Abstract
BACKGROUND: School-based interventions are effective in improving physical activity and healthy eating in adolescents. However, there has been limited research into how bundled school-based programs, and their components, may improve adolescents' metabolic health. The purpose of this study is to evaluate the effectiveness of the Healthy School Recognized Campus (HSRC) - a bundled school-based health initiative - and two HSRC components on metabolic syndrome (MetS) and other obesity-related risk factors. METHODS: A 2 × 2 cluster randomized factorial trial was conducted in eight HSRC middle schools (n = 107 students) to pilot test a novel program's (Strong Teens for Healthy Schools [STHS]) and implementation strategy's (mentoring program) preliminary effects on MetS z-scores, obesity-related risk factors (e.g., BMI z-scores), and behavioral risk factors (e.g., physical activity, healthy eating). General linear model frameworks were used to estimate the main and interaction effects on outcomes. Additionally, bivariate tests were run to determine if students had a significant change in outcomes over the year-long HSRC intervention. RESULTS: Across all schools, students involved in the HSRC program decreased BMI z-scores (mean difference [MD]=-0.12 ± 0.33, p=.003); whereas students increased glucose levels (MD = 6.29 ± 18.34, p=.003), total MetS factors (MD = 0.23 ± 0.83, p=.015), and fruit and vegetable consumption (MD = 34.47 ± 92.33, p = < 0.001). The STHS intervention was associated with an increase in waist circumference (β = 5.55, 95%CI: 0.14, 10.96, p=.044). The mentoring program was associated with a reduction in systolic blood pressure (β=-6.32, 95%CI: -12.13, -0.51, p=.033) and increase in dermal carotenoids (β = 65.50, 95%CI: 18.11, 112.89, p=.007). CONCLUSIONS: HSRC improved some obesity-related risk factors, but not MetS severity. The STHS intervention independently increased waist circumference, and the mentoring program independently improved dermal carotenoid levels and systolic blood pressure. Results suggest that complex interaction effects exist in bundled interventions within school settings; however, bundled EBPs may be effective in reducing some obesity-related outcomes (e.g., BMI z-scores) over a one-year duration for adolescents in East Texas.