Teen girls make better health choices with intervention program

LDL levels improved significantly



Students in the Teen Esteem program at Trenton Central High work out with an experienced certified fitness trainer each week.
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Trenton, NJ- Trenton, NJ - Teens around the world are becoming more overweight. Findings from a Rutgers University research study indicate a health intervention can help curb this disturbing health trend. The intervention - TEEN ESTEEM™ - is a health and fitness program for adolescent girls attending Trenton Central High School (TCHS), an inner-city school with a mostly African American and Latino population. For two consecutive years, researchers have been examining the effect of an innovative physical fitness and nutrition program on measures of cardiovascular fitness and self-esteem and found the students are making better health choices. Many of those at highest risk successfully lowered their BMI scores. Lipid levels analyzed in year two demonstrated participants' Low Density Lipoprotein (LDL) levels - the unhealthy cholesterol - decreased significantly.

"Focusing our attention on vulnerable teen girls with even moderate increases in weight is critically important since studies show this is a population at risk," said Kathleen Ashton, PhD, APRN, principal investigator, referring to results from the Nurses' Health Study II recently released by the Harvard School of Public Health that found an increased risk of mortality in younger and middle-aged women who were overweight at age 18 (Annals Internal Med 2006; 145:91-7). "Our study adds to what is known about the eating and exercise habits of teen girls and demonstrates how school systems can impact adolescent overweight and reduce risk factors for disease," stated Dr. Ashton. Dr. Ashton is a clinical associate professor of Nursing at Rutgers University in Camden.

Ashton and her colleagues hypothesized that subjects in the experimental group who completed the Teen Esteem™ program would demonstrate greater levels of self-esteem, as measured by the Multidimensional Self Concept Scale (MSCS), improved scores on the nutrition and physical activity subscales of the Youth Risk Behavior Surveillance Survey (YRBSS), and acceptable levels of Body Mass Index (BMI), blood pressure, waist circumference, blood glucose and cholesterol. Participants were sophomore girls who voluntarily enrolled in the program with girls in regular gym classes serving as the control group. The girls were followed for the entire school year with data collected at the beginning and end of the school year. Two hundred and fifty six participants have completed the program to date. The 3-year study began September 2004 and will end June 2007.

Significant findings from the 2004-05 school year - the pilot year (n=131):

  • 11 students had a BMI score of 35 or above at the beginning of the year; 9 students at the end of the year.
  • Nutrition subscales showed improvement in the number of servings taken in of fruits, vegetables and salads
  • Activity subscales showed improvement

There was a high level of self-esteem among both the participant group and the control group, with a slight increase in average self-esteem scores in the participant group at the conclusion of the program. The mean BMI scores increased slightly, which reflected an expected growth spurt.

BMI scores are age- and gender-specific in children and a score of 35 indicates a 16-year-old girl is above the upper 95 percentile for weight. A high BMI score indicates greater risk of developing health problems related to obesity.

Significant findings from the 2005-2006 school year (n=125):

  • The participant group gained 2.78 pounds
  • Low density lipoprotein (LDL) levels decreased by 2 points.
  • 15 students had a BMI score of 35 or above. Of those, 7 successfully lowered their scores.
  • Mean BMI scores increased slightly (0.23), as would be expected with a growth spurt
  • 23 students were found to have low HDL - below 40mg/dL.This number remained unchanged at the beginning and end of the school year. Other studies have shown low HDL levels in children and may be attributed to poor eating habits. An HDL level of 60 mg/dL is considered cardio-protective in an adult female, according to the NHLBI /National Institutes of Health Heart Truth campaign.
  • 8 students had three or more indicators for metabolic syndrome (pre-diabetes). Of these, three had BMI scores at or below 29. The presence of at least three of the following indicates metabolic syndrome:
    • High blood sugar >110 mg/dL after fasting
    • High triglycerides - at least 150 mg/dL
    • Low HDL (<50 mg/dL in women)
    • Blood pressure of 130/85 or higher
    • Waist >35 inches.
  • Attendance records demonstrate 90% of the students participating on any given day, as compared to regular gym class where approximately 50% of the students participate.
  • The High school drop out rate for girls enrolled in Teen Esteem was zero as compared to the school's overall drop out rate that is between 50-60%.

Lead teacher Constance Kelley attributes the success of the program to the creation of a stronger student-teacher bond, expert attention from a personal fitness trainer and nutritionist, and the 'all-girl' environment. "I have 125 daughters," she said, "and the students really seem to thrive on the structure with each day dedicated to a different focus on health and fitness."

The program is partially funded through a $15,000 grant from the Horizon Foundation for New Jersey and a $2,600 city of Trenton Community Development Block Grant. Start-up funds of $70,000 were provided by the NJ Department of Health & Senior Services Office on Women's Health and the Department of Human Services with in-kind support from Trenton Board of Education. The study is entering its third year and is being funded by the Women's Heart Foundation (WHF) with in-kind support from Rutgers University-Camden Departments of Nursing and Psychology. WHF is seeking corporate support to continue the program and expand it into other schools.

"This has been a great undertaking for all of us," said Dr. Ashton. "It's important to know how to work within school systems to implement initiatives such as Teen Esteem that address obesity and other pressing health problems. Teen Esteem targets teen girls who are potentially at high risk for developing heart disease and diabetes. We need to look at this problem now because research shows that heart disease begins in childhood and affects individuals throughout their lives. Hopefully, the healthier habits that they've established will continue into their adulthood."

"We are very pleased to have the Teen Esteem program at Trenton High providing our female students with much needed information on health and the maintenance of healthy bodies," said Rodney Lofton, Superintendent for Trenton City Schools. "As a result of their involvement in the program, they have become aware of the importance of a combination of good nutrition and exercise. It is our hope that this program will also serve Trenton families as our students share this valuable life-improving information with their own family." "It is our pleasure to support the Teen Esteem Health and Fitness Program," said Larry Altman, vice president of corporate marketing and communications for Horizon BCBSNJ. "Our community partners like the Women's Heart Foundation are making an important difference in the lives of thousands of people in New Jersey."

"WHF is grateful to The Horizon Foundation for New Jersey for providing funding for this great program, and to the city of Trenton for their support as well. We could not provide this program without their financial support. We also want to thank our collaborators for the 2006-07 school year: Rutgers University-Camden for research support, Rutgers Extension Services for the nutrition education, and UMDNJ School of Health Professionals Dietetic Internship Program and Wegmans for the grocery store tour. The Dietetic Internship Program at UMDNJ, School of Health Related Professions has helped WHF revise its Supermarket Tour curriculum to become a high school field trip. Its faculty and students work with our Foundation and the Teen Esteem program to conduct the tours on an annual basis," said Bonnie Arkus.

"We've developed a curriculum that impacts teen girls' health choices and now have an intervention that helps reduce the risk of serious health problems," said Ms. Arkus. "The WHF plans to conduct a feasibility study to examine the benefit of keeping the Teen Esteem program open after school hours as a low-cost fitness center for members of the community. Students who have graduated from Teen Esteem could then continue the program. Our next step is to extend the hours and benefits of the existing program, then make the program available to other schools that have expressed interest. We will be looking for corporate partners and sponsors as well as volunteers. This is a great opportunity to make a real difference in the community. Our mission is to reduce the risk of heart disease in women and improve quality of life and this program is a vital part of that mission."

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The Horizon Foundation for New Jersey promotes health, well-being, and quality of life in New Jersey’s communities. Priority areas include health, the arts, and education.

The Women's Heart Foundation (WHF) is the only Non Governmental Organization that designs and implements demonstration projects for the prevention and early intervention of heart disease in women. WHF was founded June 11, 1992 as a 501 c3 charitable organization dedicated to improving women's survival and quality of life. For more information, contact us.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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