Design of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study

Abstract

Background: Childhood obesity is highly prevalent, is associated with both short-and long-term adverse outcomes, disproportionately affects racial/ethnic minority and economically deprived children, and represents a major threat to public health. Among the most promising approaches for its prevention and management are multilevel, multisector strategies.Methods/Design: The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study was a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2-12 years in two selected cities in Massachusetts. Building on the Obesity Chronic Care Model, MA-CORD expanded a state public health department communitylevel obesity prevention initiative that incorporated evidence-based interventions in primary healthcare, the Women, Infants, and Children program, early care and education, schools/afterschool programs, as well as community-wide programs to improve food, beverage, physical activity (PA), and messaging environments. The study used a combination of pre-and post-time series and quasiexperimental designs to examine the extent to which the intervention resulted in changes in BMI, individual-level lifestyle behaviors, satisfaction with healthcare services, and quality of life among children, as well as changes in health policies, programs, and environments in the two intervention cities, compared to a comparison city. The intervention period was 2 years.Conclusions: MA-CORD will determine the extent to which a multisetting, multilevel intervention that integrates activities in primary care with broader public health interventions in schools, early care and education, and the community at large can improve children's dietary and PA behaviors and ultimately reduce obesity in low-income children.

Childhood Obesity Research Demonstration Project: Cross-Site Evaluation Methods

“…[1][2][3] Primary care (PC) involves obesity primary prevention efforts through changes to clinic policies, systems, and environments and the practices of medical professionals that are intended to affect all families at the participating clinics. A PC activity implemented by all three CORD projects is the changes to electronic health record systems to provide prompts related to diagnosis of obesity and links to resources the primary care physician may use to counsel the family.…”

“…A PC activity implemented by all three CORD projects is the changes to electronic health record systems to provide prompts related to diagnosis of obesity and links to resources the primary care physician may use to counsel the family. [1][2][3] Primary Care Plus (PC Plus) augments PC with additional, secondary prevention care and activities provided only to families with children who are overweight or obese (i.e., BMI ‡ 85th percentile for age and sex). Examples of PC Plus include programs to which families with an obese child are referred by the PC providers, as described in the accompanying articles from each project in this issue of Childhood Obesity: the intensive community health worker-based program in CA-CORD Across the three CORD project designs, children and families will be exposed to various combinations of these three components, as shown in Table 1, including PH only, PC Plus only, PH with PC, PH with PC Plus, or none (comparison cohorts).…”

“…The ultimate goal is to provide evidence-based recommendations for applying the CORD model in broader populations and contexts. The three demonstration projects and respective interventions are described in detail in accompanying articles in this issue of Childhood Obesity and include: the Mass in Motion Kids project in Massachusetts (MA-CORD) 1 ; Our Choice/Nuestra Opción project in California (CA-CORD) 2 ; and the Texas CORD project (TX-CORD). 3 The CORD Evaluation Center (EC-CORD) will provide a comprehensive evaluation of the pooled data across the three CORD demonstration projects.…”

Evaluation Protocol To Assess an Integrated Framework for the Implementation of the Childhood Obesity Research Demonstration Project at the California (CA-CORD) and Massachusetts (MA-CORD) Sites

“…47 Though specific activities vary across the CA-CORD and MA-CORD sites, the two interventions share a number of common features 48,49 : Both CA-CORD and MA-CORD seek to effect change in obesity factors and outcomes among underserved children 2-12 years of age. Their interventions are based on the obesity chronic care model 50,51 and, as such, span multiple sectors (healthcare, school, early care, and education) and levels of influence (family, organization, and community).…”

“…More detailed descriptions of the overall CORD project, the CA-CORD and MA-CORD interventions, and the communities in which they are being implemented are available elsewhere. 48,49,60,61 …”