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Objective: Healthy dietary habits, physical activity, and positive mental health help prevent or manage excess weight among adolescents. HealthyMe curriculum modules are designed to improve those health behaviors among middle and high school students. Methods: The HealthyMe curriculum was implemented through health classes and health-promoting activities. We evaluated the changes in weight and key health behaviors from 23 schools across 8 states in the 2017-2018 academic year. We analyzed pre-post comparisons adjusting for lesson attendance, race/ethnicity, and age, and for clustering effects of schools. We also compared percentages of improved behaviors between sexes and between rural and non-rural schools. Results: Data were available from 1463 students (44% boys, age = 15.6 (1.3) years). Body mass index (BMI) metrics, in general, were significantly improved among students who were overweight or obese. Significant positive health behavior changes reported by both boys and girls were increasing breakfast and decreasing sugary beverage consumption. Girls significantly increased fruit and vegetable intakes and physical activities; boys significantly decreased dinner at home and physical activities. Students in rural schools tended to have a smaller number of significant changes and improved behaviors. Conclusions: The HealthyMe curriculum improved weight among students, who were overweight or obese, even though it focuses on health behaviors rather than directly addressing weight issues. The positive health behavior changes in conjunction with weight improvements may reflect synergy between the health promotion teaching and school policies.

BACKGROUND: School health curricula should help students choose health goals related to the Dietary Guidelines (DG) recommendations addressing obesity. We aimed to identify characteristics associated with choice of DG recommendation items. METHODS: In 12 HealthCorps affiliated high schools, students completed a 19-item web-based questionnaire that provided a personalized health-behavior feedback report to guide setting SMART (Specific, Measurable, Action-oriented, Realistic, Time-bound) goals. We examined if gender, weight-status, and personalized feedback report messages were related to student-selected SMART Goals. RESULTS: The most frequent SMART Goals focused on breakfast (22.4%), physical activity (21.1%), and sugary beverages (20.4%). Students were more likely to choose a SMART goal related to breakfast, sugary beverages, fruit/vegetable intake or physical activity if their feedback report suggested that health behavior was problematic (p

Objective. To evaluate whether clustering effects, often quantified by the intracluster correlation coefficient (ICC), were appropriately accounted for in design and analysis of school-based trials. Methods. We searched PubMed and extracted variables concerning study characteristics, power analysis, ICC use for power analysis, applied statistical models, and the report of the ICC estimated from the observed data. Results. N=263 papers were identified, and N=121 papers were included for evaluation. Overall, only a minority (21.5%) of studies incorporated ICC values for power analysis, fewer studies (8.3%) reported the estimated ICC, and 68.6% of studies applied appropriate multilevel models. A greater proportion of studies applied the appropriate models during the past five years (2013–2017) compared to the prior years (74.1% versus 63.5%, p=0.176). Significantly associated with application of appropriate models were a larger number of schools (p=0.030), a larger sample size (p=0.002), longer follow-up (p=0.014), and randomization at a cluster level (p<0.001) and so were studies that incorporated the ICC into power analysis (p=0.016) and reported the estimated ICC (p=0.030). Conclusion. Although application of appropriate models has increased over the years, consideration of clustering effects in power analysis has been inadequate, as has report of estimated ICC. To increase rigor, future school-based trials should address these issues at both the design and analysis stages.

Background Implementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings. We conducted a randomized controlled trial to evaluate the effects of implementing the American Academy of Pediatrics overweight/obesity recommendations using a Standard Care approach alone or with the addition of an enhanced program in a safety-net pediatric primary care setting (located in Bronx, New York, United States). Methods In a 12-month trial, families of children (age 7–12 years; body mass index ≥85th American percentile for age and sex; 74% self-identified as Hispanic/Latino; n = 360) were randomly assigned to receive Standard Care Alone or Standard Care + Enhanced Program. An English/Spanish bilingual staff provided the Standard Care Alone consisting of quarterly semi-structured pediatrician visits targeting family-based behavioral changes. The Standard Care + Enhanced Program was enriched with eight Skill-Building Core and monthly Post-Core Support sessions. Results The mean body mass index Z-score declined in both arms (P