Diana Jacobson

Promoting Healthy Lifestyles in High School Adolescents: A Randomized Controlled Trial

BACKGROUND Although obesity and mental health disorders are two major public health problems in adolescents that affect academic performance, few rigorously designed experimental studies have been conducted in high schools. PURPOSE The goal of the study was to test the efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) Program, versus an attention control program (Healthy Teens) on: healthy lifestyle behaviors, BMI, mental health, social skills, and academic performance of high school adolescents immediately after and at 6 months post-intervention. DESIGN A cluster RCT was conducted. Data were collected from January 2010 to May of 2012 and analyzed in 2012-2013. SETTING/PARTICIPANTS A total of 779 culturally diverse adolescents in the U.S. Southwest participated in the trial. INTERVENTION COPE was a cognitive-behavioral skills-building intervention with 20 minutes of physical activity integrated into a health course, taught by teachers once a week for 15 weeks. The attention control program was a 15-session, 15-week program that covered common health topics. MAIN OUTCOME MEASURES Primary outcomes assessed immediately after and 6 months post-intervention were healthy lifestyle behaviors and BMI. Secondary outcomes included mental health, alcohol and drug use, social skills, and academic performance. RESULTS Post-intervention, COPE teens had a greater number of steps per day (p=0.03) and a lower BMI (p=0.01) than did those in Healthy Teens, and higher average scores on all Social Skills Rating System subscales (p-values <0.05). Teens in the COPE group with extremely elevated depression scores at pre-intervention had significantly lower depression scores than the Healthy Teens group (p=0.02). Alcohol use was 12.96% in the COPE group and 19.94% in the Healthy Teens group (p=0.04). COPE teens had higher health course grades than did control teens. At 6 months post-intervention, COPE teens had a lower mean BMI than teens in Healthy Teens (COPE=24.72, Healthy Teens=25.05, adjusted M=-0.34, 95% CI=-0.56, -0.11). The proportion of those overweight was significantly different from pre-intervention to 6-month follow-up (chi-square=4.69, p=0.03), with COPE decreasing the proportion of overweight teens, versus an increase in overweight in control adolescents. There also was a trend for COPE Teens to report less alcohol use at 6 months (p=0.06). CONCLUSIONS COPE can improve short- and more long-term outcomes in high school teens. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01704768.

Correlates Among Healthy Lifestyle Cognitive Beliefs, Healthy Lifestyle Choices, Social Support, and Healthy Behaviors in Adolescents: Implications for Behavioral Change Strategies and Future Research

INTRODUCTION The foundation for healthy lifestyle behaviors begins in childhood. As such, the relationships among cognitive beliefs, healthy lifestyle choices, and healthy lifestyle behaviors in adolescents have been explored. The purpose of this study was to assess the relationships among cognitive variables, social support, and healthy lifestyle behaviors in adolescents. METHOD A descriptive correlational design was used for this study. Students from two high schools in the Southwest United States were recruited to participate (N = 404). RESULTS Significant correlations existed among cognitive variables, social support, behavioral skills, and health lifestyle behaviors. DISCUSSION This study demonstrated that cognitive beliefs about leading a healthy lifestyle, including attitudes and intended choices, are related to physical activity as well as the intake of fruits and vegetables. In working with adolescents on healthy lifestyle behavior change, it is important to implement strategies to strengthen their cognitive beliefs about their ability to make healthy choices and engage in healthy lifestyle behaviors. Strengthening these beliefs should lessen their perception that these behaviors are difficult to perform, which ultimately should result in healthy behaviors.

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.

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 childrens weight negatively correlated with the childrens 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 childrens 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.

Improving physical activity, mental health outcomes, and academic retention in college students with Freshman 5 to thrive: COPE/Healthy lifestyles

Purpose: To assess the preliminary effects of a new course entitled Freshman 5 to Thrive/COPE Healthy Lifestyles on the cognitive beliefs, knowledge, mental health outcomes, healthy lifestyle choices, physical activity, and retention of college freshmen. Data sources: Measures included demographics, nutrition knowledge, healthy lifestyle beliefs, healthy lifestyle perceived difficulty, healthy lifestyle choices, Beck Youth Inventories‐II (anxiety, depression, anxiety, and destructive behavior), step count via pedometer, and college retention. Conclusions: The experimental COPE (Creating Opportunities for Personal Empowerment) group had greater intentions to live a healthy lifestyle (p = .02) versus the comparison group. COPE students also significantly increased their physical activity (p = .003) from baseline to postintervention and had a higher college retention rate than students who did not take the course. In addition, there was a significant decrease in depressive and anxiety symptoms in COPE students whose baseline scores were elevated. Implications for practice: The Freshman 5 to Thrive Course is a promising intervention that can be used to enhance healthy lifestyle behaviors and improve mental health outcomes in college freshmen.

Twelve-Month Effects of the COPE Healthy Lifestyles TEEN Program on Overweight and Depressive Symptoms in High School Adolescents

BACKGROUND We evaluated the 12-month effects of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) program versus an attention control program (Healthy Teens) on overweight/obesity and depressive symptoms in high school adolescents. METHODS A cluster randomized controlled trial was conducted. Participants were 779 culturally diverse adolescents in the US Southwest. COPE is a cognitive-behavioral skills-building intervention with 20 min of physical activity integrated into a health course and taught by teachers once a week for 15 weeks. Outcome measures included body mass index (BMI) and depressive symptoms. RESULTS COPE teens had a significantly lower BMI at 12 months (F(1,698)  = 11.22, p = .001) than Healthy Teens (24.95 versus 25.48). There was a significant decrease in the proportion of overweight and obese COPE teens from baseline to 12 months (χ(2)  = 5.40, p = .02) as compared with Healthy Teens. For youth who began the study with extremely elevated depressive symptoms, COPE teens had significantly lower depression at 12 months compared with Healthy Teens (COPE M = 42.39; Healthy Teens M = 57.90); (F(1 ,12)  = 5.78, p = .03). CONCLUSIONS COPE can improve long-term physical and mental health outcomes in teens.

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.

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.

The relationships among body size, biological sex, ethnicity, and healthy lifestyles in adolescents

PURPOSE. The purposes of this study were to (a) determine whether actual weight, biological sex, and race/ethnicity were related to differences of weight perception, nutrition and activity knowledge, perceived difficulty, attitudes, and choices about living a healthy lifestyle in adolescents; and (b) describe the relationships among these variables. DESIGN AND METHODS. This was a cross-sectional descriptive, correlational design with 404 adolescents. RESULTS. Perception of weight was more accurate in overweight adolescents. Teens who reported difficulty in leading a healthy lifestyle reported less healthy choices, attitudes, and knowledge. PRACTICE IMPLICATIONS. Findings suggest tailored interventions should consider biological sex and race/ethnicity.

Relationships Among Factors Related to Body Mass Index, Healthy Lifestyle Beliefs and Behaviors, and Mental Health Indicators for Youth in a Title 1 School

INTRODUCTION The effect of being overweight in childhood has both physical and psychological implications. The purpose of this study was to determine the relationships among body mass index (BMI), healthy lifestyle beliefs and behaviors, and mental health indicators for 5th- and 6th-grade children in a Title I school. METHODS This is a cross-sectional, descriptive correlational design on a convenience sample of youth in an urban school. BMI was calculated. Participants completed surveys that assessed healthy beliefs and behaviors, activity and nutrition knowledge, and mental health indicators. RESULTS Children with higher BMIs reported difficulty in living a healthy lifestyle. This perceived difficulty affected their ability to make healthy choices. Belief in the ability to live a healthy lifestyle resulted in reported healthier behaviors. Anxiety and depression symptomatology were not significantly related to healthy lifestyle indicators. DISCUSSION The results demonstrate that the proposed thinking, feeling, behavior triangle model was supported in this population.