Family Foundation Research Articles

Dissecting genetics in hypothyroidism as an independent risk factor in atherosclerotic disease

Abstract Background Thyroid disease comprises a joint group of diseases estimated to affect 10% of the general adult population [1]. Hypothyroidism is characterized by high Thyroid-Stimulating Hormone (TSH) production and low concentrations of Thyroxine (T4). This is known to increase overall mortality and risk of cardiovascular disease (CVD), including heart failure (HF), dyslipidemia, stroke, and coronary artery disease (CAD) [2,3]. Still, the association between CVD and hypothyroidism seems independent of conventional CVD risk factors. This highlights that possible genetic underlying mechanisms remain uncovered and could support CVD monitoring and treatment in patients with hypothyroidism [3]. This study aimed to dichotomize independent genetic mechanisms involved in the increased risk of atherosclerotic disease in patients with hypothyroidism. Methods We conducted the largest ever genome-wide association study (GWAS) meta-analysis of hypothyroidism from three European cohorts, which amounted to 71,590 cases and 848,581 controls. Using Linkage Disequilibrium Regression Score, we highlight novel cardiovascular disease correlations in hypothyroidism. With Mendelian Randomization, we dissected which hypothyroidism-associated Single Nucleotide Polymorphisms (SNPs) infer atherosclerotic disease risk. Results We identified 79 novel disease loci in hypothyroidism, and tested 12 correlations which identified novel genetic overlap to CVD (Figure 1). We found five significant correlations to cardiovascular disease and two to cardiometabolic disease. Interestingly, we found overlap to atherosclerotic diseases; CAD (rg=0.16, P=2.12x10–9), HF (rg=0.16, P=1.6x10–5), stroke (rg=0.17, P=1.75x10–3) and aorta aneurysm (rg=0.12, P=3.65x10–3). We also found overlap to triglycerides (rg=0.10, P=1.4x10–5) and a negative correlation to HDL (rg=−0.16, P=8.8x10–11). Mendelian Randomization suggested hypothyroidism as an independent genetic risk factor with 3% increased risk of CAD (OR=1.03, 95% CI: 1.02–1.04, P=8.1x10–7) and 4% increased risk of myocardial infarction (MI) (OR=1.04, 95% CI: 1.02–1.05, P=3.3x10–6). We identified novel causal SNPs involved in CAD and MI in genes suggesting accelerated atherogenesis, namely; TRIM14 (rs141471464, OR_MI = 1.16 and OR_CAD = 1.10), CTLA4 (rs76749018, OR_MI = 1.10 and OR_CAD = 1.11) (Figure 2). Conclusions This analysis highlights novel significant findings between atherosclerotic disease and hypothyroidism. These findings could suggest improving consideration in clinical care for hypothyroid patients at risk of atherosclerotic disease. The genetic findings point towards solid indications, that atherogenesis is frequent and accelerated in this disease. Thus, the usual treatment, monitoring, and prevention strategies, could be reviewed with respect to considering other causal pathways than dyslipidemia for atherosclerotic disease in hypothyroid patients. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The John and Birthe Meyer FoundationVilladsen Family Foundation

Retinal artery occlusion as indicator of stroke in diabetes

Abstract Background Diabetes is associated with multiple complications in organs throughout the body, including an increased risk cardiovascular disease (1). Furthermore, an association between retinal artery occlusion and diabetes have been described as well (1,2). Early predictors of complications associated with diabetes would be useful for a better prognosis of the disease. Purpose Based on data from the Danish registries, the aim of this study was to investigate whether RAO is a predictor of stroke in diabetic patients. Methods We included 992 diabetic patients with incident RAO from the Danish National Patient Register with incident RAO between 1st of January 2000 and 31st of December 2018. Each of these cases were matched on age at index, sex, and time since diabetes diagnosis with 5 random diabetes patients with no subsequent diagnosis of RAO. Survival analyses were used to estimate and contrast the risk of stroke in diabetic RAO patients compared to diabetic patients with no prior diagnosis of RAO. The included analyses were all performed at 1 and 5-year follow-up. Results At 1-year follow-up, the incidence rate of stroke in diabetic RAO patients was 10.0 per 100 person years (PY) (95% CI: 8.13–12.10). The incidence for the controls at this time point was much lower at 1.82 per 100 PY (95% CI: 1.47–2.25). After 5-years of follow-up a large difference persisted, where the cumulative incidence was 19.3% (95% CI: 16.5–22.2%) for the RAO patients compared to 7.4% (95% CI: 6.5–8.2%) for the controls. The hazard rate ratio for stroke was 5.48 (95% CI: 4.06–7.39) after 1-year follow-up and 3.17 (95% CI: 2.60–3.86) after 5-year follow-up. The results support the use of RAO as a predictor of stroke in diabetic patients. Cardiovascular diseases contribute substantially to the morbidity and mortality in diabetic patients (3,4), underlining the need for especially a predictor of cardiovascular complications in these patients. To our knowledge, the predictive usage of RAO for cardiovascular complications in diabetic patients have not been investigated previously. Small occlusions, which could indicate systemic atherosclerosis, may not always be symptomatic. Therefore, the condition may not be diagnosed before more severe events occur. Conversely, RAO usually cause visual impairments, making RAO suitable as a potential predictor of subsequent cardiovascular events. The incidence rates of stroke suggest that diabetic RAO patients should be especially monitored the first year after their RAO diagnosis, but the monitoring would be beneficial even 5 years after the RAO diagnosis to continuously evaluate risk factors and instigate early intensified treatment. Conclusion The data of this study identified a substantial larger risk of stroke in diabetic RAO patients than diabetic patients with no RAO diagnosis, indicating RAO could be a predictor of stroke in diabetic patients. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Obel Family Foundation

Martha Sharp Joukowsky, 1936–2022

Martha Sharp Joukowsky, 1936–2022

Medicaid can and should play an active role in advancing health equity.

Medicaid can and should play an active role in advancing health equity.

Cost-effectiveness of an Emergency Department–Based Intensive Care Unit

Value in health care is quality per unit cost (V = Q/C), and an emergency department-based intensive care unit (ED-ICU) model has been associated with improved quality. To assess the value of this care delivery model, it is essential to determine the incremental direct cost of care. To determine the association of an ED-ICU with inflation-adjusted change in mean direct cost of care, net revenue, and direct margin per ED patient encounter. This retrospective economic analysis evaluated the cost of care delivery to patients in the ED before and after deployment of the Joyce and Don Massey Family Foundation Emergency Critical Care Center, an ED-ICU, on February 16, 2015, at a large academic medical center in the US with approximately 75 000 adult ED visits per year. The pre-ED-ICU cohort was defined as all documented ED visits by patients 18 years or older with a complete financial record from September 8, 2012, through June 30, 2014 (660 days); the post-ED-ICU cohort, all visits from July 1, 2015, through April 21, 2017 (660 days). Fiscal year 2015 was excluded from analysis to phase in the new care model. Statistical analysis was performed March 1 through December 30, 2021. Implementation of an ED-ICU. Inflation-adjusted direct cost of care, net revenue, and direct margin per patient encounter in the ED. A total of 234 884 ED visits during the study period were analyzed, with 115 052 patients (54.7% women) in the pre-ED-ICU cohort and 119 832 patients (54.5% women) in the post-ED-ICU cohort. The post-ED-ICU cohort was older (mean [SD] age, 49.1 [19.9] vs 47.8 [19.6] years; P < .001), required more intensive respiratory support (2.2% vs 1.1%; P < .001) and more vasopressor use (0.5% vs 0.2%; P < .001), and had a higher overall case mix index (mean [SD], 1.7 [2.0] vs 1.5 [1.7]; P < .001). Implementation of the ED-ICU was associated with similar inflation-adjusted total direct cost per ED encounter (pre-ED-ICU, mean [SD], $4875 [$15 175]; post-ED-ICU, $4877 [$17 400]; P = .98). Inflation-adjusted net revenue per encounter increased by 7.0% (95% CI, 3.4%-10.6%; P < .001), and inflation-adjusted direct margin per encounter increased by 46.6% (95% CI, 32.1%-61.2%; P < .001). Implementation of an ED-ICU was associated with no significant change in inflation-adjusted total direct cost per ED encounter. Holding delivery costs constant while improving quality demonstrates improved value via the ED-ICU model of care.

"Damage Analysis of Trees in the Woodland Owned by the August Klasing Family Foundation in the Forestry Office Bielefeld, NRW, Germany Caused by the European Mouflons (Ovis Gmelini Musimon, PALLAS 1811)"

"Damage Analysis of Trees in the Woodland Owned by the August Klasing Family Foundation in the Forestry Office Bielefeld, NRW, Germany Caused by the European Mouflons (Ovis Gmelini Musimon, PALLAS 1811)"

Mental health provider shortages remain a concern in public schools

Despite an unprecedented level of engagement in trying to address the mental health needs of school‐age children, many school districts still face considerable barriers to offering effective services as the 2022–23 school year gets rolling. A report released this month by the Kaiser Family Foundation states that a shortage of qualified mental health professionals continues to stymie schools’ mental health service response.

Supply of obstetrician–gynecologists and gynecologic oncologists to the US Medicare population: a state-by-state analysis

The supply of obstetrician-gynecologists and gynecologic oncologists across the United States has been described. However, these studies focused on reproductive-age patients and did not assess the growing demand for services to the advanced-age female population. This study aimed to evaluate the supply of obstetrician-gynecologists and gynecologic oncologists who serve the US Medicare population per 100,000 female Medicare beneficiaries, over time and by state and region. The supply of obstetrician-gynecologists and gynecologic oncologists was extracted from the Physician and Other Supplier Public Use File database of Medicare Part B claims submitted to the US Centers for Medicare & Medicaid Services. Data were only available from 2012 to 2019. The supply of providers was divided by the number of original female Medicare beneficiaries obtained from the Kaiser Family Foundation; all values reported are providers per 100,000 female beneficiaries by state. Trends over time were assessed as the difference in provider-to-beneficiary ratio and the percentage change from 2012 to 2019. All data were collected in 2021. All analyses were performed with SAS, version 9.4. This study was exempt from institutional review board approval. In 2019, the average number of obstetrician-gynecologists per 100,000 female beneficiaries across all states was 121.32 (standard deviation±33.03). The 3 states with the highest obstetrician-gynecologist-to-beneficiary ratio were the District of Columbia (268.85), Connecticut (204.62), and Minnesota (171.60), and the 3 states with the lowest were Montana (78.37), West Virginia (82.28), and Iowa (83.92). The average number of gynecologic oncologists was 4.48 (standarddeviation±2.08). The 3 states with the highest gynecologic oncologist-to-beneficiary ratio were the District of Columbia (11.30), Rhode Island (10.58), and Connecticut (9.24), and the 3 states with the lowest were Kansas (0.82), Vermont (1.41), and Mississippi (1.47). The number of obstetrician-gynecologists per 100,000 female beneficiaries decreased nationally by 8.4% from 2012 to 2019; the difference in provider-to-beneficiary ratio from 2012 to 2019 ranged from+29.97 (CT) to-82.62 (AK). Regionally, the Northeast had the smallest decrease in the number of obstetrician-gynecologists per 100,000 female beneficiaries (-3.8%) and the West had the largest (-18.2%). The number of gynecologic oncologists per 100,000 female beneficiaries increased by 7.0% nationally during the study period; this difference ranged from+8.96 (DC) to-3.39 (SD). Overall, the West had the smallest increase (4.7%) and the Midwest had the largest (15.4%). There is wide geographic variation in the supply and growth rate of obstetrician-gynecologists and gynecologic oncologists for the female Medicare population. This analysis provides insight into areas of the country where the supply of obstetrician-gynecologists and gynecologic oncologists may not meet current and future demand. The national decrease in the number of obstetrician-gynecologists is alarming, especially because population projections estimate that the proportion of elderly female patients will grow. Future work is needed to determine why fewer providers are available to see Medicare patients and what minimum provider-to-enrollee ratios are needed for gynecologic and cancer care. Once such ratios are established, our results can help determine whether specific states and regions are meeting demand. Additional research is needed to assess the effect of the COVID-19 pandemic on the supply of women's health providers.

Practice patterns of dermatologists who have opted out of Medicare

Practice patterns of dermatologists who have opted out of Medicare

Correlates of suicidality among standard rating scales and the Columbia-Suicide Severity Rating Scale (C-SSRS) in adolescents undergoing transcranial magnetic stimulation

Background: Suicide is a leading cause of death in adolescents and young adults.1 This study sought to examine correlations among suicide items of standard rating scales for depression and Columbia-Suicide Severity Rating Scale (C-SSRS)2 scores in adolescents participating in a transcranial magnetic stimulation study. Methods: This study examined data from adolescent patients (N=103) enrolled in a double-blind randomized control trial of transcranial magnetic stimulation (TMS). Total scores and respective individual items assessing suicidality from the Hamilton Depression Rating Scale (HAM-D)3, Montgomery-Asberg Depression Rating Scale (MADRS)4, and Children’s Depression Rating Scale-Revised scale (CDRS-R)5 were compared with C-SSRS total severity and total intensity scores using Pearson correlation coefficients at the end of acute treatment. Results: The suicidality item of the HAM-D scores showed a positive association with C-SSRS total severity and intensity scores at the end of acute treatment for ITT sample (n=103) (r = 0.83; p-value= <0.0001, r = 0.86; p-value=<0.0001), respectively. Similarly, associations were demonstrated with the CDRS-R Item 13 scores and the MADRS scores. Conclusions: Accurate and reliable assessments of suicidality are an ongoing challenge for clinical trials and practice. Suicidality measures of HAM-D and CDRS-R correlated with the C-SSRS suicide assessment scale. These measures can potentially contribute to assessing suicidal risk and be helpful as an outcome measure to monitor treatment response in various clinical settings. Further studies should compare the sensitivity and specificity of suicidality items of HAM-D and CDRS-R. Conflicts of Interests: Dr. Croarkin has received research support from the National Institute of Mental Health, Magventure, Neuronetics, NeoSync, and Pfizer. He has received material support from and provided consultation to Myriad Neuroscience. He has consulted for Procter & Gamble Company. Dr. Elmaadawi receives research support from Duke University and the University of North Western. He receives research funding from Neurocrine, Inc, and Neuronetics. Dr. Aaronson has received research support from Compass Pathways and Neuronetics and serves as a consultant to LivaNova, Neuronetics, Janssen, Genomind, and Sage Therapeutics. He serves on speaker boards for Janssen and Sunovion. Dr. Holbert has received material support (equipment) from Neuronetics. He is also a speaker for Neuronetics. Dr. Demitrack is a consultant to Neuronetics, Inc. and a full-time employee of Trevena, Inc. Dr. Strawn has received research support from Allergan, Neuronetics, Otsuka, the National Institute of Mental Health, National Institute of Child Health and Development, and National Institute of Environmental Health Sciences as well as the Yung Family Foundation. He receives royalties from Springer Publishing and received honoraria from CMEology and Neuroscience Educational Institute. He receives royalties from UpToDate. Finally, he received material support from and provided consultation to Myriad Genetics, Intracellular Therapeutics, and the FDA. The other authors have no disclosures. Funding: This study was funded by Neuronetics, Inc.

Learning as We Go: How Emergent Process Supports Sustainable Community and Philanthropic Change

Beginning in 2014, PA Humanities, one of 56 state and territorial humanities councils across the country, drew upon the work of Orton Family Foundation to deploy the Community Heart & Soul method, which centers community planning and civic engagement around connecting people to each other, and to the many assets of the places they live, through individual storytelling and collective narrative building.

The Concept of Islamic Family Education (Study on Tafsir Ali-Imran Verses 33-37) and Its Implementation in Millennial Families in Sidoarjo Regency

The purpose of this study is to find out how the concept of Islamic family education is contained in the letter Ali-Imran verses 33-37. In this case the researcher provides answers to the following questions: 1. How is the concept of Islamic family education in accordance with the Tafsir of Ali'Imran verses 33-37. 2. How is the implementation of millennial family education at Taman Anggun Sejahtera Housing 3 Kepuh Kemiri Village. This type of research uses qualitative research for the method used in this study, namely using analysis or analysis methods. The approach used in this study is to use a descriptive approach, which is to explain the meanings contained in each verse from the main source, namely the interpretation of Surah Ali-Imran verses 33-37 and analyze the meaning contained in secondary data sources so that the results are obtained in order to The results of the research findings show that: (1) in the concept of Islamic family education in Surah Ali-Imran verses 33-37 the results of the traveler's analysis are faith education, worship education, da'wah education and moral education. (2) the application of Islamic family education in the letter Ali-Imran verses 33-37 with current education, namely by instilling values ​​that are applied every day both in the family and in the community so that the hope is able to be used as the foundation of a strong Islamic family in a person's family.

Geographic Variations in Growth of Radiologists and Medicare Enrollees From 2012 to 2019

ObjectiveAnalyze changes in the number of Medicare-serving radiologists and Medicare enrollees nationwide and by geographic region and state from 2012 to 2019 to understand variations in allocation of imaging health care services over the past decade. MethodsThe number of radiologists submitting claims to Medicare was extracted from the CMS Physician and Other Supplier Public Use File Database. The number of Medicare enrollees by state was obtained from the Kaiser Family Foundation. National-, regional-, and state-level changes in rates of growth of radiologists, Medicare enrollees, and radiologists per 100,000 Medicare enrollees from 2012 to 2019 were tabulated. ResultsThe overall number of radiologists per 100,000 Medicare enrollees was 79.7 in 2012, increasing to 79.9 in 2019. In 2012, the number of radiologists per 100,000 enrollees was lower than the national average in the South (66.9; 16% lower) and Midwest (79.1; 0.7% lower) and higher in the Northeast (98.3; 23% higher) and West (88.8; 11% higher). In 2019, the number of radiologists per 100,000 enrollees was lower than the national average in the South (69.8; 12% lower) only and was higher in the Midwest (81.4; 1.9% higher), Northeast (99.3; 24% higher), and West (80.2; 0.4% higher). By state, there was a 4.2-fold variation in the number of radiologists per 100,000 Medicare enrollees, ranging from 38.8 in Wyoming to 161.4 in Minnesota (200.5 in Washington, DC). DiscussionThe growth of Medicare-serving radiologists and Medicare enrollees was stable nationally and demonstrated tremendous variations by US region and state. These variations bring to light potential implications for patient access to care and distribution of health care resources.

Precision Agriculture and Soil Health

This is the final article in the Soil Health Institute’s 2022 series on Assessing Soil Health. In previous articles in this series, we covered aspects of soil carbon sampling and carbon marketplaces, provided details on the economics of soil health systems, and outlined a strategy for offering consulting services for soil health. In this article, we will discuss some of the ways precision agriculture can be used to enhance soil health. All articles in this series can be viewed online at https://bit.ly/3aLJemR. The Assessing Soil Health Series is part of a larger Soil Science Society of America webinar series produced in partnership with The Soil Health Institute and sponsored by The Walton Family Foundation. Earn 0.5 CEUs in Soil &amp; Water Management by reading the article and taking the quiz at https://web.sciencesocieties.org/Learning‐Center/Courses.

Beyond Charity: Family Foundations Perpetuating Longevity of Family Businesses

Family foundations are prevalent, but seldom have researchers examined its function and influence as an ownership vehicle for family businesses. This paper advances an institutionalized reference-point theory to explain family foundation’s role on perpetuating family business. The theory posits that these foundations cultivate family members long-term commitment to corporate responsibility which enhances the identification and socio-economic wealth creation of business families. In a longitundinal study of public-listed family businesses (1996-2016) in Taiwan using survival analysis, the presence of family foundation not only itself promotes, but also, as a moderator, heightens the positive effect of family ownership on longevity of family firms. Qualitative evidence from interviewing professional accountants affirmed that family foundations strengthened the identification of members to the family businesses. Further, while their purpose was for charity and not control of the business, establishing the foundation shifted family members’ orientation for the long-term, which resulted in longer survival.

The Explosive Growth of Telehealth Throughout the COVID-19 Pandemic and Beyond

The Explosive Growth of Telehealth Throughout the COVID-19 Pandemic and Beyond

Effect of Stem Cell Infusion Therapy on Sexual Function in Women with Type 2 Diabetes and Metabolic Syndrome: Post-Hoc Analysis of Randomized Controlled Trials

ABSTRACT Introduction There is a growing interest in restorative therapies for sexual function, yet there exists a paucity of human research into potential therapeutic applications of stem cell therapy (SCT). Mesenchymal Stem Cells (MSCs) and their effect on sexual function have not yet been explored in women with Type 2 Diabetes Mellitus (DM) and Metabolic Syndrome (MetS). Objective To determine the safety and efficacy of intravenous mesenchymal stem cell infusion therapy on sexual function in women with DM or MetS. Methods Female participants enrolled in the ACESO (NCT02886884) and CERES (NCT03059355) clinical trials completed the Sexual Quality of Life Questionnaire-Female (SQOL-F). SQOL-F is a validated 18-item self-assessment questionnaire rated on a six-point scale ranging from “completely agree” to “completely disagree” in which higher scores reflect better sexual quality of life. Participants were enrolled in the trials based on diagnosis of DM or MetS, respectively. Intervention in both trials was peripheral intravenous infusion of allogeneic MSCs. Follow-up was for 1 year. Questionnaires were collected at baseline and 1-, 3-, 6-, and 12-months post-infusion. Participants received 20 or 100 million MSCs from either bone marrow (n=5) or umbilical cord (n=2). Results Data was pooled from 7 women who participated in the two trials; 5 were from ACESO and 2 were from CERES. Three received high dose MSCs (100 million) and four received low dose (20 million) MSCs. The women in the ACESO trial received MSCs derived from healthy allogeneic donor bone marrow, and both women in the CERES trial received umbilical cord tissue derived MSCs. Median age was 73 [IQR=55-74] years. Six of the seven (86%) had past medical history of hypertension. Median SQOL score among all women at baseline was 30 [IQR=19-50], 25 [IQR=23-36] at 1 month, 34 [IQR=19-46] at 3 months, 29 [IQR=21-32] at 6 months, and 34 [IQR=26-49] at the end of 12 months. Improvements in SQOL from baseline through follow up did not meet level of statistical significance. Limitations of this study include the absence of a placebo-control group, the small sample size, and that sexual function was not a primary endpoint of the original trials. Conclusions SQOL did not appear to improve following peripheral infusion of MSCs in women with DM or MetS, but nevertheless appears to be safe with no decline in sexual function over the following 1 year. Larger clinical trials with placebo-controls are needed to further investigate the optimal dose, source, and route administration of SCT to enact a meaningful change in sexual function in women with DM or MetS. Disclosure Yes, this is sponsored by industry/sponsor: This work was supported by National Institutes of Health Grant R01 DK130991 and Clinician Scientist Development Grant from the American Cancer Society to RR. JMH is supported by National Institutes of Health grants 1R01 HL137355, 1R01 HL107110, 1R01 HL134558, 5R01 CA136387, and 5UM1 HL113460 and Soffer Family Foundation. Clarification Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: JMH discloses a relationship with Vestion Inc. that includes equity, board membership, and consulting. Neither Longeveron, Vestion, or any other companies participated in the funding of this work. All other authors indicated no potential conflicts of interest.

Engaging Trainees by Enriching Nephrology Elective Experiences.

Engaging Trainees by Enriching Nephrology Elective Experiences.

Review: Via Chicago, by J. E. Sumerau

Review: <i>Via Chicago</i>, by J. E. Sumerau

P123 Novel Type 2 Diabetes Prevention Curriculum Increased Skin Carotenoids and Lowered BMI Percentile in Adolescents

<h3>Background</h3> Adolescent type 2 diabetes (T2D) incidence increased 4.8% annually between 2002-2015 and accounts for 20% of adolescent diabetes diagnoses. Obesity is strongly correlated with T2D among adolescents. Few previous interventions show efficacy at improving adolescent eating and exercise behaviors, which could decrease the proportion of overweight and obese adolescents and reduce risk for T2D. <h3>Objective</h3> To evaluate efficacy of a novel T2D prevention curriculum on nutrition behaviors and anthropometrics in adolescents. <h3>Study Design, Setting, Participants</h3> Quasi-experimental intervention versus control study with convenience sampling. Trained researchers taught curriculum to adolescents at three schools during mandatory health education classes, while students in three population-matched control schools received standard nutrition education in their health education classes. Six lessons incorporated elements of Social Cognitive Theory including technology, goal-setting, competition, incentives, and peer support to promote behaviors that reduce risk for type 2 diabetes. Outcome variables were assessed at baseline (T1); 1-day post curriculum delivery (T2); and 1-month follow-up (T3). <h3>Measurable Outcome/Analysis</h3> Outcome variables included BMI percentile for age and sex, skin carotenoids, and sugar-sweetened beverage (SSB) intake. Multi-level general linear mixed effects regression models, independent t-tests, and Pearson chi-square tests assessed differences in intervention effectiveness (Stata version 15). <h3>Results</h3> Adolescents in intervention group (n = 436) lowered BMI percentile (<i>P</i> = 0.011) and increased skin carotenoids (<i>P</i> < 0.001) compared to control group (n = 316), at T3 follow-up visit. No changes in SSB consumption occurred. <h3>Conclusions</h3> Novel intervention components may increase adolescent motivation and engagement, resulting in behavioral changes that reduce risk for type 2 diabetes. Future intervention designs focused on strategies shown to motivate adolescent behavior change are recommended. <h3>Funding</h3> Larry and Gail Miller Family Foundation