Leisure-Time Physical Activity in a Southern Brazilian City (2004-2021): Applying an Equity Lens to Time-Trend Analyses.

BACKGROUND: This study aimed to verify leisure-time physical activity trends over 15 years and monitor inequalities according to gender, self-reported skin color, and socioeconomic position in a Southern Brazilian city. A secondary aim is to evaluate intersectionalities in physical activity. METHODS: Trend analysis using 3 population-based surveys carried out in 2004, 2010, and 2021. Main outcome assessed was the prevalence of physical activity according to recommendations (150 min/wk). Inequalities dimensions measured were sex, self-reported skin color, and wealth. Intersectionalities were evaluated using Jeopardy index combining all inequality dimensions. Trend analysis was performed using least-squares weighted regression. RESULTS: We included data from 3090, 2656, and 5696 adults in 2004, 2010, and 2021, respectively. Prevalence of physical activity remains stable around 25% in the 3 years. In the 3 periods evaluated, men presented a prevalence in average 10 percentage points higher than women (SII2004 = -11.1 [95% confidence interval, CI, -14.4 to -7.8], SII2021 = -10.7 [95% CI, -13.7 to -7.7]). Skin color inequalities did not present a clear pattern. Richest individuals, in general presented a prevalence of leisure-time physical activity level 20pp higher than poorest ones (SII2004 = 20.5 [95% CI, 13.7 to 27.4]; SII2021 = 16.7 [95% CI, 11.3 to 22.0]). Inequalities were widely marked, comparing the most privileged group (represented by men, the wealthiest, and White) and the most socially vulnerable group (represented by women, the poorest, and Black/Brown). The Slope Index of Inequality for intersectionalities was -24.5 (95% CI, -31.1 to -17.9) in 2004 and -18.8 in 2021 (95% CI, -24.2 to -13.4). CONCLUSIONS: Our analysis shows that women, Black/Brown, and poor present lower leisure-time physical activity level. This group is often neglected regarding other health and social outcomes.

Two decades of socioeconomic inequalities in the prevalence of untreated dental caries in early childhood: Results from three birth cohorts in southern Brazil.

OBJECTIVES: To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. METHODS: The socioeconomic data to this study were collected at the 48-month follow-up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality-SII and Concentration Index-CIX) were used. RESULTS: The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro-poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. CONCLUSIONS: Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children.

Physical activity in birth cohorts of three Brazilian cities (Ribeirão Preto, Pelotas, and São Luís): A cross-sectional study.

OBJECTIVE: To describe the prevalence of physical activity among subjects from birth cohorts of three cities located in different regions of Brazil according to sociodemographic characteristics and sex, comparing the relationships within and between cohorts. METHODS: Cross-sectional study involving 12,724 adolescents and young adults who participated in five birth cohorts: Ribeirão Preto [1978/79 (37/39 years old in 2016) and 1994 (22 years in 2016)]; Pelotas [1982 (30 years in 2012) and 1993 (22 years in 2015)], and São Luís [1997/98 (18/19 years in 2016)]. Leisure-time physical activity was evaluated with questionnaires (insufficiently active: <150 min/week and active: ≥150 min/week) and moderate and vigorous physical activity (MVPA) was objectively measured by accelerometry. Those, in each city, were evaluated accordingly to skin color, socioeconomic classification, and study/work activities. RESULTS: The prevalence of leisure-time physical activity ranged from 29.2% at 30 years old in Pelotas to 54.6% among adolescents from São Luís. The prevalence of leisure-time physical activity was higher among younger people (54.6% in São Luís 1997), while the same was not observed for total physical activity. MVPA (3rd tercile) was higher in the cohorts from Pelotas and São Luís. The prevalence of leisure-time physical activity and MVPA was higher in men. The data showed that the variation in physical activity was associated with sex and sociodemographic conditions in all cohorts. CONCLUSION: Sociodemographic characteristics should be considered when promoting leisure-time physical activity and actions aimed at young people, and adults who are more socioeconomically vulnerable should be encouraged.

Corrigendum: Trends and Inequalities in Unplanned Pregnancy in Three Population-Based Birth Cohorts in Pelotas, Brazil.

[This corrects the article DOI: 10.1007/s00038-020-01505-0.].

Association between cesarean section and human capital in adulthood: 1982 and 1993 Pelotas birth cohorts, Rio Grande do Sul State, Brazil.

This study aims to assess the association between mode of delivery and human capital among young adults enrolled in the 1982 and 1993 Pelotas birth cohorts, Rio Grande do Sul State, Brasil. In 1982 and 1993, the maternity hospitals of the municipality were daily visited, the births identified, and those live births, whose family lived in the urban area of Pelotas, were examined and their mothers interviewed. Information on mode of delivery, vaginal or cesarean, was provided by the mother in the perinatal study. Performance in intelligence tests achieved schooling and income were evaluated in the 30 years visit at the 1982 cohort. At the 1993 cohort, schooling and income were assessed at the 22 years visit, whereas IQ was evaluated at 18 years. Tobacco smoking in adulthood and type of school was used as negative outcomes to strength causal inference. Initially, cesarean section was positively associated with human capital at adulthood, with the exception of income in the 1993 cohort. After controlling for confounders, the magnitude of the associations was strongly reduced, and the regression coefficients were close to the null value. The negative outcome analysis showed that, after controlling for confounding variables, the mode of delivery was not associated with tobacco smoking and type of school. Suggesting that the variables included in the regression model to control for confounding, provided an adequate adjustment and it is unlikely that the results are due to residual confounding by socioeconomic status. On the other hand, considering the short- and long-term risks and the epidemic of cesarean sections, measures should be implemented to reduce its prevalence.

RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís): history, objectives and methods.

This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.

RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís): history, objectives and methods / Consórcio RPS (Ribeirão Preto, Pelotas e São Luís) de coortes de nascimento brasileiras: história, objetivos e métodos / Consorcio RPS (Ribeirão Preto, Pelotas y São Luís) cohortes brasileñas de nacimiento: historia, objetivos y métodos

Abstract: This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.

Resumo: O artigo descreve a história, objetivos e métodos utilizados pelas nove coortes do Consórcio RPS de Coortes de Nascimento. São identificados eixos temáticos comuns, com apresentação dos objetivos, anos de linha de base, fases de seguimento e representatividade das populações de estudo. O Consórcio inclui três coortes de nascimento de Ribeirão Preto, Estado de São Paulo (1978/1979, 1994 e 2010), quatro de Pelotas, Estado do Rio Grande do Sul (1982, 1993, 2004 e 2015) e duas de São Luís, Estado do Maranhão (1997 e 2010). As coortes provêm de três regiões do Brasil, de três estados diferentes, com importantes diferenças socioeconômicas, culturais e de infraestrutura. As coortes foram iniciadas ao nascer dos participantes, exceto a mais recente em cada município, onde as mães foram recrutadas durante a gestação. Os instrumentos para a coleta de dados foram refinados para aproximar diferentes exposições na primeira infância e a influência, a longo prazo, no processo saúde-doença. Os investigadores das nove coortes realizaram estudos perinatais e depois examinaram o capital humano, saúde mental, nutrição e sinais percursores de doenças crônicas. Um total de 17.636 nascidos vivos foram recrutados em Ribeirão Preto, 19.669 em Pelotas e 7.659 em São Luís. Nas coortes que foram iniciadas durante a gestação, foram entrevistadas 1.400 gestantes em Ribeirão Preto, 3.199 em Pelotas e 1.447 em São Luís. Foram utilizadas diferentes estratégias para reduzir as perdas de seguimento. A rede de pesquisa do Consórcio permite analisar a incidência de doenças e identificar possíveis relações causais que podem explicar os desfechos de saúde nessas populações e contribuir para o desenvolvimento de medidas públicas e políticas de saúde que estejam mais de acordo com as respectivas realidades.

Resumen: El trabajo describe la historia, objetivos y métodos usados por nueve cohortes brasileñas del RPS Consorcio de Cohortes de Nacimiento. Se identificaron los ejes temáticos comunes y los objetivos, así como los periodos de referencia, la presentación del estadio de seguimiento y representatividad de la población estudiada. El consorcio incluye tres cohortes de nacimiento de Ribeirão Preto, Estado de São Paulo (1978/1979, 1994 y 2010), cuatro de Pelotas, Estado del Rio Grande do Sul (1982, 1993, 2004 y 2015), y dos de São Luís, Estado del Maranhão (1997 y 2010). Las cohortes cubren tres regiones de Brasil, de tres estados distintos, con marcadas diferencias socioeconómicas, culturales y de infraestructura. Las cohortes comenzaron con el nacimiento, excepto para la más reciente en cada municipio, donde las madres fueron reclutadas durante la gestación. Los instrumentos para la recogida de datos han sido depurados, con el fin de realizar una aproximación a diferentes exposiciones durante las fases tempranas de la vida y su influencia a largo plazo en el proceso de salud-enfermedad. Se incluyeron a los investigadores de las nueve cohortes, donde se llevaron a cabo estudios perinatales, así como los recursos humanos analizados posteriormente, al igual que la salud mental, nutrición y signos precursores de enfermedades no comunicables. Un total de 17.636 nacidos vivos fueron reclutados en Ribeirão Preto, 19.669 en Pelotas, y 7.659 en São Luís. En los estudios que comenzaron durante el embarazo, 1.400 mujeres embarazadas fueron entrevistadas en Ribeirão Preto, 3.199 en Pelotas, y 1.447 en São Luís. Se usaron diferentes estrategias para reducir pérdidas, con el fin de realizar el seguimiento. Esta red de investigación permite el análisis de la incidencia de enfermedades y el establecimiento de posibles relaciones causales que podrían explicar los resultados de salud de estas poblaciones, con el fin de contribuir al desarrollo de acciones gubernamentales y políticas de salud más consistentes con la realidad.

Association between cesarean section and human capital in adulthood: 1982 and 1993 Pelotas birth cohorts, Rio Grande do Sul State, Brazil / Associação entre cesariana e capital humano na idade adulta: as coortes de nascimentos de Pelotas, 1982 e 1993, Rio Grande do Sul, Brasil / Asociación entre cesárea y capital humano en la etapa adulta: cohortes de nacimiento de 1982 y 1993 en Pelotas, Río Grande do Sul, Brasil

Abstract: This study aims to assess the association between mode of delivery and human capital among young adults enrolled in the 1982 and 1993 Pelotas birth cohorts, Rio Grande do Sul State, Brasil. In 1982 and 1993, the maternity hospitals of the municipality were daily visited, the births identified, and those live births, whose family lived in the urban area of Pelotas, were examined and their mothers interviewed. Information on mode of delivery, vaginal or cesarean, was provided by the mother in the perinatal study. Performance in intelligence tests achieved schooling and income were evaluated in the 30 years visit at the 1982 cohort. At the 1993 cohort, schooling and income were assessed at the 22 years visit, whereas IQ was evaluated at 18 years. Tobacco smoking in adulthood and type of school was used as negative outcomes to strength causal inference. Initially, cesarean section was positively associated with human capital at adulthood, with the exception of income in the 1993 cohort. After controlling for confounders, the magnitude of the associations was strongly reduced, and the regression coefficients were close to the null value. The negative outcome analysis showed that, after controlling for confounding variables, the mode of delivery was not associated with tobacco smoking and type of school. Suggesting that the variables included in the regression model to control for confounding, provided an adequate adjustment and it is unlikely that the results are due to residual confounding by socioeconomic status. On the other hand, considering the short- and long-term risks and the epidemic of cesarean sections, measures should be implemented to reduce its prevalence.

Resumo: O estudo buscou avaliar a associação entre modo de parto e capital humano entre adultas jovens nas coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 1982 e 1993. Em 1982 e 1993, as maternidades de Pelotas foram visitadas diariamente, os nascimentos foram identificados e os nascidos vivos cujas famílias residiam na área urbana foram examinados e suas mães foram entrevistadas. As informações sobre modo de parto (vaginal versus cesáreo) foram coletadas durante a entrevista perinatal. O desempenho em testes de inteligência, nível de escolaridade e renda foram avaliados na visita de 30 anos da coorte de 1982. Para a coorte de 1993, escolaridade e renda foram avaliadas na visita de 22 anos, enquanto o QI foi avaliado aos 18 anos. Tabagismo na vida adulta e tipo de escola foram usados como desfechos negativos para fortalecer a inferência causal. Inicialmente, parto cesáreo mostrou associação positiva com capital humano na vida adulta, com exceção de renda na coorte de 1993. Depois de controlar para fatores de confusão, o tamanho das associações foi reduzido fortemente, e os coeficientes de regressão chegaram perto de valor nulo. A análise de desfechos negativos mostrou que depois de controlar para variáveis de confusão, o modo de parto não esteve associado ao tabagismo ou ao tipo de escola. Os resultados sugerem que as variáveis incluídas no model de regressão para controlar os fatores de confusão resultaram em ajuste adequado, e é improvável que os resultados atuais sejam devidos à confusão por posição socioeconômica. Por outro lado, devido aos riscos no curto e longo prazo e à epidemia de cesarianas, são necessárias medidas para reduzir a prevalência de partos cesáreos.

Resumen: El objetivo de este estudio es evaluar la asociación entre la forma de parto y el capital humano entre adultos jóvenes, que se encontraban en las cohortes de nacimiento de 1982 y 1993, en Pelotas, Río Grande do Sul, Brasil. En 1982 y 1993, se visitaron diariamente los hospitales de maternidad de la ciudad, se identificaron los nacimientos, se examinaron aquellos nacimientos vivos, cuya familia vivía en el área urbana de la ciudad, al igual que se realizaron entrevistas a sus madres. La información sobre la forma de parto (vaginal o cesárea) fue proporcionada por la madre en el estudio perinatal. Se evaluó tanto el rendimiento escolar alcanzado en tests de inteligencia, como los ingresos, transcurridos 30 años de la primera visita en la cohorte de 1982. En la cohorte de 1993, la escolaridad y los ingresos fueron evaluados tras la visita de hacía 22 años, mientras que el CI se evaluó a los 18 años. Fumar tabaco en la etapa adulta y el tipo de financiación de la escuela fueron usados como resultados negativos para la fortaleza de la inferencia causal. Inicialmente, la cesárea estuvo positivamente asociada con el capital humano en la etapa adulta, con la excepción de los ingresos en la cohorte de 1993. Tras controlar los factores de confusión, la magnitud de las asociaciones se vio fuertemente reducida, y los coeficientes de regresión eran cercanos al valor nulo. El análisis de resultado negativo mostró que, tras controlar las variables de confusión, el modo de parto no estuvo asociado con fumar tabaco y el tipo de financiación de la escuela. Sugiriendo que las variables incluidas en el modelo de regresión para el control de los factores de confusión, proporcionaron un ajuste adecuado, y es poco probable que los resultados actuales se deban a factores de confusión residuales por el estatus socioeconómico. Por otro lado, debido a los riesgos a corto y largo plazo y la epidemia de cesáreas, se deben implementar medidas para reducir la prevalencia de las cesáreas.

Trends and inequalities in unplanned pregnancy in three population-based birth cohorts in Pelotas, Brazil.

OBJECTIVES: To assess time trends in unplanned pregnancy, stratified by sociodemographic status, reproductive history, and inequalities in family income and women's skin color, in Pelotas, Brazil. METHODS: Data from mothers of participants of the 1993 (N = 5264), 2004 (N = 4243), and 2015 (N = 4268) Pelotas birth cohorts were analyzed. Unplanned pregnancy was investigated in the perinatal period, with tests to assess changes over time among different sociodemographic and reproductive history subgroups and inequalities as a function of family income and skin color. RESULTS: The prevalence of unplanned pregnancy was 62.7% (3299/ 5264), 65.9% (2794/ 4243), and 52.2% (2226/ 4268) in the 1993, 2004, and 2015 cohorts, respectively. Black or brown women and women of lower socioeconomic status had a higher prevalence of unplanned pregnancy in all cohorts. The overall rate of unplanned pregnancy decreased over time in most subgroups. Inequality as a function of family income and skin color increased during the time frame of assessment. CONCLUSIONS: The prevalence of unplanned pregnancies decreased in the period analyzed, but it is still unjustifiably high. Efforts aimed at reducing unplanned pregnancy are vital and will require special attention to the most vulnerable groups.

[Dietary patterns of elderly Brazilians and associated determinants: a population-based study in the south of Brazil]. / Padrões alimentares de idosos e seus determinantes: estudo de base populacional no sul do Brasil.

This cross-sectional study sought to assess the effect of demographic and socioeconomic factors, chronic diseases, and health counseling on dietary patterns of the elderly. Food consumption was assessed by means of a reduced eating frequency questionnaire distributed to 1,426 elderly residents in Pelotas, State of Rio Grande do Sul, Brazil, and dietary patterns were obtained using main component analysis. Two dietary patterns were identified: healthy diet (wholegrain food, fruits, vegetables, and milk) and Western diet (sweet snacks, fried foods, frozen foods, processed meats, and fast food). Females, non-smokers, and alcohol-free individuals tended more toward the healthy diet, whereas males, smokers, alcohol-dependent, and overweight individuals tended more toward the Western diet. Higher income and schooling were associated with a higher tendency toward both diets, and chronic diseases were not associated with either diet. Receiving counseling for adopting healthy habits was associated with a higher tendency toward a healthy diet and a lower tendency toward the Western diet. There is a need to increase effective guidance on healthy habits by health services to promote healthier eating practices, with special attention to elderly males, smokers, alcohol-dependent and overweight individuals.

Este estudo teve como objetivo avaliar o efeito de fatores demográficos e socioeconômicos, de doenças crônicas e do recebimento de orientações em saúde no padrão alimentar de idosos. O consumo alimentar foi avaliado por meio de questionário de frequência alimentar reduzido aplicado a 1.426 idosos residentes em Pelotas, RS, Brasil e os padrões alimentares foram obtidos por análise de componentes principais. Dois padrões foram identificados: saudável (alimentos integrais, frutas, legumes/verduras e leite) e ocidental (doces, frituras, alimentos congelados, embutidos e "fast food"). Mulheres, não fumantes e não dependentes alcoólicos aderiam mais ao padrão saudável, enquanto que homens, fumantes, dependentes alcóolicos e indivíduos com sobrepeso aderiam mais ao padrão ocidental. Maior renda e escolaridade estiveram associadas à maior adesão de ambos os padrões e a presença de doenças crônicas não esteve associada a nenhum padrão. O recebimento de orientações para hábitos saudáveis esteve associado à maior adesão ao padrão saudável e menor ao padrão ocidental. Há necessidade do fortalecimento de orientações eficazes sobre hábitos saudáveis nos serviços de saúde, com especial atenção para idosos do sexo masculino, tabagistas, dependentes alcoólicos e indivíduos com sobrepeso.

Maternal pregnancy smoking in three Brazilian cities: trends and differences according to education, income, and age.

OBJECTIVES: To estimate and assess pregnancy smoking trends since 1978, according to sociodemographic characteristics, in three Brazilian sites. METHODS: We used cross-sectional data from the perinatal studies of nine birth cohorts, located in the southeast (Ribeirão Preto-1978/1979, 1994, and 2010), south (Pelotas-1982, 1993, 2004, and 2015), and northeast (São Luís-1997/1998 and 2010) regions of Brazil. We estimated the prevalence of pregnancy smoking at each time point according to age, education, and family income, in each cohort, and evaluated smoking trends. RESULTS: We analyzed data of 17,275 women in Ribeirão Preto, 19,819 in Pelotas, and 7753 in São Luís. Smoking decreased by 59% in Ribeirão Preto (p < 0.001), 54% in Pelotas (p < 0.001), and 32% in São Luís (p < 0.001). However, among those with 0-4 years of education, smoking did not change in Ribeirão Preto (p-trend = 0.501) nor São Luís (p = 0.556) and increased in Pelotas (p-trend = 0.003). CONCLUSIONS: Pregnancy smoking has been declining during the last decades. However, among less-educated women, pregnancy smoking did not change in two sites and increased in one of them.

Sleep parameters measured by accelerometry: descriptive analyses from the 22-year follow-up of the Pelotas 1993 birth cohort.

OBJECTIVE: To describe the sleep time window (STW), total sleep time (TST), and sleep percent [SP = (TST/STW) × 100] by accelerometry in a population-based young adult cohort in Brazil. METHODS: Cross-sectional analysis with a 22-year sample (N = 2462). Sleep variables were measured using an accelerometer. The devices were worn on the non-dominant wrist for approximately seven days. A raw data analysis using the GGIR package was performed. The following sleep variables were extracted: TST, STW, and SP. Linear regression was used to adjust averages. All analyses were stratified according to sex. A comparison between weekday and weekend averages was also conducted. RESULTS: The means of TST, STW, and SP for men were 5.9 h, 7.1 h, and 83.1%, respectively. For women, the means of TST, STW, and SP were 6.4 h, 7.6 h, and 84.6%, respectively. Women presented a higher means of all outcomes compared to men (p < 0.001). After adjusting for both sexes, white skin color and not working or studying were associated with higher TST. Individuals not working or studying presented higher means of STW and lower sleep SP. Women with children who were less than two years of age presented lower values of three evaluated outcomes. Regarding behavior and health condition variables, obesity was associated with lower STW only for men. Physical activity was associated with higher SP and risk drinking with lower TST and STW only for women. CONCLUSION: Differences between sexes were observed in TST, STW, and SP. In all outcomes women presented a higher means. Socioeconomic variables were associated with both sexes, but having children and behavior/health conditions differed between sexes.

The emergence of vaccine hesitancy among upper-class Brazilians: Results from four birth cohorts, 1982-2015.

Vaccine hesitancy has been increasingly reported in Brazil. We describe secular trends and socioeconomic disparities from 1982 to 2015, using data from four population-based birth cohorts carried out in the city of Pelotas. Full immunization coverage (FIC) was defined as having received four basic vaccines (one dose of BCG and measles, and three doses of polio and DTP) scheduled for the first year of life. Information on income was collected through standardized questionnaires, and the slope index of inequality (SII) was calculated to express the difference in percent points between the rich and poor extremes of the income distribution. Full immunization coverage was 80.9% (95% CI 79.8%; 82.0%) in 1982, 97.2% (96.1%; 98.0%) in 1993, 87.8% (86.7%; 88.8%) in 2004 and 77.2% (75.8%; 78.4%) in 2015. In 1982 there was a strong social gradient with higher coverage among children from wealthy families (SII = 25.0, P < 0.001); by 2015, the pattern was inverted with higher coverage among poor children (SII = -6.0; P = 0.01). Vertical immunization programs in the 1980s and creation of the National Health Services in 1980 eliminated the social gradient that had been present up to the 1980s, to reach near universal coverage. The recent decline in coverage is likely associated with the growing complexity of the vaccination schedule and underfunding of the health sector. In addition, the faster decline observed among children from wealthy families is probably due to vaccine hesitancy.

The Intersectionality of Gender and Wealth in Adolescent Health and Behavioral Outcomes in Brazil: The 1993 Pelotas Birth Cohort.

PURPOSE: Brazilian society is characterized by deep socioeconomic inequalities. Using data from a population-based birth cohort, we explored how the intersectionality of family income and gender may affect adolescent health and behavioral outcomes. METHODS: Children born in 1993 in the Brazilian city of Pelotas have been followed up prospectively at the age of 15 years when the follow-up rate was 85.7% of the original cohort. Participants answered standardized questionnaires, and anthropometric measures were obtained. Outcomes in five domains were studied: overweight (body mass index above +1 SD of the World Health Organization standard for age and sex), cigarette smoking (in the previous month), violence (fight in which someone was injured, in the past year), self-reported unhappiness (based on a face scale), and psychological symptoms (Strengths and Difficulties Questionnaire). Monthly family income was recoded in quintiles. RESULTS: Results were available for more than 4,101-4,334 adolescents, depending on the outcome. Overweight was more common among boys than girls (29.7% and 25.6%; p = .004) and was directly related to family income among boys (p < .001), but not among girls (p = .681). Smoking was less common among boys than girls (12.3% and 21.0%, p < .001) and showed strong inverse association with income among girls (p < .001), but not among boys (p = .099). Reported violence was twice as common among boys than girls (16.4% vs. 8.0%; p < .001); an inverse association with income was present among girls (p < .001), but not for boys (p = .925). Boys and girls were similarly likely to report being unhappy (18.4% and 20.1%; p = .176), with an inverse association with family income in girls. Psychological symptoms were slightly less common among boys than girls (25.3% and 28.3%; p = .014), with strong inverse associations with income in both sexes (p < .001). Adolescent girls from poor families were the group with the highest prevalence for three of the five outcomes: smoking, unhappiness, and psychological problems. CONCLUSIONS: Gender norms influence adolescent health and behavioral outcomes, but the direction and strength of the associations are modified by socioeconomic position. Preventive strategies must take into account the intersectionality of gender and wealth.

Padrões alimentares de idosos e seus determinantes: estudo de base populacional no sul do Brasil / Dietary patterns of elderly Brazilians and associated determinants: a population-based study in the south of Brazil

Resumo Este estudo teve como objetivo avaliar o efeito de fatores demográficos e socioeconômicos, de doenças crônicas e do recebimento de orientações em saúde no padrão alimentar de idosos. O consumo alimentar foi avaliado por meio de questionário de frequência alimentar reduzido aplicado a 1.426 idosos residentes em Pelotas, RS, Brasil e os padrões alimentares foram obtidos por análise de componentes principais. Dois padrões foram identificados: saudável (alimentos integrais, frutas, legumes/verduras e leite) e ocidental (doces, frituras, alimentos congelados, embutidos e "fast food"). Mulheres, não fumantes e não dependentes alcoólicos aderiam mais ao padrão saudável, enquanto que homens, fumantes, dependentes alcóolicos e indivíduos com sobrepeso aderiam mais ao padrão ocidental. Maior renda e escolaridade estiveram associadas à maior adesão de ambos os padrões e a presença de doenças crônicas não esteve associada a nenhum padrão. O recebimento de orientações para hábitos saudáveis esteve associado à maior adesão ao padrão saudável e menor ao padrão ocidental. Há necessidade do fortalecimento de orientações eficazes sobre hábitos saudáveis nos serviços de saúde, com especial atenção para idosos do sexo masculino, tabagistas, dependentes alcoólicos e indivíduos com sobrepeso.

Abstract This cross-sectional study sought to assess the effect of demographic and socioeconomic factors, chronic diseases, and health counseling on dietary patterns of the elderly. Food consumption was assessed by means of a reduced eating frequency questionnaire distributed to 1,426 elderly residents in Pelotas, State of Rio Grande do Sul, Brazil, and dietary patterns were obtained using main component analysis. Two dietary patterns were identified: healthy diet (wholegrain food, fruits, vegetables, and milk) and Western diet (sweet snacks, fried foods, frozen foods, processed meats, and fast food). Females, non-smokers, and alcohol-free individuals tended more toward the healthy diet, whereas males, smokers, alcohol-dependent, and overweight individuals tended more toward the Western diet. Higher income and schooling were associated with a higher tendency toward both diets, and chronic diseases were not associated with either diet. Receiving counseling for adopting healthy habits was associated with a higher tendency toward a healthy diet and a lower tendency toward the Western diet. There is a need to increase effective guidance on healthy habits by health services to promote healthier eating practices, with special attention to elderly males, smokers, alcohol-dependent and overweight individuals.

Association of risk behaviours, socio-economic characteristics and academic progress in adolescents: an analysis of the 1993 birth cohort in Pelotas, Brazil.

To analyze how socio-economic factors and behavioural characteristics are related to the failure of academic progress. Data of the 1993 Birth Cohort of the city of Pelotas, Brazil, were analyzed using four follow-up waves. As a measure of the failure of academic progress, we used indicators of the age-grade gap. We analyzed the association of demographic, socio-economic, and behavioural characteristics. Factors associated with failure of academic progress were assessed through logistic regression. There are a higher odds of the age-grade gap when the adolescent is not white, man, of low socio-economic status, whose parents have low schooling and living in large families. In relation to risk behaviours, alcohol and tobacco consumption represent higher odds of the age-grade gap at age 18. The results show that socio-economic factors and behavioural characteristics are important predictors of academic progress. Public policies that seek to promote education should be targeted at the most vulnerable groups, decreasing the observed inequalities.

How different online recruitment methods impact on recruitment rates for the web-based coortesnaweb project: a randomised trial.

BACKGROUND: The number of web-based E-epidemiologic studies using online recruitment methods is increasing. However, the optimal online recruitment method in terms of maximizing recruitment rates is still unknown. Our aim was to compare the recruitment rates of three online recruitment methods and to describe how these rates differ according to individual's socioeconomic and demographic factors. METHODS: A total of 2394 members of the 1993 Pelotas birth cohort that provided an e-mail address, a Facebook name, and a WhatsApp number during a face-to-face follow-up were randomly allocated to be recruited by e-mail, Facebook or WhatsApp (798 individuals per method). This was a parallel randomised trial applying a block randomisation (block size = 3). Between January and February 2018, we sent messages inviting them to register into the web-based coortesnaweb platform. Recruitment rates were calculated for each method, and stratified according to the individual's socioeconomic and demographic characteristics. We also analysed absolute and relative inequalities on recruitment according to schooling and socioeconomic position. RESULTS: Out of the 2394 individuals analysed, 642 registered into the platform. The overall recruitment rate was 26.8%. Recruitment rates for women were almost 10 percentage points higher compared to men. Facebook was the most effective recruitment method, as 30.6% of those invited through the social network were recruited. Recruitment rates of e-mail and WhatsApp were similar (recruitment rate = 24.9%). E-mail and Facebook were the most effective recruitment methods to invite highly educated and wealthier individuals. However, sending e-mails to recruit individuals also reflected in the highest inequalities according to schooling and socioeconomic position. In contrast, the lowest inequalities according to socioeconomic position were observed using Facebook. CONCLUSIONS: Facebook was the most effective online recruitment method, also achieving the most equitable sample in terms of schooling and socioeconomic position. The effectiveness of online recruitment methods depends on the characteristics of the sample. It is important to know the profile of the target sample in order to decide which online recruitment method to use. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials, identifier: RBR-3dv7gc , retrospectively registered in 10 April 2018.

Trends and inequalities in maternal and child health in a Brazilian city: methodology and sociodemographic description of four population-based birth cohort studies, 1982-2015.

BACKGROUND: Few low-middle-income countries have data from comparable birth cohort studies spanning over time. We report on the methods used by the Pelotas cohorts (1982, 1993, 2004 and 2015) and describe time trends in sociodemographic characteristics of the participant families. METHODS: During the four study years, all maternity hospitals in the city were visited daily, and all urban women giving birth were enrolled. Data on socioeconomic and demographic characteristics were collected using standardized questionnaires, including data on maternal and paternal skin colour, age and schooling, maternal marital status, family income and household characteristics. The analyses included comparisons of time trends and of socioeconomic and ethnic group inequalities. RESULTS: Despite a near 50% increase in the city's population between 1982 and 2015, the total number of births declined from 6011 to 4387. The proportion of mothers aged ≥35 years increased from 9.9% to 14.8%, and average maternal schooling from 6.5 [standard deviation (SD) 4.2] to 10.1 (SD 4.0) years. Treated water was available in 95.3% of households in 1982 and 99.3% in 2015. Three-quarters of the families had a refrigerator in 1982, compared with 98.3% in 2015. Absolute income-related inequalities in maternal schooling, household crowding, household appliances and access to treated water were markedly reduced between 1982 and 2015. Maternal skin colour was associated with inequalities in age at childbearing and schooling, as well as with household characteristics. CONCLUSIONS: During the 33-year period, there were positive changes in social and environmental determinants of health, including income, education, fertility and characteristics of the home environment. Socioeconomic inequality was also reduced.

Infant nutrition and growth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015.

BACKGROUND: Levels of child undernutrition have declined in many middle-income countries, whereas overweight and obesity have increased. We describe time trends in nutritional indicators at age 1 year in the 1982, 1993, 2004 and 2015 Pelotas (Brazil) Birth Cohorts. METHODS: Each study included all children born in the urban area of the city, with over 4 200 births in each cohort. Children were measured at approximately 12 months of age. Anthropometric indicators were calculated according to World Health Organization Growth Standards. Stunting and wasting were defined as <-2 Z scores for length for age and weight for length, and overweight as >2 Z scores for weight for length. Prevalence was stratified by sex, maternal skin colour and family income. RESULTS: The prevalence of stunting declined by 53% (from 8.3% to 3.9%) from 1982 to 2015. Wasting prevalence remained stable at low levels (1.8% in 1982 and 1.7% in 2015), whereas overweight increased by 88% (6.5% to 12.2%). Undernutrition was more common among boys, those born to mothers with brown or black skin colour and in the poorest quintile of families. Socioeconomic inequalities in undernutrition decreased markedly over time. Overweight was markedly more common among the rich in 1982, but fast increase among the poor eliminated socioeconomic differences by 2015, when all groups showed similar prevalence. CONCLUSIONS: Our results confirm the rapid nutrition transition in Brazil, with marked reduction in levels and inequalities in undernutrition in parallel with a rapid increase in overweight, which became the main nutritional problem for children.

Are cytokines (IL-6, CRP and adiponectin) associated with bone mineral density in a young adult birth cohort?

BACKGROUND: Studies have shown that cytokines play a role in bone remodeling. METHODS: In 1993, all hospital births occurred in Pelotas (Brazil) were identified and a total of 5249 newborns were included in the present cohort. Sub-samples of this cohort were visited during childhood and all members were traced at 11, 15, 18 and 22 years old. At 18 and 22 years the following biomarkers were measured: IL-6, CRP and adiponectin (the last one in a sub-sample) and bone mineral density (BMD-mg/cm2) was evaluated at 22 years. Crude regression analysis as well as adjusted for confounders (birth weight, pregnancy maternal smoking, gestational age, skin color, schooling, income, smoking, alcohol, physical activity, medical diagnosis of asthma, diabetes and hypertension, BMI, height, calcium intake, corticosteroid use, age at menarche, insulin and testosterone) were performed between the three biomarkers and the whole-body, lumbar spine and femoral BMD. RESULTS: No statistical significant association was found between IL-6 and CRP with BMD, in males. Significant inverse association in the adjusted analysis, among females, was found for the highest tertiles of CRP at 22 y (beta - 15.2 mg/cm2; 95% CI: -25.4; - 4.9; p = 004), of CRP and IL-6 at 22 years (beta - 20.0 mg/cm2; 95% CI: -31.7; - 8.3; p = 0.003), and of IL-6 and CRP at both ages (beta - 20.3 mg/cm2; 95% CI: -38.0; - 2.5; p = 0.001) with total body BMD. Significant association, among males, was also found between the highest tertile of adiponectin at 22 y (beta - 23.3 mg/cm2; 95% CI: -35.5; - 11.1; p = < 001; beta - 22.5 mg/cm2; 95% CI: -42.9; - 2.2; p = 0.03; and beta - 31.8 mg/cm2; 95% CI: -55.5; - 9.1; p = 0.006) and total body, lumbar spine and femur neck BMD, respectively; and, among females, - 17.8 mg/cm2; 95% CI: -34.9; - 0.9; p = 0.033, with lumbar spine BMD. CONCLUSION: CRP at 22 years, in females, seems to be a marker for total body BMD; adiponectin at 22 years is also a marker for BMD at the three sites, in males, and for lumbar spine BMD, in females.