School-based Wellness Program Research Articles

Non-Cooperation within a School-Based Wellness Program during the COVID-19 Pandemic-A Qualitative Research.

This paper presents a qualitative analysis of COVID-19′s impact on the development, delivery, and uptake of “Favoring Myself”, a school-based interactive wellness program conducted via Zoom during 2020–2021. “Favoring Myself” targets resilience, self-esteem, body-esteem, self-care behaviors, and media literacy among 5th-grade preadolescents. Data were obtained from meetings, 23 semi-structured interviews with parents, teachers, and principals, and other modes of correspondence. All data were transcribed and thematically analyzed. The analysis highlighted the barriers faced when delivering external programs during COVID-19. Parents’ difficulties in cooperating with the program, distrustful relationships between parents and the education system, as well as teachers’ overload and stress, were identified as barriers to the external program’s sustainability. These challenges are discussed in light of previous studies of school-based programs, the psychological and social contexts of an ongoing crisis and the impact of neoliberalism on education. This study concludes that school-based prevention programs and accompanying research should be more flexible and focus on understanding and relating to parents’ and schools’ fears, uncertainties, and resistance. It is the hope of the authors that knowledge created through this exploration will be helpful in future coping vis-à-vis prevention program teams and recipients in times of unpredictable, unmanageable, and overpowering crises.

Feasibility and effect of adding a concurrent parental component to a school-based wellness program using two modes of mobile-based technology \u2013 mixed methods evaluation of RCT

BackgroundThis study assessed the feasibility and effect of two mobile modes (WhatsApp vs. a specially designed app) in their delivery of updates and assignments to parents.MethodsTwo three-armed, randomized, controlled feasibility studies were conducted. In each trial, four schools with a total of 418 students in grade 5th, mean age 10.1 years, were randomly allocated to the control arm, youth-only arm, or youth & parental component arm. Only the data of those that completed all three assessments (pre, post and 3 months post program) were analyzed: 133 in the first trial and 137 in the second.In the youth-only arm, students participated in an interactive age-tailored prevention program delivered in 10 weekly, 90-min sessions on self-care behaviors, media literacy, self-esteem, and positive body image. The control groups in both studies received three health- and nutrition-related sessions.In the parental arm, in addition to the ‘Favoring-Myself–Young’s ten sessions program, parents received updates and were requested to complete shared assignments with their children. In the first year, the assignments were sent via WhatsApp, and in the following year via “Favoring Myself” smartphone application.Facilitators were third year undergraduate students. They used a detailed semi-structured guide and received 4-weekly hours of didactic and group dynamic supervision. Mixed-methods assessments were performed using semi-structured interviews with ten parents and five school staff members each year, as well as a computerized self-report questionnaire.ResultsFeasibility of parent-adolescent shared assignments in both digital modes was lower than expected. The use of WhatsApp had higher feasibility and uptake than the use of the special application.The addition of the concurrent parental component via WhatsApp was associated with superior improvement in self-esteem and identification of advertisement strategies, compared with the youth-only program. However, adolescents in the youth-only program delivered via the smartphone application demonstrated superior improvement compared to those in the youth and parental component arm.ConclusionsAlthough the addition of the concurrent parenting component was praised by the actively participating parents, overall, under the chosen structure and population, it did not prove to add statistically significant value to the youth-only arm.Trial registrationsNCT03216018 (12.7.2017) and NCT03540277 (26.4.2018).

High Technology Use at Bedtime Doubles Risk for Sleep Insufficiency

Source: Stine F, Collier DN, Fang X, et al. Impact of body mass index, socioeconomic status, and bedtime technology use on sleep duration in adolescents [published online ahead of print September 25, 2021). Clin Pediatr (Phila). doi:10.1177/00099228211047791Investigators from East Carolina University, Greenville, NC, conducted a cross-sectional study to evaluate the association of use of technology prior to going to bed and insufficient sleep. Study participants were children enrolled in the seventh grade in the fall of 2017 at 1 of 47 schools in 10 counties in North Carolina who were participating a school-based wellness program. Data were analyzed on those children in the program who had height and weight measured for BMI determination and who completed a questionnaire on sleep and technology use. Participant sex and race data also were collected. Socioeconomic status was approximated for each participant by school-level participation in the National School Lunch Program (NSLP), with higher percentages of participation indicative of lower SES. The primary study outcome was insufficient sleep, defined as a self-report of sleeping <8 hours/night. The main exposure of interest was high technology use (TU), which was based on a student reporting use of a form of technology within 1 hour of trying to go to sleep either “a few nights each week,” or “every night or almost every night.” The bivariate association between insufficient sleep and self-report of having a TV in the bedroom, being overweight (BMI ≥85th and <95th percentile for age) or obese (BMI >95th percentile for age), sex, race, and SES also were evaluated using chi-square tests. Logistic regression was used to determine the independent association of these variables and insufficient sleep.Data were analyzed on 3,956 seventh graders, of whom 38.7% reported getting insufficient sleep (<8 hours/night), 83.1% reported high TU, and 72.9% reported having a TV in their bedroom. There were no significant differences in reporting insufficient sleep by sex (P = 0.116), or race (P = 0.160), and these characteristics were not included in the multivariate model. In the multivariate logistic model, high TU was an independent predictor of insufficient sleep (OR, 0.53; 95% CI, 0.46, 0.61), indicating that the risk of sleep <8 hours/night was almost twice as high in those with high TU. Having a TV in the bedroom (OR, 0.82; 95% CI, 0.70, 0.95) and being obese (OR, 0.82; 95% CI, 0.70, 0.95) also were significantly associated with sleeping <8 hours/night. There was no significant association between being overweight and insufficient sleep (OR, 0.85; 95% CI, 0.71, 1.01), but children in schools with higher participation in the NSLP were at significantly increased risk for reporting <8 hour/night of sleep.The authors conclude that seventh graders reporting high bedtime TU were at increased risk for insufficient sleep.Dr Candee has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Adolescent sleep deprivation is a growing health problem with profound consequences, including depressed mood, cognitive impairment, behavioral dysregulation, and poor school performance.1 This problem is in large part related to the availability and use of electronic devices at bedtime.2The investigators of the current study found that more than a third of nearly 4,000 seventh graders in rural North Carolina were not getting sufficient sleep. Those with high TU within 1 hour of trying to go to sleep were nearly twice as likely (as those with lower TU) to be getting <8 hours of sleep per night. Having a TV in the bedroom, obesity, and lower SES also were associated with a higher likelihood of sleep insufficiency. The study results fortify those of previous studies showing that portable devices have more deleterious effects on sleep than those that are not (eg, a TV).3The investigators’ findings are strengthened by the large sample size. Potential weaknesses include the use of the national school lunch program as a surrogate for the SES level of the entire school (rather than tracking by individual participants), the use of self-reported health data, and the use of a single question to capture sleep duration despite adolescent propensity for weekend catch-up sleep. The results of another recently published study showed that greater electronic device use at bedtime was not only associated with delayed sleep onset and decreased sleep duration but also with overall sleep disturbance symptom severity.4If seventh graders in rural North Carolina aren’t getting enough sleep, it stands to argue that older adolescents attending high school in more urban settings with increased access to phones/technology are likely not getting enough sleep either. More counseling on the importance of sleep hygiene and the impact of electronic device use upon sleep is needed in order to help adolescents and their families prioritize and protect sleep duration.High bedtime technology use in adolescents is a significant risk factor for insufficient sleep and is a modifiable behavior.

Analysis of Concordance Between Parent Proxy and Child Self-report of KIDSCREEN-10 Health-related Quality of Life Questionnaire in an Elementary School-based Wellness Program: A Pilot Focus Group Study

Background: Researchers have previously commenced examining the degree of concordance between parent proxy and child self-reports on health-related quality of life (HRQOL) of many disease and impairment populations. Objects: To explore the differences between parent proxy and child self-reports on the HRQOL using Korean version of KIDSCREEN-10 questionnaires for applying to elementary school children and their parents who participated for a school-based wellness program. Methods: The focus groups were recruited for a school-based wellness program by implementing the following wellness services: 1) referring to a screening session for detecting potential posture-related musculoskeletal problems and 2) recommending home exercise programs. Before a primary field testing for the program, two focus groups were formed with a group of 9 parents and their 9 elementary school children aged 8-10 years of age. The parent proxy and child self-report versions of KIDSCREEN-10 questionnaires were administered to both groups after completion of the wellness program. Item level Rasch rating scale analysis was applied to compute logit scales of KIDSCREEN-10 questionnaire. Intraclass correlation coefficients (ICCs) and scatterplot of item difficulty between two reports were analyzed. Results: For fit statistics of parent proxy report, all items except 4 items (i.e., psychological well-being, mood/emotions, self-perception, parent relation) were found to be acceptable. For fit statistics of child self-report, all items except 3 items (i.e., psychological well-being, autonomy and home life) were acceptable. The relationship between two reports using ICCs were ranging from weak to very strong at p = 0.05 (i.e, ICCs = 0.011 to 0.905). Scatterplot analysis between two reports showed a major disparity on self-perception item at 95% confidence intervals. Conclusion: Both item level analyses and ICC comparisons provided a disparity between parent proxy and child self-reports of the HRQOL on self-perception item after competing a school-based wellness program. Therapist should consider the item as part of the HRQOL assessment.

Physiological and Lifestyle Factors Associated With Abnormal Blood Pressure in Adolescents Before and After a School-Based Wellness Program in Michigan: A Report From Project Healthy Schools

PurposeHypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce. MethodsStudents enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005–2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (<90th percentile for SBP and/or DBP, or <120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS. ResultsOf 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p < .001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p < .01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p < .001) or obese (38.9% vs. 11.3%, p < .001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (−4.0 vs. 2.8 mmHg, p < .001) and DBP (–3.3 vs. .8 mmHg, p < .001) than normal BP students. ConclusionsAbnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.

Abstract 261: Gender-Specific Differences in Behavioral and Physiological Risk Factors Associated with Childhood Obesity

Background: Prior research has shown differences in physiologic and behavioral measurements of adolescent boys and girls. This study sought to determine if similar gender-specific differences exist between participants of the Project Healthy Schools (PHS) school-based wellness program, both at baseline and post-PHS intervention. Methods: Demographics, physiological measures and health behaviors were compared between 6 th grade girls and boys enrolled in PHS between 2004-2017 at baseline and post-PHS intervention. Results: Health behavior data were collected in 19,995 students (46.1% girls); physiological measures were collected in 2,922 students (52.7% girls). Boys within the physiological sample were older than girls (11.62 v. 11.55, p&lt;0.001). At baseline, girls had lower HDL cholesterol and higher resting and recovery heart rates, but reported greater consumption of fruits and vegetables and less sugary beverages and fried meats than boys. Boys reported more vigorous exercise but greater hours of television and video game screen time than girls. Post-intervention, girls showed greater improvement in resting heart rate, fruit consumption and video game time. Conclusion: Girls had better health behaviors but poorer physiological markers at baseline. Lower rates of physical activity in girls at baseline highlight a potential area of focus for the PHS intervention in this population. Future exploration of gender-specific targeted strategies to improve health behaviors is warranted.

Abstract 228: Comparison of the Effect of Local and Long-Distance Delivery Models for a School-Based Wellness Intervention on Health Behaviors of Middle School Students

Background: Michigan’s upper peninsula (UP) is a remote area with only 3% of the state’s population, making it difficult to reach with health interventions. Nearly half of the UP counties have higher adult obesity rates than the state average. The Project Healthy Schools (PHS) middle school-based wellness program uses local and long-distance delivery models in Michigan’s lower peninsula (LP) and UP, respectively. Schools utilizing the local model (LP schools) have routine staff visits to assist in program implementation; conversely, long-distance model schools (UP) rely on telecommunication with PHS staff to implement the program. This study sought to determine if differences exist in health behaviors of LP and UP students at baseline, as well as post-PHS intervention to determine the effectiveness of the local and long-distance PHS delivery models. Methods: Data from 6 th grade students enrolled in PHS between 2014-2017 were analyzed. Students were divided into two groups, UP and LP students. Demographics and health behaviors at baseline and post-intervention were compared between groups. Results: Of 21,459 students, 695 (3.2%) were from the UP. Compared to LP students, UP students were more likely to be White and from lower and middle socioeconomic status communities. Pre-PHS intervention, UP students ate more fruits, vegetables, and chocolate candy, engaged in more moderate exercise, and spent less time on TV, computers, video games, and mobile devices than LP students. No significant differences in post-intervention impact on health behaviors were seen between UP and LP students. Conclusions: At baseline, UP students reported better health behaviors than LP students. However, the lack of differences in post-intervention impact suggest the local and long-distance delivery models were equally effective in influencing health behaviors. Future investigation of the effect of school-based interventions in remote communities, like the UP, are warranted.

Differences in Cardiovascular Disease Risk Factors and Health Behaviors Between Black and Non-Black Students Participating in a School-Based Health Promotion Program.

To compare cardiovascular disease (CVD) risk factors of black and non-black children participating in Project Healthy Schools (PHS), a school-based wellness program. Participants were surveyed and participated in physiological screenings pre- and post-PHS intervention. Middle schools in 4 Michigan communities of varying socioeconomic status. A total of 3813 sixth-grade students comprised the survey sample, and 2297 sixth-grade students comprised the screening sample. Project Healthy Schools is a school-based intervention designed to reduce the risk of obesity and CVD in children through the promotion of healthy eating and physical activity. Physical examination, blood test, and self-reported survey data on dietary habits, physical activity, and sedentary behaviors were collected pre- and post-PHS. Paired and independent t tests were used for physiologic variables. Wilcoxon sign-rank and rank-sum tests were used for survey variables. At baseline, blacks had a higher percentage of overweight/obese students (43% vs 34%; P < .0001) and demonstrated poorer health habits than non-blacks; however, non-blacks had poorer lipid profiles. At follow-up (post-PHS intervention), both groups demonstrated significant improvements in physiological measures and health behaviors. Despite disparities between the groups at both baseline and follow-up, changes seen post-PHS intervention were beneficial in both groups. These results suggest that early intervention for risk factor modification is possible and may be of great importance in the prevention of CVD, particularly in high-risk groups.

Abstract 363: Trends in Body Mass Index Based on Socioeconomic Status: A Report from Project Healthy Schools

Background: Project Healthy Schools (PHS) is a school-based wellness program that aims to reduce childhood obesity and its associated long-term effects through educational and environmental initiatives. This study aims to explore BMI trends from 2004 to 2014 according to socioeconomic status (SES). Methods: From 2004-2014, sixth-grade BMI measurements from 23 schools were recorded at baseline (BL) and follow-up (FU) (n=2,651). Schools were divided by SES based on area median household income. Mean BMI at BL and mean change in BMI between BL and FU are shown with 95% confidence intervals for the three SES groups at each year. Results: The high SES group had lower mean BMIs at BL than other groups each year. The trends suggest there was no difference between the low and middle SES groups at BL, although it appears low SES BMI is increasing over time. There were no notable differences in mean BMI change between groups. Conclusions: These data support previous studies showing lower BMIs in students from higher income areas. This validates the need to focus health interventions and nutritional efforts on lower SES groups.

Abstract 229: An Urban Garden Initiative: A Component of Project Healthy Schools

INTRO: Childhood obesity has been a growing problem in the US, with its prevalence linked to cardiovascular disease. School gardens can provide a hands-on method of teaching healthy dietary habits for students. Project Healthy Schools (PHS) is a school-based wellness program, a collaboration between the University of Michigan Health System and community groups that focuses mainly on middle school students. PHS currently has educational programming in 42 schools across lower and mid-Michigan. In 2010, PHS began implementing a garden initiative in select Detroit schools. METHODOLOGY: The goal of the garden initiative is to familiarize students with fruits and vegetables and increase their interest in eating fresh produce and other healthy foods. Students are invited to participate in the gardening, which increases time spent outdoors, away from televisions, computers and video games. Initial funding for this project came from multiple donors interested in promoting healthy lifestyles in school-age children: The University Cultural Center Association, Detroit’s Garden Resource Program, Lowe’s Education Toolbox Grant, Whole Kids Foundation and the American Heart Association. RESULTS: Six Detroit schools participated in the garden initiative. The gardens are located either directly at or within walking distance of the school. At each school, the garden initiative consists of an afterschool club, led by a PHS Wellness Coordinator and/or a teacher. Students from regular classes also visit the garden as a way to engage additional students with the project. Each year, the gardening starts in April and the harvest season ends in October. During summer vacation, students have the opportunity to remain involved. In the fall, the produce they harvest has been used in lessons where students consume the produce raw, learn to cook with produce, or even sell the garden produce. While not all changes reached a level of significance, there were some notable trends, including an increase in vegetable consumption in four schools in 2012. The gardens have also encouraged parental involvement as some parents accompanied their children to the school garden. CONCLUSIONS: Garden initiatives have given a number of Detroit students the opportunity to learn about fresh produce, encouraged healthy eating, and promoted parental involvement. Garden initiatives for this program will continue with the goal of incorporation into the schools’ curricula. As the project expands, future studies will further evaluate the effects of students’ participation in the gardens on students’ eating habits and physiological markers.

Abstract 144: Breakfast Habits and Cardiovascular Disease Risk Factors in Middle School Children

Background: Previous studies have found that children and adolescents who skip breakfast are at greater risk of developing obesity and other chronic diseases. This study seeks to examine the relationship between breakfast consumption and cardiovascular disease risk factors in middle school children involved in Project Healthy Schools (PHS), a school-based wellness program. Methods: Data was collected from 1,651 sixth-grade students who consented to a health screening which collected physiologic data including blood pressure (BP), heart rate, lipids, and body mass index (BMI). Students also completed a survey evaluating their diet and other health behaviors. This study used data from the follow-up screening post-PHS intervention. Though PHS does not encourage students to fast on the day of the health screening, some students reported to be fasting. Based on this question, students were divided into two cohorts: breakfast eaters (non-fasting) and non-breakfast eaters (fasting). Results: Of the students in the study, 85.4% (1410 of 1651) had eaten breakfast on the day of the screening. Students who ate breakfast had lower BMIs than non-breakfast eaters (20.87 vs. 22.24) (p≤0.001). Breakfast eaters reported healthier diet choices, consuming less regular soda (p≤0.001) and high-fat meat (p=0.003), while eating more servings of fruits (p=0.010), vegetables (p≤0.001), and milk (p≤0.001). These students also reported higher levels of various physical activity sessions (p&lt;0.05), and less time in front of the television (p≤0.001) and computer (p=0.016) screen. Students who ate breakfast also had significantly lower BP and LDL-cholesterol (Figure). Conclusions: Students who ate breakfast had lower BMIs, were more active, and made better diet choices. These students also had lower BP and LDL-cholesterol. These results suggest that students who eat breakfast may be at lower risk of developing cardiovascular disease, and the importance of breakfast as part of a healthy lifestyle should be emphasized among children and adolescents.

Sustainable Practices Within a School‐Based Intervention: A Report from Project Healthy Schools

AbstractOver the past three decades the proportion of students classified as overweight has almost tripled. This trend in childhood obesity is a cause for concern. Stakeholders have come together to stem growth and implement healthy habits in childhood to not only prevent obesity, but also future cardiovascular risk. School‐based health interventions have proven to be an effective medium to reach youth. Sustainable practices remain the largest determinant of long‐term success of these programs. Project Healthy Schools, a community–university collaborative school‐based health intervention program, sustainable practices have led to positive changes in participating middle schools. This collaborative has provided important insight on key factors needed for long‐term sustainability for a school‐based wellness program. These key factors are described under leadership, policy, finances, and reproducibility. Future school‐based programs may plan for success with sustainability while drawing from our experience.

Abstract 144B: Racial Differences in Physiological and Behavioral Response to School Based Wellness Program

Background: Racial differences in cardiovascular (CV) risk factors have been shown to exist in children. However, much of this data was obtained decades ago in a rural cohort of children in Bogalusa, LA. Given the growing epidemic of childhood obesity, we sought to examine CV risk factors in black and non-black 6 th grade students prior to and seven months after implementation of a school-based wellness program targeting both inner city and suburban children in Southeast Michigan. Methods: Data from 1,979 middle-school students enrolled in Project Healthy Schools (PHS) were used to compare health behaviors and physiologic markers including lipids, blood pressure (BP), and BMI. PHS is designed to promote physical activity, consumption of fruits and vegetables, decrease consumption of fast/fatty foods and leisure screen time and encourage healthier beverage choices. Pre/post assessments included surveys of diet and physical activity. A Mann-Whitney, non-parametric test was used to compare the differences. Results: Among the 1,979, 504 (25.5%) were black. At baseline, % overweight/obese was significantly different between blacks and non-blacks (39.9% vs. 33.0%, p=0.003. Blacks had poorer diets and were less active than non-blacks (p&lt; 0.001). BP and low-density lipoprotein (LDL) cholesterol were similar, while high-density lipoprotein (HDL) was higher in blacks (55 mg/dL vs. 52 in non-blacks) (p=0.004), and triglycerides were higher in non-blacks (92 vs.122 mg/dL) (p&lt;0.001). Seven months after PHS was initiated, blacks improved their diets and physical activity more (p&lt; 0.02). Blacks had a significant decrease in LDL cholesterol (10 mg/dL vs. 1) (p&lt;0.001) whereas non-blacks had significant reduction in triglycerides (3 vs. 16 mg/dL) (p=0.041). Conclusion: Black 6 th grade students show higher rates of obesity, poor dietary habits, and less physical activity at baseline. This data suggests that school-based wellness programs such as PHS can improve dietary, physical behavior and cholesterol profile. Early intervention for risk factor modification is not only possible but may be of great importance to the prevention of CV disease in adults, particularly in high risk groups like blacks.

Abstract 270: Self-Efficacy and Cardiovascular Health in 6 th Graders: An Insight from Project Healthy Schools

Background: Behaviors such as regular physical activity are associated with improved self-esteem among children and adolescents. However, associations between wellness behaviors (including diet) and both self-esteem and leadership among middle-school children have not been well studied. Methods: Data were collected from middle-school children enrolled in Project Healthy Schools, a school-based wellness program. Baseline data included self-reported information on diet, physical activity, and questions on self-efficacy for empathy and leadership. Physiologic data included body mass index (BMI), blood pressure (BP), heart rates (resting and one minute post exercise protocol), non-fasting lipids, glucose. Respondents were grouped into tertiles based on survey items related to empathy. Results: Data from 1,079 6 th graders (mean age 11.6 years) were included. Students in the low tertile for empathy had higher BMIs than students in the middle/higher tertiles (p=0.03) with no difference between tertiles for lipids (including total cholesterol, HDL-cholesterol, triglycerides, and LDL-cholesterol). A trend towards higher glucose levels was observed among children in the lower tertile compared to the other tertiles (101.2, 99.4, and 99.5 for tertile 1, 2, and 3 respectively, p = 0.58). A similar trend was observed for systolic BP (p = 0.52) but not diastolic BP, resting HR or HR post exercise. No difference was observed between self-efficacy for leadership and any of the physiologic parameters. Those in the highest tertile for leadership self-efficacy were more likely to be physically active, averaging 4.71 (± 2.11) days of vigorous activity; a similar trend was noted for empathy. Moderate exercise (≥ 30 minutes per day) and team sports positively correlated with empathy and leadership. Conclusions: Among middle-school students, measures of empathy and leadership were associated with higher levels of physical activity and participation in team sports; but not with physiologic parameters. Given that higher levels of empathy and leadership were associated with lower BMI, it is possible that programs which improve leadership skills and promote empathy can improve healthy lifestyle habits.

Web-Supported Program Improved Diet and Increased Physical Activity Among Children

Provide an effective school-based wellness program for elementary students to encourage healthy behaviors, including increased consumption of fruits and vegetables, decreasing consumption of sugar-sweetened beverages, and increasing physical activity.

Love Your Body, Love Yourself: Development of a nutrition and physical activity curriculum for a school‐based obesity intervention in high‐risk girls ages 11–17 years.

Overweight adolescents have a 70% chance of becoming overweight or obese adults. One of the consequences of overweight as perceived by the children themselves is social discrimination. This is associated with poor self‐esteem and depression. The Love Your Body, Love yourself nutrition and physical activity weight loss curriculum was designed for girls ages 11–17 years who were involved in a residential treatment center for mental health, substance abuse, trauma recovery, and other psychosocial issues. Within this residential program, 50% had a BMI classification of obese, 30% had high blood cholesterol levels, 20% had hypertension, and 40% had asthma. The residential population was 30% Caucasian, 64% African American and 2% Hispanic girls. The overall theme of the curriculum development was focused on the importance of different body parts as they relate to overall health, taking away from the attention on outward appearance. The lesson plans are divided into weekly modules, each module includes a specific body part and how nutrition and physical activity play a role with the overall health of their bodies. Nutrition and physical activity lesson content was also designed based on results from survey data that was collected from the girls regarding their nutrition and physical activity knowledge and level of interest. These modules are designed to be integrated into an 8 month school‐based wellness program.