Clinician Promotion of Healthy Diet and Activity to Reduce Obesity Among Adolescents: HEALTHY SMILES
Condition: Obesity
MeSH terms: Obesity
Study type: Interventional

Summary: 
      This study will test an 18-month intervention designed to increase physical activity, reduce
      sedentary practices and promote healthy diets or reduce tobacco use and exposure among
      preteens who obtain orthodontic care. Relevance: If successful, this study may inform
      policies that would promote all specialists (orthodontists, physicians, general dentists) to
      deliver brief counseling for diet, physical activity, and tobacco prevention.
    

Detailed description: 
      This study will test a 18-month multi-component intervention designed to increase physical
      activity, reduce sedentary practices and promote healthy diets among preteens who obtain
      orthodontic care. The intervention is based on the Behavioral Ecological Model (BEM), where
      interacting physiological, environmental, and cultural contingencies select behavior. This
      study will require five years to recruit 40 orthodontist offices, and 1700 youth, and
      implement an office-wide intervention for promoting healthy diet and physical activity among
      8-14 yr old youth. Our primary aims are to detect a differential change in diet, physical
      activity and BMI in our experimental group compared to the tobacco prevention control group;
      to observe differential effects of the intervention between low vs. high SES; and similarly
      for males vs. females; to validate our primary outcome variables by contrasting them with a
      "gold standard"; and determine the degree to which family and peer encouragement for
      sedentary and high caloric diet at baseline increases the relative effect of the orthodontist
      intervention. Offices will be assigned at random to condition producing a 2 (experimental
      group) by 2 strata (low vs. high SES) by 2 strata (male vs. female) by 4 (repeated measures)
      experimental design. Those in the experimental condition will be exposed to the office-wide
      intervention for diet and activity; those in the control condition will be exposed to an
      office-wide intervention for tobacco prevention. The intervention will consist of training of
      orthodontists and office staff to provide appropriate social prompts, reinforcement and
      counseling, and modification of the offices to provide supportive physical and social
      resources for their patients and parents. Measures of diet, physical activity, body
      composition, tobacco use, fitness and family and peer encouragement will occur at baseline,
      12, 18, and 24 months. Differential change over time will be analyzed using Random Effects
      Multivariate modeling. Analyses will include control for office cluster effects and
      multivariate models will include analyses of hypothetical main effects, experimental group by
      time interactions, and moderating effects by inclusion of interaction terms for
      susceptibility by experimental condition and other possible moderators. Relevance: If
      successful, this study may inform policies that would promote all specialists (physicians,
      general dentists) to deliver brief counseling for diet and physical activity. Doing so might
      yield the cumulative exposure necessary to effect and sustain change in a large proportion of
      the preteen population.
    

Intervention name(s): Obesity Prevention; Tobacco Prevention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Those in the experimental, obesity prevention, condition will be exposed to the office-wide intervention for diet and activity. The intervention will consist of training of orthodontists and office staff to provide appropriate social prompts, reinforcement and counseling, and modification of the offices to provide supportive physical and social resources for their patients and parents.; Those in the control, tobacco prevention, condition will be exposed to the office-wide intervention for avoidance of tobacco and second hand smoke. The intervention will consist of training of orthodontists and office staff to provide appropriate social prompts, reinforcement and counseling, and modification of the offices to provide supportive physical and social resources for their patients and parents.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: obesity prevention; tobacco prevention; nutrition; physical activity; sedentary activity; tobacco use; tobacco exposure; prevention; clinician intervention; preteen; adolescents