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26 项荷兰与肥胖相关的生活方式干预措施的特定权益效应。

Equity-specific effects of 26 Dutch obesity-related lifestyle interventions.

机构信息

Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, the Netherlands.

出版信息

Am J Prev Med. 2013 Jun;44(6):e57-66. doi: 10.1016/j.amepre.2012.11.041.

Abstract

CONTEXT

Reducing health inequalities is a policy priority in many developed countries. Little is known about effective strategies to reduce inequalities in obesity and its underlying behaviors. The goal of the study was to investigate differential effectiveness of interventions aimed at obesity prevention, the promotion of physical activity or a healthy diet by SES.

EVIDENCE ACQUISITION

Subgroup analyses in 2010 and 2011 of 26 Dutch studies funded by The Netherlands Organization for Health Research and Development after 1990 (n=17) or identified by expert contact (n=9). Methodologic quality and differential effects were synthesized in harvest plots, subdivided by setting, age group, intensity, and time to follow-up.

EVIDENCE SYNTHESIS

Seven lifestyle interventions were rated more effective and four less effective in groups with high SES; for 15 studies no differential effects could be demonstrated. One study in the healthcare setting showed comparable effects in both socioeconomic groups. The only mass media campaign provided modest evidence for higher effectiveness among those with high SES. Individually tailored and workplace interventions were either more effective in higher-SES groups (n=4) or no differential effects were demonstrated (n=9). School-based studies (n=7) showed mixed results. Two of six community studies provided evidence for better effectiveness in lower-SES groups; none were more effective in higher-SES groups. One high-intensity community-based study provided best evidence for higher effectiveness in low-SES groups.

CONCLUSIONS

Although for the majority of interventions aimed at obesity prevention, the promotion of physical activity, or a healthy diet, no differential effectiveness could be demonstrated, interventions may widen as well as reduce socioeconomic inequalities in these outcomes. Equity-specific subgroup analyses contribute to needed knowledge about what may work to reduce socioeconomic inequalities in obesity and underlying health behaviors.

摘要

背景

减少健康不平等是许多发达国家的政策重点。对于减少肥胖及其潜在行为不平等的有效策略知之甚少。本研究的目的是调查旨在预防肥胖、促进身体活动或健康饮食的干预措施按 SES 分层的差异效果。

证据获取

2010 年和 2011 年,对 26 项荷兰研究进行了亚组分析,这些研究是由荷兰健康研究与发展组织资助的,研究时间为 1990 年以后(n=17)或通过专家联系确定的(n=9)。在收获图中综合了方法学质量和差异效应,根据设置、年龄组、强度和随访时间进行了细分。

证据综合

7 种生活方式干预措施在 SES 较高的群体中被评为更有效,4 种干预措施被评为效果较差;对于 15 项研究,没有显示出差异效应。在医疗保健环境中进行的一项研究显示,两个社会经济群体的效果相当。唯一的大众媒体活动为 SES 较高的人群提供了更高效果的适度证据。个体化和工作场所干预措施在 SES 较高的群体中更有效(n=4)或没有显示出差异效应(n=9)。基于学校的研究(n=7)显示出混合结果。6 项社区研究中有两项为 SES 较低的群体提供了更好效果的证据;在 SES 较高的群体中,没有一个更有效。一项高强度的社区基础研究为 SES 较低的群体提供了更高效果的最佳证据。

结论

尽管大多数旨在预防肥胖、促进身体活动或健康饮食的干预措施都没有显示出差异效果,但这些干预措施可能会扩大和缩小这些结果的社会经济不平等。针对特定公平性的亚组分析有助于了解哪些措施可能有助于减少肥胖和潜在健康行为方面的社会经济不平等。

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