moderate-intensity intervention includes a structured after-school exercise program delivered by school staff, weekly weigh-ins, and school nurse visits across the entire school year. We will test this higher intensity program's feasibility and ability to reduce BMI and to improve dietary quality, physical activity, and sedentary behaviors in overweight and obese adolescents. One in each of four matched pairs of high schools (8 schools in all) will be assigned to either: (1) Lookin' Good Feelin' Good (LGFG) program -- six 30-minute individual student-centered counseling sessions delivered by school nurses during the first two months followed by weekly weigh-ins and monthly visits over the subsequent 6 months, plus a school-based exercise program 3 times weekly for the full 8 months, or (2) Information attention-control (IC) comparison condition - six individual sessions with the school nurse over the first 2 months followed by monthly visits over the remaining 6 months to check weight and behavior changes and provide pamphlets on weight and weight management. We will recruit 136 adolescents (17/school) in grades 9 through 12 who are overweight or obese (>85th percentile for age/sex) and conduct baseline and 8-month assessments. Our primary aim is to determine the feasibility and efficacy of LGFG compared to IC in reducing BMI. Secondary aims include: determining the effect of the LGFG on adherence to behaviors that mediate BMI change (i.e., dietary quality, physical activity, sedentary behavior) and on secondary physiologic (waist circumference, body fat, blood pressure, lipids, and insulin sensitivity) and psychosocial (e.g., self-efficacy, quality of life, and depression) outcomes. Extending the intervention time-frame and adding an accessible exercise program to our previous, well-accepted program should enable us to achieve both statistically and clinically significant weight loss. This school-based weight management intervention, leveraging existing infrastructure in an accessible setting, has tremendous potential for wide-scale dissemination with significant public health impact. PUBLIC HEALTH RELEVANCE: Adolescent overweight and obesity have increased dramatically in the past several decades. High schools are well-positioned to deliver weight loss treatment to overweight and obese adolescents, as they have the facilities and staff to deliver a physical activity program, school nurses with the skills to provide counseling, and are easily accessible by adolescents. This exploratory study will test the feasibility and ability of a school- based intervention, consisting of school nurse counseling and a school-based exercise program, to reduce BMI and improve dietary quality, physical activity, and sedentary behaviors in overweight and obese adolescents. If effective, this could prove to be a cost-effective and relatively easy intervention to disseminate widely for significant public health impact.

描述（由申请人提供）：在美国，青少年超重和肥胖症的关注程度很大。尽管全面的中度到高强度行为计划会导致年轻人的短期，适度的体重减轻，但在易于访问的环境中没有实践实施的模型可以将有希望的治疗方法转化为实践。高中良好地提供了这样的干预措施。他们拥有提供体育锻炼计划的设施和工作人员，具有解决肥胖症技巧的学校护士，并为青少年提供便捷的访问。该申请基于一项最低强度，六阶段的，学校护士分配的咨询干预措施的随机试验（NIH R21HD053371），该干预措施与青少年参与并改善了关键的与自我报告的与体重相关的行为。在这种适度的干预中证明了实施和短期行为改善的可行性后，我们现在提出了8个月的扩展干预措施，进一步利用现有的基于学校的资源来评估长期行为效应以及包括BMI在内的关键健康结果。这种中等强度的干预包括整个学年由学校工作人员，每周称重和学校护士访问的结构化课后锻炼计划。我们将测试该更高强度计划的可行性和减少BMI并改善超重和肥胖青少年中饮食质量，体育锻炼和久坐行为的能力。四个匹配的高中（总共8所学校）中的每对中的每一部分都将分配给：（1）看待“良好的感觉”好（LGFG）计划 - 六个30分钟的学校以学生为中心的个人咨询课程护士在最初的两个月中，随后每周举行一次称重和每月访问，再加上每周3次基于学校的锻炼计划，或（2）信息注意力控制（IC）比较条件 - 在最初的两个月中，与学校护士进行了六次个人会议，然后在剩下的6个月内每月访问，以检查体重和行为的变化，并提供体重和体重管理的小册子。我们将在9至12年级的136名青少年（17个/学校）招募超重或肥胖（年龄/性别> 85％），并进行基线和8个月的评估。我们的主要目的是确定与降低BMI相比，LGFG的可行性和功效。次要目的包括：确定LGFG对介导BMI变化的行为（即饮食质量，体育锻炼，久坐行为）和次级生理学的影响（腰围，体内脂肪，血压，脂质和胰岛素敏感性）和社会心理（例如自我效能感，生活质量和抑郁症）的结果。将干预时间范围延长，并在我们以前的良好接受的计划中添加可访问的锻炼计划，这应该使我们能够在统计和临床上显着减肥。这种基于学校的体重管理干预措施利用现有的基础设施在可访问的环境中，具有巨大的广泛传播潜力，并具有重大的公共卫生影响。 公共卫生相关性：在过去的几十年中，青少年超重和肥胖症急剧增加。高中的位置良好，可以为超重和肥胖的青少年提供减肥治疗，因为他们拥有提供体育锻炼计划的设施和工作人员，具有提供咨询技能的学校护士，并且很容易被青少年接触。这项探索性研究将测试由学校护士咨询和基于学校的锻炼计划组成的学校干预措施的可行性和能力，以减少BMI并改善超重和肥胖青少年的饮食质量，体育锻炼以及久坐的行为。如果有效，这可能被证明是一项具有成本效益且相对容易的干预措施，可以广泛传播产生重大的公共卫生影响。