Reducing Obesity & Diabetes in High Risk Youth

Yale University, New Haven CT

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05), Comparative Effectiveness Research and Specific Challenge Topic, 05-MD-102, Prevention of Chronic Diseases in Disparity Populations. Building on our previous research in teens with type 1 diabetes (T1D) and in minority teens at high-risk for type 2 diabetes (T2D), we propose to develop and evaluate the comparative effectiveness of two innovative and interactive web-based high school educational programs aimed at reducing obesity and risk for T2D in a population of high risk teens. The aims are to: 1. Modify a classroom-based educational and coping skills training (CST) intervention developed to reduce obesity and T2D risk in minority teens (Tween") and an internet CST program developed for youth with T1D (TeenCope") collaboratively with teens, parents, high school teachers, our Information Technology (IT) team, and our research team. The outcome of this modification process will be two interactive web-based high school educational programs. One program will be a comprehensive psychoeducational curriculum on healthy eating and physical activity to prevent obesity and T2D (health-e-teen) and the other will provide the same psychoeducational curriculum plus a CST component (health-e-teen + CST). 2. Conduct a pilot test of all processes and procedures associated with delivering the internet programs in a classroom setting to high school students. 3. Compare the effect of the health-e-teen program and the health-e-teen + CST program delivered to high school students on BMI, nutrition and physical activity behaviors, and self-efficacy over 6 months. Usage, satisfaction, and costs will also be compared. In collaboration with the West Haven and 2 New Haven high schools, and our established IT and research team, we will use the same approach we used to successfully translate our in-person CST program for teens with T1D to the internet, now being tested in a large clinical trial. This approach will be iterative and participatory, including the targeted users in the design, development, and evaluation phases to develop two interactive internet programs (health-e-teen;health-e-teen + CST). These programs will build on the 'reading and writing across the curriculum'initiatives that fit with current educational priorities. Following development, the feasibility of program delivery will be evaluated and final revisions to the programs or the processes will be completed by the end of year 1. In the second year, a randomized comparative effectiveness trial will be undertaken in the West Haven and New Haven public high schools. The program will be offered in the fall of the second year of the project. All youth in the 10th grade will be eligible to participate. The population of these schools is 50% Hispanic, 58% African American, 40% White, and 6% other. Inclusion criteria include pupils in the appropriate classes who have parental permission to participate. No youth will be excluded from participation, yielding a potential sample size of nearly 900. Data on health behaviors, weight and height to calculate BMI, self efficacy, and satisfaction will be collected online at baseline, 3, and 6 months. Usage and cost data will be collected throughout. Analyses will include mixed model ANCOVA, stratifying by weight status (BMI <85th %'ile, BMI >85th%'ile). This approach will allow us to provide a standard curriculum in the schools on a critical topic - health education and behavioral support to promote healthy eating and physical activity - in an interactive format that is appealing to teens. The program will allow for primary and secondary prevention of obesity and T2D in a high risk, minority population. While there are a number of barriers and challenges for this population, including limited internet access, poor health literacy, and the obesogenic environment, our approach will allow us to reach a large number of youth through the schools, provide much needed education at a low health literacy level, engage teens in the content by using media and technology innovatively, and provide teens with the skills to overcome environmental challenges and change behavior. In addition, we propose a comparative effectiveness trial of two psychoeducational programs, one with CST and one without CST. Delivery of these programs over the internet allows for standardization of intervention delivery, which is important to comparative effectiveness research, yet often challenging in behavioral research. Most importantly, because of our ongoing relationship with the schools and our experience in developing an engaging internet-based program for teens with T1D, we can overcome myriad barriers to the challenging problem of obesity and T2D in youth and be successful in the development and evaluation of two innovative and interactive internet programs. Public Health Relevance Obesity and type 2 diabetes have increased in prevalence among youth at an alarming rate. In minority communities, the rates are as high as nearly 30%. Approaches that are appealing to youth and that can be cost-effectively delivered are necessary to reduce this epidemic.