JAMA Pediatrics: Lifestyle Behaviors Topic Collection

Clinical Trials for Adolescent Obesity Cooking Up an Alphabet Stew of What to Do Clinical Trials for Adolescent Obesity

Schwimmer JB. — Mon, 01 Apr 2013 00:00:00 GMT

Exenatide is a glucagon-like peptide-1 (GLP-1) agonist. The GLP-1 is principally produced in the enteroendocrine cells of the ileum in response to local contact with postprandial nutrients in the intestinal lumen. It stimulates insulin secretion and inhibits glucagon release. Long-acting GLP-1 receptor agonists were developed as glucose-lowering drugs for the treatment of type 2 diabetes mellitus. In the large phase 3 trials conducted for diabetes, it was observed that these drugs also produced weight loss. The effect of GLP-1 agonists on body weight is believed to be a central effect leading to reduced food intake. Collectively, the studies in obese adults with or without diabetes demonstrate that long-acting GLP-1 agonists promote weight loss on the order of 2% to 4%. In this issue of the journal, Kelly et al report the results of a randomized, double-blind, placebo-controlled clinical trial of exenatide vs placebo injected twice daily for 3 months in severely obese adolescents.

Prime Time Sexual Health Outcomes at 24 Months for a Clinic-Linked Intervention to Prevent Pregnancy Risk Behaviors Intervention to Prevent Pregnancy Risk Behaviors

Sieving RE, McRee A, McMorris BJ, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches. Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy.

Objective

To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey, 6 months after the conclusion of the Prime Time intervention.

Design

Randomized controlled trial.

Setting

Community and school-based primary care clinics.

Participants

Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria, 236 (93.3%) completed the 24-month follow-up survey.

Intervention

Offered during an 18-month period, Prime Time includes case management and youth leadership programs.

Main Outcome Measures

Self-reported consistency of condom, hormonal, and dual-method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months.

Results

At 24-month follow-up, the intervention group reported significantly more consistent use of condoms, hormonal contraception, and dual-method contraception than the control group. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. No between-group differences were found in the number of recent male sex partners.

Conclusions and Relevance

This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk. Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth.

Effect of Volunteering on Risk Factors for Cardiovascular Disease in Adolescents A Randomized Controlled Trial Volunteering and Cardiovascular Disease Risks

Schreier HC, Schonert-Reichl KA, Chen E. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

The idea that individuals who help others incur health benefits themselves suggests a novel approach to improving health while simultaneously promoting greater civic orientation in our society. The present study is the first experimental trial, to our knowledge, of whether regular volunteering can reduce cardiovascular risk factors in adolescents.

Objective

To test a novel intervention that assigned adolescents to volunteer with elementary school–aged children as a means of improving adolescents' cardiovascular risk profiles.

Design

Randomized controlled trial, with measurements taken at baseline and 4 months later (postintervention).

Setting

Urban public high school in western Canada.

Participants

One hundred six 10th-grade high school students who were fluent in English and free of chronic illnesses.

Intervention

Weekly volunteering with elementary school–aged children for 2 months vs wait-list control group.

Main Outcome Measures

Cardiovascular risk markers of C-reactive protein level, interleukin 6 level, total cholesterol level, and body mass index.

Results

No statistically significant group differences were found at baseline. Postintervention, adolescents in the intervention group showed significantly lower interleukin 6 levels (log₁₀ mean difference, 0.13; 95% CI, 0.004 to 0.251), cholesterol levels (log₁₀ mean difference, 0.03; 95% CI, 0.003 to 0.059), and body mass index (mean difference, 0.39; 95% CI, 0.07 to 0.71) compared with adolescents in the control group. Effects for C-reactive protein level were marginal (log₁₀ mean difference, 0.13; 95% CI, −0.011 to 0.275). Preliminary analyses within the intervention group suggest that those who increased the most in empathy and altruistic behaviors, and who decreased the most in negative mood, also showed the greatest decreases in cardiovascular risk over time.

Conclusions and Relevance

Adolescents who volunteer to help others also benefit themselves, suggesting a novel way to improve health.

Trial Registration

clinicaltrials.gov Identifier: NCT01698034