Get Fruved: Obesity Prevention for Older Adolescents
Get Fruved: Obesity Prevention for Older Adolescents
This program is a non-diet approach to obesity prevention for older adolescents which does
 not promote following a special diet to manage weight; it promotes healthy behavior
 associated with obesity prevention. This approach is important with youth and older
 adolescent populations to avoid impairment in emotional well-being associated with body
 dissatisfaction. Healthy weight status will be achieved by improving dietary intake patterns,
 increasing physical activity, and improving stress management. Fall of year 01 was devoted to
 the recruitment of student partners (intense intervention group) and the development of
 partnerships. In the spring of year 01, recruited students were enrolled in two newly
 developed undergraduate courses across four intervention state partners, became collegiate
 4-H members, planned a social marketing campaign, and/or learned to be peer mentors or
 student researchers. In year 02, first year college students were recruited, peer mentors
 were matched with a group of first year students, and the developed social marketing campaign
 was pilot tested on four college campuses (diffuse intervention) by the collegiate 4-H teams.
 In year 02, a toolkit with 24 weeks of intervention activities was also refined. In year 03,
 the collegiate 4-H team (intense intervention group) used the refined toolkit to test and
 implement the intervention on college campuses. In year 03, the assessment process for high
 school 4-H students (intense intervention group) will be pilot tested and college students
 will work with the high school students on adapting the toolkit for use in the implementation
 of the social marketing campaign in high school settings in year 04 (diffuse intervention).
 ). In year 04, the pilot and feasibility tested college intervention was tested with a
 randomized control trial design with 30 intervention and 29 control university partners. The
 adapted high school toolkit was pilot and feasibility tested in three intervention and two
 control high school settings. In year 05, the high school intervention was tested with a
 randomized control trial design with 9 intervention and 7 control high schools in one
 district's high schools. On all measures it is anticipated that participants in the intensive
 intervention group will have greater improvements than those in the diffuse intervention
 group and both intensive and diffuse intervention groups will have improvements over those in
 the control groups.
The goal of the research is to develop a novel strategy to promote healthy behaviors
 associated with obesity prevention in older adolescent populations. A community based
 participatory research (CBPR) approach is used with partnerships among older adolescents,
 university researchers and faculty, and Extension partners. The objective is to test the
 effectiveness of a peer-led, train-the-trainer intervention. The intervention is an
 interactive, non-traditional social marketing, online media, and environmental change
 approach seeking to promote healthy behavior with communities of college and high school
 students. Specific health behaviors targeted include increasing intakes of fruits and
 vegetables, decreasing foods high in saturated fats and added sugars, managing stress, and
 increasing physical activity. This project uniquely 1) increases participant engagement
 through creative interactions, participant-created content, and incorporation of
 age-appropriate technology; 2) incorporates social environments and peer-led strategies; and
 3) simultaneously addresses changes in environments to support participant-driven behavior
 change efforts.

 This project is a Pretest-Posttest, Control Group Trial using a nested cohort design with
 three conditions (intense intervention, diffuse intervention, and control), four control
 universities and four intervention universities in years 01- 03, one high school as control
 and one as intervention at each of the four intervention university towns in years 03-04, and
 disseminated to four additional university and high school pairs in years 04-05.

 A CBPR, peer-led approach is used in that upper level college students mentor freshmen 4-H
 college students through the development of the intervention. The CBPR, peer-led approach
 continues when the now sophomore 4-H college students implement the intervention with
 incoming college freshmen in the following year. The train-the-trainer approach is utilized
 when the now junior level 4-H college students mentor 4-H high school students in the
 modification of the intervention for high schools. The approach continues when 4-H high
 school students implement the intervention with incoming freshmen in high schools.

 In the fall of year 01, 283 freshman students were recruited from general/survey nutrition
 courses at the four intervention universities to participate in a special undergraduate
 spring course (the intense intervention group). 94 freshman students were also recruited from
 general/survey nutrition courses at the four control universities. During the fall,
 researchers at the intervention schools worked with nutrition (graduate and undergraduate)
 students to identify and develop partnerships with student organizations for the development
 of a social marketing health promotion campaign. Researchers and student partners also worked
 with local high schools (including student organizations, school food service, Parent Teacher
 Associations, school wellness committees, and administration) and school boards to formalize
 research agreements and relationships.

 In the spring of year 01, as a part of the newly developed undergraduate course, the freshman
 students (the intense intervention group) from each intervention university joined their
 collegiate 4-H program. The courses were offered as independent studies or as a newly
 developed course through the respective University's PI. The course covered principals of
 social marketing for health behavior change. University researchers and Extension faculty
 collaborated and taught in-person classes with their respective collegiate 4-H students.
 Collegiate 4-H students were co-taught (by all four University's research and Extension
 faculty) and had the opportunity to interact with the other collegiate 4-H students from all
 four intervention universities through web-based technologies. Throughout the course, the
 collegiate 4-H students developed and planned a social marketing campaign. Following a
 peer-led approach, the 4-H students partnered with and were mentored by upper-level nutrition
 students and student organizations (student partners) in the development and planning of the
 campaign.

 In year 02, the now sophomore collegiate 4-H students in the intense intervention group
 (receiving hourly compensation) worked with student partners to implement the developed
 nine-month social marketing campaign. The campaign centered around five costumed characters
 (Spinach, Carrot, Banana, Grapes, and Tomato). Characters interacted with students on campus
 in freshmen residence halls, dining halls/cafeterias and highly trafficked public areas on
 campus. Photos and videos of interactions were put on the website (www.fruved.com), Facebook,
 twitter, YouTube, Snap Chat, and Instagram. Online educational modules (focused on healthy
 diet patterns, physical activity, and stress management) will also become available on the
 website. Student participants from the general freshman population were asked to set weekly
 healthy goals related to diet, physical activity, and stress management throughout the
 campaign and receive email and/or text messages with goal-specific written and video health
 promotion messages. Extension faculty and staff partnered with the collegiate 4-H student
 teams throughout the intervention process to educate and give advice on the content of health
 promotion messages. Throughout the campaign, collegiate 4-H students worked with researchers
 to assess the healthiness of their campus environments using a previously developed Healthy
 Campus Audit and advocated for changes to the physical and food environment.

 In year 02, a random sample of 1,153 freshmen (the diffuse intervention group), determined by
 screening to be at increased health risk were recruited from the eight universities (four
 intervention and four control). The collegiate 4-H students (the intense intervention group)
 and the same students from the control schools recruited in year 01 were reassessed.

 In year 03, the collegiate 4-H team (intense intervention group) will use the refined toolkit
 to test and implement the intervention on college campuses. The sustainability of observed
 changes at the individual and environmental college level will be assessed by conducting
 follow-up assessments with the students in the intervention (the diffuse intervention group)
 and control sites at colleges in year 03. The collegiate 4-H students (the intensive
 intervention group) leading the project at the high school level and the same students from
 the control schools recruited in year 01 will be reassessed at the beginning of fall year 03,
 and end of spring year 03. Also in year 03, the assessment process for high school 4-H
 students (intense intervention group) will be piloted tested and college students will work
 with the high school students on adapting the toolkit for use in the implementation of the
 social marketing campaign in high school settings (diffuse intervention).

 In year 04, two high schools in each of the four intervention University states participated
 in the research process and were randomized to control and intervention. High schools in each
 state were matched by size and community composition and geographically separated to prevent
 potential exposure to the campaign. Following the train-the-trainer model, teams of now
 junior collegiate 4-H students (the intense intervention group) mentored teams of high school
 4-H students (the intense intervention group) at each of the intervention sites in the
 development and implementation of the Fruved campaign in the high school environment. In the
 fall, collegiate students will work with the high school students (the intense intervention
 group) to modify the campaign to meet the age and cultural needs of a high school audience
 and plan the specific campaign components. The high school 4-H teams will partner with their
 school's food service, Parent Teacher Association (PTA), school Wellness committee, and
 school administration throughout the campaign development, implementation, and evaluation.
 The campaign will be conducted in the intervention high schools over the remaining nine-month
 school year.

 In year 04, a random sample of 331 freshman high school students (the diffuse intervention
 group) will be recruited from the intervention high schools and a random sample of 331
 freshman high school students (the control group) from the control high schools in each of
 the four intervention University town areas. Assessments will take place in early fall and
 late spring. The 4-H high school students (intensive intervention group) recruited to
 participate in the design and implementation phases of the project will also be assessed in
 early fall/late spring in year 04.

 Also in year 04, to continue to assess the sustainability of observed changes at the
 individual and environmental high school level, participants will be assessed by conducting
 follow-up assessments with the students in the intensive intervention group and control sites
 in high schools. The collegiate 4-H students (the intensive intervention group) that lead the
 project at the high school level and the same students from the control schools recruited in
 year 01 will be reassessed at the beginning of fall year 04 and end of spring year 04.

 In year 04-05, materials will be developed allowing the project to be further disseminated to
 other college and high school environments. Four additional college and high school pairs
 will be recruited to participate in the dissemination phase. In year 04 the college students
 will receive training materials, study manual, costumes, cameras, and a small implementation
 budget but will not receive support for incentives or student 4-H compensation. The campaign
 will be developed and implemented over one school year. A modified project assessment will be
 required to be completed by the collegiate student 4H groups. In year 05 the collegiate 4-H
 students will work with high school 4-H students to develop and implement the project in high
 schools. The high school 4-H student group will complete the modified project assessments.

 The nine month interactive, social marketing environmental intervention will aid older
 adolescents in effectively preventing obesity through increasing healthfulness of diet,
 increased physical activity, and improved stress management behavior as compared to a control
 group. On all measures it is anticipated that participants in the intensive intervention
 group will have greater improvements than those in the diffuse intervention group and both
 intensive and diffuse intervention groups will have improvements over those in the control
 groups. Students participating in the intervention will more effectively manage their weight
 than those in the non-intervention control condition; those participating in the intervention
 will improve intermediary outcomes related to diet, physical activity, and improved stress
 management to a greater extent than those in the control condition; and environments at
 intervention sites will show health behavior-supportive changes as compared to control sites.

 Since there are more than two time intervals in the design, General Linear Modeling will be
 used to analyze for changes in physical assessments, specifically a mixed-model Analysis of
 variance and covariance (ANCOVA) if the group-specific slopes are homogeneous. A wide range
 of analyses will be employed to analyze the influence of the intervention on secondary
 outcomes, including multivariate analyses of variance (MANOVA), ANOVAs, and logistic
 regression. Significant ANOVAs will be followed up with tests of simple and main effects as
 appropriate. The intervention group-by-occasions interaction test will assess the impact of
 the intervention in the treatment group relative to the control group across time on the
 secondary outcome measures.
Inclusion criteria:

 -  Students in the intensive intervention group must be registered for a general/survey
 nutrition or wellness course

 -  Students in the diffuse intervention group randomly selected from those who screen in
 because they are at increased health risk (increased BMI and waist circumference, low
 intakes of fruits and vegetables, high levels of stress, and low levels of physical
 activity)

 Exclusion criteria:

 -  There are no exclusionary criteria for students in the intensive intervention group

 -  Students who are not at-risk for health issues are excluded from the diffuse
 intervention group