Mantziki Krystallia, Renders Carry M, Vassilopoulos Achilleas, Radulian Gabriella, Borys Jean-Michel, du Plessis Hugues, Gregório Maria João, Graça Pedro, de Henauw Stefaan, Handjiev Svetoslav, Visscher Tommy L S, Seidell Jacob C
Department of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.
Department of Agricultural Economics and Rural Development, Agricultural University of Athens, Athens, Greece.
Int J Equity Health. 2016 Sep 29;15(1):160. doi: 10.1186/s12939-016-0438-1.
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 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.
This 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 (T) and for 921 children after two years (T). 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.
Post-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.
Inequalities 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.
欧洲各国健康方面的社会不平等现象日益加剧，正在扩大社会经济地位较低和较高群体之间的差距，尤其是在肥胖患病率方面。公共卫生干预措施可能会对不同人群产生不同影响。因此，促进健康公平的欧洲预防肥胖示范项目（EPHE）基于预防儿童肥胖综合措施（EPODE）模型，分析了以社区为基础的项目在七个欧洲社区减少儿童能量平衡相关行为及其家庭环境相关决定因素方面的社会经济不平等的附加价值。本研究呈现了为期一年的干预措施实施后基线与随访之间的变化以及一年后的可持续性情况。
这是一项前瞻性研究，包括一个学年的干预措施，随后是一年的随访。在基线阶段，共招募了1266名来自不同社会经济背景的6至8岁儿童及其家庭。一年后（T1）有1062名儿童的信息可用，两年后（T2）有921名儿童的信息可用。家长填写一份自我报告问卷，以调查儿童与能量平衡相关的行为以及家庭环境决定因素。社会经济地位由母亲的教育水平界定。使用配对数据的Wilcoxon符号秩检验来检验每个社会经济地位组在基线与中期、中期与最终测量之间的差异。
在社会经济地位较低的群体中，干预后与能量平衡相关行为的改善情况如下：水果消费量增加（荷兰）、果汁消费量减少（罗马尼亚）以及工作日看电视时间减少（比利时）。仅在后者的情况下，行为变化伴随着家庭环境决定因素的改善（监测孩子看电视的时间），同时还观察到与软饮料/果汁和电视接触相关的家长规则和做法有其他改善。其中一些影响是可持续的，尤其是在比利时的案例中。
实施针对不平等差距并采用EPODE方法的社区干预措施时，与肥胖相关行为的不平等现象可能会得到潜在减少。组内变化差异很大，而对干预措施的监测和过程评估对于理解观察到的结果至关重要。
