Rodrigo Siqueira Reis

Brazilian version of a lifestyle questionnaire: translation and validation for young adults

BACKGROUNDnInappropriate lifestyles have been responsible for the leading causes of mortality. The purpose of the Fantastic Lifestyle Questionnaire is to help physicians involved in health prevention to identify and assess their patients lifestyles.nnnOBJECTIVEnTo translate and validate the Fantastic Lifestyle Questionnaire for use with young adults.nnnMETHODSnThe process of translation into Portuguese and validation consisted of four steps: 1) translation; 2) correction and semantic adaptation by professional experts (judges); 3) content validation; and 4) a final evaluation by the target population. The statistical analyses used were Cronbachs alpha to measure internal consistency reliability, intra-class correlation coefficient (R) for external consistency, and the Kappa index to test construct validity.nnnRESULTSnCronbachs alpha coefficient measured the correlation between items and the total was 0.69, which is considered reasonable for an instrument designed to evaluate a latent variable that can only be estimated and not measured. When the items were grouped into domains, it was possible to verify that they all contributed equally to the stability of the questionnaire (alpha=0.60). The external consistency evaluated by intra-class correlation was R=0.92 (p=0.2), which demonstrates a high degree of reproducibility; the construct validity of 4 and 3 categories was 75 and 80.7% with Kappa indices of 0.58 and 0.7, respectively, which show an excellent discriminatory classificatory capacity.nnnCONCLUSIONnThe Fantastic Lifestyle Questionnaire has an adequate internal and external consistency for evaluating young adult lifestyles, and it can be recommended for primary care and epidemiological studies.

Time trends of physical activity in Brazil (2006-2009)

OBJECTIVEnTo examine time trends in physical activity (PA) in Brazilian state capitals from 2006 to 2009.nnnMETHODSnThis analysis is based on data from the Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases (VIGITEL) accounting for an annual sample of approximately 54,000 individuals. PA indicators were analyzed in free time (leisure), work, home and transportation, time spent in front of the television and inactivity considering all PA domains. Poisson regression models were used to measure the variation of indicators over time. We considered the changes corresponding to a regression coefficient different from zero as being statistically significant (p<0.05).nnnRESULTSnThe percentage of active commuters increased from 11.7 to 14.4% (p<0.001) whereas the proportion of physically inactive individuals in the four domains decreased from 11.7 to 8.7% (p<0.001). There were no significant changes in the other indicators. Women were less active than men in all indicators, except for household chores. However, in this indicator the percentage of active women decreased from 71.4 to 67.1% (p<0.001). Between 2006 and 2009, PA levels in the Brazilian population were stable during free time and household chores, but increased in transportation, resulting in a decrease in the percentage of inactive individuals.nnnCONCLUSIONnThe continued monitoring and strengthening of VIGITEL are public health priorities, and PA is a key part of it. In the long run, PA evolution may be re-evaluated.

Physical activity interventions in Latin America: expanding and classifying the evidence.

Context Systematic reviews of public health interventions are useful for identifying effective strategies for informing policy and practice. The goals of this review were to (1) update a previous systematic review of physical activity interventions in Latin America which found that only school-based physical education had sufficient evidence to recommend widespread adoption; (2) assess the reporting of external validity elements; and (3) develop and apply an evidence typology for classifying interventions. Evidence acquisition In 2010–2011, community-level, physical activity intervention studies from Latin America were identified, categorized, and screened based on the peer-reviewed literature or Brazilian theses published between 2006 and 2010. Articles meeting inclusion criteria were evaluated using U.S. Community Guide methods. External validity reporting was assessed among a subset of articles reviewed to date. An evidence rating typology was developed and applied to classify interventions along a continuum based on evidence about their effectiveness in the U.S. context, reach, adoption, implementation, institutionalization, and benefits and costs. Evidence synthesis Thirteen articles published between 2006 and 2010 met inclusion criteria and were abstracted systematically, yet when combined with evidence from articles from the previous systematic review, no additional interventions could be recommended for practice. Moreover, the reporting of external validity elements was low among a subset of 19 studies published to date (median=21% of elements reported). By applying the expanded evidence rating typology, one intervention was classified as evidence-based, seven as promising, and one as emerging. Conclusions Several physical activity interventions have been identified as promising for future research and implementation in Latin America. Enhanced reporting of external validity elements will inform the translation of research into practice.

Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America

OBJECTIVEnThere is evidence linking the built environment (BE) with physical activity (PA), but few studies have been conducted in Latin America (LA). State-of-the-art methods and protocols have been designed in and applied in high-income countries (HIC). In this paper, we identify key challenges and potential solutions to conducting high-quality PA and BE research in LA.nnnMETHODSnThe experience of implementing the IPEN data collection protocol (IPEN: International Physical Activity Environment Network) in Curitiba, Brazil; Bogotá, Colombia; and Cuernavaca, Mexico (2010-2011); is described to identify challenges for conducting PA and BE research in LA.nnnRESULTSnFive challenges were identified: lack of academic capacity (implemented solutions (IS): building a strong international collaborative network); limited data availability, access and quality (IS: partnering with influential local institutions, and crafting creative solutions to use the best-available data); socio-political, socio-cultural and socio-economic context (IS: in-person recruitment and data collection, alternative incentives); safety (IS: strict rules for data collection procedures, and specific measures to increase trust); and appropriateness of instruments and measures (IS: survey adaptation, use of standardized additional survey components, and employing a context-based approach to understanding the relationship between PA and the BE). Advantages of conducting PA and BE research in LA were also identified.nnnCONCLUSIONSnConducting high-quality PA and BE research in LA is challenging but feasible. Networks of institutions and researchers from both HIC and LMIC play a key role. The lessons learned from the IPEN LA study may be applicable to other LMIC.

Association between the perceived environment and physical activity among adults in Latin America: a systematic review

BackgroundActivity friendly environments have been identified as promising strategies to increase physical activity levels in the population. Associations between perceived environmental attributes and physical activity in Latin America may vary from those observed in high income countries. The objective of this systematic review is to identify which perceived environmental attributes are associated with physical activity in Latin America.MethodsSystematic literature search of articles published in English, Portuguese, and Spanish in four databases was conducted (PubMed, Virtual Health Library, EBSCO, and Web of Science). Associations with environmental attributes were analyzed separately for physical activity domains. Fifteen articles were included in the analysis.ResultsAll studies had cross-sectional designs. The majority of associations were statistically non-significant, and only four associations were found in the unexpected direction. Leisure-time and transport-related physical activity were the domains most frequently included in the studies and had higher number of associations in the expected direction. Leisure-time physical activity showed a convincing association in the expected direction with safety during the day. Transport-related physical activity had a convincing association with presence of street lighting.ConclusionsThis study shows that perceived environmental attributes and their relationship with physical activity appears to be domain, and context specific. In addition, findings from this study show inconsistencies with the information gathered from high-income countries.

Understanding administrative evidence-based practices: findings from a survey of local health department leaders.

BACKGROUNDnThere are sparse data showing the extent to which evidence-based public health is occurring among local health departments.nnnPURPOSEnThe purpose of the study was to describe the patterns and predictors of administrative evidence-based practices (structures and activities that are associated with performance measures) in a representative sample of local health departments in the U.S.nnnMETHODSnA cross-sectional study of 517 local health department directors was conducted from October through December 2012 (analysis in January-March 2013). The questions on administrative evidence-based practices included 19 items based on a recent literature review (five broad domains: workforce development, leadership, organizational climate and culture, relationships and partnerships, financial processes).nnnRESULTSnThere was a wide range in performance among the 19 individual administrative evidence-based practices, ranging from 35% for providing access to current information on evidence-based practices to 96% for funding via a variety of sources Among the five domains, values were generally lowest for organizational climate and culture (mean for the domain=49.9%) and highest for relationships and partnerships (mean for the domain=77.1%). Variables associated with attaining the highest tertile of administrative evidence-based practices included having a population jurisdiction of 25,000 or larger (adjusted ORs [aORs] ranging from 4.4 to 7.5) and state governance structure (aOR=3.1).nnnCONCLUSIONSnThis research on the patterns and predictors of administrative evidence-based practices in health departments provides information on gaps and areas for improvement that can be linked with ongoing quality improvement processes.

Transport and health: a look at three Latin American cities

Transport is associated with environmental problems, economic losses, health and social inequalities. A number of European and US cities have implemented initiatives to promote multimodal modes of transport. In Latin America changes are occurring in public transport systems and a number of projects aimed at stimulating non-motorized modes of transport (walking and cycling) have already been implemented. Based on articles from peer-reviewed academic journals, this paper examines experiences in Bogotá (Colombia), Curitiba (Brazil), and Santiago (Chile), and identifies how changes to the transport system contribute to encourage active transportation. Bus rapid transit, ciclovias, bike paths/lanes, and car use restriction are initiatives that contribute to promoting active transportation in these cities. Few studies have been carried out on the relationship between transport and physical activity. Car ownership continues to increase. The public health sector needs to be a stronger activist in the transport policy decision-making process to incorporate health issues into the transport agenda in Latin America.

Developing a research agenda for promoting physical activity in Brazil through environmental and policy change

OBJECTIVEnTo identify the highest priorities for research on environmental and policy changes for promoting physical activity (PA) in Brazil; to uncover any gaps between researchers and practitioners priorities; and to consider which tools, methods, collaborative strategies, and actions could be useful to moving a research agenda forward.nnnMETHODSnThis was a mixed-methods study (qualitative and quantitative) conducted by Project GUIA (Guide for Useful Interventions for Activity in Brazil and Latin America) in February 2010-January 2011. A total of 240 individuals in the PA field (186 practitioners and 54 researchers) were asked to generate research ideas; 82 participants provided 266 original statements from which 52 topics emerged. Participants rated topics by importance and feasibility; a separate convenience sample of 21 individuals categorized them. Cluster analysis and multidimensional scaling were used to create concept maps and pattern matches.nnnRESULTSnFive distinct clusters emerged from the concept mapping, of which effectiveness and innovation in PA interventions was rated most important by both practitioners and researchers. Pattern matching showed a divergence between the groups, especially regarding feasibility, where there was no consensus.nnnCONCLUSIONSnThe study results provided the basis for a research agenda to advance the understanding of environmental and policy influences on PA promotion in Brazil and Latin America. These results should stimulate future research and, ultimately, contribute to the evidence-base of successful PA strategies in Latin America.

Urban environment interventions linked to the promotion of physical activity: a mixed methods study applied to the urban context of Latin America.

This study summarizes the evidence from quantitative systematic reviews that assessed the association between urban environment attributes and physical activity. It also documents sociopolitical barriers and facilitators involved in urban interventions linked with active living in the ten most populated urban settings of Latin America. The synthesis of evidence indicates that several attributes of urban environments are associated with physical activity, including land-use mix and cycling infrastructure. The documentary analysis indicated that despite the benefits and opportunities provided by the programs and existing infrastructure in the examined cities, an overall concern is the rising inequality in the coverage and distribution of the initiatives in the region. If these programs and initiatives are to achieve a real population level effect that helps to reduce health disparities, they need to examine their social and spatial distribution within the cities so they can reach underserved populations and develop to their full potential.

Estágios de mudança de comportamento para a atividade física em adolescentes

The objective of this study was to identify and to describe factors associated with the distribution in relation to the stages of change for physical activity (SCPA) in adolescents. This cross-sectional study was carried out through data analysis from a sample of 4,207 adolescents high-school students (14-19 years old) from the state of Pernambuco (Brazil), selected by a 2-stage cluster sampling process. The data were collected by using a previously tested questionnaire (GSHS-WHO), adopting the following classifications for SCPA: (1) maintenance - subject physically active for more than 6 months; (2) action - subject physically active for less than 6 months; (3) preparation - subject is not active, but would like to become physically active in the next 30 days; (4) contemplation - subject is not active, but would like to become physically active in the next 6 months; and (5) pre-contemplation - subject is not and does not intend to become physically active in the next 6 months. Ordinal logistic regression analyses were used to identify factors associated with SCPA. It was found that 31.1% and 16.4% of subjects, respectively, were in action and maintenance stages. The boys of 14-16 years old and, adolescents who worked and lived in the coastal region of the state, regardless of gender, were more likely to be classified in the action and maintenance stages. Age for male adolescents, and region of residence and occupational status for adolescents of both genders were identified as factors associated with SCPA.