Dataset Information

Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children.

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.

SUBMITTER: Taveras EM

PROVIDER: S-EPMC5506684 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children.

Taveras Elsie M EM Perkins Meghan M Anand Shikha S Woo Baidal Jennifer A JA Nelson Candace C CC Kamdar Neil N Kwass Jo-Ann JA Gortmaker Steven L SL Barrett Jessica L JL Davison Kirsten K KK Land Thomas T

Obesity (Silver Spring, Md.) 20170701 7

<h4>Objective</h4>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]).<h4>Methods</h4>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 wer ...[more]

PMID: 28653504

Similar Datasets

Project description:IntroductionThe objective of this study was to identify predictors of severe obesity in a low-income, predominantly Hispanic/Latino sample of children in Texas.MethodsThis cross-sectional analysis examined baseline data on 517 children from the secondary prevention component of the Texas Childhood Obesity Research Demonstration (TX CORD) study; data were collected from September 2012 through February 2014. Self-administered surveys were used to collect data from parents of children who were aged 2 to 12 years, had a body mass index (BMI) in the 85th percentile or higher, and resided in Austin, Texas, or Houston, Texas. Multivariable logistic regression models adjusted for sociodemographic covariates were used to examine associations of children's early-life and maternal factors (large-for-gestational-age, exclusive breastfeeding for ≥4 months, maternal severe obesity [BMI ≥35.0 kg/m2]) and children's behavioral factors (fruit and vegetable consumption, physical activity, screen time) with severe obesity (BMI ≥120% of 95th percentile), by age group (2-5 y, 6-8 y, and 9-12 y).ResultsAcross all ages, 184 (35.6%) children had severe obesity. Among children aged 9 to 12 years, large-for-gestational-age at birth (odds ratio [OR] = 2.31; 95% confidence interval [CI], 1.13-4.73) was significantly associated with severe obesity. Maternal severe obesity was significantly associated with severe obesity among children aged 2 to 5 years (OR = 2.67; 95% CI, 1.10-6.47) and 9 to 12 years (OR = 4.12; 95% CI, 1.84-9.23). No significant association was observed between behavioral factors and severe obesity in any age group.ConclusionIn this low-income, predominantly Hispanic/Latino sample of children, large-for-gestational-age and maternal severe obesity were risk factors for severe obesity among children in certain age groups. Promoting healthy lifestyle practices during preconception and prenatal periods could be an important intervention strategy for addressing childhood obesity.

Project description:BACKGROUND:The recruitment of participants into community-based randomized controlled trials studying childhood obesity is often challenging, especially from low-income racial/ethnical minorities and when long-term participant commitments are required. This paper describes strategies used to recruit and enroll predominately low-income racial/ethnic minority parents and children into the Childhood Obesity Prevention and Treatment Research (COPTR) consortium. METHODS:The COPTR consortium has run four independent 3-year, multi-level (individual, family, school, clinic, and community) community-based randomized controlled trials. Two were prevention trials in preschool children and the other two were treatment trials in pre-adolescents and adolescent youth. All trials reported monthly participant recruitment numbers using a standardized method over the projected 18-24?months of recruitment. After randomization of participants was completed, recruitment staff and investigators from each trial retrospectively completed a survey of recruitment strategies and their perceived top three recruitment strategies and barriers. RESULTS:Recruitment was completed in 15-21?months across trials, enrolling a total of 1745 parent-child dyads- out of 6314 screened. The number of children screened per randomized child was 4.6 and 3.5 in the two prevention trials, and 3.1 and 2.5 in the two treatment trials. Recruitment strategies reported included: (1) careful planning, (2) working with trusting community partners, (3) hiring recruitment staff who were culturally sensitive, personality appropriate, and willing to work flexible hours, (4) contacting potential participants actively and repeatedly, (5) recruiting at times and locations convenient for participants, (6) providing incentives to participants to complete baseline measures, (7) using a tracking database, (8) evaluating whether participants understand the activities and expectations of the study, and (9) assessing participants' motivation for participating. Working with community partners, hiring culturally sensitive staff, and contacting potential participants repeatedly were cited by two trials among their top three strategies. The requirement of a 3-year commitment to the trial was cited by two trials to be among the top three recruitment barriers. CONCLUSIONS:Comprehensive strategies that include community partnership support, culturally sensitive recruitment staff, and repeated contacts with potential participants can result in successful recruitment of low-income racial/ethnic minority families into obesity prevention and treatment trials. TRIAL REGISTRATION:NET-Works trial: ClinicalTrials.gov, NCT01606891 . Registered on 28 May 2012. GROW trial: ClinicalTrials.gov, NCT01316653 . Registered on 16 March 2011. GOALS trial: ClinicalTrials.gov, NCT01642836 . Registered on 17 July 2012. IMPACT trial: ClinicalTrials.gov, NCT01514279 . Registered on 23 January 2012.

Project description:Background: Several studies have found that children in the United States gain weight at a faster rate in the summer than in the school year, but little is known about the prevalence of this problem, its effect on high-risk subgroups, or its determinants. This study compares school year and summer weight change in a low-income, ethnically diverse sample of school-age children in Massachusetts and explores differences by race/ethnicity, weight status, and exposure to school year physical activity (PA) programming. Diet and PA are examined as potential mediators of summer weight gain. Methods: Children participating in a school-based PA program evaluation (in which weight change was not a primary outcome) had their height and weight measured three times between October 2015 and September 2016 to capture a school year and summer interval. Diet and PA patterns were assessed mid-school year and mid-summer in a subsample of children. Mixed linear models were used to estimate the effect of season (school year vs. summer) on change in BMI and to examine the influence of race/ethnicity, weight status, and program (walk/run, classroom activity breaks, or control) on any observed effects. Structural equation models were used to explore diet and PA as mediators of seasonal weight change in a subsample of participants. Results: Of 769 participants, 53% were non-Caucasian, 40% were overweight or obese, and 58% were eligible for free or reduced-price school meals. BMI increased in both the school year and summer but increased more rapidly in the summer (0.046?kg/m2 more per month, p?=?0.007). Of the three tested interactions, statistical significance was only observed between season and program (?2?=?14.90, p?<?0.001); on average, children exposed to a school year walk/run program did not gain weight more rapidly during the summer, whereas children in the control group and a classroom activity breaks program did. Poorer diet and PA patterns were observed in the summer, but neither diet nor PA was statistically significant mediators of BMI change. Conclusions: Children in this high-risk sample gained weight at a faster rate during the summer than during the school year, with no discernable demographic differences. However, this phenomenon was not observed in the subgroup exposed to a school year walk/run program. More research is needed to clarify the determinants of summer weight gain and understand how school year programming and its effects can be transferred to the summer months.

Dataset Information

Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children.

Objective

Methods

Results

Conclusions

Publications

Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure