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BackgroundDrop out from upper secondary school represents a risk for the future health and wellbeing of young people. Strengthening of psychosocial aspects of the learning environment may be an effective strategy to promote completion of upper secondary school. This paper is a study protocol of a school based cluster randomized controlled trial (RCT) evaluating two school-based interventions, namely the Dream School Program (DSP) and the Mental Health Support Team (MHST). The interventions aim to improve psychosocial learning environments and subsequently school achievements and decrease drop-out and absence.Methods/DesignThe COMPLETE RCT is aimed at youth in upper secondary school, grade 1 (age 15-16 years), and examines the effect of the combination of the DSP and the MHST; and the DSP only, compared with a comparison group on the following primary outcomes: student completion, presence, average grade, and self-reported mental health. Seventeen upper secondary schools from four counties in Norway were randomized to one of the three arms: 1) DSP and MHST; 2) DSP; and 3) comparison (offered DSP intervention in 2018/2019). The study will evaluate the interventions based on information from two cohorts of students (cohort 1 (C1) and cohort 2 (C2)). For C1, data was collected at baseline (August 2016), and at first follow-up seven months later. Second follow-up will be collected 19 months after baseline. For C2, data was collected at baseline (August 2017), and first and second follow-up will be collected similarly to that of C2 seven and 19 months respectively after baseline. Process evaluations based on focus groups, interviews and observation will be conducted twice (first completed spring 2017).DiscussionThe COMPLETE trial is a large study that can provide useful knowledge about what interventions might effectively improve completion of upper secondary school. Its thorough process evaluation will provide critical information about barriers and points of improvement for optimizing intervention implementation. Findings can guide school development in the perspective of improving psychosocial learning environments and subsequent completion of upper secondary schooling.Trial registrationThe trial was retrospectively registered in the ClinicalTrials.gov register on December 22.2017: NCT03382080.

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Purpose: This study examines statistical associates of cardiovascular disease risk factors, as defined by the American Heart Association's Life's Simple Seven, among Muslim women who reside in the United States.Methods: Data collected nationally through the 2015 Muslim Women's Health project were analyzed (N=373). Logistic regression models estimated associations between sample characteristics and diet, exercise, alcohol consumption, blood pressure, cholesterol, and weight.Results: Over half of respondents reported exercising regularly (64%) and maintaining a healthy diet (85%); 20% consumed alcohol. About 5% reported having high cholesterol, 4% had high blood pressure, and 42% reported being overweight. Perceived and experienced stigma were associated with alcohol use (odds ratio [OR]=1.085, p<0.001) and being overweight (OR=0.938, p<0.001). Married respondents had 42% lower odds of exercising and 83% lower odds of drinking alcohol. Compared to foreign-born respondents, U.S.-born respondents had 2.9 higher odds of drinking alcohol and 2.7 higher odds of having high cholesterol (OR=2.931, p<0.001; OR=2.732, p<0.01, respectively). Significant effects were also found when examining the statistical impact of of age, Islamic sect, and education on cardiovascular disease risk factors.Conclusion: With increasing focus on precision medicine, personalized healthcare, and patient-centered medical homes (all interventions designed to promote disease prevention and assist in managing chronic health conditions) better understanding the health of understudied populations is imperative to the success of these interventions. Our findings suggest countervailing forces may affect the health of American Muslim women; therefore, additional studies with this hard-to-reach population are warranted and will be informative to improving overall population health in the United States, an overarching priority for both public health practitioners and medical providers.