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While the family is a critical determinant of educational achievement, methodological difficulties and the availability of data limit estimation of the family contribution in school effectiveness models. This study uses multilevel modeling to estimate the proportion of variation in student educational achievement between families, family-level intraclass correlation coefficients, and specific family structure effects (family size, birth order, birth spacing, sibling sex ratio). We use cross-classified random effects to account for school and neighborhood variation. We analyze Swedish administrative education records linked with birth records for four academic cohorts of students, with siblings identified from a wider pool of 21 cohorts. We show that almost half of the variation in student achievement described as "between students" in traditional school effectiveness studies would be better described as variation "between families," suggesting effectiveness research might give greater consideration to family-based interventions in tandem with existing student- and school-based approaches to raising low achievement.

Reviewing complex interventions is challenging because they include many elements that can interact dynamically in a nonlinear manner. A systems perspective offers a way of thinking to help understand complex issues, but its application in evidence synthesis is not established. The aim of this project was to understand how and why systems perspectives have been applied in evidence synthesis. A methodological mapping review was conducted to identify papers using a systems perspective in evidence synthesis. A search was conducted in seven bibliographic databases and three search engines. A total of 101 papers (representing 98 reviews) met the eligibility criteria. Two categories of reviews were identified: (1) reviews using a "systems lens" to frame the topic, generate hypotheses, select studies, and guide the analysis and interpretation of findings (n = 76) and (2) reviews using systems methods to develop a systems model (n = 22). Several methods (e.g., systems dynamic modeling, soft systems approach) were identified, and they were used to identify, rank and select elements, analyze interactions, develop models, and forecast needs. The main reasons for using a systems perspective were to address complexity, view the problem as a whole, and understand the interrelationships between the elements. Several challenges for capturing the true nature and complexity of a problem were raised when performing these methods. This review is a useful starting point when designing evidence synthesis of complex interventions. It identifies different opportunities for applying a systems perspective in evidence synthesis, and highlights both commonplace and less familiar methods.

This paper critically explores how survey and routinely collected data could aid in assessing the generalisability of public health evidence. We propose developing approaches that could be employed in understanding the relevance of public health evidence, and investigate ways of producing meta-analytic estimates tailored to reflect local circumstances, based on analyses of secondary data. Currently, public health decision makers face challenges in interpreting "global" review evidence to assess its meaning in local contexts. A lack of clarity on the definition and scope of generalisability, and the absence of consensus on its measurement, has stunted methodological progress. The consequence of failing to tackle generalisability means that systematic review evidence often fails to fulfil its potential contribution in public health decision making. Three approaches to address these problems are considered and emerging challenges discussed: (1) purposeful exploration after a review has been conducted, and we present a framework of potential avenues of enquiry and a worked example; (2) recalibration of the results to weight studies differentially based on their similarity to conditions in an inference population, and we provide a worked example using UK Census data to understand potential differences in the effectiveness of community engagement interventions among sites in England and Wales; (3) purposeful exploration before starting a review to ensure that the findings are relevant to an inference population. The paper aims to demonstrate how a more nuanced treatment of context in reviews of public health interventions could be achieved through greater engagement with existing large sources of secondary data.

Background: Sexual orientation has been measured in a wide variety of ways which reflect both theoretical and practical considerations. However, choice of sexual orientation measure and recoding strategy can impact analytic sample, as well as demographic and health profiles, in analyses of sexual minority populations. We aimed to examine how choice of sexual orientation dimension and recoding decisions impact estimates in the sexual minority population in two population-based studies in the UK. Methods: We used data collected at age 17 (2018) in the UK Millennium Cohort Study and at sweep six (2012–13) and eight (2017–18) of the English Longitudinal Study of Ageing. Descriptive statistics were used to examine the impact of choice of sexual orientation dimension (i.e. identity, attraction and experience) and recoding decisions on achieved analytic sample and composition by selected demographic and health measures within and between datasets. Results: Dimension choice and recoding decisions resulted in variation in analytic sample. For example, more respondents reported some same-sex sexual attraction than reported a non-heterosexual identity (adolescents: 20.77% vs 8.97%, older adults: 4.77% vs 1.04%). Demographic distributions varied, but not substantially by dimension choice or recoding strategy. Overall, in both datasets sexual minority respondents were more likely to be White and in the highest quintiles for income and education than heterosexual respondents. Health status did not vary substantially by dimension choice or recoding strategy, however sexual minority respondents reported worse health than their heterosexual peers. Conclusions: This study explores a range of practical and theoretical considerations when analysing sexual minority respondents using survey data. We highlight the impact recoding decisions may have on the numbers of sexual minority respondents identified within a dataset and demographic and health distributions in this understudied population. We also demonstrate the benefits of including multiple dimensions for capturing mechanisms of interest in elucidating ambiguous responses and exploring sexual diversity. [ABSTRACT FROM AUTHOR]

Background: Theories of change explaining how interventions work are increasingly important, yet the methods/data to develop these are less advanced than for evaluating effects. Methods: We conducted a systematic evidence synthesis to develop a theory of change for structural adolescent contraception interventions. We reflect on the utility of the information provided in evaluation reports. Findings/discussion: Few of the included evaluations presented their theory of change, or included rich, qualitative process data. Authors' descriptions of context and implementation, typically in introduction and discussion sections, were very useful. These helped to understand the intervention's context, how it was experienced and why or how it had the effect that it did. We recommend incorporating rich process evaluations into studies, and reporting contextual insights into the intervention's development, implementation and experience. We also recommend including these data and insights within syntheses that aim to develop theories of change. [ABSTRACT FROM AUTHOR]

Non-pharmacological interventions for attention-deficit/hyperactivity disorder are useful treatments, but it is unclear how effective school-based interventions are for a range of outcomes and which features of interventions are most effective. This paper systematically reviews randomised controlled trial evidence of the effectiveness of interventions for children with ADHD in school settings. Three methods of synthesis were used to explore the effectiveness of interventions, whether certain types of interventions are more effective than others and which components of interventions lead to effective academic outcomes. Twenty-eight studies (n = 1807) were included in the review. Eight types of interventions were evaluated and a range of different ADHD symptoms, difficulties and school outcomes were assessed across studies. Meta-analyses demonstrated beneficial effects for interventions that combine multiple features (median effect size g = 0.37, interquartile range 0.32, range 0.09-1.13) and suggest some promise for daily report card interventions (median g = 0.62, IQR = 0.25, range 0.13-1.62). Meta-regression analyses did not give a consistent message regarding which types of interventions were more effective than others. Finally, qualitative comparative analysis demonstrated that self-regulation and one-to-one intervention delivery were important components of interventions that were effective for academic outcomes. These two components were not sufficient though; when they appeared with personalisation for individual recipients and delivery in the classroom, or when interventions did not aim to improve child relationships, interventions were effective. This review provides updated information about the effectiveness of non-pharmacological interventions specific to school settings and gives tentative messages about important features of these interventions for academic outcomes.

Lesbian, Gay, Bisexual, Transgender, Queer, Questioning (LGBTQ+) are at greater risk of poorer COVID‐19 prognosis due to higher levels of chronic disease and a greater impact on mental health from pandemic mitigation strategies due to worse pre‐pandemic mental health. We examine how a hostile social system contributes to LGBTQ+ people's negative health experiences during the pandemic through adopting a syndemic framework and using data from The Queerantine Study, a cross‐sectional, web‐based survey (n = 515). Identification of a health syndemic is based on depressive symptoms, perceived stress and limiting long‐term illness. We used Latent Class Analysis to identify latent classes based on experiences of a hostile social system. A syndemic was identified among a third of respondents (33.2%), with transgender/gender‐diverse and younger participants at higher risk. Latent Class Analysis identified five groups based on experiences of hostile social systems using psychosocial and socioeconomic indicators. Classes reflecting psychosocial hostility were predictive of a health syndemic and worsening health. This study emphasises (i) mental and physical health issues are intertwined among LGBTQ+ people; (ii) experiences of hostile social systems can account for part of variation in health across LGBTQ+ groups; (iii) that psychosocial hostility continued and was exacerbated throughout the pandemic, and (iv) experiences of psychosocial hostility in particular were associated with a greater likelihood of experiencing a syndemic. [ABSTRACT FROM AUTHOR]