Exploring subgroup effects by socioeconomic position of three effective school-based dietary interventions: the European TEENAGE project

Lien, Nanna; Haerens, Leen; Velde, Saskia te; Mercken, Liesbeth; Klepp, Knut‐Inge; Moore, Linda; Bourdeaudhuij, Ilse De; Faggiano, Fabrizio; Lenthe, Frank van

doi:10.1007/s00038-013-0524-8

Cited by 8 publications

(11 citation statements)

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“…Differential effects were sometimes reported in separate articles or across multiple papers [ 55 – 61 ]. One additional study was reanalysed as part of project TEENAGE [ 24 ], providing a total of 20 studies for synthesis. Although the collection of measures of SES has become substantially more common in more recent studies (from 26/42 earlier studies to 45/56 more recent studies), their use to evaluate differential effects has increased very little.…”

Section: Resultsmentioning

confidence: 99%

“…family level measures such as parental education, occupation or income, or school-level measures such as free school meal entitlement) and presented using harvest plot methodology [ 32 ]. Consistent with Project TEENAGE [ 24 ], we included measures of parental education, occupation or income, as well as school-level measures such as area deprivation or free school meal entitlement levels. Effects of interventions were separated by school and family level measure, although no further disaggregation was possible with this number of studies.…”

Section: Methodsmentioning

confidence: 99%

“…A recent review of equity impacts of tobacco control policies, identified 5 childhood studies which reported effects by SES [ 20 ], including 2 in a school setting. One study reanalysing European trials of ‘effective’ interventions in four behavioural domains (smoking, diet, physical activity and alcohol use) reported that effects often varied by SES, but drew few conclusions regarding why due to the small number of studies [ 21 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic gradients in the effects of universal school-based health behaviour interventions: a systematic review of intervention studies

et al. 2015

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BackgroundSocioeconomic inequalities in health behaviour emerge in early life before tracking into adulthood. Many interventions to improve childhood health behaviours are delivered via schools, often targeting poorer areas. However, targeted approaches may fail to address inequalities within more affluent schools. Little is known about types of universal school-based interventions which make inequalities better or worse.MethodsSeven databases were searched using a range of natural language phrases, to identify trials and quasi-experimental evaluations of universal school-based interventions focused on smoking, alcohol, diet and/or physical activity, published from 2008–14. Articles which examined differential effects by socioeconomic status (N = 20) were synthesised using harvest plot methodology. Content analysis of 98 intervention studies examined potential reasons for attention or inattention to effects on inequality.ResultsSearches identified approximately 12,000 hits. Ninety-eight evaluations were identified, including 90 completed studies, of which 20 reported effects on SES inequality. There were substantial geographical biases in reporting of inequality, with only 1 of 23 completed North American studies testing differential effects, compared to 15 out of 52 completed European studies. Studies reported a range of positive, neutral or negative SES gradients in effects. All studies with a negative gradient in effect (i.e. which widened inequality) included educational components alone or in combination with environmental change or family involvement. All studies with positive gradients in effects included environmental change components, alone or combined with education. Effects of multi-level interventions on inequality were inconsistent. Content analyses indicated that in approximately 1 in 4 studies SES inequalities were discussed in defining the problem or rationale for intervention. Other potential barriers to testing effect on inequality included assumptions that universal delivery guaranteed universal effect, or that interventions would work better for poorer groups because they had most to gain.ConclusionsUniversal school-based interventions may narrow, widen or have no effect on inequality. There is a significant need for more routine testing of the effects of such interventions on inequality to enable firmer conclusions regarding types of interventions which affect inequality.PROSPERO registration numberCRD42014014548Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2244-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Socioeconomic gradients in the effects of universal school-based health behaviour interventions: a systematic review of intervention studies

et al. 2015

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“…Researchers have cited similar difficulties in being able to find studies that conduct subgroup analyses, that measure socioeconomic variables at baseline or that are powered to detect differences by demographic groups [11, 15, 22, 46]. The TEENAGE project reanalysed interventions targeting any of four risk behaviours (smoking, diet, physical activity and alcohol) for differential effects by SES, but was limited by the small number of studies that collected demographic information [26, 47]. Moore et al [11] conducted a systematic review of school-based health interventions but could only draw tentative conclusions due to a small sample and called for more routine testing of effects of interventions on inequality.…”

Section: Discussionmentioning

confidence: 99%

Examining subgroup effects by socioeconomic status of public health interventions targeting multiple risk behaviour in adolescence

et al. 2018

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BackgroundMultiple risk behaviour (MRB) refers to two or more risk behaviours such as smoking, drinking alcohol, poor diet and unsafe sex. Such behaviours are known to co-occur in adolescence. It is unknown whether MRB interventions are equally effective for young people of low and high socioeconomic status (SES). There is a need to examine these effects to determine whether MRB interventions have the potential to narrow or widen inequalities.MethodsTwo Cochrane systematic reviews that examined interventions to reduce adolescent MRB were screened to identify universal interventions that reported SES. Study authors were contacted, and outcome data stratified by SES and intervention status were requested. Risk behaviour outcomes alcohol use, smoking, drug use, unsafe sex, overweight/obesity, sedentarism, peer violence and dating violence were examined in random effects meta-analyses and subgroup analyses conducted to explore differences between high SES and low SES adolescents.ResultsOf 49 studies reporting universal interventions, only 16 also reported having measured SES. Of these 16 studies, four study authors provided data sufficient for subgroup analysis. There was no evidence of subgroup differences for any of the outcomes. For alcohol use, the direction of effect was the same for both the high SES group (RR 1.26, 95% CI: 0.96, 1.65, p = 0.09) and low SES group (RR 1.14, 95% CI: 0.98, 1.32, p = 0.08). The direction of effect was different for smoking behaviour in favour of the low SES group (RR 0.83, 95% CI: 0.66, 1.03, p = 0.09) versus the high SES group (RR 1.16, 95% CI: 0.82, 1.63, p = 0.39). For drug use, the direction of effect was the same for both the high SES group (RR 1.29, 95% CI: 0.97, 1.73, p = 0.08) and the low SES group (RR 1.28, 95% CI: 0.84, 1.96, p = 0.25).ConclusionsThe majority of studies identified did not report having measured SES. There was no evidence of subgroup difference for all outcomes analysed among the four included studies. There is a need for routine reporting of demographic information within studies so that stronger evidence of effect by SES can be demonstrated and that interventions can be evaluated for their impact on health inequalities.

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“…Parents from low socio economic position may be less receptive to the parental component in the Boost intervention and may not possess the resources necessary to act upon the knowledge acquired from the Boost intervention. Other studies exploring socioeconomically differential effects of health behavior interventions show inconsistent results [44, 45]. …”

Section: Discussionmentioning

confidence: 99%

Parental involvement and association with adolescents’ fruit and vegetable intake at follow-up: Process evaluation results from the multi-component school-based Boost intervention

Jørgensen

Jørgensen²,

Aarestrup

et al. 2016

Int J Behav Nutr Phys Act

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BackgroundBased on the assumption of parental influence on adolescent behavior, multicomponent school-based dietary interventions often include a parental component. The effect of this intervention component is seldom reported and the evidence is inconsistent. We conducted a systematic process evaluation of the parental component and examined whether the leveal of parental involvement in a large multi-component intervention: the Boost study was associated with adolescents’ fruit and vegetable (FV) intake at follow-up.MethodsThe Boost study was targeting FV intake among 1,175 Danish 7th graders (≈13- year-olds) in the school year 2010/11. The study included a school component: free FV in class and curricular activities; a local community component: fact sheets for sports- and youth clubs; and a parental component: presentation of Boost at a parent-school meeting, 6 newsletters to parents, 3 guided student-parent curricular activities, and a student-parent Boost event. Study population: Students whose parent replied to the follow-up survey (n = 347). Data: Questionnaire data from students, parents and teachers at 20 intervention schools. Process evaluation measures: dose delivered, dose received, appreciation and level of parental involvement. Parental involvement was trichotomized into: low/no (0–2 points), medium (3 points) and high (4–6 points). The association between level of parental involvement and self-reported FV intake (24-h recall), was analyzed using multilevel regression analyses.ResultsThe Boost study was presented at a parent-school meeting at all intervention schools. The dose delivered was low to moderate for the three other parental elements. Most parents appreciated the intervention and talked with their child about Boost (83.5 %). High, medium and low parental involvement was found among 30.5 %, 29.6 % and 39.4 % of the students respectively. Parental involvement was highest among women. More men agreed that the parental newsletters provided new information.Students with a medium and high level of parental involvement ate 47.5 and 95.2 g more FV per day compared to students with low level/no parental involvement (p = 0.02).ConclusionsStudents with a high level of parental involvement ate significantly more FV at follow-up compared to students with a low level/no parental involvement. Parental involvement in interventions may improve adolescents’ FV intake if challenges of implementation can be overcome.Trial registration ISRCTN11666034. Registered 06/01/2012. Retrospectively registered.

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Exploring subgroup effects by socioeconomic position of three effective school-based dietary interventions: the European TEENAGE project

Abstract: Reanalysing intervention studies by SEP is a quick and easy way to explore patterns in effects by SEP across interventions. Providing healthy food might be a promising strategy for decreasing social inequalities.

Cited by 8 publications

References 32 publications

Socioeconomic gradients in the effects of universal school-based health behaviour interventions: a systematic review of intervention studies

Socioeconomic gradients in the effects of universal school-based health behaviour interventions: a systematic review of intervention studies

Examining subgroup effects by socioeconomic status of public health interventions targeting multiple risk behaviour in adolescence

Parental involvement and association with adolescents’ fruit and vegetable intake at follow-up: Process evaluation results from the multi-component school-based Boost intervention

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