Integrating Primary Care and Public Health Approaches Outcomes

Integrating Primary Care and Public Health Approaches: Outcomes of the TX CORD Deanna Hoelscher, Ph. D, RD, LD Project Michael & Susan Dell Center for Healthy Living University of Texas School of Public Health Southern Obesity Summit, November 14, 2016 Deanna. M. Hoelscher@uth. tmc. edu | 512. 391. 2510 @deannahoelscher

TX CORD Study Design Hoelscher et al. , 2015

Primary Prevention versus Secondary Prevention Primary Prevention Secondary Prevention • Efforts targeting the entire • Efforts focus on overweight population 1 and obese children • Healthy weight as well as • Prevent disease overweight/obese progression and children development of co • Prevention of child morbidities obesity • More intensive programs 2 • Environmental and • SCT programmatic 1 changes Hoelscher et al. , 2013; 2 Whitlock et al. , 2010 • SCT, SEM, MI

AUSTIN, TX. HOUSTON, TX. TX CORD CATCHMENT AREAS Index was based on (1) % African American/black, (2) % Hispanic, (3) % >25 yr with <12 th grade education, (4) % < 185% poverty, families with <18 yr olds; (5) % house <100 K, with a range of 5 -25 Oluyomi et al. , 2015

Secondary Prevention Within Primary Prevention areas RCT begins at Provider (Next Steps) n = 576 (288 Intervention, 288 Comparison) Source: Sacher et al. , 2010; Kelder et al. , 2005; Evans et al. , 2012; Ranjit et al. , under review

Primary Outcome: %95 th BMI ** ** ** * Arm-by-time (3 month vs baseline) interaction, (p<0. 05) ** Time effect (p<0. 05)

Results – Intervention Dosage NEXT STEPS* MEND/CATCH** 2 -5 y 6 -8 y 9 -12 y Dosage (#sessions) 0. 2 ± 0. 4 4 ± 3 10 ± 6 8 ± 5 Dosage (%) 8 ± 21 11 ± 21 9 ± 21 *Maximum sessions offered in NEXT STEPS = 2 46 ± 34 58 ± 33 47 ± 30 **Maximum sessions offered in MEND/CATCH 2 -5 y = 9 MEND/CATCH 6 -8, 9 -12 y = 18

Conclusions • Summary of results – A total of 549 families with overweight or obese children, 2 -12 y, randomized into MEND/CATCH or NEXT STEPS – Low income families, predominately Hispanic and Black – 78% retention at 3 months – Significant intervention effects MEND/CATCH relative to NEXT STEPS at 3 months: – BMI z-score for 6 - 8 y, and 9 -12 y – Waist and waist: height for 9 -12 y – Fat mass for 9 -12 y – Diastolic blood pressure for 9 -12 y • Secondary Prevention Programs can decrease BMI with elementary school children (ages 6 -8 and perhaps 9 -12) – Effects are greater with greater dose • Combining Primary and Secondary Prevention Efforts is challenging in a large urban setting

TX CORD Acknowledgements • Texas Center for the Prevention and Treatment of Childhood Obesity This research was supported by cooperative agreement RFA-DP-11 -007 from the Centers for Disease Control and Prevention. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention. Additional support was provided by the Michael and Susan Dell Center for Healthy Living. This work is a publication of the United States Department of Agriculture (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and had been funded in part with federal funds from the USDA/ARS under Cooperative Agreement No. 58 -6250 -0 -008. The contents of this publication do not necessarily reflect the views or policies of the USDA, nor does mention of trade names, commercial products, or organizations imply endorsement from the U. S. government. Investigators: Nancy Butte (Co-PI), Sarah Barlow, Steve Kelder, Elizabeth Vandewater, Shreela Sharma, Courtney Byrd-Williams, Casey Durand, Abiodun Oluyomi, Brett Spenser, Cari Browning, Paul Sacher, Terry Huang, Stephen Pont, Eric Finkelstein