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Rabbani B, Chiti H, Sharifi F, Mazloomzadeh S. Effect of lifestyle modification for two years on obesity and metabolic syndrome components in elementary students: A community- based trial. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:555-566. [PMID: 35974937 PMCID: PMC9348219 DOI: 10.22088/cjim.13.3.555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/04/2021] [Accepted: 08/28/2021] [Indexed: 11/03/2022]
Abstract
Background Lifestyle modifications, especially improving nutritional patterns and increasing physical activity are the most important factors in preventing obesity and metabolic syndrome in children and adolescents. For this purpose, the following interventional study was designed to investigate the effects of educational programs for students, as well as the changes in diet and physical activity on obesity and components of the metabolic syndrome. Methods This study is part of an interventional research project (elementary school) conducted on all students of Sama schools in Zanjan and Abhar in three levels;elementary, middle and high school, including 1000 individuals in Zanjan (intervention group) and 1000 individuals (control group) in Abhar in 2011. Interventions were based on educating students, teachers and parents, changes in food services and physical activity. We primarily measured anthropometric indices, fasting blood sugar, lipid profiles and blood pressure and completed standard nutrition and physical activity questionnaires. Also, blood insulin levels were randomly measured in a number of students. Data analysis was done by SPSS software Version 16.0. Results Overall, 589 individuals (252 males, 337 females) entered the case group and 803 individuals (344 males, 459 females) entered the control group. After two years of intervention, the mean waist circumference (63.8±10.9) and diastolic BP (63.8±10.4) were significantly lower, however, the mean systolic BP (10.1.0±12.5), food score (25.0±5.0) and drinking score (12.1±2.3) were higher in the intervention group (p<0.001). Comparing the components of metabolic syndrome between the second year and at the time of recruitment within the intervention group, showed that although the number of overweight/obese individuals, individuals with hypertriglyceridemia and high LDL increased, while those with abdominal obesity, high BP, hyperglycemia, and insulin resistance decreased (p<0.001). On the other hand, in the control group, the number of individuals with high BP increased significantly. Conclusion The prevalence of abdominal obesity and hypertension, which are the two major components of metabolic syndrome, are much higher in our study than the other regions of the country. However, interventions for modification of diet and increasing physical activity, are effective in lowering of their prevalence.
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Affiliation(s)
- Bita Rabbani
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Chiti
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran,Correspondence: Hossein Chiti, Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran. E-mail: , Tel: 0098 2433420651, Fax: 0098 2433420651
| | - Faranak Sharifi
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Saeedeh Mazloomzadeh
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
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2
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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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Hardin HK, Moore SM, Moore SE, Uli NK. Associations between Trust of Healthcare Provider and Body Mass Index in Adolescents. Compr Child Adolesc Nurs 2020:1-12. [PMID: 32574088 PMCID: PMC7755707 DOI: 10.1080/24694193.2020.1783028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Abstract
Adolescent obesity continues to be a serious concern around the world, placing young people at risk for chronic conditions and early death. Research has shown that social relationships are important in making health behavior changes, such as following health-care recommendations for eating and physical activity. Specifically, the trust of health-care providers has been shown to be important in making health behavior change. Evidence suggests that obese young adults are less trusting of health-care providers than their healthy weight peers, but it is not known if this also applies to obese adolescents. The purpose of this secondary analysis study was to determine relationships between the trust of health-care providers and body mass index percentile in adolescents. Participants were 224 adolescents aged 14-19 years attending a public high school in the Midwestern United States. The Wake Forest Physician Trust scale measured the trust of health-care providers. Height and weight were collected at a school screening; body mass index percentile categories were determined according to age- and sex-adjusted body mass index percentiles. One-way analysis of variance and post hoc Tukey tests showed trust scores varied significantly between body mass index percentile categories of girls. Results suggest it may be necessary for health-care providers to make additional efforts to build trust with obese adolescent girls than with other groups of adolescents.
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Affiliation(s)
- Heather K Hardin
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Scott E Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Naveen K Uli
- School of Medicine, Case Western Reserve University
- Director of Pediatric Endocrinology, Rainbow Babies and Children's Hospital, Cleveland Medical Center, Cleveland, OH, USA
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4
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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] [Grants] [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.
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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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Ruggiero CF, Poirier L, Trude ACB, Yang T, Schwendler T, Gunen B, Loh IH, Perepezko K, Nam CS, Sato P, Gittelsohn J. Implementation of B'More Healthy Communities for Kids: process evaluation of a multi-level, multi-component obesity prevention intervention. HEALTH EDUCATION RESEARCH 2018; 33:458-472. [PMID: 30202959 PMCID: PMC6293311 DOI: 10.1093/her/cyy031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/31/2018] [Accepted: 08/16/2018] [Indexed: 05/10/2023]
Abstract
B'More Healthy Communities for Kids was a multi-level, multi-component obesity prevention intervention to improve access, demand and consumption of healthier foods and beverages in 28 low-income neighborhoods in Baltimore City, MD. Process evaluation assesses the implementation of an intervention and monitor progress. To the best of our knowledge, little detailed process data from multi-level obesity prevention trials have been published. Implementation of each intervention component (wholesaler, recreation center, carryout restaurant, corner store, policy and social media/text messaging) was classified as high, medium or low according to set standards. The wholesaler component achieved high implementation for reach, dose delivered and fidelity. Recreation center and carryout restaurant components achieved medium reach, dose delivered and fidelity. Corner stores achieved medium reach and dose delivered and high fidelity. The policy component achieved high reach and medium dose delivered and fidelity. Social media/text messaging achieved medium reach and high dose delivered and fidelity. Overall, study reach and dose delivered achieved a high implementation level, whereas fidelity achieved a medium level. Varying levels of implementation may have balanced the performance of an intervention component for each process evaluation construct. This detailed process evaluation of the B'More Healthy Communities for Kids allowed the assessment of implementation successes, failures and challenges of each intervention component.
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Affiliation(s)
- C F Ruggiero
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Poirier
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A C B Trude
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Yang
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - T Schwendler
- Peace Corps, Serekunda, The Gambia, Washington, DC, USA
| | - B Gunen
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - I H Loh
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K Perepezko
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - C S Nam
- Joint Learning Initiative on Faith and Local Communities, Washington, DC, USA
| | - P Sato
- University of S�o Paulo, S�o Paulo, SP, Brazil
| | - J Gittelsohn
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Robbins LB, Ling J, Clevenger K, Voskuil VR, Wasilevich E, Kerver JM, Kaciroti N, Pfeiffer KA. A School- and Home-Based Intervention to Improve Adolescents' Physical Activity and Healthy Eating: A Pilot Study. J Sch Nurs 2018; 36:121-134. [PMID: 30068245 DOI: 10.1177/1059840518791290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study evaluated feasibility, acceptability, and preliminary efficacy of a 12-week Guys/Girls Opt for Activities for Life (GOAL) intervention on 10- to 13-year-old adolescents' body mass index (BMI), percent body fat, physical activity (PA), diet quality, and psychosocial perceptions related to PA and healthy eating. Parent-adolescent dyads from two schools were enrolled. Schools were assigned to either GOAL (38 dyads) or control (43 dyads) condition. The intervention included an after-school club for adolescents 2 days/week, parent-adolescent dyad meeting, and parent Facebook group. Intervention adolescents had greater autonomous motivation for PA and self-efficacy for healthy eating than control adolescents (both p < .05). Although between-group differences were not significant, close-to-moderate effect sizes resulted for accelerometer-measured moderate-to-vigorous PA and diet quality measured via 24-hr dietary recall (d = .46 and .44, respectively). A trivial effect size occurred for percent body fat (d = -.10). No differences emerged for BMI. Efficacy testing with a larger sample may be warranted.
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Affiliation(s)
| | - Jiying Ling
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Kimberly Clevenger
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | | | | | - Jean M Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.,Department of Biostatistics, Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Karin A Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
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7
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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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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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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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10
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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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11
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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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