Despite the potential high impact of prevention programs in reducing health inequalities, this question has received little attention in intervention research. To reduce health inequalities, prevention programs have to be applied with particular care, avoiding the selection of the population receiving the intervention: if the population is advantaged, the effect can be an increase of inequalities. On the other side, prevention interventions can have a bigger impact on disadvantaged subjects, so reducing inequalities. However, this effect should be formally evaluated, and a balance between increase and reduction of health inequalities should be made in order to make a statement on it. The aim of this work is to evaluate if the Unplugged prevention program as implemented in some European countries in the last years is more likely to have reduced or increased health inequalities. In order to achieve this objective, data on program implementation will be presented, together with the results on the moderating effect of the social environment on Unplugged effects as measured in the Eudap trial. During the school year 2004-2005, 143 schools (7079 pupils) of seven European countries were randomly assigned to either control or a 12-session curriculum based on a social influence model. Randomisation was blocked within socioeconomic levels of the school environment. Alcohol use and alcohol-related problem behaviours were investigated at baseline and 18 months thereafter. Data was analysed using multilevel regression modelling. At baseline, adolescents from schools located in neighbourhoods of low socioeconomic level were more likely to report problem drinking than other students. Participation in the programme was associated in this group with a decreased odds of reporting episodes of drunkenness, intention to get drunk, and marginally alcohol-related problem behaviours. No significant programme’s effects emerged for students in schools of medium or high socioeconomic level. Effects on frequency of alcohol consumption were also stronger among students in disadvantaged schools. Social influence school-based curricula may have a more favourable effect on problematic drinking among students in underprivileged social environments. If administered in unselected populations, they can contribute to reduce inequalities in risk factors for ill-health.
Can School-Based Prevention Programs Reduce Health Inequalities? the Example of Unplugged
VIGNA-TAGLIANTI, Federica;
2014-01-01
Abstract
Despite the potential high impact of prevention programs in reducing health inequalities, this question has received little attention in intervention research. To reduce health inequalities, prevention programs have to be applied with particular care, avoiding the selection of the population receiving the intervention: if the population is advantaged, the effect can be an increase of inequalities. On the other side, prevention interventions can have a bigger impact on disadvantaged subjects, so reducing inequalities. However, this effect should be formally evaluated, and a balance between increase and reduction of health inequalities should be made in order to make a statement on it. The aim of this work is to evaluate if the Unplugged prevention program as implemented in some European countries in the last years is more likely to have reduced or increased health inequalities. In order to achieve this objective, data on program implementation will be presented, together with the results on the moderating effect of the social environment on Unplugged effects as measured in the Eudap trial. During the school year 2004-2005, 143 schools (7079 pupils) of seven European countries were randomly assigned to either control or a 12-session curriculum based on a social influence model. Randomisation was blocked within socioeconomic levels of the school environment. Alcohol use and alcohol-related problem behaviours were investigated at baseline and 18 months thereafter. Data was analysed using multilevel regression modelling. At baseline, adolescents from schools located in neighbourhoods of low socioeconomic level were more likely to report problem drinking than other students. Participation in the programme was associated in this group with a decreased odds of reporting episodes of drunkenness, intention to get drunk, and marginally alcohol-related problem behaviours. No significant programme’s effects emerged for students in schools of medium or high socioeconomic level. Effects on frequency of alcohol consumption were also stronger among students in disadvantaged schools. Social influence school-based curricula may have a more favourable effect on problematic drinking among students in underprivileged social environments. If administered in unselected populations, they can contribute to reduce inequalities in risk factors for ill-health.
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