Table S1: Statements relating to ethnicity in UK Guidelines
Source
Evidence statements
NICE
PH1Brief
Ethnic* Minorit*
interventions and
Differences in risk between diverse populations. Despite a reduction in smoking prevalence, some groups such as
referral for smoking
ethnic minority groups and deprived communities retain a high prevalence.
cessation in primary
Smoking cessation advice and support should be targeted to high risk population groups including ethnic minorities
care and other
and focus on their needs.
settings
There are unique risk behaviours for some ethnic minority groups, such as chewing tobacco, which are not provided
2006
for by current service provision, and need to be addressed.
PH10 Smoking
Ethnic* Minorit*
cessation services
NHS Stop Smoking Services should target ethnic minority communities.
2008
Ensure that smoking cessation interventions are tailored and language appropriate for ethnic minority communities
Source
Evidence statements
– both for individual services and public education and communications campaigns.
Ethnic minority and disadvantaged groups should be treated by smoking cessation services at least in proportion to
their representation in the local population of tobacco users.
PH13 Workplace
Ethnic*
health promotion:
Queried the differential effect of interventions according to contexts including ethnicity.
how to encourage
Lack of evidence of how workplace interventions for physical activity are influenced by contexts such as ethnicity.
employees to be
physically active
2008
PH6 Behaviour
change at
populations,
community and
Ethnic*, Minorit*, Cultur*
Awareness that different groups (including ethnicity) react differently to health promotion messages e.g. ‘fear’
messages.
Source
Evidence statements
individual levels
Need to target and tailor interventions to the needs of populations to be effective, with the goal of health equity.
2007
Service user views may be helpful when planning interventions and needs assessment is a method to gather
information to inform the appropriate development and tailoring of interventions.
The cultural acceptability and value of behaviours varies according to contexts, including ethnicity, and it is
important not to stereotype or stigmatise groups of people because of these differences; working with
communities and addressing prejudice and discrimination in professional practice is recommended.
Some “negative” health behaviours may provide positive benefits (psychological, social or physical) for individuals
in certain social and cultural contexts and these contexts, plus economic considerations, must be taken into
consideration to develop effective interventions (account for diversity).
Lack of high quality evidence (randomised controlled trials) and cost-effectiveness data for interventions
concerning specific subgroups including ethnic groups and a lack of research, which considers health inequalities in
relation to cultural differences.
Recommend research always takes ethnic minority groups into consideration and that there is improved reporting
Source
Evidence statements
on access, recruitment and uptake according to contextual variables including ethnicity.
Recommend research that takes into account the social and cultural contexts of behaviour and behaviour change,
including socioeconomic status, income levels, environmental characteristics of neighbourhoods and work-related
factors.
CG43 Obesity
Ethnic* Minorit* Cultur* Asian Black
2006
Recommend tailoring of advice for different populations and vulnerable groups, particularly black and minority
ethnic groups, and considering barriers (such as cost, personal tastes, availability, time, views of family and
community members).
Engagement with communities is important to assess barriers to physical activity and healthy eating, and these
barriers may vary according to different contexts, including ethnicity, such that specific needs assessment is
required.
Advice, treatment and care should be non-discriminatory, culturally appropriate, and accessible to people who do
Source
Evidence statements
not read or speak English.
Acknowledge that some ethnic backgrounds may be at greater risk of obesity, and have different beliefs and
attitudes regarding weight and weight management.
Information should be delivered in appropriate language and be conscious of peoples culture and ethnicity.
Lack of evidence for multi-component obesity interventions for particular sub-groups including ethnic minority
groups.
Recommend future research and the collation of data which considers the effectiveness of interventions for
different sub-groups, including how it varies by ethnicity.
PH8 Promoting and
Ethnic*, Minorit*, Cultur*
creating built or
Shortage of evidence on the differential effectiveness of environmental interventions for physical activity for
natural
different groups, including how effectiveness varies with ethnicity and culture, and therefore it is unclear how these
environments that
interventions affect health inequalities. Must take into account health inequalities when implementing
encourage and
Source
Evidence statements
support physical
recommendations.
activity
Cycling interventions in both urban and rural areas can be effective in increasing participation in cycling and could
2008
be considered with modification for cultural issues.
PH2 Four commonly
Ethnic* Minorit* Cultur* Asian, Chinese, Bangladeshi
used methods to
A difference in participation in physical activity between ethnic groups was reported by the health of ethnic
increase physical
minority groups survey - it found that South Asian and Chinese, of both genders, were much less likely to
activity: brief
participate in physical activity of any kind (whether it was sport and exercise, walking, heavy housework or DIY).
interventions in
Bangladeshi men and women were the most inactive, being almost twice as likely as the general population to be
primary care,
classified as sedentary.
exercise referral
schemes,
Gaps in the evidence for interventions for physical activity for the effectiveness and cost effectiveness; long term
outcomes; the differential effect of interventions according to varying contexts including ethnicity.
pedometers and
community-based
When developing services and infrastructure for the promotion of physical activity, particular thought needs to be
Source
Evidence statements
exercise
taken regarding the needs of disadvantaged and hard to reach communities, including ethnic minority groups.
programmes for
Physical activity is an important factor in a number of government Public Service Agreements targets. These include
walking and cycling
targets to tackle obesity, to increase cultural and sporting opportunities and to improve the quality of the built
2006
environment.
PH17 Promoting
Ethnic*, Minorit*, Cultur*, Rac*, Asia*, Chines*, Black, India*, Bangladesh*, Pakistan*, Afric*
physical activity,
Levels of physical activity vary according to many contextual factors including ethnicity. Fewer differences were
active play and sport
reported in relation to participation in sports and exercise, active play and walking; the biggest differences were for
for pre-school and
sports and exercise, where Indian, Pakistani, Bangladeshi and Chinese children participated less in sports and
school-age children
exercise than children from the general population.
and young people in
family, pre-school,
Active consultation is required to determine the best delivery of messages including the appropriate language for
different groups (including different ethnic groups amongst many other variables).
school and
community settings
Actively involve all children and young people, including those from different socioeconomic and ethnic minority
Source
Evidence statements
2009
groups in physical activity initiatives; all groups should have the opportunity to be involved.
Ensure physical activity facilities are suitable for all children and young people, particularly those from ethnic
minority groups with specific cultural requirements.
Recognise the need to tailor to individuals, including being sensitive to culture and gender issues, yet also
encourage people to explore a variety of options for involvement in physical activity.
Lack of evidence on how to engage children and young people in physical activity who are the least likely to be
active, including children and young people from certain ethnic minority groups or traveller and refugee
communities.
Need to determine the most effective and cost-effective interventions to increase and maintain increased levels of
physical activity in sub-groups of children and young people (taking account of age, culture, ethnicity, disability,
gender, geographic area (for example, inner-city, urban, rural), religion or socioeconomic status, and giving
particular attention to disadvantaged groups).
Establish continuing professional development (CPD) programmes for people involved in carrying out physical
Source
Evidence statements
activity interventions to assist them in understanding practical issues and barriers to involvement, including cultural
appropriateness.
Evaluations of physical activity intervention should be undertaken regularly and should measure uptake of different
groups, including people from different ethnic backgrounds.
PH5 Workplace
Ethnic* Minorit* Cultur*
health promotion:
Intervention materials may be aimed at a particular sub-group of the population, including certain ethnic groups
how to help
A tailored intervention study in the US reported effectiveness in promoting behaviour change in a working class
employees to stop
multi ethnic population
smoking 2007
There are gaps in the evidence, and research required to uncover what the most effective and cost-effective
interventions are for smoking cessation for different sectors of the workforce, including ethnic minority groups
SIGN
SIGN 69
Ethnic* Cultur* African*
Source
Evidence statements
Management of
Interested in differential risk among ethnic populations in the UK
obesity in children
Evidence searched for “culture” only in relation to the UK
and young people
Studies which included African American or Far Eastern patients perceived not to apply or were not relevant to the
2003
Scottish population
SIGN 8 Obesity in
Ethnic* Indian*
Scotland 1996
Age-specific BMI cut-offs provided for ethnic origin UK children in the Annex
Increased likelihood of abdominal fat deposit for weight gain which increased susceptibility to glucose intolerance,
diabetes and CHD over Caucasians
SIGN 97 Risk
Ethnic*
estimation and
There are differences in the baseline population risk for different ethnic groups
prevention of CVD
Ethnicity should be considered as a risk factor in CVD risk assessment
2007
Scotland’s ethnic minority population is at present small but increasing (ethnic minorities represent 2% of 5 million
Source
Evidence statements
in Scotland)
INTERHEART study reported on nine risk factors for CVD and observed that risk was consistent for men and women
by ethnic group
Current risk prediction algorithms are unable to accurately predict risk profiles for different ethnic groups and
cultures and may under predict risk in Chinese populations
ASSIGN CVD prediction tool includes social deprivation and family history as proxy to ethnic susceptibility, however,
tools not validated and may underestimate risk for South Asians for example
Prevalence of smoking or effectiveness of interventions for ethnic minorities have not been reliably measured in
Scotland, therefore, report on research from England
No evidence found for relevant interventions with ethnic minority groups
A mapping exercise identified some evidence of targeted smoking cessation materials but in general, tobacco
services were not attracting ethnic minority populations
Source
Evidence statements
Optimal dose and intensity of physical activity has not been addressed in terms of how it relates or varies for
different populations including ethnic minority groups