Researchers find what's missing in teen health programs

Adding a mental health component to school-based lifestyle programs for teens could be key to lowering obesity, improving grades, alleviating severe depression and reducing substance use, a new study suggests.

As a group, high-school students who participated in an intervention that emphasized cognitive behavioral skills building in addition to nutrition and physical activity had a lower average body mass index, better social behaviors and higher health class grades and drank less alcohol than did teenagers in a class with standard health lessons.

Symptoms in teens who were severely depressed also dropped to normal levels at the end of the semester compared to the control group, whose symptoms remained elevated.

Most of the positive outcomes of the program, called COPE, were sustained for six months.

Thirty-two percent of youths in the United States are overweight or obese, and suicide is the third leading cause of death among young people age 14 to 24, according to the Centers for Disease Control and Prevention. Yet most school-based interventions don't take on both public health problems simultaneously or measure the effects of programs on multiple outcomes, said Bernadette Melnyk, creator of the COPE program, dean of The Ohio State University College of Nursing and lead author of the study.

"This is what has been missing from prior healthy lifestyle programs with teens - getting to the thinking piece. We teach the adolescents that how they think directly relates to how they feel and how they behave," said Melnyk, also Ohio State's chief wellness officer.

"This program dropped scores of severely depressed teens almost in half. Less than 25 percent of adolescents who have mental health problems get any help, and here we have an intervention that addresses that suffering and also can prevent or reduce obesity."

The study is published in the American Journal of Preventive Medicine.

A total of 779 high-school students age 14 to 16 in the Southwestern United States participated in the study. Half attended a control class that covered standard health topics such as road safety, dental care and immunizations. The others were enrolled in the intervention Melnyk and colleagues were testing for its effectiveness - a program called COPE: (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition).

Melnyk began developing COPE more than 20 years ago while she was a nurse practitioner at an inpatient psychiatric unit for children and adolescents. The program is based on the concepts of cognitive behavioral therapy, with an emphasis on skills building.

It's not counseling in the classroom, however: The entire COPE curriculum, a blend of weekly 50-minute behavioral skills sessions, nutrition information and physical activity over the course of 15 weeks, is spelled out for instructors in manuals and PowerPoints. This study was the first to test COPE's effectiveness when taught by trained teachers in a health classroom setting. In pilot studies, Melnyk and her team have taught the curriculum themselves.