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Abstract Background The ‘agentic demand’ of population health interventions (PHIs) refers to the capacity, resources and freedom to act that interventions demand of their recipients to benefit, which have a socio-economical pattern. Highly agentic interventions, e.g. information campaigns, rely on recipients noticing and responding to the intervention and thus might affect intervention effectiveness and equity. The absence of an adequate framework to classify agentic demands limits the fields’ ability to systematically explore these associations. Methods We systematically developed the Demands for Population Health Interventions (Depth) framework using an iterative approach: (1) developing the Depth framework by systematically identifying examples of PHIs aiming to promote healthier diets and physical activity, coding of intervention actors and actions and synthesising the data to develop the framework; (2) testing the Depth framework in online workshops with academic and policy experts and a quantitative reliability assessment. We applied the final framework in a proof-of-concept review, extracting studies from three existing equity-focused systematic reviews on framework category, overall effectiveness and differential socioeconomic effects and visualised the findings in harvest plots. Results The Depth framework identifies three constructs influencing agentic demand: exposure — initial contact with intervention (two levels), mechanism of action — how the intervention enables or discourages behaviour (five levels) and engagement — recipient response (two levels). When combined, these constructs form a matrix of 20 possible classifications. In the proof-of-concept review, we classified all components of 31 interventions according to the Depth framework. Intervention components were concentrated in a small number of Depth classifications; Depth classification appeared to be related to intervention equity but not effectiveness. Conclusions This framework holds potential for future research, policy and practice, facilitating the design, selection and evaluation of interventions and evidence synthesis.

Background: Cycling is beneficial for health and the environment but the evidence on the overall and differential impacts of interventions to promote cycling is limited. Here we assess the equity impacts of funding awarded to support cycling in 18 urban areas between 2005 and 2011. Methods: We used longitudinally linked 2001 and 2011 census data from 25,747 individuals in the Office for National Statistics Longitudinal Study of England and Wales. Logistic regression was used to assess the impacts of funding on commute mode as the interaction between time and area (intervention/comparison) in individual-level difference-in-difference analyses, adjusting for a range of potential confounding factors. Differential impacts were examined by age, gender, education and area-level deprivation, and uptake and maintenance of cycling were examined separately. Results: Difference-in-difference analyses showed no intervention impact on cycle commuting prevalence in the whole sample (AOR = 1.08; 95% CI 0.92, 1.26) or among men (AOR = 0.91; 95% CI 0.76, 1.10) but found an intervention effect among women (AOR = 1.56; 95% CI 1.16, 2.10). The intervention promoted uptake of cycling commuting in women (AOR = 2.13; 95% CI 1.56, 2.91) but not men (AOR = 1.19; 95% CI 0.93, 1.51). Differences in intervention effects by age, education and area-level deprivation were less consistent and more modest in magnitude. Conclusions: Living in an intervention area was associated with greater uptake of cycle commuting among women but not men. Potential gender differences in the determinants of transport mode choice should be considered in the design and evaluation of future interventions to promote cycling.

Public health professionals have the opportunity to impact middle school students’ dietary behaviors to combat childhood obesity. The purpose of this study was to investigate the dietary behavior results from the YRBS taken by middle school students in Duval County in 2009, 2011 and 2013. A two-stage cluster design was used and the survey was completed by 6th through 8th grade students following parent notification. Compared to other health zones, Health Zone 1 had the lowest intake of fruits and vegetables in 2009 (2.66 ±1.65) and 2011 (2.77 ± 1.60) and the second lowest intake in 2013 (2.92 ± 1.70). In 2009, 2011 and 2013, Health Zone 1 students’ response for soda intake was consistently higher compared to other health zones (2.39 ±1.54; 2.40 ±1.47; 2.29 ± 1.54 respectively). Health Zone 1, the urban core of Jacksonville, consistently had the lowest intake of fruits and vegetables and the highest intake of soda. Public health strategies should focus on improving fruit and vegetable intake and reducing soda intake within the school environment particularly focusing on Health Zone 1.

The purpose of this study was to compare the results of fruit and vegetable intake data from the 2009, 2011, 2013 Duval County Youth Risk Surveys (YRBS) by health zone. The survey instrument (questionnaire) is administered using a cluster sample design in all ninth grade classes in public schools (except charter schools) every two (odd) years. The surveys are anonymous and there is parental notification. Oversampling is done to allow for sub-county analysis. There were no statistically significant differences across health zones for any of the fruit and vegetable consumption questions for year 2009 however all health zones were below the recommended level of fruit and vegetable intake. For years 2011 and 2013 despite significant statistical differences by health zone in the frequency of consumption for fruits and vegetables, all health zones had a low mean intake of fruits and vegetables for years 2009, 2011 and 2013. Most respondents indicated consuming fruits, green salad, potatoes (not fried), carrots and vegetables “1 to 3 times during the past 7 days.” Overall intake of fruits and vegetables, however, was low for all health zones.