RESUMO
The occurrence of multiple risk behaviors among adolescents imposes challenges in the context of public policies of health, particularly in low- and middle-income countries. Evidence on the conditions leading to the exposure to and adoption of multiple risk behaviors allows the identification of vulnerable groups of adolescents, and may support the proposition of targeted strategies directed to individuals at risk. Therefore, the aim of this study was to perform a quantitative analysis to identify recent trends in the exposure to and adoption of multiple health risk behaviors among Brazilian adolescents, highlighting individual-, household-, and school-level characteristics linked to inequalities among social groups. The analysis was based on cross-sectional data from the National Student Health Survey (PeNSE), conducted by the Brazilian Institute for Geography and Statistics in 2009, 2012, 2015, and 2019. The trends in the occurrence of multiple risk behaviors among adolescents were estimated according to social strata, allowing the calculation of concentration indexes and their disaggregation into major determinants of inequalities in the exposure and adoption of risk behaviors. The analyses were conducted using a complex survey design to allow representativeness at the population level. The results showed a rise in the incidence of multiple risk behaviors among youngsters in Brazil from 2009 to 2019. Factors influencing inequalities in the exposure to multiple risk behaviors were socioeconomic status and the characteristics of the household and school environments, whilst the adoption of multiple risk behaviors was also influenced by early exposure to multiple risk behaviors. Furthermore, trends in inequalities in the exposure to and adoption of multiple risk behaviors showed an intensification from 2009 to 2019, being initially concentrated among wealthier adolescents, followed by a transition to higher incidence in the lower socioeconomic strata in 2012 and 2015, respectively. The findings underscore the role of support systems for adolescents at risk within the familial and school contexts, whereas strategies of public policies of health based on the strengthening of community ties may require improvements to tackle socioeconomic inequalities in the occurrence of risk behaviors among youngsters.
RESUMO
Introdução: Práticas alimentares inadequadas associadas a um nível de atividade física insuficiente acarretam maior risco de manifestação precoce de doenças crônicas não transmissíveis. Objetivo: Analisar padrão de consumo de determinados alimentos saudáveis e nível de atividade física de adolescentes escolares brasileiros pertencentes a famílias de diferentes estratos sociais, investigados nas três edições da Pesquisa Nacional de Saúde do Escolar (PeNSE), conduzida pelo Instituto Brasileiro de Geografia e Estatística em 2009, 2012 e 2015. Metodologia: A tese foi composta de três artigos. O primeiro artigo baseia-se em revisão sistemática da literatura para identificação de evidências sobre associação entre características socioeconômicas, nível de atividade física e frequência de consumo de alimentos entre adolescentes. Os demais artigos foram construídos a partir de análise estatística de base de dados unificada composta pelas três edições da PeNSE (2009, 2012 e 2015). O segundo artigo utilizou modelo de regressão logística multivariada para verificação da associação entre características socioeconômicas, nível de atividade física e frequência do consumo de alimentos saudáveis e não saudáveis entre adolescentes brasileiros, usando dados de amostra representativa em nível de capitais de Unidades da Federação das três edições da PeNSE 2009, 2012 e 2015. O terceiro artigo empregou modelo de regressão logística multivariada para investigação da associação entre autoavaliação do peso corporal e adoção de medidas de controle de peso em relação ao nível de atividade física e à frequência do consumo de alimentos saudáveis e não saudáveis entre adolescentes brasileiros, segundo dependência administrativa da escola (rede pública ou privada) em amostra representativa em nível de municípios capitais e grandes regiões brasileiras, a partir de dados de duas edições da PeNSE 2012 e 2015. Resultados: Os estudos analisados na revisão sistemática apontaram adoção de piores hábitos alimentares e estilo de vida sedentário entre adolescentes de menor nível socioeconômico. Em termos de análise dos dados brasileiros, no segundo artigo verificou-se que a renda familiar e o nível de escolaridade dos pais estavam associados com os hábitos alimentares e nível de atividade física entre os adolescentes. No terceiro artigo, observaram-se diferenças importantes de autoavaliação do peso corporal relacionadas ao gênero, assim como importância do ambiente escolar na determinação do nível de influência social quanto às práticas de alimentação e atividade física adotadas entre adolescentes brasileiros. Conclusão: Resultados da presente tese indicam importância de monitoramento dos fatores de risco e proteção associados às características socioeconômicas como parte das pressões às quais jovens brasileiros estão submetidos. A análise dos dados das edições da PeNSE indicou possibilidade de constituir um sistema de vigilância de fatores de risco à saúde dirigido a adolescentes, gerando evidências para avaliação e orientação de políticas destinadas aos adolescentes e escolares no país
Introduction: Inadequate dietary practices associated with insufficient physical activity lead to increased risk in early onset of non-communicable chronic diseases. Objective: To analyze food pattern and level of physical activity among Brazilian adolescents enrolled in school from families in diverse social strata, investigated in the three editions of the National School Health Survey (PeNSE), conducted by the Brazilian Institute for Geography and Statistics in 2009, 2012 and 2015. Methodology: The thesis was composed of three articles. The first article is based on systematic literature review designed to identify evidences regarding the association between socioeconomic characteristics, physical activity level and frequency of food consumption among adolescents. The following articles were constructed on statistical analysis of single dataset encompassing information on the three editions of the PeNSE (2009, 2012 and 2015). The second article used multivariate logistic regression model to verify the association between socioeconomic characteristics, physical activity level and frequency of healthy and unhealthy foods consumption among Brazilian adolescents, based on sample representative at capital of state level from three editions of PeNSE 2009, 2012 and 2015. The third article used multivariate logistic regression model to investigate the association among self-assessment of body weight and adoption of weight control measures in relation to level of physical activity and frequency of consumption of healthy and unhealthy foods among Brazilian adolescents, according to administrative dependence of school (public or private) in sample representative at the level of state capitals and Brazilian macroregions, in two editions of PeNSE 2012 and 2015. Results: The studies analyzed in the systematic review of literature indicated worst eating habits and sedentary lifestyle among adolescents with low socioeconomic status. Regarding data analysis, evidences in the second article pointed to the family income and parents' educational attainment were associated with eating habits and physical activity level among adolescents. In the third article, significant differences were observed in terms of self-assessment of body weight related to gender, as well as importance of school environment in determining the social influence on practices of food consumption and physical activity among Brazilian adolescents. Conclusion: Results of the dissertation indicate the importance of monitoring risk and protection factors related to socioeconomic characteristics which comprise pressures in Brazilian adolescents' life. The analysis of data from the three issues of the national survey on adolescents' health indicate the possibility to compose a system for monitoring health risk factors directed towards adolescents, generating evidences for assessment and guidance of public policies aimed at adolescents and schoolchildren in Brazil