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Review
. 2018 Oct 16;18(1):1180.
doi: 10.1186/s12889-018-6042-0.

Examining Subgroup Effects by Socioeconomic Status of Public Health Interventions Targeting Multiple Risk Behaviour in Adolescence

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Free PMC article
Review

Examining Subgroup Effects by Socioeconomic Status of Public Health Interventions Targeting Multiple Risk Behaviour in Adolescence

Laura Tinner et al. BMC Public Health. .
Free PMC article

Abstract

Background: Multiple 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.

Methods: Two 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.

Results: Of 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).

Conclusions: The 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.

Keywords: Adolescence; Inequalities; Interventions; Multiple risk behaviour; SES; Socioeconomic status; Systematic review.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

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Not applicable.

Competing interests

Authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram detailing the systematic review screening process. The figure shows at what stage studies were excluded from the eligible dataset and gives reasons for exclusion, resulting in the final sample
Fig. 2
Fig. 2
Forest plot of meta regression analysis for outcome alcohol by SES group. The plot shows the data meta-analysed in two subgroups (high SES: parent with a degree or ineligible for free school meals) (low SES: parents do not have a degree or young person eligible for free school meals). The boxes represent the estimates and the arrows coming out of the boxes the 95% confidence intervals. The diamond is the pooled estimate for each subgroup. The overall pooled estimate is not shown as the figure is concerned with comparing the two groups. Estimates on the right-hand side of the figure labelled ‘favours control’ equates to an increase in negative alcohol behaviour while the ‘favours intervention’ arm refers to a reduction in negative alcohol behaviour following intervention
Fig. 3
Fig. 3
Forest plot of meta regression analysis for outcome smoking by SES group. The plot shows the data meta-analysed in two subgroups (high SES: parent with a degree or ineligible for free school meals) (low SES: parents do not have a degree or young person eligible for free school meals). The boxes represent the estimates and the arrows coming out of the boxes the 95% confidence intervals. The diamond is the pooled estimate for each subgroup. The overall pooled estimate is not shown as the figure is concerned with comparing the two groups. Estimates on the right-hand side of the figure labelled ‘favours control’ equates to an increase in smoking behaviour while the ‘favours intervention’ arm refers to a reduction in smoking behaviour following intervention
Fig. 4
Fig. 4
Forest plot of meta regression analysis for outcome drug use by SES group. The plot shows the data meta-analysed in two subgroups (high SES: parent with a degree or ineligible for free school meals) (low SES: parents do not have a degree or young person eligible for free school meals). The boxes represent the estimates and the arrows coming out of the boxes the 95% confidence intervals. The diamond is the pooled estimate for each subgroup. The overall pooled estimate is not shown as the figure is concerned with comparing the two groups. Estimates on the right-hand side of the figure labelled ‘favours control’ equates to an increase in drug use while the ‘favours intervention’ arm refers to a reduction in drug use following intervention

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