Suicide risk among undergraduate students in Brazil in the periods before and during the COVID-19 pandemic: results of the SABES-Grad national survey.

BACKGROUND: Undergraduate students present high rates of psychological distress, including suicide risk. Due to the coronavirus disease 2019 (COVID-19) pandemic, this scenario may have been aggravated. Thus, the objective of the current study was to evaluate changes in the suicide risk rate from the period before to during the COVID-19 pandemic, as well as the factors associated with this outcome among Brazilian undergraduate students. METHODS: This was a nationwide survey carried out in Brazil with a cross-sectional design, including two data collection periods: a single-center in-person collection in 2019 and another multicenter online collection in 2020/2021. Data were collected using self-administered instruments. The outcome was a high risk of suicide, measured through the Mini International Neuropsychiatric Interview. Analyses were carried out on data from two periods, i.e. before and during the pandemic (bivariate analysis and interaction tests), and a model of associated factors (multivariate analysis using Poisson regression) was developed including all participating universities distributed in the five regions of Brazil. RESULTS: In total, 6716 Brazilian undergraduate students participated (996 in 2019 and 5720 in 2020/2021). The prevalence of a high suicide risk rose from 11.3% to 17.0%, especially among women and poorer individuals. The prevalence of a high risk of suicide among Brazilian undergraduates was 19.6% and was associated with several socioeconomic, academic, pandemic, and mental health factors. CONCLUSIONS: The prevalence of a high suicide risk increased from prepandemic to during the pandemic, appearing to be largely influenced by social determinants, in conjunction with the implications of the COVID-19 pandemic.

Physical activity during early life and the risk of all-cause mortality in midlife: findings from a birth cohort study.

BACKGROUND: The objective of this study was to examine the association between physical activity during childhood and adolescence and the risk of all-cause mortality in midlife. We analyzed data from a birth cohort (The 1958 National Child Development Survey), including births in England, Wales and Scotland. METHODS: Physical activity was assessed using questionnaires at ages 7, 11 and 16. Death certificates defined all-cause mortality. Cumulative exposure, sensitive and critical periods, and physical activity trajectory from childhood to adolescence were tested using multivariate Cox proportional hazard models. The sweep the death was confirmed was defined as the time event. RESULTS: From age 23 to 55, 8.9% of participants (n = 9398) died. Physical activity in childhood and adolescence affected the risk of all-cause mortality in midlife. In men, physical activity at ages 11 [hazard ratio (HR): 0.77; 95% confidence interval (CI): 0.60-0.98] and 16 (HR: 0.60; 95% CI: 0.46-0.78) was associated with reduced risk of all-cause mortality. In women, physical activity at age 16 (HR: 0.68; 95% CI: 0.48-0.95) was associated with reduced risk of all-cause mortality. Physical activity in adolescence eliminated the risk of all-cause mortality associated with physical inactivity in adulthood in women. CONCLUSIONS: Physical activity during childhood and adolescence was associated with reduced risk of all-cause mortality with different effects by sex.

Alcohol Consumption and Smoking During Covid-19 Pandemic: Association with Sociodemographic, Behavioral, and Mental Health Characteristics.

The Covid-19 pandemic is related to increased alcohol consumption and smoking. These behaviors may be related to several sociodemographic, behavioral and mental health factors. Thus, the aim of this study was to assess the association between alcohol consumption and cigarette smoking with sociodemographic, behavioral and mental health characteristics. This study used data from two population-based studies conducted in two cities from Southern Brazil amid the Covid-19 pandemic. Individuals aged 18 years or older were included and selected using a multistage sampling procedure. Alcohol consumption and smoking and changes in such consumption during the Covid-19 pandemic were evaluated. Sociodemographic, behavioral, pandemic-related, and mental health variables were also included. A hierarchical model was used to conduct the adjusted analyses, and Poisson regression with robust adjustment was used for variance. A total of 2170 individuals were studied. The prevalence of alcohol consumption and smoking were 9.3% and 14.2%, respectively. The rates of increase in alcohol consumption and smoking during the Covid-pandemic were about 20% and 30%, respectively. They were higher among those with depressive symptoms, feeling of sadness and self-reported stress. Those with poor diet quality had higher prevalence of alcohol consumption (PR: 1.82) and were 1.58 times more likely to smoke. The findings may help stakeholders in health and political systems to better understand the consequences of the Covid-19 pandemic and develop strategies to mitigate these consequences in Brazil and elsewhere.

Does Money Buy Happiness? Disentangling the Association Between Income, Happiness and Stress.

Although there is evidence of an inverse relationship between stress and happiness, less is known about the interrelationship between income, happiness and stress. The purpose of this research brief was to investigate whether and how income and stress shape the distribution of happiness. A population-based cross-sectional study was conducted in the city of Rio Grande, Southern Brazil, with 1,168 individuals aged 18 years or older. The data were collected in 2016 and analyzed in 2019. Wealthiest people tended to be happier and less stressed. Less-stressed people had higher levels of happiness, which remain stable regardless of their income. Most-stressed individuals had lower prevalence of happiness throughout all income subgroups. Happiness levels among both rich and poor respondents decreased as stress levels increased. Nonetheless, this reduction was more pronounced among the poorest respondents. Concluding, stress plays an important role in the relationship between income and happiness. Although there is some evidence that money can exert influence on happiness, it seems that this association is highly dependent of individuals' stress levels.

Association between job lost and mental health outcomes during the COVID-19 pandemic and the role of food insecurity as mediator of this relationship.

This study aimed to evaluate the association between employment status and mental health, considering food insecurity as a mediator of this relation. A cross-sectional population-based study was conducted with adults (≥ 18 and < 60 years) during the COVID-19 outbreak in two cities from Southern Brazil. Employment status was categorized into working, not working, and lost job. The mental health outcomes evaluated were depressive symptoms, perceived stress, and sadness. Food insecurity was identified by the short-form version of the Brazilian Food Insecurity Scale. Adjusted analyses using Poisson regression were performed to assess the association between employment status and mental health. Mediation analysis was performed to investigate the direct and indirect effects of employment status on mental health outcomes. In total, 1,492 adults were analyzed. The not working status was associated with 53% and 74% higher odds of perceived stress and of sadness, respectively. Being dismissed during the pandemic increased the odds of depressive symptoms, perceived stress, and sadness by 68%, 123%, and 128%, respectively. Mediation analyses showed that food insecurity was an important mediator of the association between employment status and depressive symptoms and sadness, but not of perceived stress. The complexity of these results highlights economic and nutritional aspects involved in mental health outcomes.

Associated factors for accelerated growth in childhood: a systematic review.

Several studies have shown that accelerated growth in the postnatal period is critical for the development of chronic diseases. The term catch-up has been used for the accelerated growth of children who have suffered some sort of restriction of nutrition or oxygen supply. However, accelerated growth has been observed among children who have an appropriate birth weight for their gestational age (AGA) and with no apparent morbidity. Therefore, this systematic review was carried out on the associated factors of accelerated growth, or catch-up, using the Medline/Pubmed database. Only cohort studies written in Portuguese, English or Spanish, with children between zero and 12 years old who presented accelerated growth or catch-up as the outcome were included. Out of the 2,155 articles found, 9 were selected. There is no uniformity in the operational definition of accelerated growth, or in the concept of catch-up. According to this review, accelerated growth is associated with primiparity, maternal smoking during pregnancy, lower birth weight, and early weaning. The main limitations in the available literature are the high number of follow-up losses and the lack of control for confounding factors. The determinants of accelerated growth still need to be studied further, especially among AGA children.

Do neighborhoods make people active, or do people make active neighborhoods? Evidence from a planned community in Austin, Texas.

INTRODUCTION: Whether patterns of physical activity in different communities can be attributed to the built environment or instead reflect self-selection is not well understood. The objective of this study was to examine neighborhood preferences and behavior-specific physical activity among residents who moved to a new urbanist-designed community. METHODS: We used data from a 2009 survey (n = 424) that was designed and administered to evaluate neighborhood preferences and behavior-specific physical activity before and after residents moved. Data were grouped and stratified by pre-move physical activity levels into low-, middle-, and high-activity groups. We used Student's paired sample t test and Wilcoxon signed-rank test to compare pre- and post-move scores and used an analysis of variance to compare mean changes as a function of pre-move physical activity level. RESULTS: After moving, the high-activity group continued to be significantly more active than the middle- and low-activity groups (P < .001). However, we saw the biggest increase in pre- to post-move total physical activity in the low-activity group (mean increase, 176.3 min/wk) compared with the middle- (mean increase, 69.5 min/wk) and high-activity groups (mean decrease, 67.9 min/wk). All 3 groups had significant increases in walking inside the neighborhood for recreation. The preferred neighborhood features with the most significant pre- to post-move change scores were those associated with greater walkability. CONCLUSION: This study supports the role the environment plays in physical activity. These data suggest that moving to an activity-friendly neighborhood can positively affect physical activity levels, particularly among residents who had previously been least active.

A Study on the Health and Wellness of Undergraduate Students (SABES-Grad): methodological aspects of a nationwide multicenter and multilevel study overlapping with the Covid-19 pandemic.

INTRODUCTION: The academic environment can negatively impact the mental health of undergraduate students, particularly in the context of the coronavirus disease 2019 (Covid-19) pandemic. This study aimed to describe the methodological and operational aspects of a study of the health and well-being of undergraduate students: the Study on the Health and Wellness of Undergraduate Students (SABES-Grad) project. METHOD: This was a nationwide cross-sectional study divided across two data collection strategies: a single-center, on-site data collection carried out in 2019 at the Universidade Federal do Rio Grande (FURG) and a multicenter, multilevel, online data collection carried out in 2020/2021 at FURG, the Universidade Federal Fluminense (UFF), the Universidade Federal do Mato Grosso (UFMT), the Universidade do Estado do Amazonas (UEA), and the Universidade Federal Rural de Pernambuco (UFRPE). The main outcomes of interest were depressive symptoms, generalized anxiety, and suicide risk. RESULTS: A total of 996 students participated in the 2019 data collection (63.8% female; median age of 22 years; response rate of 85.2%) and 5,720 students participated in the 2020/2021 collection (66.7% female; median age of 22 years; response rate of 84.3%). Significant variations in socioeconomic and demographic profiles were observed between the different universities. Approximately one-third of the sample had been tested for Covid-19 in 2020/2021, 7.8% of whom had tested positive. CONCLUSION: The SABES-Grad project was the result of collaborative work between several actors from public universities in Brazil. Several aspects of the preparation and execution of this research are discussed in terms of its originality and relevance. Barriers and limitations and strategies adopted to overcome them are also presented.

[The experience of forced sexual intercourse among undergraduate students: associated factors and possible consequences]. / Experiência de relação sexual forçada entre estudantes de graduação: fatores associados e possíveis consequências.

The scope of this article is to investigate the prevalence of the experience of forced sexual intercourse on life and its possible consequences on mental and sexual health among undergraduate students at a public university in Brazil. It is a quantitative cross-sectional study with 996 undergraduate students. Sampling was carried out systematically by single-stage clusters. Descriptive, bivariate and multivariate analyses were performed using the Poisson Regression model, and the etiological fractions of the consequences of forced sexual intercourse were calculated. The lifetime prevalence of forced sexual intercourse was 12.1%. Female sex, non-heterosexual sexual orientation, first sexual intercourse before the age of 14, child food insecurity and domestic violence were associated with a higher prevalence of the outcome. Individuals who experienced forced sexual intercourse were more likely to be diagnosed with sexually transmitted infections and to represent a potential suicide risk. The study revealed the problems of sexual violence in the university context.

O objetivo deste artigo é investigar a prevalência de relação sexual forçada na vida e suas possíveis consequências na saúde mental e sexual em acadêmicos de cursos de graduação de uma universidade pública no Brasil. Estudo transversal quantitativo com 996 estudantes de graduação. A amostragem realizada de forma sistemática por conglomerados. Foi usado o modelo de Regressão de Poisson, e foram calculadas as frações etiológicas das consequências de relação sexual forçada. A prevalência de relação sexual forçada ao longo da vida foi de 12,1%. Sexo feminino, orientação sexual não heterossexual, primeira relação sexual antes de 14 anos de idade, insegurança alimentar e violência no contexto doméstico na infância foram associados à maior prevalência do desfecho. Indivíduos que sofreram relação sexual forçada foram mais propensos a apresentar diagnóstico de infecções sexualmente transmissíveis e de ter risco de suicídio. O estudo evidenciou a problemática da violência sexual no contexto universitário.

Infancy and childhood growth and physical activity in adolescence: prospective birth cohort study from Brazil.

BACKGROUND: The Developmental Origins of Health and Disease hypothesis suggests that intrauterine, infancy and early childhood variables play a key role at programming later health. However, little is known on the programming of behavioral variables, because most studies so far focused on chronic disease-related and human capital outcomes. The aim of the present study was to evaluate the effects of prenatal, infancy and childhood weight and length/height gains on objectively-measured physical activity (PA) in adolescence. METHODS: This is a prospective birth cohort study in Pelotas, Brazil, including 457 adolescents (mean age: 13.3 years) with weight and length/height data at birth, one, three and six months, one and four years of age. PA was measured using a GT1M Actigraph accelerometer, and expressed as (a) minutes per day spent on sedentary, light, moderate, vigorous and very-vigorous activities; (b) total counts per day. RESULTS: 61.3% of the adolescents accumulated 60+ minutes of moderate-to-vigorous PA per day. Weight and length/height trajectories in infancy and childhood were similar between those classified as active or inactive at 13.3 years. However, those classified as inactive were heavier and taller at all ages; differences were statistically significant only in terms of length at three, six and 12 months. CONCLUSIONS: Weight gain in infancy and childhood did not predict variability in adolescent PA, but those active in adolescence showed somewhat smaller average gains in length in infancy. These findings suggest that PA may partially be sensitive to early hormonal programming, or that genetic factors may affect both early growth and later metabolism or predisposition for PA.

Clustering of risk factors for chronic diseases among adolescents from Southern Brazil.

OBJECTIVE: To investigate the clustering of risk behaviors for chronic non-communicable diseases and their associated factors among adolescents from Southern Brazil. METHODS: In 2008, a survey was conducted with 3990 adolescents aged 14-15 years (mean: 14.3; SD: 0.6) from the 1993 Pelotas Birth Cohort Study. Clustering was determined by comparing observed (O) and expected (E) prevalence of all possible combinations of the four risk factors investigated (smoking, alcohol intake, low fruit intake, and physical inactivity). We carried out Poisson regression to evaluate the effect of individual characteristics on the presence of at least three risk behaviors. RESULTS: All risk factors tended to cluster together (O/E prevalence=3.0), especially smoking and alcohol intake (odds ratio to present on behavior in the presence of other >5.0). Approximately 15% of adolescents displayed three or more risk behaviors. Females (adjusted OR=1.55), people 15 years and older (OR=1.47), with black skin color (OR=1.23), and of low socioeconomic level (OR=1.29) were more likely to display three or more risk factors. CONCLUSION: These findings suggest that lifestyle-related risk factors tend to cluster among adolescents. Identifying subgroups at greater risk of simultaneously engaging in multiple risk behaviors may aid in the planning of preventive strategies.

Predictors of physical activity change during adolescence: a 3.5-year follow-up.

OBJECTIVE: To investigate the predictors of change in physical activity (PA) from early to mid adolescence in a cohort of adolescents. DESIGN: Prospective, population-based birth cohort study. PA level was evaluated by means of questionnaire, and was analysed in continuous form (min/week) and as a trajectory (inactive-inactive, inactive-active, active-inactive, active-active) based on the cut-off point of 300 min/week. SETTING: Pelotas, a city of 340 000 inhabitants in southern Brazil. SUBJECTS: Adolescents (n 4120) followed from 11 to 15 years of age. RESULTS: Maternal PA change and more exposure to outdoors were directly associated with a positive change in PA level (min/week) for both genders. Higher maturation status (among boys) and later menarche were also associated with positive PA change in min/week. Predictors to remain inactive were: maternal PA change (inverse association), more exposure to outdoors, higher socio-economic level, fear of living in the neighbourhood and non-overweight girls. Predictors to become inactive were higher socio-economic level among boys and increase in screen time among girls. CONCLUSIONS: The study demonstrates that social, family, biological, behavioural and environmental factors exert an important role in the PA change among youngsters as they move into adolescence. These findings may be relevant to the design of policies and intervention programmes aimed at promoting PA in teenagers.

Gestational age at birth and morbidity, mortality, and growth in the first 4 years of life: findings from three birth cohorts in Southern Brazil.

BACKGROUND: We assessed anthropometric status, breastfeeding duration, morbidity, and mortality outcomes during the first four years of life according to gestational age, in three population-based birth cohorts in the city of Pelotas, Southern Brazil. METHODS: Total breastfeeding duration, neonatal mortality, infant morbidity and mortality, and anthropometric measures taken at 12 and 48 months were evaluated in children of different gestational ages born in 1982, 1993 and 2004 in Southern Brazil. RESULTS: Babies born <34 weeks of gestation and those born between 34-36 weeks presented increased morbidity and mortality, were breastfed for shorter periods, and were more likely to be undernourished at 12 months of life, in comparison with the 39-41 weeks group. Children born with 37 weeks were more than twice as likely to die in the first year of life, and were also at increased risk of hospitalization and underweight at 12 months of life. Post-term infants presented an increased risk of neonatal mortality. CONCLUSION: The increased risks of morbidity and mortality among preterm (<37 weeks of gestation) and post-term (>41 weeks) are well known. In our population babies born at 37 also present increased risk. As the proportion of preterm and early term babies has increased markedly in recent years, this is a cause for great concern.

A longitudinal evaluation of physical activity in Brazilian adolescents: tracking, change and predictors.

This study aimed to: 1) describe the change in leisure-time physical activity (LTPA) during early-to-mid adolescence; 2) analyze the tracking of LTPA; 3) identify the predictors of LTPA change. 4,120 adolescents were from 11 to 15 years old. Outcome was self-reported LTPA (min/wk). Boys increased their LTPA level over the four years (mean: 75 min/wk; 95%CI: 49,100), whereas a decrease was observed among girls (mean: -42 min/wk; 95%CI: -57,-28). Likelihood to be active at 15 years of age was 50% higher (95%CI: 39-62) among those who were active at 11 years. The main predictor of LTPA change was the number of physical activities performed at baseline. Regular physical activity early in life can predict this behavior afterward.

Bidirectional cross-sectional and prospective associations between physical activity and body composition in adolescence: birth cohort study.

The aim of this study was to investigate the cross-sectional and prospective associations between physical activity and body composition in adolescence. This is a prospective study, including 4,103 adolescents belonging to the Pelotas (Brazil) 1993 birth cohort, who were followed up at the mean ages of 11.3 and 14.7 years. Subsample analyses included 511 individuals with accelerometry and deuterium dilution data at 13.3 years. Sum of skinfolds at age 11.3 years was highly correlated with skinfolds at age 14.7 years (rho = 0.74, P < 0.001). More than 85% of participants remained in the same quintile or changed by not more than one quintile during the 3.4 year period. Tracking of physical activity was considerably lower, although still significant; the correlation was 0.24 (P < 0.001) and 61.4% of the adolescents moved one or less quintiles. In fully-adjusted models, no significant cross-sectional or longitudinal associations were found between physical activity and body composition, neither in boys nor in girls. These null results were confirmed in the 511 individuals with accelerometry and deuterium data. We provide evidence of tracking of physical activity and particularly body composition during adolescence. Our results do not support the hypothesis that physical activity and fatness are strongly related in adolescents.

[Self-reported discrimination by adolescents in a Brazilian birth cohort: prevalence and associations]. / Discriminação autorrelatada por adolescentes de uma coorte de nascimentos brasileira: prevalência e associações.

OBJECTIVE: To evaluate the prevalence of and factors associated with discrimination self-reported by adolescents. METHODS: Cross-sectional analysis of adolescents belonging to a cohort of live births in 1993 in the city of Pelotas, Brazil. From the 5 249 members of the cohort, information was collected from 4 452 adolescents in 2004 and 2005 regarding self-reported discrimination, sociodemographic variables, physical attributes, and nutritional status. A Poisson regression was utilized in the raw and adjusted analyses to estimate prevalence rates (RP). RESULTS: The global prevalence of self-reported discrimination was 16.4%. In the adjusted analysis, discrimination was reported more by the following groups: girls (RP = 1.27, 95%CI: 1.10-1.48), people identified by others as black (RP = 1.28, 95%CI: 1.04-1.57), poorer adolescents (RP = 1.58, 95%CI: 1.23-2.02), those who perceived themselves to be very thin or very fat (RP = 1.81 and 1.54 respectively), those whose families had financial trouble (RP = 1.76, 95%CI: 1.49-2.08), those who wore glasses (RP = 1.74, 95%CI: 1.45-2.10), those who thought their teeth looked bad (RP = 1.58, 95%CI: 1.21-2.07), those who had been reprimanded in school (RP = 1.23, 95%CI: 1.01- 1.51), and those who had been involved in fights in the past year (RP = 1.62, 95%CI: 1.36-1.94). The association between discrimination and nutritional status varied by sex (interaction P = 0.009). Thin children reported greater discrimination than those who were overweight or obese. Discrimination on the basis of obesity was higher among girls, with this effect more strongly felt among rich girls than among poor ones. CONCLUSIONS: Self-reported discrimination was prevalent and unequally distributed among the population. Actions to reduce experiences of discrimination must be implemented during the initial stages of life.

An invisible villain: high perceived stress, its associated factors, and possible consequences in a population-based survey in southern Brazil.

INTRODUCTION: Much of the evidence on the relationship between stress, lifestyle, and other physical and mental health outcomes comes from studies conducted in high-income countries. There is therefore a need for research among populations in low and middle-income settings. OBJECTIVES: To measure stress levels and identify factors associated with a high stress level and its consequences for health. METHODS: This was a population-based cross-sectional study carried out in 2016 with adults aged 18 years or older in a municipality in southern Brazil. A two-stage sampling strategy based on census tracts was used. Stress levels were measured with the Perceived Stress Scale (PSS-14) and classified into quartiles. The impact of the highest stress levelon each outcome was assessed with etiologic fractions (EF). RESULTS: The most stressed groups were: females (PR = 1.51, 95%CI 1.25-1.81), younger people (PR = 1.76, 95%CI 1.26-2.46), middle-aged individuals (PR = 1.60, 95%CI 1.17-2.19), those with lower schooling (PR = 1.56, 95%CI 1.20-2.02), the physically inactive (PR = 1.51, 95%CI 1.20-1.91), people who spent three or more hours watching television per day (PR = 1.29, 95%CI 1.12-1.50), and those with food insecurity (PR = 1.44, 95%CI 1.19-175). Possible consequences of high stress level were regular or poor self-perception of health (EF = 29.6%), poor or very poor sleep quality (EF = 17.3%), lower quality of life (EF = 45.6%), sadness (EF = 24.2%), and depressive symptoms (EF = 35.8%). CONCLUSIONS: Stress plays an important role in several domains of health. Both public policies that target reduction of inequalities and specific stress-management interventions can reduce stress levels in populations, thereby decreasing the burden of other negative physical and mental health outcomes related to stress.

Physical Inactivity From Childhood to Adolescence and Incident Depression.

INTRODUCTION: The long-term impact of physical activity during early life on the risk of depression in later stages of adulthood remains unclear. This study examines the association between physical activity during childhood and adolescence and the incidence of depressive symptoms in early, middle, and late adulthood. METHODS: Data from a birth cohort (the 1958 National Child Development Survey), including births (N=17,415) in England, Wales, and Scotland, were used. After birth, 11 more follow-ups were carried out between ages 7 and 62 years (2020). Leisure-time physical activity was assessed through a self-reported questionnaire. Psychological measures were assessed with the teacher-rated Bristol Social Adjustment Guide, the teacher-rated Rutter scale, and the self-rated Malaise Inventory. Leisure-time physical activity and psychological symptoms were examined in all the 11 follow-up assessments included in this study. Best-fit model was used to obtain hazard ratios and 95% CIs of depression symptoms by physical activity status in different ages, including demographic, behavioral, and health-related variables as potential confounders. RESULTS: After multivariate analysis, being physically active at age 16 years reduced the risk of incident elevated depressive symptoms (hazard ratio=0.73, 95% CI=0.62, 0.85) throughout adulthood. The long-term impacts of physical activity practiced at age 16 years persisted throughout adulthood up to age 62 years. CONCLUSIONS: Adolescence is a critical early-life period to promote physical activity for reducing the incidence of elevated depressive symptoms throughout adulthood. Public health policies should promote healthy lifestyles during the lifespan to reduce both the burden of physical inactivity and depressive symptoms at the population level.

Socioeconomic inequalities in the access to health services: a population-based study in Southern Brazil.

This article aims to measure socioeconomic inequalities regarding access to health services, contact with health professionals, and specific health interventions. This was a cross-sectional population-based study with individuals aged 18 years or older, living in the city of Rio Grande. The outcomes were the following: Family Health Strategy (FHS) coverage; having a health insurance plan; receiving a visit of a community health worker; medical consultation; dental consultation; dietary counseling; having a class with a physical education professional; flu vaccination; mammography, cytopathological and prostate exams. Relative and absolute measures were used to assess inequalities in the distribution of the outcomes. There was a response rate of 91% (1,300 adults were interviewed). Coverage indicators ranged from 16.1%, for having a class with a physical education professional, to 80.0% for medical consultation. FHS coverage and visit of a community health agent presented higher proportions among the poorest while outcomes regarding contact with health professionals, screening exams and flu vaccine were more prevalent among richest group. We observed low coverage levels of access to health services and professionals in addition to marked socioeconomic inequalities.

Fear of Covid-19 and health-related outcomes: results from two Brazilian population-based studies.

Fear is a reaction that can influence multiple aspects of health and life. During the Covid-19 pandemic, there have been serious pathophysiological, social, behavioral and mental consequences that can be related to fear. This study aimed to assess the fear of Covid-19 and its association with sociodemographic, behavioral and health variables. Data were gathered from two cross-sectional population-based studies conducted in 2020 with adults from two cities from Southern Brazil. The Fear of Covid-19 scale was used to evaluate fear of Covid. Exposure variables were socioeconomic, demographic, health and pandemic-related factors. Adjusted Poisson regression was performed to assess the association between fear of Covid-19 and the exposure variables. A total of 2,152 subjects were assessed. Higher fear of Covid-19 was found among women and in individuals with symptoms of Covid-19. Living alone, being richer, and testing positive for Covid-19 were associated with lower prevalence of fear. Higher prevalence of fear of Covid-19 was related to worse sleep quality, worse health perception, sadness, higher stress, depressive symptoms, and suicidal ideation. There was a linear association between fear of Covid-19 and health outcomes. The results provide evidence that fear of Covid-19 seems to be associated with socioeconomic, demographic, health and pandemic-related factors.