Childhood Obesity Research Demonstration (CORD)

Study Specifics

Lead/funding agency:

Centers for Disease Control and Prevention

Co-funders:

U.S. Department Health and Human Services (DHHS), Centers for Disease Control and Prevention (CDC). Administered by the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Nutrition, Physical Activity, and Obesity (DNPAO).

Scientific partners:

N/A

Contract/grant number:

RFA-DP-11-007

Link to FOA (Funding Opportunity Announcement):

http://www.grants.gov/web/grants/view-opportunity.html?oppId=65553

Project website:

http://www.cdc.gov/obesity/childhood/researchproject.html

Last updated:

June 2015

Project Timeline

Contract award date:

September 2011

Projected completion:

Summer 2016

Data collection window:

N/A

Abstract

The CORD project builds on existing community efforts that focus on improving children’s nutrition and physical activity in the places where they live, learn, and play. The aim of the project is to determine if a model of evidence-based primary care and community public health strategies supports improvements in children’s healthy eating and active living and improvements in childhood obesity.

The project targets communities with children aged 2-12 years covered by the Children’s Health Insurance Program (CHIP), which provides low- cost health insurance to more than 7 million children from working families. Rates of childhood obesity are high overall but for many minority and low-income children, they are even higher. Using both community and clinic approaches to reach low-income and minority families to tackle childhood obesity may help reduce disease risk factors and reduce the odds of developing adult obesity and its related diseases.

CORD was awarded on September 30, 2011, to demonstration sites in Texas, Massachusetts, and California, and an evaluation center in Houston, Texas. The research goal of CORD is to determine whether an intervention model that integrates activities in health care settings with broader public health interventions in schools, early care and education (ECE) centers, and the community at large can improve children’s dietary and physical activity behaviors and ultimately reduce obesity in low-income children.

CORD promotes the following behavioral changes: increase physical activity, reduce television and screen time viewing, increase fruit and vegetable intake, increase intake of water, decrease energy dense food and sugary drink consumption, obtain adequate amounts of sleep, and improve parenting skills. CORD also seeks to improve use of preventive health care services, such as obesity-related screening and counseling to improve child quality of life.

Research Design & Aims

Research design:

Quasi-experimental

Sites/target populations:

Sites

• Texas—One intervention and one control catchment in the cities of Houston and Austin. (Please note: Because Houston and Austin are very large urban areas, each city has their own intervention and control catchment)
• California—Two intervention communities and one control community
• Massachusetts—Two intervention communities and one control community

Target populations

Children aged 2-12 years who are eligible for Medicaid or Children’s Health Insurance Program (CHIP) programs or who live in low-income areas where ≥50% of students are eligible for the U.S. Department of Agriculture (USDA) National School Lunch Program.

Actual or expected sample sizes for each level of respondent.

Interventions take place in multiple settings:

• Intervention communities n = 6, control communities n = 4.
• Approximately 75 schools total across the three sites.
• Approximately 48 ECEs total across the three sites.
• Approximately 15 clinics total across the three sites.

Each site will also enroll a cohort of children and follow them for range of 1-2 years (anticipated enrollment; varies by site)

• Cohort TX n = ~580
• Cohort CA n = ~1200
• Cohort MA n = ~1200

Aims:

The research goal of CORD is to determine whether an intervention model that integrates activities in health care settings with broader public health interventions in schools, early care and education (ECE) centers, and the community at large can improve children’s dietary and physical activity behaviors and ultimately reduce obesity in low-income children.

Intervention description if applicable:

This project fills in the existing research gap by evaluating a multi-setting, multi-level approach to prevent and control childhood obesity. Multi-setting means that grantees were required to incorporate multiple settings including the home, school, ECE, health care, and community settings in their interventions. Multi-level means that interventions must be aimed at both individuals and factors external to individuals such as the environments and systems where children spend time. Community health workers will serve to help link children and families to resources in the community, including affordable healthy food venues and low-cost physical activity opportunities, and obesity prevention efforts in multiple settings, or both.

Both individual- and cross-site evaluations are planned. Specifically a rigorous evaluation of the entire CORD project, including process, outcome, sustainability, and cost evaluations will be performed. This cross-site evaluation will attempt to bridge individual designs and research questions from the three demonstration grantees into one overarching, cross-site evaluation.

Logic Models

Data Collection Approach

Data collection:

Formation of common sociodemographic and behavioral outcomes

There are two approaches for data collection. First, individual principal investigators in each of the three demonstration sites will use validated survey instruments and data collection tools of their choice to collect data relevant to their specific project. Second, all sites will use a set of common individual child measures that were developed from validated instruments and standardized for parent report on child or child self-report. Measures include the following: child’s behavioral outcomes (e.g., fruit and vegetable intake, physical activity, screen time, sugary drink consumption, water consumption, sleep); parent reported sociodemographic questions (e.g., age, sex, race/ethnicity); and quality of life for the child, satisfaction with care, and parenting-style questions. In addition height, weight, and body mass index will be measured. These common measures, developed through consensus, will form the basis of the overall evaluation of the project. The use of common measures will allow CORD to compare child outcomes across the three sites.

Common data collection tools used in each setting

Common tools are used to assess early care and education (ECE) centers, health care centers, schools, and aspects of the community:

• ECE setting: Each site will use the Nutrition and Physical Self Assessment for Child Care (NAP SACC) tool and select questions from instruments from the University of Connecticut Rudd Center for Food Policy and Obesity including the Child Care Director Survey and Interview (to assess ECEs participating in the CORD project).
• Health care setting: A survey was developed specifically for CORD that includes questions on the diet and physical activity environments of health care centers and policies and practices of staff regarding the prevention and treatment of childhood obesity. The survey elements have been tested by CDC and other groups.
• Schools: Each demonstration site will use their own school assessment tool drawing from existing school assessment tools, but common elements were required.
• Community setting: The Wilder Collaboration Factors Inventory is being used to assess community coalition presence and strength at baseline and post intervention. A common tool on local jurisdiction environmental and policy supports related to healthy eating and active living in the community developed by CDC is being used. GIS and census data from  the Amherst H. Wilder Foundation will also be used.

Resources

Questionnaires/surveys:

Common measures available upon request

See paper by O’Connor et al. (2015) for more information on CORD evaluation

Publication information:

Several publications about CORD exist including:

CORD overview paper written in 2013 and published in the journal Childhood Obesity:
Click here to read.

CORD special supplement written in February 2015. This special supplement featured nine baseline CORD articles and was published in the journal Childhood Obesity:
Click here to read.