The Massachusetts Childhood Obesity Research Demonstration Project, also known as Mass in Motion, is a statewide initiative aimed at promoting healthy lifestyles and preventing childhood obesity through a multilevel intervention strategy. Funded by the Affordable Care Act, the program focuses on combining healthcare interventions with community programs that target social and environmental factors affecting child health. Despite progress in improving community health and access to resources, the program does not adequately address economic barriers that limit healthy food access for low-income families.

1. PROGRAM ANALYSIS 2
PROGRAM ANALYSIS 8
Program Analysis
Sample Paper
Running head: PROGRAM ANALYSIS 1
PHE 525 Milestone Three: Program Analysis
Overview
The Massachusetts Childhood Obesity Research
Demonstration Project, known as Mass In Motion, is a state-
wide initiative to promote a healthy lifestyle in places where
people work, live and play. The initiative was funded by in
2011 by a grant through the Affordable Care Act with a goal to
create a multilevel and multisector intervention strategy to
prevent and control obesity, combining interventions in the
health care setting with public health interventions in the
community. (Davison et al., 2015)The project was designed to
be a comprehensive wellness initiative, incorporating evidence-
based interventions in primary healthcare with community
programs, WIC and other nutrition programs, as well as early
childhood education centers and schools/afterschool programs.
The goal was to form a partnership among the many different

2. social and environmental factors that effect a child’s health and
well-being, as well as to identify and target these factors to
institute a change in health behaviors. (MA-CORD Study
Group, 2015)
The program began as a part of a 2009 initiative started by
Governor Deval Patrick which funded projects in 14 cities and
towns across Massachusetts. In 2011 the state was awarded a
grant through the CDC which allowed the program to be
expanded to cover 52 Massachusetts cities and towns, impacting
33% of the state population, and as of 2014 there are 60 cities
and towns with active Mass in Motion projects. While the main
focus of the CORD component, funded by the CDC was on
children 2-12 year sold, the Mass In Motion program has also
developed programs for improving worksite health and overall
community health. These programs have increased workplace
productivity, lowered stress levels, encouraged weight loss, and
improved green space across the state. (Mass in Motion, 2016)
Theoretical Approach
The framework of Mass in Motion is the social ecological
model, a model which looks at the complex relationships
between an individual, his/her personal relationships,
community, institutional elements, community, and overall
social policy. This framework is not designed to distinguish one
factor as a reason or cause for the obesity, but rather looks at
the interaction of these factors and how they can effect
individual risk for obesity. The MA-CORD Study Group then
developed interventions based on Social Cognitive Theory,
recognizing and emphasizing the importance of social influence
and reinforcement for behavior change.
Figure 1. MA-CORD Intervention Sectors
As seen in Figure 1, the project is designed to combat childhood
obesity by impacting the individual and environmental factors
that can contribute to living a non-healthy lifestyle. At the
individual level, children and parents are both given

3. information and support to develop healthy habits while in the
school the child is also getting reinforcement through school-
based learning programs. Because the MA-CORD grant was
focused on improving childhood obesity, the Mass in Motion
program focused on institutional changes in early childhood
education centers, public schools, and after school programs.
However, worksite programs were funded by the state
legislature to work with employers across the state to improve
healthy lifestyle choices in adults. At the community level there
were initiatives to work with local restaurants to improve
healthy menu options, expand community garden space, and
improve parks and greenspace for healthy activity. The overall
funding and advocacy for the program, and its continued
expansions was done at the policy level of the social ecological
model.
Social and Behavioral Risks
Obesity is complex global epidemic and it is increasingly
effecting the health and livelihood of children. While there are
genetic components to obesity risk, there are many social and
behavioral risks that contribute to the epidemic. There are
individual risk factors including race/ethnicity, diet, and
activity level as well as social and economic factors like family
income level, and living environment. In order to decrease
current childhood obesity levels, and prevent obesity in future
generations, all of these contributing factors must be addressed.
Diet plays a significant role in a child’s risk for obesity. While
changes in diet seem like an easy way to prevent obesity, there
are multiple factors that contribute to a person’s diet. Parents
control the nutritional and physical environment for a child that
influence the health behaviors that will develop over the child’s
lifetime. In low-income families there is a higher rate of
obesity, this can often be attributed to less availability of
healthy foods as well as the higher cost of healthy foods.
(Sonneville, LaPelle, Taveras, Gilman, & Prosser, 2009)

4. Healthy foods are also more time consuming to prepare, and
many low income families are limited in time with difficult
work schedules and transportation issues. Fast food is often a
convenient and affordable option for low-income working
families, and the intense marketing campaigns by many fast
food companies contributes to the child’s desire to eat fast food.
The increasing sedentary lifestyle lives by most Americans also
contributes to the overall obesity crisis, and particularly to
childhood obesity. Many schools have reduced recess time and
physical education programs. Children in low-income homes are
less likely to participate in sports because of costs and often
these communities do not have safe outdoor spaces where
children can play. (Sonneville et al., 2009) The increase of
television, tablets, and computers has created the concern of
sedentary “screen time” activities and the impact they may have
on childhood obesity. The Harvard School of Public Health
(2016) found that the more TV a child watched, the more likely
they were to be overweight or obese and that in addition to
screen time contributing to weight by reducing physical activity
there is evidence that the food marketing on TV is having an
impact on diet. (HSPH, 2016)
The MA-CORD Mass in Motion project partnered with early
childhood and public schools to implement several national
programs including “I Am Moving, I am Learning”, “Eat Well,
Keep Moving”, and “Planet Health”. These are school-based
programs that give children the knowledge, skills, and support
to lead healthier lives, make healthy food choices, and be more
physically active. These programs have been implemented in
many early childhood centers and schools nationwide, and they
incorporate education with physical activity and nutrition
education which teach children that healthier choices are the
better choices. In early childhood centers, like Head Start, the
children participate in movement activities and teachers use
music and dance to help children get daily exercise. “Eat Well
and Keep Moving” and “Planet Health” elementary students
have physical and problem-solving activities to teach children

5. to make healthy food choices, reduce screen time, and increase
physical activity. Children spend a significant amount of time in
the school environment which makes this an idea place to
influence health behavior, in addition the programs are designed
to educate and include parents to help children reinforce healthy
behaviors at home.
Neglected Factors
While overall Mass in Motion, and the MA-CORD project, are
positive steps in the fight against childhood obesity, there are
some areas where the programs are lacking. There is no program
or initiative in either program to address the many economic
factors that impact a child’s health. In a 2009 focus group
(Sonneville et al., 2009), economic factors was one of the
biggest barriers to healthy eating. The Mass in Motion program
is adequately educating parents and children on the importance
of healthy choices, but it is not addressing the problem of a
parent not being able afford to buy a healthier cereal option or
fresh fruits and vegetables.
The Mass in Motion program also does not address problems
with food access. Many low income communities have low
access to healthy food options, often defined as “Food Deserts”
by the USDA. These areas often lack grocery stores or farmers
markets, and residents rely on convenience stores and fast-food
chains. This limits food choices to fast food, convenience foods
(frozen dinners/vegetables), or snack foods like chips and
candy. (Food Empowerment Project, n.d.) Parents and children
in Mass in Motion communities may be getting the education
they need about healthy food choices, but without access to
grocery stores that provide these foods there is little
opportunity to make change. While some Mass in Motion
communities have begun working with farmer’s markets to
create more health food access, this is not a complete solution
to the food access problem.
Overall Impact

6. Actual data on the outcomes of the MA-CORD program, as part
of Mass in Motion, will be released this summer, but the
Commonwealth of Massachusetts has released two reports for
2012 and 2013 highlighting different MIM projects and
successes. These outcomes include the improvement of healthy
menu options at 126 restaurants across 14 Massachusetts
communities. Improved school nutrition programs, including
partnerships with local farms to provide produce and allowing
children recess time before lunch so they can build up an
appetite and avoid eating in a rush. Since the adoption of the
program, Mass in Motion communities have expanded walking
in bike trails and implemented a safe routes program allowing
students to increase physical activity by walking or biking to
school. In many communities previously abandoned lots have
been changed into green spaces and parks, and community
garden space has been expanded to allow families to grow fresh
fruits and vegetables. (MHHS, 2015)
The general success of Mass in Motion, and programs using a
wide-scale community intervention approach show promise in
reducing childhood obesity. A 2005 study looking at school-
based program in Florida (HOPS/OWG) found that the programs
show positive outcomes in improving health and academic
achievement in low-income students. Children in these
programs had improvement in body mass and blood pressure, as
well as showing academic improvement in reading and math.
These programs were not as comprehensive an approach as Mass
in Motion, and were subject to some loss of value over the
summer when children were out of school. (Hollar et al., 2010)
Programs like Mass in Motion, and the other CORD projects,
show that a comprehensive childhood obesity strategy must use
a multisector approach, incorporating public policy, healthcare
centers and providers, community, legislative and financial
tools, and a range of settings where children and families can be
reached.
References

7. Davison, PhD, K. K., Falbe, ScD, MPH, J., Taveras, MD, MPH,
E. M., Gortmaker, SD, S., Kulldorff, PhD, M., Perkins, MPH,
M., ... Land, PhD, T. (2015). Evaluation Overview for the
Massachusetts Childhood Obesity Research Demonstration
(MA-CORD) Project. Childhood Obesity, 11.
http://dx.doi.org/10.1089
Food Empowerment Project. (n.d.).
http://www.foodispower.org/
Harvard School of Public Health. (2016). Television Watching
and “Sit Time”. Retrieved from
http://www.hsph.harvard.edu/obesity-prevention-source/obesity-
causes/television-and-sedentary-behavior-and-obesity/
Hollar, PhD, MHA, MS, D., Lombardo, DC, M., Lopez-Mitnik,
MS, MPhil, G., Hollar, PhD, T., Almon, MS, RD, M., Agatston,
MD, A., & Messiah, PhD, MPH, S. E. (2010). E!ective Multi-
level, Multi-sector, School-basedObesity Prevention
Programming Improves Weight,Blood Pressure, and Academic
Performance,Especially among Low-Income, Minority Children.
Journal of Health Care for the Poor and Underserved, 21, 93-
108. Retrieved from
https://www.researchgate.net/profile/T_Hollar/publication/4458
3434_Effective_Multi-level_Multi-sector_School-
based_Obesity_Prevention_Programming_Improves_Weight_Bl
ood_Pressure_and_Academic_Performance_Especially_among_
Low-
Income_Minority_Children/links/552554a30cf223aa5573f5e9.pd
f
MA-CORD Study Group. (2015, February). Design of the
Massachusetts Childhood Obesity Research Demonstration
(MA-CORD) Study. Childhood Obesity, 11.
http://dx.doi.org/10.1089
Mass in Motion. (2016).
http://www.mass.gov/eohhs/gov/departments/dph/programs/com
munity-health/mass-in-motion/
Mass in Motion Kids. (n.d.).
http://massinmotionnewbedford.org/mim-kids/mass-in-motion-

8. kidsabout-mim-kids/
Massachusetts Department of Health and Human Services.
(2015). Mass in Motion: Community Success Stories. Retrieved
from
http://www.mass.gov/eohhs/gov/departments/dph/programs/com
munity-health/mass-in-motion/community/stories/
Sonneville, K. R., LaPelle, N., Taveras, E., Gilman, M., &
Prosser, L. (2009, December 21). Economic and other barriers
to adopting recommendations to prevent childhood obesity:
results of a focus group study with parents. BMC Pediatrics.
http://dx.doi.org/10.1186/1471-2431-9-81