Abstract
BackgroundRural Appalachian populations have poorer health and fewer positive health-related behaviors compared to other United States populations. Appalachians are the most sedentary U.S. population and teens are particularly sedentary. Obesity prevention through improving physical activity is a top priority in Rural Healthy People 2020. Obesity prevalence among Appalachian teens exceeds the national rates of 13.9% and has consistently been greater than 26%. Organized sports has not been effective at improving daily physical activity or health outcomes for Appalachian teens. The purpose of this study is to test the efficacy of a 10-week school-based intervention in promoting self-regulation of physical activity among adolescents not participating in organized sports. By using accelerometers, our study will measure both sedentary time and planned exercise during waking hours.MethodsThe design for this four-year study is a group-randomized controlled trial (G-RCT). We will recruit high schools in 3 waves, with 4 in Wave 1, 8 in Wave 2, and 8 in Wave 3, for a total of 20 schools. For each wave of schools, we will randomly assign half of the schools to each condition--intervention (peer-to-peer mentoring [MBA]) and comparison (teacher-led [PBA])--for a total of 10 schools in each of the two conditions by study’s end. We will collect data at baseline (T1), 3 months post intervention (T2), and 6 months post intervention (T3). Linear Mixed Models (LMMs) and Generalized Linear Mixed Models (GLMMs) will be used to test the main hypotheses. Power for this study was based the primary analysis comparing BMI outcomes at T2 between the groups, adjusting for baseline BMI values.DiscussionThis study provides age-appropriate lifestyle education and skill building. Peer-to-peer mentoring by local high school students and school-based tailored support strengthens sustainable behavioral change. Focusing on unique healthy-lifestyle challenges prevalent in low-resource areas such as Appalachia such as overcoming environmental, social, and psychological barriers may improve adherence to physical activity. Serving as role models, peer mentors may improve their own lifestyle behaviors, providing a dual intervention.Trial registrationNCT02329262.
Highlights
Rural Appalachian populations have poorer health and fewer positive health-related behaviors compared to other United States populations
The long-term goal of this study is to positively impact the physical activity patterns to improve health outcomes including the high rates of obesity in Appalachian teens
This study is innovative by: (a) providing age-appropriate lifestyle education and skill building; (b) providing peer-to-peer mentoring by local high school students and school-based tailored support to change behaviors; (c) focusing on unique healthy-lifestyle challenges prevalent in low-resource areas such as Appalachia; (d) overcoming environmental, social, and psychological barriers to improve adherence to physical activity; and (e) increasing teen resources and support to perform the targeted behaviors
Summary
Rural Appalachian populations have poorer health and fewer positive health-related behaviors compared to other United States populations. Obesity prevalence among Appalachian teens exceeds the national rates of 13.9% and has consistently been greater than 26%. Obesity prevalence among Appalachian teens exceeds the national rates of 13.9% and has persistently been greater than 26% [10,11,12,13,14,15,16]. The high prevalence of obesity combined with high rates of sedentary behaviors place Appalachian teens at increased risk for development of poor health outcomes later in life. Though most teens in the United States receive less physical activity than is recommended, in rural, under-resourced areas of Appalachia, sedentary activity rates are significantly higher than national levels [2, 10, 17,18,19]
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