Strong Teens for Healthy Schools (STHS) is a school-based, civic engagement program that empowers middle school students to improve their physical activity and healthy eating behaviors, improve their cardiovascular disease outcomes, and create positive change in their school health environments.
The investigators will conduct a cluster-randomized controlled trial to evaluate the impact of the Strong Teens for Healthy Schools (STHS) program on cardiovascular disease-related outcomes. STHS is a multi-level, theory-based civic engagement program to catalyze positive food and physical activity environmental change and improve cardiovascular disease-related health (CVD) outcomes among 6th and 7th-grade students. Title 1 middle schools in Texas (n=20) with \> 40% Hispanic and Black students will be randomized at baseline to the intervention condition (STHS program) or control condition (will continue with usual care, as they will not be asked to add or remove any of their current, physical activity, healthy eating, or positive youth development programming) (n=20-25 students per school). The investigators hypothesize that students who participate in STHS will have reduced MetS risk, improved positive youth developmental outcomes, and improved social and environmental outcomes immediately post-intervention and one year after study completion compared to students in a control condition.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
500
STHS program The intervention group (10 schools) will participate in the STHS program. During the fall semester (September to December), the intervention group will receive 24 thirty-minute modules (or twelve 1-hour modules) that provide education on civic engagement, healthy eating, and physical activity. During the spring semester (February to May), the intervention group will receive 24 thirty-minute modules (or twelve 1-hour modules) that focus on implementing the school health environmental change project and receive support for maintaining individual-level healthy eating and physical activity behaviors.
No STHS program The usual care group will be offered the same activities as the intervention group after the conclusion of the research study.
Texas A&M AgriLife Dallas Center
Dallas, Texas, United States
RECRUITINGPresence or absence of metabolic syndrome (MetS)
MetS is present after identifying abdominal obesity plus at least two of the four other MetS Risk factors: high blood pressure, high blood sugar, low HDL cholesterol, and high triglyceride levels. MetS = (abdominal obesity) + (2 of 4 other MetS Risk factors) Measures to determine MetS risk factors: 1. Abdominal obesity: waist circumference \>90th percentile for child's sex and age 2. High blood pressure: systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥90 mmHg) 3. High blood glucose: blood glucose ≥5.6 mmol/L or known diabetes 4. Low HDL cholesterol: HDL cholesterol \<1.03 mmol/L 5. High triglyceride level: Triglyceride level ≥ 1.7mmol/L
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Change in the number of MetS risk factors
Change in the number of MetS risk factors = (new # of MetS risk factors) - (original # of MetS risk factors) Measures to determine MetS risk factors: 1. Abdominal obesity: waist circumference \>90th percentile for child's sex and age 2. High blood pressure: systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥90 mmHg) 3. High blood glucose: blood glucose ≥5.6 mmol/L or known diabetes 4. Low HDL cholesterol: HDL cholesterol \<1.03 mmol/L 5. High triglyceride level: Triglyceride level ≥ 1.7mmol/L
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Positive Youth Development score
Positive youth development will be measured using a 5 C's Model of Positive Youth Development Scale-Short Form (PYD-SF): A 34-item scale that assesses the strength of psychological, behavioral, and social development in youth. The five dimensions measured are: 1. Competence (sense of proficiency) 2. Confidence (self-worth, self-efficacy) 3. Character (adherence to societal and cultural rules) 4. Connection (bonds with people and institutions) 5. Caring (sympathy and empathy towards others)
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
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Blood pressure level
Blood pressure (systolic and diastolic) will be measured with two numbers using an automated Omron sphygmomanometer.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Concentration of blood glucose
Glucose will be measured using a portable Cholestech LDX analyzer to assess a single capillary blood sample following an overnight fast.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Waist circumference
Waist circumference will be measured at the midpoint between the floating rib and iliac crest using a tape measure.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Concentration of HDL cholesterol
HDL-C will be measured using a portable Cholestech LDX analyzer to assess a single capillary blood sample following an overnight fast.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Concentration of serum triglycerides
Triglycerides will be measured using a portable Cholestech LDX analyzer to assess a single capillary blood sample following an overnight fast.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Height
Height will be measured using a stadiometer in inches.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Weight
Weight will be measured with a scale in pounds.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Body mass index (BMI)
Weight will be measured with a scale, and height will be measured using a stadiometer. BMI will be calculated as BMI = (weight (lb)/height (inches)2) x 703.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Concentration of subdermal carotenoids
The concentration of subdermal carotenoids will assess the changes in fruit and vegetable consumption using the Veggie Meter: A non-invasive, portable machine that measures subdermal carotenoid levels using resonance Raman spectroscopy.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
Accelerometer-derived physical activity estimation
Physical activity will be measured using Actigraph accelerometers. Measurements will include light physical activity (PA), moderate PA, moderate to vigorous PA, and vigorous PA.
Time frame: Baseline to 9 months
Sedentary time
Sedentary time will be measured using Actigraph accelerometers.
Time frame: Baseline to 9 months
Time spent sleeping
Sleep time will be measured using Actigraph accelerometers.
Time frame: Baseline to 9 months
Physical fitness capacity estimation
Physical fitness will be measured using the FitnessGram PACER multistage aerobic capacity test: Children will run back and forth 20 meters, with an initial running speed of 8.5 km/hour and a progressive 0.5-km/hour increase in running speed every minute. As the test continues it becomes progressively harder. The number of laps completed is used to estimate children's physical fitness physical fitness.
Time frame: Baseline, 9 months (immediate post intervention), 4 months and 12 months post intervention
School physical activity and nutrition environment assessment
The school's physical activity and nutrition environments will be measured using a self-reported School Environment Survey.
Time frame: Baseline to 9 months
Assessment of perceptions of school environments and school-specific dietary intake patterns
Perceptions related to physical activity and nutrition within the school setting will be measured using the Perceptions of the Environment and Patterns of Diet at School (PEA-PODS) survey.
Time frame: Baseline to 9 months
Assessment of perceived sociopolitical control
Perceived sociopolitical control will be measured using the Youth Engagement and Action for Health (YEAH!) survey. The YEAH survey will be used to assess students' perceived sociopolitical control (i.e., participation in advocacy programs and optimism for change).
Time frame: Baseline to 9 months
Assessment of assertiveness
Assertiveness will be measured using the Youth Engagement and Action for Health (YEAH!) survey. The YEAH survey will be used to assess students' assertiveness (i.e., ability to engage with adults and peers).
Time frame: Baseline to 9 months
Assessment of participatory competence and decision-making
Participatory competence and decision-making will be measured using the Youth Engagement and Action for Health (YEAH!) survey. The YEAH survey will be used to assess students' participatory competence and decision-making (i.e., ability to influence group decision-making).
Time frame: Baseline to 9 months
Assessment of advocacy outcome efficacy
Advocacy outcome efficacy will be measured using the Youth Engagement and Action for Health (YEAH!) survey. The YEAH survey will be used to assess students' advocacy outcome efficacy (i.e., belief in their ability to work with others to improve the school's physical activity and nutrition environment).
Time frame: Baseline to 9 months
Peer concentration of subdermal carotenoids
The concentration of subdermal carotenoids will assess peers' engagement in health behaviors changes in fruit and vegetable consumption using the Veggie Meter: A non-invasive, portable machine that measures subdermal carotenoid levels using resonance Raman spectroscopy.
Time frame: Baseline to 9 months
Peer Body mass index (BMI)
Peers' engagement in health behaviors will be measured by the change in peers' BMI. Weight will be measured with a scale, and height will be measured using a stadiometer. Calculate BMI with the formula: BMI = (weight (lb)/height (inches)2) x 703.
Time frame: Baseline to 9 months
Peer physical fitness capacity estimation
Peers' engagement in health behaviors will be measured by the change in peers' physical fitness. Physical fitness will be measured using the FitnessGram PACER multistage aerobic capacity test: Children will run back and forth 20 meters, with an initial running speed of 8.5 km/hour and a progressive 0.5-km/hour increase in running speed every minute. As the test continues it becomes progressively harder. The number of laps completed is used to estimate children's physical fitness physical fitness.
Time frame: Baseline to 9 months