Promoting Healthy Lifestyles in High School Adolescents
Open accessAbstract
Background Although obesity and mental health disorders are two major public health problems in adolescents that affect academic performance, few rigorously designed experimental studies have been conducted in high schools.Purpose The goal of the study was to test the efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) Program, versus an attention control program (Healthy Teens) on: healthy lifestyle behaviors, BMI, mental health, social skills, and academic performance of high school adolescents immediately after and at 6 months post-intervention.Design A cluster RCT was conducted. Data were collected from January 2010 to May of 2012 and analyzed in 2012-2013.Setting/participants A total of 779 culturally diverse adolescents in the U.S. Southwest participated in the trial.Intervention COPE was a cognitive-behavioral skills-building intervention with 20 minutes of physical activity integrated into a health course, taught by teachers once a week for 15 weeks. The attention control program was a 15-session, 15-week program that covered common health topics.Main outcome measures Primary outcomes assessed immediately after and 6 months post-intervention were healthy lifestyle behaviors and BMI. Secondary outcomes included mental health, alcohol and drug use, social skills, and academic performance.Results Post-intervention, COPE teens had a greater number of steps per day (p=0.03) and a lower BMI (p=0.01) than did those in Healthy Teens, and higher average scores on all Social Skills Rating System subscales (p-values <0.05). Teens in the COPE group with extremely elevated depression scores at pre-intervention had significantly lower depression scores than the Healthy Teens group (p=0.02). Alcohol use was 12.96% in the COPE group and 19.94% in the Healthy Teens group (p=0.04). COPE teens had higher health course grades than did control teens. At 6 months post-intervention, COPE teens had a lower mean BMI than teens in Healthy Teens (COPE=24.72, Healthy Teens=25.05, adjusted M=-0.34, 95% CI=-0.56, -0.11). The proportion of those overweight was significantly different from pre-intervention to 6-month follow-up (chi-square=4.69, p=0.03), with COPE decreasing the proportion of overweight teens, versus an increase in overweight in control adolescents. There also was a trend for COPE Teens to report less alcohol use at 6 months (p=0.06).Conclusions COPE can improve short- and more long-term outcomes in high school teens.Trial registration This study is registered at www.clinicaltrials.gov NCT01704768.
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Social skills improved following a likely moderate-intensity intervention in university students with high anxiety sensitivity compared with health education.
“Social skills improved following a likely moderate-intensity intervention in university students with high anxiety sensitivity, compared with health education.42”
From Physical activity and exercise in youth mental health promotion: a scoping review (2020) · cites this paper as [42]
There was less support for moderate-intensity interventions in reducing depression symptoms, with only two positive studies from seven.
“There was less support for moderate-intensity interventions in reducing depression symptoms, with only two positive studies from seven39 42 and only one positive study for anxiety59 and stress59 from the four that measured these outcomes.”
From Physical activity and exercise in youth mental health promotion: a scoping review (2020) · cites this paper as [42]
Only five included studies included follow-up assessments.
“Only five studies included follow-up assessments39 42 46 50 56 and none assessed whether PA/exercise prevented the onset of future episodes of threshold mental disorder, rendering longer-term preventive effects unknown.”
From Physical activity and exercise in youth mental health promotion: a scoping review (2020) · cites this paper as [42]
Only nine included studies included a comparison group that delivered an intervention.
“As only nine studies included a comparison group that delivered an intervention41 42 45 46 50 52 59 61 75—the remaining included a wait-list or additional PA/exercise group—in the majority of studies it remains unknown if the observed effects are due to PA/exercise or from non-specific time/attention effects.”
From Physical activity and exercise in youth mental health promotion: a scoping review (2020) · cites this paper as [42]
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Militello, L. K., Melnyk, B. M., Hekler, E. B., Small, L., & Jacobson, D. (2016) · JMIR mhealth and uhealth · doi:10.2196/mhealth.4398 · Cited by 51 · see citing works
Self-citationTajik, E., Latiff, L. A., Awang, H., Adznam, S. N., Chin, Y. S., Shah, A., Koh, C. H. P., & Hariz, C. G. M. I. (2015) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2015.06.001 · Cited by 50 · see citing works
Hickman, C., Jacobson, D., & Melnyk, B. M. (2014) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2014.05.001 · Cited by 49 · see citing works
Self-citationFekkes, M., van de Sande, M. C., Gravesteijn, J. C., Pannebakker, F. D., Buijs, G. J., Diekstra, R. F. W., & Kocken, P. (2015) · Health Education · doi:10.1108/he-05-2014-0068 · Cited by 47 · see citing works
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Tinner, L., Caldwell, D. M., Hickman, M., MacArthur, G. J., Gottfredson, D. C., Lana, A., Moberg, D. P., Wolfe, D. A., & Campbell, R. M. (2018) · BMC Public Health · doi:10.1186/s12889-018-6042-0 · Cited by 45 · see citing works
Physical Activity Interventions to Decrease Substance Use in Youth: A Review of the Literature
Simonton, A. J., Young, C. C., & Johnson, K. E. (2018) · Substance Use & Misuse · doi:10.1080/10826084.2018.1452338 · Cited by 44 · see citing works
Hoying, J., & Melnyk, B. M. (2016) · The Journal of School Nursing · doi:10.1177/1059840516635713 · Cited by 44 · see citing works
Self-citationAyala, A. M. C., Parker, K. E., Mazzoli, E., Lander, N., Ridgers, N. D., Timperio, A. F., Lubans, D. R., Abbott, G., Koorts, H., & Salmon, J. (2024) · Sports Medicine - Open · doi:10.1186/s40798-024-00688-7 · Cited by 40 · see citing works
Kozlowski, J. L., Lusk, P., & Melnyk, B. M. (2015) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2015.01.009 · Cited by 38 · see citing works
Self-citationExercise interventions for mental disorders in young people: a scoping review
Pascoe, M. C., Bailey, A. P., Craike, M. J., Carter, T., Patten, R. K., Stepto, N. K., & Parker, A. G. (2020) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2019-000678 · Cited by 37 · see citing works
Tamanal, J. M., & Kim, C. H. (2020) · Journal of Lifestyle Medicine · doi:10.15280/jlm.2020.10.1.30 · Cited by 37 · see citing works
George, S. M. S., Agosto, Y., Rojas, L. M., Soares, M., Bahamón, M., Prado, G. J., & Smith, J. D. (2019) · Obesity Reviews · doi:10.1111/obr.12939 · Cited by 37 · see citing works
Mazurek Melnyk, B., Hoying, J., & Tan, A. (2022) · Journal of American College Health · doi:10.1080/07448481.2020.1782922 · Cited by 36 · see citing works
Self-citationMichael, S. L., Barnes, S. P., & Wilkins, N. J. (2023) · Journal of School Health · doi:10.1111/josh.13367 · Cited by 42 · see citing works
Wrona, S. K., Melnyk, B. M., & Hoying, J. (2021) · Pain Management Nursing · doi:10.1016/j.pmn.2020.12.004 · Cited by 36 · see citing works
Self-citationSchool-based yoga intervention increases adolescent resilience: a pilot trial
Felver, J. C., Razza, R. A., Morton, M. L., Clawson, A. J., & Mannion, R. S. (2020) · Journal of Child and Adolescent Mental Health · doi:10.2989/17280583.2019.1698429 · Cited by 34 · see citing works
Lifestyle medicine for anxiety symptoms: A meta-analysis of randomized controlled trials
Wong, V. W.-H., Ho, F. Y., Shi, N.-K., Sarris, J. J., Ng, C. H., & Tam, O. K.-Y. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.151 · Cited by 32 · see citing works
Militello, L. K., Melnyk, B. M., Hekler, E. B., Small, L., & Jacobson, D. (2015) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2015.08.002 · Cited by 33 · see citing works
Self-citationNursing Science: Claiming the Future
Grady, P. A., & Gough, L. L. (2015) · Journal of Nursing Scholarship · doi:10.1111/jnu.12170 · Cited by 33 · see citing works
Physical activity interventions promoting social competence at school: A systematic review
Schüller, I., & Demetriou, Y. (2018) · Educational Research and Reviews · doi:10.1016/j.edurev.2018.09.001 · Cited by 32 · see citing works
Bursnall, P. (2014) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12064 · Cited by 32 · see citing works
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Kim, K. K., Logan, H. C., Young, E., & Sabee, C. M. (2014) · Personal and Ubiquitous Computing · doi:10.1007/s00779-014-0808-x · Cited by 31 · see citing works
Bourke, M., Patten, R. K., Dash, S. R., Pascoe, M. C., Craike, M. J., Firth, J., Bailey, A. P., Jacka, F. N., & Parker, A. G. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.08.005 · Cited by 31 · see citing works
School nutrition: Support for providing healthy food and beverage choices in schools
Critch, J. (2020) · Paediatrics & Child Health · doi:10.1093/pch/pxz102 · Cited by 30 · see citing works
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Psychometric Properties of the Healthy Lifestyle Beliefs Scale for Adolescents
Melnyk, B. M., Kelly, S. A., & Tan, A. (2021) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2020.11.002 · Cited by 25 · see citing works
Self-citationAdolescents’ healthy lifestyle
Marques, A., Loureiro, N., Avelar‐Rosa, B., Naia, A., & de Matos, M. G. (2020) · Jornal de Pediatria (Versão em Português) · doi:10.1016/j.jpedp.2018.09.001 · Cited by 25 · see citing works
McGovern, C. M., Arcoleo, K. J., & Melnyk, B. M. (2019) · School Psychology · doi:10.1037/spq0000310 · Cited by 25 · see citing works
Self-citationPei, L., Cheng, Y., Kang, Y., Yuan, S., & Yan, H. (2015) · BMC Public Health · doi:10.1186/s12889-015-1503-1 · Cited by 24 · see citing works
Militello, L. K., Kelly, S. A., Melnyk, B. M., Smith, L. H., & Petosa, R. L. (2018) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2018.07.013 · Cited by 23 · see citing works
Self-citationPhysical Activity of Secondary School Adolescents at Risk of Depressive Symptoms
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Jackson, D., Prochnow, T. M., & Ettekal, A. V. (2024) · Journal of School Health · doi:10.1111/josh.13486 · Cited by 22 · see citing works
The Health Behaviours of Students from Selected Countries—A Comparative Study
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Melnyk, B. M., Gennaro, S., Szalacha, L. A., Hoying, J., O'Connor, C., Cooper, A., & Gibeau, A. M. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106090 · Cited by 21 · see citing works
Self-citationHopkins, L. C., Fristad, M. A., Goodway, J. D., Eneli, I., Holloman, C., Kennel, J. A., Melnyk, B. M., & Gunther, C. W. (2016) · BMC Public Health · doi:10.1186/s12889-016-3765-7 · Cited by 19 · see citing works
Self-citationZhou, S., Xu, Y., Yang, Y., Song, H., Wang, X., & Yu, Y. (2025) · BMC Public Health · doi:10.1186/s12889-025-25044-6 · Cited by 22 · see citing works
Scholz, D., Taylor, A. M., & Strelan, P. (2022) · Adolescent Research Review · doi:10.1007/s40894-022-00193-6 · Cited by 18 · see citing works
MENTAL HEALTH NEEDS OF ADOLESCENTS AND THE NURSING CARES: INTEGRATIVE REVIEW
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Lusk, P., Abney, B. G. H., & Melnyk, B. M. (2017) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390317723989 · Cited by 17 · see citing works
Self-citationCorrêa, R. S., da Cruz, L. P., Gómez‐Baya, D., de Almeida, A. M., & de Matos, M. G. (2020) · Análisis y Modificación de Conducta · doi:10.33776/amc.v46i173-4.3718 · Cited by 16 · see citing works
Li, X., Tan, W. H., Zheng, X., Dou, D., Wang, Y., & Yang, H. (2024) · Education and Information Technologies · doi:10.1007/s10639-024-12990-8 · Cited by 14 · see citing works
Dapari, R., Bashaabidin, M. S. M., Hassan, M. R., Dom, N. C., Rahim, S. S. S. A., & Mahiyuddin, W. R. W. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192215362 · Cited by 13 · see citing works
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Neill, R., Lloyd, K., Best, P., & Tully, M. (2022) · SN Social Sciences · doi:10.1007/s43545-022-00465-x · Cited by 12 · see citing works
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Self-citationSchool as a Protective Setting for Excess Weight Gain and Child Obesity: A Meta‐Analysis
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The evidence-based COPE program
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Self-citationKelly, S. A., Melnyk, B. M., & Hoying, J. (2020) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2020.06.012 · Cited by 10 · see citing works
Self-citationPendidikan Kesehatan tentang Gaya Hidup Sehat Pada Remaja Tahap Akhir
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Self-citationPani, S. C., Khabbaz, H. J. A., Enayeg, S. H. B., & Zouman, A. H. B. (2016) · European Journal Of Dental Education · doi:10.1111/eje.12225 · Cited by 9 · see citing works
Melnyk, B. M., Davidson, J. E., Mayfield, C., Zisook, S., Tucker, S., Hsieh, A. P., Cooper, A., Gray-Bauer, R., Hoying, J., Cuccia, A. F., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0303425 · Cited by 8 · see citing works
Self-citationAnxiety Reducing Effects of Physical Activity in Adolescents and Young Adults
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Zhang, Z., Li, L., Wang, H., Dong, K., & Li, D. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-025-02893-5 · Cited by 6 · see citing works
- Authors
- Melnyk, B. M., Jacobson, D., Kelly, S., Belyea, M., Shaibi, G., Small, L., O’Haver, J., & Marsiglia, F. F.
- Affiliations
- The Ohio State University (US)
- Phoenix Children's Hospital (US)
- Arizona State University (US)
- Corresponding author
- Melnyk, Bernadette M.
- ORCID
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 45
- Issue
- 4
- Pages
- 407-415
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC4285557
- OpenAlex
- W176301900
- Cited by
- 183
- References
- 53
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 13 · 2023: 5 · 2022: 18 · 2021: 14 · 2020: 29 · 2019: 12 · 2018: 13 · 2017: 4 · 2016: 18 · 2015: 19 · 2014: 11 · 2013: 3
- FWCI
- 17.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (R01NR012171)
- National Institute on Minority Health and Health Disparities (P20MD002316)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Health Professions › General Health Professions › Adolescent Health and Behaviors
- Keywords
- healthy lifestyle intervention, high school adolescents, obesity prevention, body mass index, depression, social skills, physical activity, alcohol consumption, drug use, academic performance, cognitive-behavioral intervention, school-based health education, nutrition education, teacher-delivered intervention, step count, overweight, mental health promotion
- MeSH terms
- Adaptation, Psychological, Adolescent, Adolescent Behavior, Diet, Female, Health Promotion, Humans, Interpersonal Relations, Health Knowledge, Attitudes, Practice, Life Style, Male, Mental Health, Power, Psychological, Stress, Psychological, Health Behavior, Exercise, Body Mass Index
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