Adair da Silva Lopes

Comportamentos de risco à saúde em adolescentes no Sul do Brasil: prevalência e fatores associados

OBJECTIVE To determine the prevalence of health risk behaviors and to analyze factors associated with exposure to such behaviors among adolescents in the state of Santa Catarina in the south of Brazil. METHODS Adolescents attending 240 high school classes at the states public schools answered a questionnaire that collected demographics (sex, age, area of residence, and day versus night classes), social and economic data (working status and monthly family income), and information on health risk behaviors (insufficient levels of physical activity, low intake of fruits/vegetables, smoking, alcohol abuse, illicit drug use, involvement in physical fights, and irregular use of condoms). RESULTS The completed questionnaires of 5 028 adolescents (2 984 females and 2 044 males), 15-19 years of age (mean = 17.0; standard deviation = 1.12), were considered valid. The most prevalent health risk behaviors were insufficient levels of physical activity (36.5%), low intake of fruits/vegetables (46.5%), and irregular use of condoms (38.3%). Approximately 7 of 10 adolescents (64.7%) were exposed to two or more risk behaviors simultaneously. The following risk subgroups were identified: male adolescents, adolescents from 18-19 years of age, living in urban areas, studying at night, and having a higher family income. CONCLUSIONS The percentage of adolescents exposed to health risk behaviors was high, especially when simultaneous exposure to different behaviors was considered. These results can contribute to developing health promotion campaigns for the school setting that are specifically aimed at the risk subgroups identified.

Associações entre atividade física, índice de massa corporal e comportamentos sedentários em adolescentes

OBJETIVO: Este estudo teve como objetivo determinar a associacao do indice de massa corporal (IMC) com os niveis de atividade fisica (AF) e comportamentos sedentarios (assistir TV, usar computador ou jogar videogames) em adolescentes de escolas publicas do Estado de Santa Catarina (15-19 anos; n = 5.028). METODOS: As informacoes foram coletadas por meio de questionario desenvolvido e validado para adolescentes. Foram considerados insuficientemente ativos, os jovens que nao acumulavam pelo menos 300 minutos/semana de atividades fisicas moderadas ou vigorosas. Considerou-se para o uso excessivo de TV e computador/games um tempo > 2 horas/dia; para excesso de peso corporal, utilizou-se a tabela internacional de IMC para adolescentes. RESULTADOS: O excesso de peso corporal foi mais prevalente entre os rapazes (12,7% vs 7,9%, p<0,001), e houve uma maior proporcao de mocas insuficientemente ativas (37,0% vs 21,0%, p<0,001). A chance de ter excesso de peso corporal foi 74% maior entre os rapazes pouco ativos em comparacao com os ativos, e entre as mocas de menor renda familiar (OR=1,85) e as que residiam na zona urbana (OR=2,22). A chance de serem menos ativos foi 43% maior entre os rapazes que assistiam mais TV e 73% maior para aqueles com excesso de peso corporal. Nas mocas, a chance de pouca atividade fisica foi 54% maior entre as que trabalhavam. CONCLUSOES: a prevalencia de excesso de peso corporal foi maior entre os rapazes, mesmo sendo mais ativos do que as mocas. Nos rapazes, o excesso de peso estava significativamente associado a menor pratica de atividade fisica e, nas mocas, a menor renda familiar e local de moradia.

Prevalência de fatores de risco cardiovascular em adolescentes

The aim of this study was to determine the prevalence of cardiovascular risk factors in adolescents and to verify its association with age and gender. 644 high school students from public schools in the city of Londrina, Parana State, Brazil, participated in the study. A two-step sampling process was used. Behavioral risk factors (physical inactivity, inadequate consumption of fruits and vegetables, and smoking) and biological risk factors (overweight and high blood pressure) were investigated. Nearly 90% of adolescents showed at least one risk factor. Inadequate consumption of fruits (56.7%) and vegetables (43.9%) and physical inactivity (39.2%) were the most prevalent risk factors. Prevalence rates for high blood pressure and overweight were 18.6 and 12.7%, respectively. Cardiovascular risk factors were more frequent among boys (PR = 1.20; 95%CI = 1.01-1.42). In conclusion, cardiovascular risk factors are a prevalent health issue among students in the city of Londrina.

Prevalence of alcohol and tobacco use among Brazilian adolescents: a systematic review

OBJECTIVE To analyze alcohol and tobacco use among Brazilian adolescents and identify higher-risk subgroups. METHODS A systematic review of the literature was conducted. Searches were performed using four databases (LILACS, MEDLINE /PubMed, Web of Science, and Google Scholar), specialized websites and the references cited in retrieved articles. The search was done in English and Portuguese and there was no limit on the year of publication (up to June 2011). From the search, 59 studies met all the inclusion criteria: to involve Brazilian adolescents aged 10-19 years; to assess the prevalence of alcohol and/or tobacco use; to use questionnaires or structured interviews to measure the variables of interest; and to be a school or population-based study that used methodological procedures to ensure representativeness of the target population (i.e. random sampling). RESULTS The prevalence of current alcohol use (at the time of the investigation or in the previous month) ranged from 23.0% to 67.7%. The mean prevalence was 34.9% (reflecting the central trend of the estimates found in the studies). The prevalence of current tobacco use ranged from 2.4% to 22.0%, and the mean prevalence was 9.3%. A large proportion of the studies estimated prevalences of frequent alcohol use (66.7%) and heavy alcohol use (36.8%) of more than 10%. However, most studies found prevalences of frequent and heavy tobacco use of less than 10%. The Brazilian literature has highlighted that environmental factors (religiosity, working conditions, and substance use among family and friends) and psychosocial factors (such as conflicts with parents and feelings of negativeness and loneliness) are associated with the tobacco and alcohol use among adolescents. CONCLUSIONS The results suggest that consumption of alcohol and tobacco among adolescents has reached alarming prevalences in various localities in Brazil. Since unhealthy behavior tends to continue from adolescence into adulthood, public policies aimed towards reducing alcohol and tobacco use among Brazilians over the medium and long terms may direct young people and the subgroups at higher risk towards such behavior.OBJETIVO: Analisar o uso de alcool e tabaco em adolescentes brasileiros e identificar os subgrupos de maior risco. METODOS: Foi realizada revisao sistematica da literatura. A busca dos artigos foi feita em quatro bases de dados (LILACS, MEDLINE/PubMed, Web of Science e Google Scholar), websites especializados e referencias dos artigos selecionados. Foram selecionadas referencias em ingles e portugues, sem limites para ano de publicacao (ate junho de 2011), das quais foram incluidos 59 artigos que atenderam aos criterios de inclusao: envolver adolescentes brasileiros de dez a 19 anos de idade; avaliar a prevalencia do uso de alcool e/ou de tabaco; usar questionarios ou entrevistas estruturadas para mensurar as variaveis de interesse; ser um estudo populacional ou de base escolar que adotou procedimentos metodologicos para garantir a representatividade da populacao alvo (isto e, amostra aleatoria). RESULTADOS: A prevalencia de uso atual de alcool (uso na epoca da pesquisa ou no mes anterior) variou de 23,0% a 67,7%. A prevalencia media (refletindo uma tendencia central das estimativas encontradas nos estudos) de uso atual de alcool foi de 34,9%. A prevalencia de uso atual de tabaco variou de 2,4% a 22,0%, com uma prevalencia media de 9,3%. Grande parte dos estudos estimou prevalencias superiores a 10% para o uso frequente (66,7%) e pesado (36,8%) de alcool; a maioria deles estimou prevalencias menores de 10% para o uso frequente e pesado de tabaco. A literatura nacional tem destacado a associacao de fatores ambientais (religiosidade, condicao de trabalho e uso de substâncias entre os amigos e parentes) e psicossociais (como conflitos com pais e sentimentos negativos e de solidao) com o uso de alcool e tabaco entre os adolescentes. CONCLUSOES: Os resultados sugerem que o consumo de alcool e tabaco entre adolescentes tem atingido alarmantes prevalencias em varias localidades do Brasil. Como habitos nao saudaveis tendem a continuar da adolescencia ate a vida adulta, politicas publicas que visam a reducao do uso de alcool e de tabaco na populacao brasileira a medio e longo prazos podem direcionar a populacao jovem e os subgrupos de maior risco a esses comportamentos.

Prática de atividade física e fatores associados em adolescentes no Nordeste do Brasil

OBJETIVO: Estimar a proporcao de adolescentes fisicamente ativos e identificar fatores associados. METODOS: A amostra foi composta por 2.874 estudantes de 14 a 19 anos de idade, do ensino medio (escolas publicas e privadas), em Joao Pessoa, PB, Brasil. O nivel de atividade fisica foi mensurado por meio de questionario e considerado fisicamente ativo se > 300 minutos/semana. Foram analisadas variaveis sociodemograficas, estado nutricional, comportamento sedentario, autoavaliacao do estado de saude e participacao nas aulas de educacao fisica. A razao de prevalencia foi utilizada como medida de associacao, estimada por meio da regressao de Poisson. RESULTADOS: A prevalencia de atividade fisica foi de 50,2% (IC95%: 47,3;53,1). Os jovens do sexo masculino foram fisicamente mais ativos do que as do feminino (66,3% vs. 38,5%; p < 0,001). Os fatores diretamente associados a pratica de atividade fisica foram: maior escolaridade do pai para o sexo masculino, e da mae, para o feminino; percepcao positiva de saude e participar das aulas de educacao fisica. CONCLUSOES: A maioria dos adolescentes foi classificada como fisicamente ativa, sobretudo os do sexo masculino. Adolescentes filhos de pais com maior escolaridade, com percepcao positiva de saude e que participavam das aulas de educacao fisica foram mais propensos a serem fisicamente ativos.OBJECTIVE To estimate the proportion of physically active adolescents and identify associated factors. METHODS The sample was composed of 2,874 high school students (public and private schools) aged 14 to 19 years in the city of João Pessoa, Northeastern Brazil. Physical activity level was measured by means of a questionnaire and considered physically active if > 300 minutes/week. Sociodemographic variables were analyzed, as well as nutritional status, sedentary behavior, self-report of health status and participation in physical education classes. The prevalence ratio was used as association measure, estimated by means of Poisson regression. RESULTS The prevalence of physical activity was 50.2% (95%CI: 47.3;53.1). Male adolescents were more physically active than female adolescents (66.3% vs. 38.5%; p<0.001). The factors directly associated with practice of physical activity were: fathers higher level of schooling for the male sex and mothers higher level of schooling for the female sex, positive self-reported health status, and participation in physical education classes. CONCLUSIONS The majority of the adolescents was classified as physically active, particularly the male youths. Adolescents with parents whose level of schooling was higher, with positive health status perception, and who participated in physical education classes were more likely to be physically active.

Percepção da imagem corporal de crianças e adolescentes com diferentes níveis socio-econômicos na cidade de Florianópolis, Santa Catarina, Brasil

OBJECTIVES: to identify the body image perception in children and adolescents from different socio-economic backgrounds. METHODS: a cross-cutting study was carried out in the city of Florianopolis, in the State of Santa Catarina, Brazil, in the year 2006. Four hundred and two schoolchildren, with an average age of 11.35 ± 1.98 years, enrolled in the final years of primary school were investigated. Body image perception was identified using the Stunkard silhouettes protocol and socio-economic status was evaluated using the criteria proposed by the National Pres and Research Association (ANEP). Prevalence ratios were calculated for dissatisfaction arising from perceived excessive weight or excessive thinness. RESULTS: among males, silhouette 3 was the one most often chosen among those from the upper and middle classes, whereas those of lower socio-economic status opted for silhouette 4; middle and upper class girls, however, opted for silhouette 2 was chosen and girls from less privileged backgrounds tended to select silhouette 3 as best representing their own silhouette. Silhouette 3 for males and 2 for females are considered to be the ideal for most school-age children. Less privileged young people had a higher prevalence of dissatisfaction arising from excess weight than more privileged ones. CONCLUSIONS: there was a tendency to children of a higher social status to be dissatisfied because they regarded themselves as being too thin and for children of lower social status to be dissatisfied because they perceived themselves to be overweight.

Fatores de risco cardiovascular em adolescentes de município do sul do Brasil: prevalência e associações com variáveis sociodemográficas

OBJETIVO: Determinar a prevalencia de fatores de risco cardiovascular e analisar sua associacao com variaveis sociodemograficas em adolescentes do municipio de Tres de Maio/RS. METODOS: Estudo transversal de base escolar com amostra probabilistica, estratificada por sexo e nivel economico, composta por 660 adolescentes de 14 a 19 anos, 343 mocas (52%). Foram investigadas as prevalencias dos fatores de risco comportamentais (sedentarismo, dieta aterogenica, tabagismo) e biologicos (excesso de peso, excesso de adiposidade abdominal, pre-hipertensao/hipertensao arterial, hiperglicemia e dislipidemias) e sua associacao com variaveis sociodemograficas (sexo, idade e nivel economico). As associacoes foram testadas por meio do teste qui-quadrado e razao de prevalencia (intervalo de confianca de 95%) entre os fatores de risco e as variaveis sociodemograficas. RESULTADOS: Os fatores de risco mais prevalentes foram: dieta aterogenica (98,3%), sedentarismo (61,2%), excesso de adiposidade abdominal (32,6%), baixos niveis de lipoproteina de alta densidade (25,9%) e colesterol total elevado (20,3%). Foram encontradas associacoes significativas entre sexo feminino, sedentarismo [razao de prevalencia (RP) = 1,33 (1,17 - 1,50)], excesso de adiposidade abdominal [RP = 2,44 (1,89 - 3,16)] e colesterol total elevado [RP = 1,89 (1,36 - 2,62)]; e, entre o sexo masculino, baixos niveis de lipoproteina de alta densidade [RP = 2,22 (1,67 - 2,94)] e pre-hipertensao/hipertensao arterial [RP = 4,87 (1,67 - 14,23)]. Verificou-se tambem,associacao entre a idade de 17 a 19 anos e o tabagismo [RP = 1,84 (1,05 - 3,22)] e pre-hipertensao/hipertensao arterial [RP = 3,36 (1,43 - 7,90)]. O nivel economico nao foi associado aos fatores de risco cardiovascular na amostra estudada. CONCLUSAO: Os resultados indicam a necessidade de intervencoes que promovam um estilo de vida saudavel, com enfase a adocao de habitos alimentares adequados e ao aumento dos niveis de atividade fisica.

Excesso de peso, pressão arterial e atividade física no deslocamento à escola

BACKGROUND The prevalence of obesity and elevated arterial pressure (AP) has increased in children and adolescents, whereas physical activity has decreased. OBJECTIVE To identify and correlate excess weight, body fat and elevated AP among active and passive students with the way they commute to school. METHODS One thousand five hundred and seventy students aged 7 to 12 years participated in the study conducted in João Pessoa, state of Paraíba. Students completed a questionnaire about the way they commuted to school (active = walking/biking or passive = by car/motorcycle/bus) and the time spent traveling to school. Excess weight was determined by BMI > or =25 kg/m(2), excess body fat as > or =85th percentile for tricipital fold measurement, and high AP as > or =90th percentile. Chi-square test and Poissons regression were used for the analysis. RESULTS Active commuting was associated with a lower prevalence of excess weight and body fat as compared to passive commuting (p<0.05). The prevalence ratio (PR) of excess weight was associated with excess body fat (Male: PR= 6.45 95%CI= 4.55-9.14; Female: PR= 4.10 95%CI= 3.09-5.45), elevated SAP [Systolic Arterial Pressure] (Male: PR= 1.99 95%CI= 1.30-3.06; Female: PR= 2.09 95%CI= 1.45-3.01), and elevated DAP [Diastolic Arterial Pressure] in girls (PR = 1.96 95%CI= 1.41-2.75). No association with active commuting was observed (p>0.05) CONCLUSION Passive commuting to school showed a correlation with excess weight and body fat but not with elevated AP. Excess weight was associated with excessive body fat and elevated AP. Excess weight should be prevented as a way to avoid fat accumulation and AP elevation.

Anthropometric indicators as predictors of high blood pressure in adolescents

FUNDAMENTO: A hipertensao arterial esta relacionada ao incremento da gordura corporal, a qual pode ser avaliada por meio de indicadores antropometricos. OBJETIVO: Determinar o poder preditivo de indicadores antropometricos e estabelecer seus pontos de corte como discriminadores de pressao arterial elevada. METODOS: Estudo transversal realizado com uma amostra de 660 adolescentes de 14 a 19 anos sendo 51,9% mocas. Foram considerados os seguintes indicadores antropometricos: indice de massa corporal (IMC), circunferencia da cintura, razao cintura/estatura e indice de conicidade. A pressao arterial elevada foi caracterizada por valores acima do percentil 90 para pressao arterial sistolica e/ou pressao arterial diastolica. Para identificacao dos preditores de pressao arterial elevada, foi adotada a analise das curvas Receiver Operating Characteristic (ROC), com intervalo de confianca de 95%. Posteriormente, identificaram-se os pontos de corte com suas respectivas sensibilidades e especificidades. RESULTADOS: As areas sob as curvas ROC com os intervalos de confianca foram: rapazes - circunferencia de cintura = 0,80 (0,72-0,89); IMC = 0,79 (0,68-0,89); razao cintura/estatura = 0,77 (0,66-0,88); indice de conicidade = 0,69 (0,56-0,81) e para as mocas - circunferencia de cintura = 0,96 (0,92-1,00); IMC = 0,95 (0,87-1,00); razao cintura/estatura = 0,93 (0,85-1,00); indice de conicidade = 0,74 (0,50-0,98). Os diversos pontos de corte dos indicadores antropometricos com melhores poderes preditivos e suas respectivas sensibilidades e especificidades foram identificados. CONCLUSAO: Apesar de a razao cintura/estatura e de o IMC terem apresentado boas areas sob a curva ROC, sugere-se a utilizacao da circunferencia de cintura para a predicao da pressao arterial elevada.BACKGROUND Hypertension is related to increased body fat, which can be evaluated by anthropometric indicators. OBJECTIVE To determine the predictive power of anthropometric indicators and establish their cutoff points as discriminators of high blood pressure. METHODS Cross-sectional study with a sample of 660 adolescents aged 14 to 19 including 51.9% girls. We considered the following anthropometric indicators: body mass index (BMI), waist circumference, waist-to-height ratio and conicity index. High blood pressure was characterized by values above the 90th percentile for systolic and/or diastolic blood pressure. To identify predictors of high blood pressure, we adopted the analysis of receiver operating characteristic curves (ROC) with a confidence interval of 95%. Subsequently, we identified the cutoff points with their relevant sensitivities and specificities. RESULTS The areas under the ROC curves with confidence intervals were: boys--waist circumference = 0.80 (0.72 to 0.89); BMI = 0.79 (0.68 to 0.89), waist-to-height ratio = 0.77 (0.66 to 0.88); conicity index = 0.69 (0.56 to 0.81) and for girls--waist circumference = 0.96 (0.92 to 1.00); BMI 0.95 (0.87 to 1.00), waist-to-height ratio = 0.93 (0.85 to 1.00); conicity index = 0.74 (0.50 to 0.98). The different cutoff points of anthropometric indicators with better predictive power and their relevant sensitivities and specificities were identified. CONCLUSION Although the waist-to-height ratio and BMI have shown good areas under the ROC curve, we suggest the use of waist circumference to predict high blood pressure.

Indicadores antropométricos como preditores de pressão arterial elevada em adolescentes

FUNDAMENTO: A hipertensao arterial esta relacionada ao incremento da gordura corporal, a qual pode ser avaliada por meio de indicadores antropometricos. OBJETIVO: Determinar o poder preditivo de indicadores antropometricos e estabelecer seus pontos de corte como discriminadores de pressao arterial elevada. METODOS: Estudo transversal realizado com uma amostra de 660 adolescentes de 14 a 19 anos sendo 51,9% mocas. Foram considerados os seguintes indicadores antropometricos: indice de massa corporal (IMC), circunferencia da cintura, razao cintura/estatura e indice de conicidade. A pressao arterial elevada foi caracterizada por valores acima do percentil 90 para pressao arterial sistolica e/ou pressao arterial diastolica. Para identificacao dos preditores de pressao arterial elevada, foi adotada a analise das curvas Receiver Operating Characteristic (ROC), com intervalo de confianca de 95%. Posteriormente, identificaram-se os pontos de corte com suas respectivas sensibilidades e especificidades. RESULTADOS: As areas sob as curvas ROC com os intervalos de confianca foram: rapazes - circunferencia de cintura = 0,80 (0,72-0,89); IMC = 0,79 (0,68-0,89); razao cintura/estatura = 0,77 (0,66-0,88); indice de conicidade = 0,69 (0,56-0,81) e para as mocas - circunferencia de cintura = 0,96 (0,92-1,00); IMC = 0,95 (0,87-1,00); razao cintura/estatura = 0,93 (0,85-1,00); indice de conicidade = 0,74 (0,50-0,98). Os diversos pontos de corte dos indicadores antropometricos com melhores poderes preditivos e suas respectivas sensibilidades e especificidades foram identificados. CONCLUSAO: Apesar de a razao cintura/estatura e de o IMC terem apresentado boas areas sob a curva ROC, sugere-se a utilizacao da circunferencia de cintura para a predicao da pressao arterial elevada.BACKGROUND Hypertension is related to increased body fat, which can be evaluated by anthropometric indicators. OBJECTIVE To determine the predictive power of anthropometric indicators and establish their cutoff points as discriminators of high blood pressure. METHODS Cross-sectional study with a sample of 660 adolescents aged 14 to 19 including 51.9% girls. We considered the following anthropometric indicators: body mass index (BMI), waist circumference, waist-to-height ratio and conicity index. High blood pressure was characterized by values above the 90th percentile for systolic and/or diastolic blood pressure. To identify predictors of high blood pressure, we adopted the analysis of receiver operating characteristic curves (ROC) with a confidence interval of 95%. Subsequently, we identified the cutoff points with their relevant sensitivities and specificities. RESULTS The areas under the ROC curves with confidence intervals were: boys--waist circumference = 0.80 (0.72 to 0.89); BMI = 0.79 (0.68 to 0.89), waist-to-height ratio = 0.77 (0.66 to 0.88); conicity index = 0.69 (0.56 to 0.81) and for girls--waist circumference = 0.96 (0.92 to 1.00); BMI 0.95 (0.87 to 1.00), waist-to-height ratio = 0.93 (0.85 to 1.00); conicity index = 0.74 (0.50 to 0.98). The different cutoff points of anthropometric indicators with better predictive power and their relevant sensitivities and specificities were identified. CONCLUSION Although the waist-to-height ratio and BMI have shown good areas under the ROC curve, we suggest the use of waist circumference to predict high blood pressure.