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McGowan LJ, John DA, Kenny RPW, Joyes EC, Adams EA, Shabaninejad H, Richmond C, Beyer FR, Landes D, Watt RG, Sniehotta FF, Paisi M, Bambra C, Craig D, Kaner E, Ramsay SE. Improving oral health and related health behaviours (substance use, smoking, diet) in people with severe and multiple disadvantage: A systematic review of effectiveness and cost-effectiveness of interventions. PLoS One 2024; 19:e0298885. [PMID: 38635524 PMCID: PMC11025870 DOI: 10.1371/journal.pone.0298885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/31/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND People experiencing homelessness co-occurring with substance use or offending ('severe and multiple disadvantage' SMD) often have high levels of poor oral health and related health behaviours (particularly, substance use, smoking, poor diet). This systematic review aimed to assess the effectiveness and cost-effectiveness of interventions in adults experiencing SMD to improve oral health and related health behaviours. METHODS AND FINDINGS From inception to February 2023, five bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus) and grey literature were searched. Two researchers independently screened the search results. Randomized controlled trials (RCTs), comparative studies and economic evaluations were included that reported outcomes on oral health and the related health behaviours. Risk of bias was assessed and results narratively synthesized. Meta-analyses were performed where appropriate. This review was registered with PROSPERO (reg. no: CRD42020202416). Thirty-eight studies were included (published between 1991 and 2023) with 34 studies reporting about effectiveness. Most studies reported on substance use (n = 30). Interventions with a combination of housing support with substance use and mental health support such as contingent work therapy appeared to show some reduction in substance use in SMD groups. However, meta-analyses showed no statistically significant results. Most studies had short periods of follow-up and high attrition rates. Only one study reported on oral health; none reported on diet. Three RCTs reported on smoking, of which one comprising nicotine replacement with contingency management showed improved smoking abstinence at 4 weeks compared to control. Five studies with economic evaluations provided some evidence that interventions such as Housing First and enhanced support could be cost-effective in reducing substance use. CONCLUSION This review found that services such as housing combined with other healthcare services could be effective in improving health behaviours, particularly substance use, among SMD groups. Gaps in evidence also remain on oral health improvement, smoking, and diet. High quality studies on effectiveness with adequate power and retention are needed to address these significant health challenges in SMD populations.
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Affiliation(s)
- Laura J. McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Deepti A. John
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ryan P. W. Kenny
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emma C. Joyes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emma A. Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hosein Shabaninejad
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona R. Beyer
- Evidence Synthesis Group and Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - David Landes
- NHS England & Improvement, Newcastle Upon Tyne, United Kingdom
| | - Richard G. Watt
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Falko F. Sniehotta
- NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Public Health, Social and Preventive Medicine, Centre for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martha Paisi
- Faculty of Medicine and Dentistry, Peninsula Dental School, University of Plymouth, Plymouth, United Kingdom
| | - Claire Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Hoebel J, Waldhauer J, Blume M, Schienkiewitz A. Socioeconomic Status, Overweight, and Obesity in Childhood and Adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:839-845. [PMID: 36345700 PMCID: PMC9981977 DOI: 10.3238/arztebl.m2022.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/06/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Overweight and obesity in early life increase the risk of chronic disease and ill health later on. We studied secular trends in the prevalence of overweight and obesity among young people in Germany, with consideration of socioeconomic status (SES). METHODS We used repeated cross-sectional data from 3- to 17-year-olds from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Overweight and obesity were defined according to the body mass index, based on measured height and weight from the KiGGS baseline survey (2003-2006) and the KiGGS second wave (2014-2017). SES was assessed with a composite index of parental education, occupation, and income. RESULTS In both study periods, the prevalence of overweight and obesity was highest among girls and boys from families of low SES. In the group with lowest SES, the prevalence of overweight rose from 20.0% in 2003-2006 (95% CI [18.0; 22.1]) to 25.5% [20.5; 31.2] in 2014-2017 (p = 0.043). Thus, social differences in the prevalence of overweight increased over time. No such trend was found for the prevalence of obesity. CONCLUSION Social differences in the prevalence of overweight among children and adolescents increased from the early 2000s to the mid-2010s. Structural measures are needed to help prevent overweight among young people in socially disadvantaged circumstances.
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Affiliation(s)
- Jens Hoebel
- Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin,*Fachgebiet Soziale Determinanten der Gesundheit Abteilung für Epidemiologie und Gesundheitsmonitoring Robert Koch-Institut General-Pape-Str. 62–66, 12101 Berlin, Germany
| | - Julia Waldhauer
- Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin
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3
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Tufford AR, Diou C, Lucassen DA, Ioakimidis I, O'Malley G, Alagialoglou L, Charmandari E, Doyle G, Filis K, Kassari P, Kechadi T, Kilintzis V, Kok E, Lekka I, Maglaveras N, Pagkalos I, Papapanagiotou V, Sarafis I, Shahid A, van ’t Veer P, Delopoulos A, Mars M. Toward Systems Models for Obesity Prevention: A Big Role for Big Data. Curr Dev Nutr 2022; 6:nzac123. [PMID: 36157849 PMCID: PMC9492244 DOI: 10.1093/cdn/nzac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/24/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
The relation among the various causal factors of obesity is not well understood, and there remains a lack of viable data to advance integrated, systems models of its etiology. The collection of big data has begun to allow the exploration of causal associations between behavior, built environment, and obesity-relevant health outcomes. Here, the traditional epidemiologic and emerging big data approaches used in obesity research are compared, describing the research questions, needs, and outcomes of 3 broad research domains: eating behavior, social food environments, and the built environment. Taking tangible steps at the intersection of these domains, the recent European Union project "BigO: Big data against childhood obesity" used a mobile health tool to link objective measurements of health, physical activity, and the built environment. BigO provided learning on the limitations of big data, such as privacy concerns, study sampling, and the balancing of epidemiologic domain expertise with the required technical expertise. Adopting big data approaches will facilitate the exploitation of data concerning obesity-relevant behaviors of a greater variety, which are also processed at speed, facilitated by mobile-based data collection and monitoring systems, citizen science, and artificial intelligence. These approaches will allow the field to expand from causal inference to more complex, systems-level predictive models, stimulating ambitious and effective policy interventions.
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Affiliation(s)
- Adele R Tufford
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Christos Diou
- Department of Informatics and Telematics, Harokopio University of Athens, Athens, Greece
| | - Desiree A Lucassen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Ioannis Ioakimidis
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Grace O'Malley
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
- Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland University for Medicine and Health Sciences, Dublin, Ireland
| | - Leonidas Alagialoglou
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Gerardine Doyle
- College of Business, University College Dublin, Dublin, Ireland
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
| | | | - Penio Kassari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Tahar Kechadi
- CeADAR: Ireland's Centre for Applied AI, University College Dublin, Dublin 4, Ireland
| | - Vassilis Kilintzis
- Lab of Computing, Medical Informatics, and Biomedical Imaging Technologies, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Esther Kok
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Irini Lekka
- Lab of Computing, Medical Informatics, and Biomedical Imaging Technologies, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nicos Maglaveras
- Lab of Computing, Medical Informatics, and Biomedical Imaging Technologies, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Pagkalos
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Vasileios Papapanagiotou
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Sarafis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Arsalan Shahid
- CeADAR: Ireland's Centre for Applied AI, University College Dublin, Dublin 4, Ireland
| | - Pieter van ’t Veer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Anastasios Delopoulos
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Monica Mars
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
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McDonald MD, Hunt K, Sivaramakrishnan H, Moullin J, Avenell A, Kerr DA, Birch JM, Ntoumanis N, Quested E. A systematic review examining socioeconomic factors in trials of interventions for men that report weight as an outcome. Obes Rev 2022; 23:e13436. [PMID: 35187778 PMCID: PMC9285916 DOI: 10.1111/obr.13436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/19/2022]
Abstract
Weight management interventions designed specifically for men have become more common, but the extent to which socioeconomic factors are considered in trials of these interventions is unclear. We synthesized study characteristics, methods, and reporting of interventions with a behavioral component for men that report weight as an outcome, to establish the extent to which socioeconomic factors are considered during intervention design, conduct, and reporting. A comprehensive search was conducted on Medline, Embase, PsycINFO, and CENTRAL for studies published from January 2000 to July 2021. Thirty-six trials were included. Educational attainment (n = 24) was the most frequently reported socioeconomic characteristic, followed by working status (n = 14) and area level deprivation (n = 12). Seven studies did not report any socioeconomic characteristics. Most studies (n = 20) did not mention the socioeconomic profile of their samples in relation to study strengths or limitations. Few (n = 4) consulted with men from lower socioeconomic groups during intervention design. One study examined potential differential intervention effects across socioeconomic groups, with most not powered to do so. Recent feasibility trials (n = 3) targeting specific socioeconomic groups suggest a potential nascent towards a greater consideration of factors related to equity. To best inform public health policy related to health inequalities, greater consideration of socioeconomic factors is required in trials of men's weight management interventions.
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Affiliation(s)
- Matthew D McDonald
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Kate Hunt
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, Western Australia, Australia.,Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Hamsini Sivaramakrishnan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Joanna Moullin
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Deborah A Kerr
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Jack M Birch
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nikos Ntoumanis
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, Western Australia, Australia.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Eleanor Quested
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, Western Australia, Australia
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5
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Robertson C, Aceves-Martins M, Cruickshank M, Imamura M, Avenell A. Does weight management research for adults with severe obesity represent them? Analysis of systematic review data. BMJ Open 2022; 12:e054459. [PMID: 35641006 PMCID: PMC9157335 DOI: 10.1136/bmjopen-2021-054459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Our objective was to determine the extent to which current evidence from long-term randomised controlled trials (RCTs) of weight management is generalisable and applicable to underserved adult groups with obesity (body mass index (BMI) ≥35 kg/m2). METHODS Descriptive analysis of 131 RCTs, published after 1990-May 2017 with ≥1 year of follow-up, included in a systematic review of long-term weight management interventions for adults with BMI ≥35 kg/m2 (the REBALANCE Project). Studies were identified from MEDLINE, EMBASE, PsychINFO, SCI, CENTRAL and from hand searching. Reporting of trial inclusion and exclusion criteria, trial recruitment strategies, baseline characteristics and outcomes were analysed using a predefined list of characteristics informed by the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital)-Plus framework and the UK Equality Act 2010. RESULTS Few (6.1%) trials reported adapting recruitment to appeal to underserved groups. 10.0% reported culturally adapting their trial materials. Only 6.1% of trials gave any justification for their exclusion criteria, yet over half excluded participation for age or mental health reasons. Just over half (58%) of the trials reported participants' race or ethnicity, and one-fifth reported socioeconomic status. Where outcomes were reported for underserved groups, the most common analysis was by sex (47.3%), followed by race or ethnicity (16.8%). 3.1% of trials reported outcomes according to socioeconomic status. DISCUSSION Although we were limited by poor trial reporting, our results indicate inadequate representation of people most at risk of obesity. Guidance for considering underserved groups may improve the appropriateness of research and inform greater engagement with health and social care services. FUNDING National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04). PROSPERO REGISTRATION NUMBER CRD42016040190.
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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6
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Is it possible to model the impact of calorie-reduction interventions on childhood obesity at a population level and across the range of deprivation: Evidence from the Avon Longitudinal Study of Parents and Children (ALSPAC). PLoS One 2022; 17:e0263043. [PMID: 35100299 PMCID: PMC8803143 DOI: 10.1371/journal.pone.0263043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Simulated interventions using observational data have the potential to inform policy and public health interventions where randomised controlled trials are not feasible. National childhood obesity policy is one such area. Overweight and obesity are primarily caused by energy-rich and low-nutrient diets that contribute to a positive net energy imbalance. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated whether causal modelling techniques could be applied to simulate the potential impact of policy-relevant calorie-reduction interventions on population prevalence and inequalities in obesity in childhood. Methods Predicted probabilities of obesity at age 11 (UK90 cut offs) were estimated from logistic marginal structural models (MSM) accounting for observed calorie consumption at age 7 and confounding, overall and by maternal occupational social class. A series of population intervention scenarios were modelled to simulate daily calorie-reduction interventions that differed in effectiveness, targeting mechanism and programme uptake level. Results The estimated effect of maternal social class on obesity after accounting for confounding and observed calorie intake was provided by the controlled direct effect (CDE), in which, 18.3% of children were living with obesity at age 11 years,. A universal simulation to lower median intake to the estimated average requirement (EAR) (a 6.1% reduction in daily calories) with 75% uptake reduced overall obesity prevalence by 0.6%; there was little impact on inequalities. A targeted intervention to limit consumption to the EAR for children with above average intake reduced population obesity prevalence at 11 years by 1.5% but inequalities remained broadly unchanged. A targeted intervention for children of low-income families reduced prevalence by 0.7% and was found to slightly reduce inequalities. Conclusions MSMs allow estimation of effects of simulated calorie-reduction interventions on childhood obesity prevalence and inequalities, although estimates are limited by the accuracy of reported calorie intake. Further work is needed to understand causal pathways and opportunities for intervention. Nevertheless, simulated intervention techniques have promise for informing national policy where experimental data are not available.
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7
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Earle R, Littlewood R, Nalatu S, Walker J. Empowerment Approaches in Childhood Weight Management: A Systematic Review. Child Obes 2022; 18:2-30. [PMID: 34314612 DOI: 10.1089/chi.2021.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Empowerment interventions facilitate individuals, organizations, and communities to gain better control over their health. They are distinctly different from traditional behavior change models and encourage participants to set their own health priorities and agenda. Current evidence suggests empowerment interventions are efficacious for smoking, sexual, and mental health outcomes. However, empowerment in childhood obesity (which remains a global public health challenge) is underresearched. This review systematically analyzed the evidence for empowerment approaches in childhood weight management. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A search strategy was applied to six databases from inception to May 25, 2021. Evidence was appraised using The Academy of Nutrition and Dietetics Quality Criteria Checklist and National Health and Medical Research Council Levels of Evidence. Of the 9274 articles identified, 29 articles describing 14 programs met the inclusion criteria. Twenty-five studies rated positive and four rated neutral. Overall, the evidence body rated "B." Seventy-two percent of the 3318 participants were from priority populations, highlighting the unique ability of empowerment interventions to engage those most in need. Results demonstrate small to large improvements in participant body mass index with effect sizes ranging from 0.08 to 1.13. Throughout the literature, empowerment was measured inconsistently and usually with a surrogate marker. All studies were set in America or Canada. This review suggests empowerment should be further investigated in childhood weight management. Empowerment interventions represent a unique opportunity to meaningfully integrate self-determination to clinical childhood weight management practice and overcome current barriers related to priority population engagement.
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Affiliation(s)
- Renae Earle
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Robyn Littlewood
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.,Health and Wellbeing Queensland, Milton, Queensland, Australia
| | - Simone Nalatu
- Health and Wellbeing Queensland, Milton, Queensland, Australia
| | - Jacqueline Walker
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
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8
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McGowan LJ, Joyes EC, Adams EA, Coyte A, Gavin R, Richmond C, Shabaninejad H, Beyer F, Broadbridge A, Dobson K, Landes D, Moffatt S, Watt RG, Sniehotta FF, Freeman R, Paisi M, Bambra C, Craig D, Kaner E, Ramsay SE. Investigating the Effectiveness and Acceptability of Oral Health and Related Health Behaviour Interventions in Adults with Severe and Multiple Disadvantage: Protocol for a Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11554. [PMID: 34770066 PMCID: PMC8582803 DOI: 10.3390/ijerph182111554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/17/2022]
Abstract
Increasing numbers of people in England experience homelessness, substance use, and repeated offending (known as 'severe and multiple disadvantage'; SMD). Populations experiencing SMD often have extremely poor oral health, which is closely inter-linked with high levels of substance use, smoking, and poor diet. This study aims to undertake an evidence synthesis to identify the effectiveness, resource requirements, and factors influencing the implementation and acceptability of oral health and related health behaviour interventions in adults experiencing SMD. Two systematic reviews will be conducted using mixed-methods. Review 1 will investigate the effectiveness and resource implications of oral health and related health behaviours (substance use, smoking, diet) interventions; Review 2 will investigate factors influencing the implementation of such interventions. The population includes adults (≥18 years) experiencing SMD. Standard review methods in terms of searches, screening, data extraction, and quality appraisal will be conducted. Narrative syntheses will be conducted. If feasible, a meta-analysis will be conducted for Review 1 and a thematic synthesis for Review 2. Evidence from the two reviews will then be synthesised together. Input from people with experience of SMD will be sought throughout to inform the reviews. An initial logic model will be iteratively refined during the review.
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Affiliation(s)
- Laura J. McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Emma C. Joyes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Emma A. Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Aishah Coyte
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Richard Gavin
- Northumbria Healthcare, NHS Foundation Trust, Newcastle upon Tyne NE27 0QG, UK;
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Hosein Shabaninejad
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Angela Broadbridge
- Fulfilling Lives Newcastle/Gateshead, Gateshead NE8 4DY, UK; (A.B.); (K.D.)
| | - Kevin Dobson
- Fulfilling Lives Newcastle/Gateshead, Gateshead NE8 4DY, UK; (A.B.); (K.D.)
| | | | - Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Richard G. Watt
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK;
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Ruth Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee DD1 4HN, UK;
| | - Martha Paisi
- School of Nursing and Midwifery, University of Plymouth, Plymouth PL4 8AA, UK;
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
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9
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McGowan VJ, Buckner S, Mead R, McGill E, Ronzi S, Beyer F, Bambra C. Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review. BMC Public Health 2021; 21:1888. [PMID: 34666742 PMCID: PMC8524206 DOI: 10.1186/s12889-021-11852-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments. METHODS Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR). RESULTS Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms - can all have positive impacts on health outcomes - particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear. CONCLUSIONS Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities. TRIAL REGISTRATION PROSPERO CRD42019158309.
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Affiliation(s)
- V J McGowan
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - S. Buckner
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - R. Mead
- Department of Health Research, Lancaster University, Lancaster, UK
- LiLaC – Liverpool and Lancaster Universities Collaboration for Public Health Research, Lancaster, UK
| | - E. McGill
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - S. Ronzi
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - F. Beyer
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - C. Bambra
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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Petkovic J, Duench S, Trawin J, Dewidar O, Pardo Pardo J, Simeon R, DesMeules M, Gagnon D, Hatcher Roberts J, Hossain A, Pottie K, Rader T, Tugwell P, Yoganathan M, Presseau J, Welch V. Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population. Cochrane Database Syst Rev 2021; 5:CD012932. [PMID: 34057201 PMCID: PMC8406980 DOI: 10.1002/14651858.cd012932.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions. OBJECTIVES We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics. SEARCH METHODS We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language. SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support. DATA COLLECTION AND ANALYSIS We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important. MAIN RESULTS We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data. AUTHORS' CONCLUSIONS This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.
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Affiliation(s)
| | | | | | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, Ottawa, Canada
| | - Rosiane Simeon
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Marie DesMeules
- Social Determinants and Science Integration/ Direction des déterminants sociaux et de l'intégration scientifique, Public Health Agency of Canada/Agence de santé publique du Canada, Ottawa, Canada
| | - Diane Gagnon
- Department of Communication, University of Ottawa, Ottawa, Canada
| | | | - Alomgir Hossain
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kevin Pottie
- Family Medicine, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Vivian Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Canada
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Dodd-Reynolds CJ, Vallis D, Kasim A, Akhter N, Hanson CL. The Northumberland Exercise Referral Scheme as a Universal Community Weight Management Programme: A Mixed Methods Exploration of Outcomes, Expectations and Experiences across a Social Gradient. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155297. [PMID: 32717836 PMCID: PMC7432420 DOI: 10.3390/ijerph17155297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 01/20/2023]
Abstract
Exercise referral schemes (ERS) are internationally recognised, yet little attention has been paid to discrete referral groups or the influence of wider social determinants of health. The primary quantitative element of this mixed methods study used a mixed effects linear model to examine associations of sociodemographic predictors, obesity class and profession of referrer on weight and physical activity (PA) variables for weight-related referrals (n = 3624) to an established 24-week ERS. Chained equations modelling imputed missing data. The embedded qualitative element (n = 7) used individual semi-structured interviews to explore participant weight-related expectations and experiences. Age, gender and profession of referrer influenced weight loss. PA increased and was influenced by age and gender. The weight gap between the most and least obese narrowed over time but the PA gap between most and least widened. Age, employment and obesity class were most predictive of missing data but would unlikely alter overall conclusions. Qualitative themes were weight-loss support, personal circumstances and strategies, and weight expectations versus wellbeing rewards. This ERS worked, did not widen existing obesity inequalities, but demonstrated evidence of PA inequalities for those living with deprivation. To improve equity of experience, we recommend further stakeholder dialogue around referral experience and ongoing support needs.
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Affiliation(s)
- Caroline J. Dodd-Reynolds
- Department of Sport and Exercise Sciences, Durham University, Durham DH1 3HN, UK
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham DH1 3HN, UK; (A.K.); (N.A.)
- Durham Research Methods Centre, Durham University, Durham DH1 3HN, UK;
- Correspondence:
| | - Dimitris Vallis
- Durham Research Methods Centre, Durham University, Durham DH1 3HN, UK;
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham DH1 3HN, UK; (A.K.); (N.A.)
- Durham Research Methods Centre, Durham University, Durham DH1 3HN, UK;
- Department of Anthropology, Durham University, Durham DH1 3HN, UK
| | - Nasima Akhter
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham DH1 3HN, UK; (A.K.); (N.A.)
- Department of Anthropology, Durham University, Durham DH1 3HN, UK
| | - Coral L. Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
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12
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Estimating Reductions in Ethnic Inequalities in Child Adiposity from Hypothetical Diet, Screen Time, and Sports Participation Interventions. Epidemiology 2020; 31:736-744. [PMID: 32618712 DOI: 10.1097/ede.0000000000001221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Childhood obesity is a global epidemic, and its prevalence differs by ethnicity. The objective of this study was to estimate the change in ethnic inequalities in child adiposity at age 10 resulting from interventions on diet at age 8 and screen time and sports participation at age 9. METHODS We conducted a population-based cohort study, the Generation R Study, from 9,749 births in Rotterdam (2002-2006), of which 9,506 children remained in the analysis. We measured ethnicity, diet, screen time, and sports participation through questionnaires; we measured weight, body mass index (BMI), fat mass index, and fat-free mass index directly. We used sequential G-estimation to estimate the reduction in inequality that would result from the interventions. RESULTS We observed that sociodemographic characteristics, diet, screen time, sports participation, and all adiposity measurements were more favorable in children from Western versus non-Western ethnic backgrounds: weight = -1.2 kg (95% confidence interval [CI] = -1.7, -0.8), BMI = -1.0 kg/m (CI = -1.2, -0.9), and fat mass index = -0.8 kg/m (CI = -0.9, -0.7). We estimated that extreme intervention (maximum diet score of 10, no screen time, and >4 hours/week of sports) reduced ethnic inequalities by 21% (CI = 8%, 35%) for weight, 9% (CI = 4%, 14%) for BMI, and 9% (CI = 6%, 13%) for fat mass index. A diet score ≥5 points, screen time ≤2 hours/day, and sports participation >2 hours/week reduced ethnic inequalities by 17% (CI = 6%, 28%) for weight, 7% (CI = 3%, 11%) for BMI, and 7% (CI = 4%, 10%) for fat mass index. CONCLUSIONS Our results are consistent with the hypothesis that interventions integrating diet, screen time, and sports participation have a moderate impact on reducing ethnic inequalities in child adiposity.
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13
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Chapman P, Lindsey I, Dodd-Reynolds C, Oliver E, Summerbell C. Targeting childhood obesity through primary schools: reviewing alignment amongst English policies for physical activity and healthy eating. CHILD AND ADOLESCENT OBESITY 2020. [DOI: 10.1080/2574254x.2020.1740548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Pippa Chapman
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
| | - Iain Lindsey
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | | | - Emily Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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14
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Besnier E, Thomson K, Stonkute D, Mohammad T, Akhter N, Todd A, Jensen MR, Kilvik A, Bambra C. Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low-income and middle-income countries (LMICs): protocol for an umbrella review. BMJ Open 2019; 9:e032981. [PMID: 31888932 PMCID: PMC6937061 DOI: 10.1136/bmjopen-2019-032981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Despite significant progress in the last few decades, infectious diseases remain a significant threat to children's health in low-income and middle-income countries. Effective means of prevention and control for these diseases exist, making any differences in the burden of these diseases between population groups or countries inequitable. Yet, gaps remain in our knowledge of the effect these public health interventions have on health inequalities in children, especially in low-income and middle-income countries. This umbrella review aims to address some of these gaps by exploring which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases among children in low-income and middle-income countries. METHODS AND ANALYSIS An umbrella review will be conducted to identify systematic reviews or evidence synthesis of public health interventions that reduce morbidity, mortality and/or health inequalities due to infectious diseases among children (aged under 5 years) in low-income and middle-income countries. The interventions of interest are public health interventions targeting infectious diseases or associated risk factors in children. We will search for reviews reporting health and health inequalities outcomes in and between populations. The literature search will be undertaken using the Cochrane Library, Medline, EMBASE, the CAB Global Health database, Health Evidence, the Campbell Collaboration Library of Systematic Reviews, International Initiative for Impact Evaluation Systematic review repository, Scopus, the Social Sciences Citation Index and PROSPERO. Additionally, a manual search will be performed in Google Scholar and three international organisations websites (UNICEF Office of Research-Innocenti, UNICEF, WHO) to capture grey literature. Data from the records meeting our inclusion/exclusion criteria will be collated using a narrative synthesis approach. ETHICS AND DISSEMINATION This review will exclusively work with anonymous group-level information available from published reviews. No ethical approval was required.The results of the review will be submitted for publication in academic journals and presented at international public health conferences. Additionally, key findings will be summarised for dissemination to a wider policy and general public audience as part of the Centre for Global Health Inequalities Research's policy work. PROSPERO REGISTRATION NUMBER CRD42019141673.
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Affiliation(s)
- Elodie Besnier
- Centre for Global Health Inequalities Research (CHAIN) / Department of Sociology and Political Science, NTNU, Trondheim, Norway
| | - Katie Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Donata Stonkute
- Department of Public Health and Nursing / CHAIN, NTNU, Trondheim, Norway
| | - Talal Mohammad
- Department of Public Health and Nursing / CHAIN, NTNU, Trondheim, Norway
| | - Nasima Akhter
- Department of Anthropology, Durham University, Stockton-on-Tees, UK
| | - Adam Todd
- School of Pharmacy / CHAIN, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Astrid Kilvik
- Medicine and Health Library, NTNU, Trondheim, Norway
| | - Clare Bambra
- Institute of Health & Society / CHAIN, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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15
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Manneville F, Omorou AY, Legrand K, Langlois J, Lecomte E, Guillemin F, Briançon S, Angel N, Ancellin R, Aptel E, Bailly F, Barthelemy L, Bezaz D, Bonsergent E, Collin JF, De Lavenne R, Dietz E, Enrietto P, Favre E, Gentieu M, Gouault E, Helfenstein M, Hercberg S, Kurtz F, Laure P, Lighezzolo J, Marx P, Osbery A, Piquee MO, Renaudin P, Robert G, Schichtel A, Tessier S, Vuillemin A, Villemin E, Wuillaume M. Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents. Child Obes 2019; 15:532-540. [PMID: 31448956 DOI: 10.1089/chi.2019.0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Differences in weight status by socioeconomic position occur during adolescence and is known as weight social gradient (WSG). The PRALIMAP (Promotion de l'ALIMentation et de l'Activité Physique) trial highlighted that a universal intervention was effective in reducing overweight and obesity prevalence among adolescents. However, its ability to reduce the WSG is unclear. This study aimed to evaluate the impact of the PRALIMAP intervention on the WSG among adolescents. Methods: Data were obtained from 3504 adolescents who participated in the school-based PRALIMAP trial between 2006 and 2009. The PRALIMAP study consisted of three interventional strategies: educational, environmental, screening and care. Weight status was assessed by body mass index (BMI) z-score and overweight and obesity prevalence. The "indice de position sociale des élèves" was used to measure adolescents' socioeconomic status. Linear regression and hierarchical models were used to assess the WSG and its evolution, respectively. Results: Among all adolescents (14-18 years old), significant WSG was identified at baseline: BMI z-score (β = -0.06; p < 0.0001), overweight and obesity prevalence (β = -2.86; p < 0.0001). Overall, the intervention conferred no significant reduction in the WSG: BMI z-score (β = -0.01 [-0.02 to 0.01], p = 0.48), overweight and obesity prevalence (β = -0.01 [-0.07 to 0.05], p = 0.73). Similar results were observed for adolescents whatever the interventional strategy they benefited from in the PRALIMAP trial. Conclusions: This study provided no evidence that the PRALIMAP universal intervention was effective in reducing the socioeconomic inequalities in weight status among adolescents. Different interventions that account for social differences should be considered to tackle these inequalities.
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Affiliation(s)
| | - Abdou Y Omorou
- University of Lorraine, APEMAC, Team MICS, Nancy, France.,CHRU-Nancy, INSERM, University of Lorraine, CIC, Clinical Epidemiology, Nancy, France
| | - Karine Legrand
- University of Lorraine, APEMAC, Team MICS, Nancy, France.,CHRU-Nancy, INSERM, University of Lorraine, CIC, Clinical Epidemiology, Nancy, France
| | - Johanne Langlois
- University of Lorraine, APEMAC, Team MICS, Nancy, France.,National Conservatory of Arts and Crafts (CNAM), Scientific and Technical Institute for Food and Nutrition (ISTNA), Nancy, France
| | - Edith Lecomte
- National Conservatory of Arts and Crafts (CNAM), Scientific and Technical Institute for Food and Nutrition (ISTNA), Nancy, France
| | - Francis Guillemin
- University of Lorraine, APEMAC, Team MICS, Nancy, France.,CHRU-Nancy, INSERM, University of Lorraine, CIC, Clinical Epidemiology, Nancy, France
| | - Serge Briançon
- University of Lorraine, APEMAC, Team MICS, Nancy, France
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Dodd-Reynolds CJ, Nevens L, Oliver EJ, Finch T, Lake AA, Hanson CL. Prototyping for public health in a local context: a streamlined evaluation of a community-based weight management programme (Momenta), Northumberland, UK. BMJ Open 2019; 9:e029718. [PMID: 31676645 PMCID: PMC6830698 DOI: 10.1136/bmjopen-2019-029718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Stakeholder co-production in design of public health programmes may reduce the 'implementation gap' but can be time-consuming and costly. Prototyping, iterative refining relevant to delivery context, offers a potential solution. This evaluation explored implementation and lessons learnt for a 12-week referral-based weight-management programme, 'Momenta', along with feasibility of an iterative prototyping evaluation framework. DESIGN Mixed methods evaluation: Qualitative implementation exploration with referrers and service users; preliminary analysis of anonymised quantitative service data (12 and 52 weeks). SETTING Two leisure centres in Northumberland, North East England. PARTICIPANTS Individual interviews with referring professionals (n=5) and focus groups with service users (n=13). Individuals (n=182) referred by healthcare professionals (quantitative data). INTERVENTIONS Three 12-week programme iterations: Momenta (n=59), Momenta-Fitness membership (n=58) and Fitness membership only (n=65). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: Qualitative themes developed through stakeholder-engagement. Secondary outcomes included preliminary exploration of recruitment, uptake, retention, and changes in weight, body mass index, waist circumference and psychological well-being. RESULTS Service users reported positive experiences of Momenta. Implementation gaps were revealed around the referral process and practitioner knowledge. Prototyping enabled iterative refinements such as broadening inclusion criteria. Uptake and 12-week retention were higher for Momenta (84.7%, 45.8%) and Momenta-Fitness (93.1%, 60.3%) versus Fitness only (75.4%, 24.6%). Exploration of other preliminary outcomes (completers only) suggested potential for within-group weight loss and increased psychological well-being for Momenta and Momenta-Fitness at 12 weeks. 52 week follow-up data were limited (32%, 33% and 6% retention for those who started Momenta, Momenta-Fitness and Fitness, respectively) but suggested potential weight loss maintenance for Momenta-Fitness. CONCLUSIONS Identification of issues within the referral process enabled real-time iterative refinement, while lessons learnt may be of value for local implementation of 'off-the-shelf' weight management packages more generally. Our preliminary data for completers suggest Momenta may have potential for weight loss, particularly when offered with a fitness membership.
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Affiliation(s)
- Caroline J Dodd-Reynolds
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham, UK
| | - Lisa Nevens
- Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Emily J Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham, UK
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Amelia A Lake
- Department of Science, School of Science, Engineering and Design, Teesside University, Teesside, UK
- Fuse - UKCRC Centre for Translational Research in Public Health, North East England, UK
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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17
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Ek A, Chamberlain KL, Sorjonen K, Hammar U, Malek ME, Sandvik P, Somaraki M, Nyman J, Lindberg L, Nordin K, Ejderhamn J, Fisher PA, Chamberlain P, Marcus C, Nowicka P. A Parent Treatment Program for Preschoolers With Obesity: A Randomized Controlled Trial. Pediatrics 2019; 144:peds.2018-3457. [PMID: 31300528 PMCID: PMC8853645 DOI: 10.1542/peds.2018-3457] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST). METHODS Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (-0.5) was assessed with risk ratios. RESULTS A total of 174 children (mean age: 5.3 years [SD = 0.8]; BMI z score: 3.0 [SD = 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n = 44; No Booster, n = 43; ST, n = 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: -0.45 to -0.15) compared with ST (0.07; 95% CI: -0.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (-0.54; 95% CI: -0.77 to -0.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of ≥0.5 of the BMI z score compared with ST. CONCLUSION A parent-only treatment with boosters outperformed standard care for obesity in preschoolers.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology,
| | | | - Kimmo Sorjonen
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Ulf Hammar
- Department of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden,Section of Molecular Epidemiology, Departments of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mahnoush Etminan Malek
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden,Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Sandvik
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden,Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Maria Somaraki
- Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Jonna Nyman
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Louise Lindberg
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Ejderhamn
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Philip A. Fisher
- Oregon Social Learning Center, Eugene, Oregon,Department of Psychology, University of Oregon, Eugene, Oregon
| | | | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden,Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
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Health Technology Assessment of Public Health Interventions Published 2012 to 2016: An Analysis of Characteristics and Comparison of Methods. Int J Technol Assess Health Care 2019; 35:280-290. [DOI: 10.1017/s0266462319000515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractObjectivesThe aim of this study was to provide an overview of the methodological characteristics and compare the assessment methods applied in health technology assessments (HTAs) of public health interventions (PHIs).MethodsWe defined a PHI as a population-based intervention on health promotion or for primary prevention of chronic or nonchronic diseases. HTAs on PHIs were identified by systematically searching the Web pages of members of international HTA networks. We included only full HTA reports published between 2012 and 2016. Two reviewers extracted data on the methods used to assess effectiveness/safety, as well as on economic, social, cultural, ethical, and legal aspects using a-priori standardized tables.ResultsWe included ten HTAs provided by four different organizations. Of these, all reports assessed the effectiveness of the interventions and conducted economic evaluations, seven investigated social/cultural aspects, and four each considered legal and ethical aspects, respectively. Some reports addressed applicability, context/setting, and intervention fidelity issues in different ways. We found that most HTAs adapted their methods to some extent, for example, by including nonrandomized studies, expanding the search strategy, involving stakeholders, or applying a framework to guide the HTA process.ConclusionsOur analysis provides a comprehensive overview of methods applied in HTAs on public health interventions. We found that a heterogeneous set of approaches is used to deal with the challenges of evaluating complex public health interventions.
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Ek A, Delisle Nyström C, Chirita-Emandi A, Tur JA, Nordin K, Bouzas C, Argelich E, Martínez JA, Frost G, Garcia-Perez I, Saez M, Paul C, Löf M, Nowicka P. A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study - an intervention within the STOP project. BMC Public Health 2019; 19:945. [PMID: 31307412 PMCID: PMC6631737 DOI: 10.1186/s12889-019-7161-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 12/15/2022] Open
Abstract
Background Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families. Methods/design A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline. Discussion This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided. Trial registration ClinicalTrials.gov NCT03800823; 11 Jan 2019.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | | | - Adela Chirita-Emandi
- Genetics Department, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.,"Louis Turcanu" Clinical Emergency Hospital for Children, Timisoara, Romania
| | - Josep A Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain.,CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Cristina Bouzas
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain.,CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain
| | - Emma Argelich
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain.,CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain
| | - J Alfredo Martínez
- CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain.,Department of Nutrition, Food Science, and Physiology, Centre for Nutrition Research, University of Navarra, Pamplona, Spain.,IMDEA Food Precision Nutrition, Madrid, Spain
| | - Gary Frost
- Section for Nutrition Research, Department of Medicine, Imperial College London, Hammersmith Campus, London, UK
| | - Isabel Garcia-Perez
- Division of Systems and Digestive Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, South Kensington Campus, London, UK
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Campus de Montilivi, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Instituto Carlos III, Madrid, Spain
| | - Corina Paul
- Pediatrics Department, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.,2nd Pediatrics Clinic, Clinical Emergency County Hospital Timisoara, Timisoara, Romania
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
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Gillespie J, Hughes A, Gibson AM, Haines J, Taveras E, Reilly JJ. Protocol for Healthy Habits Happy Homes (4H) Scotland: feasibility of a participatory approach to adaptation and implementation of a study aimed at early prevention of obesity. BMJ Open 2019; 9:e028038. [PMID: 31175198 PMCID: PMC6561609 DOI: 10.1136/bmjopen-2018-028038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Prevention of childhood obesity is an important public health objective. Promoting healthful energy balance related behaviours (EBRBs) in the early years should be a key focus. In Scotland, one in five children are overweight or obese by age 5 years, with levels highest in deprived areas. This study protocol outlines the stages of a feasibility study to translate the highly promising North American Healthy Habits, Happy Homes (4H) a home based, preschool childhood obesity prevention intervention to Scotland (4H Scotland). First, elements of participatory and co-production approaches utilised to: (a) engage key stakeholders, (b) enable inclusive recruitment of participants and (c) adapt original study materials. Second, 4H Scotland intervention will be tested within a community experiencing health/social inequalities and high levels of deprivation in Dundee, Scotland. METHODS AND ANALYSIS 4H Scotland aims to recruit up to 40 families. Anthropometry, objective and subjective measures of EBRBs will be collected at baseline and at 6 months. The intervention consists of monthly visits to family home, using motivational interviewing and SMS to support healthful EBRBs: sleep duration, physical activity (active play), screen time, family meals. The Control Group will receive standard healthy lifestyle information. Fidelity to intervention will be assessed using recordings of intervention visits. Feasibility and acceptability of study design components will be assessed through qualitative interviews and process evaluation of recruitment, retention rates; appropriateness, practicality of obtaining outcome measures; intervention duration, content, mode of delivery and associated costs. Adaptation through participatory and co-production will support development of 4H Scotland. Process evaluation offers two future directions; advancement towards a definitive, larger trial or routine practice. ETHICS AND DISSEMINATION This study was granted ethical approval by the University of Strathclyde's School of Psychological Sciences and Health Ethics Committee. Results will be disseminated through lay summaries workshops, peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN13385965; Pre-results.
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Affiliation(s)
- Jenny Gillespie
- Physical Activity for Health, University of Strathclyde School of Psychological Sciences and Health, Glasgow, UK
- Nutrition and Dietetics, NHS Tayside, Dundee, UK
| | - Adrienne Hughes
- University of Strathclyde School of Psychological Sciences and Health, Glasgow, UK
| | - Ann-Marie Gibson
- University of Strathclyde School of Psychological Sciences and Health, Glasgow, UK
| | - Jess Haines
- University of Guelph, Guelph, Ontario, Canada
| | - Elsie Taveras
- Massachusetts General Hospital, Boston, Massachusetts, USA
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McCrory C, Leahy S, Ribeiro AI, Fraga S, Barros H, Avendano M, Vineis P, Layte R, Baglietto L, Bartley M, Bellone M, Berger E, Bochud M, Candiani G, Carmeli C, Carra L, Castagne R, Chadeau‐Hyam M, Cima S, Costa G, Courtin E, Delpierre C, D'Errico A, Donkin A, Dugué P, Elliott P, Fagherazzi G, Fiorito G, Gandini M, Gares V, Gerbouin‐Rerrolle P, Giles G, Goldberg M, Greco D, Guida F, Hodge A, Karimi M, Karisola P, Kelly M, Kivimaki M, Laine J, Lang T, Laurent A, Lepage B, Lorsch D, Machell G, Mackenbach J, Marmot M, Milne R, Muennig P, Nusselder W, Petrovic D, Polidoro S, Preisig M, Recalcati P, Reinhard E, Ricceri F, Robinson O, Jose Rubio Valverde, Severi G, Simmons T, Stringhini S, Terhi V, Than J, Vergnaud A, Vigna‐Taglianti F, Vollenweider P, Zins M. Maternal educational inequalities in measured body mass index trajectories in three European countries. Paediatr Perinat Epidemiol 2019; 33:226-237. [PMID: 31090081 DOI: 10.1111/ppe.12552] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/05/2019] [Accepted: 03/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Social inequalities in the prevalence of childhood overweight and obesity are well-established, but less is known about when the social gradient first emerges and how it evolves across childhood and adolescence. OBJECTIVE This study examines maternal education differentials in children's body mass trajectories in infancy, childhood and adolescence using data from four contemporary European child cohorts. METHODS Prospective data on children's body mass index (BMI) were obtained from four cohort studies-Generation XXI (G21-Portugal), Growing Up in Ireland (GUI) infant and child cohorts, and the Millennium Cohort Study (MCS-UK)-involving a total sample of 41,399 children and 120,140 observations. Children's BMI trajectories were modelled by maternal education level using mixed-effect models. RESULTS Maternal educational inequalities in children's BMI were evident as early as three years of age. Children from lower maternal educational backgrounds were characterised by accelerated BMI growth, and the extent of the disparity was such that boys from primary-educated backgrounds measured 0.42 kg/m2 (95% CI 0.24, 0.60) heavier at 7 years of age in G21, 0.90 kg/m2 (95% CI 0.60, 1.19) heavier at 13 years of age in GUI and 0.75 kg/m2 (95% CI 0.52, 0.97) heavier in MCS at 14 years of age. The corresponding figures for girls were 0.71 kg/m2 (95% CI 0.50, 0.91), 1.31 kg/m2 (95% CI 1.00, 1.62) and 0.76 kg/m2 (95% CI 0.53, 1.00) in G21, GUI and MCS, respectively. CONCLUSIONS Maternal education is a strong predictor of BMI across European nations. Socio-economic differentials emerge early and widen across childhood, highlighting the need for early intervention.
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Affiliation(s)
- Cathal McCrory
- Department of Medical Gerontology, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Siobhan Leahy
- Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ana Isabel Ribeiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Silvia Fraga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Mauricio Avendano
- Department of Social Science, Health and Medicine, Kings College London, London, UK
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Richard Layte
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
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Gillespie J, Magee E, White A, Stewart L. Eat, play, learn well—a novel approach to co-production and analysis grid for environments linked to obesity to engage local communities in a child healthy weight action plan. Public Health 2019; 166:99-107. [DOI: 10.1016/j.puhe.2018.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 09/17/2018] [Accepted: 09/30/2018] [Indexed: 10/27/2022]
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Hoebel J, Kuntz B, Kroll LE, Schienkiewitz A, Finger JD, Lange C, Lampert T. Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990-2011. Obes Facts 2019; 12:344-356. [PMID: 31167203 PMCID: PMC6696774 DOI: 10.1159/000499718] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/16/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. METHODS Data were drawn from three national examination surveys conducted in 1990-1992, 1997-1999 and 2008-2011 (n = 18,541; age range: 25-69 years). Obesity was defined by a body mass index ≥30 kg/m2 using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. RESULTS In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01-1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05-0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19-1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI -0.27 to 0.92, p = 0.283). CONCLUSIONS These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.
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Affiliation(s)
- Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany,
| | - Benjamin Kuntz
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lars E Kroll
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anja Schienkiewitz
- Division of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jonas D Finger
- Division of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Cornelia Lange
- Division of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Lampert
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Hooper L, Anderson AS, Birch J, Forster AS, Rosenberg G, Bauld L, Vohra J. Public awareness and healthcare professional advice for obesity as a risk factor for cancer in the UK: a cross-sectional survey. J Public Health (Oxf) 2018; 40:797-805. [PMID: 29155951 PMCID: PMC6306085 DOI: 10.1093/pubmed/fdx145] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/25/2017] [Indexed: 01/01/2023] Open
Abstract
Background Overweight and obesity is the second biggest preventable cause of cancer after smoking, causing ~3.4 million deaths worldwide. This study provides current UK data on awareness of the link between obesity and cancer by socio-demographic factors, including BMI, and explores to what degree healthcare professionals provide weight management advice to patients. Methods Cross-sectional survey of 3293 adults completed an online survey in February/March 2016, weighted to be representative of the UK population aged 18+. Results Public awareness of the link between obesity and cancer is low (25.4% unprompted and 57.5% prompted). Higher levels of awareness existed for least deprived groups (P < 0.001), compared to more deprived groups. Most respondents had seen a healthcare practitioner in the past 12 months (91.6%) and 17.4% had received advice about their weight, although 48.4% of the sample were overweight/obese. Conclusion Cancer is not at the forefront of people's minds when considering health conditions associated with overweight or obesity. Socio-economic disparities exist in health knowledge across the UK population, with adults from more affluent groups being most aware. Healthcare professionals are uniquely positioned to provide advice about weight, but opportunities for intervention are currently under-utilized in healthcare settings.
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Affiliation(s)
- Lucie Hooper
- Policy Research Centre for Cancer Prevention (PRCP), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Level 7, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Jack Birch
- Policy Research Centre for Cancer Prevention (PRCP), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
| | - Alice S Forster
- Department of Behavioural Science and Health, UCL, Gower Street, London, UK
| | - Gillian Rosenberg
- Policy Research Centre for Cancer Prevention (PRCP), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
| | - Linda Bauld
- Cancer Research UK, Angel Building, 407 St. John Street, London, UK
- University of Stirling, Stirling, UK
| | - Jyotsna Vohra
- Policy Research Centre for Cancer Prevention (PRCP), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
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Wagner KJP, Bastos JLD, Navarro A, Gonzalez-Chica DA, Boing AF. Socioeconomic status in childhood and obesity in adults: a population-based study. Rev Saude Publica 2018; 52:15. [PMID: 29489991 PMCID: PMC5825134 DOI: 10.11606/s1518-8787.2018052000123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 02/03/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. METHODS A cross-sectional analysis of a population-based cohort study, including a sample of adults (22-63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant's parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. RESULTS Of the 1,222 adults evaluated, 20.4% (95%CI 18.1-22.8) presented overall obesity and 24.8% (95%CI 22.4-27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m2 (95%CI -2.3- -0.04) and 2.8 cm (95%CI -5.3- -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0-6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34-0.90), and no such association was observed among men. CONCLUSIONS The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators.
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Affiliation(s)
| | - João Luiz Dornelles Bastos
- Universidade Federal de Santa Catarina. Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Pública. Florianópolis, SC, Brasil
| | - Albert Navarro
- Universitat Autónoma de Barcelona. Facultat de Medicina. Unitat de Bioestadística. Barcelona, España
| | | | - Antonio Fernando Boing
- Universidade Federal de Santa Catarina. Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Pública. Florianópolis, SC, Brasil
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Welch V, Petkovic J, Simeon R, Presseau J, Gagnon D, Hossain A, Pardo Pardo J, Pottie K, Rader T, Sokolovski A, Yoganathan M, Tugwell P, DesMeules M. Interactive social media interventions for health behaviour change, health outcomes, and health equity in the adult population. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd012932] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vivian Welch
- Bruyère Research Institute; Methods Centre; 85 Primrose Avenue Ottawa ON Canada
| | - Jennifer Petkovic
- University of Ottawa; Bruyère Research Institute; 43 Bruyère St Annex E, room 312 Ottawa ON Canada K1N 5C8
| | - Rosiane Simeon
- University of Ottawa; Bruyère Research Institute; 43 Bruyère St Annex E, room 312 Ottawa ON Canada K1N 5C8
| | - Justin Presseau
- Ottawa Hospital Research Institute; Clinical Epidemiology Program; 501 Smyth Road Ottawa Ontario Canada K1H 8L6
| | - Diane Gagnon
- University of Ottawa; Department of Communication; Ottawa ON Canada
| | - Alomgir Hossain
- University of Ottawa Heart Institute; Cardiovascular Research Methods Centre; 40 Ruskin Street Room H-2265 Ottawa ON Canada K1Y 4W7
| | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus; Centre for Practice-Changing Research; 501 Smyth Road, Box 711 Room L1258 Ottawa ON Canada K1H 8L6
| | - Kevin Pottie
- University of Ottawa; Family Medicine; 75 Bruyere St Ottawa ON Canada K1N 5C8
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH); 600-865 Carling Avenue Ottawa ON Canada
| | | | - Manosila Yoganathan
- University of Ottawa; Bruyère Research Institute; 43 Bruyère St Annex E, room 312 Ottawa ON Canada K1N 5C8
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa; Department of Medicine; Ottawa ON Canada K1H 8M5
| | - Marie DesMeules
- Public Health Agency of Canada/Agence de santé publique du Canada; Social Determinants and Science Integration/ Direction des déterminants sociaux et de l'intégration scientifique; Ottawa Ontario Canada
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Maden M, Cunliffe A, McMahon N, Booth A, Carey GM, Paisley S, Dickson R, Gabbay M. Use of programme theory to understand the differential effects of interventions across socio-economic groups in systematic reviews-a systematic methodology review. Syst Rev 2017; 6:266. [PMID: 29284538 PMCID: PMC5747153 DOI: 10.1186/s13643-017-0638-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Systematic review guidance recommends the use of programme theory to inform considerations of if and how healthcare interventions may work differently across socio-economic status (SES) groups. This study aimed to address the lack of detail on how reviewers operationalise this in practice. METHODS A methodological systematic review was undertaken to assess if, how and the extent to which systematic reviewers operationalise the guidance on the use of programme theory in considerations of socio-economic inequalities in health. Multiple databases were searched from January 2013 to May 2016. Studies were included if they were systematic reviews assessing the effectiveness of an intervention and included data on SES. Two reviewers independently screened all studies, undertook quality assessment and extracted data. A narrative approach to synthesis was adopted. RESULTS A total of 37 systematic reviews were included, 10 of which were explicit in the use of terminology for 'programme theory'. Twenty-nine studies used programme theory to inform both their a priori assumptions and explain their review findings. Of these, 22 incorporated considerations of both what and how interventions do/do not work in SES groups to both predict and explain their review findings. Thirteen studies acknowledged 24 unique theoretical references to support their assumptions of what or how interventions may have different effects in SES groups. Most reviewers used supplementary evidence to support their considerations of differential effectiveness. The majority of authors outlined a programme theory in the "Introduction" and "Discussion" sections of the review to inform their assumptions or provide explanations of what or how interventions may result in differential effects within or across SES groups. About a third of reviews used programme theory to inform the review analysis and/or synthesis. Few authors used programme theory to inform their inclusion criteria, data extraction or quality assessment. Twenty-one studies tested their a priori programme theory. CONCLUSIONS The use of programme theory to inform considerations of if, what and how interventions lead to differential effects on health in different SES groups in the systematic review process is not yet widely adopted, is used implicitly, is often fragmented and is not implemented in a systematic way.
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Affiliation(s)
- Michelle Maden
- Liverpool Reviews and Implementation Group (LRIG), Department of Health Services Research, University of Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| | - Alex Cunliffe
- Liverpool Reviews and Implementation Group (LRIG), Department of Health Services Research, University of Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| | - Naoimh McMahon
- Faculty of Health and Wellbeing, University of Central Lancashire, Brook Building, Preston, PR1 2HE UK
| | - Andrew Booth
- Evidence Based Information Practice, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | | | - Suzy Paisley
- Innovation and Knowledge Transfer (IKT), ScHARR, University of Sheffield, Sheffield, UK
| | - Rumona Dickson
- Liverpool Reviews and Implementation Group (LRIG), Department of Health Services Research, University of Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| | - Mark Gabbay
- Department of Health Services Research, University of Liverpool, Block B Waterhouse Building, 1–5 Brownlow St., Liverpool, L69 3GL UK
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Dorling H, Ollerhead L, Kidgell C. The NIHR public health research programme: intervention approaches to tackle health inequalities. J Public Health (Oxf) 2017; 39:856-862. [PMID: 27915256 PMCID: PMC5896582 DOI: 10.1093/pubmed/fdw128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The National Institute for Health Research (NIHR) Public Health Research (PHR) Programme evaluates interventions intended to improve the health of the public and reduce inequalities in health in the UK. The aim of the research was to establish how projects funded by the PHR Programme between 2009 and 2014 addressed health inequalities. Methods A health inequalities intervention framework developed by Bambra et al. was used to map PHR funded studies to a typology. The framework is based on interventions that are characterized by their level of action and their approach to tackling inequalities. Results A total of 57 primary research projects funded by the PHR Programme were categorized using the framework; 16 PHR research projects were classified as strengthening individuals, 24 strengthening communities, 15 improving living and school/work conditions and 2 promoting healthy macro policies. Eighteen were classified as targeted interventions whereas 39 were universal. Conclusions Mapping the interventions being evaluated by the PHR Programme to a typology differentiated health inequality interventions and illustrates how they are expected to have an impact. Emerging findings will contribute to the evidence base for addressing health inequalities to inform research and future commissioning of public health services.
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Affiliation(s)
- H Dorling
- Wessex Institute, University of Southampton, Southampton, UK
| | - L Ollerhead
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), University of Southampton, Southampton , UK
| | - C Kidgell
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), University of Southampton, Southampton , UK
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29
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Fisher A, Craigie AM, Macleod M, Steele RJC, Anderson AS. The impact of social deprivation on the response to a randomised controlled trial of a weight management intervention (BeWEL) for people at increased risk of colorectal cancer. J Hum Nutr Diet 2017; 31:306-313. [PMID: 29171112 PMCID: PMC6001549 DOI: 10.1111/jhn.12524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although 45% of colorectal cancer (CRC) cases may be avoidable through appropriate lifestyle and weight management, health promotion interventions run the risk of widening health inequalities. The BeWEL randomised controlled trial assessed the impact of a diet and activity programme in overweight adults who were diagnosed with a colorectal adenoma, demonstrating a significantly greater weight loss at 12 months in intervention participants than in controls. The present study aimed to compare BeWEL intervention outcomes by participant deprivation status. METHODS The intervention group of the BeWEL trial (n = 163) was classified by the Scottish Index of Multiple Deprivation (SIMD) quintiles into 'more deprived' (SIMD 1-2, n = 58) and 'less deprived' (SIMD 3-5, n = 105). Socio-economic and lifestyle variables were compared at baseline to identify potential challenges to intervention adherence in the more deprived. Between group differences at 12 months in primary outcome (change in body weight) and secondary outcomes (cardiovascular risk factors, diet, physical activity, knowledge of CRC risk and psychosocial variables) were assessed by deprivation status. RESULTS At baseline, education (P = 0.001), income (P < 0.001), spending on physical activity (P = 0.003) and success at previous weight loss attempts (P = 0.007) were significantly lower in the most deprived. At 12 months, no between group differences by deprivation status were detected for changes in primary and main secondary outcomes. CONCLUSIONS Despite potential barriers faced by the more deprived participants, primary and most secondary outcomes were comparable between groups, indicating that this intervention is unlikely to worsen health inequalities and is equally effective across socio-economic groups.
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Affiliation(s)
- A Fisher
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - A M Craigie
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - M Macleod
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - R J C Steele
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - A S Anderson
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
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Naik Y, Baker P, Walker I, Tillmann T, Bash K, Quantz D, Hillier-Brown F, Bambra C. The macro-economic determinants of health and health inequalities-umbrella review protocol. Syst Rev 2017; 6:222. [PMID: 29100497 PMCID: PMC5670527 DOI: 10.1186/s13643-017-0616-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/19/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The economic determinants of health have been widely recognised as crucial factors affecting health; however, to date, no comprehensive review has been undertaken to summarise these factors and the ways in which they can influence health. We conceptualise the economy as a complex system made up of underlying approaches, regulation from institutions, markets, finance, labour, the public-private balance as well as production and distributional effects, which collectively impact on health through the effect of moderators. This protocol details the methods for an umbrella review to explore the macro-economic factors, strategies, policies and interventions that affect health outcomes and health inequalities. METHODS We will identify relevant systematic reviews using search terms derived from the Journal of Economic Literature classification. Reviews will be included if they meet the Database of Abstracts and Reviews of Effects criteria for systematic reviews. Reviews of studies with and without controls will be included; both association and intervention studies will be included. Primary outcomes will include but are not limited to morbidity, mortality, prevalence and incidence of conditions and life expectancy. Secondary outcomes will include health inequalities by gender, ethnicity or socio-economic status. Six databases will be searched using tailored versions of our piloted search strategy to locate relevant reviews. Data will be extracted using a standardized pro forma, and the findings will be synthesized into a conceptual framework to address our review aim. DISCUSSION Our umbrella review protocol provides a robust method to systematically appraise the evidence in this field, using new conceptual models derived specifically to address the study question. This will yield important information for policymakers, practitioners and researchers at the local, national and international level. It will also help set the future research agenda in this field and guide the development of interventions. SYSTEMATIC REVIEW REGISTRATION This umbrella review protocol has been registered with PROSPERO CRD42017068357 .
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Affiliation(s)
- Yannish Naik
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Health Sciences (LIHS), Level 10, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | | | - Ian Walker
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
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Gebremariam MK, Lien N, Nianogo RA, Arah OA. Mediators of socioeconomic differences in adiposity among youth: a systematic review. Obes Rev 2017; 18:880-898. [PMID: 28434193 DOI: 10.1111/obr.12547] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Youth with a low socioeconomic position in developed countries are at a disproportionately higher risk of being overweight or obese than their counterparts. Tackling these inequalities requires that the mechanisms behind them are well understood. OBJECTIVES The aim of this review was to summarize existing evidence regarding the factors that mediate or contribute to the explanation of the relationship between socioeconomic position and adiposity among youth. METHODS AND RESULTS A systematic literature search, conducted using the databases Medline, Embase, Web of Science and PsycINFO, yielded 28 eligible studies. These studies were of low to moderate methodological quality. The most consistent mediators of the association between socioeconomic position and adiposity identified in this review were as follows: consumption of sugar-sweetened beverages, television viewing, computer use, parental body mass index, breastfeeding duration, breakfast consumption, maternal smoking during pregnancy and infant feeding practices. The mediating role of physical activity as well as fruit and vegetable consumption was found to be indeterminate. Other potential mediators were explored in too few studies to make conclusions about their mediating role. CONCLUSION The review found several modifiable factors that could be targeted as feasible in interventions aimed at reducing socioeconomic differences in overweight and obesity among youth.
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Affiliation(s)
- M K Gebremariam
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA.,Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - N Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - R A Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - O A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA.,UCLA Center for Health Policy Research, Los Angeles, California, USA.,California Center for Population Research, UCLA, Los Angeles, California, USA
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Ulijaszek SJ, Pentecost M, Marcus C, Karpe F, Frühbeck G, Nowicka P. Inequality and childhood overweight and obesity: a commentary. Pediatr Obes 2017; 12:195-202. [PMID: 26990034 DOI: 10.1111/ijpo.12128] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/17/2016] [Indexed: 02/02/2023]
Abstract
Statements on childhood overweight and obesity (COO) have focused on different avenues for prevention and treatment, critical stages of the life cycle, including pregnancy and lactation, individual, family, school and community-based interventions, multidisciplinary family programmes and multicomponent interventions. This commentary is concerned with the less-addressed relationship between COO and inequality. It describes current global patterns of inequality and COO and the ways in which those inequalities are linked to COO at micro-level, meso-level and macro-level. It then describes current programmatic approaches for COO inequality, preventive and medical, and considers important pitfalls in the framing of the problem of COO and inequality. It ends with describing how childhood and adolescent overweight and obesity prevention and treatment programmes might be formulated within broader socio-political frameworks to influence outcomes.
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Affiliation(s)
- S J Ulijaszek
- School of Anthropology, University of Oxford, Oxford, UK
| | - M Pentecost
- School of Anthropology, University of Oxford, Oxford, UK
| | - C Marcus
- Karolinska Institutet, Stockholm, Sweden
| | - F Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - G Frühbeck
- Department of Endocrinology and Nutrition, Clinica Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain
| | - P Nowicka
- Karolinska Institutet, Stockholm, Sweden.,Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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Abstract
PURPOSE OF REVIEW The aim of this current narrative review is to critique the scope and value of recent studies with a focus on obesity-related health promotion in faith organizations. RECENT FINDINGS Electronic database searches, scanning of the reference lists of identified articles, and hand searching of journals for articles written in English and published in 2013-2016 revealed 16 studies. Half of the studies involved African-Americans, in churches and with predominantly female participants. Research among other ethnic groups was more likely to be exploratory. All of the 11 studies reporting the impact of programmes on weight-related measures showed favourable outcomes. However, due to study limitations (small sample size, short duration, attrition), significant unbiased effects cannot yet be concluded for most of the interventions reviewed. Study strengths included application of theory in community engagement and detailed description of cultural tailoring. Faith organizations show promise as settings for obesity prevention among high-risk groups, particularly African-Americans. Support for progressing formative work to adequately powered, randomized controlled trials is vital. Wider involvement of diverse faith settings and targeting obesity in men and childhood would be valuable developments.
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Affiliation(s)
- Maria J Maynard
- School of Clinical & Applied Sciences, Leeds Beckett University, City Campus, CL 413, Calverley Building, Leeds, LS1 3HE, UK.
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Socio-economic life course and obesity among adults in Florianopolis, southern Brazil. GACETA SANITARIA 2017; 32:244-250. [PMID: 28364961 DOI: 10.1016/j.gaceta.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To estimate the association between socio-economic life course and body mass index (BMI), waist circumference (WC) and general and abdominal obesity in adults. METHODS A cross-sectional analysis of a population-based cohort study of 1,222 adults (aged 22-63) from Florianopolis, southern Brazil. The socio-economic life course was analysed using the educational level of participants and their parents. Height, weight and WC were measured by specially trained staff. Linear and logistic regressions were used with adjustment for confounding factors, and data were stratified according to sex. RESULTS Mean BMI and WC were about 2kg/m2 (95% CI: -3.3 to -0.7) and 6cm (95% CI: -9.7 to -2.9) lower in women with a high socio-economic position, while the association was reversed in men with a high socio-economic position, with WC being about 4cm higher (95% CI: 0.1 to 7.5). In addition, women who had always been in a high socio-economic position were less likely to have abdominal obesity (OR: 0.38; 95% CI: 0.20 to 0.76) while no such association was found in men. CONCLUSION Socio-economic life course influences BMI, WC and obesity, with differences between males and females, thereby indicating that public policies that contemplate a socio-economic life course approach can be effective for controlling obesity.
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Bambra C. Task-based weight management programme delivered in primary care promotes better long-term weight loss among women from lower socioeconomic groups than usual practice. Evid Based Nurs 2017; 20:54-55. [PMID: 28188236 DOI: 10.1136/eb-2016-102585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Clare Bambra
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
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36
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Hillier-Brown FC, Summerbell CD, Moore HJ, Routen A, Lake AA, Adams J, White M, Araujo-Soares V, Abraham C, Adamson AJ, Brown TJ. The impact of interventions to promote healthier ready-to-eat meals (to eat in, to take away or to be delivered) sold by specific food outlets open to the general public: a systematic review. Obes Rev 2017; 18:227-246. [PMID: 27899007 PMCID: PMC5244662 DOI: 10.1111/obr.12479] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Ready-to-eat meals sold by food outlets that are accessible to the general public are an important target for public health intervention. We conducted a systematic review to assess the impact of such interventions. METHODS Studies of any design and duration that included any consumer-level or food-outlet-level before-and-after data were included. RESULTS Thirty studies describing 34 interventions were categorized by type and coded against the Nuffield intervention ladder: restrict choice = trans fat law (n = 1), changing pre-packed children's meal content (n = 1) and food outlet award schemes (n = 2); guide choice = price increases for unhealthier choices (n = 1), incentive (contingent reward) (n = 1) and price decreases for healthier choices (n = 2); enable choice = signposting (highlighting healthier/unhealthier options) (n = 10) and telemarketing (offering support for the provision of healthier options to businesses via telephone) (n = 2); and provide information = calorie labelling law (n = 12), voluntary nutrient labelling (n = 1) and personalized receipts (n = 1). Most interventions were aimed at adults in US fast food chains and assessed customer-level outcomes. More 'intrusive' interventions that restricted or guided choice generally showed a positive impact on food-outlet-level and customer-level outcomes. However, interventions that simply provided information or enabled choice had a negligible impact. CONCLUSION Interventions to promote healthier ready-to-eat meals sold by food outlets should restrict choice or guide choice through incentives/disincentives. Public health policies and practice that simply involve providing information are unlikely to be effective.
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Affiliation(s)
- F C Hillier-Brown
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - C D Summerbell
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - H J Moore
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - A Routen
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A A Lake
- Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.,Centre for Public Policy & Health, School of Medicine, Pharmacy & Health, Durham University, Stockton-on-Tees, UK
| | - J Adams
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M White
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - V Araujo-Soares
- Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - C Abraham
- Psychology Applied to Heath, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - A J Adamson
- Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK.,Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK
| | - T J Brown
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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Bann D, Johnson W, Li L, Kuh D, Hardy R. Socioeconomic Inequalities in Body Mass Index across Adulthood: Coordinated Analyses of Individual Participant Data from Three British Birth Cohort Studies Initiated in 1946, 1958 and 1970. PLoS Med 2017; 14:e1002214. [PMID: 28072856 PMCID: PMC5224787 DOI: 10.1371/journal.pmed.1002214] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/01/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND High body mass index (BMI) is an important contributor to the global burden of ill-health and health inequality. Lower socioeconomic position (SEP) in both childhood and adulthood is associated with higher adult BMI, but how these associations have changed across time is poorly understood. We used longitudinal data to examine how childhood and adult SEP relates to BMI across adulthood in three national British birth cohorts. METHODS AND FINDINGS The sample comprised up to 22,810 participants with 77,115 BMI observations in the 1946 MRC National Survey of Health and Development (ages 20 to 60-64), the 1958 National Child Development Study (ages 23 to 50), and the 1970 British Cohort Study (ages 26 to 42). Harmonized social class-based SEP data (Registrar General's Social Class) was ascertained in childhood (father's class at 10/11 y) and adulthood (42/43 years), and BMI repeatedly across adulthood, spanning 1966 to 2012. Associations between SEP and BMI were examined using linear regression and multilevel models. Lower childhood SEP was associated with higher adult BMI in both genders, and differences were typically larger at older ages and similar in magnitude in each cohort. The strength of association between adult SEP and BMI did not vary with age in any consistent pattern in these cohorts, but were more evident in women than men, and inequalities were larger among women in the 1970 cohort compared with earlier-born cohorts. For example, mean differences in BMI at 42/43 y amongst women in the lowest compared with highest social class were 2.0 kg/m2 (95% CI: -0.1, 4.0) in the 1946 NSHD, 2.3 kg/m2 (1.1, 3.4) in the 1958 NCDS, and 3.9 kg/m2 (2.3, 5.4) the in the 1970 BCS; mean (SD) BMI in the highest and lowest social classes were as follows: 24.9 (0.8) versus 26.8 (0.7) in the 1946 NSHD, 24.2 (0.4) versus 26.5 (0.4) in the 1958 NCDS, and 24.2 (0.3) versus 28.1 (0.8) in the 1970 BCS. Findings did not differ whether using overweight or obesity as an outcome. Limitations of this work include the use of social class as the sole indicator of SEP-while it was available in each cohort in both childhood and adulthood, trends in BMI inequalities may differ according to other dimensions of SEP such as education or income. Although harmonized data were used to aid inferences about birth cohort differences in BMI inequality, differences in other factors may have also contributed to findings-for example, differences in missing data. CONCLUSIONS Given these persisting inequalities and their public health implications, new and effective policies to reduce inequalities in adult BMI that tackle inequality with respect to both childhood and adult SEP are urgently required.
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Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, UCL Institute of Education, London, United Kingdom
- * E-mail:
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Leah Li
- Population, Policy and Practice, UCL Institute of Child Health, London, United Kingdom
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
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Mantziki K, Renders CM, Vassilopoulos A, Radulian G, Borys JM, du Plessis H, Gregório MJ, Graça P, de Henauw S, Handjiev S, Visscher TLS, Seidell JC. Inequalities in energy-balance related behaviours and family environmental determinants in European children: changes and sustainability within the EPHE evaluation study. Int J Equity Health 2016; 15:160. [PMID: 27680964 PMCID: PMC5041563 DOI: 10.1186/s12939-016-0438-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background Increasing social inequalities in health across Europe are widening the gap between low and high socio-economic groups, notably in the prevalence of obesity. Public health interventions may result in differential effects across population groups. Therefore, the EPHE (EPODE for the Promotion of Health Equity) project analysed the added value of community-based programmes, based on the EPODE (Ensemble Prévenons l’Obésité Des Enfants-Together Let’s Prevent Obesity) model, to reduce socio-economic inequalities in energy balance-related behaviours of children and their family-environmental related determinants in seven European communities. This study presents the changes between baseline and follow-up after the one-year interventions and their sustainability one year after. Methods This is a prospective study with a one school-year intervention, followed by one year of follow-up. In all, 1266 children (age 6-8 years) and their families from different socio-economic backgrounds were recruited at baseline. For 1062 children, information was available after one year (T1) and for 921 children after two years (T2). A self-reported questionnaire was completed by the parents to examine the children’s energy balance-related behaviours and family- environmental determinants. Socio-economic status was defined by the educational level of the mother. The Wilcoxon signed-rank test for paired data was used to test the differences between baseline and intermediate, and between intermediate and final, measurements for each of the socio-economic status groups. Results Post-intervention effects in energy-balance related behaviours showed the following improvements among the low socio-economic status groups: increased fruit consumption (Netherlands), decreased fruit juices amount consumed (Romania) and decreased TV time on weekdays (Belgium). Whereas in only the latter case the behavioural change was accompanied with an improvement in a family-environmental determinant (monitoring the time the child watches TV), other improvements in parental rules and practices related to soft drinks/fruit juices and TV exposure were observed. A few of those effects were sustainable, notably in the case of Belgium. Conclusions Inequalities in obesity-related behaviours could be potentially reduced when implementing community-based interventions, tailored to inequality gaps and using the EPODE methodology. Within-group changes varied widely, whereas monitoring of interventions and process evaluation are crucial to understand the observed results. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0438-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Krystallia Mantziki
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.
| | - Carry M Renders
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
| | - Achilleas Vassilopoulos
- Department of Agricultural Economics and Rural Development, Agricultural University of Athens, Athens, Greece
| | | | | | | | - Maria João Gregório
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Pedro Graça
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Directorate General of Health, Lisbon, Portugal
| | | | - Svetoslav Handjiev
- Bulgarian Association for the study of Obesity and related diseases, Sofia, Bulgaria
| | - Tommy L S Visscher
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.,Research Centre for the Prevention of Overweight, Windesheim University of Applied Sciences Zwolle, Zwolle, The Netherlands.,Research Centre for the Prevention of Overweight, VU University, Zwolle, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
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Thomson K, Bambra C, McNamara C, Huijts T, Todd A. The effects of public health policies on population health and health inequalities in European welfare states: protocol for an umbrella review. Syst Rev 2016; 5:57. [PMID: 27059307 PMCID: PMC4826536 DOI: 10.1186/s13643-016-0235-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/04/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The welfare state is potentially an important macro-level determinant of health that also moderates the extent, and impact, of socio-economic inequalities in exposure to the social determinants of health. The welfare state has three main policy domains: health care, social policy (e.g. social transfers and education) and public health policy. This is the protocol for an umbrella review to examine the latter; its aim is to assess how European welfare states influence the social determinants of health inequalities institutionally through public health policies. METHODS/DESIGN A systematic review methodology will be used to identify systematic reviews from high-income countries (including additional EU-28 members) that describe the health and health equity effects of upstream public health interventions. Interventions will focus on primary and secondary prevention policies including fiscal measures, regulation, education, preventative treatment and screening across ten public health domains (tobacco; alcohol; food and nutrition; reproductive health services; the control of infectious diseases; screening; mental health; road traffic injuries; air, land and water pollution; and workplace regulations). Twenty databases will be searched using a pre-determined search strategy to evaluate population-level public health interventions. DISCUSSION Understanding the impact of specific public health policy interventions will help to establish causality in terms of the effects of welfare states on population health and health inequalities. The review will document contextual information on how population-level public health interventions are organised, implemented and delivered. This information can be used to identify effective interventions that could be implemented to reduce health inequalities between and within European countries. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016025283.
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Affiliation(s)
- Katie Thomson
- Centre for Health and Inequalities Research, Department of Geography, Durham University, Lower Mountjoy, South Road, Durham, DH1 3LE, UK.
| | - Clare Bambra
- Centre for Health and Inequalities Research, Department of Geography, Durham University, Lower Mountjoy, South Road, Durham, DH1 3LE, UK
| | - Courtney McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Dragvoll, Building 9, Level 5, 7491, Trondheim, Norway
| | - Tim Huijts
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58 Turner Street, Whitechapel, London, E1 2AB, UK
| | - Adam Todd
- Centre for Health and Inequalities Research, Department of Geography, Durham University, Lower Mountjoy, South Road, Durham, DH1 3LE, UK.,Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, TS17 6BH, UK
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40
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Brown TJ, Todd A, O’Malley CL, Moore HJ, Husband AK, Bambra C, Kasim A, Sniehotta FF, Steed L, Summerbell CD. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe Department of Health has identified interventions to manage alcohol misuse, smoking and overweight, delivered by community pharmacists, as public health priorities.ObjectivesTo systematically review the effectiveness of community pharmacy interventions to manage alcohol misuse, smoking cessation and weight loss; to explore if and how age, sex, ethnicity and socioeconomic status moderate effectiveness; and to describe how the interventions have been organised, implemented and delivered.Data sourcesTen electronic databases were searched: Applied Social Sciences Index and Abstracts; Cumulative Index to Nursing and Allied Health Literature; EMBASE; International Bibliography of the Social Sciences; MEDLINE; NHS Economic Evaluation Database; PsycINFO; Social Science Citation Index; Scopus; and the Sociological Abstracts from inception to May 2014. There was no restriction on language or country. Supplementary searches included website, grey literature, study registers, bibliographies and contacting experts.Review methodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Any type of intervention of any duration based in any country and in people of any age was included. The review included interventions set in a community pharmacy and delivered by the pharmacist or the wider pharmacy team. Randomised controlled trials, non-randomised controlled trials, controlled before-and-after studies and interrupted time series studies were included. Data extraction and quality assessment were conducted independently for each study by two reviewers. Meta-analysis and narrative synthesis were also conducted.ResultsThe searches identified over 14,000 records, of which 24 studies were included. There were two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. Pharmacy-based smoking cessation interventions including behavioural support and/or nicotine replacement therapy are effective and cost-effective in helping adults to stop smoking, particularly when compared with usual care. The pooled odds ratio of the intervention effects for smoking cessation was 1.85 (95% confidence interval 1.25 to 2.75). It is currently unknown which specific types of smoking cessation interventions are the most effective. There was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions. Evidence suggests that pharmacy-based weight-loss interventions are as effective as similar interventions in other primary care settings, but not as effective or cost-effective as commercially provided weight management services based in community settings. None of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.LimitationsThe information reported in the publications of included studies did not allow us to assess in detail if and how age, sex, ethnicity and socioeconomic status moderate effectiveness, or to describe how the interventions had been organised, implemented and delivered.ConclusionsCommunity pharmacy interventions are effective for smoking cessation. Evaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. The effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness.Study registrationThis study is registered as PROSPERO CRD42013005943.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Tamara J Brown
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
- Fuse, UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
| | - Adam Todd
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
- Fuse, UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
- Centre for Health and Inequalities Research, Department of Geography, Durham University, Durham, UK
| | - Claire L O’Malley
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
- Fuse, UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
| | - Helen J Moore
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
- Fuse, UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
| | - Andrew K Husband
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
- Fuse, UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
| | - Clare Bambra
- Fuse, UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
- Centre for Health and Inequalities Research, Department of Geography, Durham University, Durham, UK
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
| | - Falko F Sniehotta
- Fuse, UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Liz Steed
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carolyn D Summerbell
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
- Fuse, UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Durham, Stockton-on-Tees, UK
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41
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Brown TJ, Todd A, O'Malley C, Moore HJ, Husband AK, Bambra C, Kasim A, Sniehotta FF, Steed L, Smith S, Nield L, Summerbell CD. Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation. BMJ Open 2016; 6:e009828. [PMID: 26928025 PMCID: PMC4780058 DOI: 10.1136/bmjopen-2015-009828] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/26/2015] [Accepted: 01/11/2016] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management. DESIGN Systematic review and meta-analyses. 10 electronic databases were searched from inception to May 2014. ELIGIBILITY CRITERIA FOR SELECTING STUDIES STUDY DESIGN randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series. INTERVENTION any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language. RESULTS 19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 'strong', 4 'moderate' and 9 'weak'. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions. CONCLUSIONS Community pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services.
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Affiliation(s)
- Tamara J Brown
- School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees, UK FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees, UK
| | - Adam Todd
- School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees, UK FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees, UK Centre for Health and Inequalities Research, Department of Geography, Durham University, Durham, UK
| | - Claire O'Malley
- School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees, UK FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees, UK
| | - Helen J Moore
- School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees, UK FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees, UK
| | - Andrew K Husband
- School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees, UK FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees, UK
| | - Clare Bambra
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees, UK Centre for Health and Inequalities Research, Department of Geography, Durham University, Durham, UK
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees, UK
| | - Falko F Sniehotta
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Liz Steed
- Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Sarah Smith
- School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees, UK FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees, UK
| | - Lucie Nield
- Sheffield Business School, Sheffield Hallam University, Sheffield, UK
| | - Carolyn D Summerbell
- School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees, UK FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton-on-Tees, UK
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Lissner L, Wijnhoven TMA, Mehlig K, Sjöberg A, Kunesova M, Yngve A, Petrauskiene A, Duleva V, Rito AI, Breda J. Socioeconomic inequalities in childhood overweight: heterogeneity across five countries in the WHO European Childhood Obesity Surveillance Initiative (COSI-2008). Int J Obes (Lond) 2016; 40:796-802. [PMID: 27136760 PMCID: PMC4856730 DOI: 10.1038/ijo.2016.12] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 11/17/2015] [Accepted: 12/09/2015] [Indexed: 11/23/2022]
Abstract
Background: Excess risk of childhood overweight and obesity occurring in socioeconomically disadvantaged families has been demonstrated in numerous studies from high-income regions, including Europe. It is well known that socioeconomic characteristics such as parental education, income and occupation are etiologically relevant to childhood obesity. However, in the pan-European setting, there is reason to believe that inequalities in childhood weight status may vary among countries as a function of differing degrees of socioeconomic development and equity. Subjects and Methods: In this cross-sectional study, we have examined socioeconomic differences in childhood obesity in different parts of the European region using nationally representative data from Bulgaria, the Czech Republic, Lithuania, Portugal and Sweden that were collected in 2008 during the first round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Results: Heterogeneity in the association between parental socioeconomic indicators and childhood overweight or obesity was clearly observed across the five countries studied. Positive as well as negative associations were observed between parental socioeconomic indicators and childhood overweight, with statistically significant interactions between country and parental indicators. Conclusions: These findings have public health implications for the WHO European Region and underscore the necessity to continue documenting socioeconomic inequalities in obesity in all countries through international surveillance efforts in countries with diverse geographic, social and economic environments. This is a prerequisite for universal as well as targeted preventive actions.
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Affiliation(s)
- L Lissner
- Section for Epidemiology and Community Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - T M A Wijnhoven
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen Ø, Denmark
| | - K Mehlig
- Section for Epidemiology and Community Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - A Sjöberg
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - M Kunesova
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - A Yngve
- School of Hospitality, Culinary Arts and Meal Science, Örebro University, Grythyttan, Sweden
| | - A Petrauskiene
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - V Duleva
- Department of Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - A I Rito
- Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - J Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen Ø, Denmark
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43
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Lissner L, De Bourdeaudhuij I, Konstabel K, Mårild S, Mehlig K, Molnár D, Moreno LA, Pigeot I, Siani A, Tornaritis M, Williams G. Differential outcome of the IDEFICS intervention in overweight versus non-overweight children: did we achieve 'primary' or 'secondary' prevention? Obes Rev 2015; 16 Suppl 2:119-26. [PMID: 26707021 DOI: 10.1111/obr.12326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 08/30/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to explore whether the IDEFICS intervention had a differential effect on 11,041 children's weight trajectories depending on their baseline body mass index status. METHODS Two subgroups of children are considered in the present analysis: those who were overweight or obese prior to the intervention and those who were neither overweight nor obese. RESULTS Among children in all eight countries who did not have prevalent overweight or obesity (OWOB) at baseline, 2 years later, there was no significant difference between intervention and control groups in risk of having developed OWOB. However, we observed a strong regional heterogeneity, which could be attributed to the presence of one distinctly outlying country, Belgium, where the intervention group had increased risk for becoming overweight. In contrast, among the sample of children with prevalent OWOB at baseline, we observed a significantly greater probability of normalized weight status after 2 years. In other words, a protective effect against persistent OWOB was observed in children in intervention regions compared with controls, which corresponded to an adjusted odds ratio of 0.76 (95% confidence interval: 0.58, 0.98). DISCUSSION This analysis thus provided evidence of a differential effect of the IDEFICS intervention, in which children with overweight may have benefited without having been specifically targeted. However, no overall primary preventive effect could be observed in children without initial overweight or obesity.
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Affiliation(s)
- L Lissner
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - K Konstabel
- Research Centre, National Institute for Health Development, Tallinn, Estonia
| | - S Mårild
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Mehlig
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition, and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - A Siani
- Epidemiology & Population Genetics, Institute of Food Sciences, CNR, Avellino, Italy
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - G Williams
- Department of Politics, Philosophy & Religion, Lancaster University, Lancaster, UK
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