Effectiveness of a socially adapted intervention in reducing social inequalities in adolescence weight. The PRALIMAP-INÈS school-based mixed trial.,International Journal of Obesity

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Effectiveness of a socially adapted intervention in reducing social inequalities in adolescence weight. The PRALIMAP-INÈS school-based mixed trial.
International Journal of Obesity ( IF 4.2 ) Pub Date : 2020-01-22 , DOI: 10.1038/s41366-020-0520-z
Serge Briançon ₁ , Karine Legrand _{1,

2} , Laurent Muller ₁ , Johanne Langlois ₃ , Laura Saez ₁ , Elisabeth Spitz ₁ , Marie-Hélène Quinet ₄ , Philip Böhme ₅ , Edith Lecomte ₃ , Abdou Y Omorou _{1,

2} ,

Affiliation

BACKGROUND A high prevalence of overweight/obesity among low socioeconomic status adolescents contributes to health inequalities. However, evidence-based interventions for reducing social inequalities in adolescent weight are lacking. We aimed to investigate whether strengthened care management for adolescents with low socioeconomic status has an equivalent effect in reducing overweight as standard care management in adolescents with high status. METHODS PRALIMAP-INÈS was a multicentre trial including 35 state-run high and middle schools in the north-eastern France. A population-based sample of 1639 adolescents aged 13-18 years with screened and clinically confirmed overweight/obesity were proposed for inclusion and divided into two groups by the Family Affluence Scale score: advantaged (score > 5), receiving standard care management (A.S) and less-advantaged randomly assigned to two groups (1:2 ratio): standard care management (LA.S) and standard and strengthened care management (LA.S.S). Interventions were based on the proportionate universalism principle: universal standard care for all groups and proportionate care for the LA.S.S group. Main outcome was body mass index z-score (BMIz) assessed before and 1 year after inclusion. RESULTS A total of 1419 adolescents were included and 1143 followed up at 1 year: 649 in A.S, 158 in LA.S and 336 in LA.S.S groups. BMIz decreased significantly for boys (-0.11 [95% CI, -0.13 to -0.08]; p < 0.0001) and girls (-0.05 [-0.08 to -0.03]; p < 0.0001). No equivalence between LA.S.S and A.S groups was evidenced. For girls, the trend to superiority for LA.S.S was confirmed by the more favourable change (-0.06 [-0.11 to -0.01]; p = 0.01) observed on superiority analysis, with no differential change for boys (0.02 [-0.03 to 0.08]; p = 0.41). CONCLUSIONS A public health school-based intervention using the proportionate universalism principle may be effective in not worsening or even reducing overweight social inequalities in adolescents, especially for girls. Overcoming social barriers may help health professionals dealing with the burden and inequalities of overweight in adolescents.

中文翻译：

适应社会的干预措施在减少青春期体重社会不平等方面的有效性。PRALIMAP-INÈS 基于学校的混合试验。

背景社会经济地位低的青少年中超重/肥胖的高患病率导致了健康不平等。然而，缺乏减少青少年体重社会不平等的循证干预措施。我们旨在调查对社会经济地位低的青少年加强护理管理是否在减少超重方面与社会经济地位高的青少年的标准护理管理具有同等效果。方法 PRALIMAP-INÈS 是一项多中心试验，包括法国东北部的 35 所公立高中和中学。建议纳入 1639 名年龄在 13-18 岁且经筛查和临床证实超重/肥胖的基于人群的样本，并根据家庭富裕量表评分将其分为两组：优势（得分 > 5）、接受标准护理管理（A . S) 和较差的随机分配到两组（1:2 比例）：标准护理管理 (LA.S) 和标准和加强护理管理 (LA.SS)。干预措施基于比例普遍主义原则：所有群体的普遍标准护理和 LA.SS 群体的比例护理。主要结果是纳入之前和之后 1 年评估的体重指数 z 分数 (BMIz)。结果共纳入 1419 名青少年，1 年随访 1143 名：AS 组 649 名，LA.S 组 158 名，LA.SS 组 336 名。男孩（-0.11 [95% CI，-0.13 至 -0.08]；p < 0.0001）和女孩（-0.05 [-0.08 至 -0.03]；p < 0.0001）的 BMIz 显着降低。没有证据表明 LA.SS 和 AS 组之间存在等效性。对于女孩来说，更有利的变化证实了 LA.SS 的优势趋势（-0.06 [-0.11 至 -0.01]；p = 0. 01）在优势分析中观察到，男孩没有差异变化（0.02 [-0.03 至 0.08]；p = 0.41）。结论使用比例普遍主义原则的基于公共卫生学校的干预可能有效地不会恶化甚至减少青少年，尤其是女孩的超重社会不平等。克服社会障碍可能有助于卫生专业人员应对青少年超重的负担和不平等。

更新日期：2020-01-22

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