This proposal focuses on interventions to treat obesity and reduce BP in overweight/obese urban youth. Although childhood obesity is multi-factorial in origin with contributors at the child-family, school-community, and policy environments, few studies have targeted multiple environments and examined innovative behavioral interventions that may be beneficial to disadvantaged youth. This proposal addresses these deficits, focusing on lifestyle change through both child-family and school-community environments. It asks two main questions: (1) What is the differential impact on BMI and BP of three distinct psycho-educational interventions targeting the child-family environment? (2) Will an enriched school-community environment (echoing the interventions' messages and providing a venue for their implementation) influence the interventions' impact? Our target population is Cleveland Metropolitan School District students (6th-8th grade; n=450) recruited via an established screening program. Participants will be drawn from two school-community environments (enriched and non-enriched); 25 CMSD schools each. Enriched schools will participate in an innovative YMCA partnership to increase students' physical activity, and have supplemental nutrition education programs, social marketing, and navigators. Using a 3-group stratified randomized trial design, participants in each enriched and non-enriched school will be randomized into 3 intervention arms: 1) SystemCHANGE, a promising new behavioral approach focusing on system redesign of the family environment and daily routines (based on ecological and personal process improvement theory), 2) HealthyCHANGE, a behavioral approach focusing on building skills and increasing intrinsic motivation (based mainly on cognitive behavioral theory), and 3) education only (attention control). Following 6 months of intensive intervention and 6 months of boosters, subjects will be followed for another year. Primary outcomes will be BMI and BP z scores. Other cardiovascular risk indices, costs, and quality of life will also be assessed, as will potential mediators and moderators of the interventions' effects. This project incorporates several innovations and has the potential to establish a replicable system of aligned programs that have major impact on pediatric obesity.
Childhood obesity, often associated with elevated blood pressure, causes morbidity and may cause early death. Finding ways to effectively treat childhood obesity is therefore a top health priority. This research (a) assesses three behavioral approaches to treating obesity and reducing blood pressure in urban youth, and (b) examines the influence of the school-community environment on the interventions' impact.
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