What types of interventions reduce or worsen inequalities in adolescent smoking? A review of the literature and reanalysis of intervention studies.

哪些类型的干预措施可以减少或加剧青少年吸烟的不平等？

• 批准号: MR/K021400/1
• 负责人: Graham Moore
• 金额: $ 32.28万
• 依托单位: CARDIFF UNIVERSITY
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2013
• 资助国家: 英国
• 起止时间: 2013 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FK021400%2F1
• 关键词: What; types; interventions; reduce; worsen

In many developed countries including the UK, health outcomes improve significantly as socioeconomic position (SEP) increases. Poorer health behaviours among lower SEP individuals contribute to these inequalities. In particular, while smoking rates have fallen in recent times, smoking remains more common among lower SEP individuals. Most smoking uptake occurs in adolescence (1 in 9 English adolescents are daily smokers by age 15), with socioeconomic inequalities emerging in adolescence before tracking into adulthood. Hence, action to reduce inequalities in adolescent smoking may play a vital role in reducing inequality. There is increasing debate regarding what types of actions might increase or decrease health inequalities. Many argue from perspectives such as socio-ecological theory or the theory of fundamental causes, that interventions based upon education or individual choice may widen inequality, while targeting more structural factors, such as pricing and availability may reduce inequality. However, there is currently limited empirical evidence for these propositions, as few studies have analysed effects by SEP, or attempted to identify what types of actions reduce or increase existing inequalities, in what contexts. The study will involve a review of current published evidence for impacts of such intervention on inequalities and reanalysis of published studies which collected measures of SEP. Phase 1 will be largely descriptive and will aim to examine the extent to which socioeconomic inequalities have been considered in the design of evaluations and interventions to reduce adolescent smoking. Systematic searches of a range of databases will be used to identify intervention studies in developed countries since the turn of the century. How commonly, and in what ways, differential effectiveness was examined (e.g whether via subgroup analysis, use of interaction terms, or targeting of interventions toward lower SEP groups) within such studies will be examined. How commonly, and in what ways, impacts on inequalities in adolescent smoking are considered in intervention development will also be examined. The extent and nature of consideration of impacts on inequality in intervention and evaluation design will be compared across intervention types (i.e individual level, community level, or society level intervention). Harvest plot methodology will be used to combine studies which examine impacts of different levels of intervention on socioeconomic inequality. A database of studies which collected measures of SEP will be compiled, with studies labelled according to intervention type, study quality and country. Studies to be reanalysised in Phase 2 will be sampled from this database. Phase 2 will aim to advance our understandings of the impacts of various types of public health interventions upon socioeconomic inequalities through reanalysis of datasets from intervention studies which collected measures of SEP. Up to 40 studies will be selected from the database developed during Phase 1, representing a range of i) individual, ii) community, iii) society and iv) multi-level interventions from a range of developed countries. Corresponding authors will be contacted by email and asked whether any unpublished analyses of differential effectiveness were conducted, and if so, if they are willing to share these. Where they were not, authors will be asked to supply original data, which will be reanalysed for differential effectiveness by SEP, or to conduct reanalysis and supply syntax and log files. The harvest plot will then be extended to incorporate these additional analyses, with effects combined using meta-analysis where feasible. The study will provide policymakers with information on how their actions might impact inequalities, advance social science theory for reducing inequalities, and highlight the importance of designing evaluations in a manner which captures impacts on inequality.

在包括英国在内的许多发达国家，随着社会经济地位（SEP）的提高，健康结果显着改善。SEP较低的人的健康行为导致了这些不平等。特别是，虽然吸烟率近年来有所下降，但吸烟在SEP较低的人中仍然更常见。大多数吸烟发生在青春期（九分之一的英国青少年在15岁时每天吸烟），社会经济不平等在进入成年之前的青春期就出现了。因此，采取行动减少青少年吸烟方面的不平等现象可能在减少不平等方面发挥至关重要的作用。关于哪些类型的行动可能会增加或减少健康不平等的辩论越来越多。许多人从社会生态理论或根本原因理论等角度认为，基于教育或个人选择的干预措施可能会扩大不平等，而针对定价和可获得性等结构性因素可能会减少不平等。然而，目前这些主张的经验证据有限，因为很少有研究分析了《加强教育方案》的效果，或试图确定在何种情况下何种行动减少或增加了现有的不平等。这项研究将涉及审查目前公布的证据，这种干预措施对不平等的影响，并重新分析已发表的研究，其中收集的措施SEP。第一阶段将主要是描述性的，目的是检查在何种程度上社会经济不平等已被认为是在设计的评估和干预措施，以减少青少年吸烟。将利用对一系列数据库的系统检索来确定发达国家自世纪以来的干预研究。在这些研究中，将检查差异有效性的常见程度和方式（例如，是否通过亚组分析、使用相互作用术语或将干预措施针对SEP较低的群体）。还将研究在制定干预措施时如何普遍地以及以何种方式考虑对青少年吸烟不平等的影响。在干预和评估设计中考虑对不平等影响的程度和性质将在不同的干预类型（即个人层面、社区层面或社会层面的干预）之间进行比较。收获图方法将用于联合收割机研究，这些研究审查了不同程度的干预对社会经济不平等的影响。将汇编一个收集SEP测量结果的研究数据库，并根据干预类型、研究质量和国家对研究进行标记。将从该数据库中抽取2期重新分析的研究样本。第二阶段的目标是通过重新分析收集了社会经济不平等指标的干预研究数据集，提高我们对各种公共卫生干预措施对社会经济不平等影响的认识。将从第一阶段开发的数据库中选择多达40项研究，代表一系列i）个人，ii）社区，㈢社会; ㈣来自一系列发达国家的多层次干预。通讯作者将通过电子邮件联系，询问是否进行了任何未发表的差异有效性分析，如果是，他们是否愿意分享这些。如果没有，将要求作者提供原始数据，由SEP重新分析差异有效性，或进行重新分析并提供语法和日志文件。然后将扩展收获图以纳入这些额外的分析，并在可行的情况下使用荟萃分析组合效果。这项研究将为决策者提供信息，说明他们的行动可能如何影响不平等，推进减少不平等的社会科学理论，并强调以捕捉对不平等的影响的方式设计评价的重要性。

项目成果

Smoking, distress and COVID-19 in England: Cross-sectional population surveys from 2016 to 2020.

• DOI: 10.1016/j.pmedr.2021.101420
• 发表时间: 2021-09
• 期刊: Preventive medicine reports
• 影响因子: 2.8
• 作者: Kock L;Brown J;Shahab L;Moore G;Horton M;Brose L
• 通讯作者: Brose L

Cross-sectional study examining the prevalence, correlates and sequencing of electronic cigarette and tobacco use among 11-16-year olds in schools in Wales.

• DOI: 10.1136/bmjopen-2016-012784
• 发表时间: 2017-02-03
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: de Lacy E;Fletcher A;Hewitt G;Murphy S;Moore G
• 通讯作者: Moore G

Inequalities in Smoking and Quitting-Related Outcomes Among Adults With and Without Children in the Household 2013-2019: A Population Survey in England.

• DOI: 10.1093/ntr/ntab211
• 发表时间: 2022-03-26
• 期刊: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
• 作者: Kock L;Brown J;Shahab L;Tattan-Birch H;Moore G;Cox S
• 通讯作者: Cox S

Perceptions of friendship, peers and influence on smoking according to socioeconomic status and tobacco control context: A systematic review and meta-ethnography of qualitative research

根据社会经济地位和烟草控制背景对友谊、同伴和吸烟影响的看法：定性研究的系统回顾和元民族志

• DOI: 10.21203/rs.3.rs-1961885/v1
• 发表时间: 2022
• 作者: Littlecott H

Implementation of e-cigarette regulation through the EU Tobacco Products Directive (2016) in Wales, Scotland and England from the perspectives of stakeholders involved in policy introduction and enforcement.

• DOI: 10.18332/tpc/134370
• 发表时间: 2021
• 期刊: Tobacco prevention & cessation
• 影响因子: 1.8
• 作者: Brown R;Van Godwin J;Page N;Bauld L;McKell J;Hallingberg B;Maynard O;Blackwell A;Moore G
• 通讯作者: Moore G