Promoting Healthy Lifestyles in High School Adolescents

Abstract

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). Alcohol use was 11.17% in the COPE group and 21.46% 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 were no differences in 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.

The Effect of Exercise on Depressive Symptoms in Adolescents: A Systematic Review and Meta-Analysis

“…26 Seven trials allocated participants through individual randomisation, 16,17,20,22,[24][25][26] and four reported using cluster randomisation. 18,19,21,23 …”

“…Five trials used an outcome measure that focused solely on depression: the Beck Depression Inventory (BDI) 16,20 ; the Children's Depression Rating Scale-Revised (CDRS-R) 17 ; the Children's Depression Inventory (CDI) 22 ; the Children's Depression Inventory 2 nd Version (CDI-2) 26 ; and the Hamilton Depression Rating Scale. 24 Three trials used outcome measures that captured both anxiety and depressive symptoms: the Beck Youth Inventory (BYI), 19,21 and the Hospital Anxiety and Depression Scale (HADS). 23 …”

“…The intervention was conducted within school settings in five trials, 18,19,21,23,25 within institution or inpatient setting in three trials, 16,20,22 and within community-based settings in three trials. 17,24,26 A limited number of trials provided an adequate description of the employed intensity exercise.…”

“…18,19,21,23,25 One trial included participants with scores indicating moderate depression from an "at risk" population in a juvenile delinquent institution. 20 Five trials recruited clinical samples: two trials recruited inpatients receiving treatment for depression or dysthymia from psychiatric inpatient settings 16,22 ; two trials included participants with a diagnosis of depression who were not currently receiving psychiatric treatment 17,24 ; and one trial included participants who were receiving outpatient treatment for depression.…”

“…20 Five trials recruited clinical samples: two trials recruited inpatients receiving treatment for depression or dysthymia from psychiatric inpatient settings 16,22 ; two trials included participants with a diagnosis of depression who were not currently receiving psychiatric treatment 17,24 ; and one trial included participants who were receiving outpatient treatment for depression. 26 Based on the average baseline depression score, severity of depression was interpreted as follows: severe in two trials 24,26 ; moderate to severe in one trial 22 ; moderate in two trials 17,20 ; mild in two trials 16,25 ; average (i.e., below mild) in three trials 19,21,23 ; and unable to be classified in one trial. 18 Only two trials included baseline exercise participation data, 25,26 reporting that participants were sedentary.…”