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: 8321012
• 负责人: LORI PBERT
• 金额: $ 20.78万
• 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 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8321012
• 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; Childhood; Clinic; Computers; Consumption; Counseling; Diet; 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; Weight maintenance regimen; 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; obesity in children; 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.

描述（由申请人提供）：青少年超重和肥胖在美国受到越来越多的关注。尽管全面的中等到高强度的行为计划可以在青少年中产生短期、适度的体重减轻，但目前还没有在易于接近的环境中实际实施的模型来将有希望的治疗方法转化为实践。高中有能力提供此类干预措施。他们拥有提供体育活动计划的设施和工作人员、拥有解决肥胖问题技能的学校护士以及方便青少年使用的设施。该应用程序建立在一项随机试验 (NIH R21HD053371) 的基础上，该试验涉及学校护士提供的最低强度、6 个疗程的咨询干预措施，该干预措施吸引了青少年并改善了自我报告的与体重相关的关键行为。在证明了这种适度干预措施的实施和短期行为改善的可行性后，我们现在提出一项为期 8 个月的扩大干预措施，进一步利用现有的学校资源来评估长期行为影响以及包括 BMI 在内的关键健康结果。这种中等强度的干预措施包括由学校工作人员提供的结构化课后锻炼计划、每周称重以及整个学年学校护士的拜访。我们将测试这一更高强度计划的可行性以及降低超重和肥胖青少年体重指数以及改善饮食质量、身体活动和久坐行为的能力。四对匹配的高中（总共 8 所学校）中的每一个将被分配到以下任一学校： (1) Lookin' Good Feelin' Good (LGFG) 计划——由学校提供的六次 30 分钟的以学生为中心的个人咨询课程前两个月由护士进行，随后在接下来的 6 个月内每周称重和每月访视，加上在整个 8 个月内每周 3 次的校内锻炼计划，或 (2) 信息注意力控制 (IC) 比较条件- 六次单独的会议学校护士在前 2 个月内对学校护士进行检查，然后在剩下的 6 个月内每月进行一次访问，以检查体重和行为变化，并提供有关体重和体重管理的小册子。我们将招募 136 名 9 至 12 年级超重或肥胖（年龄/性别 > 85%）的青少年（每学校 17 名）进行基线评估和 8 个月评估。我们的主要目的是确定 LGFG 与 IC 相比在降低 BMI 方面的可行性和功效。次要目标包括：确定 LGFG 对介导 BMI 变化的行为（即饮食质量、体力活动、久坐行为）和次要生理（腰围、体脂、血压、血脂和胰岛素敏感性）的依从性的影响和心理社会（例如自我效能、生活质量和抑郁）结果。延长干预时间并在我们之前广为接受的计划中添加一个易于接受的锻炼计划应该能够使我们实现统计上和临床上显着的减肥效果。这种以学校为基础的体重管理干预措施利用现有基础设施和便利的环境，具有大规模传播的巨大潜力，对公共卫生产生重大影响。