Background Chronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas. Objective This is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping. Methods A systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool. Results As of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022. Conclusions This systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations. Trial Registration PROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=294119 International Registered Report Identifier (IRRID) PRR1-10.2196/35408

No abstract

Disadvantaged adolescents such as those of low socioeconomic and geographically remote backgrounds experience disproportionate chronic disease burden and tend to engage in greater risk behaviors including poor diet, alcohol use, tobacco smoking, and vaping. The social, structural, and economical barriers to health that uniquely affect adolescents of low socioeconomic and geographically remote backgrounds, such as stigma, access to and affordability of services, may partially explain their disadvantage in attaining health equity. Universal eHealth interventions can provide effective prevention, however, it is unclear whether they benefit disadvantaged adolescents, including those from low socioeconomic and geographically remote contexts. This study systematically reviewed the effectiveness of eHealth interventions targeting disadvantaged adolescents in preventing poor diet, alcohol use, tobacco smoking and vaping. Of 3278 identified records, 15 publications assessing 14 interventions were included, comprising 7170 youth (aged 9–18 years, 50.1% female, 56% low-mid SES, 33% remote). Nine interventions targeted poor diet, three targeted alcohol, one targeted tobacco, and one targeted alcohol and tobacco. No interventions targeted vaping. eHealth interventions significantly increased fruit and vegetable intake and percentage energy of nutrient-rich food, decreased sugar-sweetened beverage consumption, total energy intake, nutrient-poor food percentage energy consumption, and were associated with reduced binge drinking at 1-month follow-up among intervention completers. The findings of this study highlight that eHealth interventions can be effective in targeting poor diet and alcohol use among disadvantaged adolescents. However, due to the limited number of studies meeting inclusion criteria for this study, it is critical future research focus on developing and evaluating effective eHealth interventions targeting disadvantaged adolescents.

BACKGROUND Chronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas. OBJECTIVE This is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping. METHODS A systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool. RESULTS As of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022. CONCLUSIONS This systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations. CLINICALTRIAL PROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=294119 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/35408