Absolute income is a better predictor of coverage by skilled birth attendance than relative wealth quintiles in a multicountry analysis: comparison of 100 low- and middle-income countries.

BACKGROUND: Having high-quality data available by 2020, disaggregated by income, is one of the Sustainable Development Goals (SGD). We explored how well coverage with skilled birth attendance (SBA) is predicted by asset-based wealth quintiles and by absolute income. METHODS: We used data from 293 national surveys conducted in 100 low and middle-income countries (LMICs) from 1991 to 2014. Data on household income were computed using national income levels and income inequality data available from the World Bank and the Standardized World Income Inequality Database. Multivariate regression was used to explore the predictive capacity of absolute income compared to the traditional measure of quintiles of wealth index. RESULTS: The mean SBA coverage was 68.9% (SD: 24.2), compared to 64.7% (SD: 26.6) for institutional delivery coverage. Median daily family income in the same period was US$ 6.4 (IQR: 3.5-14.0). In cross-country analyses, log absolute income predicts 51.5% of the variability in SBA coverage compared to 22.0% predicted by the wealth index. For within-country analysis, use of absolute income improved the understanding of the gap in SBA coverage among the richest and poorest families. Information on income allowed identification of countries - such as Burkina Faso, Cambodia, Egypt, Nepal and Rwanda - which were well above what would be expected solely from changes in income. CONCLUSION: Absolute income is a better predictor of SBA and institutional delivery coverage than the relative measure of quintiles of wealth index and may help identify countries where increased coverage is likely due to interventions other than increased income.

Socioeconomic Correlates of Sedentary Behavior in Adolescents: Systematic Review and Meta-Analysis.

BACKGROUND: The body of evidence on associations between socioeconomic status (SES) and sedentary behaviors in adolescents is growing. OBJECTIVES: The overall aims of our study were to conduct a systematic review and meta-analysis of this evidence and to assess whether (1) the associations between SES and sedentary behavior are consistent in adolescents from low-middle-income and from high-income countries, (2) the associations vary by domain of sedentary behavior, and (3) the associations vary by SES measure. METHODS: We performed a systematic literature search to identify population-based studies that investigated the association between SES and sedentary behavior in adolescents (aged 10-19 years). Only studies that presented risk estimates were included. We conducted meta-analyses using random effects and univariate meta-regression and calculated pooled effect sizes (ES). RESULTS: Data from 39 studies were included; this provided 106 independent estimates for meta-analyses. Overall, there was an inverse association between SES and sedentary behavior (ES 0.89; 95 % confidence interval [CI] 0.81-0.98). However, the direction of the association varied: in high-income countries, SES was inversely associated with sedentary behavior (ES 0.67; 95 % CI 0.62-0.73), whereas in low-middle-income countries, there was a positive association between SES and sedentary behavior (ES 1.18; 95 % CI 1.04-1.34). In high-income countries, the associations were strongest for screen time (ES 0.68; 95 % CI 0.62-0.74) and television (TV) time (ES 0.58; 95 % CI 0.49-0.69), whereas in low-middle-income countries, the associations were strongest for 'other' screen time (i.e., computer, video, study time, but not including TV time) (ES 1.38; 95 % CI 1.07-1.79). All indicators of SES were negatively associated with sedentary behavior in high-income countries, but only resources (income and assets indexes) showed a significant positive association in low-middle-income countries. CONCLUSION: The associations between SES and sedentary behavior are different in high- and low-middle-income countries, and vary by domain of sedentary behavior. These findings suggest that different approaches may be required when developing intervention strategies for reducing sedentary behavior in adolescents in different parts of the world.

Physical Activity and Safety From Crime Among Adults: A Systematic Review.

BACKGROUND: The aim of this study was to review the evidence to date on the association between physical activity and safety from crime. METHODS: Articles with adult populations of 500+ participants investigating the association between physical activity and safety from crime were included. A methodological quality assessment was conducted using an adapted version of the Downs and Black checklist. RESULTS: The literature search identified 15,864 articles. After assessment of titles, abstracts and full-texts, 89 articles were included. Most articles (84.3%) were derived from high-income countries and only 3 prospective articles were identified. Articles presented high methodological quality. In 38 articles (42.7%), at least one statistically significant association in the expected direction was reported (ie, safety from crime was positively associated with physical activity). Nine articles (10.1%) found an association in the unexpected direction and 42 (47.2%) did not find statistically significant associations. The results did not change when we analyzed articles separately by sex, age, type of measurement, or domains of physical activity evaluated. CONCLUSION: The current evidence, mostly based on cross-sectional studies, suggests a lack of association between physical activity and safety from crime. Prospective studies and natural experiments are needed, particularly in areas with wide crime variability.

Brazilian adults' sedentary behaviors by life domain: population-based study.

BACKGROUND: There is rapidly-emerging evidence on the harmful health effects of sedentary behaviors. The aim of this paper was to quantify time in sedentary behaviors and document socio-demographic variations in different life domains among adults. METHODS: A population-based survey was carried out in 2012 through face-to-face interviews with Brazilian adults aged 20+ years (N = 2,927). Information about time spent sedentary in a typical weekday was collected for five different domains (workplace, commuting, school/university, watching TV, and computer use at home). Descriptive and bivariate analyses examined variations in overall and domain-specific sedentary time by gender, age, educational attainment and socioeconomic position. RESULTS: On average, participants reported spending 5.8 (SD 4.5) hours per day sitting. The median value was 4.5 (interquartile range: 2.5-8) hours. Men, younger adults, those with higher schooling and from the wealthiest socioeconomic groups had higher overall sedentary scores. TV time was higher in women, older adults and among those with low schooling and socioeconomic position. Sedentary time in transport was higher in men, younger adults, and participants with high schooling and high socioeconomic position. Computer use at home was more frequent among young adults and those from high socioeconomic groups. Sitting at work was higher in those with higher schooling and from the wealthiest socioeconomic groups. Sedentary behavior at school was related inversely to age and directly to schooling. CONCLUSION: Patterns of sedentary behavior are different by life domains. Initiatives to reduce prolonged sitting among Brazilian adults will be required on multiple levels for different life domains.

Physical activity advice: short report from a population-based study in Brazil.

PURPOSE: To evaluate the prevalence of physical activity advice, the source of the information, and the types of recommendation in a population-based sample of adults living in South Brazil. METHODS: Population-based study including 972 adults living in Pelotas, Brazil. The outcome variable was based on the following question: "Has anyone ever recommended you to practice physical activity"? If the answer was positive, we asked who was responsible for the prescription (an open question, which was categorized later) and which recommendation was done. RESULTS: The prevalence of physical activity advice was 56.2% (95% CI 52.3-60.1). Physical activity advice was mostly done by physicians (92.5%). Walking was, by far, the most frequent recommendation. Females were more likely to receive advice for physical activity practice than males (OR 1.74; 95% CI 1.30-2.31). Age, economic level, body mass index and leisure-time physical activity were positively associated with physical activity advice, while self-reported health presented an inverse association with the outcome. CONCLUSIONS: The prevalence of physical activity advice was high in this sample, suggesting that the Brazilian health system is incorporating physical activity in its routine.