1. Feasibility Study of a School- based Health Center Intervention to Decrease Metabolic Syndrome Risks in Overweight/Obese Teens Alberta Kong, MD, MPH Andrew Sussman, PhD, MCRP Carolina Yahne, PhD Betty Skipper, PhD Nina Wallerstein, DrPH 1st Annual UNM National Health Disparities Conference May 24, 2011

3. Background Up to 44% of obese teens have metabolic syndrome. Greater prevalence of metabolic syndrome among Mexican-American adolescents Adolescents visit their medical care providers infrequently, especially for preventive care School-based health centers (SBHCs), offer a logical alternative to reach adolescents given that they spend a significant portion of their day at school

4. Adolescents Committed to Improvement of Nutrition and Physical Activity Phase 1: Use an adaptive community-based participatory research approach to create a school-based health center intervention for overweight/obese teens Phase 2: Feasibility testing of the school- based health center intervention against standard care for weight loss R21 HL092533 NIH/NHLBI

5. Hypothesis Adolescents receiving the intervention condition will demonstrate a greater decrease in mean BMI percentile when compared to adolescents receiving standard care. Secondary outcomes: mean insulin resistance (by HOMA IR), HDL-C, triglycerides, and systolic blood pressure

6. Phase 2: Feasibility Trial Recruit students with BMI 85%-ile and their parents from intervention school Intervention: 8 motivational interviewing sessions with clinical provider at the schools clinic Standard care: 1 visit with clinical provider at the schools clinic & self-help materials Intervention ArmControl Arm Recruit students with BMI 85%-ile and their parents from control school

7. Screening/Enrollment Numbers InterventionControl Screened4952 -Diabetes00 -BMI<85%ile1518 -BMI40 2 *0 -Stage 2 HTN01 -Medications that interfere with weight 00 -Non-ambulatory 2 *0 -12 th graders04 Enrolled3129 * 1 student at the intervention school was not ambulatory and had a BMI 40

8. Participant Characteristics Variable Intervention (N=31) Control (N=29) p-value Gender* Female Male 61% 39% 62% 38% 1.00 Ethnicity* Hispanic Non-Hispanic 84% 16% 66% 34% 0.14 Age years mean (SE)**15.0 (0.2)14.6 (0.1)0.12 BMI %-ile mean (SE)**94.6 (0.8)94.2 (0.8)0.58 HOMA IR mean (SE)**3.8 (0.7)2.8 (0.3)0.54 *Fishers exact test used for discrete variables. **Wilcoxon rank sum test used for continuous variables.

9. Participation Rate Intervention (N=31) Control (N=29) Moved (out of state):21 Dropped out:1 2 Pregnant:01 Transferred to another school: 02 Completers:28 = 90%23 = 79%

10. Significant Difference in BMI Percentile p = 0.04 (N = 28) (N = 23)

11. Significant Difference in Waist Circumference p = 0.04 (N = 28) (N = 23)

12. No Significant Difference in Insulin Resistance p = 1.00 (N = 28) (N = 23)

13. No Significant Difference in Systolic Blood Pressure p = 0.66 (N = 28) (N = 23)

14. No Significant Difference in Triglycerides p = 0.62 (N = 28) (N = 23)

15. No Significant Difference in HDL p = 0.62 (N = 28) (N = 23)

16. Satisfaction of Intervention Topic28 Students (0-5 Likert scale) 25 Parents (0-5 Likert scale) Usefulness of DVD 3.1 (26 students)4.0 (6 parents) Usefulness of toolkit handouts 4.0 (27 students)3.7 (23 parents) Provider4.4 (28 students)Did not ask Overall4.4 (28 students)4.3 (25 parents)

17. Satisfaction of Intervention Parent: I am very satisfied with the ACTION Project. It was more than I expected when I signed up ___ & ___. Their doctor was impressed with the changes they made and the things they learned. Overall, they were much healthier through out the school year and rarely got sick. The 'gifts' they received were great incentives and I appreciated the feedback 'pink slips' I received after their visits.

18. Satisfaction of Intervention Parent: I just want to say thanks for this ACTION project, because this has motivated my son to be more aware of his health and it has motivated him to work out more, and this is good, I hope you will continue with this project, thanks a lot. Student: I just want to thank the woman I met for each visit. She was a great listener and really nice. Student: I really enjoyed it and thought it was cool.

19. Conclusions A school-base health center intervention program consisting of 8 motivational interviewing sessions with overweight/ obese high school students and their parents was feasible. Students receiving the intervention had significantly greater pre-post improvement in BMI percentile as compared to the standard care group.

20. Acknowledgements Funded by NIH/NHLBI, R21HL092533 Bionutrition and research nursing services from the UNM CTSC grant # DHHS/NIH/NCRR UL1RR031977 PI (AK) time was funded in part by NIH/NCRR KL2 Scholar Award, KL22RR031976 2 urban participating high schools, parents, and students UNM SBHC program, Department of Family and Community Medicine