Our Choice/Nuestra Opción:The Imperial County, California, Childhood Obesity Research Demonstration Study (CA-CORD)

Abstract

Background: Despite recent declines among young children, obesity remains a public health burden in the United States, including among Latino/Hispanic children. The determining factors are many and are too complex to fully address with interventions that focus on single factors, such as parenting behaviors or school policies. In this article, we describe a multisector, multilevel intervention to prevent and control childhood obesity in predominantly Mexican-origin communities in Southern California, one of three sites of the CDC-funded Childhood Obesity Research Demonstration (CA-CORD) study.Methods: CA-CORD is a partnership between a university-affiliated research institute, a federally qualified health center, and a county public health department. We used formative research, advisory committee members' recommendations, and previous research to inform the development of the CA-CORD project. Our theory-informed multisector, multilevel intervention targets improvements in four health behaviors: fruit, vegetable, and water consumption; physical activity; and quality sleep. Intervention partners include 1200 families, a federally qualified health center (including three clinics), 26 early care and education centers, two elementary school districts (and 20 elementary schools), three community recreation centers, and three restaurants. Intervention components in these sectors target changes in behaviors, policies, systems, and the social and physical environment. Evaluation activities include assessment of the primary outcome, BMI z-score, at baseline, 12-, and 18-months post-baseline, and sector evaluations at baseline, 12, and 24 months.Conclusions: Identifying feasible and effective strategies to prevent and control childhood obesity has the potential to effect real changes in children's current and future health status.

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).…”

“…Because the communities and catchment areas were selected by the demonstration project investigators using population-level matching on a wide range of demographic and socioeconomic variables, the initial design groups are adequately sized, matched, and balanced to facilitate within-project comparisons. 2,3,9 Consequently, including categorical variables representing the units of assignment in the analytical model will provide a method for incorporating the heterogeneity among projects and communities into the analysis of the pooled data. This statistical approach is consistent with existing recommendations for pooled analysis and meta-analysis of individual-level data from different studies.…”

“…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).…”