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Do Parenting Interventions Increase Social Inequalities in Child Conduct Problems? Pan-European Individual Participant Data (IPD) Meta-Analysis

57 Pages Posted: 18 Sep 2018

See all articles by Frances Gardner

Frances Gardner

University of Oxford - Department of Social Policy and Intervention

Patty Leijten

University of Oxford; University of Amsterdam

Victoria Harris

King's College London

Joanna Mann

University of Oxford

Judy Hutchings

Bangor University - Bangor University

Jennifer Beecham

London School of Economics & Political Science (LSE) - London School of Economics

Vashti Berry

University of Exeter

Sinead McGilloway

National University of Ireland, Maynooth (NUI Maynooth)

Maria Gaspar

Universidade de Coimbra

Bram Orobio de Castro

Utrecht University

Margiad Williams

Bangor University - Bangor University

Ulf Axberg

University of Gothenburg

Willy-Tore Morch

University of Tromso

Stephen Scott

King's College London

Sabine Landau

King's College London

More...

Abstract

Background: Childhood conduct problems are a costly public health problem, five times commoner in socially disadvantaged groups. Untreated, they have a poor prognosis, with increasing gaps between socio-economic groups, and high rates of subsequent criminality. The Incredible Years (IY) is a high-quality parenting programme as recommended by NICE for reducing conduct problems, and is widely disseminated in Europe. Many trials show IY to be effective, but the potential effects on social inequality of parenting interventions are unknown. This matters since some behavioural interventions (e.g. smoking cessation programmes), while beneficial overall, can widen inequality gaps. Since single trials and aggregate-level meta-analysis are ill-equipped for examining differential intervention (moderator) effects, we pooled individual-level trial data.

Method: Individual participant data (IPD) meta-analysis of a near-complete set of randomised trials of European IY parenting programmes (k=13; N=1696; for 1/15 trials, data unavailable). Children were aged 2-10 years (M 5.1; 30% minority; 58% low-income). Primary outcome was child conduct problems, measured by Eyberg Child Behavior Inventory (ECBI-I). Moderators were analysed using multilevel modelling with multiple imputation.

Findings: IY led to an overall reduction in child conduct problems (estimated 13.5 points on ECBI-I, 95% CI 10.9 to 16.1). There was no evidence for differential effects in families with different levels of social disadvantage (poverty, lone or teen parenthood, joblessness; low education), or from ethnic minorities.

Interpretation: This world-first IPD meta-analysis of parenting trials, found IY was equally likely to be effective with disadvantaged as non-disadvantaged children, suggesting the programme is unlikely to widen socioeconomic inequalities in conduct problems. Furthermore, the programme may be an important tool for reducing social disparities and improving the poor long-term outcomes in disadvantaged families, since follow-up studies indicate that benefits persist. Meantime, clinicians and commissioners can be reassured the programme is equally effective for families from different backgrounds.

Funding Statement: NIHR Public Health Research funded the study, grant 12-3070-04, PI FG. SL received salary support from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.

Declaration of Interests: FG, PL, JH, SS, VB, SM, MG, MJSS, BOdC, AM, UA, WM led trials that were included in IPD set. JH, MG, MJSS have received occasional payments for training leaders in the Incredible Years parent programme. FG, JH are co-developers of a non-profit parenting programme with WHO, ‘Parenting for Lifelong Health’. The authors declare no other conflicts of interest.

Ethics Approval Statement: Ethical approval was granted by University of Oxford, Social Policy and Intervention DREC.

Suggested Citation

Gardner, Frances and Leijten, Patty and Harris, Victoria and Mann, Joanna and Hutchings, Judy and Beecham, Jennifer and Berry, Vashti and McGilloway, Sinead and Gaspar, Maria and Orobio de Castro, Bram and Williams, Margiad and Axberg, Ulf and Morch, Willy-Tore and Scott, Stephen and Landau, Sabine, Do Parenting Interventions Increase Social Inequalities in Child Conduct Problems? Pan-European Individual Participant Data (IPD) Meta-Analysis (July 26, 2018). Available at SSRN: https://ssrn.com/abstract=3221415 or http://dx.doi.org/10.2139/ssrn.3221415

Frances Gardner (Contact Author)

University of Oxford - Department of Social Policy and Intervention ( email )

Oxford
United Kingdom

Patty Leijten

University of Oxford

Mansfield Road
Oxford, Oxfordshire OX1 4AU
United Kingdom

University of Amsterdam

Spui 21
Amsterdam, 1018 WB
Netherlands

Victoria Harris

King's College London

Strand
London, England WC2R 2LS
United Kingdom

Joanna Mann

University of Oxford

Mansfield Road
Oxford, Oxfordshire OX1 4AU
United Kingdom

Judy Hutchings

Bangor University - Bangor University

Bangor, Wales LL57 2DG
United Kingdom

Jennifer Beecham

London School of Economics & Political Science (LSE) - London School of Economics

United Kingdom

Vashti Berry

University of Exeter

Northcote House
The Queen's Drive
Exeter, Devon EX4 4QJ
United Kingdom

Sinead McGilloway

National University of Ireland, Maynooth (NUI Maynooth)

2nd Floor
Iontas Building
Maynooth, County Kildare W23 F2H6
Ireland

Maria Gaspar

Universidade de Coimbra

Avenida Dias da Silva, 165
Coimbra, 3001-454
Portugal

Bram Orobio de Castro

Utrecht University

Vredenburg 138
Utrecht, 3511 BG
Netherlands

Margiad Williams

Bangor University - Bangor University

Bangor, Wales LL57 2DG
United Kingdom

Ulf Axberg

University of Gothenburg

Viktoriagatan 30
Göteborg, 405 30
Sweden

Willy-Tore Morch

University of Tromso

Tromsø, N-9037
Norway

Stephen Scott

King's College London ( email )

Strand
London, England WC2R 2LS
United Kingdom

Sabine Landau

King's College London

Strand
London, England WC2R 2LS
United Kingdom

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