Behavior, Health, Healthy Lifestyle, Obesity, Childhood
Conditions
Brief summary
The purpose of this proof-of-concept study is to assess the initial signal of effectiveness of summer youth employment programs (SYEP) on understudied obesity-related outcomes in adolescents. This small-scale study is essential to identify early success and refine the intervention before scaling to a larger, more resource-intensive randomized trial. Specifically, this one-group pre-posttest study will: Aim 1 (Primary): Evaluate if a 6-week SYEP provides an initial signal for effectiveness (maintenance or decrease in zBMI) over the summer. Hypothesis 1: Adolescents who participated in a SYEP will maintain or decrease their BMI over the summer. Aim 2 (Secondary): Evaluate changes in obesogenic behaviors (physical activity, sleep, sedentary, and diet) over the summer. Hypothesis 2: Adolescents who participated in a SYEP will increase physical activity, reduce sedentary behavior, and improve sleep and diet quality over the summer. Aim 3 (Secondary): Evaluate the feasibility of SYEP for obesity prevention intervention to inform intervention scalability. Hypothesis 3: The SYEP program will be a feasible and acceptable intervention strategy for the prevention of obesity in adolescents over the summer.
Detailed description
Preliminary evidence suggests that summer employment can be an age-appropriate, structured intervention to prevent unhealthy changes in obesogenic behaviors among adolescents. While these findings are promising, none of the existing studies have measured changes in BMI over the summer or conducted comprehensive assessments of obesogenic behaviors, including diet, sedentary behavior, sleep, and physical activity. To address these gaps, this study proposes a small proof-of-concept study to assess the initial signal of effectiveness on understudied obesity-related outcomes in adolescents. SYEPs are well-established, continuously operating initiatives over 60 years with proven benefits in academics, workforce development, and crime prevention, and may also act as obesity prevention strategies. Rather than creating new interventions, investing in and expanding access to SYEPs-programs with high demand yet limited capacity (with only \ 28% of applicants matched with jobs each summer, leaving the majority on waitlists)-can offer a practical solution for youth obesity prevention.
Interventions
BEHAVIORALSummer Youth Employment Program
The intervention aims to employ adolescents in paid positions for six weeks during the summer, providing them with a structured, routine-based, and adult-supervised environment similar to that of the school year.
Sponsors
University of Houston
National Institute on Minority Health and Health Disparities (NIMHD)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Single group pre- and post-test design
Eligibility
Sex/Gender
ALL
Age
14 Years to 17 Years
Healthy volunteers
Yes
Inclusion criteria
* Age 14-17 years at the time of enrollment, in accordance with Texas Child Labor Law * Willing to work at the summer camp for six consecutive weeks * Able to pass the employment admission procedure (job interview) * Able to obtain parental consent and provide assent for study participation
Exclusion criteria
* Currently pregnant or planning to become pregnant, due to physical activity restrictions and potential weight changes that could confound study results * Diagnosis of an intellectual and/or physical disability requiring specialized employment regulations or intervention strategies * Participation in a health promotion intervention within the past six months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Age- and Sex-Specific Body Mass Index (BMI)-For-Age Z-Score (zBMI) From Baseline to Week 6 | Baseline and Week 6 (post) | Height and weight will be directly measured by trained staff. Each measurement will be taken twice, and the average will be used for analysis. Body mass index (BMI) will be calculated and expressed as Centers for Disease Control and Prevention (CDC) age- and sex-specific BMI-for-age z-scores (zBMI). The outcome will represent the change in zBMI from baseline to Week 6. A positive change score will indicate an increase (gain) in zBMI from baseline to Week 6, which will be considered a less favorable outcome. A negative change score will indicate a decrease in zBMI, which will be considered a favorable outcome. A change score of 0 will indicate no change in zBMI (maintenance), which will also be considered a favorable outcome for this intervention because preventing excess BMI gain during summer is a primary goal. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Sedentary Behavior From Baseline to Week 6 | Baseline and Week 6 (post) | Sedentary behavior will be measured in minutes per day using a wrist-worn ActiGraph GT3X accelerometer on the non-dominant wrist over 8 consecutive days, including at least 2 valid weekdays and 1 valid weekend day. Activity intensities will be classified using cut points published by Hildebrand et al. The reported outcome will be the change in average daily sedentary behavior (minutes/day) from baseline to Week 6. A positive change score will indicate an increase in sedentary behavior, which will be considered an unfavorable outcome. A negative change score will indicate a decrease in sedentary behavior, which will be considered a favorable outcome. A change score of 0 will indicate no change in sedentary behavior (maintenance). |
| Change in Moderate-to-Vigorous Physical Activity (MVPA) From Baseline to Week 6 | Baseline and Week 6 (post) | Moderate-to-vigorous physical activity (MVPA) will be measured in minutes per day using a wrist-worn ActiGraph GT3X accelerometer on the non-dominant wrist over 8 consecutive days, including at least 2 valid weekdays and 1 valid weekend day. Activity intensities will be classified using cut points published by Hildebrand et al. The reported outcome will be the change in average daily MVPA (minutes/day) from baseline to Week 6. A positive change score will indicate an increase in MVPA, which will be considered a favorable outcome. A negative change score will indicate a decrease in MVPA, which will be considered an unfavorable outcome. A change score of 0 will indicate no change in MVPA (maintenance), which will also be considered a favorable outcome. |
| Change in Sleep Duration From Baseline to Week 6 | Baseline and Week 6 (post) | Sleep duration will be measured in minutes per day using a wrist-worn ActiGraph GT3X accelerometer on the non-dominant wrist over 8 consecutive days, including at least 2 valid weekdays and 1 valid weekend day. Sleep duration will be estimated using the heuristic algorithm looking at the distribution of change in Z-Angle (HDCZA). The reported outcome will be the change in average daily sleep duration (minutes/day) from baseline to Week 6. A positive change score will indicate an increase in sleep duration, which will be considered a favorable outcome. A negative change score will indicate a decrease in sleep duration, which will be considered an unfavorable outcome. A change score of 0 will indicate no change in sleep duration (maintenance), which will also be considered a favorable outcome. |
| Change in Screen Time From Baseline to Week 6 | Baseline and Week 6 (post) | Screen time in hours and minutes (e.g., television, computer, video games, smart phones, tablets) will assessed via self-report during each 8-day behavioral assessment period. Screen time will be calculated as the average daily duration (minutes/day) by summing total reported screen time across completed daily logbooks and dividing by the number of valid diary days within each assessment period. The reported outcome will be the change in average daily screen time (minutes/day) from baseline to Week 6. A positive change score will indicate an increase in screen time, which will be considered an unfavorable outcome. A negative change score will indicate a decrease in screen time, which will be considered a favorable outcome. A change score of 0 will indicate no change in screen time (maintenance), which will also be considered a favorable outcome. |
| Change in Unhealthy Food Intake From Baseline to Week 6 | Baseline and Week 6 (post) | Dietary intake will be assessed using the NHANES 23-item Dietary Screener Questionnaire. Adolescents will self-report consumption of food and beverage items over the past day. For this outcome, unhealthy food items will include desserts, sugar-sweetened beverages, salty snacks, and fast food items. Responses will be used to estimate daily intake frequency (times/day) of unhealthy food consumption. The reported outcome will be the change in average daily frequency of unhealthy food intake (times/day) from baseline to Week 6. A positive change score will indicate an increase in unhealthy food intake, which will be considered an unfavorable outcome. A negative change score will indicate a decrease in unhealthy food intake, which will be considered a favorable outcome. A change score of 0 will indicate no change in unhealthy food intake (maintenance), which will also be considered a favorable outcome. |
| Recruitment Capacity (Percentage Meeting Recruitment Goal) | Baseline | Recruitment capacity is the percentage meeting the recruitment goal. |
| Retention | Baseline and Week 6 (post) | Retention will be calculated as the percentage of enrolled participants who complete both baseline and post-intervention assessments for the primary outcome measures. |
| Fidelity | Weekly during intervention (Weeks 1-6) | Fidelity will be assessed through weekly unannounced direct observations using a structured checklist developed by the research team specifically for the intervention. The checklist will assess key components of intervention implementation, including adherence, dose delivered, quality of delivery, and participant engagement. Each item will be rated using either binary scoring (0 = not implemented, 1 = implemented) or a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), depending on the construct. All domain scores will be standardized and converted to a percentage scale. Each intervention session will be independently rated by two trained researcher, and ratings will be averaged. Session-level fidelity scores will then be averaged across all observation weeks to produce a single fidelity score. The fidelity score will be expressed as a percentage, with higher scores indicating greater fidelity to the intervention protocol and lower scores indicating reduced fidelity. |
| Attendance | Weekly during intervention (Weeks 1-6) | Attendance will be calculated as the average number of days attended across total offered workdays, using employer time sheets. |
| Acceptability | Week 7 (Follow-up) | Acceptability will be assessed using a quantitative satisfaction measure administered to adolescents following intervention participation. Participants will be asked to rate their likelihood of returning as a paid counselor the following summer on a scale ranging from 1 (not at all likely) to 10 (extremely likely). Individual responses will be averaged to generate a single acceptability score. The total score will range from 1 to 10, with higher scores indicating greater acceptability and willingness to participate again, and lower scores indicating lower acceptability. Scores closer to 10 will represent high acceptability, while scores closer to 1 will represent low acceptability of the intervention experience. |
| Change in Healthy Food Intake From Baseline to Week 6 | Baseline and Week 6 (post) | Dietary intake will be assessed using the NHANES 23-item Dietary Screener Questionnaire. Adolescents will self-report consumption of food and beverage items over the past day. For this outcome, healthy food items will include fruits, vegetables, 100% fruit juice, and milk items. Responses will be used to estimate daily intake frequency (times/day) of healthy food consumption. The reported outcome will be the change in average daily frequency of healthy food intake (times/day) from baseline to Week 6. A positive change score will indicate an increase in healthy food intake, which will be considered a favorable outcome. A negative change score will indicate a decrease in healthy food intake, which will be considered an unfavorable outcome. A change score of 0 will indicate no change in healthy food intake (maintenance), which will also be considered a favorable outcome. |
Countries
United States
Participant flow
Recruitment details
Participants were recruited from a public high school in Houston, Texas, that primarily serves students from low socioeconomic backgrounds. During the second half of March 2025, all students and their caregivers received study invitations via text messages, flyers, and emails. Recruitment was conducted over a two-week period. Eligibility was assessed through an online screening questionnaire prior to obtaining informed consent.
Pre-assignment details
This study used a single-group design. Participants were assigned to the intervention after successfully completing the employment admission process. The employment admission included submission of a resume and a one-page letter of interest, as well as participation in virtual interviews. Following successful completion of the employment admission process, eligible adolescents were assigned to the intervention.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 16.4 years STANDARD_DEVIATION 0.8 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 13 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 2 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants |
| Race (NIH/OMB) More than one race | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 12 Participants |
| Sex: Female, Male Female | 12 Participants |
| Sex: Female, Male Male | 3 Participants |
| Socioeconomic Status Family does not participate in at least one assistance program | 5 Participants |
| Socioeconomic Status Family participates in at least one assistance program | 7 Participants |
| Socioeconomic Status Prefer not to respond | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 15 |
| other Total, other adverse events | 0 / 15 |
| serious Total, serious adverse events | 0 / 15 |
Outcome results
None listed