Abstract
One in three youth in the United States are overweight, and 85% of all overweight youth have at least one
Metabolic Syndrome (MetS) risk factor that increases their chance of developing cardiovascular disease.
Comprehensive school- and evidence-based interventions (EBIs) that focus on students’ physical activity and
fruit and vegetable consumption can reduce a school’s prevalence of overweight students by up to 8%.
Additionally, multi-level interventions that target school health environments may be more effective than
interventions that focus on individuals alone. Currently, there is an absence of multi-level EBIs for middle
school students that address both physical activity and healthy eating behaviors and environments. Strong
Teens for Healthy Schools Change Club (STHS-CC) is a novel, multi-level, and theory-based civic engagement
program that equips and supports middle school students in racially/ethnically diverse, Title 1 middle schools
to make a positive food and physical activity environmental change and personally engage in physical activity
and healthy eating behaviors to reduce their MetS risk. This study utilizes a community advisory board to
engage Cooperative Extension agents, 4-H staff, school administrators, teachers, and students in the
refinement of STHS-CC for the middle school setting. Once refined, the community advisory board oversees
the delivery and testing of STHS-CC using traditional and collaborative data analysis processes (e.g.,
Photovoice) in a pilot cluster-randomized controlled trial (n=20 schools; 20-25 participants per school). At the
individual level, this study tests STHS-CC’s effectiveness for improving students’ MetS risk factors and positive
youth development outcomes (i.e., competence, confidence, character, connection, and caring). At the social
level, this study evaluates peers’ support for and participation in physical activity and healthy eating behaviors.
At the environmental level, this study evaluates the physical, situational, and policy aspects of schools’ physical
activity and nutrition environments. Long-term, the goal of this body of work is to motivate middle school
students to improve their physical activity and nutrition behaviors and environments through a student led
EBI that is part of a collection of comprehensive school-based health promotion programs. If effective, STHSCC has the potential to be disseminated through schools, Cooperative Extension networks, and 4-H
organizations statewide and nationally.
