A randomized controlled trial of students for nutrition and eXercise: a community-based participatory research study.
OBJECTIVE
To conduct a randomized controlled trial of Students for Nutrition and eXercise, a 5-week middle school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education.


METHODS
We randomly selected schools (five intervention, five waitlist control) from the Los Angeles Unified School District. School records were obtained for number of fruits and vegetables served, students served lunch, and snacks sold per attending student, representing an average of 1,515 students (SD = 323) per intervention school and 1,524 students (SD = 266) per control school. A total of 2,997 seventh-graders (75% of seventh-graders across schools) completed pre- and postintervention surveys assessing psychosocial variables. Consistent with community-based participatory research principles, the school district was an equal partner, and a community advisory board provided critical input.


RESULTS
Relative to control schools, intervention schools showed significant increases in the proportion of students served fruit and lunch and a significant decrease in the proportion of students buying snacks at school. Specifically, the intervention was associated with relative increases of 15.3% more fruits served (p = .006), 10.4% more lunches served (p < .001), and 11.9% fewer snacks sold (p < .001) than would have been expected in its absence. Pre-to-post intervention, intervention school students reported more positive attitudes about cafeteria food (p = .02) and tap water (p = .03), greater obesity-prevention knowledge (p = .006), increased intentions to drink water from the tap (p = .04) or a refillable bottle (p = .02), and greater tap water consumption (p = .04) compared with control school students.


CONCLUSIONS
Multilevel school-based interventions may promote healthy adolescent dietary behaviors.
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: laura.bogart@childrens.harvard.edu.
Laura M
LM
Bogart
Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
Burton O
BO
Cowgill
RAND Corporation, Santa Monica, California.
Marc N
MN
Elliott
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
David J
DJ
Klein
RAND Corporation, Santa Monica, California.
Jennifer
J
Hawes-Dawson
Student Medical Services, Los Angeles Unified School District, Los Angeles, California.
Kimberly
K
Uyeda
Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
Jacinta
J
Elijah
Food Services Branch, Los Angeles Unified School District, Los Angeles, California.
David G
DG
Binkle
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Mark A
MA
Schuster
D000293:Adolescent; D000886:Anthropometry; D002648:Child; D055812:Community-Based Participatory Research; D004032:Diet; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D015141:Los Angeles; D008297:Male; D019212:Multimedia; D009765:Obesity / Q000517:prevention & control*; D010379:Peer Group; D012572:School Health Services / Q000458:organization & administration*
Adolescent obesity; Community participation; Eating; Intervention studies; Schools