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McMahon N, Thomson K, Kaner E, Bambra C. Effects of prevention and harm reduction interventions on gambling behaviours and gambling related harm: An umbrella review. Addict Behav 2019; 90:380-388. [PMID: 30529994 DOI: 10.1016/j.addbeh.2018.11.048] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Harms related to gambling have been found not only to affect problem gamblers, but also to occur amongst low- and moderate-risk gamblers. This has resulted in calls for a public health approach to address a possible 'prevention paradox' in gambling related harm. The aim of this study was to evaluate the systematic review evidence base on the effects of prevention and harm reduction interventions on gambling behaviours, and gambling related harm. We also aimed to examine differential effects of interventions across socio-demographic groups. METHODS Systematic methods were used to locate and evaluate published systematic reviews of prevention and harm reduction interventions. We designed the review using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Equity extension Guidelines. Four databases were searched from their start date until May 2018. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). RESULTS Ten systematic reviews were identified reporting 55 unique relevant primary studies. Much of the review evidence-base related to pre-commitment and limit setting (24%), self-exclusion (20%), youth prevention programmes (20%), and machine messages/feedback (20%). The effectiveness of harm reduction interventions are limited by the extent to which users adhere to voluntary systems. Less than half of studies examining youth prevention programmes demonstrated positive effects on behaviour. No review extracted data or reported on the differential effects of intervention strategies across sociodemographic groups. The quality of the included reviews (and their primary studies) were generally poor and clear gaps in the evidence base have been highlighted. CONCLUSIONS The evidence base is dominated by evaluations of individual-level harm reduction interventions, with a paucity of research on supply reduction interventions. Review conclusions are limited by the quality and robustness of the primary research. Future research should consider the equity effects of intervention strategies.
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Graham J, Tudor K, Jebb SA, Lewis A, Tearne S, Adab P, Begh R, Jolly K, Daley A, Farley A, Lycett D, Nickless A, Aveyard P. The equity impact of brief opportunistic interventions to promote weight loss in primary care: secondary analysis of the BWeL randomised trial. BMC Med 2019; 17:51. [PMID: 30819170 PMCID: PMC6396456 DOI: 10.1186/s12916-019-1284-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/08/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Guidelines recommend that clinicians should make brief opportunistic behavioural interventions to patients who are obese to increase the uptake of effective weight loss programmes. The objective was to assess the effect of this policy on socioeconomic equity. METHODS One thousand eight hundred eighty-two consecutively attending patients with obesity and who were not seeking support for weight loss from their GP were enrolled in a trial. Towards the end of each consultation, GPs randomly assigned participants to one of two 30-s interventions. In the active intervention (support arm), the GP offered referral to a weight management group. In the control intervention (advice arm), the GP advised the patient that their health would benefit from weight loss. Agreement to attend a behavioural weight loss programme, attendance at the programme and weight loss at 12 months were analysed by socioeconomic status, measured by postcode using the Index of Multiple Deprivation (IMD). RESULTS Mean weight loss was 2.43 kg (sd 6.49) in the support group and 1.04 kg (sd 5.50) for the advice only group, but these effects were moderated by IMD (p = 0.039 for the interaction). In the support arm, weight loss was greater in higher socioeconomic groups. Participants from lower socioeconomic backgrounds were more likely to accept the offer and equally likely to attend a weight loss referral but attended fewer sessions. Adjusting for these sequentially reduced the gradient for the association of socioeconomic status with weight loss from + 0.035 to - 0.001 kg/IMD point. In the advice only arm, 10% took effective action to promote weight loss. The decision to seek support for weight loss outside of the trial did not differ by socioeconomic status, but weight loss among deprived participants who used external support was greater than among more affluent participants (p = 0.025). CONCLUSION Participants' responses to GPs' brief opportunistic interventions to promote weight loss differed by socioeconomic status and trial arm. In the support arm, more deprived people lost less weight because they attended fewer sessions at the programme. In the advice arm, more deprived people who sought and paid for support for weight loss themselves lost more weight than more affluent people who sought support. TRIAL REGISTRATION This trial is registered with the ISRCTN registry, number ISRCTN26563137 . Date of registration: January 3, 2013; date of first participant recruited: June 4, 2014.
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Affiliation(s)
- J Graham
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - K Tudor
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK.
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - A Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - S Tearne
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - P Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - R Begh
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - A Daley
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - A Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - D Lycett
- Faculty Research Centre for Advances in Behavioural Science, Coventry University, Coventry, CV1 5FB, UK
| | - A Nickless
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
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Sabbath EL, Yang J, Dennerlein JT, Boden LI, Hashimoto D, Sorensen G. Paradoxical Impact of a Patient-Handling Intervention on Injury Rate Disparity Among Hospital Workers. Am J Public Health 2019; 109:618-625. [PMID: 30789763 DOI: 10.2105/ajph.2018.304929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To test whether a comprehensive safe patient-handling intervention, which successfully reduced overall injury rates among hospital workers in a prior study, was differentially effective for higher-wage workers (nurses) versus low-wage workers (patient care associates [PCAs]). METHODS Data were from a cohort of nurses and PCAs at 2 large hospitals in Boston, Massachusetts. One hospital received the intervention in 2013; the other did not. Using longitudinal survey data from 2012 and 2014 plus longitudinal administrative injury and payroll data, we tested for socioeconomic differences in changes in self-reported safe patient-handling practices, and for socioeconomic differences in changes in injury rates using administrative data. RESULTS After the intervention, improvements in self-reported patient-handling practices were equivalent for PCAs and for nurses. However, in administrative data, lifting and exertion injuries decreased among nurses (rate ratio [RR] = 0.64; 95% confidence interval [CI] = 0.41, 1.00) but not PCAs (RR = 1.10; 95% CI = 0.74,1.63; P for occupation × intervention interaction = 0.02). CONCLUSIONS Although the population-level injury rate decreased after the intervention, most improvements were among higher-wage workers, widening the socioeconomic gap in injury and exemplifying the inequality paradox. Results have implications for public health intervention development, implementation, and analysis.
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Affiliation(s)
- Erika L Sabbath
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Jie Yang
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Jack T Dennerlein
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Leslie I Boden
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Dean Hashimoto
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Glorian Sorensen
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
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Higgs S, Liu J, Collins EIM, Thomas JM. Using social norms to encourage healthier eating. NUTR BULL 2019. [DOI: 10.1111/nbu.12371] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- S. Higgs
- School of Psychology University of Birmingham Birmingham UK
| | - J. Liu
- School of Psychology University of Birmingham Birmingham UK
| | | | - J. M. Thomas
- Department of Psychology Aston University Birmingham UK
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155
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Goffe L, Hillier-Brown F, Hildred N, Worsnop M, Adams J, Araujo-Soares V, Penn L, Wrieden W, Summerbell CD, Lake AA, White M, Adamson AJ. Feasibility of working with a wholesale supplier to co-design and test acceptability of an intervention to promote smaller portions: an uncontrolled before-and-after study in British Fish & Chip shops. BMJ Open 2019; 9:e023441. [PMID: 30782880 PMCID: PMC6377521 DOI: 10.1136/bmjopen-2018-023441] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore the feasibility of working with a wholesale supplier to co-design and deliver, and to assess the acceptability of, an intervention to promote smaller portions in Fish & Chip shops. DESIGN Uncontrolled before-and-after study. SETTING Fish & Chip shops in northern England, 2016. PARTICIPANTS Owners (n=11), a manager and customers (n=46) of Fish & Chip shops; and intervention deliverers (n=3). INTERVENTION Supplier-led, three-hour engagement event with shop owners and managers, highlighting the problem of excessive portion sizes and potential ways to reduce portion sizes; provision of box packaging to serve smaller portions; promotional posters and business incentives. DATA COLLECTION In-store observations and sales data collected at baseline and postintervention. Exit survey with customers. Semistructured interviews with owners/managers and intervention deliverers postintervention. RESULTS Twelve Fish & Chip shops were recruited. Observational data were collected from eight shops: at baseline, six shops did not promote the availability of smaller portion meals; at follow-up, all eight did and five displayed the promotional poster. Seven out of 12 shops provided sales data and all reported increased sales of smaller portion meals postintervention. Of 46 customers surveyed: 28% were unaware of the availability of smaller portion meals; 20% had bought smaller portion meals; and 46% of those who had not bought these meals were interested to try them in the future. Interviews revealed: owners/managers found the intervention acceptable but wanted a clearer definition of a smaller portion meal; the supplier valued the experience of intervention co-production and saw the intervention as being compatible with their responsibility to drive innovation. CONCLUSIONS The co-design of the intervention with a supplier was feasible. The partnership facilitated the delivery of an intervention that was acceptable to owners and customers. Sales of smaller meal packaging suggest that promotion of such meals is viable and may be sustainable.
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Affiliation(s)
- Louis Goffe
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Frances Hillier-Brown
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Department of Sport and Exercise Sciences, Durham University, Durham City, UK
| | - Natalie Hildred
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Matthew Worsnop
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, UK
- Henry Colbeck Limited, Gateshead, UK
| | - Jean Adams
- MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Vera Araujo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Linda Penn
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Wendy Wrieden
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Carolyn D Summerbell
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Department of Sport and Exercise Sciences, Durham University, Durham City, UK
| | - Amelia A Lake
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Department of Science, School of Science, Engineering and Design, Teesside University, Middlesbrough, UK
| | - Martin White
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Ashley J Adamson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Pechey R, Cartwright E, Pilling M, Hollands GJ, Vasiljevic M, Jebb SA, Marteau TM. Impact of increasing the proportion of healthier foods available on energy purchased in worksite cafeterias: A stepped wedge randomized controlled pilot trial. Appetite 2019; 133:286-296. [PMID: 30468803 PMCID: PMC6335439 DOI: 10.1016/j.appet.2018.11.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/26/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022]
Abstract
Increasing the proportion of healthier foods available could encourage healthier consumption, but evidence to date is limited in scope and quality. The current study aimed to: (a) examine the feasibility and acceptability of intervening to change product availability in worksite cafeterias; and (b) estimate the impact on energy purchased of increasing the proportion of healthier (i.e. lower energy) cooked meals, snacks, cold drinks and sandwiches. Six English worksite cafeterias increased the proportion of healthier foods available, aiming to keep the total number of options constant, in a stepped wedge randomized controlled pilot trial conducted between January and May 2017. The intervention was generally successfully implemented and acceptable to clientele. Generalized linear mixed models showed a reduction of 6.9% (95%CI: -11.7%, -1.7%, p = 0.044) in energy (kcal) purchased from targeted food categories across all sites. However, impact varied across sites, with energy purchased from targeted categories significantly reduced in two sites (-10.7% (95%CI: -18.1% to -2.6%, p = 0.046); -18.4% (95%CI: -26.9% to -8.8%, p = 0.013)), while no significant differences were seen in the other four sites. Overall, increasing the proportion of healthier options available in worksite cafeterias seems a promising intervention to reduce energy purchased but contextual effects merit further study.
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Affiliation(s)
- Rachel Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Emma Cartwright
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Mark Pilling
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Milica Vasiljevic
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Susan A Jebb
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
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157
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Hunter JA, Hollands GJ, Pilling M, Marteau TM. Impact of proximity of healthier versus less healthy foods on intake: A lab-based experiment. Appetite 2019; 133:147-155. [PMID: 30367891 PMCID: PMC6335384 DOI: 10.1016/j.appet.2018.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/20/2018] [Accepted: 10/18/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Placing food further away from people decreases likelihood of consumption ("Proximity Effect"). However, it is unclear how proximity affects consumption when both healthier and less healthy foods are available and cognitive resource for self-control is limited. AIMS To test the hypothesis that when both healthier (raisins) and less healthy (chocolate M&Ms) foods are available, placing less healthy food far, rather than near, increases the likelihood that healthier food is consumed. METHODS General population participants (N = 248) were all put under cognitive load and randomised to one of four groups: 1. Raisins near (20 cm), M&Ms far (70 cm); 2. Both foods near; 3. M&Ms near, raisins far; 4. Both far. PRIMARY OUTCOME proportions of participants consuming raisins and M&Ms, respectively. RESULTS The results did not support the primary hypothesis: when healthier and less healthy foods were both available, placing M&Ms far, rather than near, did not increase likelihood of consuming raisins (OR = 1.54, p = .432). Regardless of the M&Ms proximity, likelihood of consuming raisins was unaffected by the raisins' proximity (62.9%(near) vs. 56.5%(far) OR = 0.61, p = .211). Likelihood of consuming M&Ms non-significantly decreased when they were far and raisins were near, and when both foods were far (OR = 2.83, p = .057). Likelihood of consuming M&Ms was affected by M&Ms proximity, being higher when near (68.3%) than far (55.6%), OR = 0.39, p = .015. Indices of cognitive load impact (higher vs lower) were unrelated to consumption of either food. CONCLUSIONS Likelihood of consuming a healthier food was unaffected by its proximity and that of a less healthy food. By contrast, likelihood of consuming a less healthy food was influenced by its proximity and possibly by that of a healthier food. These effects need replication in studies designed to detect smaller effect sizes. TRIAL REGISTRATION This study was registered online with ISRCTN (ISRCTN11740813).
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Affiliation(s)
- J A Hunter
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom
| | - G J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom
| | - M Pilling
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom
| | - T M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
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158
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Vogel C, Abbott G, Ntani G, Barker M, Cooper C, Moon G, Ball K, Baird J. Examination of how food environment and psychological factors interact in their relationship with dietary behaviours: test of a cross-sectional model. Int J Behav Nutr Phys Act 2019; 16:12. [PMID: 30700323 PMCID: PMC6354411 DOI: 10.1186/s12966-019-0772-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/15/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To improve population diet environmental strategies have been hailed the panacea because they require little agency or investment of personal resources; this contrasts with conventional strategies that rely on individuals to engage high levels of agency and make deliberate choices. There is an immediate need to improve understanding of the synergy between the psychological and environmental determinants of diet in order to optimise allocation of precious public health resources. This study examined the synergistic and relative association between a number of food environment and psychological factors and the dietary behaviours of a population sample of women with young children. METHODS Women in Hampshire were recruited from children's centres and asked about their demographic characteristics, psychological resources, dietary behaviours (food frequency questionnaire) and perceptions of healthy food access and affordability. Three local food environment factors were objectively assessed: i) spatial access to food outlets using activity spaces; ii) healthfulness of the supermarket where women did their main food shop, (based on nine in-store factors including price, placement and promotion on seven healthy and five less healthy foods); iii) nutrition environment of children's centres visited frequently by the women, assessed via staff-administered questionnaire. A theoretical model linking environmental factors to dietary behaviours, both directly and indirectly through three factors representing individual agency (psychological resources, perceived food affordability, perceived food accessibility), was tested using Structural Equation Modelling. RESULTS Complete data were available for 753 women. The environment of women's main supermarket was indirectly related to their dietary behaviours through psychological resources and perceived food affordability. Shopping at supermarkets classified as having a healthier in-store environment was associated with having greater psychological resources associated with healthy eating (standardised regression weight β = 0.14SD, p = 0.03) and fewer food affordability concerns (β = - 0.14SD, p = 0.01), which in turn related to healthier dietary behaviours (β = 0.55SD, < 0.001 and β = - 0.15, p = 0.01 respectively). The three food environment factors were not directly associated with dietary behaviour (p > 0.3). The overall model fit was good (CFI = 0.91, RMSEA = 0.05 [0.05, 0.06]). CONCLUSIONS This pathway analysis identified three focal points for intervention and suggests that high-agency interventions targeting individual psychological resources when combined with low-agency supermarket environment interventions may confer greater benefits on dietary behaviours than either intervention alone.
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Georgia Ntani
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
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159
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Affiliation(s)
- Michael Marmot
- Institute of Health Equity, University College London, London, UK
| | - Ruth Bell
- Institute of Health Equity, University College London, London, UK
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160
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Ejlerskov K, Sharp SJ, Stead M, Adamson AJ, White M, Adams J. Socio-economic and age variations in response to supermarket-led checkout food policies: a repeated measures analysis. Int J Behav Nutr Phys Act 2018; 15:125. [PMID: 30518393 PMCID: PMC6282373 DOI: 10.1186/s12966-018-0755-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dietary inequalities between population groups are common with older and more affluent individuals tending to have healthier diets. Differential responses to health interventions may exacerbate inequalities. Changing what foods are displayed at supermarket checkouts is one intervention that has the potential to change diets. The aim of this study was to assess whether differences in purchases of common checkout foods from supermarkets with different checkout food policies varied according to age group and social grade. METHODS We analysed annual household purchase data for 2013-17 from nine leading UK supermarkets, split according to age of the main household shopper and household social grade. Checkout food policies were categorised as clear and consistent, vague or inconsistent, and none. Policies were heterogeneous but all included removal of confectionery and/or chocolate from checkouts. Mixed effects linear regression models were used to assess differences in purchases of common checkout foods (sugary confectionery, chocolate and potato crisps) by checkout food policy and whether these varied by age group or occupational social grade. RESULTS Relative to supermarkets with no checkout food policy, 14% (95% CI: 4-22%) fewer purchases of common checkout foods per household per percentage market share were made in supermarkets with a clear and consistent policy. Adjusted mean numbers of purchases were higher in older age groups than the youngest, but there were no differences between the highest and other social grades. There were significant interactions between checkout food policy and both age group and social grade. In supermarkets with clear and consistent policies, 23% (6-36%), 20% (2-34%), and 23% (7-37%) fewer purchases were made in age groups 45-54, 55-64 and 65+ years respectively, compared to all groups combined. In supermarkets with clear and consistent policies, there were 21% (4-35%), 26% (9-39%) and 21% (3-35%) fewer purchases made by households in the highest two and lowest social grades respectively, compared to all groups combined. CONCLUSIONS Households with older main shoppers and those in the most and least affluent social grades may be most responsive to supermarket checkout food policies. As older and more affluent groups tend to have healthier diets overall, it is unlikely that supermarket checkout food policies contribute to greater dietary equity.
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Affiliation(s)
- Katrine Ejlerskov
- MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Martine Stead
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ashley J Adamson
- Institute of Health & Society and Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Martin White
- MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.
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161
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Stea TH, Hovdenak IM, Rønnestad J, Rennestraum K, Vik FN, Klepp KI, Bere E. Effects of 1 y of free school fruit on intake of fruits, vegetables, and unhealthy snacks: 14 y later. Am J Clin Nutr 2018; 108:1309-1315. [PMID: 30339182 DOI: 10.1093/ajcn/nqy243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background There are not many studies evaluating the long-term effects of fruit and vegetable interventions. Objective We examined the effects of 1 y of free fruit in elementary school on long-term consumption of fruit, vegetables, and unhealthy snacks, according to sex and educational attainment, 14 y after the intervention period. Design In 2001, the baseline survey of the longitudinal cohort, Fruits and Vegetables Make the Marks (FVMM), included 1950 children (mean age: 11.8 y) attending 38 randomly drawn elementary schools from 2 counties in Norway. In the following 10 mo, 9 schools served as intervention schools by participating in the Norwegian School Fruit Program for free, whereas 29 schools served as control schools. A follow-up survey conducted in 2016 included 982 participants (50%) from the original study sample (mean age: 26.5 y). The consumption of fruit and vegetables was measured by a 24-h recall (portions per day), and the consumption of unhealthy snacks was measured by food-frequency questions (portions per week). Linear mixed models were performed to test possible intervention effects on the consumption of fruit, vegetables, and unhealthy snacks 14 y after the intervention period. Results No overall intervention effects after 14 y due to the free-fruit scheme on the consumption of fruit, vegetables, and unhealthy snacks were observed, but significant interactions showed a sustained higher frequency of fruit consumption among females in the intervention group compared with the control group [mean difference (MD): 0.38 portions/d; P = 0.023] and that this effect was only significant among less-educated females (MD: 0.73 portions/d; P = 0.043). No significant long-term intervention effects were observed in the consumption of fruit among highly educated females and males nor in the consumption of vegetables or unhealthy snacks. Conclusion Results from the present study indicate that receiving free fruit at school for 1 y may have positive long-term effects for females without higher education.
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Affiliation(s)
- Tonje Holte Stea
- Department of Public Health, Sport, and Nutrition, University of Agder, Kristiansand, Norway
| | - Ingrid Marie Hovdenak
- Department of Public Health, Sport, and Nutrition, University of Agder, Kristiansand, Norway
| | - Jannike Rønnestad
- Department of Public Health, Sport, and Nutrition, University of Agder, Kristiansand, Norway
| | - Kjersti Rennestraum
- Department of Public Health, Sport, and Nutrition, University of Agder, Kristiansand, Norway
| | - Frøydis Nordgård Vik
- Department of Public Health, Sport, and Nutrition, University of Agder, Kristiansand, Norway
| | | | - Elling Bere
- Department of Public Health, Sport, and Nutrition, University of Agder, Kristiansand, Norway
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162
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Anttila J, Tolvanen M, Kankaanpää R, Lahti S. School-level changes in factors related to oral health inequalities after national recommendation on sweet selling. Scand J Public Health 2018; 47:576-582. [PMID: 30486749 DOI: 10.1177/1403494818812641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: In 2007, Finnish authorities gave a national recommendation that schools should not sell sweet products. This study aimed to determine the effects of the national recommendation on school-level intermediary determinants (factors related to oral health inequalities) and if the changes were different according to school-level socio-economic position (SEP). Methods: This ecological and longitudinal study combined school-level data from two independent studies from Finnish upper comprehensive schools (N = 970): the School Health Promotion study (SHPS) and the School Sweet Selling survey (SSSS). The baseline data (SHPS from 2006-2007 and SSSS from 2007) and the post-intervention data (SHPS and SSSS from 2008-2009) were combined into a longitudinal school-level data set (n = 360 and response rate = 37%). The intermediary determinants were: attitudes and access to intoxicants, school health services, school environment, home environment, schools' health-promoting actions (including sweet product selling) and pupils' eating habits. Three equal-sized school-level SEP group - slow, middle and high - were formed. The changes in the intermediary determinants were analysed using Wilcoxon Signed Ranks test. Differences between school SEP groups were analysed the using Kruskal-Wallis test. Longitudinal linear mixed modelling was used to determine the contribution of intermediary determinants to the changes in pupils' eating habits. Results: The national recommendation was effective in decreasing sweet product selling at schools and the effect was equal in each school-level SEP group. Intermediary determinants contributed differently to eating habits in the three SEP groups. Conclusions: A national recommendation seems to be an effective tool in making the school environment healthier without increasing inequalities.
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Affiliation(s)
- Jaakko Anttila
- 1 Department of Community Dentistry, University of Turku, Finland
| | - Mimmi Tolvanen
- 1 Department of Community Dentistry, University of Turku, Finland
| | - Rami Kankaanpää
- 1 Department of Community Dentistry, University of Turku, Finland
| | - Satu Lahti
- 1 Department of Community Dentistry, University of Turku, Finland.,2 Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
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163
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Croot L, Rimmer M, Salway S, Hatton C, Dowse E, Lavin J, Bennett SE, Harris J, O'Cathain A. Adjusting a mainstream weight management intervention for people with intellectual disabilities: a user centred approach. Int J Equity Health 2018; 17:159. [PMID: 30348176 PMCID: PMC6198382 DOI: 10.1186/s12939-018-0871-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with intellectual disabilities (ID) may not be able to access and respond to uniformly delivered health interventions. Public bodies have a legal duty to make ‘reasonable adjustments’ to policies and practices to provide fair access and treatment for people with ID. This study aimed to identify adjustments to the Slimming World weight management programme to improve accessibility and assess acceptability and feasibility for this population. Methods This user-centred qualitative study was carried out with a steering group of people with ID (n = 4). Barriers and facilitators to using Slimming World were identified through interviews and focus groups with people with ID (n = 54), carers (n = 12) current members with ID (n = 8) and Slimming World group leaders (n = 11). Adjustments were made and their feasibility and acceptability were explored in a before-and-after mixed methods study where people with ID attended Slimming World for eight weeks. Participants (n = 9), carers (n = 7) and Slimming World group leaders (n = 4) were interviewed to explore their experiences of the adjustments. Participants were weighed at baseline then each week. Results Four key adjustments were identified and addressed by Slimming World who developed prototype Easy Read materials and a letter for carers. Six of the nine participants attended Slimming World for eight weeks and lost weight (1.4 kg to 6.6 kg, reduction in BMI between 0.5 and 1.7 kg/m2), indicating that the adjustments were feasible and acceptable. Two participants dropped out because they felt uncomfortable in a mainstream group and another left because they lacked control over food choice in their residential setting. Conclusions This user-centred approach identified reasonable adjustments that were feasible to implement. In a small uncontrolled feasibility study, people with ID were positive about the adjustments and lost weight. However, issues in the wider context of people’s lives, such as obesogenic environments and concerns about joining mainstream groups, limited the acceptability of Slimming World even with these adjustments. These findings have important implications for policy and suggest that environmental and organisational level interventions are needed alongside those targeting individual behaviour to tackle the obesogenic environment in which many people with ID spend their time, in order to reduce inequalities associated with the consequences of obesity.
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Affiliation(s)
- Liz Croot
- School of Health and Related Research, Sheffield University, Sheffield, UK.
| | - Melanie Rimmer
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Sarah Salway
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Chris Hatton
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Emma Dowse
- Slimming World Health and Research Team, Slimming World, Alfreton, UK
| | - Jacquie Lavin
- Slimming World Health and Research Team, Slimming World, Alfreton, UK
| | - Sarah E Bennett
- Slimming World Health and Research Team, Slimming World, Alfreton, UK
| | - Janet Harris
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, Sheffield University, Sheffield, UK
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164
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Inglis G, Archibald D, Doi L, Laird Y, Malden S, Marryat L, McAteer J, Pringle J, Frank J. Credibility of subgroup analyses by socioeconomic status in public health intervention evaluations: An underappreciated problem? SSM Popul Health 2018; 6:245-251. [PMID: 30417067 PMCID: PMC6214868 DOI: 10.1016/j.ssmph.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 01/12/2023] Open
Abstract
There is increasing interest amongst researchers and policy makers in identifying the effect of public health interventions on health inequalities by socioeconomic status (SES). This issue is typically addressed in evaluation studies through subgroup analyses, where researchers test whether the effect of an intervention differs according to the socioeconomic status of participants. The credibility of such analyses is therefore crucial when making judgements about how an intervention is likely to affect health inequalities, although this issue appears to be rarely considered within public health. The aim of this study was therefore to assess the credibility of subgroup analyses in published evaluations of public health interventions. An established set of 10 credibility criteria for subgroup analyses was applied to a purposively sampled set of 21 evaluation studies, the majority of which focussed on healthy eating interventions, which reported differential intervention effects by SES. While the majority of these studies were found to be otherwise of relatively high quality methodologically, only 8 of the 21 studies met at least 6 of the 10 credibility criteria for subgroup analysis. These findings suggest that the credibility of subgroup analyses conducted within evaluations of public health interventions' impact on health inequalities may be an underappreciated problem.
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Affiliation(s)
- Greig Inglis
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, EH8 9DX, United Kingdom
| | - Daryll Archibald
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, EH8 9DX, United Kingdom
| | - Lawrence Doi
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, EH8 9DX, United Kingdom
| | - Yvonne Laird
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, EH8 9DX, United Kingdom
| | - Stephen Malden
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, EH8 9DX, United Kingdom
| | - Louise Marryat
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, EH8 9DX, United Kingdom
| | - John McAteer
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, EH8 9DX, United Kingdom
| | - Jan Pringle
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, EH8 9DX, United Kingdom
| | - John Frank
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, EH8 9DX, United Kingdom
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165
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Tinner L, Caldwell D, Hickman M, MacArthur GJ, Gottfredson D, Lana Perez A, Moberg DP, Wolfe D, Campbell R. Examining subgroup effects by socioeconomic status of public health interventions targeting multiple risk behaviour in adolescence. BMC Public Health 2018; 18:1180. [PMID: 30326897 PMCID: PMC6192072 DOI: 10.1186/s12889-018-6042-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/17/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Multiple 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. METHODS Two 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. RESULTS Of 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). CONCLUSIONS The 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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Affiliation(s)
- Laura Tinner
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Deborah Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Georgina J MacArthur
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Denise Gottfredson
- Department of Criminology and Criminal Justice, University of Maryland, College Park, Prince George’s, MD USA
| | - Alberto Lana Perez
- Department of Preventive Medicine and Public Health, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
| | - D Paul Moberg
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - David Wolfe
- Faculty of Education, Western University, Ontario, Canada
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
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166
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Chang KCM, Vamos EP, Palladino R, Majeed A, Lee JT, Millett C. Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis. J Epidemiol Community Health 2018; 73:11-18. [PMID: 30282645 DOI: 10.1136/jech-2018-210961] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/27/2018] [Accepted: 08/31/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND We assessed impacts of a large, nationwide cardiovascular disease (CVD) risk assessment and management programme on sociodemographic group inequalities in (1) early identification of hypertension, type 2 diabetes (T2D) and chronic kidney disease (CKD); and (2) management of global CVD risk among high-risk individuals. METHODS We obtained retrospective electronic medical records from the Clinical Practice Research Datalink for a randomly selected sample of 138 788 patients aged 40-74 years without known CVD or diabetes, who were registered with 462 practices between 2009 and 2013. We estimated programme impact using a difference-in-differences matching analysis that compared changes in outcome over time between attendees and non-attendees. RESULTS National Health Service Health Check attendance was 21.4% (29 672/138 788). A significantly greater number of hypertension and T2D incident cases were identified in men than women (eg, an additional 4.02%, 95% CI 3.65% to 4.39%, and 2.08%, 1.81% to 2.35% cases of hypertension in men and women, respectively). A significantly greater number of T2D incident cases were identified among attendees living in the most deprived areas, but no differences were found for hypertension and CKD across socioeconomic groups. No major differences in CVD risk management were observed between sociodemographic subgroups (eg, programme impact on 10-year CVD risk score was -1.13%, -1.48% to -0.78% in male and -1.53%, -2.36% to -0.71% in female attendees). CONCLUSION During 2009-2013, the programme had low attendance and small overall impacts on early identification of disease and risk management. The age, sex and socioeconomic subgroups appeared to have derived similar level of benefits, leaving existing inequalities unchanged. These findings highlight the importance of population-wide interventions to address inequalities in CVD outcomes.
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Affiliation(s)
- Kiara C-M Chang
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Raffaele Palladino
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - John Tayu Lee
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK.,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
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167
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Thomas MM, Phongsavan P, McGill B, O'Hara BJ, Bauman AE. A review of the impact of physical activity mass media campaigns on low compared to high socioeconomic groups. HEALTH EDUCATION RESEARCH 2018; 33:429-446. [PMID: 30203025 DOI: 10.1093/her/cyy032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
Physical inactivity is a major contributor to non-communicable disease and people of low socioeconomic status (SES) are more likely to be insufficiently active. Physical activity mass media campaigns aim to increase physical activity participation, but little is known about their impact on low SES groups. We reviewed the published literature from 1990 to June 2016 to identify reports of physical activity mass media campaigns. We documented evaluation/study design, target population, campaign outcomes assessed, SES measures used and analysed the results of the SES comparisons. A total of 23 papers were reviewed, reporting on 17 physical activity campaigns and 12 campaigns compared SES differences for 85 outcomes: 45 comparisons showed no difference between lowest and highest SES groups, 20 showed a better outcome for the lowest SES group and 20 showed a worse outcome. Some campaigns found inconsistent results, but seven found only equal and/or better results for low SES groups. Post-campaign physical activity behaviour most commonly showed no SES differences, but no other patterns were seen. Our review found that physical activity mass media campaigns have mostly equitable or better impacts for low SES groups, but to reduce inequalities these campaigns need to be maximally effective for low SES populations.
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Affiliation(s)
- Margaret M Thomas
- Prevention Research Collaboration, Sydney School of Public Health
- Charles Perkins Centre (D17), Level 6, The Hub, The University of Sydney, NSW 2006 Sydney, Australia
| | - Philayrath Phongsavan
- Prevention Research Collaboration, Sydney School of Public Health
- Charles Perkins Centre (D17), Level 6, The Hub, The University of Sydney, NSW 2006 Sydney, Australia
| | - Bronwyn McGill
- Prevention Research Collaboration, Sydney School of Public Health
- Charles Perkins Centre (D17), Level 6, The Hub, The University of Sydney, NSW 2006 Sydney, Australia
| | - Blythe J O'Hara
- Prevention Research Collaboration, Sydney School of Public Health
- Charles Perkins Centre (D17), Level 6, The Hub, The University of Sydney, NSW 2006 Sydney, Australia
| | - Adrian E Bauman
- Prevention Research Collaboration, Sydney School of Public Health
- Charles Perkins Centre (D17), Level 6, The Hub, The University of Sydney, NSW 2006 Sydney, Australia
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168
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Bianchi F, Garnett E, Dorsel C, Aveyard P, Jebb SA. Restructuring physical micro-environments to reduce the demand for meat: a systematic review and qualitative comparative analysis. Lancet Planet Health 2018; 2:e384-e397. [PMID: 30177007 PMCID: PMC6120131 DOI: 10.1016/s2542-5196(18)30188-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/08/2018] [Accepted: 08/20/2018] [Indexed: 05/15/2023]
Abstract
BACKGROUND Reducing meat consumption could help to protect the natural environment and promote population health. Interventions restructuring physical micro-environments might help to change habitual behaviour. We synthesised the scientific evidence pertaining to whether, and which, interventions restructuring physical micro-environments effectively reduce the demand for meat. METHODS We did a systematic review of quantitative studies evaluating the effectiveness of interventions restructuring physical micro-environments to reduce the demand for meat. We identified relevant records by searching six electronic databases (CAB Abstracts, Embase, PsycINFO, Science Citation Index, MEDLINE, and Dissertations & Theses) on Aug 31, 2017, contacting experts, screening publicly accessible online resources, and searching references. We included studies that evaluated the effectiveness of interventions restructuring physical micro-environments to reduce the demand for meat, defined as the actual or intended consumption, purchase, or selection of meat in real or virtual environments. We extracted data pertaining to the study samples, the interventions, and meat demand at the follow-up closest to intervention completion and at the longest follow-up, with the former representing our primary outcome. We synthesised data narratively and did a qualitative comparative analysis to identify configurations of intervention characteristics associated with, and those not found to be associated with, significant reductions in meat demand. Our Systematic Review is registered with PROSPERO, number CRD42017081532. RESULTS Of 10 733 titles and abstracts screened for eligibility, we assessed 60 full papers and included 14 papers reporting on 18 studies with 22 intervention conditions. Three interventions reducing the portion size of meat servings reduced meat consumption in randomised trials. Three interventions providing meat alternatives with supporting educational material were associated with reduced meat demand in pre-post design studies. Three of four interventions altering the sensory properties (eg, visual presentation) of meat or meat alternatives at point of purchase reduced meat demand in randomised trials. Four interventions repositioning meat products to be less prominent at point of purchase were associated with lower meat demand, but only two such interventions reached statistical significance in a randomised trial and a multiple treatment reversal design. Only one of five interventions manipulating the description of meat or meat alternatives at point of purchase was associated with lower meat demand in a multiple treatment reversal design. Evidence from randomised trials evaluating a pricing intervention or interventions restructuring several aspects of micro-environments was too scarce or inconsistent to be conclusive. The results from our qualitative comparative analysis supported the findings of this narrative synthesis. INTERPRETATION Some interventions restructuring physical micro-environments could help to promote lower demand for meat. Interventions reducing portion sizes of meat servings, providing meat alternatives, or changing the sensory properties of meat and meat alternatives at point of purchase offered the most promise in the context of experimental studies. FUNDING None.
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Affiliation(s)
- Filippo Bianchi
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK.
| | - Emma Garnett
- University of Cambridge, Department of Zoology, Cambridge, UK
| | - Claudia Dorsel
- Heinrich Heine University Düsseldorf, Department of Psychology, Düsseldorf, Germany
| | - Paul Aveyard
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Susan A Jebb
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
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169
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Langfield T, Pechey R, Pilling M, Marteau TM. Impact of glass shape on time taken to drink a soft drink: A laboratory-based experiment. PLoS One 2018; 13:e0202793. [PMID: 30148889 PMCID: PMC6110468 DOI: 10.1371/journal.pone.0202793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/09/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Glassware design may affect drinking behaviour for alcoholic beverages, with glass shape and size influencing drinking speed and amount consumed. Uncertainty remains both about the extent to which these effects are restricted to alcohol and the underlying mechanisms. The primary aim of the current study was to examine the effect of differently shaped glasses on time taken to drink a soft drink. The secondary aim was to develop hypotheses about mechanisms concerning micro-drinking behaviours and perceptual effects. METHOD In a single-session experiment, 162 participants were randomised to receive 330ml of carbonated apple juice in a glass that was either inward-sloped, straight-sided, or outward-sloped. The primary outcome measure was total drinking time. Secondary outcome measures included micro-drinking behaviours (sip size, sip duration, interval duration), and perceptual measures (midpoint bias, drink enjoyment). RESULTS Participants drank 21.4% faster from the outward-sloped glass than from the straight-sided glass [95%CI: 0.2%,38.0%] in adjusted models. They were also 18.2% faster from the inward-sloped glass than the straight-sided glass, but this did not reach statistical significance with wide confidence intervals also consistent with slower drinking [95%CI: -3.8%,35.6%]. Larger sips were associated with faster drinking times (Pearson's r(162) = -.45, p < .001). The direction of effects suggested sips were larger from the outward-sloped and inward-sloped glasses, compared to the straight-sided glass (15.1%, 95%CI: -4.3%,38.0%; 19.4%, 95%CI: -0.5%,43.6%, respectively). There were no significant differences between glasses in mean sip or interval duration. Bias in midpoint estimation was greater for the outward-sloped glass (12.9ml, 95%CI: 6.6ml,19.2ml) than for the straight-sided glass, although the degree of bias was not associated with total drinking time (Pearson's r(162) = 0.01, p = .87). DISCUSSION Individuals drank a soft drink more quickly from an outward-sloped glass, relative to a straight-sided glass. Micro-drinking behaviours, such as sip size, are promising candidates for underlying mechanisms.
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Affiliation(s)
- Tess Langfield
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Mark Pilling
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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170
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Toward a theory-led metaframework for considering socioeconomic health inequalities within systematic reviews. J Clin Epidemiol 2018; 104:84-94. [PMID: 30125710 DOI: 10.1016/j.jclinepi.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/08/2018] [Accepted: 08/12/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To develop a theory-led framework to inform reviewers' understanding of what, how, and why health care interventions may lead to differential effects across socioeconomic groups. STUDY DESIGN AND SETTING A metaframework approach combined two theoretical perspectives (socioeconomic health inequalities and complex interventions) into a single framework to inform socioeconomic health inequality considerations in systematic reviews. RESULTS Four theories relating to complexity within systematic reviews and 16 health inequalities intervention theories informed the development of a metaframework. Factors relating to the type of intervention, implementation, context, participant response, and mechanisms associated with differential effects across socioeconomic groups were identified. The metaframework can inform; reviewer discussions around how socioeconomic status (SES) can moderate intervention effectiveness during question formulation, approaches to data extraction and help identify a priori analysis considerations. CONCLUSION The metaframework offers a transparent, practical, theory-led approach to inform a program theory for what, how, and why interventions work for different SES groups in systematic reviews. It can enhance existing guidance on conducting systematic reviews that consider health inequalities, increase awareness of how SES can moderate intervention effectiveness, and encourage a greater engagement with theory throughout the review process.
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171
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Alves D, Santos Z, Amado M, Craveiro I, Delgado AP, Correia A, Gonçalves L. Low potassium and high sodium intakes: a double health threat to Cape Verdeans. BMC Public Health 2018; 18:995. [PMID: 30092771 PMCID: PMC6085717 DOI: 10.1186/s12889-018-5911-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/27/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cape Verde presents a high rate of cardiovascular diseases. Low potassium and high sodium intakes are related to cardiovascular diseases. However, studies regarding these two micronutrients continue to be rare in African urban settings. This work aims to estimate potassium and sodium intakes and to analyse the self-reported salt intake by gender and by type of urban area in the city of Praia - the capital of Cape Verde. METHODS In the first stage (n = 1912), an intra-urban study was designed in two types of urban areas (formal and informal), using a sampling strategy based on random selection of geographical coordinates, in order to apply a questionnaire. In a second stage, a 24-h dietary recall and anthropometric measurements were performed by local nutritionists. Potassium and sodium intakes were estimated for 599 participants (149 men and 450 women). Non-parametric methods (including quantile regression) were used in the statistical analysis. RESULTS In informal areas, a higher percentage of women reported having hypertension (31.0%) compared to formal areas (19.7%). Based on 24-h dietary recall, median potassium intake for men was 2924.2 mg/day and for women and 2562.6 mg/day. Almost 70.0% of men and 80.0% of women ingested less than the recommended 3510 mg/day of potassium. In informal areas, men and women presented high medians of sodium intakes compared to formal areas (men: 4131.2 vs 3014.6 mg/day and women: 3243.4 vs 2522.4 mg/day). On the other hand, the percentage of participants exceeding 2000 mg/day for sodium was high (≥70.8%), even for participants that self-reported low-salt intake. Quantile regression models revealed effects of the type of urban area and gender in the potassium and sodium intakes, at least, in some quartiles, accounting for age, academic qualifications, and professional situation. CONCLUSIONS A low potassium intake and a high sodium intake were found in Praia. Thus, efficient health education campaigns and health promotion are needed and should be tailored considering gender and urban areas.
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Affiliation(s)
- Daniela Alves
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Global Health and Tropical Medicine, GHTM, IHMT-UNL, Lisbon, Portugal
| | - Zélia Santos
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Miguel Amado
- Civil Enginnering Research and Inovation for Sustainability, CERis, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Isabel Craveiro
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Global Health and Tropical Medicine, GHTM, IHMT-UNL, Lisbon, Portugal
| | - António Pedro Delgado
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Direção Nacional da Saúde, Ministério da Saúde, Praia, Cape Verde
| | - Artur Correia
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Comité de Coordenação Combate à SIDA, Ministério da Saúde, Praia, Cape Verde
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, IHMT-UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Global Health and Tropical Medicine, GHTM, IHMT-UNL, Lisbon, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal
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172
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Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: how informatics interventions can worsen inequality. J Am Med Inform Assoc 2018; 25:1080-1088. [PMID: 29788380 PMCID: PMC7646885 DOI: 10.1093/jamia/ocy052] [Citation(s) in RCA: 266] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/12/2018] [Accepted: 05/03/2018] [Indexed: 01/09/2023] Open
Abstract
Health informatics interventions are designed to help people avoid, recover from, or cope with disease and disability, or to improve the quality and safety of healthcare. Unfortunately, they pose a risk of producing intervention-generated inequalities (IGI) by disproportionately benefiting more advantaged people. In this perspective paper, we discuss characteristics of health-related interventions known to produce IGI, explain why health informatics interventions are particularly vulnerable to this phenomenon, and describe safeguards that can be implemented to improve health equity. We provide examples in which health informatics interventions produced inequality because they were more accessible to, heavily used by, adhered to, or effective for those from socioeconomically advantaged groups. We provide a brief outline of precautions that intervention developers and implementers can take to guard against creating or worsening inequality through health informatics. We conclude by discussing evaluation approaches that will ensure that IGIs are recognized and studied.
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Affiliation(s)
- Tiffany C Veinot
- School of Information and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Hannah Mitchell
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, New York, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, New York, USA
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Lakerveld J, Mackenbach JD, de Boer F, Brandhorst B, Broerse JEW, de Bruijn GJ, Feunekes G, Gillebaart M, Harbers M, Hoenink J, Klein M, Mensink F, Middel C, de Ridder DTD, Rutters F, Sluijs I, van der Schouw YT, Schuitmaker TJ, Te Velde SJ, Velema E, Waterlander W, Brug J, Beulens JWJ. Improving cardiometabolic health through nudging dietary behaviours and physical activity in low SES adults: design of the Supreme Nudge project. BMC Public Health 2018; 18:899. [PMID: 30029600 PMCID: PMC6054749 DOI: 10.1186/s12889-018-5839-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/12/2018] [Indexed: 12/15/2022] Open
Abstract
Background Initiating and maintaining a healthy lifestyle -including healthy eating and sufficient physical activity- is key for cardiometabolic health. A health-promoting environment can facilitate a healthy lifestyle, and may be especially helpful to reach individuals with a lower socio-economic status (SES). In the Supreme Nudge project, we will study the effects of pricing and nudging strategies in the supermarket – one of the most important point-of-choice settings for food choices – and of a context-specific mobile physical activity promotion app. This paper describes the stepwise and theory-based design of Supreme Nudge, which aims to develop, implement and evaluate environmental changes for a sustained impact on lifestyle behaviours and cardiometabolic health in low SES adults. Methods Supreme Nudge uses a multi-disciplinary and mixed methods approach, integrating participatory action research, qualitative interviews, experimental pilot studies, and a randomized controlled trial in a real-life (supermarket) setting. First, we will identify the needs, characteristics and preferences of the target group as well as of the participating supermarket chain. Second, we will conduct a series of pilot studies to test novel, promising and feasible intervention components. Third, a final selection of intervention components will be implemented in a full-scale randomised controlled supermarket trial. Approximately 1000 low SES adults will be recruited across 8–12 supermarkets and randomised at supermarket level to receive 1) no intervention (control); 2) environmental nudges such as food product placement or promotion; 3) nudges and a tailored physical activity app that provides time- and context specific feedback; 4) pricing interventions, nudges, and the physical activity app. The effects on dietary behaviours and physical activity will be evaluated at 3, 6 and 12 months, and on cardiometabolic health at 6 and 12 months. Finally, we will evaluate the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of the intervention, and we will use insights from System Innovation and Transition Management theories to define the best strategies for implementation and upscaling beyond the study period. Discussion The Supreme Nudge project is likely to generate thorough evidence relevant for policy and practice on the effects of a mixed method and multi-disciplinary intervention targeting dietary behaviours and physical activity. Trial registration The real-life trial has been registered on 30 May 2018, NTR7302.
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Affiliation(s)
- Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands.
| | - Joreintje D Mackenbach
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Femke de Boer
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Boris Brandhorst
- University of Amsterdam, Amsterdam School of Communication Research ASCoR, Amsterdam, the Netherlands
| | - Jacqueline E W Broerse
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, the Netherlands
| | - Gert-Jan de Bruijn
- University of Amsterdam, Amsterdam School of Communication Research ASCoR, Amsterdam, the Netherlands
| | - Gerda Feunekes
- Netherlands Nutrition Centre, the Hague, the Netherlands
| | - Marleen Gillebaart
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Marjolein Harbers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jody Hoenink
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Michel Klein
- Department of Computer Science, VU University Amsterdam, Amsterdam, the Netherlands
| | | | - Cédric Middel
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, the Netherlands
| | - Denise T D de Ridder
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Ivonne Sluijs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tjerk Jan Schuitmaker
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, the Netherlands
| | | | | | - Wilma Waterlander
- Department of Public Health, Amsterdam Public Health Research institute, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes Brug
- University of Amsterdam, Amsterdam School of Communication Research ASCoR, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Thomson K, Hillier-Brown F, Todd A, McNamara C, Huijts T, Bambra C. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health 2018; 18:869. [PMID: 30005611 PMCID: PMC6044092 DOI: 10.1186/s12889-018-5677-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/06/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Socio-economic inequalities are associated with unequal exposure to social, economic and environmental risk factors, which in turn contribute to health inequalities. Understanding the impact of specific public health policy interventions will help to establish causality in terms of the effects on health inequalities. METHODS Systematic review methodology was used to identify systematic reviews from high-income countries that describe the health equity effects of upstream public health interventions. Twenty databases were searched from their start date until May 2017. The quality of the included articles was determined using the Assessment of Multiple Systematic Reviews tool (AMSTAR). RESULTS Twenty-nine systematic reviews were identified reporting 150 unique relevant primary studies. The reviews summarised evidence of all types of primary and secondary prevention policies (fiscal, regulation, education, preventative treatment and screening) across seven public health domains (tobacco, alcohol, food and nutrition, reproductive health services, the control of infectious diseases, the environment and workplace regulations). There were no systematic reviews of interventions targeting mental health. Results were mixed across the public health domains; some policy interventions were shown to reduce health inequalities (e.g. food subsidy programmes, immunisations), others have no effect and some interventions appear to increase inequalities (e.g. 20 mph and low emission zones). The quality of the included reviews (and their primary studies) were generally poor and clear gaps in the evidence base have been highlighted. CONCLUSIONS The review does tentatively suggest interventions that policy makers might use to reduce health inequalities, although whether the programmes are transferable between high-income countries remains unclear. TRIAL REGISTRATION PROSPERO registration number: CRD42016025283.
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Affiliation(s)
- Katie Thomson
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Frances Hillier-Brown
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- School of Applied Social Sciences, Durham University, 32 Old Elvet, Durham, DH1 3HN UK
| | - Adam Todd
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU UK
| | - Courtney McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Building 9, Level 5, 7491 Dragvoll, Trondheim, Norway
| | - Tim Huijts
- Research Centre for Education and the Labour Market, Maastricht University, Tongersestraat 53, 6211 LM Maastricht, The Netherlands
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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175
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Green MA, Radley D, Lomax N, Morris MA, Griffiths C. Is adolescent body mass index and waist circumference associated with the food environments surrounding schools and homes? A longitudinal analysis. BMC Public Health 2018; 18:482. [PMID: 29716577 PMCID: PMC5930416 DOI: 10.1186/s12889-018-5383-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There has been considerable interest in the role of access to unhealthy food options as a determinant of weight status. There is conflict across the literature as to the existence of such an association, partly due to the dominance of cross-sectional study designs and inconsistent definitions of the food environment. The aim of our study is to use longitudinal data to examine if features of the food environment are associated to measures of adolescent weight status. METHODS Data were collected from secondary schools in Leeds (UK) and included measurements at school years 7 (ages 11/12), 9 (13/14), and 11 (15/16). Outcome variables, for weight status, were standardised body mass index and standardised waist circumference. Explanatory variables included the number of fast food outlets, supermarkets and 'other retail outlets' located within a 1 km radius of an individual's home or school, and estimated travel route between these locations (with a 500 m buffer). Multi-level models were fit to analyse the association (adjusted for confounders) between the explanatory and outcome variables. We also examined changes in our outcome variables between each time period. RESULTS We found few associations between the food environment and measures of adolescent weight status. Where significant associations were detected, they mainly demonstrated a positive association between the number of amenities and weight status (although effect sizes were small). Examining changes in weight status between time periods produced mainly non-significant or inconsistent associations. CONCLUSIONS Our study found little consistent evidence of an association between features of the food environment and adolescent weight status. It suggests that policy efforts focusing on the food environment may have a limited effect at tackling the high prevalence of obesity if not supported by additional strategies.
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Affiliation(s)
- Mark A Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK.
| | - Duncan Radley
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Nik Lomax
- School of Geography, University of Leeds, Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Michelle A Morris
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK.,Leeds Institute for Biomedical and Clinical Services, University of Leeds, Leeds, UK
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Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme: Microsimulation modelling using data from Liverpool, UK. PLoS Med 2018; 15:e1002573. [PMID: 29813056 PMCID: PMC5973555 DOI: 10.1371/journal.pmed.1002573] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/26/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Aiming to contribute to prevention of cardiovascular disease (CVD), the National Health Service (NHS) Health Check programme has been implemented across England since 2009. The programme involves cardiovascular risk stratification-at 5-year intervals-of all adults between the ages of 40 and 74 years, excluding any with preexisting vascular conditions (including CVD, diabetes mellitus, and hypertension, among others), and offers treatment to those at high risk. However, the cost-effectiveness and equity of population CVD screening is contested. This study aimed to determine whether the NHS Health Check programme is cost-effective and equitable in a city with high levels of deprivation and CVD. METHODS AND FINDINGS IMPACTNCD is a dynamic stochastic microsimulation policy model, calibrated to Liverpool demographics, risk factor exposure, and CVD epidemiology. Using local and national data, as well as drawing on health and social care disease costs and health-state utilities, we modelled 5 scenarios from 2017 to 2040: Scenario (A): continuing current implementation of NHS Health Check;Scenario (B): implementation 'targeted' toward areas in the most deprived quintile with increased coverage and uptake;Scenario (C): 'optimal' implementation assuming optimal coverage, uptake, treatment, and lifestyle change;Scenario (D): scenario A combined with structural population-wide interventions targeting unhealthy diet and smoking;Scenario (E): scenario B combined with the structural interventions as above. We compared all scenarios with a counterfactual of no-NHS Health Check. Compared with no-NHS Health Check, the model estimated cumulative incremental cost-effectiveness ratio (ICER) (discounted £/quality-adjusted life year [QALY]) to be 11,000 (95% uncertainty interval [UI] -270,000 to 320,000) for scenario A, 1,500 (-91,000 to 100,000) for scenario B, -2,400 (-6,500 to 5,700) for scenario C, -5,100 (-7,400 to -3,200) for scenario D, and -5,000 (-7,400 to -3,100) for scenario E. Overall, scenario A is unlikely to become cost-effective or equitable, and scenario B is likely to become cost-effective by 2040 and equitable by 2039. Scenario C is likely to become cost-effective by 2030 and cost-saving by 2040. Scenarios D and E are likely to be cost-saving by 2021 and 2023, respectively, and equitable by 2025. The main limitation of the analysis is that we explicitly modelled CVD and diabetes mellitus only. CONCLUSIONS According to our analysis of the situation in Liverpool, current NHS Health Check implementation appears neither equitable nor cost-effective. Optimal implementation is likely to be cost-saving but not equitable, while targeted implementation is likely to be both. Adding structural policies targeting cardiovascular risk factors could substantially improve equity and generate cost savings.
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The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. Br J Cancer 2018; 118:1130-1141. [PMID: 29567982 PMCID: PMC5931106 DOI: 10.1038/s41416-018-0029-6] [Citation(s) in RCA: 289] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them. METHODS Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country. RESULTS Nearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors. CONCLUSION Tobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels-both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable 'lifestyle' factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.
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Capewell S, Lloyd-Williams F. The role of the food industry in health: lessons from tobacco? Br Med Bull 2018; 125:131-143. [PMID: 29438486 DOI: 10.1093/bmb/ldy002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/19/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In this review, we highlight poor diet as the biggest risk factor for non-communicable diseases. We examine the denial tactics used by the food industry, how they reflect the tactics previously used by the tobacco industry, and how campaigners can use this knowledge to achieve future public health successes. SOURCES OF DATA Data sources are wide ranging, notably publications relating to public health, obesity and processed food, the effectiveness hierarchy and food industry denialism tactics. AREAS OF AGREEMENT Global burden of disease analyses consistently demonstrate that poor diet produces a bigger burden of non-communicable disease than tobacco, alcohol and inactivity put together. The lessons learnt from the tobacco control experience of successfully fighting the tobacco industry can be applied to other industries including processed food and sugary drinks. AREAS OF CONTROVERSY Tackling obesity and poor diet is a more complex issue than tobacco. Food industries continue to promote weak or ineffective policies such as voluntary reformulation, and resist regulation and taxation. However, the UK food industry now faces increasing pressure from professionals, public and politicians to accept reformulation and taxes, or face more stringent measures. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH The rise in childhood and adult obesity needs to be arrested and then reversed. Unhealthy processed food and sugary drinks are a major contributing factor. There is increasing interest in the tactics being used by the food industry to resist change. Advocacy and activism will be essential to counter these denialism tactics and ensure that scientific evidence is translated into effective regulation and taxation.
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Affiliation(s)
- Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, UK
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, UK
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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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180
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Hunter JA, Hollands GJ, Couturier DL, Marteau TM. Effect of snack-food proximity on intake in general population samples with higher and lower cognitive resource. Appetite 2018; 121:337-347. [PMID: 29183701 PMCID: PMC5768324 DOI: 10.1016/j.appet.2017.11.101] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/18/2017] [Accepted: 11/18/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Placing snack-food further away from people consistently decreases its consumption ("proximity effect"). However, given diet-related health inequalities, it is important to know whether interventions that alter food proximity have potential to change behaviour regardless of cognitive resource (capacity for self-control). This is often lower in those in lower socio-economic positions, who also tend to have less healthy diet-related behaviours. Study 1 aims to replicate the proximity effect in a general population sample and estimate whether trait-level cognitive resource moderates the effect. In a stronger test, Study 2 investigates whether the effect is similar regardless of manipulated state-level cognitive resource. METHOD Participants were recruited into two laboratory studies (Study 1: n = 159; Study 2: n = 246). A bowl of an unhealthy snack was positioned near (20 cm) or far (70 cm) from the participant, as randomised. In Study 2, participants were further randomised to a cognitive load intervention. The pre-specified primary outcome was the proportion of participants taking any of the snack. RESULTS Significantly fewer participants took the snack when far compared with near in Study 2 (57.7% vs 70.7%, β = -1.63, p = 0.020), but not in Study 1 (53.8% vs 63.3%, X2 = 1.12, p = 0.289). Removing participants who moved the bowl (i.e. who did not adhere to protocol), increased the effect-sizes: Study 1: 39.3% vs 63.9%, X2 = 6.43, p = 0.011; Study 2: 56.0% vs 73.9%, β = -2.46, p = 0.003. Effects were not moderated by cognitive resource. CONCLUSIONS These studies provide the most robust evidence to date that placing food further away reduces likelihood of consumption in general population samples, an effect unlikely to be moderated by cognitive resource. This indicates potential for interventions altering food proximity to contribute to addressing health inequalities, but requires testing in real-world settings. TRIAL REGISTRATION Both studies were registered with ISRCTN (Study 1 reference no.: ISRCTN46995850, Study 2 reference no.: ISRCTN14239872).
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Affiliation(s)
- Jennifer A Hunter
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
| | - Dominique-Laurent Couturier
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
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181
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Consumption of sugar-sweetened beverages and artificially sweetened beverages from childhood to adulthood in relation to socioeconomic status - 15 years follow-up in Norway. Int J Behav Nutr Phys Act 2018; 15:8. [PMID: 29343247 PMCID: PMC5773139 DOI: 10.1186/s12966-018-0646-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/09/2018] [Indexed: 12/25/2022] Open
Abstract
Background In Norway, social inequalities in health and health-related behaviors have been reported despite the well-developed welfare state. The objective of the present study was to analyze; (i) the development in frequency of consumption of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) from childhood to adulthood; (ii) socioeconomic inequalities in the consumption of SSB and ASB using different indicators of socioeconomic status (SES); (iii) time trends in potential disparities in SSB and ASB consumption among different socioeconomic groups to assess the development in socioeconomic inequality from childhood to adulthood. Methods This study uses data from the Fruits and Vegetables Make the Marks (FVMM) longitudinal cohort, including participants (n = 437) from 20 random schools from two Norwegian counties. Data from the first survey in 2001 (mean age 11.8) and follow-up surveys in 2005 (mean age 15.5) and 2016 (mean age 26.5) were used. Consumption of SSB and ASB were measured using a food frequency questionnaire, which the participants completed at school in 2001 and 2005, and online in 2016. Various indicators of SES were included; in 2001, parental education and income were measured, in 2005, participants’ educational intentions in adolescence were measured, and in 2016, participants’ own education and income were measured. The main analyses conducted were linear mixed effects analysis of the repeated measures. Results Between 2001 and 2016, a decrease in frequency of consumption of SSB (2.8 v 1.3 times/week; p = < 0.001) and an increase in frequency of consumption of ASB (1.1 v 1.6 times/week; p = 0.002) were observed. Participants with a higher educational level in adulthood and higher educational intentions in adolescence had a significantly lower frequency of consumption of SSB at all time points (2001, 2005 and 2016). No significant widening (or narrowing) of inequalities were observed from childhood to adulthood. Conclusions A decrease in consumption of SSB and an increase in consumption of ASB from childhood to adulthood were found. Participants with high SES consumed in general less SSB (but not ASB), however, results varied depending on SES indicator used. The established inequalities persisted from childhood to adulthood.
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182
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Stautz K, Zupan Z, Field M, Marteau TM. Does self-control modify the impact of interventions to change alcohol, tobacco, and food consumption? A systematic review. Health Psychol Rev 2018; 12:157-178. [PMID: 29291664 DOI: 10.1080/17437199.2017.1421477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Low self-control is associated with increased consumption of alcohol, tobacco, and unhealthy food. This systematic review aimed to assess whether individual differences in self-control modify the effectiveness of interventions to reduce consumption of these products, and hence their potential to reduce consumption amongst those whose consumption is generally greater. Searches of six databases were supplemented with snowball searches and forward citation tracking. Narrative synthesis summarised findings by: consumption behaviour (alcohol, tobacco, food); psychological processes targeted by the intervention (reflective, non-reflective, or both); and study design (experiment, cohort, or cross-sectional). Of 54 eligible studies, 22 reported no evidence of modification, 18 reported interventions to be less effective in those with low self-control, and 14 reported interventions to be more effective in those with low self-control. This pattern did not differ from chance. Whilst self-control often influenced intervention outcomes, there was no consistent pattern of effects, even when stratifying studies by consumption behaviour, intervention type, or study design. There was a notable absence of evidence regarding interventions that restructure physical or economic environments. In summary, a heterogeneous, low-quality evidence base suggests an inconsistent moderating effect of low self-control on the effectiveness of interventions to change consumption behaviours.
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Affiliation(s)
- Kaidy Stautz
- a Behaviour and Health Research Unit , University of Cambridge , Cambridge , UK
| | - Zorana Zupan
- a Behaviour and Health Research Unit , University of Cambridge , Cambridge , UK
| | - Matt Field
- b Department of Psychological Sciences , University of Liverpool , Liverpool , UK
| | - Theresa M Marteau
- a Behaviour and Health Research Unit , University of Cambridge , Cambridge , UK
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183
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Fayet-Moore F, George A, Cassettari T, Yulin L, Tuck K, Pezzullo L. Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis. Nutrients 2018; 10:E34. [PMID: 29301298 PMCID: PMC5793262 DOI: 10.3390/nu10010034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/06/2017] [Accepted: 12/22/2017] [Indexed: 01/16/2023] Open
Abstract
An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million-$1.6 billion for CVD and AUD$18.2 million-$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia.
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Affiliation(s)
- Flavia Fayet-Moore
- Nutrition Research Australia, Level 13 167 Macquarie Street, Sydney, NSW 2000, Australia.
| | - Alice George
- Deloitte Access Economics, 8 Brindabella Circuit, Brindabella Business Park, Canberra Airport, Canberra, ACT 2609, Australia.
| | - Tim Cassettari
- Nutrition Research Australia, Level 13 167 Macquarie Street, Sydney, NSW 2000, Australia.
| | - Lev Yulin
- Deloitte Access Economics, 8 Brindabella Circuit, Brindabella Business Park, Canberra Airport, Canberra, ACT 2609, Australia.
| | - Kate Tuck
- Nutrition Research Australia, Level 13 167 Macquarie Street, Sydney, NSW 2000, Australia.
| | - Lynne Pezzullo
- Deloitte Access Economics, 8 Brindabella Circuit, Brindabella Business Park, Canberra Airport, Canberra, ACT 2609, Australia.
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184
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Welch V, Petkovic J, Simeon R, Presseau J, Gagnon D, Hossain A, Pardo JP, Pottie K, Rader T, Sokolovski A, Yoganathan M, Tugwell P, DesMeules M. PROTOCOL: Interactive social media interventions for health behaviour change, health outcomes, and health equity in the adult population. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-38. [PMID: 37131397 PMCID: PMC8428005 DOI: 10.1002/cl2.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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185
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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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186
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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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187
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Shimazaki T, Bao H, Deli G, Uechi H, Lee YH, Miura K, Takenaka K. Cross-cultural validity of the theory of planned behavior for predicting healthy food choice in secondary school students of Inner Mongolia. Diabetes Metab Syndr 2017; 11 Suppl 1:S497-S501. [PMID: 28408191 DOI: 10.1016/j.dsx.2017.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Indexed: 10/19/2022]
Abstract
AIMS Unhealthy eating behavior is a serious health concern among secondary school students in Inner Mongolia. To predict their healthy food choices and devise methods of correcting unhealthy choices, we sought to confirm the cross-cultural validity of the theory of planned behavior among Inner Mongolian students. MATERIALS AND METHODS A cross-sectional study, conducted between November and December 2014. Overall, 3047 students were enrolled. We devised a questionnaire based on the theory of planned behavior to measure its components (intentions, attitudes, subjective norms, and perceived behavioral control) in relation to healthy food choices; we also assessed their current engagement in healthy food choices. RESULTS A principal component analysis revealed high contribution rates for the components (69.32%-88.77%). A confirmatory factor analysis indicated that the components of the questionnaire had adequate model fit (goodness of fit index=0.997, adjusted goodness of fit index=0.984, comparative fit index=0.998, and root mean square error of approximation=0.049). Notably, data from participants within the suburbs did not support the theory of planned behavior construction. Several paths did not predict the hypothesis variables. However, attitudes toward healthy food choices strongly predicted behavioral intention (path coefficients 0.49-0.77, p<0.01), regardless of demographic characteristics. CONCLUSION Our results support that the theory of planned behavior can apply to secondary school students in urban areas. Furthermore, attitudes towards healthy food choices were the best predictor of behavioral intentions to engage in such choices in Inner Mongolian students.
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Affiliation(s)
- Takashi Shimazaki
- Department of Health & Physical Education, Faculty of Humanities, Sophia University, Japan.
| | - Hugejiletu Bao
- College of Physical Education, Inner Mongolia Normal University, China.
| | - Geer Deli
- College of Physical Education, Inner Mongolia Normal University, China.
| | | | - Ying-Hua Lee
- Hsinchu Municipal Min Fu Elementary School, Taiwan.
| | - Kayo Miura
- Faculty of Health & Medical Care, Saitama Medical University, Japan.
| | - Koji Takenaka
- Faculty of Human Sciences, Waseda University, Japan.
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188
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Socioeconomic Inequities in Diet Quality and Nutrient Intakes among Australian Adults: Findings from a Nationally Representative Cross-Sectional Study. Nutrients 2017; 9:nu9101092. [PMID: 28976927 PMCID: PMC5691709 DOI: 10.3390/nu9101092] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 02/07/2023] Open
Abstract
Poor diet may represent one pathway through which lower socioeconomic position (SEP) leads to adverse health outcomes. This study examined the associations between SEP and diet quality, its components, energy, and nutrients in a nationally representative sample of Australians. Dietary data from two 24-h recalls collected during the cross-sectional Australian Health Survey 2011-13 (n = 4875; aged ≥ 19 years) were analysed. Diet quality was evaluated using the Dietary Guidelines Index (DGI). SEP was assessed by index of area-level socioeconomic disadvantage, education level, and household income. Linear regression analyses investigated the associations between measures of SEP and dietary intakes. Across all of the SEP indicators, compared with the least disadvantaged group, the most disadvantaged group had 2.5–4.5 units lower DGI. A greater area-level disadvantage was associated with higher carbohydrate and total sugars intake. Lower education was associated with higher trans fat, carbohydrate, and total sugars intake and lower poly-unsaturated fat and fibre intake. Lower income was associated with lower total energy and protein intake and higher carbohydrate and trans fat intake. Lower SEP was generally associated with poorer diet quality and nutrient intakes, highlighting dietary inequities among Australian adults, and a need to develop policy that addresses these inequities.
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189
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Perignon M, Dubois C, Gazan R, Maillot M, Muller L, Ruffieux B, Gaigi H, Darmon N. Co-construction and Evaluation of a Prevention Program for Improving the Nutritional Quality of Food Purchases at No Additional Cost in a Socioeconomically Disadvantaged Population. Curr Dev Nutr 2017; 1:e001107. [PMID: 29955680 PMCID: PMC5998781 DOI: 10.3945/cdn.117.001107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/21/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Food prices influence food choices. Purchasing foods with higher nutritional quality for their price may help improve the diet quality of socioeconomically disadvantaged individuals. Objective: This study aimed to describe the co-construction and evaluation of the Opticourses prevention program, which promotes healthy eating among participants in socioeconomically deprived situations by improving the nutritional quality of their household food purchases with no additional cost. Methods: Individuals were recruited in poor districts of Marseille, France. The intervention and evaluation tools and protocols were co-constructed with 96 individuals. Then, 93 adults willing to participate in a standardized intervention comprising 5 participative workshops on diet and budget were enrolled. Impact on food purchases was estimated with experimental economics: 2-d experimental food purchase intents were observed at baseline and endline for workshop participants (WPs, n = 35) and controls (n = 23), with the use of monetary incentives to limit social-desirability bias. Changes in food and nutrient content and energy cost (expressed in €/2000 kcal) of experimental purchases were assessed. Results: The co-constructed participative workshops included playful activities around food purchase practices and the nutritional quality, taste, and price of foods. Experimental purchases contained a large amount of energy at baseline for both WPs and controls (5114 and 4523 kcal ⋅ d-1 ⋅ person-1, respectively). For WPs only, the mean energy content decreased between baseline and endline (-1729 kcal ⋅ d-1 ⋅ person-1; P < 0.01; medium effect size: Cohen's d = 0.5), and the percentage of energy from free sugars and from foods high in fat, sugar, and salt also decreased (both P < 0.05 and medium effect sizes), whereas energy cost remained unchanged. No significant changes between baseline and endline were observed for the controls. Conclusions: After the intervention, the energy content of participants' experimental purchases was closer to their needs, suggesting that the workshops helped them plan and rationalize their food purchases better. The nutritional quality of the experimental purchases increased but energy cost did not, showing that the co-constructed Opticourses prevention program can favorably change food purchasing behaviors of socioeconomically disadvantaged individuals with no additional cost. This trial was registered at clinicaltrials.gov as NCT02383875.
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Affiliation(s)
- Marlène Perignon
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
- Marchés, Organisations, Institutions et Stratégies d'Acteurs (MOISA) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Centre International de Hautes Etudes Agronomiques Méditerranéennes-Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Montpellier Supagro, Univ Montpellier, Montpellier, France
| | - Christophe Dubois
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
| | - Rozenn Gazan
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
- MS-Nutrition, Marseille, France
| | | | - Laurent Muller
- Grenoble Applied Economics Laboratory (GAEL) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Grenoble, France
| | - Bernard Ruffieux
- Grenoble Applied Economics Laboratory (GAEL) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Grenoble, France
| | - Hind Gaigi
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
| | - Nicole Darmon
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
- Marchés, Organisations, Institutions et Stratégies d'Acteurs (MOISA) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Centre International de Hautes Etudes Agronomiques Méditerranéennes-Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Montpellier Supagro, Univ Montpellier, Montpellier, France
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190
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Kraak VI, Englund T, Misyak S, Serrano EL. A novel marketing mix and choice architecture framework to nudge restaurant customers toward healthy food environments to reduce obesity in the United States. Obes Rev 2017; 18:852-868. [PMID: 28560794 DOI: 10.1111/obr.12553] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 01/19/2023]
Abstract
This review identified and adapted choice architecture frameworks to develop a novel framework that restaurant owners could use to promote healthy food environments for customers who currently overconsume products high in fat, sugar and sodium that increase their risk of obesity and diet-related non-communicable diseases. This review was conducted in three steps and presented as a narrative summary to demonstrate a proof of concept. Step 1 was a systematic review of nudge or choice architecture frameworks used to categorize strategies that cue healthy behaviours in microenvironments. We searched nine electronic databases between January 2000 and December 2016 and identified 1,244 records. Inclusion criteria led to the selection of five choice architecture frameworks, of which three were adapted and combined with marketing mix principles to highlight eight strategies (i.e. place, profile, portion, pricing, promotion, healthy default picks, prompting or priming and proximity). Step 2 involved conducting a comprehensive evidence review between January 2006 and December 2016 to identify U.S. recommendations for the restaurant sector organized by strategy. Step 3 entailed developing 12 performance metrics for the eight strategies. This framework should be tested to determine its value to assist restaurant owners to promote and socially normalize healthy food environments to reduce obesity and non-communicable diseases.
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Affiliation(s)
- V I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, USA
| | - T Englund
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, USA
| | - S Misyak
- Virginia Cooperative Extension's Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - E L Serrano
- Virginia Cooperative Extension's Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
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Kraak V, Englund T, Misyak S, Serrano E. Progress Evaluation for the Restaurant Industry Assessed by a Voluntary Marketing-Mix and Choice-Architecture Framework That Offers Strategies to Nudge American Customers toward Healthy Food Environments, 2006-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E760. [PMID: 28704965 PMCID: PMC5551198 DOI: 10.3390/ijerph14070760] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/01/2017] [Accepted: 07/04/2017] [Indexed: 12/02/2022]
Abstract
Consumption of restaurant food and beverage products high in fat, sugar and sodium contribute to obesity and non-communicable diseases. We evaluated restaurant-sector progress to promote healthy food environments for Americans. We conducted a desk review of seven electronic databases (January 2006-January 2017) to examine restaurant strategies used to promote healthful options in the United States (U.S.). Evidence selection (n = 84) was guided by the LEAD principles (i.e., locate, evaluate, and assemble evidence to inform decisions) and verified by data and investigator triangulation. A marketing-mix and choice-architecture framework was used to examine eight voluntary strategies (i.e., place, profile, portion, pricing, promotion, healthy default picks, priming or prompting and proximity) to evaluate progress (i.e., no, limited, some or extensive) toward 12 performance metrics based on available published evidence. The U.S. restaurant sector has made limited progress to use pricing, profile (reformulation), healthy default picks (choices), promotion (responsible marketing) and priming and prompting (information and labeling); and some progress to reduce portions. No evidence was available to assess progress for place (ambience) and proximity (positioning) to promote healthy choices during the 10-year review period. Chain and non-chain restaurants can apply comprehensive marketing-mix and nudge strategies to promote healthy food environments for customers.
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Affiliation(s)
- Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Tessa Englund
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Sarah Misyak
- Virginia Cooperative Extension's Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA.
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Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O’Flaherty M, McGill R, Orton L, Bromley H, Cappuccio FP, Capewell S. Systematic review of dietary salt reduction policies: Evidence for an effectiveness hierarchy? PLoS One 2017; 12:e0177535. [PMID: 28542317 PMCID: PMC5436672 DOI: 10.1371/journal.pone.0177535] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 04/29/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Non-communicable disease (NCD) prevention strategies now prioritise four major risk factors: food, tobacco, alcohol and physical activity. Dietary salt intake remains much higher than recommended, increasing blood pressure, cardiovascular disease and stomach cancer. Substantial reductions in salt intake are therefore urgently needed. However, the debate continues about the most effective approaches. To inform future prevention programmes, we systematically reviewed the evidence on the effectiveness of possible salt reduction interventions. We further compared "downstream, agentic" approaches targeting individuals with "upstream, structural" policy-based population strategies. METHODS We searched six electronic databases (CDSR, CRD, MEDLINE, SCI, SCOPUS and the Campbell Library) using a pre-piloted search strategy focussing on the effectiveness of population interventions to reduce salt intake. Retrieved papers were independently screened, appraised and graded for quality by two researchers. To facilitate comparisons between the interventions, the extracted data were categorised using nine stages along the agentic/structural continuum, from "downstream": dietary counselling (for individuals, worksites or communities), through media campaigns, nutrition labelling, voluntary and mandatory reformulation, to the most "upstream" regulatory and fiscal interventions, and comprehensive strategies involving multiple components. RESULTS After screening 2,526 candidate papers, 70 were included in this systematic review (49 empirical studies and 21 modelling studies). Some papers described several interventions. Quality was variable. Multi-component strategies involving both upstream and downstream interventions, generally achieved the biggest reductions in salt consumption across an entire population, most notably 4g/day in Finland and Japan, 3g/day in Turkey and 1.3g/day recently in the UK. Mandatory reformulation alone could achieve a reduction of approximately 1.45g/day (three separate studies), followed by voluntary reformulation (-0.8g/day), school interventions (-0.7g/day), short term dietary advice (-0.6g/day) and nutrition labelling (-0.4g/day), but each with a wide range. Tax and community based counselling could, each typically reduce salt intake by 0.3g/day, whilst even smaller population benefits were derived from health education media campaigns (-0.1g/day). Worksite interventions achieved an increase in intake (+0.5g/day), however, with a very wide range. Long term dietary advice could achieve a -2g/day reduction under optimal research trial conditions; however, smaller reductions might be anticipated in unselected individuals. CONCLUSIONS Comprehensive strategies involving multiple components (reformulation, food labelling and media campaigns) and "upstream" population-wide policies such as mandatory reformulation generally appear to achieve larger reductions in population-wide salt consumption than "downstream", individually focussed interventions. This 'effectiveness hierarchy' might deserve greater emphasis in future NCD prevention strategies.
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Affiliation(s)
- Lirije Hyseni
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Alex Elliot-Green
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Chris Kypridemos
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Rory McGill
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Lois Orton
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Helen Bromley
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Francesco P. Cappuccio
- University of Warwick, WHO Collaborating Centre, Warwick Medical School, Coventry, United Kingdom
| | - Simon Capewell
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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Pinket AS, De Craemer M, Huybrechts I, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno LA, Socha P, Iotova V, Manios Y, Van Lippevelde W. Multibehavioural Interventions with a Focus on Specific Energy Balance-Related Behaviours Can Affect Diet Quality in Preschoolers from Six European Countries: The ToyBox-Study. Nutrients 2017; 9:E479. [PMID: 28489048 PMCID: PMC5452209 DOI: 10.3390/nu9050479] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to examine whether a multibehavioural intervention with a focus on specific energy balance-related behaviours can affect total diet quality and its four subcomponents in European preschoolers and to investigate if these intervention effects differed by socioeconomic status (SES). Parents/caregivers of 3.5 to 5.5 year-olds (n = 4968) recruited through kindergartens in six European countries within the ToyBox-study completed questionnaires on socio-demographics and a food frequency questionnaire on their preschoolers' diet. To assess intervention effects and differences by SES, multilevel repeated measures analyses were conducted. In contrast to no significant difference in total diet quality, in both the intervention and control group, the dietary quality and dietary equilibrium increased, with a larger increase in the intervention group (mean difference quality: +3.4%; mean difference equilibrium: +0.9%) compared to the control group (quality: +1.5%; equilibrium: +0.2%). SES was not a significant moderator for intervention effects on total diet quality, nor for the four subcomponents. This study indicates that multibehavioural interventions with a focus on specific energy balance-related behaviours in preschoolers not only affect those targeted behaviours, but can also have more generalized effects. The ToyBox-intervention effects were similar for both lower and high SES preschoolers.
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Affiliation(s)
- An-Sofie Pinket
- Department of Public Health, Ghent University, 9000 Ghent, Belgium.
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
| | - Inge Huybrechts
- International Agency for Research on Cancer (IARC/WHO), 69000 Lyon, France.
| | | | - Benedicte Deforche
- Department of Public Health, Ghent University, 9000 Ghent, Belgium.
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, 1000 Brussels, Belgium.
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Berthold Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, 80337 München, Germany.
| | - Luis A Moreno
- GENUD Research Group, University of Zaragoza, 50009 Zaragoza, Spain.
| | - Piotr Socha
- The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, 9002 Varna, Bulgaria.
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
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Singh A, Bassi S, Nazar GP, Saluja K, Park M, Kinra S, Arora M. Impact of school policies on non-communicable disease risk factors - a systematic review. BMC Public Health 2017; 17:292. [PMID: 28376833 PMCID: PMC5379668 DOI: 10.1186/s12889-017-4201-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/25/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Globally, non-communicable diseases (NCDs) are identified as one of the leading causes of mortality. NCDs have several modifiable risk factors including unhealthy diet, physical inactivity, tobacco use and alcohol abuse. Schools provide ideal settings for health promotion, but the effectiveness of school policies in the reduction of risk factors for NCD is not clear. This study reviewed the literature on the impact of school policies on major NCD risk factors. METHODS A systematic review was conducted to identify, collate and synthesize evidence on the effectiveness of school policies on reduction of NCD risk factors. A search strategy was developed to identify the relevant studies on effectiveness of NCD policies in schools for children between the age of 6 to 18 years in Ovid Medline, EMBASE, and Web of Science. Data extraction was conducted using pre-piloted forms. Studies included in the review were assessed for methodological quality using the Effective Public Health Practice Project (EPHPP) quality assessment tool. A narrative synthesis according to the types of outcomes was conducted to present the evidence on the effectiveness of school policies. RESULTS Overall, 27 out of 2633 identified studies were included in the review. School policies were comparatively more effective in reducing unhealthy diet, tobacco use, physical inactivity and inflammatory biomarkers as opposed to anthropometric measures, overweight/obesity, and alcohol use. In total, for 103 outcomes independently evaluated within these studies, 48 outcomes (46%) had significant desirable changes when exposed to the school policies. Based on the quality assessment, 18 studies were categorized as weak, six as moderate and three as having strong methodological quality. CONCLUSION Mixed findings were observed concerning effectiveness of school policies in reducing NCD risk factors. The findings demonstrate that schools can be a good setting for initiating positive changes in reducing NCD risk factors, but more research is required with long-term follow up to study the sustainability of such changes.
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Affiliation(s)
- Ankur Singh
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Shalini Bassi
- Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana 122002 India
| | - Gaurang P. Nazar
- Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana 122002 India
| | - Kiran Saluja
- Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana 122002 India
| | - MinHae Park
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana 122002 India
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Hughes J, Kabir Z, Kee F, Bennett K. Cardiovascular risk factors-using repeated cross-sectional surveys to assess time trends in socioeconomic inequalities in neighbouring countries. BMJ Open 2017; 7:e013442. [PMID: 28373251 PMCID: PMC5387991 DOI: 10.1136/bmjopen-2016-013442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES This study compares trends in socioeconomic inequalities related to key cardiovascular risk factors in neighbouring countries Northern Ireland (NI) and the Republic of Ireland (RoI). DESIGN Repeated cross-sectional studies. SETTING Population based. PARTICIPANTS 3500-4000 in national surveys in NI and 5000-9000 in RoI, aged 20-69 years. MEASURES Educational attainment was used as a socioeconomic indicator by which the magnitude and direction of trends in inequalities for smoking, diabetes, obesity and physical inactivity in NI and RoI were examined between 1997/1998 and 2007/2011. Gender-specific relative and absolute inequalities were calculated using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII) for both countries. RESULTS In both countries, the prevalence of diabetes and obesity increased whereas levels of smoking and physical inactivity decreased over time. In NI relative inequalities increased for obesity (RII 1.1 in males and 2.1 in females in 2010/2011) and smoking (RII 4.5 in males and 4.2 in females in 2010/2011) for both genders and absolute inequalities increased for all risk factors in men and increased for diabetes and obesity in women. In RoI greater inequality was observed in women, particularly for smoking (RII 2.8 in 2007) and obesity (RII 8.2 in 2002) and in men for diabetes (RII 3.2 in 2002). CONCLUSIONS Interventions to reduce inequalities in risk factors, particularly smoking, obesity and diabetes are encouraged across both countries.
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Affiliation(s)
- John Hughes
- UKCRC Centre of Excellence for Public Health, Queen's University, Belfast, UK
| | - Zubair Kabir
- Department of Epidemiology & Public Health University College Cork, Cork, Ireland
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, Queen's University, Belfast, UK
| | - Kathleen Bennett
- Population Health Sciences Division, RCSI St Stephen's Green, Dublin, Ireland
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de Mestral C, Marques-Vidal P, Gaspoz JM, Theler JM, Guessous I. Independent association between socioeconomic indicators and macro- and micro-nutrient intake in Switzerland. PLoS One 2017; 12:e0174578. [PMID: 28369086 PMCID: PMC5378340 DOI: 10.1371/journal.pone.0174578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Socioeconomic differences in diet are rarely assessed with more than one indicator. We aimed to assess differences in macro- and micro-nutrient intake in both sexes according to education, income, and occupation. METHODS We used data from validated food frequency questionnaire measured dietary intake in 5087 participants (2157 women) from yearly adult population-based cross-sectional surveys conducted from 2005 to 2012 in the canton of Geneva, Switzerland. We used two ANOVA models: age-adjusted and multivariable adjusted simultaneously for all three socioeconomic indicators. RESULTS Low-education men consumed more calcium but less vitamin D than high-education men; low-income men consumed less total and animal protein (80.9±0.9 vs 84.0±0.6 g/d; 55.6±1.0 vs 59.5±0.7 g/d) and more total carbohydrates and sugars (246±2 vs 235±2 g/d; 108±2 vs 103±1 g/d) than high-income men. Occupation and diet showed no association. Low-education women consumed less vegetable protein (20.7±0.2 vs 21.6±0.2 g/d), fibre (15.7±0.3 vs 16.8±0.2 g/d), and carotene (4222±158 vs 4870±128 μg/d) than high-education women; low-income women consumed more total carbohydrates (206±2 vs 197±1 g/d) and less monounsaturated fat (27.7±0.4 vs 29.3±0.3 g/d) than high-income women. Finally, low-occupation women consumed more total energy (1792±27 vs 1714±15 kcal/d) and total carbohydrates (206±2 vs 200±1 g/d), but less saturated fat (23.0±0.3 vs 24.4±0.2 g/d), calcium (935±17 vs 997±10 mg/d) and vitamin D (2.5±0.1 vs 2.9±0.1 μg/d), than high-occupation women. CONCLUSION In Switzerland, the influence of socioeconomic factors on nutrient intake differs by sex; income and education, but not occupation, drive differences among men; among women, all three indicators seem to play a role. Interventions to reduce inequalities should consider the influence of education, income, and occupation in diet to be most effective.
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Affiliation(s)
- Carlos de Mestral
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Michel Gaspoz
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Marc Theler
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, United States of America
- * E-mail:
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Capewell S, Kypridemos C. Socioeconomic Inequalities in Dietary Sodium Intake: Upstream Versus Downstream Interventions. Am J Public Health 2017; 107:499-500. [PMID: 28272941 PMCID: PMC5343722 DOI: 10.2105/ajph.2017.303673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Simon Capewell
- All of the authors are with the Department of Public Health and Policy, University of Liverpool, Liverpool, Liverpool, United Kingdom
| | - Chris Kypridemos
- All of the authors are with the Department of Public Health and Policy, University of Liverpool, Liverpool, Liverpool, United Kingdom
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199
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Hollands GJ, Carter P, Shemilt I, Marteau TM, Jebb SA, Higgins J, Ogilvie D. Altering the availability or proximity of food, alcohol and tobacco products to change their selection and consumption. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Gareth J Hollands
- University of Cambridge; Behaviour and Health Research Unit; Forvie Site Robinson Way Cambridge UK CB2 0SR
| | - Patrice Carter
- University of Cambridge; Behaviour and Health Research Unit; Forvie Site Robinson Way Cambridge UK CB2 0SR
| | - Ian Shemilt
- University College London; EPPI-Centre; 10 Woburn Square London UK WC1H 0NR
| | - Theresa M Marteau
- University of Cambridge; Behaviour and Health Research Unit; Forvie Site Robinson Way Cambridge UK CB2 0SR
| | - Susan A Jebb
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford Oxfordshire UK OX2 6GG
| | - Julian Higgins
- University of Bristol; School of Social and Community Medicine; Canynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - David Ogilvie
- University of Cambridge; MRC Epidemiology Unit; Box 285 Cambridge Biomedical Campus Cambridge UK CB2 0QQ
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Tainio M, Monsivais P, Jones NRV, Brand C, Woodcock J. Mortality, greenhouse gas emissions and consumer cost impacts of combined diet and physical activity scenarios: a health impact assessment study. BMJ Open 2017; 7:e014199. [PMID: 28399514 PMCID: PMC5337665 DOI: 10.1136/bmjopen-2016-014199] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To quantify changes in mortality, greenhouse gas (GHG) emissions and consumer costs for physical activity and diet scenarios. DESIGN For the physical activity scenarios, all car trips from <1 to <8 miles long were progressively replaced with cycling. For the diet scenarios, the study population was assumed to increase fruit and vegetable (F&V) consumption by 1-5 portions of F&V per day, or to eat at least 5 portions per day. Health effects were modelled with the comparative risk assessment method. Consumer costs were based on fuel cost savings and average costs of F&V, and GHG emissions to fuel usage and F&V production. SETTING Working age population for England. PARTICIPANTS Data from the Health Survey for England, National Travel Survey and National Diet and Nutrition Survey. PRIMARY OUTCOMES MEASURED Changes in premature deaths, consumer costs and GHG emissions stratified by age, gender and socioeconomic status (SES). RESULTS Premature deaths were reduced by between 75 and 7648 cases per year for the physical activity scenarios, and 3255 and 6187 cases per year for the diet scenarios. Mortality reductions were greater among people of medium and high SES in the physical activity scenarios, whereas people with lower SES benefited more in the diet scenarios. Similarly, transport fuel costs fell more for people of high SES, whereas diet costs increased most for the lowest SES group. Net GHG emissions decreased by between 0.2 and 10.6 million tons of carbon dioxide equivalent (MtCO2e) per year for the physical activity scenarios and increased by between 1.3 and 6.3 MtCO2e/year for the diet scenarios. CONCLUSIONS Increasing F&V consumption offers the potential for large health benefits and reduces health inequalities. Replacing short car trips with cycling offers the potential for net benefits for health, GHG emissions and consumer costs.
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Affiliation(s)
- Marko Tainio
- MRC Epidemiology Unit, Centre for Diet and Activity Research, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
- Systems Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Pablo Monsivais
- MRC Epidemiology Unit, Centre for Diet and Activity Research, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Nicholas RV Jones
- MRC Epidemiology Unit, Centre for Diet and Activity Research, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Christian Brand
- Transport Studies Unit, School of Geography and the Environment, University of Oxford, Oxford, UK
| | - James Woodcock
- MRC Epidemiology Unit, Centre for Diet and Activity Research, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
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