Evanice Avelino de Souza

Rationale and methods of a cluster-randomized controlled trial to promote active and healthy lifestyles among Brazilian students: the “Fortaleça sua Saúde” program

BackgroundInterventions on adolescents’ lifestyle are important, but the main mechanisms that explain the changes (mediating variables) on lifestyle are unclear. This paper presents the rationale and methods of an intervention program focused on promoting active and healthy lifestyles (especially physical activity [PA] practice and reducing screen time) among Brazilian students-the Fortaleça sua Saúde program (Portuguese for “strengthen your health”).Methods/DesignThis is a school-based cluster-randomized controlled trial. Three intervention and three control (no intervention) full-time public schools were randomly selected in Fortaleza, northeastern Brazil. Students (n = 1,272) from classes in Grades 7–9 were eligible, and 1,085 (548 in the intervention and 537 in control schools) completed the baseline and follow-up measures. The program duration was approximately four months and took place in 2014. Intervention strategies focused on teacher training, activities on health in the curriculum, active opportunities in the school environment (the availability of equipment for PA), and health education (health materials for students and parents). Data collection was undertaken before and immediately after the intervention. The primary variables included the practice of PA (weekly PA volume, PA behavior change stage and preference for PA during leisure-time) and screen time (TV and computer/video games). Potential intrapersonal, interpersonal and environmental mediators of PA and screen time were evaluated by a standardized questionnaire. Other lifestyle components (e.g., eating habits, substance use), psychological (e.g., self-rated health, body satisfaction) and biological (general and abdominal obesity) aspects, as well as academic performance were also evaluated in the total sample. Depressive symptoms, eating disorders, sleep quality, objectively-measured PA, and sedentary time were evaluated in obese students.DiscussionIf effective, this program will contribute to the development of public policies for the promotion of active and healthy lifestyles in youth, especially those from low- and middle-income countries. The main intrapersonal, interpersonal and/or environmental mediators of PA and screen time may also be indicated. Finally, we anticipate that the proposed strategies may be adaptable to public schools and may even be extended to the entire school system.Trial registrationClinicalTrials.Gov: NCT02439827. Registration date: May 3, 2015.

Isolated and combined presence of elevated anthropometric indices in children: prevalence and sociodemographic correlates

This study analyzed the prevalence and sociodemographic factors associated to the isolated and combined presence of elevated anthropometric indices among children. A cross-sectional study was performed with 2,035 children (aged 6-11 years, 50.1% of girls) who were randomly selected in schools from Colombo, Brazil. Body Mass Index (BMI), Waist Circumference (WC) and Waist-to-Height Ratio (WHtR) were classified using reference values. Age, gender, type of school, shift, and residence area were potential risk factors. Binary logistic regression was used (p < 0.05). The prevalence of children with isolated presence of elevated BMI, WHtR or WC was observed in 9.4% (confidence interval [CI] of 95%: 3.3; 15.7), 8.7% (CI 95%: 1.7; 15.9) and 4.4% (CI 95%: 1.0; 7.9), 8.7% of children, respectively. The presence of one or more elevated anthropometric index was observed in 16.9% (CI 95%: 5.4; 28.5) of children. Boys (BMI), younger children (WC) and children from public schools (BMI, WC or WHtR) were high-risk subgroups to the isolated presence of elevated anthropometric indices. Children from public schools and rural areas were high-risk subgroup to the combined presence of elevated anthropometric indices. In conclusion, Public policies to combat childhood obesity may be more effective whether they targeted at children from public schools and rural areas.

Imagem corporal e fatores associados em meninas de escolas militares

Objective: To investigate the prevalence of body image (BI) dissatisfaction in female adolescents and its association with age range, nutritional status and physical activity practice. Methods: A cross-sectional study of 393 female adolescents (aged 14-18 years) studying in military schools of the city of Fortaleza, Ceara, in the period from August to November 2015. The figure rating scale by Stunkard was used for BI assessment. The nutritional status was evaluated according to the Body Mass Index (BMI) (BMI = weight/height2) and the practice of physical activity (yes or no) was self-reported. Descriptive analysis was initially conducted, in absolute (n) and relative (%) values, followed by the chi-square test, adopting p≤0.05. Results: A majority of the adolescents were 16-17 years old (52.7%, n=207), practiced physical activity (62.6%, n=246), adequate weight (63.4%, n=249) and were dissatisfied with their BI (65.4%, n=257). Age range and physical activity were associated with BI (p=0.04 and p=0.02, respectively). There was no association between nutritional status and BI in this sample. Conclusion: The results indicate a high prevalence of body image dissatisfaction, regardless of age group and physical activity practice.

Factors associated with screen time among high school students in Fortaleza, Northeastern Brazil

Aims: To investigate the factors associated with the time adolescents spend watching television, using the computer, or playing video games. Methods: Cross-sectional study with adolescents attending high school, randomly selected from four schools of the Liceu do Ceara network in the city of Fortaleza, Northeastern Brazil. The number of students invited to participate in the study was proportional to the representative sample of the school. All the data were self-reported, including: daily screen time (time spent watching television or using the video game or the computer), intake of soft drinks, sweets, and packaged snack foods, sex, age, school shift, occupational status, participation in physical education classes, and practice of extracurricular physical activity. The chi-square test for linear trend was used to assess the associations, and the significance level was set as p <0.05. Results: A total of 964 students (46.4% aged 17 to 19 years and 51.5% female) were assessed. The prevalence of students who watched TV for more than 3 hours a day was 51.1% and the highest rate was observed among younger adolescents of both sexes, who did not work, went to school in the afternoon, and often consumed soft drinks, sweets, and packaged snack foods. Excessive use of computer / video games was observed in 21.85% of the sample, with a higher prevalence among boys who attended school in the morning and regularly consumed packaged snack foods. Conclusions: Sociodemographic and behavioral factors, including eating habits, are associated with screen time among adolescents. However, associated factors differed depending on the most widely type of media used (TV, computer, or video games). These aspects should be considered in programs for the elimination of leisure time sedentary behavior among adolescents.Aims: To investigate the factors associated with the time adolescents spend watching television, using the computer, or playing video games. Methods: Cross-sectional study with adolescents attending high school, randomly selected from four schools of the Liceu do Ceara network in the city of Fortaleza, Northeastern Brazil. The number of students invited to participate in the study was proportional to the representative sample of the school. All the data were self-reported, including: daily screen time (time spent watching television or using the video game or the computer), intake of soft drinks, sweets, and packaged snack foods, sex, age, school shift, occupational status, participation in physical education classes, and practice of extracurricular physical activity. The chi-square test for linear trend was used to assess the associations, and the significance level was set as p <0.05. Results: A total of 964 students (46.4% aged 17 to 19 years and 51.5% female) were assessed. The prevalence of students who watched TV for more than 3 hours a day was 51.1% and the highest rate was observed among younger adolescents of both sexes, who did not work, went to school in the afternoon, and often consumed soft drinks, sweets, and packaged snack foods. Excessive use of computer / video games was observed in 21.85% of the sample, with a higher prevalence among boys who attended school in the morning and regularly consumed packaged snack foods. Conclusions: Sociodemographic and behavioral factors, including eating habits, are associated with screen time among adolescents. However, associated factors differed depending on the most widely type of media used (TV, computer, or video games). These aspects should be considered in programs for the elimination of leisure time sedentary behavior among adolescents.

Cardiorespiratory fitness and risk factors for high blood pressure among adolescents

AIMS: To analyze possible associations of blood pressure level with cardiorespiratory fitness and body mass index in adolescents of low socioeconomic status. METHODS: The study included adolescents aged 14 to 17 years at a public school in Fortaleza, Ceara, which serves a population of low income and high social risk. Weight, height, systolic and diastolic blood pressure were measured, and cardiorespiratory fitness was estimated by the running test. The statistical analysis included percentages, mean, standard deviation, Student t test, chi-square and binary logistic regression, adopting p<0,05 as significant. SPSS 17.0 package was used for analysis. RESULTS: The study included 308 adolescents, being 177 boys. It was found that 12.3% of adolescents were overweight; 75.3% had low cardiorespiratory fitness; and 51% had high blood pressure. Adolescents whose body mass index was above the health criteria had higher risk of increased levels of systolic blood pressure (odds ratio 3.02; 95% confidence interval 2.94-6.13; p<0.01) and diastolic (odds ratio 3.41; 95% confidence interval 1.55-7.49; p=0.02). Cardiorespiratory fitness had no statistically significant association with blood pressure and body mass index. CONCLUSIONS: In adolescents of low socioeconomic status, high body mass index were associated with increased blood pressure. Excess weight, low cardiorespiratory fitness and blood pressure above normal were prevalent in this population.OBJETIVOS: Analisar possiveis associacoes do nivel de pressao arterial com a aptidao cardiorrespiratoria e o indice de massa corporal em adolescentes de nivel socioeconomico baixo.METODOS: O estudo incluiu adolescentes de 14 a 17 anos de uma escola publica em Fortaleza, Ceara, que atende uma populacao de baixo poder aquisitivo e elevado risco social. Foram aferidos peso, estatura, pressao arterial sistolica e diastolica e aptidao cardiorrespiratoria estimada por meio do teste de corrida. A analise estatistica incluiu valores percentuais, media, desvio padrao, teste t de Student, Qui-quadrado e regressao logistica binaria, adotando-se p<0,05 como significativo. Foi utilizado o pacote SPSS 17.0 para as analises.RESULTADOS: Participaram do estudo 308 adolescentes, sendo 177 meninos. Verificou-se que 12,3% dos adolescentes encontravam-se acima do peso; 75,3% apresentavam baixa aptidao cardiorrespiratoria; e 51% apresentavam valores elevados de pressao arterial. Os adolescentes cujo indice de massa corporal estava acima dos criterios de saude apresentaram maior risco de niveis aumentados de pressao arterial sistolica (razao de chances 3,02; intervalo de confianca 95% 2,94-6,13; p<0,01) e diastolica (razao de chances 3,41; intervalo de confianca 95% 1,55-7,49; p=0,02). A aptidao cardiorrespiratoria nao apresentou associacao estatisticamente significativa com pressao arterial e indice de massa corporal.CONCLUSOES: Em adolescentes de nivel socioeconomico baixo, elevados indices de massa corporal foram associados a aumento da pressao arterial. O excesso de peso, a baixa aptidao cardiorrespiratoria e a pressao arterial acima do normal foram prevalentes nessa populacao.(AU) AIMS: To analyze possible associations of blood pressure level with cardiorespiratory fitness and body mass index in adolescents of low socioeconomic status.METHODS: The study included adolescents aged 14 to 17 years at a public school in Fortaleza, Ceara, which serves a population of low income and high social risk. Weight, height, systolic and diastolic blood pressure were measured, and cardiorespiratory fitness was estimated by the running test. The statistical analysis included percentages, mean, standard deviation, Student t test, chi-square and binary logistic regression, adopting p<0,05 as significant. SPSS 17.0 package was used for analysis.RESULTS: The study included 308 adolescents, being 177 boys. It was found that 12.3% of adolescents were overweight; 75.3% had low cardiorespiratory fitness; and 51% had high blood pressure. Adolescents whose body mass index was above the health criteria had higher risk of increased levels of systolic blood pressure (odds ratio 3.02; 95% confidence interval 2.94-6.13; p<0.01) and diastolic (odds ratio 3.41; 95% confidence interval 1.55-7.49; p=0.02). Cardiorespiratory fitness had no statistically significant association with blood pressure and body mass index.CONCLUSIONS: In adolescents of low socioeconomic status, high body mass index were associated with increased blood pressure. Excess weight, low cardiorespiratory fitness and blood pressure above normal were prevalent in this population.(AU)

Comparação de variáveis antropométricas e comportamentais entre escolares do ensino de tempo integral e convencional

Objective: To compare anthropometric and behavioral variables between participants and non-participants of Fulltime class.Methods: This was a cross-sectional study with a convenience sample of 209 children (7-12 years old) who were 104 from the Mais Educação Program (Fulltime class) and 105 who were from part-time classes. Anthropometric variables were body mass index, waist and hip circumference, waist-to-hip ratio and waist-to height ratio. The frequency of participation in organized physical activity, active participation in Physical Education class and consumption of snacks offered at school were obtained by interview. Results: Excess body weight was presented in 26.0 % and 23.7 % of children in the fulltime and conventional, respectively. There were no differences between groups for anthropometric variables (p > 0.05). Only the consumption of snack offered by the school was different between groups (p = 0.024). Only 12.5% of fulltime students never consumed the snack offered by school, while this percentage rate was 27,6% in the conventional group. Conclusions: the involvement of children in fulltime classes can contribute to health promotion, especially for higher consumption of healthy foods in the school environment.