Evaluation of the Impact of the Creating Opportunity for Personal Empowerment (COPE) Healthy Lifestyles Thinking, Emotions, Exercise, and Nutrition (TEEN) Program in a Rural High School Health Class

Background. More than 12.5 million children in the United States are overweight. More specifically, in 2007, 31% of 9th grade students in West Virginia were overweight. Healthy People 2010 identified obesity as among the top ten health issues and set a goal to reduce the proportion of children and adolescents who were overweight to 5%. This goal was not attained because most current interventions to prevent and treat obesity have not been effective in changing the weight status of children and adolescents. However, cognitive behavioral interventions, combined with parent education have been found to be an effective strategy in weight loss among adolescents.;Objectives. The primary goal of this project was to increase healthy lifestyle behaviors in 9th graders in a rural health class after receiving the COPE TEEN program. Secondary outcomes included that teens would: have stronger beliefs about the ability to engage in a healthy lifestyle, perceive living a healthy lifestyle as less difficult, increase the amount of time spent in physical activity, have a higher self-esteem, lose weight if overweight at the start of the program, and that parents would be able to help their teen achieve healthy lifestyle goals. A third outcome was to determine the feasibility of this program as part of the health class curriculum in a rural high school.;Design. This study used a pre-experimental design with pre- and post-testing. The COPE intervention was incorporated into the health class curriculum for ninth grade students during the 2009 fall and spring semesters. Cognitive behavior skills building (CBSB) sessions were conducted once a week for 15 weeks during the regular scheduled health class. Each weekly class involved 30 minutes of CBSB education, followed by 20 minutes of physical activity. The intervention included a parent education component by newsletter three times during the program. Pre- and post- measurements included: BMI (calculated from height and weight), BMI %, teen healthy lifestyles behavior, cognitive beliefs, perceived difficulty in leading a healthy lifestyle, self-esteem, and parent\u27s healthy lifestyle behaviors, beliefs, and perceived difficulty in leading a healthy lifestyle. Other data included a post-intervention exit questionnaire consisting of five open-ended questions about the participants\u27 perception of the helpfulness of the COPE program.;Subjects. Fifty-five students began the program and forty- nine (89%) completed the entire 15 week program. All the students were enrolled in the ninth grade health class with a mean age of 14.67 years.;Results. Teens healthy lifestyles behavior improved during the 15 week COPE Program with a statistically significant improvement in the students\u27 healthy behavior scores from Time 1 (M=51.32, SD=11.15) to Time 2 (M=57.45, SD=9.71), t (43) 3.93, p=.000 (two-tailed). There was a statistically significant difference in self-esteem of a sub-group of eight teens with low-esteem at baseline. Self-esteem scores improved in this group from Time 1 (M=20.41, SD=5.98) to Time 2 (M=21.54 SD=5.63) p=.010. Although not statistically significant, there was an increase in healthy lifestyles beliefs as well as a decrease in perceived difficulty among the COPE teen participants, which resulted in positive effect sizes for the intervention. The parents of the adolescents participating in the program had increased healthy lifestyle behaviors and beliefs and a decrease in perceived difficulty to engage in a healthy lifestyle. Forty-nine percent of the students lost a total of 143.6 pounds and 6% maintained their weight. BMI % improved in seven teens resulting in them moving from a category of obese to overweight or overweight to healthy weight. Only one student had an increase in BMI %.;Conclusion. The COPE Program which consists of education with cognitive behavioral skills building combined with physical activity and parent newsletters is an effective strategy in improving healthy lifestyles behaviors and weight management among teens, and can be easily incorporated into the curriculum of a rural high school health class