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Czwikla G, Boen F, Cook DG, de Jong J, Harris T, Hilz LK, Iliffe S, Lechner L, Morris RW, Muellmann S, Peels DA, Pischke CR, Schüz B, Stevens M, Telkmann K, van Lenthe FJ, Vanderlinden J, Bolte G. Equity-specific effects of interventions to promote physical activity among middle-aged and older adults: results from applying a novel equity-specific re-analysis strategy. Int J Behav Nutr Phys Act 2021; 18:65. [PMID: 34001171 PMCID: PMC8130354 DOI: 10.1186/s12966-021-01131-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration. METHODS The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis. RESULTS The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status. CONCLUSIONS To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of 'hard to reach' groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.
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Affiliation(s)
- Gesa Czwikla
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | - Filip Boen
- Physical Activity, Sports & Health Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Derek G Cook
- Population Health Research Institute, St George's University of London, London, UK
| | - Johan de Jong
- School of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Tess Harris
- Population Health Research Institute, St George's University of London, London, UK
| | - Lisa K Hilz
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Lilian Lechner
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Richard W Morris
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Saskia Muellmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Denise A Peels
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Claudia R Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine UniversityDuesseldorf, Duesseldorf, Germany
| | - Benjamin Schüz
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department of Prevention and Health Promotion, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaus Telkmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Julie Vanderlinden
- Physical Activity, Sports & Health Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Briançon S, Legrand K, Muller L, Langlois J, Saez L, Spitz E, Quinet MH, Böhme P, Lecomte E, Omorou AY. Effectiveness of a socially adapted intervention in reducing social inequalities in adolescence weight. The PRALIMAP-INÈS school-based mixed trial. Int J Obes (Lond) 2020; 44:895-907. [PMID: 31969652 DOI: 10.1038/s41366-020-0520-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 11/19/2019] [Accepted: 01/03/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND A high prevalence of overweight/obesity among low socioeconomic status adolescents contributes to health inequalities. However, evidence-based interventions for reducing social inequalities in adolescent weight are lacking. We aimed to investigate whether strengthened care management for adolescents with low socioeconomic status has an equivalent effect in reducing overweight as standard care management in adolescents with high status. METHODS PRALIMAP-INÈS was a multicentre trial including 35 state-run high and middle schools in the north-eastern France. A population-based sample of 1639 adolescents aged 13-18 years with screened and clinically confirmed overweight/obesity were proposed for inclusion and divided into two groups by the Family Affluence Scale score: advantaged (score > 5), receiving standard care management (A.S) and less-advantaged randomly assigned to two groups (1:2 ratio): standard care management (LA.S) and standard and strengthened care management (LA.S.S). Interventions were based on the proportionate universalism principle: universal standard care for all groups and proportionate care for the LA.S.S group. Main outcome was body mass index z-score (BMIz) assessed before and 1 year after inclusion. RESULTS A total of 1419 adolescents were included and 1143 followed up at 1 year: 649 in A.S, 158 in LA.S and 336 in LA.S.S groups. BMIz decreased significantly for boys (-0.11 [95% CI, -0.13 to -0.08]; p < 0.0001) and girls (-0.05 [-0.08 to -0.03]; p < 0.0001). No equivalence between LA.S.S and A.S groups was evidenced. For girls, the trend to superiority for LA.S.S was confirmed by the more favourable change (-0.06 [-0.11 to -0.01]; p = 0.01) observed on superiority analysis, with no differential change for boys (0.02 [-0.03 to 0.08]; p = 0.41). CONCLUSIONS A public health school-based intervention using the proportionate universalism principle may be effective in not worsening or even reducing overweight social inequalities in adolescents, especially for girls. Overcoming social barriers may help health professionals dealing with the burden and inequalities of overweight in adolescents.
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Affiliation(s)
- Serge Briançon
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France.
| | - Karine Legrand
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France.,CHRU-Nancy, INSERM, University of Lorraine, CIC-1433 Clinical Epidemiology, Nancy, France
| | - Laurent Muller
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France
| | | | - Laura Saez
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France
| | | | | | - Philip Böhme
- Department of endocrinology, diabetology and nutrition, Nancy University Hospital, Nancy, France
| | - Edith Lecomte
- National Conservatory of Arts and Crafts, Nancy, France
| | - Abdou Y Omorou
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France.,CHRU-Nancy, INSERM, University of Lorraine, CIC-1433 Clinical Epidemiology, Nancy, France
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Equity-Specific Effects of Interventions to Promote Physical Activity among Middle-Aged and Older Adults: Development of a Collaborative Equity-Specific Re-Analysis Strategy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173195. [PMID: 31480561 PMCID: PMC6747170 DOI: 10.3390/ijerph16173195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023]
Abstract
Reducing social inequalities in physical activity (PA) has become a priority for public health. However, evidence concerning the impact of interventions on inequalities in PA is scarce. This study aims to develop and test the application of a strategy for re-analyzing equity-specific effects of existing PA intervention studies in middle-aged and older adults, as part of an international interdisciplinary collaboration. This article aims to describe (1) the establishment and characteristics of the collaboration; and (2) the jointly developed equity-specific re-analysis strategy as a first result of the collaboration. To develop the strategy, a collaboration based on a convenience sample of eight published studies of individual-level PA interventions among the general population of adults aged ≥45 years was initiated (UK, n = 3; The Netherlands, n = 3; Belgium, n = 1; Germany, n = 1). Researchers from these studies participated in a workshop and subsequent e-mail correspondence. The developed strategy will be used to investigate social inequalities in intervention adherence, dropout, and efficacy. This will allow for a comprehensive assessment of social inequalities within intervention benefits. The application of the strategy within and beyond the collaboration will help to extend the limited evidence regarding the effects of interventions on social inequalities in PA among middle-aged and older adults.
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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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Yazdi Feyzabadi V, Keshavarz Mohammadi N, Omidvar N, Karimi-Shahanjarini A, Nedjat S, Rashidian A. Factors Associated With Unhealthy Snacks Consumption Among Adolescents in Iran's Schools. Int J Health Policy Manag 2017; 6:519-528. [PMID: 28949464 PMCID: PMC5582438 DOI: 10.15171/ijhpm.2017.09] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 01/18/2017] [Indexed: 12/03/2022] Open
Abstract
Background: Well-informed interventions are needed if school-based health promotion is to be effective. Among other aims, the Iranian Health Promoting School (IHPS) program that was launched in 2011, has an important aim
of promoting dietary behaviors of adolescents. The present study, therefore, aimed to investigate the factors affecting
unhealthy snacking of adolescents and provide evidence for a more effective IHPS program.
Methods: In a cross-sectional study design, 1320 students from 40 schools in Kerman city were selected using a
proportional stratified random sampling method. A modified qualitative Food Frequency Questionnaire (FFQ) was
used to gather data about unhealthy snacking behavior. Data about intrapersonal and environmental factors were
obtained using a validated and reliable questionnaire. A mixed-effects negative-binomial regression model was used
to analyze the data.
Results: Taste and sensory perception (prevalence rate ratio [PRR]=1.18; 95% CI: 1.09-1.27), being a male (PRR=1.20;
95% CI: 1.05-1.38) and lower nutritional knowledge (PRR=0.96; 95% CI: 0.91-0.99) were associated with higher weekly
unhealthy snaking. Perceived self-efficacy (PRR=0.95; 95% CI: 0.91-1.00) negatively influenced the frequency of
unhealthy snaking, with this approaching significance (P<.06). In case of environmental factors, high socio-economic
status (SES) level (PRR=1.45; 95% CI: 1.26-1.67), single-parent family (PRR=1.14; 95% CI: 1.01-1.30), more social
norms pressure (PRR=1.08; 95% CI: 1.01-1.17), pocket money allowance (PRR=1.21; 95% CI: 1.09-1.34), easy
accessibility (PRR=1.06; 95% CI:1.01-1.11), and less perceived parental control (PRR=0.96; 95% CI: 0.92-0.99) all had
a role in higher consumption of unhealthy snacks. Interestingly, larger school size was associated with less unhealthy
snacking (PRR=0.79; 95% CI: 0.68-0.92).
Conclusion: Unhealthy snacking behavior is influenced by individual, socio-cultural and physical-environmental
influences, namely by factors relating to poor parenting practices, high SES level, family characteristics, improper social
norms pressure, and less knowledge and self-efficacy of students. This evidence can be used to inform a more evidencebased
IHPS program through focusing on supportive strategies at the home, school, and local community levels.
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Affiliation(s)
- Vahid Yazdi Feyzabadi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Karimi-Shahanjarini
- Social Determinants of Health Research Center and Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saharnaz Nedjat
- Epidemiology and Biostatistics Department, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Legrand K, Lecomte E, Langlois J, Muller L, Saez L, Quinet MH, Böhme P, Spitz E, Omorou AY, Briançon S. Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis. Contemp Clin Trials Commun 2017; 7:141-157. [PMID: 29696179 PMCID: PMC5898577 DOI: 10.1016/j.conctc.2017.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 01/25/2023] Open
Abstract
Background Despite social inequalities in overweight/obesity prevalence, evidence-based public health interventions to reduce them are scarce. The PRALIMAP-INÈS trial aimed to investigate whether a strengthened-care management for adolescents with low socioeconomic status has an equivalent effect in preventing and reducing overweight as a standard-care management for high socioeconomic status adolescents. Methods PRALIMAP-INÈS was a mixed, prospective and multicenter trial including 35 state-run schools. It admitted overweight or obese adolescents, age 13–18 years old, for 3 consecutive academic years. One-year interventions were implemented. Data were collected before (T0), after (T1) and post (T2) intervention. Among 2113 eligible adolescents who completed questionnaires, 1639 were proposed for inclusion and 1419 were included (220 parental refusals). Two groups were constituted according to the Family Affluence Scale (FAS) score: the less advantaged (FAS≤5) were randomly assigned to 2 groups in a 2/1 ratio. The 3 intervention groups were: advantaged with standard-care management (A.S, n = 808), less advantaged with standard-care management (LA.S, n = 196), and less advantaged with standard and strengthened-care management (LA.S.S, n = 415). The standard-care management was based on the patient education principle and consisted of 5 collective sessions. The strengthened-care management was based on the proportionate universalism principle and consisted of activities adapted to needs. Inclusion results The written parental refusal was less frequent among less advantaged and more overweight adolescents. A dramatic linear social gradient in overweight was evidenced. Discussion The PRALIMAP-INÈS outcomes should inform how effectively a socially adapted public health program can avoid worsening social inequalities in overweight adolescents attending school. Trial registration ClinicalTrials.gov (NCT01688453).
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Affiliation(s)
- Karine Legrand
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,Inserm, CIC-1433 Clinical Epidemiology, Nancy University Hospital, Nancy, France
| | - Edith Lecomte
- National Conservatory of Arts and Crafts, Nancy, France
| | - Johanne Langlois
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,National Conservatory of Arts and Crafts, Nancy, France
| | - Laurent Muller
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France
| | - Laura Saez
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France
| | | | - Philip Böhme
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,Department of Diabetology, Metabolic Diseases and Nutrition, Nancy University Hospital, Nancy, France
| | - Elisabeth Spitz
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France
| | - Abdou Y Omorou
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,Inserm, CIC-1433 Clinical Epidemiology, Nancy University Hospital, Nancy, France
| | - Serge Briançon
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,Inserm, CIC-1433 Clinical Epidemiology, Nancy University Hospital, Nancy, France
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Jørgensen SE, Jørgensen TS, Aarestrup AK, Due P, Krølner R. Parental involvement and association with adolescents' fruit and vegetable intake at follow-up: Process evaluation results from the multi-component school-based Boost intervention. Int J Behav Nutr Phys Act 2016; 13:112. [PMID: 27782838 PMCID: PMC5080706 DOI: 10.1186/s12966-016-0435-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 10/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Based on the assumption of parental influence on adolescent behavior, multicomponent school-based dietary interventions often include a parental component. The effect of this intervention component is seldom reported and the evidence is inconsistent. We conducted a systematic process evaluation of the parental component and examined whether the leveal of parental involvement in a large multi-component intervention: the Boost study was associated with adolescents' fruit and vegetable (FV) intake at follow-up. METHODS The Boost study was targeting FV intake among 1,175 Danish 7th graders (≈13- year-olds) in the school year 2010/11. The study included a school component: free FV in class and curricular activities; a local community component: fact sheets for sports- and youth clubs; and a parental component: presentation of Boost at a parent-school meeting, 6 newsletters to parents, 3 guided student-parent curricular activities, and a student-parent Boost event. STUDY POPULATION Students whose parent replied to the follow-up survey (n = 347). DATA Questionnaire data from students, parents and teachers at 20 intervention schools. Process evaluation measures: dose delivered, dose received, appreciation and level of parental involvement. Parental involvement was trichotomized into: low/no (0-2 points), medium (3 points) and high (4-6 points). The association between level of parental involvement and self-reported FV intake (24-h recall), was analyzed using multilevel regression analyses. RESULTS The Boost study was presented at a parent-school meeting at all intervention schools. The dose delivered was low to moderate for the three other parental elements. Most parents appreciated the intervention and talked with their child about Boost (83.5 %). High, medium and low parental involvement was found among 30.5 %, 29.6 % and 39.4 % of the students respectively. Parental involvement was highest among women. More men agreed that the parental newsletters provided new information. Students with a medium and high level of parental involvement ate 47.5 and 95.2 g more FV per day compared to students with low level/no parental involvement (p = 0.02). CONCLUSIONS Students with a high level of parental involvement ate significantly more FV at follow-up compared to students with a low level/no parental involvement. Parental involvement in interventions may improve adolescents' FV intake if challenges of implementation can be overcome. TRIAL REGISTRATION ISRCTN11666034 . Registered 06/01/2012. Retrospectively registered.
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Affiliation(s)
- Sanne Ellegård Jørgensen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2., 1353 Copenhagen K, Denmark
| | | | - Anne Kristine Aarestrup
- Intersectoral Research Unit for Health Services, The Capital Region of Denmark, Bispebjerg Hospital, 23 Bispebjerg Bakke, 2400 Copenhagen NV, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2., 1353 Copenhagen K, Denmark
| | - Rikke Krølner
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2., 1353 Copenhagen K, Denmark
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Zota D, Dalma A, Petralias A, Lykou A, Kastorini CM, Yannakoulia M, Karnaki P, Belogianni K, Veloudaki A, Riza E, Malik R, Linos A. Promotion of healthy nutrition among students participating in a school food aid program: a randomized trial. Int J Public Health 2016; 61:583-92. [PMID: 27022997 DOI: 10.1007/s00038-016-0813-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the potential benefits on students' eating habits, of incorporating healthy nutrition education as part of a school food aid program. METHODS 146 schools participating in the DIATROFI Program in Greece during the 2013-2014 school year were randomly allocated to the environmental intervention (received a healthy daily meal) and the multicomponent intervention (MI) group (in addition to the meal, a healthy nutrition educational program was applied). The analysis, based on 3627 pre-post intervention questionnaire pairs, was stratified for children (ages 4-11 years) and adolescents (ages 12-18 years). RESULTS Children participating in the MI group displayed 25 % higher odds of increasing the weekly consumption of milk/yoghurt and fruits, 61 % higher odds of improving BMI from overweight/obese to normal and 2.5 times higher odds of improving from underweight to normal. For adolescents in the MI group, the odds of increasing the consumption of vegetables were 40 % higher. In both intervention groups, approximately one in four overweight/obese adolescents reached normal weight. CONCLUSIONS Educational programs on healthy nutrition might be considered worth implementing in the framework of school food aid programs.
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Affiliation(s)
- Dina Zota
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
| | - Archontoula Dalma
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanassios Petralias
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Anastasia Lykou
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina-Maria Kastorini
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Pania Karnaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
| | - Katerina Belogianni
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
| | - Afroditi Veloudaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhea Malik
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | - Athena Linos
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Moore GF, Littlecott HJ, Turley R, Waters E, Murphy S. Socioeconomic gradients in the effects of universal school-based health behaviour interventions: a systematic review of intervention studies. BMC Public Health 2015; 15:907. [PMID: 26381233 PMCID: PMC4574356 DOI: 10.1186/s12889-015-2244-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/07/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in health behaviour emerge in early life before tracking into adulthood. Many interventions to improve childhood health behaviours are delivered via schools, often targeting poorer areas. However, targeted approaches may fail to address inequalities within more affluent schools. Little is known about types of universal school-based interventions which make inequalities better or worse. METHODS Seven databases were searched using a range of natural language phrases, to identify trials and quasi-experimental evaluations of universal school-based interventions focused on smoking, alcohol, diet and/or physical activity, published from 2008-14. Articles which examined differential effects by socioeconomic status (N = 20) were synthesised using harvest plot methodology. Content analysis of 98 intervention studies examined potential reasons for attention or inattention to effects on inequality. RESULTS Searches identified approximately 12,000 hits. Ninety-eight evaluations were identified, including 90 completed studies, of which 20 reported effects on SES inequality. There were substantial geographical biases in reporting of inequality, with only 1 of 23 completed North American studies testing differential effects, compared to 15 out of 52 completed European studies. Studies reported a range of positive, neutral or negative SES gradients in effects. All studies with a negative gradient in effect (i.e. which widened inequality) included educational components alone or in combination with environmental change or family involvement. All studies with positive gradients in effects included environmental change components, alone or combined with education. Effects of multi-level interventions on inequality were inconsistent. Content analyses indicated that in approximately 1 in 4 studies SES inequalities were discussed in defining the problem or rationale for intervention. Other potential barriers to testing effect on inequality included assumptions that universal delivery guaranteed universal effect, or that interventions would work better for poorer groups because they had most to gain. CONCLUSIONS Universal school-based interventions may narrow, widen or have no effect on inequality. There is a significant need for more routine testing of the effects of such interventions on inequality to enable firmer conclusions regarding types of interventions which affect inequality. PROSPERO REGISTRATION NUMBER CRD42014014548.
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Affiliation(s)
- Graham F Moore
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
| | - Hannah J Littlecott
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
| | - Ruth Turley
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
| | - Elizabeth Waters
- Jack Brockhoff Child Health and Wellbeing Program, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Simon Murphy
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
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