Association of public physical activity facilities and participation in community programs with leisure-time physical activity: does the association differ according to educational level and income?

BACKGROUND: Our aim was to analyze the association of the presence of public physical activity (PA) facilities and participation in public PA programs with leisure-time PA, with an emphasis on the moderating role of educational level and income. METHODS: We used data of 88,531 adults (46,869 women), with a mean age of 47.2 ± 17.1y, from the 2019 Brazilian National Health Survey. Leisure-time PA (dichotomized considering 150 min/week), the presence of a public PA facility near the household (yes or no), participation in public PA programs (yes or no), educational level (divided into quintiles) and per capita income (divided into quintiles) were all self-reported through interviews. Adjusted logistic regression models were used for the analyses. RESULTS: The presence of public PA facilities near the household and the participation in public PA programs were associated with higher leisure-time PA among all quintiles of income and educational level. However, multiplicative interactions revealed that participating in PA programs [Quintile (Q)1: OR: 13.99; 95%CI: 6.89-28.38 vs. Q5: OR: 3.48; 95%CI: 2.41-5.01] and the presence of public PA facilities near the household (Q1: OR: 3.07; 95%CI: 2.35-4.01 vs. Q5: OR: 1.38; 95%CI: 1.22-1.55) were more associated with higher odds of being active in the leisure-time among the lowest quintile of educational level. CONCLUSIONS: The presence of public PA facilities and participation in public PA programs are environmental correlates that may be relevant for designing effective public health interventions to reduce social inequalities in leisure-time PA among adults in low-income areas.

Time Trends and Sociodemographic Inequalities in Physical Activity and Sedentary Behaviors Among Brazilian Adults: National Surveys from 2003 to 2019.

BACKGROUND: The authors analyzed time trends and sociodemographic inequalities in different physical activity and sedentary behavior domains between 2003 and 2019. METHODS: A secondary analysis of data from 5 cross-sectional Brazilian epidemiological surveys (World Health Survey-2003, National Household Sample Survey-2008/2015, and Brazilian Health Survey-2013/2019) conducted among a nationally representative sample of Brazilian adults. The authors used data on different domains of physical activity (leisure, commute, total transport, and total physical activity) and sedentary behavior (TV viewing and other types of screens) that were available in the different surveys. Gender, age group, country region, ethnicity, type of area and city, and quintiles of income and educational achievement were used as sociodemographic correlates. RESULTS: The prevalence of leisure-time physical activity increased over time (2008: 7.0% vs 2019: 26.5%). There was also an increased trend of social inequality in leisure-time physical activity. A trend of reduction was observed for active commuting (2008: 35.0% vs 2019: 21.8%), while total transport physical activity was stable (2013: 49.5% vs 2019: 49.6%). Directions of findings were opposite for sedentary behavior, with reduced trend for >3 hours per day of TV viewing (2008: 34.8% vs 2019: 21.8%) and increased trend for >3 hours per day of other types of screen time (2008: 6.4% vs 2019: 22.2%). CONCLUSION: A positive trend exists in leisure-time physical activity, but there was also an increase in social inequalities for physical activity in Brazil.

International Physical Activity and Built Environment Study of adolescents: IPEN Adolescent design, protocol and measures.

INTRODUCTION: Only international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape and generalisability of associations of the community environment (geographic information systems (GIS)-based and self-reported) with physical activity and sedentary behaviour (accelerometer-measured and self-reported) and weight status (normal/overweight/obese). METHODS AND ANALYSIS: The IPEN Adolescent observational, cross-sectional, multicountry study involves recruiting adolescent participants (ages 11-19 years) and one parent/guardian from neighbourhoods selected to ensure wide variations in walkability and socioeconomic status using common protocols and measures. Fifteen geographically, economically and culturally diverse countries, from six continents, participated: Australia, Bangladesh, Belgium, Brazil, Czech Republic, Denmark, Hong Kong SAR, India, Israel, Malaysia, New Zealand, Nigeria, Portugal, Spain and USA. Countries provided survey and accelerometer data (15 countries), GIS data (11), global positioning system data (10), and pedestrian environment audit data (8). A sample of n=6950 (52.6% female; mean age=14.5, SD=1.7) adolescents provided survey data, n=4852 had 4 or more 8+ hours valid days of accelerometer data, and n=5473 had GIS measures. Physical activity and sedentary behaviour were measured by waist-worn ActiGraph accelerometers and self-reports, and body mass index was used to categorise weight status. ETHICS AND DISSEMINATION: Ethical approval was received from each study site's Institutional Review Board for their in-country studies. Informed assent by adolescents and consent by parents was obtained for all participants. No personally identifiable information was transferred to the IPEN coordinating centre for pooled datasets. Results will be communicated through standard scientific channels and findings used to advance the science of environmental correlates of physical activity, sedentary behaviour and weight status, with the ultimate goal to stimulate and guide actions to create more activity-supportive environments internationally.

Physical activity can attenuate, but not eliminate, the negative relationships of high TV viewing with some chronic diseases: findings from a cohort of 60 202 Brazilian adults.

BACKGROUND: This study examined the joint associations of leisure time physical activity and television (TV) viewing time with the prevalence of chronic diseases among Brazilian adults. METHODS: Data from the Brazilian Health Survey, a nationally representative survey conducted in 2013 (n = 60 202; ≥18 years), were used. Time spent in TV viewing and leisure physical activity, physician diagnoses of diabetes, hypertension and heart disease and information on co-variables (chronological age, education, ethnicity, candies/sweets consumption, sodium intake and tobacco smoking) were collected via interview. Descriptive statistics (mean and 95% confidence interval) and logistic regression models were used for etiological analyses. RESULTS: Physical activity attenuated but did not eliminate the risk associated with high TV viewing for at least one chronic disease in the general population [odds ratio [OR]: 1.29 (1.11-1.50)] and among women [OR: 1.31 (1.09-1.60)], adults [OR: 1.24 (1.05-1.46)] and older adults [OR: 1.63 (1.05-2.53)]. On the other hand, physical activity eliminated the risk associated with high TV viewing for at least one chronic disease among men [OR: 1.24 (0.98-1.58)]. CONCLUSIONS: We conclude that physical activity can attenuate but not eliminate the negative effects of high TV viewing on chronic disease among subgroups of Brazilian adults.

Body mass index trajectories and noncommunicable diseases in women: The role of leisure time physical activity.

OBJECTIVE: To analyze the association between body mass index trajectories and non-communicable diseases (NCDs) in women, and the interaction effects of leisure time physical activity on this relationship. METHODS: Sample was composed by 15 628 women (≥30 years old) who performed objective measurement of body mass, height, and blood pressure in the 2013 Brazilian Health Survey (2013). Information regarding the body mass at 20 years old, current type 2 diabetes (T2DM), dyslipidemia diagnosis, and leisure time physical activity were self-reported by the participants. Socio-demographic and behavioral covariates were considered. Logistic regression models were used for the statistical analysis. RESULTS: Those who were obese in both moments and women who become obese showed similar high risk, however, the prevalence of NCDs among women who were no longer obese was similar to the consistently non-obese. Leisure time physical activity attenuated the general deleterious effect of obesity, especially among the consistently obese women for dyslipidemia (inactive: OR: 2.02 [95%CI: 1.69-2.43] vs active: OR: 1.05 [95%CI: 0.55-1.99]), T2DM (inactive: OR: 3.84 [95%CI: 2.72-5.43] vs active: OR: 4.38 [95%CI: 1.49-12.86]) and high blood pressure (inactive: OR: 2.00 [95%CI: 1.56-2.57] vs active: OR: 1.15 [95%CI: 0.57-2.52]). CONCLUSIONS: Changes in body mass index appear to be sensitive to detecting the risk of NCDs over lifespan. In addition, leisure time physical activity attenuates the negative effects of obesity on NCDs, but this appears more important for the consistently non-obese women.

Independent and combined associations of sugar-sweetened beverage consumption, TV viewing, and physical activity with severe depressive symptoms among 59,402 adults.

OBJECTIVE: Our aim was to analyze the association between sugar-sweetened beverage consumption and depressive symptoms, as well as the extent to which TV viewing and physical activity moderate this association. METHODS: We used cross-sectional data from the 2013 Brazilian National Survey (Pesquisa Nacional de Saúde) of 59,402 adults (33,482 women, mean age = 42.9 years, 95%CI 42.7-43.2 years). Depressive symptoms (Patient Health Questionnaire-9), physical activity, TV viewing, and sugar-sweetened beverage consumption, as well as potential confounders (chronological age, ethnicity, consumption of candy/sweets and fruit, multimorbidity, education, and employment status) were self-reported. Poisson regression models were used for association analyses. RESULTS: The consumption of 16 or more glasses/week of sugar-sweetened beverages was associated with higher levels of severe depressive symptoms among women compared to no consumption (prevalence ratio [PR] 1.71 [95%CI 1.38-2.11]). Consistent interactions were observed between 1-5 glasses and TV viewing (PR 2.09 [95%CI 1.06-4.12]) and between 11-15 glasses and TV viewing (PR 2.90 [95%CI 1.29-6.50]) among men compared to no consumption, given that the co-occurrence of sugar-sweetened beverage consumption and elevated TV viewing was associated with higher odds of severe depressive symptoms. Sugar-sweetened beverage consumption did not interact with physical activity, only presenting an independent association. CONCLUSION: Sugar-sweetened beverage consumption was independently associated with severe depressive symptoms among women and interacted with TV viewing, but not with physical activity among men.

Lifestyle behaviors among 4,343 Brazilian adults with severe mental illness and 55,859 general population controls: data from the Brazilian National Health Survey

Objective: To analyze the association between severe mental illnesses and health behaviors among Brazilian adults. Methods: We used data from the Brazilian National Health Survey, a large nationally representative cross-sectional study conducted in 2013 among 60,202 adults (≥ 18 years). Clinical diagnoses (major depressive disorder, bipolar disorder and schizophrenia), lifestyle behaviors (leisure-time physical activity, TV viewing, tobacco use and the consumption of alcohol, sweets, and soft drinks) and potential confounders (chronological age, race, educational and employment status) were self-reported. Logistic regression models were used to examine the associations between severe mental illness and lifestyle behaviors, adjusting for confounders. Results: Schizophrenia (n=41) was associated with lower odds of physical activity (OR 0.08 [95%CI 0.01-0.58]). Major depressive disorder (n=4,014) was associated with higher odds of TV viewing (OR 1.34 [95%CI 1.12-1.61]), tobacco use (OR 1.37 (95%CI 1.18-1.58]), consumption of sweets (OR 1.34 (95%CI 1.15-1.55]) and consumption of soft drinks (OR 1.24 (95%CI 1.06-1.45]). There were no significant associations between bipolar disorder (n=47) and any lifestyle behaviors. Conclusions: Schizophrenia was associated with lower physical activity, while major depressive disorder was associated with increased TV viewing, tobacco use, and consumption of sweets and soft drinks. These findings reinforce the need for prevention and treatment interventions that focus on people with severe mental illness in Brazil.

Joint association of ultra-processed food and sedentary behavior with anxiety-induced sleep disturbance among Brazilian adolescents.

AIMS: We analyzed the joint association of high ultra-processed food ingestion and sedentary behavior (SB) with anxiety-induced sleep disturbance among Brazilian adolescents. METHODS: Data from the Brazilian Scholar Health Survey, a nationally representative survey of 9th grade adolescents [mean: 14.28 years (range: 11-18 years)] conducted in 2015 (n = 100,648) were used. Self-reported anxiety-induced sleep disturbance, SB (TV viewing and total sitting time), and frequency of ingestion of different ultra-processed foods were collected. Age, ethnicity, type of city (capital or interior), region of the country, and habitual physical activity (global scholar survey questionnaire) were covariates. Logistic regression analyses were conducted to assess the associations. RESULTS: High ultra-processed food ingestion plus low SB [boys:OR:1.44(99%CI:1.16-1.79), girls:OR:1.41(99%CI:1.22-1.63)] were risk factors for anxiety-induced sleep disturbance. The highest risk of anxiety-induced sleep disturbance was observed among those who joint high ultra-processed food ingestion with high SB [boys:OR:1.85(99%CI:1.46-2.35), girls:OR:1.62(99%CI:1.39-1.89)]. In addition, the interaction of high ultra-processed food ingestion with TV-viewing substantially increased the odds of anxiety-induced sleep disturbance [boys:OR:2.03(99%CI:1.61-2.56), girls:OR:2.04(99%CI:1.76-2.36)]. CONCLUSIONS: Both the high consumption of ultra-processed foods and SB (especially TV-viewing) appear to be independently associated with anxiety-induced sleep disturbance in both sexes. However, the co-occurrence of both negative lifestyle behaviors is associated with a substantial increase in the risk of anxiety-induced sleep disturbance. Future longitudinal research is required to confirm/refute our findings and explore potential mechanisms.

Physical activity attenuates metabolic risk of adolescents with overweight or obesity: the ICAD multi-country study.

BACKGROUND: Although the benefits of physical activity (PA) at an early age are well established, there is no robust evidence of the role of PA as well as its intensities in attenuating the association between weight status and metabolic risk among adolescents. In this investigation, we analyzed the association between weight status, intensities of PA, and metabolic risk among adolescents. METHODS: Data from six cross-sectional studies in the International Children's Accelerometry Database were used (N = 5216 adolescents; boys 14.6 ± 2.1 years and girls 14.7 ± 2.0 years). Weight status was assessed and classified according to body mass index. Fasting glucose, triglycerides, inverse high-density lipoprotein cholesterol, and blood pressure composed the metabolic risk indicator (z-score). PA was measured by accelerometers. The estimated age of peak height velocity was used as a covariate for somatic maturation. RESULTS: We observed that increase in weight status showed a strong positive relationship with metabolic risk. However, adolescents with overweight or obesity in the highest tertile of PA (moderate-to-vigorous and vigorous intensity) showed a similar metabolic risk score as the normal weight groups. Moderate intensity PA seemed related to metabolic risk even within some categories of vigorous PA. CONCLUSIONS: We conclude that PA attenuates the metabolic risk of adolescents with overweight or obesity. Although this attenuation is largely explained by vigorous PA, moderate intensity seems also important for better metabolic profile.

Lifestyle behaviors among 4,343 Brazilian adults with severe mental illness and 55,859 general population controls: data from the Brazilian National Health Survey.

OBJECTIVE: To analyze the association between severe mental illnesses and health behaviors among Brazilian adults. METHODS: We used data from the Brazilian National Health Survey, a large nationally representative cross-sectional study conducted in 2013 among 60,202 adults (≥ 18 years). Clinical diagnoses (major depressive disorder, bipolar disorder and schizophrenia), lifestyle behaviors (leisure-time physical activity, TV viewing, tobacco use and the consumption of alcohol, sweets, and soft drinks) and potential confounders (chronological age, race, educational and employment status) were self-reported. Logistic regression models were used to examine the associations between severe mental illness and lifestyle behaviors, adjusting for confounders. RESULTS: Schizophrenia (n=41) was associated with lower odds of physical activity (OR 0.08 [95%CI 0.01-0.58]). Major depressive disorder (n=4,014) was associated with higher odds of TV viewing (OR 1.34 [95%CI 1.12-1.61]), tobacco use (OR 1.37 (95%CI 1.18-1.58]), consumption of sweets (OR 1.34 (95%CI 1.15-1.55]) and consumption of soft drinks (OR 1.24 (95%CI 1.06-1.45]). There were no significant associations between bipolar disorder (n=47) and any lifestyle behaviors. CONCLUSIONS: Schizophrenia was associated with lower physical activity, while major depressive disorder was associated with increased TV viewing, tobacco use, and consumption of sweets and soft drinks. These findings reinforce the need for prevention and treatment interventions that focus on people with severe mental illness in Brazil.

Potential influence of physical, psychological and lifestyle factors on the association between television viewing and depressive symptoms: A cross-sectional study.

OBJECTIVE: To investigate the potential influence of physical, psychological, and lifestyle factors on the association between TV-viewing and depressive symptoms among Brazilian adults. METHODS: We used cross-sectional data from the Brazilian National Survey, conducted in 2013 with 60,202 adults (≥18 years). Information regarding exposure (TV-viewing), potential influencing factors (multimorbidity, mobility, self-rated health, tobacco use, alcohol consumption, sugar consumption, and physical activity) as well as elevated depressive symptoms (through PHQ-9 - score > 9) (outcome) was collected via interview-administered questionnaires. Data on covariates were self-reported. Body mass index was estimated through the assessment of body mass and stature. Mediation models were estimated through the Karlson-Holm-Breen method. RESULTS: Individuals who reported >5 h/d of TV viewing showed a higher prevalence of depressive symptoms than those with <5 h/d of TV viewing [8.1%(99%CI:7.6%-8.6%) vs 14.2%(99%CI:12.2%-16.6%)]. The association between TV-viewing and depressive symptoms was influenced by tobacco use (Overall: 7.22%; men: 4.46%, women: 8.59%), physical activity (men: 3.99%, women: 2.28%), mobility (overall: 11.31%, men: 10.85%, women: 11.03%), and multimorbidity (overall: 9.11%, men: 11.6%, women: 6.03%). Poor self-rated health influenced the association between TV-viewing and elevated depressive symptoms only among men (15.55%). Similarly, the association between >4 h/d of TV viewing and depressive symptoms was influenced by tobacco use (men: 6.8%, women: 11.7%), physical activity for women (5.5%), self-rated health for men (14.7%), mobility (men: 8.7%, women: 17.0%), and multimorbidity (men: 9.6%, women: 12.3%). CONCLUSIONS: Tobacco use, physical activity, mobility, multimorbidity, and self-rated health (men) mediate the relationship between high TV-viewing and elevated depressive symptoms. Longitudinal research is required to confirm/refute our data which may also be useful to contribute to public health interventions.

Tracking of physical fitness in elementary school children: The role of changes in body fat.

OBJECTIVES: The aim of the present study was to examine the stability of physical fitness, and the interrelationships among intra-individual changes in fitness and fatness among elementary school children. METHODS: A longitudinal study was conducted among 372 adolescents (196 boys) and followed up over 3 years (from childhood to adolescence). Physical fitness was estimated using three indicators: cardiorespiratory fitness (through a 9-minute running test), flexibility (through a sit-and-reach test), and muscle resistance (through maximal abdominals in 1 minute). Body adiposity was obtained through triceps and subscapular skinfolds. Somatic maturation was assessed by the peak of height velocity. Kappa and Lin's tests of concordance as well as logistic regression analyses were conducted with P < 0.05 in STATA 15.1. RESULTS: Tracking of physical fitness from childhood to adolescence was moderate for both sexes [boys: kappa = 0.441 (P < 0.001); LCCC = 0.591 (P < 0.001). Girls: kappa = 0.335 (P < 0.001); LCCC = 0.534 (P < 0.001)]. A larger increment in body fat was associated with a higher likelihood to decrease a tertile in physical fitness among boys [OR: 4.17 (95% CI: 1.31-13.22)] and with a lower likelihood to increase a tertile in physical fitness among both sexes [boys: OR = 0.25 (95% CI: 0.09-0.67); girls: OR: 0.37 (95% CI: 0.15-0.92)]. CONCLUSIONS: Health-related physical fitness has moderate tracking from childhood to adolescence. Increases in body adiposity from childhood to adolescence are associated with a reduction in physical fitness tertile.

Association(s) Between Objectively Measured Sedentary Behavior Patterns and Obesity Among Brazilian Adolescents.

PURPOSE: To investigate the association between patterns of sedentary behavior and obesity indicators among adolescents. METHODS: This was a cross-sectional study conducted among 389 adolescents (186 boys) aged 10-14 years. Body mass index, body fat (skinfolds), and waist circumference were adopted as outcomes. Sedentary behavior patterns (total time, bouts, and breaks) measured through accelerometry (GT3X and GT3X+; ActiGraph, Pensacola, FL) were adopted as exposures. Peak height velocity, moderate to vigorous physical activity (accelerometer), cardiorespiratory fitness (Léger test), sex, and chronological age were adopted as covariates. Linear regression models adjusted for covariates were used to determine associations between outcome and exposure variables. RESULTS: The mean age of adolescents was 11.8 (0.7) years. Boys were more active than girls (P < .001). Accumulating shorter bouts (1-4 min) of sedentary behavior was negatively associated with body mass index (ß = -0.050; 95% confidence interval [CI], -0.098 to -0.003) and waist circumference (ß = -0.133; 95% CI, -0.237 to -0.028). Similarly, a higher number of breaks in sedentary behavior were negatively associated with body mass index (ß = -0.160; 95% CI, -0.319 to -0.001) and waist circumference (ß = -0.412; 95% CI, -0.761 to -0.064). CONCLUSION: Shorter bouts of sedentary behavior (1-4 min) and a higher number of breaks of sedentary behavior were associated with lower adiposity. Our findings also suggest that breaking up sedentary time to ensure bouts of sedentary behavior are short might contribute to the prevention of obesity in adolescents.

Association between physical activity and alcohol consumption: sociodemographic and behavioral patterns in Brazilian adults.

BACKGROUND: Our aim was to investigate the association between physical activity and alcohol consumption, as well as the sociodemographic and behavioral patterns of this association in a representative sample of Brazilian adults. METHODS: Data from the Brazilian Health Survey (PNS), a nationally representative survey conducted in 2013 (n = 60 202; age≥18 years), were used. Time spent in leisure physical activity, alcohol consumption as well as sociodemographic (chronological age, educational status and skin color) and associated behavioral factors (TV viewing and tobacco smoking) were collected via interview. Logistic regression models were used for the main analyses. RESULTS: Prevalence of weekly and almost daily alcohol consumption were 29.5% and 6.7% for men and 12.0% and 1.0% for women respectively. Adults with weekly alcohol consumption were more likely to be classified as physically active [young: men=OR:1.20 (CI 95%:1.02-1.39), women= OR:2.33 (CI 95%:1.92-2.82); middle-aged: men= OR:1.46 (CI 95%: 1.17-1.82), women= OR:1.75 (CI 95%:1.38-2.22); older: men= OR:1.83 (CI 95%:1.27-2.66), women= OR:2.11 (CI 95%: s1.26-3.52)], when compared to adults with no alcohol consumption. Almost daily alcohol consumption was associated with lower physical activity among young and middle-aged adults but with higher physical activity among older adults of both sexes and young women. CONCLUSIONS: Weekly alcohol consumption was associated with a higher level of physical activity among young, middle aged and older adults.

Associations between TV viewing, sitting time, physical activity and insomnia among 100,839 Brazilian adolescents.

Our aim was to examine the relationship between insomnia and levels of physical activity (PA) and time spent sitting and TV viewing among Brazilian adolescents. Data from the Brazilian Scholar Health Survey, a nationally representative survey of 9th grade adolescents [mean: 14.28 years (range: 11-18 years)] conducted in 2015 (n = 100,839) were used. Self-reported insomnia, TV viewing, sitting time and total PA (adapted International PA Questionnaire) were collected. Chronological age, race, type of city (capital or interior) country region, goodies ingestion and ultra-processed foods ingestion were covariates. Logistic regression analyses were conducted to assess the associations. A higher sitting time and TV viewing (≥8 h/day) was associated with a higher risk of insomnia among boys [sitting time: OR = 2.39 (95%CI = 1.88-3.04); TV:OR = 2.49(95%CI = 1.92-3.22) and girls [sitting time: OR = 2.17(95%CI = 1.84-2.57; TV:OR = 1.72(95%CI = 1.44-2.04)]. More than 4 h of sitting time per day was associated with higher risk of insomnia in adolescents who comply [boys: OR = 1.43(95%CI = 1.19-1.73); girls: OR = 1.66(95%CI = 1.41-1.94)] and who do not comply with the 300 min/week of physical activity recommendation [boys = OR = 1.35(95%CI = 1.13-1.60); girls: OR = 1.38(95%CI = 1.20-1.57)]. Our data suggest that higher levels of TV viewing or sitting are associated with sleep difficulties in this large cohort of adolescents, irrespective of their physical activity behavior.

Association between age at menarche and blood pressure in adulthood: is obesity an important mediator?

We investigated the association between age at menarche, and adiposity and blood pressure in adulthood, as well as the mediation effects of adiposity on the relationship between age at menarche and blood pressure. This was a nationally representative survey conducted in Brazil in 2013 (Brazilian Health Survey). The participants included 33,715 women between 18 and 100 years old. Age at menarche was self-reported and outcomes (body mass index [BMI], waist circumference, and blood pressure) were objectively measured. As covariates, data on chronological age, race, educational status, tobacco smoking, leisure physical activity, TV viewing, sodium consumption, alcohol drinking, menopause status, and antihypertensive medication use were obtained by questionnaires. Negative and linear relationships were observed between age at menarche and adiposity indicators. Early maturers presented a greater prevalence of obesity (waist circumference: 56.3% [54.0-58.7] vs. 52.4% [51.4-53.5], BMI: 32.4% [30.2-34.6] vs. 25.1% [24.2-26.0]) than on time/late maturers. Age at menarche was significantly inversely related to blood pressure and adiposity in adulthood (p < 0.05), although these associations were weaker than the association between obesity and early menarche. Adiposity indicators mediated the relationship between age at menarche, and systolic (partly) and diastolic (fully) blood pressure. In conclusion, early maturation is related to obesity and higher blood pressure in adulthood. Obesity is an important mediator of the influence of early maturation on high blood pressure in women.

Does leisure-time physical activity attenuate or eliminate the positive association between obesity and high blood pressure?

We examine the joint association of weight status and leisure-time physical activity on high blood pressure in a nationally representative sample of adults and older adults in Brazil. This was a national cross-sectional survey conducted in Brazil in 2013 (Brazilian Health Survey). The sample consisted of 59 402 participants (56% women, aged 18 to 100 years). Outcome was objectively assessed blood pressure. Body mass index (BMI) was objectively measured, while self-reported information on leisure-time physical activity, TV viewing, chronological age, race, educational status, tobacco smoking, sodium consumption, and hypertension medication was obtained using questionnaires. Logistic regression analysis with adjusted odds ratio was conducted to test the joint association of BMI and leisure-time physical activity categories on high blood pressure. Overall, compared to normal weight (NW) and physically active group, the NW/inactive (OR = 1.28; 1.04 to 1.58), overweight/active (OR = 1.38; 1.08 to 1.78), overweight/inactive (OR = 1.89; 1.53 to 2.33), obese/active (OR = 2.19; 1.59 to 3.01) and obese/inactive (OR = 2.54; 2.05 to 3.15) groups were 28% to 254% more likely to have high blood pressure. The attenuation and high blood pressure was greater for women and adults than for men and older adults. Thus, leisure-time physical inactivity and being overweight and obesity were associated with high blood pressure in Brazilian population. Engaging in sufficient level of physical activity during leisure could attenuate, but not eliminate, the negative influence of obesity on high blood pressure in Brazilian adults and older adults.

Associations between TV viewing and depressive symptoms among 60,202 Brazilian adults: The Brazilian national health survey.

BACKGROUND: Our aim was to examine associations between depression and time spent in TV viewing in a representative sample of Brazilian adults. METHODS: Data from the Brazilian National Health Survey (Pesquisa Nacional de Saúde - PNS in Portuguese) (n =60,202; ≥18 years) were used. Time spent TV viewing (h/day) was elicited via interview. Depression was evaluated through the Patient Health Questionnaire-9. Chronological age, educational status, employment status, alcohol use, tobacco smoking and body mass index were covariates. Descriptive statistics (mean and 95% confidence interval) and adjusted logistic regression models were applied. RESULTS: Five or more hours as well as less than 1 h of TV viewing was associated with increased depression (men: <1 h OR = 1.89, 95%CI = 1.40-2.54; ≥5 h OR = 2.69, 95%CI = 1.88-3.83; women: <1 h OR = 1.50, 95%CI = 1.25-1.81; ≥5 h OR = 1.65, 95%CI = 1.35-2.03) when compared to 2-2.99 h of TV viewing. CONCLUSION: More than 5 h/day seems to be associated with a higher risk for depression among Brazilian adults (except for older adults). Less than 1 h TV viewing might be a measure-of-proxy for a lower socio-economic status, which is a known risk factor for depression.

Relationship of Parental and Adolescents' Screen Time to Self-Rated Health: A Structural Equation Modeling.

AIM: To investigate the association of parental and adolescents' screen time with self-rated health and to examine the mediating effects of psychosocial factors (social relationships and distress) on this association. METHOD: A cross-sectional study was conducted among 984 Brazilian adolescents (10- to 17-year-olds). Self-rated health, screen time (adolescents and parental), and perception of social relationships and distress were evaluated through self-report questionnaires. Structural equation modeling was adopted to investigate the pathways of the relationship between adolescents' screen time and self-rated health. RESULTS: Adolescents' screen time was directly and negatively related to self-rated health only in boys ( r = -0.158, p = .015). In girls, screen time was related to self-rated health through distress ( r = -0.188, p = .007) and social relationships ( r = 0.176, p = .008). The models fit was adequate (χ2/ df ≤ 3.0, root mean square error of approximation <0.08, comparative fit index >0.90, and Tucker-Lewis Index >0.90). CONCLUSIONS: Higher screen time was associated with poor self-rated health in boys, while in girls, psychosocial factors mediated the adverse relationships between screen time and self-rated health.

Regional Socioeconomic Inequalities in Physical Activity and Sedentary Behavior Among Brazilian Adolescents.

BACKGROUND: This study aims to describe the regional prevalence and patterns of physical activity (PA) and sedentary behavior among Brazilian adolescents. METHODS: Data from the Brazilian Scholar Health Survey, a nationally representative survey of ninth-grade adolescents [mean age: 14.29 y (14.27-14.29)] conducted in 2015 (n = 101,445), were used. Outcomes were television viewing, sitting time (ST), total PA, and active traveling collected via self-administered questionnaire. Information on frequency of physical education classes and type of school was collected from the school's director. Frequencies with 95% confidence intervals were used to determine the prevalence and patterns of outcomes. RESULTS: Higher prevalence of PA (≥300 min/wk) and ST (>4 h/d) was found in Midwest (PA = 38.0%; ST = 44.5%), South (PA = 37.6%; ST = 50.1%), and Southeast (PA = 36.1%; ST = 49.3%) compared with Northeast (PA = 29.7%; ST = 36.9%) and North (PA = 34.4%; ST = 34.8%) regions of Brazil. ST was higher among adolescents from private schools (51.5%) than public schools (42.9%), whereas active traveling was greater among students of public schools than private schools (62.0% vs 34.4%). Most inequalities in outcomes between capital and interior cities were in the poorest regions. CONCLUSIONS: The results indicate that national plans targeting regional inequalities are needed to improve PA and to reduce sedentary behavior among Brazilian adolescents.