COLUMBUS, Ohio - An innovative high school health program helped students maintain healthier weights and even alleviated severe depression for a full year after the program ended.
Researchers found that 12 months after completing the COPE Healthy Lifestyles TEEN Program, students had markedly lower body mass index than students who received a more standard health curriculum. Additionally, COPE teens who began the program with extremely elevated depression had symptoms in the normal range after 12 months.
COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) teaches adolescents that how they think is directly related to how they feel and behave. It also teaches them how to turn negative beliefs triggered by "activating events" into positive beliefs so that they feel emotionally better and engage in healthy behaviors. The program is based on cognitive behavioral therapy (CBT), with an emphasis on skills-building.
"CBT is the gold standard treatment for depression and anxiety, but it has traditionally been used in one-on-one, hour-long therapy sessions," said Bernadette Melnyk, dean of The Ohio State University College of Nursing and lead author of the study.
"With COPE, any health professional or educator can teach cognitive behavior skills to adolescents. This is huge for schools or community centers. We can really make positive impacts on teens' lives by teaching these skills to them."
Melnyk, who is also Ohio State's associate vice president for health promotion and chief wellness officer, began developing COPE more than 20 years ago as a pediatric and psychiatric nurse practitioner.
The study appears in the December 2015 issue of the Journal of School Health.
This study was aimed at evaluating the long-term efficacy of COPE. A total of 779 high-school students aged 14 to 16 from 11 high schools in the southwestern United States participated in the study. Half attended a control class - called Healthy Teens -- that covered standard health topics such as road safety, dental care and immunizations. The others were enrolled in the COPE Healthy Lifestyles TEEN program.
Health teachers were provided a full-day workshop on COPE and how to teach the program. The classroom curriculum blends cognitive-behavioral skills sessions with nutrition lessons and 20 minutes of physical activity, such as dancing, walking or kick-boxing movements.
The 12-month follow-up evaluation after the COPE program showed a significant decrease in the proportion of overweight and obese teens. Only 4.8 percent of COPE teens who were in the healthy weight category moved into the overweight category after a year and none moved into the obese category. In comparison, 10 percent of the students who were in the control, Healthy Teens program, moved into the overweight or obese categories after a year. Further, COPE teens who were on public assistance had a significantly larger decline in body mass percentile following the intervention compared to similar students who completed the control health education program.
A particularly important finding, Melnyk said, was that COPE students who began the study with severely elevated depressive symptoms had significantly lower depressive scores that fell into the normal range a year after the program ended. Students with high levels of depression who completed the Healthy Teens program still tended to have scores in the depressed range after a year.
"Because the majority of adolescents with depression do not receive treatment, and even fewer receive CBT, it is vital that we provide them the tools and ability to engage in positive thinking and employ effective coping," she said.
"The feedback from the teens during the open-ended evaluations included hundreds of comments specifically indicating that the COPE program helped them deal effectively with stress and anger as well as to feel better about themselves."
Melnyk said she hopes that schools across the country will use COPE in their health curricula.
"A variety of professionals can learn the program, so it could be used in schools, community centers and youth organizations to help teens lead healthier, happier lives and perform better academically," she said.
Other co-authors were Diana Jacobsen, Michael Belyea, Gabriel Shaibi and Flavio Marsiglia of Arizona State University; Stephanie Kelly of Ohio State; Leigh Small of Virginia Commonwealth University; and Judith O'Haver of Phoenix Children's Medical Group.
The National Institute of Nursing Research, part of the National Institutes of Health, supported this research.