Abstract
BackgroundIncreasing social inequalities in health across Europe are widening the gap between low and high socio-economic groups, notably in the prevalence of obesity. Public health interventions may result in differential effects across population groups. Therefore, the EPHE (EPODE for the Promotion of Health Equity) project analysed the added value of community-based programmes, based on the EPODE (Ensemble Prévenons l’Obésité Des Enfants-Together Let’s Prevent Obesity) model, to reduce socio-economic inequalities in energy balance-related behaviours of children and their family-environmental related determinants in seven European communities. This study presents the changes between baseline and follow-up after the one-year interventions and their sustainability one year after.MethodsThis is a prospective study with a one school-year intervention, followed by one year of follow-up. In all, 1266 children (age 6-8 years) and their families from different socio-economic backgrounds were recruited at baseline. For 1062 children, information was available after one year (T1) and for 921 children after two years (T2). A self-reported questionnaire was completed by the parents to examine the children’s energy balance-related behaviours and family- environmental determinants. Socio-economic status was defined by the educational level of the mother. The Wilcoxon signed-rank test for paired data was used to test the differences between baseline and intermediate, and between intermediate and final, measurements for each of the socio-economic status groups.ResultsPost-intervention effects in energy-balance related behaviours showed the following improvements among the low socio-economic status groups: increased fruit consumption (Netherlands), decreased fruit juices amount consumed (Romania) and decreased TV time on weekdays (Belgium). Whereas in only the latter case the behavioural change was accompanied with an improvement in a family-environmental determinant (monitoring the time the child watches TV), other improvements in parental rules and practices related to soft drinks/fruit juices and TV exposure were observed. A few of those effects were sustainable, notably in the case of Belgium.ConclusionsInequalities in obesity-related behaviours could be potentially reduced when implementing community-based interventions, tailored to inequality gaps and using the EPODE methodology. Within-group changes varied widely, whereas monitoring of interventions and process evaluation are crucial to understand the observed results.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0438-1) contains supplementary material, which is available to authorized users.
Highlights
Increasing social inequalities in health across Europe are widening the gap between low and high socio-economic groups, notably in the prevalence of obesity
The dropout of the low education group was higher in Changes in energy balance-related behaviours and their sustainability Tables 4, 5, 6, 7 shows changes in dietary intake, beverage intake, screen exposure and sleep hours, respectively, between the pre- and post- intervention period
After a one school-year (8/9-months) intervention period aiming at reducing inequality gaps between low and high socio-economic status children and their families in health behaviours and determinants, an improvement of three energy-balance related behaviours among the low socio-economic status groups was observed, namely an increase of fruit consumption (Netherlands), decrease in the amount fruit juices consumed (Romania) and decrease of TV time on weekdays (Belgium)
Summary
Increasing social inequalities in health across Europe are widening the gap between low and high socio-economic groups, notably in the prevalence of obesity. Public health interventions may reach people with a relatively high income and education and they thereby may increase inequalities, despite being effective on the general population [9, 11,12,13,14,15]. This is defined as the ‘intervention-generated inequality’, which evolves from the ‘inverse care law’ [16], meaning that the groups/populations mostly in need of health care are the least likely to benefit from it [12, 15, 17]. Further research is needed to determine the specific components of interventions that result in intervention-generated inequalities [6, 17]
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