Testing the effectiveness of two psychosocial interventions - ACCENT and Didactic - to prevent HIV/AIDS behavioral risk factors in Mozambican women: a randomized controlled study.

In Mozambique, women are the most affected by HIV/AIDS and heterosexual encounters remain the main route for HIV/AIDS. Condom use is the most effective method of HIV/AIDS prevention, and the intention to use and buy/get condoms has a significant role in safe sex behavior. This study aimed to evaluate the efficacy of two psychosocial interventions - the Didactic and ACCENT Interventions - to prevent HIV/AIDS among Mozambican Women. Participants were Mozambican women (n = 150), users of the gynecology clinic of the Central Hospital of Beira. The study design was a randomized controlled trial (RCT) with assignment to three groups: Didactic intervention, ACCENT intervention, and Control group. Measures were from an adaption of the Women's Health Questionnaire, which includes questions about sociodemographic, clinical, and behavioral variables related to HIV prevention/risk. There was a significant group effect on condom use and safer sex preparatory behaviors, F(2, 146) = 6.45, p = .002, with Bonferroni post-hoc tests showing differences between the ACCENT vs. Control groups and ACCENT vs. Didactic groups (all p = .022). There were no statistically significant time effects on both condom use and safer sex preparatory behaviors. Results are promising for HIV/AIDS prevention in Mozambican women at sexual risk, but replication is needed for generalizability of findings.

The intersection of race/ethnicity and socioeconomic status: inequalities in breast and cervical cancer mortality in 20,665,005 adult women from the 100 Million Brazilian Cohort.

OBJECTIVES: There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with race/ethnicity. DESIGN: The 100 Million Brazilian Cohort data were linked to the Brazilian Mortality Database, 2004-2015 (n = 20,665,005 adult women). We analysed the association between self-reported race/ethnicity (White/'Parda'(Brown)/Black/Asian/Indigenous) and cancer mortality using Poisson regression, adjusting for age, calendar year, education, household conditions and area of residence. Additive and multiplicative interactions were assessed. RESULTS: Cervical cancer mortality rates were higher among Indigenous (adjusted Mortality rate ratio = 1.80, 95%CI 1.39-2.33), Asian (1.63, 1.20-2.22), 'Parda'(Brown) (1.27, 1.21-1.33) and Black (1.18, 1.09-1.28) women vs White women. Breast cancer mortality rates were higher among Black (1.10, 1.04-1.17) vs White women. Racial inequalities in cervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicative interaction <0.001, and 0.02, respectively). Compared to White women living in completely adequate (3-4) household conditions, the risk of cervical cancer mortality in Black women with 3-4, 1-2, and none adequate conditions was 1.10 (1.01-1.21), 1.48 (1.28-1.71), and 2.03 (1.56-2.63), respectively (Relative excess risk due to interaction-RERI = 0.78, 0.18-1.38). Among 'Parda'(Brown) women the risk was 1.18 (1.11-1.25), 1.68 (1.56-1.81), and 1.84 (1.63-2.08), respectively (RERI = 0.52, 0.16-0.87). Compared to high-educated White women, the risk in high-, middle- and low-educated Black women was 1.14 (0.83-1.55), 1.93 (1.57-2.38) and 2.75 (2.33-3.25), respectively (RERI = 0.36, -0.05-0.77). Among 'Parda'(Brown) women the risk was 1.09 (0.91-1.31), 1.99 (1.70-2.33) and 3.03 (2.61-3.52), respectively (RERI = 0.68, 0.48-0.88). No interactions were found for breast cancer. CONCLUSION: Low SES magnified racial inequalities in cervical cancer mortality. The intersection between race/ethnicity, SES and gender needs to be addressed to reduce racial health inequalities.

Sociodemographic and academic factors associated with unhealthy lifestyle among Brazilian nursing students.

This study aimed to identify sociodemographic and academic factors associated with unhealthy lifestyles among Brazilian undergraduate nursing students. A cross-sectional study was completed by 286 nursing students in Brazil. Multinomial logistic regression was conducted to examine the association between sociodemographic and academic variables with the latent lifestyle indicator. The model fit's validity was assessed using Akaike information coefficient estimation, Hosmer-Lemeshow test, and the ROC curve. A high health risk lifestyle was 2.7 times more likely among students aged 18-24 years than students aged 25 years or older (OR = 2.7, 95% CI = [1.18, 6.54] p = 0.02); 2.3 times more likely among students with ≥400 h of semester time (OR = 2.3, 95% CI = [0.93, 5.90], p = 0.07); and 3.8 times more likely among female students (OR = 3.8, 95% CI = [0.82, 8.12], p = 0.09). A moderate health risk lifestyle was 1.8 times more likely among students from the 6th to 10th semesters (OR = 1.8, 95% CI = [-0.95, 3.75], p = 0.07). Sociodemographic and academic factors were associated with unhealthy lifestyles. Health promotion efforts are necessary to improve nursing students' health behaviors.

Body image distortion among Brazilian and Portuguese women with children: A comparative study between the ELSA-Brasil and Generation XXI cohorts.

Solid evidence indicates that body image distortion is associated with various physical and mental health problems in women (e.g. Lee and Lee, 2016; Mölbert et al., 2017; Raj and Ploriya, 2020; Sagar, 2005; Shin et al., 2015). Furthermore, body image has been shown to vary according to life context and stage, particularly after a woman has had children. This scenario justifies the comparison between different countries and cultures. The objective of the present study was to evaluate the prevalence and associated factors of body image distortion/accuracy in Brazilian and Portuguese women with children. The study assessed women selected from two epidemiological cohorts: ELSA-Brasil in Brazil (n = 1468) and Generation XXI in Portugal (n = 3380). The data analyzed were based on multidimensional questionnaires from which sociodemographic and family characteristics as well as data associated with lifestyle and health were obtained. The results show that most women in both cohorts had an accurate perception of their own body size. In cases of distorted self-perception, the likelihood of the Brazilian women perceiving themselves as being heavier was greater if they had had cancer, whereas the Portuguese women were less likely to perceive themselves as heavier when they had less schooling. Perceiving themselves as thinner than they actually are, was associated with poorer self-perception of their own state of health in the Brazilian women and with poorer schooling in both the Brazilian and Portuguese women. The present findings contribute towards improving understanding of the influence of body image distortion on the health and wellbeing of Brazilian and Portuguese women, possibly leading to the implementation of health-promoting policies in both countries.

Association Between Perceived Discrimination and Alcohol and Tobacco Consumption in ELSA-Brasil Cohort: Focusing on Gender Differences.

BACKGROUND: Discrimination is detrimental to physical and mental health, particularly insofar as health-risk behaviors are concerned. Particular attention has been paid to excess alcohol consumption and smoking in view of the ready availability of these substances in Western societies. OBJECTIVES: To determine whether an association exists between perceived discrimination and excess alcohol intake and smoking in women and men enrolled in the ELSA-Brasil cohort study. METHODS: The sample included in the ELSA-Brasil cohort consisted of 15,105 civil servants. Data from waves 1 and 2 of the study were used. A multidimensional questionnaire was used to collect sociodemographic characteristics and evaluate perceived discrimination, alcohol consumption, and smoking. RESULTS: An association was found between excess alcohol intake and perceived discrimination only in the men, with this association remaining significant in the youngest age group, in university-educated individuals, and in the group classified as middle-class. An association was found between smoking and lifetime perceived discrimination in women, particularly in those ≥60 years of age, brown-skinned women, those who had completed elementary school, and those classified as upper social class. This same association was found in the men, mainly those of 50-59 years of age, white-skinned males, those who had completed high school, those with a university education, and those classified as upper social class. Conclusions/Importance: Investing in public health policies aimed at combating the different forms of discrimination would appear essential. Not only does discrimination contribute to social injustice, but it also encourages health-risk behaviors such as excess alcohol intake and smoking.

Socio-demographic, marital and psychosocial predictors of safe sex behaviour among Mozambican women at risk for HIV/AIDS.

Heterosexual encounters remain the primary route for HIV transmission in Africa. Safer sex behaviour is not adopted by many women due to several social and psychological factors. This paper aims to identify socio-demographic, marital and psychosocial predictors associated with current sexual activity and condom use in Mozambican women at sexual risk for HIV/AIDS. Women (173), patients at a public hospital and at risk for HIV infection, completed measures of condom use negotiation self-efficacy, perceived barriers against safer sex, current sexual activity and condom use. Having more than 6 years of education and being younger and single were significant predictors for current sexual activity and condom use. Regarding psychosocial factors, talking about AIDS with partners, condom use negotiation self-efficacy and fewer perceived barriers to safer sex were significant predictors for current sexual activity (intention to use and buy/get condoms). Condom use negotiation self-efficacy is a significant predictor for condom use. These results should be considered in new HIV prevention intervention design in Mozambique.

Gender differences in psychosocial predictors of self-perceived health status in the elderly: Evidence from a Brazilian community study.

This article aims to identify the psychosocial factors associated with self-perceived health status in the Brazilian elderly population and to present differences related to gender. The data were collected by questionnaire, including sociodemographic and behavioral questions, and scales for psychological dimensions. Self-perceived health status is related to level of education, physical activity, and self-efficacy in the total population. Regarding gender differences, self-rated health status among men is related to education level and self-efficacy and in women to level of education, physical activity, social support, and self-efficacy. These results can inform future health promotion interventions.

Socio-demographic, Marital, and Psychosocial Factors Associated with Condom Use Negotiation Self-Efficacy Among Mozambican Women at Risk for HIV Infection.

PURPOSE: In Mozambique, women are the most affected by HIV/AIDS. Self-efficacy is one of the main predictors of effective use of a condom. Therefore, it is essential to identify the factors that influence condom-use negotiation self-efficacy in vulnerable women. The aim of this paper is to identify socio-demographic, marital, and psychosocial factors associated with condom-use negotiation self-efficacy among Mozambican women at risk for HIV infection. METHODS: Participants were women (173) who were patients at the Gynecology Department of the Central Hospital of Beira, Mozambique, and at risk for HIV infection. Women completed measures of condom-use negotiation self-efficacy, HIV prevention knowledge, and perceived barriers against safer sex. RESULTS: The results showed that demographic and marital variables are associated with condom-use negotiation self-efficacy, namely, those having more than 9 years of education, who are younger and not living with a partner, and who talk about AIDS with partners report higher condom-use negotiation self-efficacy. Regarding psychosocial factors, higher HIV prevention knowledge and fewer perceived barriers to safer sex predict higher condom-use negotiation self-efficacy. CONCLUSION: These results can contribute to sexual health promotion and HIV/AIDS prevention in Mozambican women because they identify at-risk groups and marital and psychosocial malleable factors that can be targeted in AIDS prevention among at-risk Mozambican women.

[Body image perception, socioeconomic characteristics, and lifestyle in women participating in ELSA-Brasil in Bahia, Brazil]. / Percepção de imagem corporal, características socioeconômicas e estilo de vida em mulheres participantes do ELSA-Brasil na Bahia, Brasil.

Body image distortion is an alteration in the perception of the body that can have repercussions on health. This study aims to estimate the prevalence of body image accuracy and distortion among women participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) living in Bahia State, Brazil, and to investigate associations with socioeconomic characteristics, lifestyle, and gynecological care seeking. A total of 609 women aged 50 to 69 years participated in the study, who answered face-to-face questionnaires from 2012 to 2014. The Stunkard silhouette scale was used to investigate accurate or distorted perception for more or less weight. The relative risk ratio (RR) was calculated by multinomial logistic regression using Stata 13. Most participants have an accurate perception of their own bodies (53.7%). Among those with distorted perception, there is a tendency to distort towards less weight (38.1%). In the multinomial regression analysis, the variables race/skin color and education remained associated with the distortion towards underweight. The race/skin color variable was positively associated with the distortion towards underweight among Mixed-race women (RR = 1.89; 95%CI: 1.13-3.16) and black (RR = 2.10; 95%CI: 1.25-3.55), while the education variable among those with up to high school education (RR = 1.65; 95%CI: 1.18-2.33). There were no associations with the other variables or with distortion for more weight. The results contribute to explaining the relationships between body image perception and socioeconomic factors, revealing that women of different races/skin colors and varying educational levels are influenced in different ways by social discourses, impacting the perception of their body image.

Distorção da imagem corporal é uma alteração da percepção do corpo que pode repercutir na saúde. Este estudo visa estimar, entre mulheres participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) residentes na Bahia, Brasil, a prevalência de acurácia e distorção da imagem corporal e investigar associações com características socioeconômicas, estilo de vida e procura de cuidados ginecológicos. Participaram 609 mulheres de 50-69 anos de idade que responderam, entre 2012-2014, questionários aplicados face a face. Foi utilizada a escala de silhuetas de Stunkard para investigar a percepção acurada ou distorcida para mais ou menos peso. A razão de risco relativo (RR) foi calculada por meio de regressão logística multinomial por meio do Stata 13. A maioria das participantes tem perspectiva acurada do próprio corpo (53,7%). Entre aquelas com percepção distorcida, há uma tendência à distorção para menos peso (38,1%). Na análise de regressão multinomial, permaneceram associadas à distorção para menos peso as variáveis raça/cor e escolaridade, sendo que a primeira foi positivamente associada à distorção para menos peso entre as pardas (RR = 1,89; IC95%: 1,13-3,16) e pretas (RR = 2,10; IC95%: 1,25-3,55), enquanto a segunda entre aquelas com escolaridade até o Ensino Médio (RR = 1,65; IC95%: 1,18-2,33). Não houve associações quanto às demais variáveis, nem com distorção para mais peso. Os resultados contribuem para a explicação das relações entre percepção da imagem corporal e fatores socioeconômicos, revelando que mulheres de raça/cor diferentes e variados níveis de escolaridade são influenciadas de formas distintas pelos discursos sociais, o que impacta a percepção da sua imagem corporal.

La distorsión de la imagen corporal es una alteración en la percepción del cuerpo que puede repercutir en la salud. Este estudio busca estimar, entre las mujeres participantes del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil) que viven en Bahía, Brasil, la prevalencia de precisión y distorsión de la imagen corporal e investigar asociaciones con las características socioeconómicas, el estilo de vida y la busca de atención ginecológica. Participaron 609 mujeres que tenían entre 50 y 69 años que contestaron los cuestionarios aplicados cara a cara entre 2012 y 2014. Se utilizó la escala de siluetas de Stunkard para investigar la percepción precisa o distorsionada para más o menos peso. El cociente de riesgo relativo (RR) se calculó a través de regresión logística multinomial utilizando el Stata 13. La mayoría de los participantes tiene una perspectiva precisa del propio cuerpo (53,7%). Entre las personas con percepción distorsionada hay una tendencia a la distorsión para menos peso (38,1%). En el análisis de regresión multinomial, las variables raza/color y escolaridad permanecieron asociadas con la distorsión para menos peso, siendo la primera positivamente asociada con la distorsión para menos peso entre las mujeres pardas (RR = 1,89; IC95%: 1,13-3,16) y negras (RR = 2,10; IC95%: 1,25-3,55), mientras la segunda entre las mujeres que estudiaron hasta la enseñanza secundaria (RR = 1,65; IC95%: 1,18-2,33). No hubo asociaciones con las otras variables ni con la distorsión para más peso. Los resultados contribuyen para explicar las relaciones entre la percepción de la imagen corporal y los factores socioeconómicos, demostrando que mujeres de diferentes razas/colores y diferentes niveles de educación se influyen de distintas formas a través de discursos sociales, lo que impacta en la percepción de su imagen corporal.

Leisure-Time Physical Activity May Attenuate the Impact of Diabetes on Cognitive Decline in Middle-Aged and Older Adults: Findings From the ELSA-Brasil Study.

OBJECTIVE: To assess leisure-time physical activity (LTPA) as a modifier of the diabetes/cognitive decline association in middle-aged and older participants in the Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) study. RESEARCH DESIGN AND METHODS: ELSA-Brasil is a cohort of 15,105 participants (age 35-74 years) enrolled between 2008 and 2010. We evaluated global cognitive function, summing the scores of six standardized tests evaluating memory and verbal fluency, including the Trail-Making Test, at baseline and follow-up. Incident cognitive impairment was defined as a global cognitive function score at follow-up lower than -1 SD from baseline mean. Participants reporting ≥150 min/week of moderate to vigorous LTPA at baseline were classified as physically active. We assessed the association of LTPA with global cognition change in those with diabetes in the context of our overall sample through multivariable regression models. RESULTS: Participants' (N = 12,214) mean age at baseline was 51.4 (SD 8.8) years, and 55.5% were women. During a mean follow-up of 8.1 (SD 0.6) years, 9,345 (76.5%) inactive participants and 1,731 (14.1%) participants with diabetes at baseline experienced faster declines in global cognition than those who were active (ß = -0.003, -0.004, and -0.002) and those without diabetes (ß = -0.004, -0.005, and -0.003), respectively. Diabetes increased the risk of cognitive impairment (hazard ratio [HR] 1.71; 95% Cl 1.22, 2.39) in inactive but not in active adults (HR 1.18; 95% CI 0.73, 1.90). Among participants with diabetes, those who were active showed a delay of 2.73 (95% CI 0.94, 4.51) years in the onset of cognitive impairment. CONCLUSIONS: In adults living with diabetes, LTPA attenuated the deleterious association between diabetes and cognitive function.

Predictors and Moderators of Quality of Life in Male Users of Anti-Aging Products.

For most individuals, changes occurring during the aging process may cause dissatisfaction and concerns regarding body image, with implications on quality of life (QoL). The aim of this study was to assess the contribution of sociodemographic and psychological variables and the type of anti-aging products/treatments on men's QoL, as well as to evaluate the moderating role of aging perceptions in the relationship between psychological morbidity and QoL. This study used a cross-sectional design and included a sample of 111 male participants who used anti-aging cosmetic products/aesthetic treatments. Participants were assessed on body image, self-esteem, psychological morbidity, aging perceptions, traits of perfectionism, and QoL. Results suggested that psychological morbidity and perceptions of the aging process as chronic negatively contributed to QoL, and emotional representations of aging moderated the relationship between psychological morbidity and QoL. According to the findings, psychological intervention programs to improve QoL should focus on men with higher levels of psychological morbidity and more negative emotional responses to the aging process.

Association between meatless diet and depressive episodes: A cross-sectional analysis of baseline data from the longitudinal study of adult health (ELSA-Brasil).

BACKGROUND: The association between vegetarianism and depression is still unclear. We aimed to investigate the association between a meatless diet and the presence of depressive episodes among adults. METHODS: A cross-sectional analysis was performed with baseline data from the ELSA-Brasil cohort, which included 14,216 Brazilians aged 35 to 74 years. A meatless diet was defined from in a validated food frequency questionnaire. The Clinical Interview Schedule-Revised (CIS-R) instrument was used to assess depressive episodes. The association between meatless diet and presence of depressive episodes was expressed as a prevalence ratio (PR), determined by Poisson regression adjusted for potentially confounding and/or mediating variables: sociodemographic parameters, smoking, alcohol intake, physical activity, several clinical variables, self-assessed health status, body mass index, micronutrient intake, protein, food processing level, daily energy intake, and changes in diet in the preceding 6 months. RESULTS: We found a positive association between the prevalence of depressive episodes and a meatless diet. Meat non-consumers experienced approximately twice the frequency of depressive episodes of meat consumers, PRs ranging from 2.05 (95%CI 1.00-4.18) in the crude model to 2.37 (95%CI 1.24-4.51) in the fully adjusted model. LIMITATIONS: The cross-sectional design precluded the investigation of causal relationships. CONCLUSIONS: Depressive episodes are more prevalent in individuals who do not eat meat, independently of socioeconomic and lifestyle factors. Nutrient deficiencies do not explain this association. The nature of the association remains unclear, and longitudinal data are needed to clarify causal relationship.

Cross-cultural adaptation of discrimination and vigilance scales in ELSA-Brasil.

OBJECTIVE: To describe the process of cross-cultural adaptation for the use in Brazil of the everyday discrimination scale (EDS) and the heightened vigilance scale (HVS) applied in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Conceptual, item and semantic equivalence analyses were conducted by a group of four epidemiologists; evaluation of measurement equivalence (factorial analysis of configural, metric and scalar structures, according to sociodemographic characteristics) and reliability. A total of 11,987 participants responded to the discrimination scale, and a subsample of 260 people participated in the test-retest study. In the case of HVS, 8,916 people responded, while 149 individuals did so in the test-retest study. RESULTS: The scales presented conceptual, item and semantic equivalence pertinent in the Brazilian context, in addition to adequate correspondence of referential/denotative meaning of terms and also of the general/connotative of the items. The confirmatory factor analysis of EDS revealed a unidimensional structure, with residual correlations between two pairs of items, presenting configural and metric invariance among the four subgroups evaluated. Scalar invariance was identified according to sex and age group, but it was not observed for race/color and education. Heightened vigilance showed low loads and high residuals, with inadequate adjustment indicators. For the items of the discrimination scale the weighted kappa coefficient (Kp) ranged from 0.44 to 0.78, and the intraclass correlation coefficient (ICC) was 0.87. For HVS items, the Kp ranged from 0.47 to 0.59 and the ICC was 0.83. CONCLUSIONS: Although there are correlated items, it was concluded that the EDS is a promising scale to evaluate experiences of perceived discrimination in Brazilian daily life. However, the heightened vigilance scale did not present equivalence of measurement in the current format.

Working from home, work-time control and mental health: Results from the Brazilian longitudinal study of adult health (ELSA-Brasil).

This cross-sectional study investigated the association between work-time control (WTC), independently and in combination with hours worked (HW), and four mental health outcomes among 2,318 participants of the Longitudinal Study of Adult Health (ELSA-Brasil) who worked from home during the COVID-19 pandemic. WTC was assessed by the WTC Scale, and mental health outcomes included depression, anxiety, stress (measured by the Depression, Anxiety and Stress Scale, DASS-21), and self-rated mental health. Logistic regression models were used to determine odds ratios (ORs) and 95% confidence intervals (CIs). Among women, long HW were associated with stress (OR = 1.56; 95% CI = 1.11-2.20) and poor self-rated mental health (OR = 1.64; 95% CI = 1.13-2.38), whereas they were protective against anxiety among men (OR = 0.59; 95% CI = 0.37-0.93). In both sexes, weak WTC was associated with all mental health outcomes. Among women, the long HW/weak WTC combination was associated with all mental health outcomes, and short HW/weak WTC was associated with anxiety and stress. Among men, long HW/strong WTC was protective against depression and stress, while short HW/strong WTC and short HW/weak WTC was associated with all mental health outcomes. In both sexes, weak WTC, independently and in combination with HW, was associated with all mental health outcomes. WTC can improve working conditions, protect against mental distress, and fosterwork-life balance for those who work from home.

Testing the Effectiveness of Two Psychosocial Interventions on Socio-Cognitive Risk Factors for HIV/AIDS in Mozambican Women: A Randomized Controlled Trial.

The objective of this study was to evaluate the efficacy of two psychosocial interventions (Didactic and ACCENT) on socio-cognitive risk factors, in vulnerable Mozambican women at risk for HIV/AIDS infection. The study design was a randomized controlled trial on Mozambican women at HIV/AIDS risk (n = 150). The participants were randomized into three groups: Didactic Intervention (experimental group), ACCENT intervention (experimental group), and control group. We used an adapted version of the Women's Health Questionnaire, which includes a series of scales and questionnaires assessing psychosocial relevant dimensions to female protection towards HIV/AIDS: HIV/AIDS knowledge, condom use negotiation self-efficacy, and perceived barriers against safer sex. Both interventions were equally effective in increasing HIV/AIDS knowledge. The ACCENT intervention was especially effective in promoting condom use negotiation self-efficacy and in decreasing perceived barriers against safer sex, essential variables for sexual protection. These results support the adaptation of Western interventions to the African context.

Healthy lifestyle behaviors and the periodicity of mammography screening in Brazilian women.

INTRODUCTION: Certain behaviors have been associated with health promotion, including mammography screening, in women worldwide. OBJECTIVE: The objective of this study was to determine whether there is an association between the periodicity of mammography screening and healthy lifestyle behaviors in Brazilian women employed at a public university in Bahia, Brazil. METHODS: A total of 635 women of 50-69 years of age at the time of the interview, from the Brazilian Longitudinal Study of Adult Health cohort who were resident in Bahia, participated in the study. Data were collected using a multidimensional questionnaire that included questions on participants' sociodemographic characteristics and health-related behaviors (smoking, alcohol consumption, leisure-time physical activity and diet) and another questionnaire that dealt with risk factors and breast cancer screening. Measures of association were calculated using simple and multivariate logistic regression. RESULTS: The practice of physical activity, not smoking, moderate alcohol consumption and a healthy diet were the health behaviors most adopted by the women who had last had a mammogram ⩽2 years previously (which is in line with the interval recommended by the Brazilian Ministry of Health). A statistically significant association was found between a lapse of ⩾3 years since last undergoing mammography screening and excessive alcohol consumption, while a borderline association was found between the same screening interval and leisure-time physical inactivity. CONCLUSION: There was an association between lifestyle risk behaviors and a longer time interval between mammography screenings. The present results contribute to the debate on the use of mammography, lifestyle behaviors and health promotion among women.

Social position and anthropometric status among adults in the ELSA-Brasil study: a latent class analysis.

The objective of the present study was to evaluate the association between social position and anthropometric status in women and men Brazilian adult. This was a cross-sectional study that used baseline data collected from 2008 to 2010 for the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, in Portuguese), in the six major Brazilian state capital cities. A total of 15,105 active and retired civil servants aged from 35 to 74 years. Two latent variables were defined by latent class analysis, social position and anthropometric status. Both constructs and the analyses were separately evaluated by sex. Associations were assessed using multivariate logistic regression analysis with adjustment for age, self-reported skin color/race, and marital status. Around 44% of the women and 26% of the men were classified as overweight or obese. Social position tended to be lower in women (43.2%) and higher among men (40.4%). Heavier women were more likely to be black and brown-skinned, whereas slimmer women were more likely to be white. After adjustment, women's weight increased as social position decreased (OR = 1.52; 95%CI: 1.36-1.70), whereas in men weight decreased as social position decreased (OR = 0.87; 95%CI: 0.76-0.99). Social position affected the anthropometric status of women and men differently, with body patterns also being affected by ethnicity/skin color, showing the potentiality of taking the intersectional perspective when investigating the possible social determinants of the phenomenon.

Health behavior-related indicator of lifestyle: application in the ELSA-Brasil study.

Various behaviors are considered health enhancing. Nevertheless, according to the current scientific literature, four health behaviors are considered particularly risky in view of their association with a group of chronic diseases: 1) smoking; 2) excessive alcohol consumption; 3) poor diet; and 4) lack of physical activity. Theoretically, it should be possible to make improvements to one's health by maximizing the number of healthy behaviors and minimizing the unhealthy ones. However, in reality, the different behaviors interconnect to create more complex lifestyles. Therefore, the objective of this paper is to present the construction of a lifestyle indicator based on health behaviors selected in the ELSA-Brazil study. This indicator revealed two lifestyles: less healthy and healthier lifestyles. The model proved adequate and was confirmed using latent class analysis (LCA). Agreement was 83.2 between the indicator and the LCA results, with a kappa coefficient of 0.65. Women were more likely to have a healthier lifestyle than men, reinforcing the scientific consistency of the indicator, since this finding is in agreement with data from the scientific literature. The indicator created to define lifestyle was found to have scientific consistency and validity; therefore, its use can be recommended for future population-based studies concerning the promotion of health and healthy lifestyles.

Association between leisure-time physical activity and sedentary behavior with cardiometabolic health in the ELSA-Brasil participants.

OBJECTIVES: To assess associations, both individually and in combination, between leisure-time physical activity and sedentary behavior, and cardiometabolic health. METHODS: This cross-sectional study included 13,931 civil servants participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Leisure-time physical activity was analyzed using the leisure-time domain of the long-form International Physical Activity Questionnaire, while questions related to cumulative sitting time and leisure-based screen time on a weekday and on one day on the weekend were used to establish sedentary behavior. Data analysis was performed using multivariate logistic regression. RESULTS: Following adjustment for confounding variables, high levels of leisure-time physical activity and low levels of sedentary behavior were both associated with favorable cardiometabolic health markers in both genders. When these two factors were analyzed in conjunction, taking the combination of low levels of leisure-time physical activity and high levels of sedentary behavior as the reference, the inverse associations with cardiometabolic variables became even more significant. CONCLUSION: High levels of leisure-time physical activity and low levels of sedentary behavior were both inversely associated with the cardiometabolic variables analyzed; however, the two variables when evaluated in conjunction appear to produce more consistent associations, particularly when sedentary behavior is evaluated according to leisure-based screen time.

Percepção de imagem corporal, características socioeconômicas e estilo de vida em mulheres participantes do ELSA-Brasil na Bahia, Brasil / Body image perception, socioeconomic characteristics, and lifestyle in women participating in ELSA-Brasil in Bahia, Brazil / Percepción de la imagen corporal, características socioeconómicas y estilo de vida en mujeres participantes del ELSA-Brasil en Bahía, Brasil

Distorção da imagem corporal é uma alteração da percepção do corpo que pode repercutir na saúde. Este estudo visa estimar, entre mulheres participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) residentes na Bahia, Brasil, a prevalência de acurácia e distorção da imagem corporal e investigar associações com características socioeconômicas, estilo de vida e procura de cuidados ginecológicos. Participaram 609 mulheres de 50-69 anos de idade que responderam, entre 2012-2014, questionários aplicados face a face. Foi utilizada a escala de silhuetas de Stunkard para investigar a percepção acurada ou distorcida para mais ou menos peso. A razão de risco relativo (RR) foi calculada por meio de regressão logística multinomial por meio do Stata 13. A maioria das participantes tem perspectiva acurada do próprio corpo (53,7%). Entre aquelas com percepção distorcida, há uma tendência à distorção para menos peso (38,1%). Na análise de regressão multinomial, permaneceram associadas à distorção para menos peso as variáveis raça/cor e escolaridade, sendo que a primeira foi positivamente associada à distorção para menos peso entre as pardas (RR = 1,89; IC95%: 1,13-3,16) e pretas (RR = 2,10; IC95%: 1,25-3,55), enquanto a segunda entre aquelas com escolaridade até o Ensino Médio (RR = 1,65; IC95%: 1,18-2,33). Não houve associações quanto às demais variáveis, nem com distorção para mais peso. Os resultados contribuem para a explicação das relações entre percepção da imagem corporal e fatores socioeconômicos, revelando que mulheres de raça/cor diferentes e variados níveis de escolaridade são influenciadas de formas distintas pelos discursos sociais, o que impacta a percepção da sua imagem corporal.

Body image distortion is an alteration in the perception of the body that can have repercussions on health. This study aims to estimate the prevalence of body image accuracy and distortion among women participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) living in Bahia State, Brazil, and to investigate associations with socioeconomic characteristics, lifestyle, and gynecological care seeking. A total of 609 women aged 50 to 69 years participated in the study, who answered face-to-face questionnaires from 2012 to 2014. The Stunkard silhouette scale was used to investigate accurate or distorted perception for more or less weight. The relative risk ratio (RR) was calculated by multinomial logistic regression using Stata 13. Most participants have an accurate perception of their own bodies (53.7%). Among those with distorted perception, there is a tendency to distort towards less weight (38.1%). In the multinomial regression analysis, the variables race/skin color and education remained associated with the distortion towards underweight. The race/skin color variable was positively associated with the distortion towards underweight among Mixed-race women (RR = 1.89; 95%CI: 1.13-3.16) and black (RR = 2.10; 95%CI: 1.25-3.55), while the education variable among those with up to high school education (RR = 1.65; 95%CI: 1.18-2.33). There were no associations with the other variables or with distortion for more weight. The results contribute to explaining the relationships between body image perception and socioeconomic factors, revealing that women of different races/skin colors and varying educational levels are influenced in different ways by social discourses, impacting the perception of their body image.

La distorsión de la imagen corporal es una alteración en la percepción del cuerpo que puede repercutir en la salud. Este estudio busca estimar, entre las mujeres participantes del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil) que viven en Bahía, Brasil, la prevalencia de precisión y distorsión de la imagen corporal e investigar asociaciones con las características socioeconómicas, el estilo de vida y la busca de atención ginecológica. Participaron 609 mujeres que tenían entre 50 y 69 años que contestaron los cuestionarios aplicados cara a cara entre 2012 y 2014. Se utilizó la escala de siluetas de Stunkard para investigar la percepción precisa o distorsionada para más o menos peso. El cociente de riesgo relativo (RR) se calculó a través de regresión logística multinomial utilizando el Stata 13. La mayoría de los participantes tiene una perspectiva precisa del propio cuerpo (53,7%). Entre las personas con percepción distorsionada hay una tendencia a la distorsión para menos peso (38,1%). En el análisis de regresión multinomial, las variables raza/color y escolaridad permanecieron asociadas con la distorsión para menos peso, siendo la primera positivamente asociada con la distorsión para menos peso entre las mujeres pardas (RR = 1,89; IC95%: 1,13-3,16) y negras (RR = 2,10; IC95%: 1,25-3,55), mientras la segunda entre las mujeres que estudiaron hasta la enseñanza secundaria (RR = 1,65; IC95%: 1,18-2,33). No hubo asociaciones con las otras variables ni con la distorsión para más peso. Los resultados contribuyen para explicar las relaciones entre la percepción de la imagen corporal y los factores socioeconómicos, demostrando que mujeres de diferentes razas/colores y diferentes niveles de educación se influyen de distintas formas a través de discursos sociales, lo que impacta en la percepción de su imagen corporal.