Melhuish 2010.

Methods	Study design: controlled prospective cohort study Sampling frame: Child Benefit Register used to identify participants in Sure Start areas, and Millennium Cohort Study used to identify controls in non‐Sure Start areas Sampling method: propensity score matched Collection method: home interviews Description of the community coalition: Sure Start partnerships were formed in response to national government funding starting in 1998 to enhance the health and development of children younger than 4 years of age and their families who live in socially deprived communities in England. These area‐based initiatives had populations, on average, of about 13,000 residents and now number over 500 sites. Sure Start guidance required programs to be planned and run by partnerships of parents, local people, voluntary and community organizations, representatives from health and local government, and others involved in improving services for young children and families. Every partnership had a lead partner acceptable to the members and accountable to receive Sure Start moneys on behalf of the partnership. Most included parents, but numbers varied and partnerships commonly included two or three parents. The size of the partnership also varied widely. Partnerships drew statutory representatives from agencies (typically practitioners) and voluntary members. Lead partners were not chosen by formal process but emerged during the planning stage. Partnerships were required to consult about the content of the Sure Start program at all stages of the planning process and throughout implementation and delivery of the plan. A program manager was appointed to see that plans were completed. Sites were given flexibility in implementing the program. Statutory agencies sometimes dominated the partnership
Participants	Communities: targeted 20% of the most deprived areas in England (n > 500 sites) Country: England Ages included in assessment: 5‐year‐old children and parents or guardians Reasons provided for selection of intervention community: to prevent health inequalities, poverty, school failure, and social exclusion Intervention community (population size): Sure Start Local Programme areas (approximately 13,000 per site) Comparison community (population size): Millennium Cohort Study areas (similar)
Interventions	Name of intervention: Sure Start Local Programmes Theory: not reported Aim: to enhance the health and development of children younger than 4 years of age and their families who live in socially deprived communities in England Description of costs and resources: not reported Components of the intervention: Core services consisted of outreach or home visiting; family support; support for good quality play, learning, and childcare experiences; primary and community health care; advice about child and family health and development; and support for people with special needs, including help in accessing specialized services Start date: 1999 Duration: ongoing
Outcomes	Outcomes and measures: child BMI, child health, teacher‐rated child development, maternal depression Time points: child age 5 (some measures also completed at age 3)
Notes	Data collection for intervention and control groups not concurrent: Sure Start data were collected between June 2007 and June 2009. Millemium Cohort Study data were collected from January 2006 to March 2007. Mean differences in outcome measures were calculated as an average from 3 separate analyses, 2 with imputed missing data
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	No randomization. Study used propensity score matching procedures
Allocation concealment (selection bias)	High risk	Allocation not concealed. Study used propensity score matching procedures
Baseline outcome measurement similar	High risk	Sure Start data collected from June 2007 to June 2009. Millenium Cohort data collected from January 2006 to March 2007. Outcomes not measured concurrently. Change scores incorporating baseline measures not presented for most outcomes
Baseline characteristics similar	Unclear risk	Propensity score matched, but groups still differed significantly with respect to race, spoken language, and household deprivation
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Study used propensity score matching procedures
Incomplete outcome data (attrition bias) All outcomes	High risk	30% of sample interviewed when participants were 3 years old were missing at 5‐year‐old assessment, but effects were averaged across 3 analyses with imputed data. Outcomes were measured by different research teams for intervention and comparison groups
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Study used propensity score matching procedures
Protection against contamination	High risk	Communities could be contiguous
Selective reporting (reporting bias)	Low risk	Protocols well documented