"Real World" Adolescent Intervention Research Meets Randomized Controlled Trial Methodology: Lessons Learned

The purpose of this presentation is to delineate some practical factors inherent in conducting successful healthy lifestyle intervention research within school settings with adolescents. Implementation of the Creating Opportunities for Personal Empowerment (COPE) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise and Nutrition) Program was challenged by a number of delivery and setting issues. The development of the COPE intervention components and delivery methodology are guided by Cognitive Theory (Beck, 1979) which postulates that cognitive distortions, learned misconceptions and/or exposure to unhealthy environments can negatively influence an individual’s emotions and behaviors. Utilizing cognitive behavior skills building techniques, behavior change is supported by increasing the adolescent’s evaluation of his or her own emotional responses and behavior and by correcting misconceptions to help guide the adolescent to choose more adaptive, realistic attitudes in response to negative thoughts, emotions and behavior. Therefore, it is vital that intervention researchers examine how the critical inputs of the planned intervention and theorized mediating processes are linked to selected measured outcomes and implementation processes in order to be able to explain the study’s results (Braden, 1998). Major points for discussion will focus on implementation challenges that center on recruitment and training of high school teachers to deliver the intervention with fidelity; presence of the problems of interest in the participants at baseline (i.e., overweight and obesity; depressive and anxiety symptomology); the emphasis on intervention components that facilitate negative schema change (i.e., homework completion; problem solving utilizing case scenarios; creation of positive self-statements); the creation and delivery of the comparison group, Health for Teens, attention control intervention; techniques utilized to increase parent involvement; and adaptation of the study team to school and health class scheduling, semester breaks and obtaining student information from the school districts (i.e., attendance, grades, and number of in or out of “house” suspensions). Approaches found to be successful in resolving some of the dilemmas and challenges encountered will be discussed.