Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK.
Int J Behav Nutr Phys Act. 2022 Jul 20;19(1):88. doi: 10.1186/s12966-022-01315-y.
Availability interventions have been hypothesised to make limited demands on conscious processes and, as a result, to be less likely to generate health inequalities than cognitively-oriented interventions. Here we synthesise existing evidence to examine whether the impact of altering the availability of healthier vs. less-healthy options differs by socioeconomic position.
Individual-level data (21,360 observations from 7,375 participants) from six studies (conducted online (n = 4) and in laboratories (n = 2)) were pooled for mega-analysis. Multilevel logistic regressions analysed the impact of altering the availability of healthier options on selection of a healthier (rather than a less-healthy) option by socioeconomic position, assessed by (a) education and (b) income.
Participants had over threefold higher odds of selecting a healthier option when the available range was predominantly healthier compared to selections when the range offered was predominantly less-healthy (odds ratio (OR): 3.8; 95%CIs: 3.5, 4.1). Less educated participants were less likely to select healthier options in each availability condition (ORs: 0.75-0.85; all p < 0.005), but there was no evidence of differences in healthier option selection by income. Compared to selections when the range offered was predominantly less-healthy, when predominantly healthier options were available there was a 31% increase in selecting healthier options for the most educated group vs 27% for the least educated. This modest degree of increased responsiveness in the most educated group appeared only to occur when healthier options were predominant. There was no evidence of any differential response to the intervention by income.
Increasing the proportion of healthier options available increases the selection of healthier options across socioeconomic positions. Availability interventions may have a slightly larger beneficial effect on those with the highest levels of education in settings when healthier options predominate.
人们假设，可用性干预措施对意识过程的要求有限，因此，与以认知为导向的干预措施相比，不太可能造成健康不平等。在这里，我们综合现有证据，研究改变更健康和不太健康选择的可用性是否会因社会经济地位而异。
对六项研究（在线进行的研究（n=4）和实验室进行的研究（n=2））的个体水平数据（7375 名参与者的 21360 个观察结果）进行汇总进行 mega 分析。采用多层次逻辑回归分析了通过（a）教育和（b）收入来评估的社会经济地位改变更健康选择的可用性对选择更健康（而不是不太健康）选择的影响。
与提供范围主要是不太健康选择时相比，当可提供的范围主要是更健康的选择时，参与者选择更健康选择的可能性高出三倍以上（优势比（OR）：3.8；95%CI：3.5，4.1）。在每种可用性条件下，受教育程度较低的参与者选择更健康选择的可能性较低（ORs：0.75-0.85；所有 p<0.005），但收入对更健康选择的选择没有差异。与提供范围主要是不太健康选择时相比，当主要提供更健康的选择时，最受教育群体选择更健康选择的比例增加了 31%，而受教育程度最低的群体增加了 27%。在最受教育群体中，这种适度增加的反应能力似乎仅在更健康的选择占主导地位时才会出现。没有证据表明收入对干预措施有任何不同的反应。
增加更健康选择的供应比例会增加社会经济地位的健康选择。在更健康的选择占主导地位的情况下，可用性干预措施对受教育程度最高的人群可能会产生略微更大的有益效果。
