ISBNPA Special Interest Group (SIG)

Socioeconomic inequalities in nutrition, physical activity and sedentary behaviour

Knowledge update March 2013

SIG NEWS

Remember that our ISBNPA Special Interest Group is on Twitter! Follow #ISBNPASIG – most tweets to date have been sent from SIG convenor @KylieBall3, but please join in the twitterverse and use the #ISBNPASIG hashtag so other members can follow/converse as well. Any tweets relating to SIG topics – new research, questions, challenges, debates, news – are very welcome!

Frank van Lenthe, SIG co-convenor, below provides an opinion piece suggested as a debate topic for SIG members. We hope all members find this interesting and consider contributing thoughts on this via our Twitter account, or feel free to email us directly.

Are you interested in profiling some of your work, or writing an opinion piece for our SIG quarterly knowledge update newlsetters? It could be a short piece advertising a study you’re working on in the areas of interest to the SIG, or a summary of your views on a particular burning issue. It could be great promotion for your work, as well as a way of connecting with other SIG members. If so we’d love to hear from you! Drop us a line any time – email [email protected].

SIG Debate

Should each intervention be evaluated on its equity impact?

Frank J van Lenthe, Department of Public Health, Erasmus MC Rotterdam, the Netherlands ([email protected])

In studying the effectiveness of interventions, subgroup analyses may provide interesting additional information. For example, they may answer the question for whom the intervention may be more or less effective. Subgroup analyses however, can be criticised, for example because they may easily result in a so called “fishing expedition”. Petticrew et al. adequately summarised the pro’s and con’s of subgroup analyses in a paper with a title that summarizes the dilemma well: “Damned if you do, damned if you don’t (1)”. Interestingly, the paper argues that there are circumstances in which such analyses may be rather helpful, that is when it concerns the impact of interventions on socioeconomic inequalities in health and health behaviours.

Higher prevalence rates of unhealthy behaviours contribute substantially to socioeconomic inequalities in health. To date, only little is known about interventions that are particularly effective in lower socioeconomic groups. The fact that many interventions are developed and evaluated for the general population, in which indicators of socioeconomic position (SEP) are measured for the purpose of controlling for its confounding effect, opens the opportunity to conduct subgroup analyses by indicators of SEP in existing interventions. It can easily be expanded to new intervention studies as well.

Conducting equity specific interventions is even more important because it is often thought that interventions may widen inequalities, because higher socioeconomic groups may take up in the intervention better than lower socioeconomic groups. Results may however, also be easily misinterpreted: many intervention studies are not adequately powered to detect a significant difference between socioeconomic groups, and this argument can then be translated into the conclusion that it works equally well for higher and lower socioeconomic groups.

A large consortium of Dutch researchers re-analysed 26 intervention studies on their equity impact (2). The findings were summarised in so-called harvest plots. The study will be published in the May or June issue of the American Journal of Preventive Medicine. An interesting finding of the study was that in all interventions indicators of SEP were measured. Further, although studies were able to conduct equity-specific subgroup analyses, the large majority of them did not report these findings in the papers, presumably because of the lack of statistical power. Summarising the evidence however, provides a first picture about the differential effectiveness of interventions, particularly if summarised by type of intervention and/or setting For almost half of the studies included, no differential effectiveness could be demonstrated; among the other studies, more suggested that the intervention widened the socioeconomic gradient. Community-based studies seemed to be particularly effective in lower socioeconomic groups.

A lesson from this study could be that equity specific analyses are a relatively easy way to improve knowledge about effectiveness of interventions in lower socioeconomic groups. For debate we therefore phrase the following statement, which can be discussed via Twitter – please use #ISBNPASIG so other members can follow the topic!

“Each lifestyle intervention study should investigate and report the equity impact of the effectiveness of the intervention by default”.

References

1. Petticrew M, Tugwell P, Kristjansson E, Oliver S, Ueffing E, Welch V. Damned if you do, damned if you don't: subgroup analysis and equity. J Epidemiol Comm Health 2012; 66: 95- 98. 2. Magnée T, Burdorf A, Brug J, Kremers SPM, Oenema A, Assema P van, Ezendam NPM, Genugten L van, Hendriksen IJ, Hopman-Rock M, Jansen W, Jong J de, Kocken PL, Kroeze W, Kwak L, Lechner L, Nooijer J de, Poppel MN van, Robroek SJW, Schreurs H, Sluijs EM van, Steenhuis IJM, Stralen MM van, Tak NI, te Velde SJ, Vermeer WM, Wammes B, Wier MF van, Lenthe FJ van. Equity-specific effects of 26 Dutch Obesity-related lifestyle interventions Am J Prev Med 2013; forthcoming.

The following resources may be of interest to SIG members.

Media releases, events, presentations, topics of interest

 Socioeconomic inequality in Canada has featured heavily in news and social media in recent months. Canada’s Broadbent Institute recently issued a major discussion paper, “Towards a More Equal Canada,” which discusses marked increases in income and wealth inequality over the past 20 years, arguing that these erode genuine equality of opportunity.

http://www.broadbentinstitute.ca/sites/default/files/documents/towards_a_more_equal_c anada.pdf

 Similarly, a US report shows that income inequality has grown in almost every state since the 1970s. http://inequality.org/statelevel-inequality-rise-nation/

Both reports include suggestions for how these increases might be mitigated, including raises to minimum wages and more progressive tax systems.

 This issue of Annals of Behavioral Medicine Volume 45, Issue 1, February 2013 features the second special section on health disparities, primarily related to racial disparities.

Recent journal papers

Community-based dietary and physical activity interventions in low socioeconomic groups in the UK: A mixed methods systematic review. Everson-Hock ES, Johnson M, Jones R, Woods HB, Goyder E, Payne N, Chilcott J. Prev Med. 2013 Feb 27. doi:pii: S0091-7435(13)00068-6. 10.1016/j.ypmed.2013.02.023. [Epub ahead of print]

Ethnic differences in the home environment and physical activity behaviors among low- income, minority preschoolers in Texas. Chuang RJ, Sharma S, Skala K, Evans A. Am J Health Promot. 2013 Mar;27(4):270-8. doi: 10.4278/ajhp.110427-QUAN-171.

Sociodemographic factors associated with healthy eating and food security in socio- economically disadvantaged groups in the UK and Victoria, Australia. Thornton LE, Pearce JR, Ball K. Public Health Nutr. 2013 Feb 28:1-11. [Epub ahead of print]

Health behavior and behavioral economics: economic preferences and physical activity stages of change in a low-income african-american community. Leonard T, Shuval K, de Oliveira A, Skinner CS, Eckel C, Murdoch JC. Am J Health Promot. 2013 Mar;27(4):211-21. doi: 10.4278/ajhp.110624-QUAN-264.

A Framework for Understanding Grocery Purchasing in a Low-Income Urban Environment. Zachary DA, Palmer AM, Beckham SW, Surkan PJ. Qual Health Res. 2013 Feb 26. [Epub ahead of print]

Associations of food stamp participation with dietary quality and obesity in children. Leung CW, Blumenthal SJ, Hoffnagle EE, Jensen HH, Foerster SB, Nestle M, Cheung LW, Mozaffarian D, Willett WC. Pediatrics. 2013 Mar;131(3):463-72. doi: 10.1542/peds.2012-0889. Epub 2013 Feb 25.

Moderating Effect of Socioeconomic Status on the Relationship between Health Cognitions and Behaviors. Conner M, McEachan R, Jackson C, McMillan B, Woolridge M, Lawton R. Ann Behav Med. 2013 Feb 23. [Epub ahead of print]

Food Stress in Adelaide: The Relationship between Low Income and the Affordability of Healthy Food. Ward PR, Verity F, Carter P, Tsourtos G, Coveney J, Wong KC. J Environ Public Health. 2013;2013:968078. doi: 10.1155/2013/968078. Epub 2013 Jan 29.

Food choice, eating behavior, and food liking differs between lean/normal and overweight/obese, low-income women. Dressler H, Smith C. Appetite. 2013 Feb 18;65C:145-152. doi: 10.1016/j.appet.2013.01.013. [Epub ahead of print]

Translation of a behavioral weight loss intervention for mid-life, low-income women in local health departments. Samuel-Hodge CD, Garcia BA, Johnston LF, Gizlice Z, Ni A, Cai J, Kraschnewski JL, Gustafson AA, Norwood AF, Glasgow RE, Gold AD, Graham JW, Evenson KR, Trost S, Keyserling TC. Obesity (Silver Spring). 2013 Feb 14. doi: 10.1002/oby.20317. [Epub ahead of print]

Health and Eating Behavior Differs Between Lean/Normal and Overweight/Obese Low- Income Women Living in Food-Insecure Environments. Dressler H, Smith C. Am J Health Promot. 2013 Feb 11. [Epub ahead of print]

Estimating dietary costs of low-income women in California: a comparison of 2 approaches. Aaron GJ, Keim NL, Drewnowski A, Townsend MS. Am J Clin Nutr. 2013 Apr;97(4):835-41. doi: 10.3945/ajcn.112.044453. Epub 2013 Feb 6.

Socio-economic status, neighbourhood food environments and consumption of fruits and vegetables in New York City. Jack D, Neckerman K, Schwartz-Soicher O, Lovasi GS, Quinn J, Richards C, Bader M, Weiss C, Konty K, Arno P, Viola D, Kerker B, Rundle A. Public Health Nutr. 2013 Feb 6:1-9. [Epub ahead of print]

Health, behavior, and health care disparities: disentangling the effects of income and race in the United States. Dubay LC, Lebrun LA. Int J Health Serv. 2012;42(4):607-25.

Correlates of long-term participation in a physical activity-based positive youth development program for low-income youth: Sustained involvement and psychosocial outcomes. Ullrich-French S, McDonough MH. J Adolesc. 2012 Dec 22. doi:pii: S0140-1971(12)00170-4. 10.1016/j.adolescence.2012.11.006. [Epub ahead of print]

Physical activity and perceptions of neighborhood walkability among Turkish women in low and high socio-economic environments: an exploratory study. Yildirim G, Ince ML, Muftuler M. Percept Mot Skills. 2012 Oct;115(2):661-75. Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: a systematic review. Black AP, Brimblecombe J, Eyles H, Morris P, Vally H, O Dea K. BMC Public Health. 2012 Dec 21;12:1099. doi: 10.1186/1471-2458-12-1099.

Cohort Profile: The Resilience for Eating and Activity Despite Inequality (READI) study. Ball K, Cleland V, Salmon J, Timperio AF, McNaughton S, Thornton L, Campbell K, Jackson M, Baur LA, Mishra G, Brug J, Jeffery RW, King A, Kawachi I, Crawford DA. Int J Epidemiol. 2012 Dec 18. [Epub ahead of print]

Early-Life Socioeconomic Status and Physical Activity in Later Life: Evidence From Structural Equation Models. Pudrovska T, Anishkin A. J Aging Health. 2012 Dec 16. [Epub ahead of print]

Physical activity patterns and socioeconomic position: the German National Health Interview and Examination Survey 1998 (GNHIES98). Finger JD, Tylleskär T, Lampert T, Mensink GB. BMC Public Health. 2012 Dec 15;12:1079. doi: 10.1186/1471-2458-12-1079.

Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17- years of follow up. Kamphuis CB, Turrell G, Giskes K, Mackenbach JP, van Lenthe FJ. BMC Public Health. 2012 Dec 5;12:1045. doi: 10.1186/1471-2458-12-1045.

Social Patterning in Body Mass Index (BMI) Among Contemporary Immigrant Groups: The Emergence of a Gradient. Frank R, Akresh IR. Demography. 2012 Dec 4. [Epub ahead of print]

Can the built environment reduce health inequalities? A study of neighbourhood socioeconomic disadvantage and walking for transport. Turrell G, Haynes M, Wilson LA, Giles-Corti B. Health Place. 2013 Jan;19:89-98. doi: 10.1016/j.healthplace.2012.10.008. Epub 2012 Nov 10.

Low levels of food involvement and negative affect reduce the quality of diet in women of lower educational attainment. Jarman M, Lawrence W, Ntani G, Tinati T, Pease A, Black C, Baird J, Barker M; SIH Study Group. J Hum Nutr Diet. 2012 Oct;25(5):444-52. doi: 10.1111/j.1365-277X.2012.01250.x. Epub 2012 Apr 20.

Smart choices for healthy families: a pilot study for the treatment of childhood obesity in low- income families. Pinard CA, Hart MH, Hodgkins Y, Serrano EL, McFerren MM, Estabrooks PA. Health Educ Behav. 2012 Aug;39(4):433-45. doi: 10.1177/1090198111425686. Epub 2012 Jan 3.

Weight Status as a Moderator of the Relationship Between Motivation, Emotional Social Support, and Physical Activity in Underserved Adolescents. St George SM, Wilson DK, Lawman HG, Van Horn ML. J Pediatr Psychol. 2013 Jan 31. [Epub ahead of print] Modifiable Behaviours Help to Explain the Inequalities in Perceived Health Associated with Deprivation and Social Class: Evidence from a National Sample. Nevill A, Donnelly P, Shibli S, Foster C, Murphy M. J Phys Act Health. 2013 Jan 30. [Epub ahead of print]

Active Commuting and Sociodemographic Factors Among University Students in Spain. Molina-García J, Sallis JF, Castillo I. J Phys Act Health. 2013 Jan 28. [Epub ahead of print]

Exploring the Distribution of Park Availability, Features, and Quality Across Kansas City, Missouri by Income and Race/Ethnicity: an Environmental Justice Investigation. Vaughan KB, Kaczynski AT, Wilhelm Stanis SA, Besenyi GM, Bergstrom R, Heinrich KM. Ann Behav Med. 2013 Jan 19. [Epub ahead of print]

Changes in the frequency of family meals from 1999 to 2010 in the homes of adolescents: trends by sociodemographic characteristics. Neumark-Sztainer D, Wall M, Fulkerson JA, Larson N. J Adolesc Health. 2013 Feb;52(2):201-6. doi: 10.1016/j.jadohealth.2012.06.004. Epub 2012 Aug 20.

The First National Survey of Indigenous People's Health and Nutrition in Brazil: rationale, methodology, and overview of results. Coimbra CE Jr, Santos RV, Welch JR, Cardoso AM, de Souza MC, Garnelo L, Rassi E, Follér ML, Horta BL. BMC Public Health. 2013 Jan 19;13(1):52. [Epub ahead of print]

Educational inequalities in women's depressive symptoms: the mediating role of perceived neighbourhood characteristics. Teychenne M, Ball K, Salmon J. Int J Environ Res Public Health. 2012 Dec;9(12):4241-53.

Food choices made by low-income households when feeding their pre-school children: a qualitative study. Lovelace S, Rabiee-Khan F. Matern Child Nutr. 2013 Jan 16. doi: 10.1111/mcn.12028. [Epub ahead of print]

Clustering of energy balance-related behaviors and parental education in European children: the ENERGY-project. Fernández-Alvira JM, De Bourdeaudhuij I, Singh AS, Vik FN, Manios Y, Kovacs E, Jan N, Brug J, Moreno LA. Int J Behav Nutr Phys Act. 2013 Jan 15;10(1):5. [Epub ahead of print]

A qualitative study exploring parental accounts of feeding pre-school children in two low- income populations in the UK. Hayter AK, Draper AK, Ohly HR, Rees GA, Pettinger C, McGlone P, Watt RG. Matern Child Nutr. 2013 Jan 15. doi: 10.1111/mcn.12017. [Epub ahead of print]

The social environment and walking behavior among low-income housing residents. Caspi CE, Kawachi I, Subramanian SV, Tucker-Seeley R, Sorensen G. Soc Sci Med. 2012 Dec 17. doi:pii: S0277-9536(12)00790-3. 10.1016/j.socscimed.2012.11.030. [Epub ahead of print]

Socioeconomic determinants of eating pattern of adolescent students in Mansoura, Egypt. El-Gilany AH, Elkhawaga G. Pan Afr Med J. 2012;13:22. Epub 2012 Oct 1.

Facebook Is an Effective Strategy to Recruit Low-income Women to Online Nutrition Education. Lohse B. J Nutr Educ Behav. 2013 Jan;45(1):69-76. doi: 10.1016/j.jneb.2012.06.006.

Lifestyle factors and socioeconomic variables associated with abdominal obesity in Brazilian adolescents. de Moraes AC, Falcão MC. Ann Hum Biol. 2013 Jan;40(1):1-8. doi: 10.3109/03014460.2012.745900.

Television viewing in low-income latino children: variation by ethnic subgroup and english proficiency. Thompson DA, Matson PA, Ellen JM. Child Obes. 2013 Feb;9(1):22-8. doi: 10.1089/chi.2012.0113. Epub 2013 Jan 9.

Socioeconomic trajectories from birth to adolescence and risk factors for noncommunicable disease: prospective analyses. Hallal PC, Clark VL, Assunção MC, Araújo CL, Gonçalves H, Menezes AM, Barros FC. J Adolesc Health. 2012 Dec;51(6 Suppl):S32-7. doi: 10.1016/j.jadohealth.2012.06.022. Epub 2012 Nov 10.

BMI may underestimate the socioeconomic gradient in true obesity. van den Berg G, van Eijsden M, Vrijkotte TG, Gemke RJ. Pediatr Obes. 2013 Jan 3. doi: 10.1111/j.2047-6310.2012.00133.x. [Epub ahead of print]

Functional health literacy mediates the relationship between socio-economic status, perceptions and lifestyle behaviors related to cancer risk in an Australian population. Adams RJ, Piantadosi C, Ettridge K, Miller C, Wilson C, Tucker G, Hill CL. Patient Educ Couns. 2012 Dec 28. doi:pii: S0738-3991(12)00488-0. 10.1016/j.pec.2012.12.001. [Epub ahead of print]

Trends in the prevalence of extreme obesity among US preschool-aged children living in low-income families, 1998-2010. Pan L, Blanck HM, Sherry B, Dalenius K, Grummer-Strawn LM. JAMA. 2012 Dec 26;308(24):2563-5. doi: 10.1001/jama.2012.108099. No abstract available.

Household income disparities in fruit and vegetable consumption by state and territory: results of the 2009 Behavioral Risk Factor Surveillance System. Grimm KA, Foltz JL, Blanck HM, Scanlon KS. J Acad Nutr Diet. 2012 Dec;112(12):2014-21. doi: 10.1016/j.jand.2012.08.030.