The COPE Healthy Lifestyles TEEN program: feasibility, preliminary efficacy, & lessons learned from an after school group intervention with overweight adolescents

The evidence-based COPE program: Reducing the time between diagnosing and treating depression and anxiety in youth

ABSTRACT

The soaring prevalence of depression and anxiety in children, teenagers, and young adults is now a public health epidemic, yet access to timely evidence-based mental health treatment is often lacking due to a severe shortage of mental health providers. This article provides an overview of the current state of depression and anxiety in children and adolescents as well as first-line evidence-based treatment. The Creating Opportunities for Personal Empowerment (COPE) program, a cognitive-behavioral skills-building intervention, is highlighted as an evidence-based intervention for timely treatment that can be delivered by NPs, physicians, and physician associates/assistants in primary care settings, school-based health centers, and chronic care clinics with reimbursement as well as in schools and universities as a preventive mental health intervention.

Effects of 8-week alkaline diet and aerobic exercise on body composition, aerobic performance, and lipid profiles in sedentary women

Background

Diet composition can affect systemic pH and acid-base regulation, which may in turn influence exercise performance.

Purpose

It was aimed to determine the effects of the alkaline diet and 8 weeks of aerobic exercises on body composition, aerobic performance, and blood lipid profiles in sedentary women.

Methods

Thirty-two sedentary women participated in the study voluntarily. The research was designed with a true-experimental design and the participants were divided into four different groups as the control group, aerobic exercise group, alkaline diet group, and alkaline diet + aerobic exercise group. The body compositions, aerobic exercise performances, and lipid profiles of sedentary women were measured as pre-test and post-test. In the analysis of the obtained data, One-Way ANOVA with Bonferroni post hoc test was used.

Results

It was observed that the alkaline diet consumed with 8 weeks of aerobic exercises caused a 5.17% decrease in BMI and an increase of 42.07 and 37.62% in VO2max and aerobic test durations, respectively (p < 0.05). In addition, when lipid profiles were examined, it was determined that there was no statistically significant difference in HDL-C levels (p > 0.05). Despite that, there were statistically significant differences in TG and LDL-C levels (p < 0.05). According to this result, it was determined that there was a decrease in TG and LDL-C levels by 37.61 and 20.24%, respectively.

Conclusion

An alkaline diet consumed with 8 weeks of aerobic exercises in sedentary women has positive effects on improving body composition, aerobic exercise performances, and TG and LDL-C levels.

Resilience and Mental Health in the Polish Population during the COVID-19 Lockdown: A Mediation Analysis

The aim of this paper was to assess the state of resilience and well-being in the Polish population during the COVID-19 pandemic. We also assessed the relationship between resilience and mental health. Finally, we tested the mediating role of COVID-19 anxiety, persistent thinking, and the stress burden in the relationship between mental health and resilience. This research perspective can provide important insights into how individuals can become mentally stronger during the COVID-19 pandemic.

METHODS

This study included 1758 people (73% women) aged 18-80 years. The procedure consisted of completing a questionnaire measuring well-being, COVID-19 anxiety, obsession with COVID-19, stress over COVID-19, and resilience.

RESULTS

Bootstrap sampling analysis showed significant partial mediators for the relationship between resilience and well-being. Important mediators were coronavirus anxiety, persistent thinking, and perceived stress.

CONCLUSIONS

The results of the present study clearly indicate that resilience as a protective factor is associated with reduced anxiety about COVID-19, perceived stress burden, obsessive thoughts about the pandemic, and increased well-being of individuals. Resilience plays an important role in minimizing negative and enhancing positive health indicators in the face of challenging life events.

Mindful BALANCE (breathe act learn about 'now' care everyday): A pilot project for depressed female adolescents

PROBLEM

Major depressive episodes in adolescent females have increased during the past decade, placing them at risk to engage in unhealthy lifestyle behaviors, unsafe thoughts, suicidal ideation, and lethal actions. Mindfulness, a tool for stress management, is underutilized.

METHODS

Mindful BALANCE (Breathe Act Learn About 'Now' Care Everyday), a group therapy pilot program introduced a variety of mindfulness activities. The extended mindfulness followed the Creating Opportunities for Personal Empowerment (COPE), a Cognitive Behavioral Therapy Skills Building (CBSB) Healthy Lifestyle program. The pilot program was offered in an outpatient mental health department for 7 weeks.

FINDINGS

Mindful BALANCE is a feasible program as an adjunct to individualized psychotherapy. Six subjects engaged without absence with a completion rate of 83%. Six subjects had pre- and post-scores for depression and anxiety decrease. Mindfulness practice was reported to decrease the perception of stress.

CONCLUSION

Mindful BALANCE decreased perceived depression and anxiety symptoms while positively impacting healthy activities in adolescent females. Further research is necessary to readdress feasibility and extended mindfulness components in improving global well-being and diminishing suicide risk.

Executive Function Training in Childhood Obesity: Food Choice, Quality of Life, and Brain Connectivity (TOuCH): A Randomized Control Trial Protocol

Background: Individuals with obesity are known to present cognitive deficits, especially in executive functions. Executive functions play an important role in health and success throughout the whole life and have been related to food decision-making and to the ability to maintain energy balance. It is possible to improve executive functions through targeted training. This would involve brain plasticity changes that could be studied through connectivity MRI. The general hypothesis of this study is that executive functions training in children with obesity can improve food choices and produce cognitive and neuroimaging changes (structural and functional connectivity), as well as improve emotional state and quality of life. Methods: Randomized controlled double-blind trial with 12-month follow-up. Thirty children with obesity will be randomly allocated into "executive training" (Cognifit with adaptive difficulty + Cogmed) or "control task" group (Cognifit without adaptive difficulty). Both groups will attend 30-45 min of individual gamified training (Cogmed and/or Cognifit systems) by iPad, five times per week during 6 weeks. Cogmed and Cognifit software are commercially available from Pearson and Cognifit, respectively. Participants will receive an iPad with both apps installed for a 6-week use. Participants will also receive counseling diet information via presentations sent to the iPad and will wear a Fitbit Flex 2 tracker to monitor daily activity and sleep patterns. Main outcomes will be cognitive, emotional, food decision, and quality-of-life measures, as well as neuroimaging measures. Participants are evaluated at baseline (T0), after treatment (T1), and 12 months since baseline (T2). Discussion: Longitudinal study with active control group and 3 time points: baseline, immediately after treatment, and 1 year after baseline. Threefold treatment: executive function training, psychoeducation, and feedback on activity/sleep tracking. We will evaluate the transfer effects of the intervention, including emotional and functional outcomes, as well as the effects on neural plasticity by connectivity MRI. Trial registration: This project has been registered in ClinicalTrials.gov (trial registration number NCT03615274), August 3, 2018.

Exercise Dose and Weight Loss in Adolescents with Overweight-Obesity: A Meta-Regression

BACKGROUND

A recent meta-analysis reported that exercise interventions are effective for promoting weight loss in adolescents with overweight-obesity. However, the meta-analysis did not investigate whether there is an optimal exercise dose for promoting weight loss in overweight and obese adolescents. A common method of expressing exercise dose is the calculation of metabolic equivalents (METs), expressed as MET-h/week.

OBJECTIVES

The objective of this study was to determine the association between exercise dose (MET-h/week) and weight loss [body weight, body mass index (BMI)] in adolescents with overweight-obesity.

DATA SOURCES

Trials included in the original meta-analysis were extracted, and a subsequent search to identify studies published between May 2015 and May 2018 was conducted. The search included electronic databases (PubMed, Web of Science SPORTDiscus, Google Scholar) and the reference lists of eligible articles and relevant reviews.

STUDY SELECTION

The inclusion criteria were as follows: (i) randomized controlled trial; (ii) structured exercise intervention, alone or combined with other intervention components; (iii) control group received no structured exercise or behavioral modification designed to increase physical activity; (iv) participants overweight or obese (BMI ≥ 85th percentile); and (v) participants aged between 10 and 19 years.

APPRAISAL AND SYNTHESIS METHODS

Fifteen trials were extracted from the original meta-analysis. The current search identified an additional five trials (three articles). Data from 20 trials (16 articles) involving 1091 participants (54% female, 17% not reported) were included in the analysis. Effect sizes were reported as mean difference, and random effects meta-regression quantified the association between exercise dose and weight loss. Study quality was assessed using a modified Jadad's scale.

RESULTS

Total body weight change (decrease) ranged from - 2.7 to 19.3 (median 2.5) kg, and BMI change (decrease) ranged from - 1.6 to 6.3 (median 0.9) kg/m². MET-h/week ranged from 5.4 to 36.0 (median 6.0). Each MET-h/week was associated with a 0.13 kg/m² (95% confidence interval [CI] 0.08-0.19) and 0.33 kg (95% CI 0.08-0.59) decrease in BMI and body weight, respectively.

LIMITATIONS

The prescribed exercise dose for the majority of trials was low. As such, we were unable to discern whether there was an optimal exercise dose for weight loss (i.e., if the association between dose and weight loss was non-linear). Additionally, most trials had small sample sizes (median n = 34) and 17 trials had methodological limitations.

CONCLUSIONS

Each MET-h/week was associated with a 0.13 kg/m² and 0.33 kg decrease in BMI and body weight, respectively. While this relationship appears to be linear, i.e., no optimal exercise dose, it should be emphasized that the exercise prescription dose for the majority of trials was low. Subsequent trials, with greater exercise dosage, are required to determine whether there is an 'optimal' dose for promoting weight loss in adolescents with overweight-obesity. However, the current findings lend support to the use of exercise prescription for promoting weight loss and improving health outcomes in this population.

Effectiveness of a school-based intervention on knowledge, attitude and practice on healthy lifestyle and body composition in Malaysian adolescents

Background

The ‘Eat Right, Be Positive About Your Body and Live Actively’ (EPaL) intervention programme was developed to prevent overweight and disordered eating in Malaysian adolescents. This study aimed to evaluate the effectiveness of the EPaL programme on knowledge, attitudes and practices on healthy lifestyle and body composition (body mass index z-score [zBMI], waist circumference [WC] and body fat percentage [BF%]) among adolescents.

Methods

All measures were taken at three time points: before intervention (Pre), after intervention (Post I) and 3 months after intervention (Post II). The intervention group (IG) participated in the EPaL programme for 16 weeks, whereas the comparison group (CG) received no intervention. Seventy-six adolescents (IG: n = 34; CG: n = 42) aged 13–14 years were included in the final analysis. Repeated measures analysis of covariance (ANCOVA) was used to assess the impact of the EPaL intervention programme on the measures between groups (IG and CG) at Post I and Post II.

Results

The IG reported significantly higher knowledge scores at both Post I (adjusted mean difference = 3.34; 95% confidence interval [CI] = 0.99, 5.69; p = 0.006) and Post II (adjusted mean difference = 2.82; 95% CI = 0.86, 4.78; p = 0.005) compared with the CG. No significant differences between the IG and CG were found at either Post I or Post II in attitudes, practices, zBMI, WC and BF%. The proportion of participants who were overweight or obese was consistent from Pre to Post II in the IG (35.3%) and increased from 26.2% at Pre to 28.5% at Post II in the CG, but the difference was not statistically significant. The proportion of participants who had abdominal obesity in the IG decreased from 17.6% at Pre to 14.7% at Post II and increased from 16.7% at Pre to 21.4% at Post II in the CG, but the differences were not statistically significant.

Conclusion

Despite no significant reduction of body composition, this programme shows the positive effect on the adolescents’ knowledge regarding healthy lifestyle. This study contributes to the evidence on the effectiveness of school-based health interventions in Malaysian adolescents.

Trial registration

UMIN Clinical Trial Registration UMIN000024349. Registered 11 October 2016.

Online intervention to reduce pediatric anxiety: An evidence-based review

TOPIC

Online intervention for school-age youth suffering from symptoms of generalized anxiety disorder.

PURPOSE

A review of the evidence was conducted to examine the effects of nonpharmacological interventions available online for a reduction of symptoms of generalized anxiety disorder in school-age youth.

SOURCES USED

The search strategy included the databases of Pubmed, PsychINFO, CINAHL, Cochrane Systematic Reviews, and Cochrane Clinical Trials, and Evidence-Based Reviews. A combination of search terms was used to identify studies with database-specific truncations: "Child* and youth* anxiety screen and intervention" AND "meta-analysis", "child anxiety" AND "systematic review", "child anxiety and personal empowerment and SR", "SCARED*", "COPE", and "SCARED* and SR". Studies published between 2007 and 2017 were included for this review. Twenty studies met criteria and represented level one or two using Melnyk and Fineout-Overholt, Level of Evidence Rating System for intervention inquiries.

CONCLUSION

Positive outcomes of improved physiological, social, and cognitive development are supported in the studies using cognitive behavior therapy such as the Creating Opportunities for Personal Empowerment (COPE) program. The COPE-online program is a cost-effective strategy to complements models used for early screening and timely interventions for school-age youth who struggle with symptoms of generalized anxiety disorder.

Impact of the Out-of-School Nutrition and Physical Activity (OSNAP) Group Randomized Controlled Trial on Children's Food, Beverage, and Calorie Consumption among Snacks Served

BACKGROUND

Afterschool interventions have been found to improve the nutritional quality of snacks served. However, there is limited evidence on how these interventions affect children's snacking behaviors.

OBJECTIVE

Our aim was to determine the impact of an afterschool intervention focused at the school district, site, family, and child levels on dietary consumption of foods and beverages served at snack.

DESIGN

This was a secondary analysis of a group-randomized controlled trial.

PARTICIPANTS/SETTING

Data were collected from 400 children at 20 afterschool sites in Boston, MA before (fall 2010) and after (spring 2011) intervention implementation.

INTERVENTION

The Out-of-School Nutrition and Physical Activity intervention aimed to promote fruits, vegetables, whole grains, and water, while limiting sugary drinks and trans fats. Researchers worked with district foodservice staff to change snack foods and beverages. Teams of afterschool staff participated in three 3-hour learning collaborative sessions to build skills and created action plans for changing site practices. The intervention included family and child nutrition education.

MAIN OUTCOME MEASURES

Research assistants observed dietary snack consumption using a validated measure on 2 days per site at baseline and follow-up.

STATISTICAL ANALYSES PERFORMED

This study used multivariable regression models, accounting for clustering of observations, to assess the intervention effect, and conducted post-hoc stratified analyses by foodservice type.

RESULTS

Children in intervention sites had greater decreases in consumption of juice (-0.61 oz/snack, 95% CI -1.11 to -0.12), beverage calories (-29.1 kcal/snack, 95% CI -40.2 to 18.0), foods with trans fats (-0.12 servings/snack, 95% CI -0.19 to -0.04), total calories (-47.7 kcal/snack, 95% CI -68.2 to -27.2), and increases in consumption of whole grains (0.10 servings/snack, 95% CI 0.02 to 0.18) compared to controls. In post-hoc analyses, sites with on-site foodservice had significant improvements for all outcomes (P<0.001), with no effect for sites with satellite foodservice.

CONCLUSIONS

Results demonstrate that an afterschool intervention can improve children's dietary snack consumption, particularly at sites with on-site foodservice.

Turkish Psychometric Properties of the Predictor Scales Affecting Adolescent Obesity

Adolescent obesity is one of the most important public health problems today. Identifying factors that affect obesity in adolescents and developing programs to prevent obesity are very important. This research aims to test Turkish psychometric properties of the scales to predict adolescent obesity (Healthy Lifestyle Choices Scale, Perceived Healthy Lifestyle Difficulty Scale, Activity Knowledge Scale, Nutrition Knowledge Scale, Healthy Lifestyle Attitude Scale, Healthy Lifestyle Belief Scale). The psychometric properties of the Scales were tested test-re-test reliability, the Cronbach's alpha coefficient, the item-total correlation, and the Confirmatory Factor Analysis. The relationship between the Scales was measured using the Spearman's correlation analysis. The level of internal consistency of the scales to predict adolescent obesity was found good. The goodness of fit values of the Belief Scale were measured as significantly high (χ2 = 177.24, df = 0.99, χ2/df = 1.79 (p < .001), Comparative Fit Index = 0.91, Goodness of Fit Index = 0.91, Normed Fit Index = 0.92, Incremental Fit Index = 0.92, Root Mean Square Residual = 0.05, Root Mean Square Error of Approximation Residual = 0.05). The psychometric analyses of the Scales were found to be very similar to the results of the original scales. There was a positive correlation between the Choice, Attitude, Belief, Nutrition and Activity Knowledge Scale, and a negative correlation with the Perceived Difficulty scale. The scales which measure adolescent obesity were accepted as valid and reliable measuring tools. This study will be an important resource for researchers working on the adolescent health and obesity.

Interventions for preventing obesity in children

EDITORIAL NOTE

This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024.

BACKGROUND

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review.

OBJECTIVES

To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI.

MAIN RESULTS

We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update.

AUTHORS' CONCLUSIONS

Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.

Effectiveness of School-based Health Center Delivery of a Cognitive Skills Building Intervention in Young, Rural Adolescents: Potential Applications for Addiction and Mood

PURPOSE

Uniquely positioned, school nurses address two of the most critical adolescent health issues - addiction and mood. Cognitive behavioral therapy, the mainstay in management of adolescent mood disorders, demonstrates promise in the treatment and prevention of addictive behaviors. Quality decision-making may protect adolescents from substance abuse. Executive function, a neurocognitive aspect of decision-making, involves impulse control, future thinking, and behavioral regulation. Further, the continuum of addition implicates executive function, which makes executive function a viable target for prevention and treatment of substance use. This pilot study examined the effectiveness of a nurse-led cognitive skills training intervention, Creating Opportunities for Personal Empowerment, on executive function and mood in a novel population and setting.

DESIGN AND METHODS

The study sample included adolescents ranging in age from 12 to 15 years and enrolled in a rural school-based health center. Fifteen (n = 15) adolescents completed the seven-week cognitive skills building intervention led by a nurse practitioner. Researchers measured executive function, anxiety, and depression at: baseline, after the intervention series, and three-months later.

RESULTS

One domain of executive function - behavioral regulation - improved, as did anxiety. Depression showed short-term improvement. Metacognition did not change over time.

CONCLUSIONS

Preliminary results indicate that cognitive skills building delivered by school nurses may enhance aspects of executive function linked with addiction and coping, such as behavioral regulation. Further, this intervention may also improve mood in this population.

PRACTICE IMPLICATIONS

Delivery of cognitive skills training by school nurses could be an accessible, effective piece in addressing addiction and mood in young, rural adolescents.

The effects of wellness coaching on the wellness and health behaviors of early adolescents

OBJECTIVE

This study evaluated the impact of a wellness coaching program on the health behaviors of eighth-grade students.

DESIGN AND SAMPLE

The study population comprised 132 adolescents (Wellness Coaching Group n = 33, Health Education Group n = 33, Control Group n = 66).

METHODS

A pretest/posttest randomized controlled study was used. Students completed a demographic information form, the Five-Factor Wellness Scale-Adolescent Form (5F-Wellness-AF) and the Adolescent Lifestyle Scale (ALPS). The wellness coaching program of group education, individual consulting, physical activity, and health education was provided for 12 weeks.

RESULTS

The data indicated a significant difference in the total 5F-Wellness-AF and ALPS scores after the program. No statistically significant difference was observed in the total scores of the two scales for the Health Education Group, while the Control Group's 5F-Wellness-AF mean score declined after the intervention. At the beginning of the study, 15.2% of students in the wellness coaching program were overweight; this percentage decreased to 9.1% at the end of the study.

CONCLUSIONS

This wellness coaching program significantly increased the wellness of adolescents and improved their healthy lifestyle behaviors. This program can be used together with health education provided by a public health nurse.

Viewpoints of adolescents with overweight and obesity attending lifestyle obesity treatment interventions: a qualitative systematic review

BACKGROUND

Current UK guidance recommends that adolescents with obesity attend a family-based multi-component obesity intervention. However, these programmes suffer from low recruitment and high rates of attrition. Understanding the views of adolescents is necessary for developing future interventions. The aim of this systematic review was to synthesize and explore the views of adolescents who have attended an obesity intervention.

METHODS

Published literature was identified by searching six databases. Studies of adolescents (12-17 years) who attended an obesity intervention were examined. Only studies that collected and analysed data qualitatively were included. Full texts were analysed using thematic synthesis.

RESULTS

Twenty-eight studies were included. Thirty-five analytical themes were developed that were broadly divided into seven domains. Key themes included ensuring adolescents receive a 'tailored intervention' that involves 'active engagement'. Support from professionals, family and peers were valued highly. Adolescents expressed 'prior fears of attending interventions' and wanted 'longer term support'. 'Enjoyment of sport and physical activity' was evident, and adolescents were strongly motivated by improving body image and social desirability.

DISCUSSION

Considering the views of adolescents attending obesity interventions may help to inform policy makers in the development of future interventions. This may lead to an improvement in recruitment and attrition rates.

Efficacy of Exercise Intervention for Weight Loss in Overweight and Obese Adolescents: Meta-Analysis and Implications

BACKGROUND

The global rise in obesity prevalence among children and adolescents has been linked to modifiable lifestyle factors, including lack of physical activity. However, no known meta-analysis has been conducted on the effects of exercise intervention on body composition and cardiometabolic risk factors in overweight and obese adolescents.

OBJECTIVES

The aim of this study was to (1) estimate whether exercise intervention meaningfully improves body composition and cardiometabolic risk factors in overweight and obese adolescents; and (2) discuss the implications of the findings in terms of primary healthcare provision and public health policy, using New Zealand as an exemplar context.

DATA SOURCES

Electronic databases (PubMed, Web of Science, SPORTDiscus, Google Scholar) from inception to May 2015. The reference lists of eligible articles and relevant reviews were also checked.

STUDY SELECTION

Inclusion criteria were (1) randomized controlled trial; (2) structured exercise intervention, alone or combined with any other kind of intervention; (3) control group received no structured exercise or behavioural modification designed to increase physical activity; (4) participants overweight or obese (body mass index [BMI] ≥85th percentile); and (5) participants aged between 10 and 19 years.

APPRAISAL AND SYNTHESIS METHODS

Initially, 1667 articles were identified. After evaluation of study characteristics, quality and validity, data from 13 articles (15 trials) involving 556 participants (176 male, 193 female, 187 unknown) were extracted for meta-analysis. Meta-analyses were completed on five body composition parameters and ten cardiometabolic parameters. Effect sizes (ESs) were calculated as mean differences, as well as standardized mean differences in order to determine effect magnitude.

RESULTS

Exercise intervention reduced BMI (mean 2.0 kg/m², 95 % CI 1.5-2.5; ES moderate), body weight (mean 3.7 kg, 95 % CI 1.7-5.8; ES small), body fat percentage (3.1 %, 95 % CI 2.2-4.1; ES small), waist circumference (3.0 cm, 95 % CI 1.3-4.8; ES small), but the increase (improvement) in lean mass was trivial (mean 1.6 kg, 95 % CI 0.5-2.6). The response to an oral glucose tolerance test following exercise intervention was for a decrease in the area under the curve for insulin (mean 162 μU/μl, 95 % CI 93-231; ES large) and blood glucose (mean 39 mg/dl, 95 % CI 9.4-69; ES moderate). Improvements in the homeostatic model assessment were also noted (mean 1.0, 95 % CI 0.7-1.4; ES moderate) and systolic blood pressure (mean 7.1 mmHg, 95 % CI 3.5-10.7; ES moderate). The effects of exercise on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting insulin and fasting blood glucose were inconclusive.

LIMITATIONS

Most of the included trials were short term (6-36 weeks) and 13 had methodological limitations. Additionally, the meta-analyses for some of the secondary outcomes had a small number of participants or substantial statistical heterogeneity.

CONCLUSIONS

The current evidence suggests that exercise intervention in overweight and obese adolescents improves body composition, particularly by lowering body fat. The limited available evidence further indicates that exercise intervention may improve some cardiometabolic risk factors.

Recruitment and retention strategies for an urban adolescent study: Lessons learned from a multi-center study of community-based asthma self-management intervention for adolescents

Intervention studies with urban adolescents and families affected by asthma are critical to improving the disproportionate morbidity in this population. Community-based recruitment and retention strategies in a multi-site longitudinal project evaluating an asthma self-management intervention for adolescents are presented. Successful recruitment strategies depended on the geographic and cultural characteristics of each study site. Partnering with providers and groups known to the target population and in-person contact with target population were found effective. Flexibility accommodating modified and new approaches, securing multiple contacts and repeating mailings as well as capitalizing on the benefits of subject payment was critical to achieving long-term subject engagement of 85% in the study. Ongoing monitoring and adjustment of recruitment and retention strategies is recommended.

A Successful Model for Clinical Training in Child/Adolescent Cognitive Behavior Therapy for Graduate Psychiatric Advanced Practice Nursing Students

BACKGROUND

Graduate faculty in advanced practice nursing programs seek to provide clinical training in psychotherapy for psychiatric mental health nurse practitioner (PMHNP) students and prepare them for practice with patients across the lifespan, including children and adolescents.

OBJECTIVE

To develop a clinical training model for child/adolescent cognitive behavior therapy (CBT) that is adaptable to all graduate nursing programs including online, classroom, and blended programs.

DESIGN

Clinical training included a didactic 4-hour workshop and 7 small group practice sessions utilizing Creating Opportunities for Personal Empowerment (COPE), a manualized CBT program for teens. Students completed post-clinical training evaluations. Using qualitative design, responses to the open-ended questions were analyzed and common themes identified.

RESULTS

One hundred seven PMHNP students completed evaluations. Four themes emerged from the data: (a) therapeutic understanding of adapting CBT for children and adolescents, (b) therapeutic skills and techniques for use with children/adolescents, (c) improved level of confidence through participation in the CBT program, and (d) therapeutic benefits of being in a group.

CONCLUSIONS

Positive PMHNP student evaluations indicated that this clinical training model is feasible both online and face-to-face and acceptable for providing clinical training in CBT for children and adolescents.

Psychometric Properties of the Perceived Wellness Culture and Environment Support Scale

Objective:

This study reports on the psychometric properties of the 11-item Perceived Wellness Culture and Environment Support Scale (PWCESS) and its relationship with employee healthy lifestyle beliefs and behaviors.

Methods:

Faculty and staff (N = 3959) at a large public university in the United States mid-west completed the PWCESS along with healthy lifestyle beliefs and behaviors scales. Data were randomly split into 2 halves to explore the PWCESS’ validity and reliability and the second half to confirm findings.

Results:

Principal components analysis indicated a unidimensional construct. The PWCESS was positively related to healthy lifestyle beliefs and behaviors supporting the scale’s validity. Confirmatory factor analysis supported the unidimensional construct (Cronbach’s α = .92).

Conclusion:

Strong evidence supports the validity and reliability of the PWCESS. Future use of this scale could guide workplace intervention strategies to improve organizational wellness culture and employee health outcomes.

Systematic review on evidence-based adolescent nutrition interventions

Adolescence is a critical stage in the life cycle, and adequate nutrition is necessary for the proper growth and development of individuals and their offspring. Here, we comprehensively review all published systematic reviews (through October 2016) on adolescents (10-19 years) and women of reproductive age, including pregnant women, which targeted interventions related to nutrition. For interventions where there was no existing systematic review on adolescents, we reviewed primary studies/trials. We included interventions on micronutrient supplementation (iron, folic acid, iron-folic acid (IFA), calcium, vitamin D, vitamin A, zinc, iodine, and multiple micronutrients), food/protein energy supplementation, nutrition education for pregnant adolescents, obesity prevention and management, and management of gestational diabetes. We identified a total of 35 systematic reviews, of which only five were conducted on adolescents, and 107 primary studies on adolescents. Our review suggests that iron alone, IFA, zinc, and multiple micronutrient supplementation in adolescents can significantly improve serum hemoglobin concentration. While zinc supplementation in pregnant adolescents showed improvements in preterm birth and low birth weight, we found a paucity of trials on calcium, vitamin D, vitamin A, and iodine supplementation. We found limited evidence on food/protein energy supplementation in adolescents. Interventions to prevent and manage obesity showed a nonsignificant impact on reducing body mass index. This review underscores the importance of adolescent nutrition interventions. It is imperative that countries design nutritional interventions, particularly for adolescents.

A systematic review of mediators of physical activity, nutrition, and screen time in adolescents: Implications for future research and clinical practice

BACKGROUND

Adolescents are not meeting current recommendations for daily physical activity, nutrition, and screentime which has been associated with overweight and obesity. Understanding the mediators that facilitate teens in improving their healthy lifestyle behaviors may be helpful in halting this crisis.

PURPOSE

The purpose of this systematic review was to assess published findings regarding mediators of adolescent energy balance behaviors.

METHOD

We followed the Institute of Medicine guidelines for completing a systematic review.

DISCUSSION

Fourteen analyses from 12 studies were included with mediating variables tested for nutrition, physical activity, and screen time. Mediators were identified for all three behaviors and were primarily on the individual level of the social ecological model.

CONCLUSIONS

Combining findings from this and other reviews of mediators can help guide researchers in choosing mediating factors for specific target behaviors.

The effectiveness of the COPE healthy lifestyles TEEN program: a school-based intervention in middle school adolescents with 12-month follow-up

AIM

The goal of this study is to assess the applicability and long-term effectiveness of the T-COPE Healthy TEEN program on adolescent health.

BACKGROUND

Obesity and mental health disorders are major public health problems in adolescents. In this context, including long-term and multiple behavioural obesity prevention programs are becoming increasingly important.

DESIGN

A quasi-experimental design with pre-test/post-test control group and repeated measurements.

METHODS

Eighty-seven (45 in intervention group, 42 in control group) adolescents were included from two different middle schools in the intervention program. The data were analysed by using descriptive statistics, Pearson chi-square, Fisher's exact test, Student-t test, repeated measures of variance analysis and Cohen's d effect size.

RESULTS

No significant difference was found between the intervention and control groups in terms of descriptive characteristics, behavioural and cognitive variables of the adolescents. Following the intervention, the adolescents in intervention groups showed improvements in nutritional behaviour, physical activity and stress management. These improvements concerned increased physical walking measured in the number of physical steps per week daily fruit and vegetable consumption and the daily quantity of water ingested. While their nutrition/physical activity knowledge significantly increased, their weight and anxiety symptoms significantly decreased. The effect of the program on body mass index, depression and health beliefs of the adolescents were not significant compared with the control group.

CONCLUSION

The applicability of the T-COPE Healthy TEEN program on Turkish adolescents and its effectiveness on their health behaviours, nutrition and physical activity knowledge and stress management were revealed in this study.

Correlates of Healthy Lifestyle Beliefs and Behaviors in Parents of Overweight or Obese Preschool Children Before and After a Cognitive Behavioral Therapy Intervention With Text Messaging

INTRODUCTION

Significant gaps exist in the published literature regarding the treatment of overweight/obesity in preschool-aged children, especially in primary care settings. Parental influence plays an important factor in the development of healthy behaviors in children, yet there is no consensus about why some behavior change intervention strategies for parents of young children are more influential and effective than others.

OBJECTIVE

The purpose of this secondary data analysis was to assess correlations among the study variables (healthy lifestyle beliefs, perceived difficulty, and healthy lifestyle behaviors) in parents of overweight/obese preschool children. A second aim explored if the parent's level of cognitive beliefs and perceived difficulty of engaging in healthy lifestyle behaviors correlated with text messaging cognitive behavioral support.

METHODS

Fifteen preschool-parent dyads from primary care clinics completed a 7-week cognitive behavioral skills building intervention. Beck's Cognitive Theory guided the intervention content, and Fogg's Behavior Model guided the implementation. The intervention was delivered using a combination of face-to-face clinic visits and ecological momentary interventions using text messaging.

RESULTS

Supported are the interconnected relationships among the study variables, that is, parental healthy lifestyle beliefs, thoughts, and behaviors. At baseline, parental healthy lifestyle belief scores significantly correlated with perceived difficulty (rs = 0.598, p < .05) and healthy lifestyle behaviors (rs = 0.545, p < .05). These associations strengthened after the intervention. Furthermore, as parental healthy lifestyle beliefs increased and perceived difficulty lessened, their response rate and subsequent feedback lessened to the static text messaging support.

DISCUSSION

Findings from this study support the interconnections between parents' thoughts, feelings, and actions toward healthy lifestyles. As parental beliefs became stronger through cognitive behavioral skills building and tailored text messaging, the need for general support via text messaging lessened, warranting additional research.

COPE: A Pilot Study With Urban-Dwelling Minority Sixth-Grade Youth to Improve Physical Activity and Mental Health Outcomes

Approximately one in three preadolescents (34%) is obese/overweight and one in four (25%) experience a mental health issue. Urban youth suffer from higher rates of these problems, and at earlier ages than their peers. This study's purpose was to determine feasibility/acceptability and preliminary effects of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotion, Exercise, and Nutrition) intervention on physical activity (PA) and mental health outcomes of 11- to 13-year-olds. A one group pre- and posttest design was used in a Midwest urban middle school. Preadolescents (n = 31) who received COPE reported significant decreases in anxiety and increases in healthy lifestyle beliefs and PA. Further, preadolescents at baseline with elevated anxiety, depression, suicide risk, and below average self-concept who received COPE reported significant increases in self-concept and decreases in anxiety, depression, and suicidal ideation. The COPE program is a promising intervention that can improve physical and mental health outcomes.

Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study

Background

Children are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period.

Objective

The purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting.

Methods

Fifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck’s Cognitive Theory guided the TEXT2COPE intervention content and Fogg’s Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention’s relevance to the family’s needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation.

Results

Self-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week.

Conclusions

Utilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted.

Effects of the COPE Cognitive Behavioral Skills Building TEEN Program on the Healthy Lifestyle Behaviors and Mental Health of Appalachian Early Adolescents

INTRODUCTION

Appalachian adolescents have a high prevalence of obesity and mental health problems that exceed national rates, with the two conditions often co-existing. The purpose of this study was to evaluate the feasibility and preliminary efficacy of a 15-session cognitive-behavioral skills building intervention (COPE [Creating Opportunities for Personal Empowerment] Healthy Lifestyles TEEN [Thinking, Emotions, Exercise, and Nutrition] Program) on healthy lifestyle behaviors, physical health, and mental health of rural early adolescents.

METHODS

A pre- and posttest pre-experimental design was used with follow-up immediately after the intervention.

RESULTS

Results support improvement in the students' anxiety, depression, disruptive behavior, and self-concept scores after the COPE intervention compared with baseline. Additionally, healthy lifestyle behavior scores improved before the intervention compared with after the intervention.

DISCUSSION

COPE is a promising intervention that improves mental health and healthy lifestyle behaviors and can be integrated routinely into school-based settings.

Expanding a successful community-based obesity prevention approach into new communities: Challenges and achievements

OBJECTIVE

A previously successful community-based obesity prevention intervention with a focus on school settings was expanded into new communities with varying contexts. In order to understand the complexities involved in implementing health promotion activities in schools, this study examined experiences of school staff and project officers including barriers, contextual factors and achievements.

METHODS

School environment assessments were conducted in schools across four Victorian communities with school staff (n=1-5 staff plus a trained researcher per group in 9 primary and 8 secondary schools) 12-18 months post-intervention. Process reports from project officers were also reviewed and analysed (n=4).

RESULTS

School staff commonly reported time pressures as a barrier to implementation and project officers working within schools reported competing priorities and limited health promotion experience of staff; lack of stakeholder engagement; low participation in some activities and insufficient implementation time. Contextual factors included community socioeconomic status, student ethnicity and living rurally. Achievements included student and staff enjoyment from programme activities, staff capacity building, partnerships, embedding activities into existing infrastructure and programmes, and having consistent health-related messages repeated through a variety of strategies.

CONCLUSIONS

Community-based interventions with a focus on school settings need to consider system level, organisational and contextual (i.e. socioeconomic, ethnicity, family and town characteristics) factors when expanding previously effective strategies into new communities. Implementation benefits may have added whole of school benefits in addition to child health. Focussing on overcoming the challenges experienced in this complex initiative is required for future interventions.

TRIAL REGISTRATION

ACTRN12609000892213.

Pediatric Nurse Practitioner Management of Child Anxiety in a Rural Primary Care Clinic With the Evidence-Based COPE Program

INTRODUCTION

Anxiety is the most common mental health disorder in children. Many communities have shortages of mental health providers, and the majority of children with anxiety are not receiving the evidence-based treatment they need. The purpose of this pilot study was to assess the feasibility and effects of a brief seven-session cognitive behavioral skills-building intervention, Creating Opportunities for Personal Empowerment (COPE), which was delivered to anxious children by a pediatric nurse practitioner in a primary care setting.

METHODS

A pre-experimental, one-group, pretest and post-test design was used.

RESULTS

Children who participated had a significant decrease in anxiety symptoms (13.88 points, SD = 17.96, 95% confidence interval [CI] = -1.13-28.89), as well as an increase in knowledge of cognitive-behavioral coping skills (M = 11.38, CI = 5.99-8.26, p = .00) and improved functioning (at school and at home). Evaluations by parents and children were positive.

DISCUSSION

COPE is a promising evidence-based intervention for children with anxiety with feasible delivery by pediatric nurse practitioners in primary care.

Physical activity in overweight and obese adolescents: systematic review of the effects on physical fitness components and cardiovascular risk factors

BACKGROUND

The increasing prevalence of obesity in the pediatric age range has become a major concern. Studies have investigated the role of physical activity (PA) to prevent obesity in this population. However, previous reviews did not focus on the effects of PA in overweight/obese adolescents on physical fitness and risk factors for cardiovascular disease altogether.

OBJECTIVE

The present systematic review analyzed trials investigating the effect of PA on aerobic capacity, muscle strength, body composition, hemodynamic variables, biochemical markers, and endothelial function in obese/overweight adolescents.

METHODS

PubMed, LILACS, Web of Science, Scopus (including Embase), and SPORTDiscus databases were searched for relevant reports without time limits. Inclusion criteria included studies published in English, with overweight and obese adolescents aged 12-17 years. The review was registered (Number CRD42013004632) on PROSPERO, the International Prospective Register of Systematic Reviews.

RESULTS

The results indicated that PA is associated with significant and beneficial changes in fat percentage, waist circumference, systolic blood pressure, insulin, low-density lipoprotein cholesterol, and total cholesterol, as well as with small non-significant changes in diastolic blood pressure, glucose, and high-density lipoprotein cholesterol.

CONCLUSION

Although limited, results from controlled trials suggest that PA intervention may improve physical fitness and risk factors for cardiovascular disease in adolescents who are overweight or obese.

Randomized controlled trial of the acceptability, feasibility, and preliminary effects of a cognitive behavioral skills building intervention in adolescents with chronic daily headaches: a pilot study

INTRODUCTION

The treatment challenge of adolescents with chronic daily headaches (CDHs) creates an urgent need for evidence-based interventions. Therefore the purpose of this pilot study was to evaluate the acceptability, feasibility, and preliminary effects of a brief cognitive behavioral skills building intervention with 36 adolescents, 13 to 17 years of age, who had CDHs and mild to moderate depressive symptoms.

METHODS

Participants were randomly assigned either to the Creating Opportunities for Personal Empowerment-Headache Education Program (COPE-HEP) or to a headache education comparison group.

RESULTS

Adolescents and parents found the COPE-HEP to be highly acceptable. Medium to large positive effects were demonstrated on the adolescents' depression in both groups and on anxiety and beliefs in the COPE-HEP group. COPE-HEP offered additional benefits of a larger decrease in adolescent anxiety over time and stronger beliefs in the teens' ability to manage their headaches.

DISCUSSION

Adolescents with CDHs and elevated depressive/anxiety symptoms should be offered headache hygiene education plus cognitive-behavioral skills building interventions. A full-scale trial to determine the more long-term benefits of COPE-HEP is now warranted.

Uptake of National AfterSchool Association physical activity standards among US after-school sites

OBJECTIVE

In 2011, the National AfterSchool Association (NAA) adopted standards to guide delivery of physical activity (PA). We assessed after school sites' uptake of the five PA standards.

METHOD

We conducted a descriptive study in fall 2013. NAA emailed 14,000 members requesting that afterschool site directors complete an online questionnaire regarding site characteristics, awareness and use of the standards, and implementation. We calculated implementation scores for each standard by summing points for their component best practices, and examined associations among site characteristics, implementation scores, and awareness and use of the standards.

RESULTS

Among 595 respondents, 60% were aware of the PA standards and 43% used them for program planning. Awareness and use were significantly higher among NAA members and among sites that were accredited, licensed, or operated by a parent organization. PA content and quality scores were higher among those aware of and using the standards (p<0.01) and correlated with scores for staff training and for program, social, and environmental support (p<0.0001).

CONCLUSION

We observed high recognition and use of the NAA PA standards in a national convenience sample of afterschool programs. Their uptake and use are promising lever for increasing the quality of PA in the afterschool setting.

Process evaluation for a school-based physical activity intervention for 6th- and 7th-grade boys: reach, dose, and fidelity

The purpose was to evaluate the reach, dose, and fidelity of Guys Only Activity for Life (G.O.A.L.), a 7-week pilot intervention conducted from February to March 2011 to increase 6th and 7th grade boys' moderate-to-vigorous physical activity (MVPA). One middle school was randomly assigned to the G.O.A.L. intervention and another from the same urban school district in the Midwestern U.S. to a comparison condition. Thirty boys, ages 10-14 years, participated in each school. The intervention, guided by the Health Promotion Model (HPM) and Self-Determination Theory (SDT), consisted of a 90-min after-school physical activity club 4 days/week and one motivational interviewing session with a registered (school) nurse. Data were gathered via attendance records, club observations, heart rate monitors, audio-taping of motivational interviewing sessions, and surveys. On average boys attended the club 2.11 days/week (SD=.86). A trained independent process evaluator reported that the physical activity club instructors provided the boys with the opportunity for a mean of 25.8 min/day of MVPA. Using a four-point Likert scale (1=disagree a lot; 4=agree a lot), the process evaluator perceived that the club was delivered with high fidelity and adherence to the underlying theories (M=3.48; SD=0.39). Sessions with the nurse lasted an average of 13 min, 29 s. All boys attended. Two trained independent coders indicated that the nurse demonstrated at least beginning proficiency for all tasks associated with motivational interviewing, with the exception of using sufficient open- as opposed to closed-ended questions and reflections compared to questions. Fidelity related to session delivery and adherence to the theories was high (M=3.83; SD=0.19). The process evaluation data indicated that strategies are needed to increase attendance and boys' MVPA during the club time.

Outcomes and Feasibility of a Manualized Cognitive-Behavioral Skills Building Intervention: Group COPE for Depressed and Anxious Adolescents in School Settings

PROBLEM

Despite the increasing prevalence of depressive and anxiety disorders in adolescents, less than 25% of affected teens receive any treatment.

METHODS

A preexperimental one-group pre- and posttest pilot study design with 4-week follow-up was used to assess the feasibility and preliminary effects of the COPE (Creating Opportunities for Personal Empowerment) brief-focused manualized seven-session cognitive-behavioral skills building group intervention delivered in two high schools to 16 adolescents referred by a school-based nurse practitioner for depression or elevated anxiety symptoms.

FINDINGS

Adolescents reported significant decreases in depression and anxiety on the Beck Youth Inventory as well as increases in personal beliefs about managing negative emotions. Evaluations indicated that the group COPE intervention was a positive experience for the teens.

CONCLUSIONS

COPE is a promising brief-focused cognitive behavioral therapy-based intervention that can be delivered effectively to teens in school settings using a group format.

The COPE healthy lifestyles TEEN randomized controlled trial with culturally diverse high school adolescents: baseline characteristics and methods

Obesity and mental health disorders remain significant public health problems in adolescents. Substantial health disparities exist with minority youth experiencing higher rates of these problems. Schools are an outstanding venue to provide teens with skills needed to improve their physical and mental health, and academic performance. In this paper, the authors describe the design, intervention, methods and baseline data for a randomized controlled trial with 779 culturally diverse high-school adolescents in the southwest United States. Aims for this prevention study include testing the efficacy of the COPE TEEN program versus an attention control program on the adolescents' healthy lifestyle behaviors, Body Mass Index (BMI) and BMI%, mental health, social skills and academic performance immediately following the intervention programs, and at six and 12 months post interventions. Baseline findings indicate that greater than 40% of the sample is either overweight (n = 148, 19.00%) or obese (n = 182, 23.36%). The predominant ethnicity represented is Hispanic (n = 526, 67.52%). At baseline, 15.79% (n = 123) of the students had above average scores on the Beck Youth Inventory Depression subscale indicating mildly (n = 52, 6.68%), moderately (n = 47, 6.03%), or extremely (n = 24, 3.08%) elevated scores (see Table 1). Anxiety scores were slightly higher with 21.56% (n = 168) reporting responses suggesting mildly (n = 81, 10.40%), moderately (n = 58, 7.45%) or extremely (n = 29, 3.72%) elevated scores. If the efficacy of the COPE TEEN program is supported, it will offer schools a curriculum that can be easily incorporated into high school health courses to improve adolescent healthy lifestyle behaviors, psychosocial outcomes and academic performance.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18

BACKGROUND

The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades.

OBJECTIVES

The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents.

SEARCH METHODS

The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information.

SELECTION CRITERIA

To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school-attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO2max), and pulse rate.

DATA COLLECTION AND ANALYSIS

Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured.

MAIN RESULTS

In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects.In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years.Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review.

AUTHORS' CONCLUSIONS

The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.

Impact of physical activity intervention programs on self-efficacy in youths: a systematic review

Lack of physical activity has contributed to the nation's childhood obesity crisis, but the impact of physical activity on self-efficacy as a mediator of behavior change has not been examined. This systematic review (SR) describes the published evidence related to the impact of physical activity intervention programs on self-efficacy among youths. From January 2000 to June 2011, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to identify publications from PubMed, PsychInfo, Web of Knowledge, and the Cochran Database of Systematic Reviews. The Cochrane Population, Intervention, Control, Outcome, Study Design (PICOS) approach guided this SR articles selection and evaluation process. Of the 102 publications screened, 10 original studies matched the SR inclusion criteria. The types of physical activity interventions and self-efficacy assessments for these 10 studies were diverse. Of the 10 included articles, 6 articles identified an improvement in post-self-efficacy assessments compared to baseline and 4 showed no effect. In conclusion, physical activity intervention programs may improve self-efficacy in youths. A standardized approach to classify and measure self-efficacy is required. Further research is needed to quantify the association of self-efficacy ratings after completing physical activity interventions with objective health improvements, such as weight loss.

COPE for depressed and anxious teens: a brief cognitive-behavioral skills building intervention to increase access to timely, evidence-based treatment

TOPIC

Evidence-based cognitive-behavioral therapy skills building intervention--Creating Opportunities for Personal Empowerment (COPE)--for depressed and anxious teens in brief 30 min outpatient visits.

PURPOSE

Based on COPE training workshops, this article provides an overview of the COPE program, its development, theoretical foundation, content of the sessions, and lessons learned for best delivery of COPE to individuals and groups in psychiatric settings, primary care settings, and schools.

SOURCES

Published literature and clinical examples.

CONCLUSION

With the COPE program, the advanced practice nurse in busy outpatient practice can provide timely, evidence-based therapy for adolescents and use the full extent of his/her advanced practice nursing knowledge and skills.

Bright Start: Description and main outcomes from a group-randomized obesity prevention trial in American Indian children

The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first-grade American Indian children. Bright Start was a group-randomized, school-based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. Although the intervention was not associated with statistically significant change in mean levels of BMI, BMI-Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, whereas the control children experienced a corresponding incidence of 24.8%; a difference of -11.4% (P = 0.033). The intervention significantly reduced parent-reported mean child intakes of sugar-sweetened beverages, whole milk, and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.

A parent-directed portion education intervention for young children: Be Beary Healthy

PURPOSE

This pilot study aimed to determine the effects of an intervention on nutrition knowledge, food parents serve, and children's dietary intake.

DESIGN AND METHODS

A single-group pre-/posttest design was used with 45 mothers and their 4- to 6-year-old children. After pretesting, parents received child nutrition information and portion-related activities.

RESULTS

Paired samples t-tests revealed that from pre- to posttest the average calories mothers served and the average calories children ate significantly decreased (medium effect size). Medium effects also were recognized from pre- to posttest for the carbohydrates served and carbohydrates consumed. No significant change was found in parents' nutrition knowledge.

PRACTICE IMPLICATIONS

Interventions focusing on skill building rather than on increasing knowledge may more effectively lead to changed child intake.

Parent participation in weight-related health interventions for children and adolescents: a systematic review and meta-analysis

OBJECTIVE

To review child and adolescent weight-related health intervention characteristics, with a particular focus on levels of parental participation, and examine differences in intervention effectiveness.

METHODS

Multiple social science, health, and medical databases were searched, and experimental randomized controlled studies of child and adolescent weight-related health interventions, reported in January 2004 through December 2010, were collected. Intervention characteristics were reviewed, and pre- and post-measurement data, including body mass index, were extracted for analyses. Differences in effect sizes of experimental and control groups were used to evaluate effectiveness of interventions.

RESULTS

Reports of 42 interventions were included. Intervention activities consisted of nutrition education, physical activity education, physical activity sessions, behavior education, behavior therapy, or a combination of these activities. Significant differences existed among levels of parent participation, p<0.05. In addition, intervention duration positively predicted intervention effectiveness, p=0.006, and the linear combination of parent participation and intervention duration significantly predicted intervention effectiveness, p=0.001.

CONCLUSIONS

This study suggests that weight-related health interventions that require parent participation more effectively reduce body mass indexes of child and adolescent participants. In addition, longer interventions that include parent participation appear to have greater success. Suggestions for future research and related interventions are provided.

Effect of an after-school intervention on increases in children's physical activity

PURPOSE

Evaluate the effect of an after-school intervention on physical activity program changes and individual behaviors among children.

METHODS

A quasi-experimental evaluation of a YMCA-driven environmental change intervention with 16 intervention and 16 control sites in four metropolitan areas in the United States. Intervention sites participated in learning collaboratives designed to promote physical activity and nutrition through environmental change, educational activities, and parent engagement. Behavioral foci included increasing overall physical activity levels as well as combined moderate and vigorous physical activity and vigorous physical activity. Outcomes were assessed longitudinally using preintervention and follow-up surveys of program implementation and accelerometer measures of physical activity. ActiGraph accelerometer data were collected from a sample of 212 children, ages 5-11 yr, attending the programs. On average, 3 d of data were gathered per child. Reliability of the accelerometer counts averaged 0.78. Multivariate regression models were used to control for potential confounding variables and to account for clustering of observations.

RESULTS

Data indicate greater physical activity increases in children in intervention versus control sites after modest intervention implementation. Controlling for baseline covariates, children in intervention sites showed greater increases in average physical activity level than in control sites (76 counts per minute, P = 0.037, 95% confidence interval (CI) = 8.1-144) and more minutes of moderate and vigorous physical activity (10.5 min·d(-1), P = 0.017, 95% CI = 1.5-18.6), minutes of moderate physical activity (5.6 min·d(-1), P = 0.020, 95% CI = 0.99-10.2), and minutes of vigorous physical activity (5.1 min·d(-1), P = 0.051, 95% CI = 0.21-9.93).

CONCLUSIONS

Results indicate significant increases in daily physical activity among children in intervention versus control sites. This study documents the effectiveness of an environmental change approach in an applied setting.

A primary care healthy choices intervention program for overweight and obese school-age children and their parents

INTRODUCTION

The escalating crisis of childhood overweight and obesity creates an urgent demand for evidence-based interventions that can be used by primary care providers. Therefore, the purpose of this study was to test the feasibility, acceptability, and preliminary efficacy of a theory-based Healthy Choices Intervention (HCI) Program with fifteen 9-12 year old overweight and obese children and their parents in a primary care setting.

METHODS

A 1-group, 7-week pre-/posttest study design was used. Outcome measures included: body mass index (BMI) percentile, physical activity and nutrition knowledge, beliefs, choices and behaviors, anxiety, depression, self-concept, and social competence.

RESULTS

Children and parents found the HCI to be useful and informative. Positive effects of the HCI for the children included decreased BMI percentile, increased knowledge, beliefs, choices and behaviors, and self-control. Positive effects of the intervention for the parents included increased knowledge, beliefs, behaviors, and decreased anxiety.

DISCUSSION

This study provides evidence to support the feasibility, acceptability, and preliminary effects of the HCI with overweight and obese school-age children and their parents within a primary care setting.

Predicting physical activity and fruit and vegetable intake in adolescents: a test of the information, motivation, behavioral skills model

Most adolescents do not meet national recommendations regarding physical activity and/or the intake of fruits and vegetables. The purpose of this study was to explore whether variables in the information, motivation, behavioral skills (IMB) model of health promotion predicted physical activity and fruit and vegetable intake in 404 adolescents from 2 high schools in the Southwest United States using structural equation modeling (SEM). The SEM models included theoretical constructs, contextual variables, and moderators. The theoretical relationships in the IMB model were confirmed and were moderated by gender and race. Interventions that incorporate cognitive-behavioral skills building may be a key factor for promoting physical activity as well as fruit and vegetable intake in adolescents.

Interventions for preventing obesity in children

BACKGROUND

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear.

OBJECTIVES

This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?"

SEARCH METHODS

The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted.

SELECTION CRITERIA

The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias of included studies.  Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours.  Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings).

MAIN RESULTS

This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years.  The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I(2)=82%).  Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m(2) (95% confidence interval (CI): -0.21 to -0.09).  Intervention effects by age subgroups were -0.26kg/m(2) (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m(2) (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m(2) (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention.  Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found.  Interventions did not appear to increase health inequalities although this was examined in fewer studies.

AUTHORS' CONCLUSIONS

We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:·         school curriculum that includes healthy eating, physical activity and body image·         increased sessions for physical activity and the development of fundamental movement skills throughout the school week·         improvements in nutritional quality of the food supply in schools·         environments and cultural practices that support children eating healthier foods and being active throughout each day·         support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)·         parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activitiesHowever, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.  

Psychosocial correlates of healthy beliefs, choices, and behaviors in overweight and obese school-age children: a primary care healthy choices intervention pilot study

The relationships among weight, mental health, social competence, healthy lifestyle beliefs, choices, and behaviors in overweight and obese school-age children (9 to 12 years) who were participating in a pilot Healthy Choices Intervention Program were examined using a descriptive correlational design. Results indicated that the children's weight negatively correlated with the children's self-concept, social skills, and, most importantly, healthy lifestyle choices. Their healthy lifestyle beliefs demonstrated positive correlations with their intentions to choose a healthy lifestyle. The children's healthy lifestyle beliefs and choices also were associated with increased cooperation and empathy behaviors. A positive self-concept was associated with decreased anxiety and depressive symptomology. These data support the need for health care providers to understand the psychological and social issues that overweight and obese school-age children experience. Cognitive behavior skills building techniques, such as those in the Healthy Choices Intervention Program, may promote healthy lifestyle choices and behaviors.

The relationship of perceived and actual weight in minority adolescents

The prevalence of overweight in adolescents with its associated outcomes continues to be a major public health concern. The purpose of this study was to assess whether adolescents perceived their weight accurately and to determine the relationships among perceived and actual weight, depression, anxiety, anger, disruptive behavior, and self-concept in minority adolescents. A descriptive, correlational design was conducted with 33 adolescents. Questions regarding weight perception, depression, anxiety, anger, disruptive behavior, and self-concept were correlated with body fat percentile, body mass index (BMI), and BMI percentile. Findings indicated that adolescent perception of overweight was positively related to actual weight and negatively related to self-esteem and disruptive behavior. Adolescents who were overweight identified their weight accurately and tried to lose weight.