健全な学校のために強い十代の若者がクラブを変える：身体活動と健康的な食事環境を改善するための市民参加のアプローチ

Participants in this group (10 schools) will participate in the STHS program.

STHS program

The intervention group (10 schools) will participate in the STHS program. During the fall semester (September to December), the intervention group will receive 24 thirty-minute modules (or twelve 1-hour modules) that provide education on civic engagement, healthy eating, and physical activity. During the spring semester (February to May), the intervention group will receive 24 thirty-minute modules (or twelve 1-hour modules) that focus on implementing the school health environmental change project and receive support for maintaining individual-level healthy eating and physical activity behaviors.

Participants in this group (10 schools) will continue with usual care, as they will not be asked to add or remove any of their current, physical activity, healthy eating, or positive youth development programming.

No STHS program

The usual care group will be offered the same activities as the intervention group after the conclusion of the research study.

MetS is present after identifying abdominal obesity plus at least two of the four other MetS Risk factors: high blood pressure, high blood sugar, low HDL cholesterol, and high triglyceride levels.

MetS = (abdominal obesity) + (2 of 4 other MetS Risk factors)

Measures to determine MetS risk factors:

1. Abdominal obesity: waist circumference >90th percentile for child's sex and age
2. High blood pressure: systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥90 mmHg)
3. High blood glucose: blood glucose ≥5.6 mmol/L or known diabetes
4. Low HDL cholesterol: HDL cholesterol <1.03 mmol/L
5. High triglyceride level: Triglyceride level ≥ 1.7mmol/L

Change in the number of MetS risk factors = (new # of MetS risk factors) - (original # of MetS risk factors)

Measures to determine MetS risk factors:

1. Abdominal obesity: waist circumference >90th percentile for child's sex and age
2. High blood pressure: systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥90 mmHg)
3. High blood glucose: blood glucose ≥5.6 mmol/L or known diabetes
4. Low HDL cholesterol: HDL cholesterol <1.03 mmol/L
5. High triglyceride level: Triglyceride level ≥ 1.7mmol/L

Positive youth development will be measured using a 5 C's Model of Positive Youth Development Scale-Short Form (PYD-SF): A 34-item scale that assesses the strength of psychological, behavioral, and social development in youth.

The five dimensions measured are:

1. Competence (sense of proficiency)
2. Confidence (self-worth, self-efficacy)
3. Character (adherence to societal and cultural rules)
4. Connection (bonds with people and institutions)
5. Caring (sympathy and empathy towards others)

Blood pressure (systolic and diastolic) will be measured with two numbers using an automated Omron sphygmomanometer.

Glucose will be measured using a portable Cholestech LDX analyzer to assess a single capillary blood sample following an overnight fast.

Waist circumference will be measured at the midpoint between the floating rib and iliac crest using a tape measure.

HDL-C will be measured using a portable Cholestech LDX analyzer to assess a single capillary blood sample following an overnight fast.

Triglycerides will be measured using a portable Cholestech LDX analyzer to assess a single capillary blood sample following an overnight fast.

Height will be measured using a stadiometer in inches.

Weight will be measured with a scale in pounds.

Weight will be measured with a scale, and height will be measured using a stadiometer. BMI will be calculated as BMI = (weight (lb)/height (inches)2) x 703.

The concentration of subdermal carotenoids will assess the changes in fruit and vegetable consumption using the Veggie Meter: A non-invasive, portable machine that measures subdermal carotenoid levels using resonance Raman spectroscopy.

Physical activity will be measured using Actigraph accelerometers. Measurements will include light physical activity (PA), moderate PA, moderate to vigorous PA, and vigorous PA.

Sedentary time will be measured using Actigraph accelerometers.

Sleep time will be measured using Actigraph accelerometers.

Physical fitness will be measured using the FitnessGram PACER multistage aerobic capacity test: Children will run back and forth 20 meters, with an initial running speed of 8.5 km/hour and a progressive 0.5-km/hour increase in running speed every minute. As the test continues it becomes progressively harder. The number of laps completed is used to estimate children's physical fitness physical fitness.

The school's physical activity and nutrition environments will be measured using a self-reported School Environment Survey.

Perceptions related to physical activity and nutrition within the school setting will be measured using the Perceptions of the Environment and Patterns of Diet at School (PEA-PODS) survey.

Perceived sociopolitical control will be measured using the Youth Engagement and Action for Health (YEAH!) survey. The YEAH survey will be used to assess students' perceived sociopolitical control (i.e., participation in advocacy programs and optimism for change).

Assertiveness will be measured using the Youth Engagement and Action for Health (YEAH!) survey. The YEAH survey will be used to assess students' assertiveness (i.e., ability to engage with adults and peers).

Participatory competence and decision-making will be measured using the Youth Engagement and Action for Health (YEAH!) survey. The YEAH survey will be used to assess students' participatory competence and decision-making (i.e., ability to influence group decision-making).

Advocacy outcome efficacy will be measured using the Youth Engagement and Action for Health (YEAH!) survey. The YEAH survey will be used to assess students' advocacy outcome efficacy (i.e., belief in their ability to work with others to improve the school's physical activity and nutrition environment).

The concentration of subdermal carotenoids will assess peers' engagement in health behaviors changes in fruit and vegetable consumption using the Veggie Meter: A non-invasive, portable machine that measures subdermal carotenoid levels using resonance Raman spectroscopy.

Peers' engagement in health behaviors will be measured by the change in peers' BMI. Weight will be measured with a scale, and height will be measured using a stadiometer. Calculate BMI with the formula: BMI = (weight (lb)/height (inches)2) x 703.

Peers' engagement in health behaviors will be measured by the change in peers' physical fitness. Physical fitness will be measured using the FitnessGram PACER multistage aerobic capacity test: Children will run back and forth 20 meters, with an initial running speed of 8.5 km/hour and a progressive 0.5-km/hour increase in running speed every minute. As the test continues it becomes progressively harder. The number of laps completed is used to estimate children's physical fitness physical fitness.