Equity Impact Assessment of Interventions to Promote Physical Activity among Older Adults: A Logic Model Framework.

Reducing social inequalities in health and health determinants, including physical activity (PA), is a major challenge for public health. PA-promoting interventions are increasingly implemented. Little is known, however, about the impact of these interventions on social inequalities. For prioritizing interventions most likely to be effective in reducing inequalities, studies of PA interventions need to conduct equity impact assessments. The aim of this article is to describe the development of a logic model framework for equity impact assessments of interventions to promote PA. The framework was developed within the prevention research network AEQUIPA-Physical activity and health equity: primary prevention for healthy ageing, informed by an equity-focused systematic review, expert interviews, exploratory literature searches, and joint discussions within the network. The framework comprises a general equity-focused logic model to be adapted to specific interventions. The intervention-specific equity-focused logic models illustrate the key elements relevant for assessing social inequalities in study participation, compliance with and acceptance of interventions, as well as the efficacy of interventions. Future work within AEQUIPA will reveal which key elements are most critical for the interventions' equity impacts. Equity impact assessments are beneficial for prioritizing interventions most likely to be effective in reducing health inequalities.

Impact of Public Smoking Bans on Social Inequalities in Children's Exposure to Tobacco Smoke at Home: An Equity-Focused Systematic Review.

INTRODUCTION: A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children's secondhand smoke (SHS) exposure at home. METHODS: Five databases were electronically searched for articles on children's SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children's SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot. RESULTS: Eight studies gave results on the impact of public smoking bans on social inequalities in children's SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure. CONCLUSIONS: First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children's SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation. IMPLICATIONS: There are substantial social inequalities in children's SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children's SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children's SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children's SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.

Socioeconomic status and change in sports activity among middle-aged and older men and women: evidence from the German Ageing Survey.

BACKGROUND: Sports activity (SA) behavior is unequally distributed across socioeconomic status (SES) groups. However, little is known about the impact of SES on change in SA over time. METHODS: Based on data from the German Ageing Survey, we examined the role of objective (education, occupational prestige, household equivalent income, composite SES-index) and subjective (self-rated standard of living) SES indicators on negative and positive changes in SA during a follow-up of 6 years among adults aged 40+ years using logistic regression analysis. RESULTS: Among active individuals at baseline, 32.1% of males and 24.8% of females experienced a negative change in SA. Among inactive individuals, 25.8 and 29.9% experienced a positive change. In the multivariate analysis, males and females with low SES were about twice as likely to experience a negative change and half as likely to experience a positive change. These patterns were observed regardless which SES indicator was examined. CONCLUSIONS: This study provides comprehensive evidence for socioeconomic inequalities in negative and positive changes in SA behavior among middle-aged and older adults in Germany. To reduce socioeconomic inequalities, future SA interventions should address the mechanisms leading to differential probabilities of change in SA behavior by SES.

Personal and perceived peer use and attitudes towards use of non-prescribed prescription sedatives and sleeping pills among university students in seven European countries.

INTRODUCTION: The use of non-prescribed prescription sedatives and sleeping pills (NPPSSP) among university students has been described as an important public health issue. However, the impact of perceived social norms on students' use and attitudes towards use of NPPSSP is still unclear. Our aim was to investigate whether perceptions of peer use and approval of use are associated with students' personal use and approval of NPPSSP use. METHODS: Cross-sectional data from the Social Norms Intervention for the prevention of Polydrug Use (SNIPE) project containing 4482 university students from seven European countries were analyzed to investigate self-other discrepancies regarding personal use and attitudes towards NPPSSP use. Associations between personal and perceived peer use and between personal and perceived approval of use were examined using multivariable logistic regression. RESULTS: The majority (51.0%) of students perceived their peers' NPPSSP use to be higher than their personal use. 92.6% of students perceived their peers' approval of NPPSSP use to be identical or higher than their personal approval. Students perceiving that the majority of peers had used NPPSSP at least once displayed higher odds for personal lifetime use (OR: 1.95, 95% CI: 1.49-2.55). Perceived peer approval of NPPSSP use was associated with higher odds for personal approval (OR: 5.49, 95% CI: 4.63-6.51). CONCLUSIONS: Among European university students, perceiving NPPSSP use and approval of use to be the norm was positively associated with students' personal NPPSSP use and approval of use, respectively. Interventions addressing perceived social norms may prevent or reduce NPPSSP use among university students. Final trial registration number: DRKS00004375 on the 'German Clinical Trials Register'.

Impact of universal interventions on social inequalities in physical activity among older adults: an equity-focused systematic review.

BACKGROUND: Physical activity is one of the most important contributors to healthy aging. Public health strategies aiming to promote physical activity among older adults are increasingly being implemented. However, little is known about their impact on social inequalities. Purpose of the study was to analyze whether and how studies of interventions consider effects on social inequalities in physical activity among older adults. METHODS: Nine electronic databases were searched to identify quantitative studies evaluating the effects of interventions on self-reported or objectively measured physical activity among the general population of older adults (≥50 years). English and German language peer-reviewed journal articles published between 2005 and 2015 were included. Using the PROGRESS-Plus framework, data on whether and how social factors were considered both for describing participants' baseline characteristics and for measuring intervention effects were systematically extracted. Studies examining differential intervention effects by at least one PROGRESS-Plus factor were quality assessed. Results were presented in narrative synthesis. RESULTS: Fifty-nine studies were included. Beside age and sex, 44 studies used at least 1 further PROGRESS-Plus factor for the description of participants' baseline characteristics. When measuring intervention effects, 22 studies considered PROGRESS-Plus factors as control variables. Eleven studies reported having analyzed potential effects on inequalities by testing interaction effects, stratifying effect analyses, or exploring associations between PROGRESS-Plus factors and increases in physical activity following an intervention. Effects were most often analyzed by gender/sex (n = 9) and age (n = 9), followed by education (n = 3), marital status (n = 2), and race/ethnicity (n = 2). Five studies pointed to gender/sex- or age-specific intervention effects, indicating that some interventions affect males and females, and younger and older individuals differently. CONCLUSIONS: Many studies evaluating the effects of interventions on physical activity among older adults have not exploited the potential for assessing effects on social inequalities so far. There is an urgent need for systematic application of appropriate methodological approaches and transparent reporting of social inequalities-related findings which can provide important indications for the design of those interventions most likely to be effective across all social groups of older adults. TRIAL REGISTRATION: PROSPERO registration number: CRD42015025066.

Equity impact of interventions to promote physical activity in older adults: protocol for a systematic review.

BACKGROUND: Public health strategies to promote physical activity among older adults are increasingly being implemented. However, it is not known whether these interventions are equally effective among all social groups of the older adult population. The objectives of the proposed systematic review are to (1) describe the extent to which effects on social inequalities are considered in studies evaluating the effectiveness of interventions to promote physical activity among older adults, (2) describe the methods used for measuring these effects, and (3) assess the implications of the equity related findings for health promotion research and practice. METHODS/DESIGN: MEDLINE, PsycINFO, CINAHL, CENTRAL, Physical Education Index, Social Science Citation Index, ASSIA, Sociological Abstracts, and IBSS databases as well as the German language journal Prävention und Gesundheitsförderung will be searched to identify experimental or observational quantitative studies evaluating the effects of interventions on self-reported or objectively measured physical activity among the general population of older adults (≥ 50 years). English or German language peer-reviewed journal articles published since 2005 will be included. Data on whether and how several social factors are considered for both the description of baseline characteristics of participants and for measuring intervention effectiveness will be extracted. The quality of studies will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results will be presented in a narrative synthesis. If feasible, harvest plots will be used to synthesize evidence about how intervention effects vary between different social groups. DISCUSSION: This systematic review will provide evidence on what is known about the effects of interventions on social inequalities in physical activity among older adults, which is a prerequisite for the prioritization of those interventions most likely to be effective across all social groups of this target population. Therefore, the results of this review will be of major interest to researchers, policy makers, and practitioners in the area of physical activity promotion for older adults. SYSTEMATIC REVIEW REGISTRATION: This protocol has been registered with the PROSPERO international prospective register of systematic reviews (PROSPERO 2015 CRD42015025066).