“Testing the Impact of Family-based Intervention to Improve Developmental and Health Outcomes for Female Adolescents.” - Modified Project Summary/Abstract Section This R01 proposes a scalable intervention to improve the health trajectories of vulnerable adolescent girls in low-resource settings. Adolescence is a critical period during which nutrition, mental health, and health behaviors establish trajectories for lifelong health and well-being. Yet, millions of adolescent girls face persistent poverty, food insecurity, family instability, and limited educational opportunities, placing them at elevated risk for poor nutrition, mental health, and health-compromising behaviors. In Ghana’s Northern Region, 31% of households are food insecure; 37% of girls ages 12–17 are poor, and 65% have anemia—an indicator of malnutrition. Schools provide an ideal setting for health promotion, as adolescents spend much of their time in school. Although Ghana has universal school-based health education programs, adolescent girls face barriers to adopting and sustaining healthy behaviors, underscoring the need for multicomponent interventions. Family functioning, adolescent psychosocial wellbeing, and household financial stability have been associated with positive health outcomes. ANZANSI is an innovative family-centered intervention designed to strengthen these mechanisms. We propose a cluster-randomized effectiveness trial that will recruit 960 adolescent girls (ages 11 to 14 years) at risk of school dropout, nested within 32 public junior high schools in Northern Ghana. The study aims are: Aim 1: Examine the short- and medium-term effects of ANZANSI on physical health, nutrition, mental health, and health-compromising behaviors as primary outcomes; Aim 2: Examine the impact of ANZANSI on modifiable mechanisms influencing adolescent health outcomes.; Aim 3: Evaluate the cost and cost-effectiveness of ANZANSI; and Aim 4: Qualitatively examine participants, facilitators, and school leadership’s experiences with the intervention. Although implemented in Ghana, the mechanisms targeted by this preventive school-based intervention are relevant to U.S. adolescent girls in economically disadvantaged families who face disproportionately high rates of educational disruption, family stress, and household food insecurity. Evaluating the impact of this school-based, family-centered intervention, which has demonstrated feasibility and acceptability, could generate useful evidence on approaches that address these interconnected upstream determinants to improve adolescent health in the U.S. With appropriate attention to health systems, social conditions, and cultural contexts, results could inform the adaptation and testing of similar school-based interventions in underserved settings in the U.S., with direct and indirect impacts on adolescent health.
