13.15: Case Study 2- Our Choice/Nuestra Opción- The Imperial County, California, Childhood Obesity Research Demonstration Study (CA-CORD)
A CDC funded program focusing on addressing childhood obesity in Southern California took a similar approach to address multiple drivers of health at the same time. In Imperial County, a community along the border of California and Mexico, the population is predominantly of Mexican origin. Communities are somewhat rural and surrounded by agricultural land, and poverty rates are higher than the national average. One significant health disparity exists there as well: childhood obesity rates in these communities are higher than the state and national average, something that this study aimed to change.
Using various theories of behavioral change, models of organizational change, and family systems theory to inform this project, the researchers took a multi-sector approach: involving pediatricians, community health workers, school teachers, restaurant owners, and families. The program included a healthcare approach for overweight and obese children and their families at federally funded healthcare clinics. Family workshops with trained Community Health Workers (CHWs), included education on healthy eating and physical activity. The CHWs also followed up with motivational interviewing phone calls to parents, and newsletters were sent to the families to encourage them in continuing healthy behaviors. Since local elementary schools didn’t have specialized Physical Education teachers, current staff attended training sessions and received new PE equipment to use, both sponsored by the project. A few local restaurants worked with the program to develop healthy kid’s menus. Additionally, the project funded community and school gardens to help families learn more about backyard gardening for fresh produce (Ayala et al., 2015, Renner, 2014).
While projects like these are time consuming and require the buy-in and contributions of many people, they can be instrumental in causing lasting changes in communities by addressing multiple social determinants of health at once. Ultimately, no single policy or program is likely to cause significant improvements to the social determinants of health alone. Using the social-ecological model (and other theories) can help public health practitioners design effective, meaningful programs that initiate positive changes for individuals, families, communities, and eventually - whole populations.