"Som la Pera," a School-Based, Peer-Led Social Marketing Intervention to Engage Spanish Adolescents in a Healthy Lifestyle: A Parallel-Cluster Randomized Controlled Study.

Background: Encouraging adolescents to adopt healthy lifestyles can be challenging. The aim of the "Som la Pera" study was to engage adolescents by applying new strategies to increase both their fruit and vegetable consumption and their physical activity (PA), while reducing their sedentary behavior (screen time per day). Methods: In disadvantaged neighborhoods of Reus (Spain), two high schools were randomly assigned to the intervention (n = 169 adolescents, 13- to 16-year old) and two were assigned to the control group (n = 223 adolescents, 13- to 16-year old). The intervention, which lasted 12 months and spanned two academic years (2013-2015), used social marketing (SM) to improve healthy choices. The peer-led strategy involved 5 adolescents, who designed and implemented 10 activities as challenges for their 169 school-aged peers. The control group received no intervention. To assess self-reported lifestyles in both groups, the Health Behavior in School-aged Children survey was used at baseline and end of study. Results: After 12 months, the weekly PA improved in the intervention group vs. the control one (p = 0.047). When male and female groups were examined separately, the improvement in PA remained with a borderline significance only in the male group (p = 0.050). Conclusions: A school-based, peer-led SM intervention designed and implemented by adolescents attending high schools in low-income neighborhoods promoted an increase in PA, particularly in male adolescents 13 to 16 years of age. No effect on fruit or vegetable consumption or screen time was observed. Clinical Trial Registration number: NCT02157402.

A School-Based, Peer-Led, Social Marketing Intervention To Engage Spanish Adolescents in a Healthy Lifestyle ("We Are Cool"-Som la Pera Study): A Parallel-Cluster Randomized Controlled Study.

BACKGROUND: Encouraging adolescents to adopt healthy lifestyles can be challenging. The aim of the "Som la Pera" study was to engage adolescents by applying new strategies to increase both their fruit and vegetable consumption and their physical activity (PA) while reducing their sedentary behavior. METHODS: In disadvantaged neighborhoods of Reus (Spain), two high schools were randomly assigned to the intervention (n = 170 adolescents 13- to 16-year-olds) and two were assigned to the control group (n = 223 adolescents 13- to 16-year-olds). The intervention, which lasted 12 months and spanned 2 academic years (2013-2015), used social marketing (SM) to improve healthy choices. The peer-led strategy involved 5 adolescents who designed and implemented 10 activities as challenges for their 165 school-aged peers. The control group received no intervention. To assess self-reported lifestyles in both groups, the Health Behavior in School-Aged Children Survey was used at baseline and end of study. RESULTS: After 12 months, intervention adolescents showed an increase of 28.9% in ≥1 fruit/day (p < 0.01) and of 18.5% in ≥6 hours/week of PA (p < 0.01) compared with controls. Additionally, intervention group males had an increase of 28.8% in ≥1 vegetable/day (p < 0.01) and of 15.6% in ≤2 hours/day of sedentary activity (p = 0.01) compared with controls. CONCLUSIONS: A school-based, peer-led, SM intervention developed by adolescents attending high schools in low-income neighborhoods effectively improved the healthy choices of their school-aged peers, leading to increased fruit consumption and PA in adolescents of both genders. Furthermore, adolescent males were more sensitive to improvements in healthy choices, showing increased vegetable consumption and decreased sedentary behavior.