title: Long-term predictors of blood pressure among adolescents during an 18-month school-based obesity prevention intervention.
abstract: OBJECTIVE
  To evaluate the effectiveness of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) initiative, a multicomponent school-based obesity prevention intervention based on the Centers for Disease Control and Prevention's coordinated school health approach, on the improvement of blood pressure (BP) and to determine long-term predictors of systolic and diastolic BP changes among high school students who were exposed to the intervention.
  
  
  METHODS
  Biometric and behavioral data from high school students were analyzed at baseline, 6, 12, and 18 months (N = 847, three schools). The attrition rate at 18 months was 26.1%. Sequential generalized estimating equation models were fit to the data using SAS 9.3, taking into account clustering effects within the same school and correlations within repeated measures.
  
  
  RESULTS
  A significant downward trend was observed in systolic BP (p = .0006) and diastolic BP (p < .0001) among the students who were exposed to the HEROES initiative. The prevalence of hypertension decreased from 17.1% at baseline to 12.8% at 6 months (p < .0001), 12.0% at 12 months (p < .0001), and 15.0% (p = .0024) at 18 months. Baseline body mass index, increases in body mass index percentiles, and increases of television-viewing hours were associated with BP increases. Increases in frequencies of eating french fries or chips, skipping breakfast, and consuming supersize meals when eating fast food were predictive of systolic BP changes, not of diastolic BP changes.
  
  
  CONCLUSIONS
  An 18-month multicomponent school-based obesity intervention program may be effectively used to decrease rates of high BP among adolescents.
authors.affiliation: Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana.
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.affiliation: College of Health Sciences, Ewha Womans University, Seoul, South Korea. Electronic address: dseo@ewha.ac.kr.
authors.forename: Dong-Chul
authors.initials: DC
authors.lastname: Seo
authors.affiliation: Center on Education and Lifelong Learning, Indiana University, Bloomington, Indiana.
authors.forename: Mindy H
authors.initials: MH
authors.lastname: King
authors.affiliation: Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana; Center on Education and Lifelong Learning, Indiana University, Bloomington, Indiana.
authors.forename: Alyssa M
authors.initials: AM
authors.lastname: Lederer
authors.affiliation: Center on Education and Lifelong Learning, Indiana University, Bloomington, Indiana.
authors.forename: Danielle
authors.initials: D
authors.lastname: Sovinski
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008137:Longitudinal Studies; D008297:Male; D063766:Pediatric Obesity / Q000517:prevention & control*; D015397:Program Evaluation; D012572:School Health Services
keywords: Blood pressure; Longitudinal cohort; Obesity intervention; School health