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Table 2 Summary details of community level studies included in the review

From: A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children

Study Design & quality appraisal 1 Setting & participants Study aim Intervention 2 Inequality 3 Summary results 4 ↑ = increase ↓ = decrease ↔ = no change   Impact on inequalities in obesity 5
Kain et al 2004 [36] Non-randomised cluster controlled trial; 6 month follow-up; Final sample = 3086; Quality = Strong 5 Schools, Chile; 10.6 years; 47% girls Reduction and prevention of obesity in low SES children Nutrition and physical activity intervention; Prevention: nutrition education (children and parents), extra time in PE lessons, encouragement of PA during daily recess, healthy snacks in vending machines (voluntary), incentives for healthy eating and sports equipment for schools Targeted: Low SES schools (35% children receiving School Lunch Program) BMI z score (boys) + (boys)
Triceps skinfold (boys)
Waist circumference (boys)
BMI z score (girls)
Triceps skinfold (girls)
Waist circumference (girls)
Jansen et al 2011 [37] Cluster RCT; 8 month follow-up; Final sample = 2416; Quality = Strong 20 Schools, The Netherlands; 6-12 years; 51% girls Weight reduction and prevention of obesity in low SES children Nutrition and physical activity intervention; Prevention: nutrition, activity living and healthy lifestyle education, 3 PE lessons per week and voluntary additional after-school sport and play activities Targeted: Low income inner-city, multi-ethnic schools Children 6-9 years:   + (6-9 years)
BMI
Waist circumference
Prevalence overweight
Children 9-12 years:  
BMI
Waist circumference
Prevalence overweight
Nemet et al 2011 [38] Cluster RCT; 1 year follow-up; Final sample = 297; Quality = Strong 11 Kindergartens, Israel; 4.2-6.5 years; 45% girls Prevention of obesity Nutrition and physical activity intervention; Prevention: Nutrition education classes and flyers for parents; exercise sessions and songs related to topic of nutrition and exercise Targeted: kindergarten in low SES communities BMI (boys) + (boys)
BMI% (boys
BMI (girls)
BMI% (girls)
Bingham 2002 [39] Cluster RCT; 1 year follow-up; Final sample = 985; Quality = Strong 12 schools, USA; 8-10 years; 51% girls CVD risk factor reduction Nutrition and physical activity intervention; Prevention: CVD risk factor reduction intervention – education (including nutrition and physical activity) and physical activity sessions Universal: SES was not found to be a moderator of the intervention effect Skinfold thickness 0
Simon et al 2008 [40] Randomised cluster trial; 48 month follow-up; Final sample = 732; Quality = Strong 8 schools, Eastern France; 11-12 years; 50% girls Increase physical activity by changing attitudes, promoting the social support of parents and teachers, making the environment more supportive of physical activities Physical activity intervention; Prevention: physical activity education and increased physical activity classes, ‘cycling to school’ days and sports events Universal: no differences in results by parental occupation BMI 0
Physical activity
TV/video use
Bellows 2007 [41] Cluster RCT; 18 week follow-up; Final sample = 201; Quality = Strong 4 Head Start centres, USA; 3-5 years; 46% girls Prevent obesity Nutrition and physical activity intervention; Prevention: Food Friends Get Movin’ with Mighty MovesTM intervention – physical activity sessions and nutrition education Targeted: low-income, ethnic minority preschoolers BMI z score 0
de Meij et al 2011 [42] Cluster non-randomised control trial; 20 month follow-up; Final sample = 2064; Quality = Strong 19 schools, The Netherlands; 6-12 years; 50% girls To increase physical activity among children living in socially and economically deprived areas Physical activity intervention; Prevention: physical activity education and exercise sessions Targeted: majority of pupils low SES BMI 0
Waist circumference
Organised sport participation
Physical activity
Fitness
Herrick et al 2012 [43] Cluster non-randomised controlled trial; 5 month follow-up; Final sample = 98; Quality = Strong 6 schools, USA; 10-11 years; 55% girls Increase physical activity levels Physical activity intervention; Prevention: after-school physical education sessions; self-management education Targeted: largely low-income population BMI 0
BMI z score
MVPA
Lubans et al 2012 [44] Cluster RCT; 12 month follow-up; Final sample = 294; Quality = Strong 12 schools, Australia; 13.2 years; 100% girls Prevention of unhealthy weight gain in low SES adolescent girls Nutrition and physical activity intervention; Prevention: Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) – nutrition education; exercise sessions; self-monitoring; social support Targeted: schools in low-income communities BMI 0
BMI z score
Body fat%
Sichieri et al 2008 [45] Cluster RCT; 8 month follow-up; Final sample = 927; Quality = Strong 22 schools, Brazil; 10-11 years; 53% girls Prevention of excess weight gain Nutrition intervention; Prevention: educational intervention to reduce consumption of sugar-sweetened beverages and encourage water consumption Targeted: children from low SES families BMI (overall) + (overweight girls)
BMI (overweight girls)
Walter et al 1985 [46] Cluster RCT; 1 year follow-up; Final sample = 1115; Quality = Strong 22 Schools, USA; 9 years; 49% girls Prevention of chronic disease risk factors (including obesity) Nutrition and physical activity intervention; Prevention: “Know Your Body” curriculum focusing on nutrition physical fitness and smoking prevention Targeted: Children from low income families Ponderosity index 0
Triceps skinfold thickness
Robinson 1999 [47] Randomised cluster trial; 6 month follow-up; Final sample = 192; Quality = Strong 2 schools, USA; 8-9 years; 45% girls Prevent the onset of obesity Physical activity intervention; Prevention: education course to reduce TV and video game use including a 10 day TV turn off. Home TV usage monitor. Parental education materials Universal: no differences in results by parental education BMI 0
Triceps skin fold thickness
Waist circumference
Waist-hip ratio
Kalavainen et al 2007 [48] RCT; 12 month follow-up; Final sample = 69; Quality = Strong 1 Health care centre, Finland; 7-9 years; 60% girls; Obese Treatment of obesity Nutrition and physical activity intervention; Treatment: Family-based group treatment programme – diet and physical activity education and behavioural therapy Universal: No association between social class and obesity-related outcomes Weight for height 0
BMI
BMI SDS
Alves et al 2008 [49] RCT; 6 month follow-up; Final sample = 68; Quality = Strong Community setting (exact setting unclear), Brazil; 5-10 years; 49% girls; Overweight Increase physical activity in overweight children to reduce BMI Physical activity intervention; Treatment: Physical activity sessions 3 times per week Targeted: Children from a disadvantaged area BMI +
Robinson et al 2003 [50] RCT (pilot); 12 week follow-up; Final sample = 60; Quality = Strong Community centres and homes, USA; 8-10 years; 100% girls; At risk of obesity Prevent further weight gain in low SES African American girls Physical activity intervention; Treatment: Dance classes and TV viewing reduction intervention (GEMS) targeting African American girls at risk of obesity Targeted: Recruited from low income neighbourhoods BMI 0
Waist circumference
Willet 1995 [51] Non-randomised controlled trial; 1 year follow-up; Final sample = 40; Quality = Strong 1 community setting (exact setting unclear), USA; 7-12 years; 100% girls Prevention of obesity in low income African American girls Nutrition and physical activity intervention; Prevention: Mother and daughter culturally specific obesity prevention programme (based on the Know Your Body health education curriculum) Targeted: low SES, African American girls BMI 0
% overweight
Hamad et al 2011 [52] RCT; 1 year follow-up; Final sample = 1501; Quality = Strong Microcredit institution, Republic of Peru; <5 years To improve the general health of disadvantaged children Nutrition and physical activity intervention; Prevention: Microcredit loan with the addition of health education sessions to parents Targeted: children of families receiving microcredit BMI 0
% overweight
  1. 1Global Quality appraisal from EPHPP (16); 2Prevention or treatment intervention; 3Targeted/Universal approach to inequality; 4p < 0.05.This is the relative mean differences between intervention and control at follow-up; 5+ positive intervention effect so it reduces obesity-related outcomes in low SES groups or reduces the SES gradient in obesity-related outcomes, 0 no intervention effect or no effect on SES gradient in obesity-related outcomes; SES = Socioeconomic status; BMI = Body mass index; MVPA = Moderate to vigorous intensity physical activity.