Background: Childhood obesity is highly prevalent, is associated with both short-and long-term adverse outcomes, disproportionately affects racial/ethnic minority and economically deprived children, and represents a major threat to public health. Among the most promising approaches for its prevention and management are multilevel, multisector strategies.Methods/Design: The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study was a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2-12 years in two selected cities in Massachusetts. Building on the Obesity Chronic Care Model, MA-CORD expanded a state public health department communitylevel obesity prevention initiative that incorporated evidence-based interventions in primary healthcare, the Women, Infants, and Children program, early care and education, schools/afterschool programs, as well as community-wide programs to improve food, beverage, physical activity (PA), and messaging environments. The study used a combination of pre-and post-time series and quasiexperimental designs to examine the extent to which the intervention resulted in changes in BMI, individual-level lifestyle behaviors, satisfaction with healthcare services, and quality of life among children, as well as changes in health policies, programs, and environments in the two intervention cities, compared to a comparison city. The intervention period was 2 years.Conclusions: MA-CORD will determine the extent to which a multisetting, multilevel intervention that integrates activities in primary care with broader public health interventions in schools, early care and education, and the community at large can improve children's dietary and PA behaviors and ultimately reduce obesity in low-income children.

Objective To examine the extent to which a WIC intervention improved BMI z-scores and obesity-related behaviors among children age 2–4 years. Methods In two Massachusetts communities, we implemented practice-changes in WIC as part of the MA-CORD initiative to prevent obesity among low-income children. One WIC program was the comparison. We assessed changes in BMI z-scores pre- and post-intervention and prevalence of obesity-related behaviors of WIC participants. We used linear mixed models to examine BMI z-score change and logistic regression models to examine changes in obesity-related behaviors in each intervention site versus comparison over two years. Results WIC-enrolled children in both intervention sites (v. Comparison) had improved sugar-sweetened beverage consumption and sleep duration. Compared to the comparison WIC program (n=626), we did not observe differences in BMI z-score among children in Intervention site #1 (n= 198) or #2 (n=637). In sensitivity analyses excluding Asian children, we observed a small decline in BMI z-score (−0.08 units/year [95% CI: −0.14 to −0.02], p=0.01) in Intervention Site #2 v. 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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OBJECTIVES: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income women (pregnant and postpartum) and children up to 5 years of age in the United States. However, participation is suboptimal. We explored reasons for incomplete redemption of benefits and early dropout from WIC. METHODS: In 2020–2021, we conducted semistructured interviews to explore factors that influenced WIC program utilization among current WIC caregivers (n = 20) and caregivers choosing to leave while still eligible (n = 17) in Massachusetts. By using a deductive analytic approach, we developed a codebook grounded in the Consolidated Framework for Implementation Research. RESULTS: Themes across both current and early-leaving participants included positive feelings about social support from the WIC clinic staff and savings offered through the food package. Participants described reduced satisfaction related to insufficient funds for fruits and vegetables, food benefits inflexibility, concerns about in-clinic health tests, and in-store item mislabeling. Participants described how electronic benefit transfer cards and smartphone apps eased the use of benefits and reduced stigma during shopping. Some participants attributed leaving early to a belief that they were taking benefits from others. CONCLUSIONS: Current and early-leaving participants shared positive WIC experiences, but barriers to full participation exist. Food package modification may lead to improved redemption and retention, including increasing the cash value benefit for fruits and vegetables and diversifying food options. Research is needed regarding the misperception that participation means “taking” benefits away from someone else in need.

The project demonstrated how cross-sector, coordinated efforts focused on vulnerable populations can leverage local strengths to establish/enhance breastfeeding support services customized to local needs.