Objective In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it.The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues. Methods We searched for all articles published until 6th of February 2020, mentioning "Proportionate Universalism" or its synonyms "Targeted universalism" OR "Progressive Universalism" as a topic in all Web of Science databases. Results This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs. Conclusion This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.

/pdf/theoretical-and-practical-challenges-of-proportionate-58axt3yv48.pdf

Theoretical and practical challenges of proportionate universalism: a review

Does street greenery always promote active travel? Evidence from Beijing

Understanding how street-level green space exposure influences active travel satisfaction is essential for improving physical activity and subjective well-being. Using global positioning system trajectories and street view images collected in Beijing, this study investigates how green space exposure along travel routes influences active travel satisfaction while controlling for travel characteristics and socio-economic attributes. The results show significant variations in street-level green space exposure among travel trips. Individuals’ contact with green space during travel positively contributes to their travel satisfaction. The effect of green space exposure on travel satisfaction varies by travel mode, duration and purpose. Green space exposure has a significant impact on satisfaction with walking, nonwork trips and trips of medium duration. This evidence has implications for urban greening investment, suggesting that greater attention be paid to small-scale green space along road networks to improve citizens’ well-being through active travel.

The impact of green space exposure on satisfaction with active travel trips

Physical activity rather than sedentary behaviour is socially determined in French adolescents with overweight and obesity

The design and/or remodelling of urban parks is a good health strategy to alleviate the lack of physical activity (PA) in children and, consequently, the different health problems derived from this. The main objective of the present study was to obtain a systematic review of the design features and characteristics that influence users’ visits to urban parks and the PA engagement in them. A literature search was carried out in the Web of Science (WOS) and Scopus databases during the months of June and July 2020. After considering and applying inclusion criteria, the final review sample was formed of 31 scientific papers published between 2010–2020. The results obtained in the review lead us to conclude that the needs of the population (children and family members who care for them) and socio-economic context of the area in which they are built must be considered when constructing and/or remodelling parks. Involving community members in playground renovations can have a positive effect on park use and PA engagement in children.

Determining Factors in the Use of Urban Parks That Influence the Practice of Physical Activity in Children: A Systematic Review

Background Despite social inequalities in overweight/obesity prevalence, evidence-based public health interventions to reduce them are scarce. The PRALIMAP-INES trial aimed to investigate whether a strengthened-care management for adolescents with low socioeconomic status has an equivalent effect in preventing and reducing overweight as a standard-care management for high socioeconomic status adolescents. Methods PRALIMAP-INES was a mixed, prospective and multicenter trial including 35 state-run schools. It admitted overweight or obese adolescents, age 13–18 years old, for 3 consecutive academic years. One-year interventions were implemented. Data were collected before (T0), after (T1) and post (T2) intervention. Among 2113 eligible adolescents who completed questionnaires, 1639 were proposed for inclusion and 1419 were included (220 parental refusals). Two groups were constituted according to the Family Affluence Scale (FAS) score: the less advantaged (FAS≤5) were randomly assigned to 2 groups in a 2/1 ratio. The 3 intervention groups were: advantaged with standard-care management (A.S, n = 808), less advantaged with standard-care management (LA.S, n = 196), and less advantaged with standard and strengthened-care management (LA.S.S, n = 415). The standard-care management was based on the patient education principle and consisted of 5 collective sessions. The strengthened-care management was based on the proportionate universalism principle and consisted of activities adapted to needs. Inclusion results The written parental refusal was less frequent among less advantaged and more overweight adolescents. A dramatic linear social gradient in overweight was evidenced. Discussion The PRALIMAP-INES outcomes should inform how effectively a socially adapted public health program can avoid worsening social inequalities in overweight adolescents attending school. Trial registration ClinicalTrials.gov (NCT01688453).

https://hal.univ-lorraine.fr/hal-02339019/document

Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis

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Physical activity rather than sedentary behaviour is socially determined in French adolescents with overweight and obesity

Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis