Is altering the availability of healthier vs. less-healthy options effective across socioeconomic groups? A mega-analysis

Abstract

Background Availability interventions have been hypothesised to make limited demands on conscious processes and, as a result, to be less likely to generate health inequalities than cognitively-oriented interventions. Here we synthesise existing evidence to examine whether the impact of altering the availability of healthier vs. less-healthy options differs by socioeconomic position. Methods Individual-level data (21,360 observations from 7,375 participants) from six studies (conducted online (n = 4) and in laboratories (n = 2)) were pooled for mega-analysis. Multilevel logistic regressions analysed the impact of altering the availability of healthier options on selection of a healthier (rather than a less-healthy) option by socioeconomic position, assessed by (a) education and (b) income. Results Participants had over threefold higher odds of selecting a healthier option when the available range was predominantly healthier compared to selections when the range offered was predominantly less-healthy (odds ratio (OR): 3.8; 95%CIs: 3.5, 4.1). Less educated participants were less likely to select healthier options in each availability condition (ORs: 0.75–0.85; all p < 0.005), but there was no evidence of differences in healthier option selection by income. Compared to selections when the range offered was predominantly less-healthy, when predominantly healthier options were available there was a 31% increase in selecting healthier options for the most educated group vs 27% for the least educated. This modest degree of increased responsiveness in the most educated group appeared only to occur when healthier options were predominant. There was no evidence of any differential response to the intervention by income. Conclusion Increasing the proportion of healthier options available increases the selection of healthier options across socioeconomic positions. Availability interventions may have a slightly larger beneficial effect on those with the highest levels of education in settings when healthier options predominate.

Impact on alcohol selection and online purchasing of changing the proportion of available non-alcoholic versus alcoholic drinks: A randomised controlled trial

“…Participants viewed varying proportions of non-alcoholic and alcoholic drink options depending on their assignment: Group 1: “25% non-alcoholic/75% alcoholic”; Group 2: “50% non-alcoholic/50% alcoholic”; Group 3: “75% non-alcoholic/25% alcoholic”. The proportions used were based on previous food and alcohol studies [ 12 , 24 ]. Within each range of alcoholic drinks, there were the same number of beer as wine options, and within each range of non-alcoholic drinks, there were the same number of soft drinks as alcohol-free options.…”

The impact of introducing alcohol‐free beer options in bars and public houses on alcohol sales and revenue: A randomised crossover field trial

“…Furthermore, although two recent reviews of availability interventions [35,36], and broader conceptual literature [37,38], suggest that these types of interventions are unlikely to exacerbate inequalities, more evidence is required to assess possible equity effects, particularly from real-world contexts. In particular, it is possible that the effects of introducing alcohol-free beer will differ according to the socio-demographic context within which that occurs.…”

The Impact of Introducing Alcohol-Free Beer Options in Bars and Public Houses on Alcohol Sales and Revenue: A Randomised Crossover Field Trial

“…Furthermore, although two recent reviews of availability interventions (31,32), and broader conceptual literature (33,34), suggest that these types of interventions are unlikely to exacerbate inequalities, more evidence is required to assess possible equity effects, particularly from real-world contexts. In particular, it is possible that the effects of introducing alcohol-free beer will differ according to the sociodemographic context within which that occurs.…”