During the past 4 years, this project has examined the aggregation of cardiovascular disease risk factors among adolescents having either elevated or normal blood pressure (BP). It was found that adolescents with elevated BP had greater body mass, a poorer lipid profile, elevated blood glucose, decreased insulin sensitivity, and increased left ventricular mass (LVM). In preliminary studies we have provided evidence that a program involving stress management, diet and exercise counseling can reduce body weight, enhance physical activity, and lower BP. The purpose of the competitive project renewal is to examine the long-term effects of 3 intervention conditions: 1) a 3 month self-management intervention program partially completed as part of the currently funded supplement; 2) a 6 month augmented self-management skill acquisition intervention program; 3) and usual care. The self-management interventions are designed to increase physical activity, improve nutrition, and enhance stress management. The study has three primary objectives: 1) to determine the impact of the interventions on lifestyle behaviors, cardiovascular risk factors, and preclinical disease states as indexed by LVM, endothelial function, and carotid intima medial thickness; 2) to examine the maintenance of behavior change and treatment effects across conditions; and 3) to determine what factors are associated with maintenance. Adolescents withth persistently elevated BP at or above the 90 percentile adjusted for age, gender, and height will be randomized to one of three intervention conditions after the pretreatment assessments. The 3 conditions vary in level of demand. The 3 month self-management condition involves 10 group sessions plus some parental involvement. The augmented self-management condition involves 12 group and 6 individual sessions over 6 months with active parental involvement. Both self-management interventions will be followed by 6 monthly maintenance phone calls. Usual care involves one session in which the participants are provided with a participant workbook (summarizing the content and recommendations of the self-management intervention) and are asked to follow the suggestions. Participants in the 3 month self-management condition and the usual care condition will be reassessed at post-treatment (corresponding to 3 months post randomization), at 3 month follow-up, and at 6 months post treatment. Similarly, participants in the augmented self-management condition will repeat assessments following 3 months and 6 months of treatment and at 3 and 6 months post treatment. This design permits examination of treatment effects, and both short-term and long-term maintenance.
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