ars.els-cdn.com · Web view98.Talvia S, Lagstrom H, Rasanen M, Salminen M, Rasanen L, Salo P, et al. A randomized intervention since infancy to reduce intake of saturated fat: calorie

Supplementary Table 4: Equity focused systematic reviews

Key: NR: not reported; SEP: socio-economic position; SES: socioeconomic status, U: unclear

Study1. Author2. Year3. Topic Area4. No. of included studies

Aim Participants described according to measure of SES?1. Education level2. Income3. Occupation4. Deprivation5. Poverty6. Other measure?

Participants described as disadvantaged?

Differential intervention effects using a SES measure considered?

Impact of universal intervention for disadvantaged groups?

Authors conclusions

1. Brown2. 20143. Tobacco Free Living4. 38

“What is the equity impact of interventions/ policies to reduce youth smoking?’ This was addressed by assessing primary studies of any intervention/policy that reported differential effects on a smoking-related outcome in at least two socioeconomic groups."

1. Y (58-65), parental education (66-72), householdeducation and percentage of population with a college education (62, 63, 73) 2. Y (household income (63, 74-76), Family Affluence Scale (77-81), income level at ‘zip’ code level (73, 82),3. Y (83)4. Y (e.g. Index of Multiple Deprivation/ area deprivation (80, 84-88), Measures of area deprivation includedthe Index of Relative Socio-Economic Disadvantage (88))

1. Y (93)Majority of primary studies appear to be population based i.e. not focused on disadvantaged groups.

1. Y All included studies were required to report on SES impact as part of the SR selection criteria (i.e. only studies including differential effects with >2+ socioeconomic groups were included)

1. Y 16 studies “had a neutral equity impact and indicate that these interventions/ policies have benefits for youth across all SES groups”“Two text-messaging interventions increased quit rates among young adults in the short term, and one of these showed potentialequity benefits for low SES youth”

"Only 38 studies assessed the equity impact of interventions/policieson smoking prevention or cessation in youth. The distribution of equity effects across interventions was: 7 positive, 16 neutral, 12 negative, 4 mixed and 1 unclear. Most of the neutral equity studies were beneficial for all SES groups…Only seven of the intervention/ policies showed the potential to reduce inequalities in youth smoking and all were US-based: four

1






Authors conclusions

5. Y (e.g. percentage below 150% poverty level) (62, 89)6. Y (e.g. family socioeconomic classification (78), freeschool meal eligibility (80, 90, 91), percentage ofyouth unemployment, percentage receiving social welfare andattending ‘low-qualifying’ schools (65, 87), school census tract data (92))

studies of increasing the price/tax of cigarettes, two studies of enforcing strong policies on age-of-sale, and one study of smoking cessation support through text-messaging. The review provides very little evidence to suggest thatany specific policy reduces inequalities in smoking initiation, with the exception of price/tax policies which had the most consistent positive equity impact. Overall, more interventions/ policies were found to have a negative equity impact, and therefore to potentially

2






Authors conclusions

exacerbate inequalities in youth smoking, than had a positive equity impact”

1. Rice@

2. 20093. Tobacco Free Living4. 45

“The specific focus was on estimated price elasticity effects and where sufficient evidence was available, differential effects by stage of smoking behaviour and by socio-demographic or socioeconomic group as defined by the PROGRESS criteria (place of residence or area deprivation indicator, race/ethnicity, occupation, gender, religion, educational level, income) were also assessed”

1. N2. Y - 31/45 studies (ToC and Appendix 9) but no details are reported3. N4. N5. N6. Y – 32/45 studies see ToC and Appendix 9 but no specific details are available

1. Y (128) 1. Y (68, 129-131)

1. N "Limited evidence on the price elasticity of smoking by socio-economic or demographic groupwas found. Where information was available, this was restricted to effects by age (younger and older young people), gender and ethnic groups. Consideration of the effects on groups from different socio-economic backgrounds should be a priority area for future research, as an aid to understanding the social patterning of

3






Authors conclusions

smoking among young people and the effectiveness of price in reducing inequalities in smoking behaviours."

"Limited evidence on the price elasticity of smoking by socio-economic or demographic groupwas found. Where information by PROGRESS criteria was available, this was restricted to effects by age, gender and ethnic group. Moreover, for the latter the limited evidence available was from the US where the focus is on race, and the extent to which these findings

4






Authors conclusions

translate to the UK is questionable. Evidence on price elasticities across socio-demographic groups remains a priority area for future research to gain a greater understanding of the social patterning of smoking among young people and the effectiveness of price in reducing inequalities in smoking outcomes."

1. Thomas£


“To assess the effects of population tobacco control interventions on social inequalities in smoking”

1. Y (132-136)2. Y (136)3. Y 4. N5. N6. Y (see notes)

1. NPopulation interventions were defined in such a way that it would not include disadvantaged groups

1. Y – authors report that “No studies provided evidence about possible differential effects by parental income, occupation or

1. N The review authors “extracted outcome, process and implementation datastratified by the sociodemographic characteristics specified inthe PROGRESS criteria (place of residence, race or

5






Authors conclusions

educational level”

ethnicity,occupation, gender, religion, educational level, socioeconomic status (for example, represented by income), and social capital…. No studies reported outcomes by place of residence, religion or level of social capital these characteristics were excluded from our analysis”All the conclusions of this study are relevant to health equity. "Inparticular, we know little about the differential effects of mostcategories of intervention by income, gender or ethnicity. For tobacco pricing—a

6






Authors conclusions

relatively well researched field—we also need to know more about effects on adolescents from lower-income households and on young people in general, and on lower income adults who are likely to be nicotine-dependent."

1. Moodie$


"The secondary aims are to assess any other potential impacts (benefits or disbenefits) of plain packaging not identified by the FCTC; examine whether the effects of plain packaging vary by gender, age, socio-economic status and ethnicity; and describe the facilitators and barriers to the introduction of plain packaging identified within the included studies."

1. N2. N3. N4. N5. N6. N

1. N 1. Y (61, 107, 108)

1. N Few papers actually reported SES data. Authors reported " no consistent differences seen… More data on these types of differences are needed before any conclusions can be drawn."

7






Authors conclusions

1. Patnode2. 20133. Tobacco Free Living4. 19

RQ: "Are there differences in outcomes in different subgroups, as defined by age, sex, race, socioeconomic status, type or pattern of tobacco use, residential setting (urban vs. rural), or presence of depression?"

1. N2. N3. N4. N5. N6. N

1. N 1. N 1. N Not considered

1. Moore2. 20153. General Health4. 20

“To examine the extent to which, and the ways in which effects of universal school-based interventions on socioeconomic inequality have been evaluated in peer-reviewed evaluations published since 2008. …a secondary aim is to synthesise existing evidence on the types of interventions which are more likely to worsen or improve inequality”

1. Y (109-118)2. Y (119)3. N4. Y (e.g. school deprivation index(120))5. N6. Y (e.g. School IMD(121), pupil IMP(121), Free school meals (122, 123) FAS(80); employment (111); family wealth (111, 124); family economic capacity index (112); parental SES (119); neighbourhood SES (112); school area and level SES measure

1. N 1. Y Focus is on social gradients and inequalities

1. N “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”

8






Authors conclusions

(125); school type (state vs private or vocational vs academic) (118, 126, 127)

1. Hollands*†2. 20153. GH4. 72

1. “To assess the extent to which the effects of such interventions may be modified by participant characteristics, such as age, gender or socioeconomic status (to facilitate an assessment of social differentiation in effects relevant to health equity)”

1. Y (94, 95)2. Y (95)3. N4. Y (94-96)5. N6. N

1. Y †70/ 72 studieswere conducted in low deprivation contexts, whilst the othertwo were conducted in high deprivation contexts (94, 96)

1. Y* Consider differential effects, but are unable to explore them due to lack of data*

1. N “Unable to examine effect moderation by study participants’ SES …due to the infrequency of reporting of such measures across included studies… SES remains an important potential moderator of the effects of sizing interventions that deserves closer attention in future research”

The SR authors also note: "This would not only ensure that effective policies did not cause “intervention

9






Authors conclusions

generated inequalities” (97) but would also increase understanding of their potential to reduce inequalities arising from excessive consumption of less healthy products by more socially and materially deprived people, such as those with low levels of education or income. None of the included studies assessed (or indeed were powered to assess) the moderation of intervention effects by socioeconomic status, or potential interactions between product size and cost in influencing selection with

10






Authors conclusions

purchasing."1. Bonell2. 20133. General Health4. Evidence Map: 1144;Theory: 38Outcome Evaluations: 10; Process Evaluations: 6; Multi-Level Studies: 42;Qualitative Studies: 19

1) What are the effects on health and health inequalities among school students aged 4–18 years of school environment interventions (modifying how schools are organised/managed, how they teach, provide pastoral care to and discipline students, and/or the school physical environment) that do not include health education or health services as intervention components and which are evaluated using prospective experimental and quasi-experimental designs? What are their direct and indirect costs?"

2) What are the effects on health and health inequalities among school students aged 4–18 years of school-level measures of school organisation/ management, teaching, pastoral care and discipline, student attitudes to school or relations

1. Y (13-18)2. Y (14, 15, 17, 19-25)3. Y (17, 26)4. Y (e.g. Townsend deprivation index(27, 28); residential deprivation level (29), other (23, 30-32)5. Y (26, 33-35)6. Y (e.g. housing tenure(25, 27, 28, 36), reduced or free school meals(25, 27, 28, 37-43), ‘SES’ (16, 44, 45), neighbourhood SES (46))

1. Y (e.g. (47-49)

9 studies (26, 30-32, 36, 42, 43, 48, 49) were conducted in contexts of high levels of socioeconomic disadvantage; 2 studies were conducted with a high SES sample (50, 51); and four studiesexplored students’ experiences across multiple schools and/or neighbourhoods that varied in terms of their socioeconomic characteristics (25, 35, 47, 52-54). It is difficult to assess the

1. Y "Seven of the reports of intervention outcome evaluations examine subgroup effects, but only one examinedeffects by SES. "Multilevel studies of school effects tell us very little about the impact of schools on health inequalities. One study (29) found that in secondary schools in the West Midlands, UK, there was

1. Y (see conclusions)

"We also currently know very little about the potential impact of school environment interventions on health inequalities. Intervention studies should therefore examine effects overall as well as by SES, ethnicity and sex, and should use formal tests for interaction to assess whether or not there are real differences by subgroup."

11






Authors conclusions

with teachers, and/or the physical environment (measured using ‘objective’ data rather than aggregate self-reports from the same individuals who provide data on outcomes), examined using multilevel quantitative designs?”

socioeconomic context of three of the studies (55-57), 8 studies described as disadvantaged in some way (26, 30-32, 34, 35, 48, 49).

no significant interaction of the school-level measure of value-added education withwhether or not pupils were regular smokers at baseline."

1. Priest2. 2008b3. General Health 4. None

"To determine if some interventions are more successful with particular participants, grouped by, for example, socio-economicstatus, gender, age, ethnicity or geographical location."

1. N2. N3. N4. N5. N6. N

1. N 1. N 1. N Insufficient evidence

"Studies must report on information relating to context (e.g. social, political and cultural factors relating to the setting of the intervention and evaluation)."

1. Baker To explore whether any effects of 1. Y (1) 1. Y (e.g. (1, 3-10) 1. Y (e.g. (2)) 1. Y “None of the studies

12






Authors conclusions

2. 20153. Active Living4. 33

the intervention are different within and between populations, and whether these differences form an equity gradient

2. N3. N4. Y (2) 5. Y (1, 3)6. Y (e.g. bicycle initiative (2)

) (e.g. "some evidence that the three-year, multi-strategic interventionwas effective at decreasing the proportion of a populationin a low socio-economic district in Oslo, Norway not engaging inheavy physical activity (5, 11) found no evidence of an increase in energy expenditure in the interventiongroup as compared to the comparison groups at two years postbaseline”“In the UK, using an interventiontargeting socio-economically disadvantaged neighbourhoods

provided results by socio-economic disadvantage or other markers of equity. However, of those included studies undertaken inhigh income countries, 14 studies were described as being provided to deprived, disadvantaged or low socio-economic communities”

13






Authors conclusions

of London (3), and in rural villages of Devon, found no evidence of an effect (12)."

1. Priest2. 2008a3. Active Living4. None

"To determine if interventions are more successful with particular participants, grouped by (for example) socio-economic status, gender, age, ethnicity, geographical location and individual or team sports."

1. N2. N3. N4. N5. N6. N

1. N 1. N 1. N Insufficient evidence

1. Waters^2. 20113. Obesity Prevention4. 55

Secondary aim: The evaluation of demographic characteristics of participants (socio-economic status, gender, age, ethnicity, geographical location, etc.)

1. Y (Baseline only) (137-142) 2. Y (143) 3. N4. N5. N6. (e.g. SES measure (137, 144, 145); employment status (138, 141) ; proportion of participating schools in a rural or urban region (146-148)

1. Y (e.g. describe intervention as addressing diversity / disadvantage (137, 144, 145, 149, 150))

1. Y (e.g. Jouret 2009(146))

1. YIn relation to equity and the incorporation of PROGRESS (Place,Race, Occupation, Gender, Religion, Education, Socio-economicstatus, Social status), only a minority of studies reported outcomes by any such indicators, and of

0-5 years group: "When analysing outcome data, 17 studies did not analyse by any of the items in the PROGRESS framework. Of the 22 studies that did analyse by at least one item on the PROGRESS framework, the majority analysed outcomes by gender

14






Authors conclusions

those that did, the majority focusedon SES, followed by race; 15/39 studies incorporated strategies to address disadvantageor diversity." “The review however provides evidence of significant positive outcomes for the more disadvantaged, and thus those of higher morbidity”

(n = 21). A total of six studies included analysis of outcome data by PROGRESS items other than gender”

All studies which assessed outcomes by a PROGRESS measure of equity, reported either no association between the outcomes of the intervention and the PROGRESS measure, or positive impacts for groups of lower SES. The possibility of a bias towards reporting favourable equity effects cannot be excluded."

13 - 18 year olds: "When analysing outcome data, only

15






Authors conclusions

four of the eight studies analysed results by any of the PROGRESS items…. the lack of analysis by a measure of equity or socio-economic status limits our ability to assess the effectiveness of the interventions in reducing health inequities, however it should be noted that most of the studies targeted settings or families of low socio-economic status”

1. Kader2. 20153. Obesity Prevention4. 35

To consider: "2) effectiveness in relation to family socio-economic position"

1. Y (98)2. Y (98)3. Y (98)4. N5. N6. N

1. Y (98-103)

"Minority or low SEP groups (6 studies (98-103)). However, the SR authors do not report these

1. Y (e.g.(98))

The SR authors report: "one study analysed ifthere were any moderating

1. Y (104-106) "Group-based interventions arepromising, especially for groups with low SEP, but low participationand attrition are a

“With regard to groups with low SEP, group-based approaches of relatively high intensity appear to be effective, but low participation and

16






Authors conclusions

characteristics of the studies, so it is not possible to judge if they are SES or ethnic minority. One study (101); "Children aged 3–4.9 years of 77 families from 8 SureStart children's centres in disadvantagedareas." One study (102) described as: "targeting low-income Latino mothers"

effects of SEP in a sample of parents withmixed SEP (98). Long-termcounselling was effective overall, but found no moderating effects ofeducation, income or unemployment status with regard to fat intake during their long-term study between the ages of 4 and 10". The SR authors also note: "Future studies should test individual approaches in

problem, as also shown previously (104).Previous studies have shown that parents with low incomeexperience logistical barriers to participation in parenting interventionssuch as unstable schedules, lack of transportation, lack of childcare (105) and some interpersonal barriers such as mistrust of providers, prior negative experiences, and fears of stigmatization (106)than higher income parents. Therefore, it is important to

high attrition remains a challenge. More studies should test an individual counselling approach in disadvantaged groups in order to see if this will improve participation and lead to lower attrition”

17






Authors conclusions

disadvantaged groups, and studies with mixed socioeconomic groups should examine differential effects with regard to SEP, which howeverrequires stratification and an adequate sample size."

consider such barriers when planning interventions inthis target group."

1. Welsh%

2. 20153. Mental Health4. NR

“To promote mental wellbeing and reduce inequities in children and young people. We focus on interventions that address the social determinants of wellbeing by using the Fair Foundations framework to identify different layers and sources of inequities”

1. N2. N3. N4. N5. N6. N

1. Y (at least 9 studies cited in Table 1; references not reported in bib).

1. Y (at least 5 studies cited in Table 1; references not available).“very few interventions specifically designed to address inequitiesor evaluated in

1. Y Several examples –presented (e.g. universal-school-based prevention programmeexclusively in disadvantaged schools, using the FRIENDS for Life programme) “significantly fewer

Interventions were designed to increase mental illness awareness, increase help seeking behaviour or prevent mental illness, none were designed with an equity focus and programme evaluations did not test for differential

18






Authors conclusions

regard to differential impact…We did not find any which set out to address social gradients in wellbeing, and only a few evaluations considered differentialimpacts across social groups”.

anxiety and depressive symptoms post-intervention and positive treatment gains were maintained at 12month follow-up. Improvements in self-esteem and psychosocial functioning werealso seen

impact." Authors also “found encouraging evidence that there are some interventions that could be used to promote wellbeing and reduce inequities in the future…The success of these programmes in both universal and targeted populations support the use of a proportionate universalism approaches to addressing inequities in children’s mental wellbeing in the future. However, our review also revealed that some universal programmes have the potential to

19






Authors conclusions

engrain inequities by failing to reach those with the greatest need”. These differential impacts should be monitored as the field develops."

1. De La Rue 2. 20143. Violence and Abuse Free Living4. 23

"Objective 6. Are there substantive or methodological variables that moderate the effect sizes? The substantive variables that were examined include: program characteristics, age, gender, location, racial composition, and socio-economic status (SES)".

1. N2. N3. N4. N5. N6. N

1. N 1. N 1. N Insufficient evidence. Authors report that they planned to analyse substantive or methodological variables including SES but no data was presented.

Notes: *Hollands (2015) developed a conceptual model which included a number of SES measures (e.g. occupational status, education, income, food insecurity,

welfare receipt) but reported limited data reported within individual trials. he SR authors state: "We were unable to examine effect moderation by study participants’ socioeconomic status in this review due to the infrequency of reporting of such measures across included studies (this was one component of analysis intended to inform assessment of social differentiation in effects relevant to health equity”

† Hollands (2015) described SES context in the table of characteristics as either low or high deprivation. Stating that “at the protocol stage, we intended to use the most commonly available measure of participants’ socioeconomic status to construct the socioeconomic status context variable (see Data extraction and management). We were unable to do this in practice because no single proxy measure of participants’ socioeconomic status, such as

20

education or income, was commonly measured in and reported by included studies. Therefore, we instead coded a binary study-level covariate based on authors’ explicit descriptors of the study sample and/or setting (e.g. “Low income Hispanic or non-Hispanic African American children and their mothers”, or “Faculty, graduate students, and staff members of the Department of Food Science and Nutritional Science of a large Midwestern university”. Unless explicitly described as being of low socioeconomic status, we coded the context of included studies as high socioeconomic status."

$ Moodie (2012) reported that "We extracted data on: study aims and design (aims and impacts, funding, design, country and date of publication); the sample studied (sample size, age, gender, smoking status, ethnicity, and socioeconomic status);" however the table of characteristics of studies does not report SES.

@Rice (2009) aimed to extract data according to PROGRESS criteria where this is available. Age, gender and race are routinely reported in the paper, however although several measures of SES are referred to in the table of characteristics (e.g. educational level, annual disposable income, work status, unemployment rate etc) they are cited as explanatory variables of the empirical model, but no data is actually presented.

£Thomas (2008) The references cited in Thomas 2008 are those presented in the main paper and are likely to underestimate the total number of papers that have reported participants according to an SES measures. Unfortunately, the links to supplementary files (with list of included studies) were broken, so we were not able to search the original tables to calculate this measure.

^Waters 2011 reported that “with the exception of Robbins 2006, all studies reported one or more items of the PROGRESS framework at baseline. Most studies reported gender of participants …. Socioeconomic status (SES) (n = 16) and race (n = 15) were the next most commonly reported items at baseline, followed by education level of parents (n = 11), place (n = 6), occupation or employment status of parents (n = 4) and social status (n = 2)." However, the SR authors do not report these characteristics for primary studies.

% Welsh 2015 presented data by intervention type rather than study, so the participants are not described in detail. Authors were contacted to see if table of characteristics were available but no further information was available in the original report. Multiple studies were cited in Table 1 but references were not reported in the reference list. For example: the following studies were cited as describing their participants as disadvantaged: Davis 2010; Perry preschool project; Wells et al. 2003, Stopa et al 2010, Misfud & Rapee 2005, Baker-Henningham et al., 2009, Barrera et al., 2002, Webster-Stratton and Reid, 2008, Kellam et al 2011. Differential effects were cited in the following studies: e.g. Belsky et al 2006, Durlak et al 2011, Kraag 2006, Wells et al, 2003, Stopa et al, 2010)

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ars.els-cdn.com · Web view98.Talvia S, Lagstrom H, Rasanen M, Salminen M, Rasanen L, Salo P, et al. A randomized intervention since infancy to reduce intake of saturated fat: calorie