Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities.

Social determinants of health (SDOH) refer to the broad range of social, economic, political, and psychosocial factors that directly or indirectly shape health outcomes and contribute to health disparities. There is a growing and concerted effort to address SDOH worldwide. However, the application of SDOH to health behavior change intervention research is unknown. We reviewed the synthesis literature on health behavior change interventions targeting self-regulation to (a) describe the sociodemographic characteristics, (b) determine which types of social determinants were tested as moderators of health behavior change interventions, (c) evaluate the methodological quality of the meta-analytic evidence, and (d) discuss scientific gaps and opportunities. Thirty (45.4%) of 66 articles examined heterogeneity of treatment effects by SDOH. There was a lack of racial/ethnic, immigrant, sexual/gender minority, and lifecourse sample diversity. Overall, 73.5% of SDOH moderator analyses tested heterogeneity of treatment effects by gender, race/ethnicity, and intervention setting; none examined neighborhood factors. Methodological quality was negatively correlated with number of SDOH analyses. Most SDOH moderator analyses were atheoretical and indicated statistically non-significant differences. We provide an integrated SDOH and science of behavior change framework and discuss scientific opportunities for intervention research on health behavior change to improve health equity.

Asthma associations in children attending a museum of science.

We explored the relative strength of environmental and social factors associated with pediatric asthma in middle class families and considered the efficacy of recruitment for an educational study at a science museum. Eligibility criteria were having a child aged 4-12 and English fluency. Our questionnaire included information on demographics, home environment, medical history, and environmental toxicant exposures. Statistically significant associations were found for: child's age (t = -2.46; p = 0.014), allergies (OR = 11.5; 95%CI = 5.9-22.5), maternal asthma (OR = 2.2; 95%CI = 1.2-3.9), parents' education level (OR = 0.5; 95%CI = 0.3-0.9), family income (OR = 2.4; 95%CI = 1.1-5.5), water damage at home (OR = 2.5; 95%CI = 1.1-5.5), stuffed animals in bedroom (OR = 0.4; 95%CI = 0.2-0.7), hospitalization within a week after birth (OR = 3.2; 95%CI = 1.4-7.0), diagnosis of pneumonia (OR = 2.8; 95%CI = 1.4-5.9), and multiple colds in a year (OR = 2.9; 95%CI = 1.5-5.7). Several other associations approached statistical significance, including African American race (OR = 3.3; 95%CI = 1.0-10.7), vitamin D supplement directive (OR = 0.2; 95%CI = 0.02-1.2), mice in the home (OR = 0.5, 95%CI = 0.2-1.1), and cockroaches in the home (OR = 4.3; CI = 0.8-21.6). In logistic regression, age, parents' education, allergies, mold allergies, hospitalization after birth, stuffed animals in the bedroom, vitamin D supplement directive, and water damage in the home were all significant independent predictors of asthma. The urban science museum was a low-resource approach to address the relative importance of risk factors in this population.