Examining subgroup effects by socioeconomic status of public health interventions targeting multiple risk behaviour in adolescence

Abstract

BackgroundMultiple 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.MethodsTwo 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.ResultsOf 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).ConclusionsThe 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.

Gender and socioeconomic disparities in reasons for not smoking cigarettes among Danish adolescents

“…Generally, individuals with a lower socioeconomic position are more likely to start smoking in adolescence and less likely to quit smoking in adulthood [ 1 , 2 ]; thus, contributing to social disparities in smoking and in health. An increasing priority of smoking preventive measures is to equalize socioeconomic disparities in smoking [ 3 , 4 ]. However, these efforts might be challenged because health interventions are sometimes easier adopted by individuals from higher socioeconomic backgrounds [ 5 ].…”

Equity-Specific Effects of Interventions to Promote Physical Activity among Middle-Aged and Older Adults: Development of a Collaborative Equity-Specific Re-Analysis Strategy

“…A particular strength of this study is the collaborative approach involving researchers from various relevant disciplines, including (social) epidemiologists, statisticians, health psychologists, primary care and public health researchers, as well as human movement scientists. Going beyond other projects on equity-specific re-analyses [29,32,39], the jointly developed re-analysis strategy includes harmonizing the definitions of exposure and outcome measures, the choice and definition of indicators of social inequalities, as well as modeling strategies across studies as much as possible. The collaboration procedure, comprising regular exchange via e-mail, Skype, and face-to-face meetings, further bears the advantages of discussing methodological issues, analysis findings, and implications for the future development of social inequalities-sensitive interventions.…”

“…However, due to limited resources, most studies are not prospectively designed with sufficient power to examine effects in subgroups which may limit credibility of equity-specific findings [28]. Although insufficient statistical power is a valid reason for not to conduct or report such equity-specific analyses, the importance of understanding how interventions affect health inequalities make re-analyzing intervention studies by indicators of social inequalities a potentially valuable approach [29,30,31,32,33]. As this requires access to and analyses of primary data, a collaborative approach involving authors and researchers of the primary studies is necessary.…”

Assessing Heavy Episodic Drinking: A Random Survey of 18 to 34-Year-Olds in Four Cities in Four Different Continents

“…Previous research has shown that HED is associated with increased aggression and fighting [ 5 ]. This compounding of alcohol with violence has major public health and safety consequences in adolescents and young adults, and a focus of many alcohol prevention programs worldwide in these younger age groups [ 49 , 50 ].…”