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Sultana M, Nichols M, Jacobs J, Karacabeyli D, Allender S, Novotny R, Brown V. The range of outcomes and outcome measurement instruments collected in multisectoral community-based obesity prevention interventions in children: A systematic review. Obes Rev 2024; 25:e13731. [PMID: 38432682 DOI: 10.1111/obr.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 01/14/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Multicomponent and multisectoral community-based interventions (CBIs) have proven potential in preventing overweight and obesity in children. Synthesizing evidence on the outcomes collected and reported in such CBIs is critical for the evidence of effectiveness and cost-effectiveness. This systematic review aimed to identify the range of outcomes and outcome measurement instruments collected and reported in multisectoral and multicomponent CBIs for obesity prevention in children. A systematic search updated an existing review and extended the search to 11 academic databases (2017-2023) and gray literature. Outcomes were classified into outcome domains, and common measurement instruments were summarized. Seventeen outcome domains from 140 unique outcomes were identified from 45 included interventions reported in 120 studies. The most frequently collected outcome domains included anthropometry and body composition (91% of included interventions), physical activity (84%), dietary intake (71%), environmental (71%), and sedentary behavior (62%). The most frequently collected outcomes from each of these domains included body mass index (89%), physical activity (73%), fruit and vegetable intake (58%), school environment (42%), and screen time (58%). Outcome measurement instruments varied, particularly for behavioral outcomes. Standardization of reported outcomes and measurement instruments is recommended to facilitate data harmonization and support quantifying broader benefits of CBIs for obesity prevention.
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Affiliation(s)
- Marufa Sultana
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jane Jacobs
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Derin Karacabeyli
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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2
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Petrovskis A, Baquero B, Bekemeier B. Involvement of Local Health Departments in Obesity Prevention: A Scoping Review. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E345-E353. [PMID: 33729187 PMCID: PMC8781226 DOI: 10.1097/phh.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Local health department (LHD) obesity prevention (OP) efforts, particularly by rural LHDs, are seemingly uncommon, in part, due to limited infrastructure, workforce capacity, accessible data, and available population-level interventions aimed at social determinants of health (SDOH). METHODS We conducted a scoping review to determine LHD roles in OP efforts and interventions. Inclusion criteria were articles including evidence-based OP and LHD leaders or staff. Articles were coded by type of LHD involvement, data use, intervention characteristics, use of an SDOH lens, and urban or rural setting. RESULTS We found 154 articles on LHD OP-52 articles met inclusion criteria. Typically, LHDs engaged in only surveillance, initial intervention development, or evaluation and were not LHD led. Data and SDOH lens use were infrequent, and interventions typically took place in urban settings. CONCLUSION LHDs could likely play a greater role in OP and population-level interventions and use data in intervention decision making. However, literature is limited. Future research should focus on LHD capacity building, including academic-public health partnerships. Studies should include rural populations, data, and SDOH frameworks addressing "upstream" factors.
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Affiliation(s)
- Anna Petrovskis
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
| | - Barbara Baquero
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
| | - Betty Bekemeier
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
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3
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Zhao X, Lee RE, Ledoux TA, Hoelscher DM, McKenzie TL, O'Connor DP. Harmonizing Ratings From Different School Environment Assessment Methods: A Simplified Approach. THE JOURNAL OF SCHOOL HEALTH 2022; 92:92-98. [PMID: 34796495 DOI: 10.1111/josh.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study describes a method for harmonizing data collected with different tools to compute a rating of compliance with national recommendations for school physical activity (PA) and nutrition environments. METHODS We reviewed questionnaire items from 84 elementary schools that participated in the Childhood Obesity Research Demonstration (CORD) project, which was 3 distinct childhood obesity prevention projects in 7 communities in California, Massachusetts, and Texas. Each project used tools specific to its programs, schools, and communities. While this approach increased the feasibility of data collection, it created a challenge with the need to combine data across projects. We evaluated all questionnaire items and retained only those items that assessed one or more recommendations and constructed several items to indicate compliance or noncompliance with the respective associated recommendations. RESULTS Ten constructed items covered 11 of the 20 recommendations. Analysis indicated that the scores detected variability in compliance both among communities and among school within communities. CONCLUSIONS The scores captured differences in compliance with the national recommendations at multiple levels. Our method, designed for creating common scores, may be useful in integrated data analysis, systematic reviews, or future studies requiring harmonizing of data collected via different tools.
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Affiliation(s)
- Xue Zhao
- Department of Health and Human Performance, University of Houston, 3875 Holman Street GAR 104, 77204-6015, Houston, TX, USA
| | - Rebecca E Lee
- College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street, 85004, Phoenix, AZ, USA
| | - Tracey A Ledoux
- Department of Health and Human Performance, University of Houston, 3875 Holman St., Rm 104 Garrison, 77204-6015, Houston, TX, USA
| | - Deanna M Hoelscher
- School of Public Health, Health Science Center at Houston (UTHealth), The University of Texas, 1616 Guadalupe Street, Suite 6.300, 78701, Austin, TX, USA
| | - Thomas L McKenzie
- School of Exercise and Nutritional Sciences, San Diego State University, 5127 Walsh Way, 92115, San Diego, CA, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, 3875 Holman St., Rm 104 Garrison, 77204-6015, Houston, TX, USA
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Essay AM, Schlechter CR, Mershon CA, Fial AV, Ellison J, Rosenkranz RR, Dzewaltowski DA. A scoping review of whole-of-community interventions on six modifiable cancer prevention risk factors in youth: A systems typology. Prev Med 2021; 153:106769. [PMID: 34416222 DOI: 10.1016/j.ypmed.2021.106769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/09/2021] [Accepted: 08/15/2021] [Indexed: 12/28/2022]
Abstract
Whole-of-community interventions delivered across entire geospatial areas show promise for improving population health for youth cancer prevention. The aims of this scoping review were to synthesize the whole-of-community intervention literature on six modifiable risk factors in youth for cancer prevention (alcohol use, diet, obesity, physical activity, sun exposure, tobacco use) and to develop and apply a typology describing the inclusion of fundamental control system functional characteristics. A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and Scopus for studies published to the end of 2019. Eligible studies included a geospatially defined whole-of-community intervention; youth 0-18 years; and at least one of the six cancer risk factor outcomes. An iterative process was undertaken to create a typology describing the functions for whole-of-community interventions guided by systems theory, and the typology was used to code the included interventions. A total of 41 interventions were included. Most interventions (43.9%) assessed multiple cancer risk factors. Few interventions provided fundamental functions necessary for community system coordination: sensor, controller, effector. Although communities are a patchwork quilt of microsystems where individuals interact in geographically bounded places nested within larger whole systems of influence, a control systems approach has not been used to frame the literature. Whole-of-community interventions can be characterized by the fundamental system functions necessary for coordinating population health improvement. Future whole-of-community intervention efforts should draw on fundamental knowledge of how systems operate and test whether adoption of the key functions is necessary for whole-of-community population health improvement.
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Affiliation(s)
- Ann M Essay
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA.
| | - Chelsey R Schlechter
- Department of Population Health Sciences, Huntsman Cancer Institute, Center for Health Outcomes and Population Equity (HOPE), University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA.
| | - Carrie A Mershon
- Department of Kinesiology, Kansas State University, Natatorium 8, 920 Denison Ave, Manhattan, KS 66506, USA.
| | - Alissa V Fial
- Raynor Memorial Libraries, Marquette University, 1355 W Wisconsin Ave, Milwaukee, WI 53233, USA.
| | - Jennie Ellison
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA
| | - Richard R Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, 245 Justin Hall, 1324 Lovers Lane, Manhattan, KS 66506, USA.
| | - David A Dzewaltowski
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA.
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Fiechtner L, Sierra Velez D, Ayala SG, Castro I, Lindros J, Perkins M, Baker A, Salmon J, Biggs V, Cannon-Smith G, Smith JD, Simione M, Gortmaker SL, Taveras EM. Planned Evaluation of the Healthy Weight Clinic Pediatric Weight Management and Implementation: Massachusetts-CORD 3.0. Child Obes 2021; 17:S55-S61. [PMID: 34569842 PMCID: PMC8574199 DOI: 10.1089/chi.2021.0178] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Despite evidence that offering multidisciplinary treatment for children with obesity is effective, access to evidence-based pediatric weight management interventions (PWMIs) is limited. The Healthy Weight Clinic PWMI is a multidisciplinary approach in primary care that improves BMI among children with a BMI ≥ 85th percentile. Objective: To describe the method by which we will evaluate the adoption, acceptability, and feasibility of integrating and implementing a multidisciplinary Healthy Weight Clinic (HWC) into primary care. Design/Methods: We used the Consolidated Framework for Implementation Research (CFIR) domains and constructs to inform our implementation strategies. We will use a Type III hybrid effectiveness-implementation design to test our implementation strategies and improvement in BMI. Sources of data collection will include qualitative interviews with patient caregivers, HWC staff and surveys with HWC staff, patient caregivers, and electronic health record data. Our outcomes are guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Results: We identified all five CFIR domains as integral for successful implementation. Some strategies to address barriers within these domains include online self-paced training modules for the HWC staff, a virtual learning collaborative, and engagement of site leadership. Outcomes will be measured at the patient and pilot site levels, and they will include patients reached, patient health outcomes such as BMI and quality of life, level of adoption, acceptability, feasibility, and sustainability of the PWMI. Conclusion: Our use of implementation science frameworks in the planning of Healthy Weight Clinic PWMI could create a sustainable and effective program for dissemination.
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Affiliation(s)
- Lauren Fiechtner
- Divisions of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
- Divisions of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA
| | - Desiree Sierra Velez
- Divisions of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA
| | - Sujata G. Ayala
- Divisions of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
| | - Ines Castro
- Divisions of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, USA
| | - Meghan Perkins
- Divisions of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
| | - Alison Baker
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, USA
| | - Jeremiah Salmon
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, USA
| | | | | | - Justin D. Smith
- Division of Health Systems Innovation and Research, Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City, UT, USA
| | - Meg Simione
- Divisions of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elsie M. Taveras
- Divisions of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
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6
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Fiechtner L, Castro I, Ayala SG, Velez DS, Lindros J, Perkins M, Baker A, Salmon J, Biggs V, Cannon-Smith G, Smith JD, Simione M, Gortmaker SL, Taveras EM. Design and Approach of the Healthy Weight Clinic Pediatric Weight Management Intervention Package and Implementation: Massachusetts-CORD 3.0. Child Obes 2021; 17:S48-S54. [PMID: 34569841 PMCID: PMC8574200 DOI: 10.1089/chi.2021.0177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Although proven effective interventions for childhood obesity exist, there remains a substantial gap in the adoption of recommended practices by clinicians. Objective: The aims are to: (1) package implementation and training supports to facilitate the adoption of the evidence-based Healthy Weight Clinic Pediatric Weight Management Intervention (PWMI) (based on three previous effectiveness trials); (2) pilot and evaluate the packaged Healthy Weight Clinic PWMI; and (3) develop a sustainability and dissemination plan. Design/Methods: We used the Consolidated Framework of Implementation Research constructs to create an Implementation Research Logic Model that defined the facilitators and barriers of the Healthy Weight Clinic PWMI. We linked these constructs to implementation strategies and mechanisms. Packaging and design will be informed by the core essential components and functions of the PWMI along with stakeholder engagement. Once the package is complete, we will pilot the PWMI by using a Type III effectiveness-implementation hybrid design. Implementation outcomes will be evaluated by using the RE-AIM framework. Results: We will create an integrated, multisystems level package for national dissemination. The package will include training and a suite of resources for primary care physicians and healthy weight clinic staff, including: patient and caregiver facing videos, patient and caregiver handouts, group curriculum guide, online provider trainings, and access to a virtual learning collaborative. Conclusion: The results will highlight the extent to which the package of the Healthy Weight Clinic PWMI facilitates the adoption of effective strategies for treating childhood obesity. Lessons learned will inform modifications to the Healthy Weight Clinic PWMI and strategies for future scaling.
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Affiliation(s)
- Lauren Fiechtner
- Division of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA.,Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA.,Address correspondence to: Lauren Fiechtner, MD, MPH, Division of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA.
| | - Ines Castro
- Division of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
| | - Sujata G. Ayala
- Division of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
| | - Desiree Sierra Velez
- Division of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA.,Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, USA
| | - Meghan Perkins
- Division of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
| | - Alison Baker
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, USA
| | - Jeremiah Salmon
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, USA
| | | | | | - Justin D. Smith
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Meg Simione
- Division of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elsie M. Taveras
- Division of Pediatric Health Outcomes Research, MassGeneral Hospital for Children, Boston, MA, USA
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7
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Darling KE, Hayes JF, Evans EW, Seifer R, Elwy AR, Jelalian E. Implementation of the JOIN for ME Program for Families from Low-Income Backgrounds: The Use of Theory-Driven Formative Evaluation: Rhode Island CORD 3.0. Child Obes 2021; 17:S22-S29. [PMID: 34569847 PMCID: PMC8574201 DOI: 10.1089/chi.2021.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Advances have been made in the development of effective interventions to address pediatric obesity; however, research findings often do not translate into clinical practice and a limited number of programs have been designed toward wide-spread dissemination and implementation. The Rhode Island (RI)-Childhood Obesity Research Demonstration (CORD) 3.0 Project involves adapting and testing an evidence-based pediatric weight management intervention (PWMI), JOIN for ME, for wide-scale dissemination and implementation in communities with a high proportion of families from low-income backgrounds. In this article, we describe the robust developmental formative evaluation (FE) process employed by RI-CORD as a model for the use of FE to drive dissemination of evidence-based PWMIs. The current project was guided by the Consolidated Framework for Implementation Research and Proctor Implementation Outcomes. This article also showcases examples of how the use of key informant interviews from engaged stakeholders in the community during a developmental FE process can drive selection of implementation strategies. The use of FE, driven by evidence-based theory, can help provide a roadmap to successful implementation of a pediatric weight management program, such as JOIN for ME.
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Affiliation(s)
- Katherine E. Darling
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Address correspondence to: Katherine E. Darling, PhD, Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903, USA.
| | - Jacqueline F. Hayes
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - E. Whitney Evans
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ronald Seifer
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Elissa Jelalian
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Lee RE, Parker NH, Hallett AM, Kao D, Modelska MJ, Rifai HS, Soltero EG, O'Connor DP. Stakeholder perspectives and sustainability of an integrated care model for the prevention and management of obesity: the Childhood Obesity Research Demonstration (CORD) project. Transl Behav Med 2021; 11:393-407. [PMID: 32667038 DOI: 10.1093/tbm/ibaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although reliable strategies exist to promote healthy habits that reduce childhood obesity, the sustainability of these strategies remains an ongoing public health challenge. This study aimed to identify factors experienced in a large, multisite project aimed at reducing childhood obesity that might contribute to project sustainability. Hypothesized constructs underpinning sustainability included replicability, continuation of benefits, institutionalization, and community capacity. Key informants (n = 27) completed 60 min, in-depth interviews, which were audio recorded and transcribed. Transcripts were first coded using a combined deductive and inductive approach. Four major themes emerged (with numerous subthemes): developing partnerships, challenges to the sustainability of implemented programming, the importance of intervening in multiple settings, and ongoing implementation and evaluation strategies. Replicability of complex childhood obesity interventions is possible when there are strong partnerships. Benefits can continue to be conferred from programming, particularly when evidence-based strategies are used that employ best practices. Implementation is facilitated by institutionalization and policies that buffer challenges, such as staffing or leadership changes. Community capacity both enhances the sustainability of interventions and develops as a result of strengthening partnerships and policies that support childhood obesity programming.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Nathan H Parker
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allen M Hallett
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, USA
| | - Dennis Kao
- School of Social Work, Carleton University, Ottawa, Ontario, Canada
| | - Maria J Modelska
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Hanadi S Rifai
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Erica G Soltero
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, Houston, TX, USA
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9
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Scott-Sheldon LAJ, Hedges LV, Cyr C, Young-Hyman D, Khan LK, Magnus M, King H, Arteaga S, Cawley J, Economos CD, Haire-Joshu D, Hunter CM, Lee BY, Kumanyika SK, Ritchie LD, Robinson TN, Schwartz MB. Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019. Child Obes 2020; 16:S221-S248. [PMID: 32936038 PMCID: PMC7482126 DOI: 10.1089/chi.2020.0139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Larry V Hedges
- Department of Statistics, Northwestern University, Evanston, IL, USA
| | - Chris Cyr
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Deborah Young-Hyman
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Laura Kettel Khan
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Heather King
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Sonia Arteaga
- Office of the Director, National Institutes of Health, National Institutes of Health, Bethesda, MD, USA
| | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
- Department of Economics, Cornell University, Ithaca, NY, USA
| | - Christina D Economos
- Division of Nutrition Interventions, Communication, and Behavior Change, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Debra Haire-Joshu
- Center for Obesity Prevention and Policy Research, Brown School, Washington University, Saint Louis, MO, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Bruce Y Lee
- CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Berkeley, CA, USA
| | - Thomas N Robinson
- Departments of Pediatrics and Medicine, Stanford Solutions Science Lab, Stanford University, Stanford, CA, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
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10
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Ledoux T, Thompson D, O'Connor T, Avery D, Kochi C, O'Connor DP, Lin SF, Binggeli-Vallarta A, Blaine RE, Sharma S, Hoelscher DM. Cross-Site Process Evaluation Results for the Early Childhood Education Center Setting: CORD Study. Child Obes 2020; 16:350-357. [PMID: 32471316 DOI: 10.1089/chi.2019.0314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The Childhood Obesity Research Demonstration project aimed to deliver evidence-based obesity prevention interventions to at-risk families at three demonstration sites. The interventions were delivered in multiple settings, including early childhood education centers (ECECs), public schools, and primary care clinics. An evaluation center conducted cross-site process, impact, and sustainability evaluations. Results of the cross-site process evaluation for the ECECs will be described. Methods: Reach (proportion of the target population who participated), dose delivered (materials and interventions that were distributed), and fidelity (proportion of planned intervention components delivered) were assessed at two levels (researcher-to-provider and provider-to-family levels). Standardized data forms were completed by research team members at each demonstration site with assistance from the evaluation center. Results: The Childhood Obesity Research Demonstration project reached 5174 children and 390 teachers in 58 ECECs. The centers delivered an average of 3.9 hours of training to teachers. A total of 1382 different types of materials were distributed to providers, and from 1.3 to 4.3 hours of technical support were delivered to centers monthly. For fidelity at the researcher-to-provider level, 49.5% (n = 370) of eligible teachers completed all training sessions. Considerable variations across demonstration sites in reach, dose delivered, and fidelity across were observed. Conclusion: The Childhood Obesity Research Demonstration project reached large numbers of children, families, teachers, and ECECs. Maintaining intervention fidelity while reaching large numbers of at-risk individuals proved to be a challenge.
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Affiliation(s)
- Tracey Ledoux
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Dana Avery
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Camila Kochi
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, Houston, TX, USA
| | - Shih-Fan Lin
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, USA
| | | | - Rachel E Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, USA
| | - Shreela Sharma
- Michael & Susan Dell Center for Health Living, University of Texas Health Science Center, School of Public Health, Houston, TX, USA
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Austin Campus, Austin, TX, USA
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11
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Lee RE, Kao D, Parker NH, Hallett AM, Kochi CY, Modelska MJ, Rifai HS, O'Connor DP. Evaluating sustainability in the Childhood Obesity Research Demonstration project: the model and process. ACTA ACUST UNITED AC 2020; 78:13. [PMID: 32082567 PMCID: PMC7017491 DOI: 10.1186/s13690-020-0397-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
Abstract
Background In the context of health-related interventions, sustainability is the capacity to maintain the changes resulting from the intervention. These can be improved policies, practices or trends intended to improve population health. The Childhood Obesity Research Demonstration (CORD) project was a multi-site, multi-intervention collaboration testing the Obesity Chronic Care Model with interventions for childhood obesity prevention and management. We present the model, definitions and methodology used for the cross-site sustainability evaluation of CORD. Methods We applied the Ecologic Model of Obesity to childhood obesity interventions to operationalize four sustainability constructs: replicability, continuation of benefits, institutionalization, and community capacity. We used a triangulation approach and employed mixed methods to assess sustainability constructs at each level of the Ecologic Model of Obesity: Micro, Meso, Exo and Macro. We constructed checklists to count and code intervention activities, use of evidence-based practices among providers, and environmental factors and policies hypothesized to influence intervention sustainability. We developed in-depth interviews for principal investigators and project leads. We applied the Wilder Collaboration Factors Inventory with key stakeholders. Results Lessons learned suggested that sustainability constructs should be clearly identified and operationalized a priori. Constructs must be flexible to account for differences between intervention plans and implementation to obtain robust and informative data. Conclusion Strong links are needed among researchers, program implementers and communities to accomplish consistent, robust and valuable data collection efforts to assure sustainable and healthy communities.
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Affiliation(s)
- Rebecca E Lee
- 1Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St, Phoenix, AZ 85004 USA
| | - Dennis Kao
- 2School of Social Work, Carleton University, 509 Dunton Tower, 1125 Colonel By Drive, Ottawa, ON K1S 5B6 Canada
| | - Nathan H Parker
- 3Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Unit 1330, CPB3.3278, PO Box 301439, Houston, TX 77230 USA
| | - Allen M Hallett
- 4Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, 1616 Guadalupe St, Ste 6.300, Austin, TX 78701 USA
| | - Camila Y Kochi
- 5Department of Pharmacological & Pharmaceutical Sciences, University of Houston, 4849 Calhoun Rd. #5007A, Houston, TX 77204 USA
| | - Maria J Modelska
- 6Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, 4726 Calhoun, N107 Engineering Bldg 1, Houston, TX 77204 USA
| | - Hanadi S Rifai
- 6Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, 4726 Calhoun, N107 Engineering Bldg 1, Houston, TX 77204 USA
| | - Daniel P O'Connor
- 7Department of Health and Human Performance, HEALTH Research Institute, University of Houston, 3875 Holman St. Rm. 104 Garrison, Houston, TX 77204 USA
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12
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Beets MW, Brazendale K, Weaver RG, Armstrong B. Rethinking Behavioral Approaches to Compliment Biological Advances to Understand the Etiology, Prevention, and Treatment of Childhood Obesity. Child Obes 2019; 15:353-358. [PMID: 31140855 DOI: 10.1089/chi.2019.0109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Keith Brazendale
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Bridget Armstrong
- Arnold School of Public Health, University of South Carolina, Columbia, SC
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13
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Appel JM, Fullerton K, Hennessy E, Korn AR, Tovar A, Allender S, Hovmand PS, Kasman M, Swinburn BA, Hammond RA, Economos CD. Design and methods of Shape Up Under 5: Integration of systems science and community-engaged research to prevent early childhood obesity. PLoS One 2019; 14:e0220169. [PMID: 31369570 PMCID: PMC6675039 DOI: 10.1371/journal.pone.0220169] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 07/04/2019] [Indexed: 11/21/2022] Open
Abstract
Shape Up Under 5 (SUU5) was a two-year early childhood obesity prevention pilot study in Somerville, Massachusetts (2015-2017) designed to test a novel conceptual framework called Stakeholder-driven Community Diffusion. For whole-of-community interventions, this framework posits that diffusion of stakeholders' knowledge about and engagement with childhood obesity prevention efforts through their social networks will improve the implementation of health-promoting policy and practice changes intended to reduce obesity risk. SUU5 used systems science methods (agent-based modeling, group model building, social network analysis) to design, facilitate, and evaluate the work of 16 multisector stakeholders ('the Committee'). In this paper, we describe the design and methods of SUU5 using the conceptual framework: the approach to data collection, and methods and rationale for study inputs, activities and evaluation, which together may further our understanding of the hypothesized processes within Stakeholder-driven Community Diffusion. We also present a generalizable conceptual framework for addressing childhood obesity and similar complex public health issues through whole-of-community interventions.
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Affiliation(s)
- Julia M. Appel
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Karen Fullerton
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Ariella R. Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, South Kingston, Rhode Island, United States of America
| | - Steven Allender
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Peter S. Hovmand
- Social System Design Lab, George Warren Brown School of Social Work, Washington University, Saint Louis, Missouri, United States of America
| | - Matt Kasman
- Center on Social Dynamics and Policy, The Brookings Institution, Washington D.C, United States of America
| | - Boyd A. Swinburn
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Australia
- School of Population Health, University of Auckland, Aukland, New Zealand
| | - Ross A. Hammond
- Center on Social Dynamics and Policy, The Brookings Institution, Washington D.C, United States of America
| | - Christina D. Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
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14
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Borg A, Haughton CF, Sawyer M, Lemon SC, Kane K, Pbert L, Li W, Rosal MC. Design and methods of the Healthy Kids & Families study: a parent-focused community health worker-delivered childhood obesity prevention intervention. BMC OBESITY 2019; 6:19. [PMID: 31171975 PMCID: PMC6545743 DOI: 10.1186/s40608-019-0240-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/14/2019] [Indexed: 11/22/2022]
Abstract
Background One third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids & Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Methods Participants were English or Spanish-speaking parent-child dyads (n = 247) from nine elementary schools (grades K-6) located in racial/ethnically diverse low-income communities in Worcester, Massachusetts. Using a quasi-experimental design with the school as the level of allocation, the study compared the lifestyle intervention vs. an attention-control comparison condition. The lifestyle intervention was guided by social cognitive theory and social ecological principles. It targeted the child’s social and physical home environment by intervening with parental weight-related knowledge, beliefs, and skills for managing child obesogenic behaviors; and addressed families’ needs for community resources supportive of a healthy lifestyle. The two-year CHW-delivered intervention was structured based on the 5As model (Agenda, Assess, Advise, Assist, Arrange follow up) and included two in person sessions and two telephone follow-ups per year with the parent, with a personalized letter and print materials sent after each contact. Parents also received quarterly newsletters, Facebook messages, and invitations to community events. The attention-control comparison condition used the same format and contact time as the intervention condition, but targeted positive parenting skills. Measurements occurred at baseline, and at 6-, 12-, 18- and 24-month follow-up. Assessments included anthropometrics, accelerometry, global positioning system (GPS), and self-report surveys. The primary outcome was child body mass index (BMI) z score. Secondary outcomes were parent BMI; and parent and child diet, physical activity, sedentariness, and utilization of community resources supportive of a healthy lifestyle. Discussion A CHW-delivered parent-focused lifestyle intervention may provide a translatable model for targeting the high priority public health problem of childhood obesity among low-income diverse communities. If demonstrated effective, this intervention has potential for high impact. Trial registration ClinicalTrials NCT03028233. Registered January 23,2017. The trial was retrospectively registered.
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Affiliation(s)
- Amy Borg
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Christina F Haughton
- Oak Hill Community Development Corporation, 74 Providence Street, Worcester, MA 01604 USA
| | - Mullen Sawyer
- 3Tufts University Friedman School of Nutrition and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Stephenie C Lemon
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Kevin Kane
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Lori Pbert
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Wenjun Li
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Milagros C Rosal
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
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15
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Cheng ER, Nelson CC, Leung-Strle P, Colchamiro R, Taveras EM, Woo Baidal JA. Nutrition provider confidence in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study. Prev Med Rep 2019; 13:289-292. [PMID: 30740295 PMCID: PMC6357843 DOI: 10.1016/j.pmedr.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/21/2018] [Accepted: 01/20/2019] [Indexed: 11/26/2022] Open
Abstract
Objective The multi-sector, multi-level Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study resulted in improvements in obesity risk factors among children age 2–4 years enrolled in the Special Supplemental Nutrition program for Women, Infants, and Children (WIC). The goal of this study was to examine whether the MA-CORD intervention increased WIC provider confidence in their ability to identify childhood obesity and obesity-related behaviors. Methods As part of the MA-CORD intervention conducted from 2012 to 2015, we implemented WIC practice changes focused on childhood obesity prevention within two Massachusetts communities. We examined changes in provider confidence to assess childhood obesity risk factors and practice frequency among WIC practices located in MA-CORD intervention communities over a 3-year period, compared to non-intervention sites. We measured provider confidence on a continuous scale using questions previously developed to assess provider and parent confidence to make weight-related behavior change (range 0 to 24). Results There were 205 providers at baseline and 165 at follow-up. WIC providers at intervention sites reported greater confidence in their ability to identify childhood obesity and obesity-related behaviors compared to the usual care sites (β = 1.01, standard error = 0.13). These findings persisted after adjusting for provider gender, years in practice, highest education level, and WIC position. Conclusions The MA-CORD intervention was associated with increased WIC provider confidence to assess children's obesity risk. Interventions that increase confidence in assessing obesity-related behaviors may have salutary effects within WIC programs that serve low-income families. We evaluated a WIC intervention integrated into a multi-sector trial focused on reducing childhood obesity. WIC providers in intervention sites reported a significant increase in their confidence to assess children's obesity risk. Integrating WIC may increase the reach of childhood obesity prevention efforts.
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Affiliation(s)
- Erika R Cheng
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Candace C Nelson
- Massachusetts Department of Public Health, Boston, MA, United States of America
| | - Peggy Leung-Strle
- Massachusetts Department of Public Health, Boston, MA, United States of America
| | - Rachel Colchamiro
- Massachusetts Department of Public Health, Boston, MA, United States of America
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States of America
| | - Jennifer A Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States of America
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16
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Volger S, Rigassio Radler D, Rothpletz-Puglia P. Early childhood obesity prevention efforts through a life course health development perspective: A scoping review. PLoS One 2018; 13:e0209787. [PMID: 30592757 PMCID: PMC6310279 DOI: 10.1371/journal.pone.0209787] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/11/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction The obesity rate in preschool children in the United States (US) is 13.9%, while even higher rates are associated with racial and ethnic minorities and children from low-income families. These prevalence patterns underscore the need to identify effective childhood obesity prevention programs. Method A scoping review was conducted following Arksey and O’Malley’s framework to provide an overview of the types, effectiveness and cost-effectiveness of obesity prevention interventions and policies in children up to 6 years old. Inclusion criteria were studies at least 6-months duration; included a weight-based outcome, conducted in the US, English publications from January 2001 to February 2018. Exclusions: studies in overweight/obese children and obesity treatments, no comparator group. Evidence was characterized across the early life course and multiple-levels of influence. Results From the 2,180 records identified, 34 met the inclusion criteria. Less than half of the interventions initiated during pregnancy, infancy or preschool reported a significant improvement in a weight-based outcome. All interventions included strategies to influence individual- or interpersonal-level health behaviors, yet few removed obstacles in the healthcare system, physical/built environment, or sociocultural environment. The majority (78%) of the interventions occurred during preschool years, with 63% conducted in early childcare education settings serving low-income families. The health impact of the state-wide and national policies on children under age 6 years remains unclear. There was considerable uncertainty around estimates of the health and economic impacts of obesity prevention interventions and policies. Conclusion There is a need to intensify early childhood obesity preventive efforts during critical periods of health development in the US. Future studies should estimate the feasibility, program effectiveness, and cost of implementing multilevel obesity prevention interventions and policies. Addressing these research gaps will provide stakeholders with the scientific evidence necessary to facilitate funding and policy decisions to decrease the prevalence of early childhood obesity.
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Affiliation(s)
- Sheri Volger
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, United States of America
- * E-mail:
| | - Diane Rigassio Radler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, United States of America
| | - Pamela Rothpletz-Puglia
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, United States of America
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17
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Subica AM. Public Health Interventions in the Era of Childhood Obesity and Other Racial Health Disparities. Am J Public Health 2018; 108:1125-1127. [PMID: 30089011 DOI: 10.2105/ajph.2018.304613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Andrew M Subica
- Andrew M. Subica is with the Department of Social Medicine, Population, and Public Health, University of California, Riverside School of Medicine, Riverside
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18
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Karacabeyli D, Allender S, Pinkney S, Amed S. Evaluation of complex community-based childhood obesity prevention interventions. Obes Rev 2018; 19:1080-1092. [PMID: 29768728 DOI: 10.1111/obr.12689] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Multi-setting, multi-component community-based interventions have shown promise in preventing childhood obesity; however, evaluation of these complex interventions remains a challenge. OBJECTIVE The objective of the study is to systematically review published methodological approaches to outcome evaluation for multi-setting community-based childhood obesity prevention interventions and synthesize a set of pragmatic recommendations. METHODS MEDLINE, CINAHL and PsycINFO were searched from inception to 6 July 2017. Papers were included if the intervention targeted children ≤18 years, engaged at least two community sectors and described their outcome evaluation methodology. A single reviewer conducted title and abstract scans, full article review and data abstraction. Directed content analysis was performed by three reviewers to identify prevailing themes. RESULTS Thirty-three studies were included, and of these, 26 employed a quasi-experimental design; the remaining were randomized control trials. Body mass index was the most commonly measured outcome, followed by health behaviour change and psychosocial outcomes. Six themes emerged, highlighting advantages and disadvantages of active vs. passive consent, quasi-experimental vs. randomized control trials, longitudinal vs. repeat cross-sectional designs and the roles of process evaluation and methodological flexibility in evaluating complex interventions. CONCLUSIONS Selection of study designs and outcome measures compatible with community infrastructure, accompanied by process evaluation, may facilitate successful outcome evaluation.
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Affiliation(s)
- D Karacabeyli
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - S Allender
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - S Pinkney
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - S Amed
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
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Nelson CC, Colchamiro R, Perkins M, Taveras EM, Leung-Strle P, Kwass J, Woo Baidal JA. Racial/Ethnic Differences in the Effectiveness of a Multisector Childhood Obesity Prevention Intervention. Am J Public Health 2018; 108:1200-1206. [PMID: 30024810 DOI: 10.2105/ajph.2018.304511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate racial/ethnic and language differences in the effectiveness of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study among children aged 2 to 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS We performed a multisector quasiexperimental study in 2 MA-CORD intervention communities and 1 comparison community. Using WIC data from 2010 to 2015, we examined intervention effect on child weight and behavior outcomes by child race/ethnicity and parental primary language using multilevel linear regression models with an interaction term. RESULTS Non-Hispanic Black children exposed to the intervention demonstrated a greater decrease in body mass index (BMI) than did other children (P < .05). Racial/ethnic minority children in the comparison site had greater increases in BMI than did their White counterparts (P < .05). There were no differences in intervention effectiveness by race/ethnicity or language for health behaviors. CONCLUSIONS White children demonstrated decreased BMI in both the intervention and control groups. However, intervention minority children demonstrated greater improvements in BMI than did control minority children. Public Health Implications. To reduce racial/ethnic disparities, we need to disseminate effective obesity prevention interventions during early childhood in low-income settings.
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Affiliation(s)
- Candace C Nelson
- Candace C. Nelson, Rachel Colchamiro, Peggy Leung-Strle, and JoAnn Kwass are with the Massachusetts Department of Public Health, Boston. Meghan Perkins and Elsie M. Taveras are with the Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. Jennifer A. Woo Baidal is with the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Rachel Colchamiro
- Candace C. Nelson, Rachel Colchamiro, Peggy Leung-Strle, and JoAnn Kwass are with the Massachusetts Department of Public Health, Boston. Meghan Perkins and Elsie M. Taveras are with the Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. Jennifer A. Woo Baidal is with the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Meghan Perkins
- Candace C. Nelson, Rachel Colchamiro, Peggy Leung-Strle, and JoAnn Kwass are with the Massachusetts Department of Public Health, Boston. Meghan Perkins and Elsie M. Taveras are with the Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. Jennifer A. Woo Baidal is with the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Elsie M Taveras
- Candace C. Nelson, Rachel Colchamiro, Peggy Leung-Strle, and JoAnn Kwass are with the Massachusetts Department of Public Health, Boston. Meghan Perkins and Elsie M. Taveras are with the Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. Jennifer A. Woo Baidal is with the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Peggy Leung-Strle
- Candace C. Nelson, Rachel Colchamiro, Peggy Leung-Strle, and JoAnn Kwass are with the Massachusetts Department of Public Health, Boston. Meghan Perkins and Elsie M. Taveras are with the Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. Jennifer A. Woo Baidal is with the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - JoAnn Kwass
- Candace C. Nelson, Rachel Colchamiro, Peggy Leung-Strle, and JoAnn Kwass are with the Massachusetts Department of Public Health, Boston. Meghan Perkins and Elsie M. Taveras are with the Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. Jennifer A. Woo Baidal is with the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Jennifer A Woo Baidal
- Candace C. Nelson, Rachel Colchamiro, Peggy Leung-Strle, and JoAnn Kwass are with the Massachusetts Department of Public Health, Boston. Meghan Perkins and Elsie M. Taveras are with the Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. Jennifer A. Woo Baidal is with the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY
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20
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Fiechtner L, Perkins M, Biggs V, Langhans N, Sharifi M, O'Connor G, Price S, Locascio J, Kuhlthau K, Kwass JA, Nelson C, Land T, Longjohn M, Lawson V, Hohman K, Taveras EM. Rationale and design of the Clinic and Community Approaches to Healthy Weight Randomized Trial. Contemp Clin Trials 2018; 67:16-22. [PMID: 29330083 PMCID: PMC5871582 DOI: 10.1016/j.cct.2018.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/27/2017] [Accepted: 01/08/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent studies have demonstrated the effectiveness of family-centered, pediatric weight management programs in reducing childhood obesity. Yet, programs to optimize the care of low-income children with obesity are needed. We sought to examine the comparative effectiveness of two, potentially scalable pediatric weight management programs delivered to low-income children in a clinical or community setting. MATERIALS AND METHODS The Clinic and Community Approaches to Healthy Weight Trial is a randomized trial in two communities in Massachusetts that serve a large population of low-income children and families. The two-arm trial compares the effects of a pediatric weight management program delivered in the Healthy Weight Clinics of two federally qualified health centers (FQHC) to the Healthy Weight and Your Child programs delivered in two YMCAs. Eligible children are 6 to 12 years old with a body mass index (BMI) ≥ 85th percentile seen in primary care at the two FQHCs. Both programs are one-year in duration and have at least 30 contact hours throughout the year. Measures are collected at baseline, 6 months, and 1 year. The main outcome is 1-year change in BMI (kg/m2) and percent change of the 95th percentile (%BMIp95). CONCLUSION The Clinic and Community Approaches to Healthy Weight Trial seeks to 1) examine the comparative effects of a clinical and community based intervention in improving childhood obesity, and 2) inform the care of >7 million children with obesity covered by the Children's Health Insurance Program or Medicaid.
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Affiliation(s)
- Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA; Department of Gastroenterology and Nutrition, MassGeneral Hospital for Children, 175 Cambridge St., 5th floor, Boston, MA 02114, USA.
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA.
| | - Vincent Biggs
- Holyoke Community Health Center, Department of Pediatrics, 230 Maple St., Holyoke, MA 01040, USA.
| | - Nancy Langhans
- Greater New Bedford Community Health Center, Department of Pediatrics, 874 Purchase St., New Bedford, MA 02740, USA.
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520, USA.
| | - Giselle O'Connor
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA.
| | - Sarah Price
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA.
| | - Joseph Locascio
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Karen Kuhlthau
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA.
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108, USA.
| | - Candace Nelson
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108, USA.
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108, USA.
| | - Matt Longjohn
- YMCA of the USA, 101 N Wacker Drive, Chicago, IL 60606, USA.
| | - Valerie Lawson
- YMCA of the USA, 101 N Wacker Drive, Chicago, IL 60606, USA.
| | | | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA.
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Criss S, Blaine RE, Palamé M, Perkins M, Davison K, Kwass JA, Taveras EM. Health Marketing for the Massachusetts Childhood Obesity Research Demonstration Study: A Case Study. Health Promot Pract 2018; 20:282-291. [PMID: 29566576 DOI: 10.1177/1524839918760842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. This case study describes the Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) health marketing campaign, examines the strategies used in such campaigns, and offers lessons learned to improve health marketing for future interventions. MA-CORD Health Marketing Components and Implementation. The three main components were an outdoor printed advertisement and texting campaign, social media with a focus on Facebook, and the Summer Passport Program, an event-based initiative in parks for children. The advertisements consisted of billboards, bus advertisements, and handouts. The text messaging component, which required families to actively text a keyword to join, had a low opt-in rate. Facebook page "likes" increased from 1,024 to 1,453 in New Bedford and from 175 to 1,091 in Fitchburg. Fitchburg received technical assistance and paid for ads on Facebook. The Summer Passport participation in parks ranged from 120 to 875 children with participation in the free park lunch program doubling in Fitchburg. Discussion. Key lessons learned are engage communication experts from each community at the beginning of the project, use text messaging components with in-person staff onsite to assist participants in the opt-in process, build momentum for a Facebook presence through purchasing Facebook advertisements, and partner with local park departments for programming.
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Affiliation(s)
| | | | | | | | | | - Jo-Ann Kwass
- Massachusetts Department of Public Health, Boston, MA, USA
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Berman M, Bozsik F, Shook RP, Meissen-Sebelius E, Markenson D, Summar S, DeWit E, Carlson JA. Evaluation of the Healthy Lifestyles Initiative for Improving Community Capacity for Childhood Obesity Prevention. Prev Chronic Dis 2018; 15:E24. [PMID: 29470168 PMCID: PMC5833312 DOI: 10.5888/pcd15.170306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE AND OBJECTIVES Policy, systems, and environmental approaches are recommended for preventing childhood obesity. The objective of our study was to evaluate the Healthy Lifestyles Initiative, which aimed to strengthen community capacity for policy, systems, and environmental approaches to healthy eating and active living among children and families. INTERVENTION APPROACH The Healthy Lifestyles Initiative was developed through a collaborative process and facilitated by community organizers at a local children's hospital. The initiative supported 218 partners from 170 community organizations through training, action planning, coalition support, one-on-one support, and the dissemination of materials and sharing of resources. EVALUATION METHODS Eighty initiative partners completed a brief online survey on implementation strategies engaged in, materials used, and policy, systems, and environmental activities implemented. In accordance with frameworks for implementation science, we assessed associations among the constructs by using linear regression to identify whether and which of the implementation strategies were associated with materials used and implementation of policy, systems, and environmental activities targeted by the initiative. RESULTS Each implementation strategy was engaged in by 30% to 35% of the 80 survey respondents. The most frequently used materials were educational handouts (76.3%) and posters (66.3%). The most frequently implemented activities were developing or continuing partnerships (57.5%) and reviewing organizational wellness policies (46.3%). Completing an action plan and the number of implementation strategies engaged in were positively associated with implementation of targeted activities (action plan, effect size = 0.82; number of strategies, effect size = 0.51) and materials use (action plan, effect size = 0.59; number of strategies, effect size = 0.52). Materials use was positively associated with implementation of targeted activities (effect size = 0.35). IMPLICATIONS FOR PUBLIC HEALTH Community-capacity-building efforts can be effective in supporting community organizations to engage in policy, systems, and environmental activities for healthy eating and active living. Multiple implementation strategies are likely needed, particularly strategies that involve a high level of engagement, such as training community organizations and working with them on structured action plans.
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Affiliation(s)
- Marcie Berman
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Missouri
| | - Frances Bozsik
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Missouri
| | - Robin P Shook
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Missouri
| | - Emily Meissen-Sebelius
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Missouri
| | - Deborah Markenson
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Missouri
| | - Shelly Summar
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Missouri
| | - Emily DeWit
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Missouri
| | - Jordan A Carlson
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E 22nd St, Kansas City, MO 64108.
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Abstract
The National Heart, Lung, and Blood Institute and the National Institutes of Health Office of Disease Prevention convened a meeting on August 29-30, 2013 entitled "Obesity Intervention Taxonomy and Pooled Analysis." The overarching goals of the meeting were to understand how to decompose interventions targeting behavior change, and in particular, those that focus on obesity and to combine data from groups of related intervention studies to supplement what can be learned from the individual studies. This paper summarizes the workshop recommendations and provides an overview of the two other papers that originated from the workshop and that address decomposition of behavioral change interventions and pooling of data across diverse studies within a consortium.
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Taveras EM, Perkins M, Anand S, Woo Baidal JA, Nelson CC, Kamdar N, Kwass JA, Gortmaker SL, Barrett JL, Davison KK, Land T. Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children. Obesity (Silver Spring) 2017; 25:1159-1166. [PMID: 28653504 PMCID: PMC5506684 DOI: 10.1002/oby.21866] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/21/2017] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the extent to which a clinical intervention resulted in reduced BMI z scores among 2- to 12-year-old children compared to routine practice (treatment as usual [TAU]). METHODS The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a multifaceted initiative to prevent childhood obesity among low-income children. At the federally qualified community health centers (FQHCs) of two communities (Intervention Site #1 and #2), the following were implemented: (1) pediatric weight management training, (2) electronic decision supports for clinicians, (3) on-site Healthy Weight Clinics, (4) community health worker integration, and (5) healthful clinical environment changes. One FQHC in a demographically matched community served as the TAU site. Using electronic health records, we assessed BMI z scores and used linear mixed models to examine BMI z score change over 2 years in each intervention site compared to a TAU site. RESULTS Compared to children in the TAU site (n = 2,286), children in Intervention Site #2 (n = 1,368) had a significant decline in BMI z scores following the start of the intervention (-0.16 units/y; 95% confidence interval: -0.21 to -0.12). No evidence of an effect was found in Intervention Site #1 (n = 111). CONCLUSIONS The MA-CORD clinical interventions were associated with modest improvement in BMI z scores in one of two intervention communities compared to a TAU community.
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Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Shikha Anand
- National Institute for Children’s Health Quality, Boston, MA
| | - Jennifer A. Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Candace C. Nelson
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, MA
| | - Neil Kamdar
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jessica L. Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, MA
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Woo Baidal JA, Nelson CC, Perkins M, Colchamiro R, Leung-Strle P, Kwass JA, Gortmaker SL, Davison KK, Taveras EM. Childhood obesity prevention in the women, infants, and children program: Outcomes of the MA-CORD study. Obesity (Silver Spring) 2017; 25:1167-1174. [PMID: 28653498 PMCID: PMC5600510 DOI: 10.1002/oby.21865] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/21/2017] [Accepted: 03/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the extent to which a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) intervention improved BMI z scores and obesity-related behaviors among children age 2 to 4 years. METHODS In two Massachusetts communities, practice changes in WIC were implemented as part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) initiative to prevent obesity among low-income children. One WIC program was the comparison. Changes in BMI z scores pre and post intervention and prevalence of obesity-related behaviors of WIC participants were assessed. Linear mixed models were used to examine BMI z score change, and logistic regression models were used to examine changes in obesity-related behaviors in each intervention site versus comparison over 2 years. RESULTS WIC-enrolled children in both intervention sites (vs. comparison) had improved sugar-sweetened beverage consumption and sleep duration. Compared to the comparison WIC program (n = 626), no differences were observed in BMI z score among children in Intervention Site #1 (n = 198) or #2 (n = 637). In sensitivity analyses excluding Asian children, a small decline was observed in BMI z score (-0.08 units/y [95% confidence interval: -0.14 to -0.02], P = 0.01) in Intervention Site #2 versus comparison. CONCLUSIONS Among children enrolled in WIC, the MA-CORD intervention was associated with reduced prevalence of obesity risk factors in both intervention communities and a small improvement in BMI z scores in one of two intervention communities in non-Asian children.
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Affiliation(s)
- Jennifer A. Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA
| | | | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA
| | | | | | - Jo-Ann Kwass
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Steve L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kirsten K. Davison
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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26
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Economos CD, Hammond RA. Designing effective and sustainable multifaceted interventions for obesity prevention and healthy communities. Obesity (Silver Spring) 2017; 25:1155-1156. [PMID: 28653500 DOI: 10.1002/oby.21893] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Christina D Economos
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Ross A Hammond
- Center on Social Dynamics & Policy, The Brookings Institution, Washington, DC, USA
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27
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Franckle RL, Falbe J, Gortmaker S, Barrett JL, Giles C, Ganter C, Blaine RE, Buszkiewicz J, Taveras EM, Kwass JA, Land T, Davison KK. Student obesity prevalence and behavioral outcomes for the massachusetts childhood obesity research demonstration project. Obesity (Silver Spring) 2017; 25:1175-1182. [PMID: 28653502 PMCID: PMC5488705 DOI: 10.1002/oby.21867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/02/2017] [Accepted: 03/17/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine changes in prevalence of obesity and target health behaviors (fruit, vegetable, and beverage consumption; physical activity; screen time; sleep duration) among students from communities that participated in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project compared to controls. METHODS MA-CORD was implemented in two low-income communities. School-level prevalence of obesity among students in first, fourth, and seventh grades was calculated for the intervention communities and nine matched control communities pre and post intervention. Fourth- and seventh-grade students' self-reported health behaviors were measured in intervention communities at baseline and post intervention. RESULTS Among seventh-graders (the student group with greatest intervention exposure), a statistically significant decrease in prevalence of obesity from baseline to post intervention in Community 2 (-2.68%, P = 0.049) and a similar but nonsignificant decrease in Community 1 (-2.24%, P = 0.099) was observed. Fourth- and seventh-grade students in both communities were more likely to meet behavioral targets post intervention for sugar-sweetened beverages (both communities: P < 0.0001) and water (Community 1: P < 0.01; Community 2: P = 0.04) and in Community 2 for screen time (P < 0.01). CONCLUSIONS This multisector intervention was associated with a modest reduction in obesity prevalence among seventh-graders in one community compared to controls, along with improvements in behavioral targets.
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Affiliation(s)
- Rebecca L. Franckle
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jessica L. Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claudia Ganter
- Medical Faculty Mannheim, Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
| | - Rachel E. Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA
| | - James Buszkiewicz
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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28
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Ganter C, Aftosmes-Tobio A, Chuang E, Kwass JA, Land T, Davison KK. Lessons Learned by Community Stakeholders in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Project, 2013-2014. Prev Chronic Dis 2017; 14:E08. [PMID: 28125400 PMCID: PMC5268744 DOI: 10.5888/pcd14.160273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Childhood obesity is a multifaceted disease that requires sustainable, multidimensional approaches that support change at the individual, community, and systems levels. The Massachusetts Childhood Obesity Research Demonstration project addressed this need by using clinical and public health evidence-based methods to prevent childhood obesity. To date, little information is known about successes and lessons learned from implementing such large-scale interventions. To address this gap, we examined perspectives of community stakeholders from various sectors on successes achieved and lessons learned during the implementation process. Methods We conducted 39 semistructured interviews with key stakeholders from 6 community sectors in 2 low-income communities from November 2013 through April 2014, during project implementation. Interviews were audio-recorded, transcribed, and analyzed by using the constant comparative method. Data were analyzed by using QSR NVivo 10. Results Successes included increased parental involvement in children’s health and education, increased connections within participating organizations and within the broader community, changes in organizational policies and environments to better support healthy living, and improvements in health behaviors in children, parents, and stakeholders. Lessons learned included the importance of obtaining administrative and leadership support, involving key stakeholders early in the program planning process, creating buffers that allow for unexpected changes, and establishing opportunities for regular communication within and across sectors. Conclusion Study findings indicate that multidisciplinary approaches support health behavior change and provide insight into key issues to consider in developing and implementing such approaches in low-income communities.
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Affiliation(s)
- Claudia Ganter
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Technical University Berlin, Berlin, Germany
| | | | - Emmeline Chuang
- University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California
| | - Jo-Ann Kwass
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Thomas Land
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115 MA.
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29
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Blaine RE, Franckle RL, Ganter C, Falbe J, Giles C, Criss S, Kwass JA, Land T, Gortmaker SL, Chuang E, Davison KK. Using School Staff Members to Implement a Childhood Obesity Prevention Intervention in Low-Income School Districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012-2014. Prev Chronic Dis 2017; 14:E03. [PMID: 28084989 PMCID: PMC5234440 DOI: 10.5888/pcd14.160381] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Although evidence-based interventions to prevent childhood obesity in school settings exist, few studies have identified factors that enhance school districts’ capacity to undertake such efforts. We describe the implementation of a school-based intervention using classroom lessons based on existing “Eat Well and Keep Moving” and “Planet Health” behavior change interventions and schoolwide activities to target 5,144 children in 4th through 7th grade in 2 low-income school districts. Methods The intervention was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project, a multisector community-based intervention implemented from 2012 through 2014. Using mixed methods, we operationalized key implementation outcomes, including acceptability, adoption, appropriateness, feasibility, implementation fidelity, perceived implementation cost, reach, and sustainability. Results MA-CORD was adopted in 2 school districts that were facing resource limitations and competing priorities. Although strong leadership support existed in both communities at baseline, one district’s staff reported less schoolwide readiness and commitment. Consequently, fewer teachers reported engaging in training, teaching lessons, or planning to sustain the lessons after MA-CORD. Interviews showed that principal and superintendent turnover, statewide testing, and teacher burnout limited implementation; passionate wellness champions in schools appeared to offset implementation barriers. Conclusion Future interventions should assess adoption readiness at both leadership and staff levels, offer curriculum training sessions during school hours, use school nurses or health teachers as wellness champions to support teachers, and offer incentives such as staff stipends or play equipment to encourage school participation and sustained intervention activities.
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Affiliation(s)
- Rachel E Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, 1250 Bellflower Blvd. FCS FA-15, Long Beach, California 90840.
| | - Rebecca L Franckle
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Claudia Ganter
- Medical Faculty Mannheim, Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
| | - Jennifer Falbe
- University of California, Berkeley, Berkeley, California
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shaniece Criss
- Health Sciences Department, Furman University, Greenville, South Carolina
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emmeline Chuang
- University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California
| | - Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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30
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Ganter C, Aftosmes-Tobio A, Chuang E, Blaine RE, Land T, Davison KK. Community Stakeholders' Perceptions of Major Factors Influencing Childhood Obesity, the Feasibility of Programs Addressing Childhood Obesity, and Persisting Gaps. J Community Health 2017; 41:305-14. [PMID: 26433725 DOI: 10.1007/s10900-015-0097-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Prior research has identified numerous factors contributing to increased rates of childhood obesity. However, few studies have focused explicitly on the experience of community stakeholders in low-income communities. This study sought to capture the perspectives of these on-the-ground experts regarding major factors contributing to childhood obesity as well as gaps in current prevention and control efforts. We conducted semi-structured interviews with 39 stakeholders from different community sectors (e.g., healthcare providers, childcare providers, teachers). Data were drawn from the Massachusetts Childhood Obesity Research Demonstration project, a multi-level, multi-sector intervention designed to reduce childhood obesity being implemented in two low-income communities in Massachusetts. Interviews were conducted at baseline, transcribed, coded using grounded theory approach, and analyzed in NVivo 10.0. The vast majority of stakeholders had recently participated in obesity prevention strategies, and nearly all of them identified gaps in prevention efforts either within their organizations or in the broader community. In addition to factors previously identified in the literature, several themes emerged including the need to change policies to increase physical activity during school, offer healthier snacks in schools and afterschool programs, and increase communication and collaboration within the community in prevention efforts. Community stakeholders can impact the success of interventions by bridging the gap between science and lived experience. The results of this study can guide future research by highlighting the importance of including stakeholders' frontline experiences with target populations, and using information on identified gaps to augment intervention planning efforts.
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Affiliation(s)
- Claudia Ganter
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 2, 3rd Floor, Boston, MA, 02115, USA. .,Department of Health Care Management, Technical University Berlin, Strasse des 17. Juni 135, Berlin, 10623, Germany.
| | - Alyssa Aftosmes-Tobio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 2, 3rd Floor, Boston, MA, 02115, USA
| | - Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr. South, Los Angeles, CA, 90095-1772, USA
| | - Rachel E Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, 1250 Bellflower Blvd, FCS-FA 15, Long Beach, CA, 90840-0501, USA
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA, 02108-4619, USA
| | - Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 2, 3rd Floor, Boston, MA, 02115, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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31
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Ewart-Pierce E, Mejía Ruiz MJ, Gittelsohn J. "Whole-of-Community" Obesity Prevention: A Review of Challenges and Opportunities in Multilevel, Multicomponent Interventions. Curr Obes Rep 2016; 5:361-74. [PMID: 27379620 PMCID: PMC5962013 DOI: 10.1007/s13679-016-0226-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The causes of obesity worldwide are complex and multilevel, including changing food environments, physical activity levels, policies, and food production systems. This intricate context requires multilevel and multicomponent (MLMC) interventions to improve health outcomes. We conducted a literature review of MLMC interventions for obesity prevention and mitigation; 14 studies meeting search criteria were identified. We found examples of successes in preventing obesity, reducing overweight, improving healthful behaviors, and enhancing some psychosocial indicators. Of eight studies that reported health and behavioral results, five showed no significant impact and three showed reductions in obesity. Four studies showed significant improvement in dietary behavior, and five reported significant desirable effects in physical activity or screen time. Five studies reported psychosocial impacts, and three of these showed significant improvements. MLMC approaches show promising results, particularly when they are able to integrate components at the policy, community, and interpersonal levels.
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Affiliation(s)
- Ella Ewart-Pierce
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - María José Mejía Ruiz
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Media Competition Implementation for the Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD): Adoption and Reach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:403. [PMID: 27058549 PMCID: PMC4847065 DOI: 10.3390/ijerph13040403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/11/2016] [Accepted: 02/14/2016] [Indexed: 12/19/2022]
Abstract
The Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) was a multi-level, multi-sector community intervention with a media competition component to provide an overarching synergy and promote awareness of target behaviors to reduce childhood obesity. Students participating in the media competition were tasked with developing videos, song/rap lyrics, and artwork that reflected the goals. The aim of this study is to document the process used to develop and implement the media competition along with its reach and adoption. An adapted version of Neta and colleagues’ 2015 framework on dissemination and implementation was used to summarize the process by which the media competition was developed and implemented. Adoption was defined by whether eligible schools or afterschool programs decided to implement the media competition. Reach was defined by student participation rates within schools/programs and the number of votes cast for the finalists on the coalition website and students’ paper ballots. A total of 595 students participated in the media competition from 18 school and afterschool programs in two communities. Adoption of the media competitions ranged from 22% to 100% in programs and reach ranged from 3% to 33% of the student population. The documentation of the implementation should contribute to the replication of the media competition.
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Criss S, Tran A, Ganter C, Aftosmes-Tobio A, Gortmaker S, Viswanath K, Kwass JA, Davison KK. A Cascade of Champions: A Qualitative Study about the MA-CORD Media Competition Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:404. [PMID: 27058550 PMCID: PMC4847066 DOI: 10.3390/ijerph13040404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/15/2016] [Accepted: 03/23/2016] [Indexed: 11/16/2022]
Abstract
A media competition was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study. Criss et al., previously outlined the development and implementation of the competition, including variation in reach and adoption of the intervention across schools and afterschool programs. In this qualitative study, we examine community, provider, and organizational factors that explain the variation of media competition reach in school and afterschool programs, and describe the awareness of the media competition across other community sectors. Durlak and DuPre's ecological framework for understanding effective implementation provided the theoretical underpinnings for this study. Fifty-four key informant interviews were conducted, transcribed, and analyzed. Organizational capacity of committed teachers/staff and adaptability of the media competition seemed to be drivers for higher reach within school and afterschool programs. Salient themes that emerged as facilitators of effective implementation were having a cascade of champions and providing opportunity to participate in the media competition outside traditional class time. Clinics and coalitions were identified as additional sectors aware of the media competition. Specifically, our findings offer a new perspective on intervention design and a recommended direction for further study.
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Affiliation(s)
- Shaniece Criss
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA 02115, USA.
| | - Alvin Tran
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA.
| | - Claudia Ganter
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA.
| | - Alyssa Aftosmes-Tobio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA.
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA 02115, USA.
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA 02115, USA.
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
| | - Jo-Ann Kwass
- Massachusetts Department of Public Health, Bureau of Community Health and Prevention, 250 Washington Street, Boston, MA 02108, USA.
| | - Kirsten K Davison
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA 02115, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA.
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Anchondo IM, Satter E, Danaher C, Estes PR. MA-CORD: Stop Ineffective Childhood Obesity Inverventions. Child Obes 2015; 11:731-2. [PMID: 26584415 DOI: 10.1089/chi.2015.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Inés M Anchondo
- 1 Department of Pediatrics, Texas Tech University Health Sciences Center , El Paso, TX
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Joseph S, Stevens AM, Ledoux T, O'Connor TM, O'Connor DP, Thompson D. Rationale, Design, and Methods for Process Evaluation in the Childhood Obesity Research Demonstration Project. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:560-565.e1. [PMID: 26298514 DOI: 10.1016/j.jneb.2015.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/26/2015] [Accepted: 07/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The cross-site process evaluation plan for the Childhood Obesity Research Demonstration (CORD) project is described here. DESIGN The CORD project comprises 3 unique demonstration projects designed to integrate multi-level, multi-setting health care and public health interventions over a 4-year funding period. SETTING Three different communities in California, Massachusetts, and Texas. PARTICIPANTS All CORD demonstration projects targeted 2-12-year-old children whose families are eligible for benefits under Title XXI (CHIP) or Title XIX (Medicaid). INTERVENTION(S) The CORD projects were developed independently and consisted of evidence-based interventions that aim to prevent childhood obesity. The interventions promote healthy behaviors in children by applying strategies in 4 key settings (primary care clinics, early care and education centers, public schools, and community institutions). MAIN OUTCOME MEASURE(S) The CORD process evaluation outlined 3 main outcome measures: reach, dose, and fidelity, on 2 levels (researcher to provider, and provider to participant). ANALYSIS The plan described here provides insight into the complex nature of process evaluation for consortia of independently designed multi-level, multi-setting intervention studies. The process evaluation results will provide contextual information about intervention implementation and delivery with which to interpret other aspects of the program.
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Affiliation(s)
- Sitara Joseph
- Center on Research and Evaluation, Simmons School of Education and Human Development, Southern Methodist University, Dallas, TX
| | - Andria M Stevens
- Texas Obesity Research Center, University of Houston, Houston, TX
| | - Tracey Ledoux
- Texas Obesity Research Center, University of Houston, Houston, TX
| | - Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | | | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX.
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Reasons Low-Income Parents Offer Snacks to Children: How Feeding Rationale Influences Snack Frequency and Adherence to Dietary Recommendations. Nutrients 2015. [PMID: 26197335 PMCID: PMC4517042 DOI: 10.3390/nu7075265] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Although American children snack more than ever before, the parental role in promoting snacking is not well understood. In 2012–2013 at baseline in an intervention study to prevent childhood obesity in low-income Massachusetts communities, n = 271 parents of children aged 2–12 years completed surveys regarding nutritive and non-nutritive reasons they offered children snacks, demographics, and dietary factors. An analysis of variance demonstrated that parents reported offering snacks (mean/week; standard deviation (SD)) for nutritive reasons like promoting growth (x̄ = 2.5; SD 2.2) or satisfying hunger (x̄ = 2.4; SD 2.1) almost twice as often as non-nutritive reasons like keeping a child quiet (x̄ = 0.7; SD 1.5) or celebrating events/holidays (x̄ = 0.8; SD 1.1). Parents reported giving young children (2–5 years) more snacks to reward behavior (1.9 vs. 1.1, p < 0.001), keep quiet (1.0 vs. 0.5, p < 0.001), and celebrate achievements (1.7 vs. 1.0, p < 0.001) than parents of older children (6–12 years). Multivariable logistic regression models were used to obtain adjusted odds ratios, which indicated reduced child adherence to dietary recommendations when parents offered snacks to reward behavior (Odds Ratio (OR) = 0.83; 95% Confidence Interval (CI) 0.70–0.99), celebrate events/holidays (OR = 0.72; 95% CI 0.52–0.99), or achievements (OR = 0.82; 95% CI 0.68–0.98). Parental intentions around child snacking are likely important targets for obesity prevention efforts.
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Franckle RL, Falbe J, Gortmaker S, Ganter C, Taveras EM, Land T, Davison KK. Insufficient sleep among elementary and middle school students is linked with elevated soda consumption and other unhealthy dietary behaviors. Prev Med 2015; 74:36-41. [PMID: 25712328 PMCID: PMC4390537 DOI: 10.1016/j.ypmed.2015.02.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/13/2015] [Accepted: 02/15/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study examines the extent to which insufficient sleep is associated with diet quality in students taking part in the Massachusetts Childhood Obesity Research Demonstration Project. METHODS Data were collected in Fall 2012 for all 4th and 7th grade children enrolled in public schools in two Massachusetts communities. During annual body mass index (BMI) screening, students completed a survey that assessed diet, physical activity, screen time, and sleep. Of the 2456 enrolled students, 1870 (76%) had complete survey data. Generalized estimating equations were used to examine associations between sleep duration and dietary outcomes (vegetables, fruits, 100% juice, juice drinks, soda, sugar-sweetened beverages and water), accounting for clustering by school. Models were adjusted for community, grade, race/ethnicity, gender, television in the bedroom, screen time, and physical activity. RESULTS In adjusted models, students who reported sleeping < 10 hours/day consumed soda more frequently (β = 0.11, 95% CI: 0.03, 0.20) and vegetables less frequently (β = -0.09, 95% CI: -0.18, -0.01) compared with students who reported ≥ 10 hours/day. No significant associations were observed between sleep duration and fruits, 100% juice, juice drinks or water. CONCLUSIONS In this population, insufficient sleep duration was associated with more frequent soda and less frequent vegetable consumption. Longitudinal research is needed to further examine these relationships.
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Affiliation(s)
- Rebecca L Franckle
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
| | - Jennifer Falbe
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA; Prevention Research Center, Harvard School of Public Health, Boston, MA, USA
| | - Claudia Ganter
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Elsie M Taveras
- Massachusetts General Hospital for Children, Boston, MA, USA
| | - Thomas Land
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Kirsten K Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
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Ganter C, Chuang E, Aftosmes-Tobio A, Blaine RE, Giannetti M, Land T, Davison KK. Community stakeholders' perceptions of barriers to childhood obesity prevention in low-income families, Massachusetts 2012-2013. Prev Chronic Dis 2015; 12:E42. [PMID: 25811497 PMCID: PMC4375987 DOI: 10.5888/pcd12.140371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction The etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social–ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM). Methods From 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized. Results Stakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors. Conclusion The congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity.
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Affiliation(s)
- Claudia Ganter
- Department of Nutrition, Harvard School of Public Health, Landmark Center, 401 Park Drive, 3rd floor East, Boston, MA 01225. . Ms. Ganter is also affiliated with the Technical University of Berlin, Department of Health Care Management, Berlin, Germany
| | - Emmeline Chuang
- University of California, Los Angeles, Los Angeles, California (Dr. Chuang was at University of California, San Diego, at the time this article was written)
| | | | | | - Mary Giannetti
- Montachusett Opportunity Council, Fitchburg, Massachusetts
| | - Thomas Land
- Massachusetts Department of Public Health, Boston, Massachusetts
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Davison KK, Falbe J, Taveras EM, Gortmaker S, Kulldorff M, Perkins M, Blaine RE, Franckle RL, Ganter C, Woo Baidal J, Kwass JA, Buszkiewicz J, Smith L, Land T. Evaluation overview for the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project. Child Obes 2015; 11:23-36. [PMID: 25575095 PMCID: PMC5915219 DOI: 10.1089/chi.2014.0059] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a 2-year, multilevel, multisector community intervention to prevent and control obesity among children 2-12 years of age from two predominantly low-income communities in Massachusetts. MA-CORD includes evidence-based interventions in multiple sectors, including community health centers, early care and education centers, schools, afterschool programs, the Special Supplemental Nutrition Program for Women, Infants and Children, and the broader community. Currently, implementation of MA-CORD is complete and the final year of data collection is in progress. Here, the MA-CORD evaluation plan is described and baseline data are presented. METHODS/DESIGN The impact of MA-CORD on children's BMI, lifestyle behaviors, obesity-related care, and quality of life will be assessed using sector-specific, pre/post, time-series, and quasi-experimental designs. Change in the primary outcomes will be compared for intervention and comparison communities. Additionally, change in mean BMI and obesity prevalence in intervention school districts will be compared to similar districts throughout the state. RESULTS At baseline in 2012, approximately 16% of preschool-aged and 25% of school-aged children were obese. Moreover, 15-40% of children consumed no vegetables on the previous day, 25-75% drank a sugar-sweetened beverage on the previous day, up to 87% had insufficient physical activity, 50-75% had a television in the room where they slept, and 50-80% obtained insufficient sleep. CONCLUSIONS There is ample room for improvement in BMI and health behaviors in children in MA-CORD communities. If successful, MA-CORD may serve as a model for multilevel, multisector approaches to childhood obesity prevention and control.
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Affiliation(s)
- Kirsten K. Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Steve Gortmaker
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Martin Kulldorff
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Rachel E. Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rebecca L. Franckle
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Claudia Ganter
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Jennifer Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - James Buszkiewicz
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Lauren Smith
- National Initiative for Children's Health Quality, Boston, MA
| | - Thomas Land
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
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Blanck HM, Collins JL. The Childhood Obesity Research Demonstration project: linking public health initiatives and primary care interventions community-wide to prevent and reduce childhood obesity. Child Obes 2015; 11:1-3. [PMID: 25679058 DOI: 10.1089/chi.2014.0122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Heidi M Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion , Centers for Disease Control and Prevention, Atlanta, GA
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O'Connor DP, Lee RE, Mehta P, Thompson D, Bhargava A, Carlson C, Kao D, Layne CS, Ledoux T, O'Connor T, Rifai H, Gulley L, Hallett AM, Kudia O, Joseph S, Modelska M, Ortega D, Parker N, Stevens A. Childhood Obesity Research Demonstration project: cross-site evaluation methods. Child Obes 2015; 11:92-103. [PMID: 25679060 PMCID: PMC4323026 DOI: 10.1089/chi.2014.0061] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The Childhood Obesity Research Demonstration (CORD) project links public health and primary care interventions in three projects described in detail in accompanying articles in this issue of Childhood Obesity. This article describes a comprehensive evaluation plan to determine the extent to which the CORD model is associated with changes in behavior, body weight, BMI, quality of life, and healthcare satisfaction in children 2-12 years of age. DESIGN/METHODS The CORD Evaluation Center (EC-CORD) will analyze the pooled data from three independent demonstration projects that each integrate public health and primary care childhood obesity interventions. An extensive set of common measures at the family, facility, and community levels were defined by consensus among the CORD projects and EC-CORD. Process evaluation will assess reach, dose delivered, and fidelity of intervention components. Impact evaluation will use a mixed linear models approach to account for heterogeneity among project-site populations and interventions. Sustainability evaluation will assess the potential for replicability, continuation of benefits beyond the funding period, institutionalization of the intervention activities, and community capacity to support ongoing program delivery. Finally, cost analyses will assess how much benefit can potentially be gained per dollar invested in programs based on the CORD model. CONCLUSIONS The keys to combining and analyzing data across multiple projects include the CORD model framework and common measures for the behavioral and health outcomes along with important covariates at the individual, setting, and community levels. The overall objective of the comprehensive evaluation will develop evidence-based recommendations for replicating and disseminating community-wide, integrated public health and primary care programs based on the CORD model.
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Affiliation(s)
- Daniel P. O'Connor
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Rebecca E. Lee
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Paras Mehta
- Department of Psychology, Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Alok Bhargava
- School of Public Policy, University of Maryland, College Park, MD
| | - Coleen Carlson
- Department of Psychology, Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX
| | - Dennis Kao
- Graduate College of Social Work, University of Houston, Houston, TX
| | - Charles S. Layne
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Tracey Ledoux
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Hanadi Rifai
- Department of Civil and Environmental Engineering, University of Houston, Houston, TX
| | - Lauren Gulley
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Allen M. Hallett
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Ousswa Kudia
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Sitara Joseph
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Maria Modelska
- Department of Civil and Environmental Engineering, University of Houston, Houston, TX
| | - Dana Ortega
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Nathan Parker
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Andria Stevens
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
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Foltz JL, Belay B, Dooyema CA, Williams N, Blanck HM. Childhood Obesity Research Demonstration (CORD): the cross-site overview and opportunities for interventions addressing obesity community-wide. Child Obes 2015; 11:4-10. [PMID: 25679059 PMCID: PMC4322789 DOI: 10.1089/chi.2014.0159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the first of a set of articles in this issue on the Childhood Obesity Research Demonstration (CORD) project and provides an overview of the multisite approach and community-wide interventions. Innovative multisetting, multilevel approaches that integrate primary healthcare and public health interventions to improve outcomes for children with obesity need to be evaluated. The CORD project aims to improve BMI and obesity-related behaviors among underserved 2- to 12-year-old children by utilizing these approaches. METHODS The CORD consortium, structure, model terminology and key components, and common measures were solidified in year 1 of the CORD project. Demonstration sites applied the CORD model across communities in years 2 and 3. Evaluation plans for year 4 include site-specific analyses as well as cross-site impact, process, and sustainability evaluations. RESULTS The CORD approach resulted in commonalities and differences in participant, intervention, comparison, and outcome elements across sites. Products are to include analytic results as well as cost assessment, lessons learned, tools, and materials. DISCUSSION Foreseen opportunities and challenges arise from the similarities and unique aspects across sites. Communities adapted interventions to fit their local context and build on strengths, but, in turn, this flexibility makes cross-site evaluation challenging. CONCLUSION The CORD project represents an evidence-based approach that integrates primary care and public health strategies and evaluates multisetting multilevel interventions, thus adding to the limited research in this field. CORD products will be disseminated to a variety of stakeholders to aid the understanding, prevention, and management of childhood obesity.
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Affiliation(s)
- Jennifer L. Foltz
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- U.S. Public Health Service Commissioned Corps, Atlanta, GA
| | - Brook Belay
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carrie A. Dooyema
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nancy Williams
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- U.S. Public Health Service Commissioned Corps, Atlanta, GA
| | - Heidi M. Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- U.S. Public Health Service Commissioned Corps, Atlanta, GA
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Chuang E, Ayala GX, Schmied E, Ganter C, Gittelsohn J, Davison KK. 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. Child Obes 2015; 11:48-57. [PMID: 25423618 PMCID: PMC4323117 DOI: 10.1089/chi.2014.0049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The long-term success of child obesity prevention and control efforts depends not only on the efficacy of the approaches selected, but also on the strategies through which they are implemented and sustained. This study introduces the Multilevel Implementation Framework (MIF), a conceptual model of factors affecting the implementation of multilevel, multisector interventions, and describes its application to the evaluation of two of three state sites (CA and MA) participating in the Childhood Obesity Research Demonstration (CORD) project. METHODS/DESIGN A convergent mixed-methods design is used to document intervention activities and identify determinants of implementation effectiveness at the CA-CORD and MA-CORD sites. Data will be collected from multiple sectors and at multiple levels of influence (e.g., delivery system, academic-community partnership, and coalition). Quantitative surveys will be administered to coalition members and staff in participating delivery systems. Qualitative, semistructured interviews will be conducted with project leaders and key informants at multiple levels (e.g., leaders and frontline staff) within each delivery system. Document analysis of project-related materials and in vivo observations of training sessions will occur on an ongoing basis. Specific constructs assessed will be informed by the MIF. Results will be shared with project leaders and key stakeholders for the purposes of improving processes and informing sustainability discussions and will be used to test and refine the MIF. CONCLUSIONS Study findings will contribute to knowledge about how to coordinate and implement change strategies within and across sectors in ways that effectively engage diverse stakeholders, minimize policy resistance, and maximize desired intervention outcomes.
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Affiliation(s)
- Emmeline Chuang
- Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
- Division of Health Promotion and Behavioral Sciences, San Diego State University Graduate School of Public Health, San Diego, CA
| | - Guadalupe X. Ayala
- Division of Health Promotion and Behavioral Sciences, San Diego State University Graduate School of Public Health, San Diego, CA
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA
| | - Emily Schmied
- Division of Health Promotion and Behavioral Sciences, San Diego State University Graduate School of Public Health, San Diego, CA
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA
- Department of Family and Preventive Medicine, University of California at San Diego School of Medicine, San Diego, CA
| | - Claudia Ganter
- Departments of Nutrition and of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Joel Gittelsohn
- Bloomberg School of Public Health and the Global Obesity Prevention Center, Johns Hopkins University, Baltimore, MD
| | - Kirsten K. Davison
- Departments of Nutrition and of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
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