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HEALTHY is a primary prevention trial conducted in 42 middle schools at 7 locations across the US to impact risk factors for type 2 diabetes in adolescents. Students are recruited at start of 6th grade (fall 2006) and followed to end of 8th grade (spring 2009). Half of the schools are randomized to receive an intervention that integrates four components: the school nutrition environment, physical education class activities, behavior change initiatives, and educational and promotional communications activities.
In response to increases in incident cases of type 2 diabetes in American children and youth, NIDDK has funded a multi-site primary prevention trial designed to moderate risk for type 2 diabetes in middle school aged children. In pilot studies, it was found that an indicator of adiposity, a body mass index greater than the 85th percentile for gender and age, is the most prevalent, modifiable risk factor for diabetes in this age group. In addition, indicators of insulin resistance and dysglycemia, elevated mean fasting insulin and glucose levels, can be assessed to determine if the intervention is capable of reducing these risk factors for diabetes in middle school aged children.
The trial is conducted at 7 field centers in 42 middle schools randomly assigned to intervention or control. Following student recruitment and baseline data collection in the first semester of 6th grade (2006), the intervention is implemented in the second semester of 6th grade (2007) and continues throughout 7th (school year 2007-2008) and 8th (school year 2008-2009) grades. All students are exposed to components of the intervention, which are implemented school-wide or grade-wide; however, only students who provide appropriate informed consent and assent participate in data collection and evaluation. The primary objective of the trial is to determine if, at the end of the 8th grade, the intervention significantly impacts the risk for developing type 2 diabetes compared to control.
Six pilot studies were performed to collect data to guide the development of an intervention (see appendix 14.2). The prior studies focused on:
- Establishing the feasibility of recruiting students and obtaining physical and physiological measurements, including fasting and 2-hour post glucose load blood draws (early 2003).
- Evaluating a physical education (PE) class program designed to increase moderate-to-vigorous physical activity (late 2003).
- Testing the ability of a nutrition intervention to change food and beverage offerings in school food service and vending (early 2004).
- Implementing a program that integrated the PE class and food service nutrition interventions with a communications and awareness campaign (fall 2004).
- Determining the feasibility of a behavior change intervention, delivered through in-class and other school settings and family outreach, to accomplish self monitoring and goal setting (fall 2005).
- Evaluating PE class activities targeting 7th and 8th graders and a training and support program to motivate PE teacher buy-in and adherence (fall 2005).
Formative research has been conducted to inform the creation of all intervention components.
Based on a comprehensive review of the literature and the pilot study results, a robust multi-component intervention has been developed that impacts the environment and lifestyle choices of middle school children. The intervention consists of the following integrated components:
- changes in the nutritional quality of food and beverage offerings throughout the total school food environment, including cafeteria meals and programs, a la carte, and vending machines;
- changes in the physical education (PE) program, equipment, and teacher training to increase both participation and number of minutes spent in moderate-to-vigorous physical activity when implemented by PE teachers in PE class;
- brief classroom activities designed to increase knowledge, enhance decision making skills, promote peer involvement and interaction, and enhance social influence;
- individual and group behavior change initiatives aimed at promoting healthier behaviors through self monitoring, goal setting, and problem solving;
- family outreach to involve parents/guardians and family members by providing information and strategies to support youth in accomplishing behavioral goals; and
- school-wide communications to enhance and promote changes in nutrition, activity, and behavior.
In addition to the primary objective of affecting risk for T2D, major secondary objectives are to: further understand and characterize the etiology of risk of T2D in this age group; evaluate the ability of the intervention to influence lifestyle changes and choices both in and out of school; determine the cost-effectiveness of the intervention; compare academic performance, attendance, and comportment in intervention versus control schools; and describe the influence of non-study changes in the school environment that affect student nutrition and physical activity. Finally, data are collected to evaluate the degree to which the components of the intervention are delivered and administered as planned.
Allocation: Randomized, Control: Active Control, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
Type 2 Diabetes
integrated program of nutrition, activity, behavior, and promotion
University of California at Irvine
Active, not recruiting
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Published on BioPortfolio: 2014-08-27T03:39:12-0400
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Component of the NATIONAL INSTITUTES OF HEALTH. It conducts and supports basic and applied research for a national program in diabetes, endocrinology, and metabolic diseases; digestive diseases and nutrition; and kidney, urologic, and hematologic diseases. It was established in 1948.
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