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BMC Public Health

, 15:907

First Online: 17 September 2015Received: 28 April 2015Accepted: 07 September 2015DOI: 10.1186-s12889-015-2244-x

Cite this article as: Moore, G.F., Littlecott, H.J., Turley, R. et al. BMC Public Health 2015 15: 907. doi:10.1186-s12889-015-2244-x


BackgroundSocioeconomic inequalities in health behaviour emerge in early life before tracking into adulthood. Many interventions to improve childhood health behaviours are delivered via schools, often targeting poorer areas. However, targeted approaches may fail to address inequalities within more affluent schools. Little is known about types of universal school-based interventions which make inequalities better or worse.

MethodsSeven databases were searched using a range of natural language phrases, to identify trials and quasi-experimental evaluations of universal school-based interventions focused on smoking, alcohol, diet and-or physical activity, published from 2008–14. Articles which examined differential effects by socioeconomic status N = 20 were synthesised using harvest plot methodology. Content analysis of 98 intervention studies examined potential reasons for attention or inattention to effects on inequality.

ResultsSearches identified approximately 12,000 hits. Ninety-eight evaluations were identified, including 90 completed studies, of which 20 reported effects on SES inequality. There were substantial geographical biases in reporting of inequality, with only 1 of 23 completed North American studies testing differential effects, compared to 15 out of 52 completed European studies. Studies reported a range of positive, neutral or negative SES gradients in effects. All studies with a negative gradient in effect i.e. which widened inequality included educational components alone or in combination with environmental change or family involvement. All studies with positive gradients in effects included environmental change components, alone or combined with education. Effects of multi-level interventions on inequality were inconsistent. Content analyses indicated that in approximately 1 in 4 studies SES inequalities were discussed in defining the problem or rationale for intervention. Other potential barriers to testing effect on inequality included assumptions that universal delivery guaranteed universal effect, or that interventions would work better for poorer groups because they had most to gain.

ConclusionsUniversal school-based interventions may narrow, widen or have no effect on inequality. There is a significant need for more routine testing of the effects of such interventions on inequality to enable firmer conclusions regarding types of interventions which affect inequality.

PROSPERO registration numberCRD42014014548

Electronic supplementary materialThe online version of this article doi:10.1186-s12889-015-2244-x contains supplementary material, which is available to authorized users.

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Author: Graham F. Moore - Hannah J. Littlecott - Ruth Turley - Elizabeth Waters - Simon Murphy


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