Background
Methods
Inclusion criteria
Screening
Additional searches for linked publications
Data extraction
Synthesis
Results
Description of studies obtained
Measures of SES and their usage
All studies (n = 98) | Study year (completed studies) | Region | Behavioural outcome | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2008-2010 (N = 42) | 2011-2014 (N = 56) | Europe (N = 58) | N America (N = 24) | Australasia (N = 9) | Asia (N = 3) | S America (N = 4) | Diet (N = 19) | Physical activity (N = 20) | Diet and PA (N = 21) | Smoking (N = 15) | Alcohol (N = 12) | Smoking and alcohol (N = 11) | |||
Measure collected | Any measure of SES | 71 | 26 | 45 | 46 | 15 | 7 | 1 | 2 | 14 | 14 | 16 | 13 | 8 | 6 |
School level (e.g. Free School Meals) | 32 | 12 | 20 | 14 | 11 | 6 | 1 | 0 | 7 | 7 | 5 | 6 | 3 | 4 | |
Family level (e.g. parental income) | 48 | 18 | 30 | 37 | 7 | 3 | 0 | 2 | 8 | 10 | 11 | 9 | 6 | 5 | |
Use of SES measures | Sample descriptions | 53 | 22 | 31 | 34 | 12 | 4 | 1 | 2 | 11 | 9 | 15 | 4 | 6 | 4 |
Control variables | 24 | 8 | 16 | 16 | 3 | 4 | 0 | 1 | 6 | 4 | 6 | 5 | 2 | 1 | |
Sampling procedures | 19 | 9 | 10 | 9 | 5 | 4 | 1 | 0 | 4 | 4 | 3 | 3 | 3 | 2 | |
Analysis of differential effect | 21a | 8 | 13 | 18a | 1 | 1 | 1 | 0 | 4 | 1 | 8 | 4 | 2 | 2 |
Effects on inequality
Study name | Main reference | Country | SES measurea | Intervention type | Outcomes tested | Effective? | Outcomes analysed bv SES | Gradient in effect | |
---|---|---|---|---|---|---|---|---|---|
AFLY5 | Kipping et al. 2014 | UK | School IMD Pupil IMD | Education and parental involvement | Physical activity (accelerometer) and diet outcomes | No effects on primary outcomes. Significant change in 3 secondary outcomes. | Physical activity (accelerometer) and diet outcomes | Some subgroup differences in both directions (e.g. effect on snacking only in low SES, and on central obesity only in high SES). No significant interaction effects. | Neutral e |
ASSIST | Campbell et al. 2008 | UK | FSM FAS | Education and environment | Smoking status | Significantly lower rise in smoking rates in intervention group. | Smoking status | Neutral (OR for interaction = 0.99) c | Neutral |
School fruit scheme | Bere et al. 2010 | Norway | Parental education | Environment | Fruit consumption and vegetable consumption | Significant increases in fruit intake – no change in vegetable intake | Fruit consumption and vegetable consumption | Neutral (statistics not reported) | Neutral |
Crone et al. 2011 | Crone et al. 2011 | Netherlands | Parental education and student education level | Education | Smoking | Increased intention not to smoke and lower smoking uptake after transition to secondary school. | Smoking | Neutral (statistics not reported) | Neutral |
EHealth4us | Bannink et al. 2014 | Netherlands | Parental education, employment and family affluence | Education | Smoking and alcohol (as secondary measures – primary outcomes mental health) | No significant main effects | All outcomes | Neutral (statistics not reported) | Neutral |
Energize | Rush et al. 2012 | New Zealand | School deprivation decile | Education, environment and family/community involvement | Diet and physical activity (as secondary outcomes – primary outcomes obesity measures) | No significant main effects | Obesity and blood pressure only | Larger effects on BP and body-fat in more affluent schools | Negative |
ESFA | Ariza et al. 2008 | Spain | Parental education and ‘family economic capacity index’. Neighbourhood SES | Education, environment and family/community involvement | Smoking | Significantly lower rate of increase in smoking in experimental group. | Smoking | Bigger effect in high FECI. No clear difference by parental education | Negative |
EUDap | Faggiano et al. 2010 | Austria, Belgium, Germany, Greece, Italy, Spain, Sweden | Area (school) level SES measure | Education, environment and family/community involvement | Smoking and alcohol (plus cannabis and other drugs) | Significant effects found for daily cigarette smoking and episodes of drunkenness in the past 30 days for at least one episode, or three or more episodes.. | Alcohol only | Larger effects on alcohol consumption measures in more deprived schools. | Positive |
FatAintPhat | Ezendam et al. 2012 | Netherlands | School type (vocational or pre-university) | Education | Physical activity, sedentary behaviour, fruit and vegetable intake, snacking and sugar sweetened beverages (plus BMI, waist circumference and fitness) | No effect on primary outcomes (BMI). But positive effect on some secondary outcomes (fruit and vegetable intake, snacking and sugar sweetened beverages). Negative effect on step counts. | Fruit and vegetable intake, snacking and sugar sweetened beverages (only variables with a significant and + ve main effect) | Effect on SSB only in higher SES schools. No other significant interactions | Negative |
HEIA | Grydeland et al. 2012 | Norway | Parental education | Education, environment and family/community involvement | Physical activity (accelerometer) and dietary outcomes (plus obesity outcomes) | Mixed | All outcomes | Greater effect on BMI for higher SES. No interactions for behaviours. | Negative |
KOPS | Plachta-Danielzik 2011 | Germany | Parental education | Education, environment and family/ community involvement | Healthy eating index, physical activity and media time (as secondary outcomes – primary outcomes obesity measures) | No significant main effects | All outcomes | Bigger effect on BMI for higher SES. No interactions for behaviours. | Negative |
Avall | Llargues et al. 2011 | Spain | Mother’s/Father’s education | Education, and family/community involvement | Physical activity and diet (as secondary outcomes – primary outcomes obesity measures) | Lower rise in BMI in intervention group. Twenty dietary and physical activity secondary outcomes tested. | BMI only | Effects on BMI only in high SES | Negative |
STOPP | Marcus et al. | Sweden | Parental education | Education, environment and family/community involvement | Physical activity and diet (as secondary outcomes – primary outcomes obesity measures) | Effects on BMI among those who were overweight at baseline only. Mixed effects on 8 secondary diet outcomes. | Diet outcomes | Bigger effect on dairy product and fast food intake in low SES. | Positive |
MYTRI | Perry et al. 2009 | India | School type (government vs private) | Education, environment and family/community involvement | Smoking | Lower increases in smoking or bidi uptake in intervention group. | Smoking | Neutral (statistics not reported) | Neutral |
PAS | Koning et al. 2009 | Netherlands | Parental education and school type (vocational vs academic) | Education, environment and family/community involvement | Alcohol use (Heavy weekly, weekly and frequency) | At first follow-up, only the combined student–parent intervention showed substantial and statistically significant effects on heavy weekly drinking, weekly drinking and frequency of drinking. At second follow-up these results were replicated, except effects on heavy weekly drinking. | Alcohol use (WD and HWD) | Bigger effect on HWD in low-educated adolescents. No moderation of effect on WD. | Positive |
Promise | Stallard et al. 2012 | UK | Family affluence | Education | Alcohol | No effects on primary outcome, or substance use (measured as secondary) | Mental health outcomes only | Neutral (OR for interaction = −0.45(−1.11 to 0.21)) | Neutral |
PSFBI | Murphy et al. 2011 | UK | School and individual FSM | Environment | Diet (breakfast skipping and healthy/unhealthy items) | Significant improvements in diet quality at breakfast and attitudes toward breakfast. No differences in breakfast skipping, fruit and veg intake or sweets and crisps. | All outcomes | Bigger effect in low SES for breakfast skipping and healthy breakfast items. No other significant interactions. c | Positive |
Smart Lunchbox | Evans et al. 2010 | UK | FSM | Environment and family/community involvement | Diet outcomes | Intervention group children were provided with more fruit, vegetables, dairy food and starchy food other than bread. Weight of savoury snacks (crisps and other salted snacks) lower for children in the intervention group. Weights of sweetened drinks and confectionery did not change | All outcomes | Neutral (statistics not reported) | Neutral |
SPACE | Toftager et al. 2014 | Denmark | Income and ‘parental SES’ | Environment | Physical activity, fitness, active transport and obesity | No significant main effects | All outcomes except active travel | Neutral (statistics not reported) | Neutral |
Pro Children d | Te Velde et al. 2008 | Netherlands, Spain and Norway | Parental education | Education, environment and family/community involvement | Diet outcomes | Significant effects for fruit and veg intake found at first follow-up. One year later, a significant impact was only observed in Norway. | All outcomes | Non-significant interaction effects (data unreported) Effects on F&V in high and low SES. | Neutral |
Study name | Main reference | Study quality | Sample size (school or class/individual) | Retention (numbers analysed) (school or class/individual) | Length of intervention | Length of follow-up | ||
---|---|---|---|---|---|---|---|---|
Intervention | Control | Intervention | Control | |||||
AFLY5 | Kipping et al. 2014 | Moderate | 30/1064 | 30/1157 | 30/1024 | 30/1097 | 7-11 months | Immediate post-intervention / 1 year |
ASSIST | Campbell et al. 2008 | Moderate | 30/5187 | 29/5074 | 30/5058/5044/4966 (post intervention/1 year/2 year) | 29/4753/4865/4700 | 4 months | Immediate post-intervention/ 1 year / 2 years |
School fruit scheme | Bere et al. 2010 | Weak | 27/1488 (total N. Natural experiment - baseline survey prior to adoption or non-adoption) | 27/1339 followed up (10 had adopted subscription, 5 free and 12 none) | Unclear | 7 years after baseline survey | ||
Crone et al. 2011 | Crone et al. 2011 | Weak | 62/1756 | 59/1417 | 62/1010 | 59/805 | 2 academic years | Immediate post-intervention / 1 year |
EHealth4us | Bannink et al. 2014 | Moderate | 20/533 | 20/615 | 20 / 392 | 20 / 434 | 1 month | 4 months |
20/554 (2 arms) | 20/430 | |||||||
Energize | Rush et al. 2012 | Weak | 62 | 62 | 62/692 | 62/660 | Variable (at least 18 months) | 2 years |
ESFA | Ariza et al. 2008 | Moderate | 16/1083 | 37/886 | 13/690 | 37/603 | 3 years | Immediate post-intervention |
EUDap | Faggiano et al. 2010 | Moderate | 78 (26/27/25)/1190/1164/1193 | 65/3532 | 26/27/24/6 months:1084/1068/1044 | 64/ 6 months: 3174 18 months: 2730 | 4 months | 6 months/ 18 months |
(basic arm/parent arm/ peer arm) | 18 months: 956/972/883 | |||||||
FatAintPhat | Ezendam et al. 2012 | Moderate | 11/485 | 11/145/385/395 (shuttle run/behaviour/anthropometry) | 9/398 | 9/282/333/340 | 10 weeks | 4 months/ 2 years |
HEIA | Grydeland et al. 2012 | Moderate | 12/553 | 25/975 | 12/8 months: 541/20 months: 519 | 25/8 months: 970/20 months: 945 | 20 months | 8 months/ 20 months |
KOPS | Plachta-Danielzik 2011 | Weak | 14/780 | 32/4217 | 14/4 years:345/8 years: 239 | 32/4 years:1419/8 years:950 | 2-3 weeks | 4 years/ 8 years |
Avall | Llargues et al. 2011 | Weak | 8/272 | 8/237 | 8/not specified | 8/not specified | 2 years | Immediate post-intervention |
STOPP | Marcus et al. | Moderate | 5/1670 | 5/1465 | 5/1538 | 5/1430 | 1-4 years (mean: 613 days) | Immediate post-intervention |
MYTRI | Perry et al. 2009 | Moderate | 16/6365 | 16/7698 | 16/3626 | 16/4321 | 2 academic years | Immediate post-intervention |
PAS | Koning et al. 2009 | Moderate | 5/689 | 4/779 | 5/5/5/10-22 months: 608/675/588/ 34 months: 603/671/582/ 4 years: 254/291/193 | 4/10-22 months: 699/ 34 months: 677/ 4 years: 326 | 1 year | 10 months/ 22 months/34 months/ 4 years |
5/771 | ||||||||
5/698 | ||||||||
(3 arms) | ||||||||
Promise | Stallard et al. 2012 | Weak | 10/1753 | 9/1604 | 10/308 | 9 /242 | 1 academic year | 12 months |
9/1673 (active intervention/attention control) High risk subsample: 392/374 | 298 | 9/296 (only high risk followed up) | ||||||
PSFBI | Murphy et al. 2011 | Moderate | 55/2205 | 56/2145 | 55/2272 | 56/2200 | 12 months | Immediate post-intervention |
Smart Lunchbox | Evans et al. 2010 | Moderate | 44/577 | 44/671 | 40/432 | 43/539 | 5 months | 12 months |
SPACE | Toftager et al. 2014 | Weak | 7/612 | 7/699 | 7/515 | 7/545 | 2 years | Immediate post- intervention |
Pro Children | Te Velde et al. 2008 | Moderate | 32/990 | 30/811 | 32/798 | 30/674 | 9 months | Immediate post-intervention |