Barriers and facilitators for physical activity domains in Brazil: a systematic review

Abstract This study aimed to systematically review scientific evidence on the barriers and facilitators of physical activity (PA) among the Brazilian population, considering different domains (leisure, travel, work/study, and household). The search was conducted in the MEDLINE/PubMed, ISI Web of Science, SCOPUS, BIREME/LILACS, and APA PsycNET databases and was limited to papers published between 2010 and 2020. A manual search of the Brazilian Journal of Physical Activity & Health was also conducted. The selection process consisted of screening titles and abstracts, followed by the analysis of full texts. Each paper was assessed by two independent reviewers, and when discrepancies arose, a third reviewer was consulted. Leisure, environmental barriers and facilitators were the most investigated domains in the 78 included studies. There was consistency in the positive associations between six different intrapersonal and social facilitators for leisure PA and one environmental factor for travel. There have been a small number of investigations on the work/study and household domains, and future investigations on intrapersonal and social barriers and facilitators in the travel domain are important.

Barriers and facilitators for physical activity domains in Brazil: a systematic review

This study aimed to systematically review scientific evidence on the barriers and facilitators of physical activity (PA) among the Brazilian population, considering different domains (leisure, travel, work/study, and household). The search was conducted in the MEDLINE/PubMed, ISI Web of Science, SCOPUS, BIREME/LILACS, and APA PsycNET databases and was limited to papers published between 2010 and 2020. A manual search of the Brazilian Journal of Physical Activity & Health was also conducted. The selection process consisted of screening titles and abstracts, followed by the analysis of full texts. Each paper was assessed by two independent reviewers, and when discrepancies arose, a third reviewer was consulted. Leisure, environmental barriers and facilitators were the most investigated domains in the 78 included studies. There was consistency in the positive associations between six different intrapersonal and social facilitators for leisure PA and one environmental factor for travel. There have been a small number of investigations on the work/study and household domains, and future investigations on intrapersonal and social barriers and facilitators in the travel domain are important.

Use of an Elevated Avenue for Leisure-Time Physical Activity by Adults from Downtown São Paulo, Brazil

Leisure-time physical activity (LTPA) is associated with access and use of public open spaces. The President João Goulart Elevated Avenue, currently denominated Minhocão, is a facility for leisure activities that is open for people during the night and weekends. The aim of this study was to examine if the prevalence of LTPA among individuals living in the surroundings of Minhocão is different according to proximity to, and use of, the facility. We conducted a cross-sectional study with cluster sampling with people aged ≥18 years who lived in households up to 500 m, and between 501 m and 1500 m of Minhocão. The survey was conducted between December 2017 and March 2019 using an electronic questionnaire. We conducted a bivariate analysis and Poisson regression to examine possible differences in LTPA according to the proximity of residences and use of Minhocão. The analysis used post-stratification weights. A total of 12,030 telephone numbers of people were drawn (≤500 m = 6942; and >500 m to ≤1500 m = 5088). The final sample included 235 residents who returned the questionnaires. There was a higher prevalence of individuals engaging in at least 150 min per week of LTPA among users than non-users (Prevalence Ratio = 2.19, IC95% 1.66 to 2.90), independently of sex, age, education, the distance of houses to nearest accesses and number of barriers. The main five barriers related to the usage of the Minhocão were safety issues in and around the Minhocão, rainy weather, lack of vegetation, and lack of facilities. People who used the park had higher prevalence of all types of LTPA than non-users. The results can serve to inform government decision-making on the future of Minhocão.

Mix of destinations and sedentary behavior among Brazilian adults: a cross-sectional study

Background

Sedentary behavior is influenced by contextual, social, and individual factors, including the built environment. However, associations between the built environment and sitting time have not been extensively investigated in countries with economies in transition such as Brazil. The objective of this study is to examine the relationship between sitting-time and access to a mix of destinations for adults from Sao Paulo city, Brazil.

Methods

This study uses data from the Health Survey of Sao Paulo. Sedentary behavior was assessed by a questionnaire using two questions: total sitting time in minutes on a usual weekday; and on a usual weekend day. The mix of destinations was measured by summing the number of facilities (comprising bus stops, train/subway stations, parks, squares, public recreation centres, bike paths, primary health care units, supermarkets, food stores, bakeries, and coffee-shops) within 500 m of each participant’s residence. Minutes of sitting time in a typical weekday and weekend day were the outcomes and the mix of destinations score in 500 m buffers was the exposure variable. Associations between the mix of destinations and sitting time were examined using multilevel linear regression: these models accounted for clustering within census tracts and households and adjusted for environmental, sociodemographic, and health-related factors.

Results

After adjustment for covariates, the mix of destinations was inversely associated with minutes of sitting time on a weekday (β=− 8.8, p=0.001) and weekend day (β=− 6.1, p=0.022). People who lived in areas with a greater mix of destinations had shorter average sitting times.

Conclusion

Greater mix of destinations within 500 m of peoples’ residences was inversely associated with sitting time on a typical weekday and weekend day. In Latin American cities like Sao Paulo built environments more favorable for walking may contribute to reducing sedentary behavior and prevent associated chronic disease.

Study protocol: health survey of Sao Paulo: ISA-Physical Activity and Environment

Background

Many studies have investigated the association between the built environment and physical activity behavior in urban settings. However, most of the studies conducted in low- and middle-income countries were cross-sectional, which are limited to identify behavioral determinants. We propose a prospective cohort study to verify the relationship between built environment features and leisure-time and transport-related physical activity in adults from Sao Paulo city, Brazil.

Methods

Prospective multilevel cohort, denominated “ISA-Physical Activity and Environment”. It will build on the Health Survey of Sao Paulo in 2015 (“Inquérito de Saúde de São Paulo (ISA)” in Portuguese). The Health Survey of Sao Paulo, originally designed as a cross-sectional survey, had a multi-stage sample, covering 150 census tracts distributed in five health administrative areas. Data collection was performed by face-to-face interviews until December 2015 and the sample comprised 4043 individuals aged 12 years or more. The ISA-Physical Activity and Environment study will reassess people who are aged 18 years or more in 2020, including telephone and household interviews. The primary outcome will be leisure-time and transport-related physical activity, assessed through the International Physical Activity Questionnaire long version. Exposure variables will be built environment features in the areas participants live and work in the follow-up. Data analysis will include multivariate multilevel linear and logistic models. We will also conduct cost-effectiveness analysis and develop agent-based models to help inform decision-makers. The study will be conducted by an interdisciplinary research team specialized in physical activity epidemiology, nutritional epidemiology, georeferencing applied to health, statistics, agent-based modeling, public health policy, and health economics.

Discussion

There are few longitudinal studies on the relationship between the built environment and physical activity behavior in low- and middle-income countries. We believe that the ISA-Physical Activity and Environment study will contribute with important results for the progress of the knowledge in this field and for the implementation of policies that promote leisure-time physical activity and active travel in Sao Paulo and similar cities across the world.

Predictors of influenza vaccine uptake: translation into Portuguese and validation of a questionnaire

The difficulty in achieving ideal coverage rates with the influenza vaccine in Brazil and the growing wave of antivaccine movements in the world point to the need for a more in-depth understanding of the individual determinants of to this vaccine uptake. The Health Belief Model, a theoretical model that aims to explain and predict health-related behaviors, suggests that individual beliefs influence the adoption of health-related behaviors. The objective of this study was a cross-cultural adaptation of an instrument to assess predictors of influenza vaccine uptake in Brazilian adults. The authors conducted translation, back-translation, face validity, and a survey for construct validity. They also analyzed the factors associated with influenza vaccine uptake in 2017. An instrument originally with seven domains was identified and selected. In the factor analysis, four of the model's seven constructs were validated: Susceptibility, Barriers, Cues to action, and Self-efficacy. In the survey with 396 persons, 59.3% reported having received the influenza vaccine in the last campaign in 2017. Female sex, age > 50 years, pregnancy, vaccination in private healthcare services, hepatitis B vaccination, and influenza vaccination prior to 2017 were associated with vaccination in 2017. In the final logistic regression model, perceived Barriers appeared as a strong factor for non-vaccination, while Cues to action increased the odds of vaccination.

[Identification and analysis of national physical activity guidelines in the Americas]

Given the potential of institutional approaches to health promotion, this study sought to identify the countries on the American continent which have national physical activity (PA) guidelines approved by their national health agencies. A scoping review was conducted in May 2019, with a search conducted in five electronic databases, national health agency websites and contacts with members of the Physical Activity Network of the Americas. In all, national PA guidelines were found in ten of the 36 countries surveyed (27.8%), published between 2011 and 2018, the majority being in South American countries (n = 6). All guidelines presented "approaches and strategies for primary health care," "PA recommendations for health," and the "involvement of different PA domains," however, few guidelines addressed "constructed environment and infrastructure" (n = 3), as well as "monitoring and surveillance actions" (n = 5). The conclusion can be drawn that, although few countries on the American continent have guidelines for PA and that the majority of those available address PA in a limited way, new national guidelines, based on the complexity of the determinants, monitoring and consequences of PA are needed to guide and foster policies to promote PA within the population.

Physical activity and preventable premature deaths from non-communicable diseases in Brazil

BACKGROUND

Studies on the impact of counterfactual scenarios of physical activity on premature deaths from non-communicable diseases (NCDs) are sparse in the literature. We estimated preventable premature deaths from NCDs (diabetes, ischemic heart disease, stroke, and breast and colon cancers) in Brazil by increasing population-wide physical activity (i) to theoretical minimum risk exposure levels; (ii) reaching the physical activity recommendation; (iii) reducing insufficient physical activity by 10%; and (iv) eliminating the gender differences in physical activity.

METHODS

Preventable fractions were estimated using data from a nationally representative survey, relative risks from a meta-analysis and number of premature deaths (30-69 years) from the Brazilian Mortality Information System.

RESULTS

Physical activity could potentially avoid up to 16 700 premature deaths from NCDs in Brazil, corresponding to 5.75 and 3.23% of premature deaths from major NCDs and of all-causes, respectively. Other scenarios suggested the following impact on premature deaths: reaching physical activity recommendation (5000 or 1.74% of major NCDs); 10% reduction in insufficient physical activity (500 or 0.17% of major NCDs); eliminating gender differences in physical activity (1000 or 0.33% of major NCDs).

CONCLUSIONS

Physical activity may play an important role to reduce premature deaths from NCD in Brazil.

Local collaborations for physical activity promotion: a network analysis

This study aims to describe a local network for physical activity promotion and identify factors associated to collaboration or partnership ties between its actors. The study was carried out in a district of São Paulo, Brazil. Thirty-two actors responsible for policies, programs, and initiatives to promote physical activity within the district were interviewed from June to December 2012. Interviews included information about the actors' attributes and their relationships with the other actors. Network analysis techniques were used to describe and analyze the structure of the network. Thirty-two actors maintained 179 relationships among themselves (density = 0.18), of which 46% were reciprocal. Four in 10 relationships did not extend beyond information exchange. Forty-six relationships were classified as collaborations or partnerships (density = 0.09), of which 40% were concentrated on one actor of the public sector. To perceive institutional structure and bureaucracy as limiting factors to networking has been positively associated with new collaboration or partnership ties (OR = 2.37; 95%CI: 1.2-5.50). Understanding the structure of the network may empower the actors and foster self-management, facilitating the identification and decision, in a collaborative way, in which new relationships may have greater impact in the physical activity promotion within the district.

Preventable fractions of colon and breast cancers by increasing physical activity in Brazil: perspectives from plausible counterfactual scenarios

BACKGROUND

Physical activity is associated with lower risk of colon and breast cancers. Herein we estimated preventable fractions of colon and breast cancers in Brazil by increasing population-wide physical activity to different counterfactual scenarios.

METHODS

We used data from a representative national survey in Brazil and corresponding relative risks of colon and postmenopausal breast cancers from a meta-analysis. Estimated cancer incidence was retrieved from GLOBOCAN and Brazilian National Cancer Institute. Five counterfactual scenarios for physical activity were considered: (i) theoretical minimum risk exposure level (≥8,000 metabolic equivalent of tasks-minute/week - MET-min/week); (ii) physical activity recommendation (≥600 MET-min/week); (iii) a 10% reduction in prevalence of insufficient physical inactivity (<600 MET-min/week); (iv) physical activity level in each state equals the most active state in Brazil; (v) closing the gender differences in physical activity.

RESULTS

About 19% (3,630 cases) of colon cancers and 12% (6,712 cases) of postmenopausal breast cancers could be prevented by increasing physical activity to ≥8,000 MET-min/week. Plausible counterfactual scenarios suggested the following impact on cancer prevention: reaching physical activity recommendation: 1.7% (1,113 cases) of breast and 6% (1,137 cases) of colon; 10% reduction in physical inactivity prevalence: 0.2% (111 cases) of breast and 0.6% (114 cases) of colon; most active state scenario: 0.3% (168 cases) of breast and 1% (189 cases) of colon; reducing gender differences in physical activity: 1.1% (384 cases) of breast and 0.6% (122 cases) of colon.

CONCLUSIONS

High levels of physical activity are required to achieve a sizable impact on breast and colon cancer prevention in Brazil.

Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System

OBJECTIVE

To assess the effect of interventions on the levels of physical activity of healthy adults, users of the Brazilian Unified Health System and attended by the Family Health Strategy.

METHODS

Non-randomized experimental study with 157 adults allocated in three groups: 1) physical exercise classes (n = 54), 2) health education (n = 54), 3) control (n = 49). The study lasted for18 months, with 12 months of interventions and six months of follow-up after intervention. Assessments took place at the beginning, in the 12 months, and in the 18 months of study. Physical activity has been assessed by questionnaires and accelerometry. For the analyses, we have used the intention-to-treat principle and generalized estimating equations.

RESULTS

After 12 months, both intervention groups have increased the minutes of weekly leisure time physical activity and annual scores of physical exercise, leisure and transport-related physical activity. The exercise class group has obtained the highest average annual physical exercises score when compared to the other groups (p < 0.001). In the follow-up period, the exercise class group reduced its annual score (average: -0.3; 95%CI -0.5–-0.1), while the health education group increased this score (average: 0.2; 95%CI 0.1–0.4). There have been no differences in the levels of physical activity measured by accelerometry.

CONCLUSIONS

The interventions have been effective in increasing the practice of physical activity. However, we have observed that the health education intervention was more effective for maintaining the practice of physical activity in the period after intervention. We recommend the use of both interventions to promote physical activity in the Brazilian Unified Health System, according to the local reality of professionals, facilities, and team objectives.

Physical activity as part of daily living: Moving beyond quantitative recommendations

The purpose of this study is to discuss a paradigm shift towards a broader understanding of physical activity (PA) as part of daily living and, therefore, a different approach for PA guidelines, research, and promotion. To this aim, we centered the discussion in two topics: 1) PA: from a restricted view to a broader phenomenon; and 2) Recommendations for PA: moving beyond minutes and dose-response. A holistic understanding of PA and its relationship with health is not possible unless it is considered values, meanings, and symbols that impregnate the human behavior linked to the modes of living of a given people. If we do believe that PA is a behavior essential to human life, we must align our actions to our speech. However, current guidelines, as well as in most policies and programs of PA is largely portrayed as a way to attain longer life expectancy and less diseases, which runs against our consolidated understanding of PA as part of our everyday life. New guidelines could focus on how, when, why, where, and with whom we include PA in our daily lives, based on a day-long approach, instead of how much we should do in order to prevent non-communicable diseases.

All-Cause Mortality Attributable to Sitting Time: Analysis of 54 Countries Worldwide

INTRODUCTION

Recent studies have shown that sitting time is associated with increased risk of all-cause mortality, independent of moderate to vigorous physical activity. Less is known about the population-attributable fraction for all-cause mortality associated with sitting time, and the gains in life expectancy related to the elimination of this risk factor.

METHODS

In November 2015, data were gathered from one published meta-analysis, 54 adult surveys on sitting time distribution (from 2002 to 2011), in conjunction with national statistics on population size, life table, and overall deaths. Population-attributable fraction for all-cause mortality associated with sitting time >3 hours/day was estimated for each country, WHO regions, and worldwide. Gains in life expectancy related to the elimination of sitting time >3 hours/day was estimated using life table analysis.

RESULTS

Sitting time was responsible for 3.8% of all-cause mortality (about 433,000 deaths/year) among those 54 countries. All-cause mortality due to sitting time was higher in the countries from the Western Pacific region, followed by European, Eastern Mediterranean, American, and Southeast Asian countries. Eliminating sitting time would increase life expectancy by 0.20 years in those countries.

CONCLUSIONS

Assuming that the effect of sitting time on all-cause mortality risk is independent of physical activity, reducing sitting time plays an important role in active lifestyle promotion, which is an important aspect of premature mortality prevention worldwide.

Brief introductory guide to agent-based modeling and an illustration from urban health research

There is growing interest among urban health researchers in addressing complex problems using conceptual and computation models from the field of complex systems. Agent-based modeling (ABM) is one computational modeling tool that has received a lot of interest. However, many researchers remain unfamiliar with developing and carrying out an ABM, hindering the understanding and application of it. This paper first presents a brief introductory guide to carrying out a simple agent-based model. Then, the method is illustrated by discussing a previously developed agent-based model, which explored inequalities in diet in the context of urban residential segregation.

[Evaluation of the effectiveness of home-based physical activity promotion by community health workers]

This study analyzed the effectiveness of physical activity promotion by community health workers (CHW) during home visits. This was a non-randomized controlled trial that lasted six months, with one group of CHW that received training to promote physical activity during home visits among users of the Brazilian Unified National Health System (SUS) and a control group. Physical activity and stages of behavior change were evaluated in 176 adults (n = 90 in the intervention group and n = 86 in the control group) assisted by the CHW. Associations, prevalence ratios, and generalized estimate equations were conducted to verify differences between groups. No evidence of differences in physical activity and stages of behavior change were observed between the two groups. CHW from the intervention group conducted more home visits promoting physical activity among elders, those with low schooling, unemployed, and those with chronic diseases. It is important to reassess the work and priorities of CHW to expand physical activity promotion under the SUS.

Neighborhood and family perceived environments associated with children's physical activity and body mass index

BACKGROUND

A growing body of research has been examining neighborhood environment related to children's physical activity and obesity. However, there is still not enough evidence from Latin America.

OBJECTIVE

To investigate the association of neighborhood and family perceived environments, use of and distance to public open spaces with leisure-time physical activity (LTPA) and body mass index (BMI) in Argentinean school-aged children.

METHODS

School-based, cross-sectional study with 1777 children (9 to 11years) and their parents, in Cordoba city during 2011. Children were asked about LTPA and family perceived environment. Parents were asked about neighborhood perceived environment, children's use of public open spaces and distance. Weight and height were measured for BMI. We modeled children's LTPA and BMI z-score with structural equation models with latent variables for built, social and safety neighborhood environments.

RESULTS

Parents' perceived neighborhood environment was not related with children's LTPA and BMI. Children's perceived autonomy and family environment were positively associated with LTPA. Use of unstructured open spaces and, indirectly, the distance to these, was associated with LTPA among girls. Greater distance to parks reduced their use by children.

CONCLUSIONS

Policies to increase children's LTPA should include access to better public open spaces, increasing options for activity. A family approach should be incorporated, reinforcing its role for healthy development.

[Socio-demographic factors associated with three sedentary behaviors in Brazilian workers]

This study focused on the association between socio-demographic characteristics and three sedentary behaviors among industrial workers in Brazil. Data were analyzed on 47,477 workers from 24 Brazilian states, collected by questionnaires from 2006 to 2008. Individual and simultaneous presence of ≥ 4 hours of TV time per day, commuting by car or motorcycle, and sitting most of the time at work were investigated, as well as associations between these behaviors and gender, age, schooling, and family income. Simple and multiple binary logistic regression were used. Older workers and those with more schooling and higher income had increased odds of presenting two or all of the three target behaviors. Associations between gender and sedentary behaviors depend on the specific behavior. Such information can be useful for planning interventions to reduce sedentary behavior, with better targeting and more effectiveness in reaching different population subgroups.

Barriers associated with frequency of leisure-time physical activity among Brazilian adults of different income strata

This study aimed to estimate the prevalence of the main perceived barriers to leisure-time physical activity (LTPA) and their associations with the frequency of LTPA in a representative sample of industrial workers from Brazil (n = 47,477), according to their income strata (low income: ≤$US280, middle income: $US281-$US1400, and high income: ≥$US1401). Data were collected between 2006 and 2008 via questionnaires about the main perceived barrier to LTPA and the frequency of LTPA. Multinomial logistic regression was performed to evaluate differences among groups. There was a lower prevalence of regular practice of LTPA in the low- (15.8%) and middle-income strata (18.2%) than among the individuals of the high-income stratum (27.6%). A large proportion of workers who regularly participated in LTPA reported no barriers (low: 43.1%; middle: 46.8%; high: 51.6%). Additional obligations and fatigue were the two most common perceived barriers in all family income strata among participants who engaged in different frequencies of LTPA. The odds for all perceived barriers showed a positive trend related to frequency of LTPA (from regular to no LTPA), with higher values according to income. In summary, the ordering of the main perceived barriers to LTPA differed according to workers' income stratum and frequency of engaging in LTPA.

Frequency, distribution and time trends of types of leisure-time physical activity in Brazil, 2006-2012

OBJECTIVES

To describe the frequency and the distribution of the main types of leisure time physical activity (LTPA) practiced by Brazilian adults in 2012 and to observe their time trends from 2006 to 2012.

METHODS

Cross-sectional data from the Brazilian surveillance system of risk and protective factors for non-transmissible chronic diseases from 2006 to 2012 (around 54,000 adults aged 18 years or older in all Brazilian State capitals interviewed yearly). Participants were asked whether they had practiced any type of exercise or sport in the last 3 months, and if so which type. Linear regression was used to identify trends of the five most cited LTPA.

RESULTS

In 2012, walking was reported as the main LTPA (18.1 %), followed by strength training/gymnastics (11.2 %) and football (7.2 %). Time-trend analysis showed reduction in football (9.1-7.2 %; p = 0.004, β = -0.25, R(2) = 0.79) and increase in strength training/gymnastics (7.9-11.2 %; p = 0.02, β = 0.50, R(2) = 0.62) and running (1.7-3.1 %; p < 0.001, β = 0.22, R(2) = 0.93).

CONCLUSIONS

Walking was the main type of LTPA. Patterns of LTPA types remained relatively stable over the last 7 years.

Which social support and psychological factors are associated to active commuting to school?

OBJECTIVE

The aim of this study was to investigate the association between self-efficacy, enjoyment, and volitional control with active commuting, as well as to analyze the impact of social support from parents, friends, and teachers with active commuting to school.

METHODS

Participants in this cross-sectional study were 625 students (male: 46.3%) aged 10 to 15years from Porto, Portugal (2010/2011). A questionnaire was used to assess active commuting to/from school (walk/cycle), self-efficacy, enjoyment, volitional control and social support. Binary logistic regression was performed to identify significant associations between targeted variables and active commuting.

RESULTS

The results show positive associations in crude analyses for all variables, except for enjoyment for walk/cycle to school. In the adjusted model, higher likelihood of active commuting was found among students who reported having higher self-efficacy (OR=2.10; CI95%: 1.07; 4.11) to walk/cycle to school as well as among adolescents who reported being encouraged by their parents (OR=3.66; CI95%: 1.55; 8.69), and having the partnership of friends in active journeys (OR=4.31; CI95%: 1.79; 10.37).

CONCLUSION

Self-efficacy, encouragement from parents and companionship from friends were important indicators of active commuting to school among Portuguese adolescents. These findings provide support for further research to identify and understand factors that predict and explain the active commuting.

Changes in television viewing and computers/videogames use among high school students in Southern Brazil between 2001 and 2011

OBJECTIVES

To compare the prevalence of television (TV) watching and of computer/videogame use among high school students (15-19 years) from Southern Brazil between 2001 and 2011 and to identify associated socio-demographic factors.

METHODS

Panel studies were conducted with high school students in the state of Santa Catarina, Brazil, in 2001 (n = 5,028) and 2011 (n = 6,529). TV watching and computer/videogame use were collected using questionnaires.

RESULTS

Prevalence of ≥2 h/day of TV watching dropped from 76.8 to 61.5 % and ≥2 h/day of computer/videogame use increased from 37.9 to 60.6 %. In both surveys, those aged 15-16 and those who did not work had higher likelihoods of being exposed to ≥2 h/day of TV watching. Boys, those with higher family income, and those who were living in urban areas had higher likelihoods of ≥2 h/day of computer/videogame use. Older age, studying at night and not working were protective factors to these behaviors.

CONCLUSIONS

After a decade, there was a decrease in the prevalence of TV viewing and an increase in computer/videogame use. Socio-demographic factors were differently associated with these behaviors.

Predictors and health consequences of screen-time change during adolescence--1993 Pelotas (Brazil) birth cohort study

PURPOSE

To investigate screen-time change from early to mid adolescence, its predictors, and its influence on body fat, blood pressure, and leisure-time physical activity.

METHODS

We used data from a longitudinal prospective study, conducted among participants of the 1993 Pelotas (Brazil) Birth Cohort Study. At baseline, adolescents were, on average, 11 years old. They were later visited at age 15 years. Screen time was self-reported, accounting for the time spent watching television, playing video games, and using the computer. Several predictors were examined. The effect of screen-time change on some health outcomes was also analyzed.

RESULTS

Screen time increased on average 60 min/d from 11 to 15 years of age, for the 4,218 adolescents studied. The groups that presented the highest increases in screen time were male, wealthiest, those whose mothers had higher education, and adolescents with a history of school failure. There were positive associations between screen-time change and body mass index, skinfold thickness, waist circumference, and leisure-time physical activity at 15 years of age.

CONCLUSIONS

Screen time increased from early to mid adolescence. This increment was higher among boys and the wealthiest adolescents. Increases in screen time affected body composition, with negative implications on adiposity.

Clustering of unhealthy behaviors in a Brazilian population of industrial workers

OBJECTIVE

To analyze the clustering of four unhealthy behaviors (tobacco use, excessive alcohol consumption, physical inactivity and low consumption of fruits and vegetables) and their association with sociodemographic factors among adult industrial workers in Brazil.

METHODS

Data from 23 Brazilian states and the Federal District were collected via questionnaire from 2006 to 2008. Clustering of risk behaviors was identified using the ratio between the observed and expected percentages of each combination of unhealthy behaviors.

RESULTS

Among the 44,477 workers surveyed, 18.0% of men and 11.4% of women accumulated three or four unhealthy behaviors. The most frequent combination was physical inactivity and low consumption of fruits and vegetables. The concurrent presence of all four behaviors was 86% higher in men and 148% higher in women than would be predicted if the frequency of these behaviors were independent. Presence of one or more negative behaviors was more frequent in men, younger individuals and in those with lower levels of education and family income than subjects without these characteristics.

CONCLUSIONS

There was a strong tendency for unhealthy behaviors to assume combinatorial patterns, mainly in men, people with less education, income, and age, suggesting important disparities.