Inequities in energy-balance related behaviours and family environmental determinants in European children: baseline results of the prospective EPHE evaluation study

Abstract

BackgroundTackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socio-economic status.MethodsThis study is part of the Epode for the Promotion of Health Equity (EPHE) evaluation study, the overall aim of which is to assess the impact and sustainability of EPODE methodology to diminish inequalities in childhood obesity and overweight. Seven community-based programmes from different European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands) participate in the EPHE study. In each of the communities, children aged 6–8 years participated, resulting in a total sample of 1266 children and their families. A parental self-administrated questionnaire was disseminated in order to assess the socio-economic status of the household, selected energy balance-related behaviours (1. fruit and vegetable consumption; 2. soft drink/ fruit juices and water consumption; 3. screen time and 4. sleep duration) of the children and associated family environmental determinants. The Mann–Whitney U test and Pearson’s chi-square test were used to test differences between the low and high education groups. The country-specific median was chosen as the cut-off point to determine the educational level, given the different average educational level in every country.ResultsChildren with mothers of relatively high educational level consumed fruits and vegetables more frequently than their peers of low socio-economic status. The latter group of children had a higher intake of fruit juices and/or soft drinks and had higher screen time. Parental rules and home availability were consistently different between the two socio-economic groups in our study in all countries. However we did not find a common pattern for all behaviours and the variability across the countries was large.ConclusionsOur findings are indicative of socio-economic inequalities in our samples, although the variability across the countries was large. The effectiveness of interventions aimed at chancing parental rules and behaviour on health inequalities should be studied.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2540-5) contains supplementary material, which is available to authorized users.

Inequalities in energy-balance related behaviours and family environmental determinants in European children: changes and sustainability within the EPHE evaluation study

“…This study aims: a) to identify differences in energy balance-related behaviours and related family-environmental determinants, between high and low status socio-economic groups, b) to assess the potential decrease of inequality gaps after tailored interventions and c) to assess the sustainability of potential improvements a year after the termination of the interventions. More information about the identified health inequalities within the EPHE study can be found elsewhere [ 31 ].…”

“…The EPHE programmes developed and implemented general community-based interventions for the selected behaviours towards the whole community, but primarily of children and parents, between September-December 2013. After the dissemination of the baseline results (September 2013), the programmes were instructed to conduct interventions tailored to the inequality gaps identified at baseline [ 31 ]. The EPHE Operational Board, comprising the national programme coordinators of each of the participant programmes, was responsible for the continuous training, empowerment and support of the local project managers of the communities, to design and implement the activities in accordance to the EPODE methodology.…”

“… ▪ The programmes recruited (at baseline) families with children aged between 6 to 9 years old from different socio-economic backgrounds, through schools. ▪ The programmes developed interventions for the whole population, each addressing the relevant inequality gaps identified at baseline [ 31 ]. ▪ Intervention target: to improve energy balance-related behaviours and their family-environmental determinants of low socio-economic status families with children 6-9 years old ▪ Evaluation of the interventions’ effects after the intervention period and sustainability assessment a year after [ 33 ].…”

“…The EPHE programmes developed community-based interventions (September 2013-May 2014) addressing the four behaviours and related determinants which were unhealthier in the low socio-economic groups than in the high socio-economic groups [ 31 ]. Therefore, the objectives of the current paper are: a) to assess changes in energy-balance related behaviours and family-environmental determinants within both the high and the low education groups by comparing the baseline (T 0 ) with the intermediate (T 1 ) measurements, after the termination of the interventions, after one year; b) to assess the sustainability of potential improvements identified after the interventions (T 1 ) a year after (T 2 ).…”

Screen time between Portuguese and Brazilian children: a cross-cultural study

“…Increased BMI have been observed in the Brazilian population, even in comparison to children from other countries 34 , although there are variations in the prevalence rates of overweight and obesity in the different regions of Brazil, the values identified are high and worrying 35 . Few international studies involving data from Portugal showed that 45% of girls and 52% of boys aged 11 year-old did not meet the ST recommendation 36 and it was found ST prevalence between 14.5 to 17.5 h/week in children aged 6-8year-old 37 . The ISCOLE was the only study that compared data from Portugal and Brazil adding interesting findings including Portugal among the countries with high level of sitting time assessed by accelerometer (9.2 h/day) and with ST values below the ISCOLE average (2.3 h/day) while Brazil showed sitting time values below the ISCOLE average (8.3 h/day) and it had the lowest percent of participants meeting the ST guidelines (27.6%)…”