Are school uniforms associated with gender inequalities in physical activity? A pooled analysis of population-level data from 135 countries/regions.

BACKGROUND: We assessed whether school uniforms are associated with population-level gender inequalities in physical activity, and whether associations differ by school level, country/region income, and assessment method. METHODS: An ecological study design was employed. We collected data about global uniform practices using an online survey. We searched for country/region-level estimates of school-aged youth meeting physical activity guidelines from international surveillance studies. Study selection was conducted in duplicate using a systematic process, and a random sample of all data was checked to ensure extraction and pooling processes were accurate. We calculated absolute and relative gender inequalities in physical activity for each country. Linear regression examined associations between country/region-level uniform practices (binary yes/no exposure variable) and country/region-level gender inequalities in physical activity guideline compliance (absolute and relative inequalities). We investigated moderation by school level, stratified analyses by income group, and repeated primary analyses using device-measured data. RESULTS: Pooling data from 135 countries/regions (n = 1,089,852), we found no association between population-level uniform practices and gender inequalities in physical activity across all ages (absolute: ß = -0.2; 95% confidence interval (95%CI): -1.7 to 1.3, p = 0.74; relative: ß = 0.1; 95%CI: -0.1 to 0.2, p = 0.51). Subgroup analysis suggested a positive association in primary school settings (absolute: ß = 4.3; 95%CI: -0.0 to 8.6, p = 0.05). Among high-income countries, absolute inequalities were significantly greater in countries/regions with uniform practices (N = 37) compared to those without (N = 48) (9.1 (SD = 3.6) vs. 7.8 percentage points (SD = 4.3)). Repeating analyses using device-measured data (n = 32,130; N = 24) did not alter our primary finding. From initial descriptive statistics, we found that in countries/regions where a majority of schools (>50%) reportedly use uniforms, there was lower compliance with physical activity guidelines among all genders (median: 16.0%, interquartile range: 13.2-19.9, N = 103) compared to generally non-uniform countries/regions (median: 19.5%, interquartile range: 16.4-23.5, N = 32) (z = 3.04, p = 0.002). (N = countries, regions and studies represented; n = sample size or participants included). CONCLUSION: School uniforms are associated with greater gender inequalities in physical activity in primary school settings and in high-income countries. Our population-level findings warrant testing using individual-level data across contexts.

Is rest-activity rhythm prospectively associated with all-cause mortality in older people regardless of sleep and physical activity level? The 'Como Vai?' Cohort study.

OBJECTIVE: This study aims to test the association of rest-activity rhythm (intradaily variability and interdaily stability) with all-cause mortality in an older adult cohort in Brazil. It also assesses whether the amount of time spent at each intensity level (i.e., physical activity and nocturnal sleep) interferes with this association. METHODS: This cohort study started in 2014 with older adults (≥60 years). We investigated deaths from all causes that occurred until April 2017. Rest-activity rhythm variables were obtained using accelerometry at baseline. Intradaily variability indicates higher rhythm fragmentation, while interdaily stability indicates higher rhythm stability. Cox proportional-hazard models were used to test the associations controlling for confounders. RESULTS: Among the 1451 older adults interviewed in 2014, 965 presented valid accelerometry data. During the follow-up period, 80 individuals died. After adjusting the analysis for sociodemographic, smoking, morbidity score, and number of medicines, an increase of one standard deviation in interdaily stability decreased 26% the risk of death. The adjustment for total sleep time and inactivity did not change this association. On the other hand, the association was no longer significant after adjusting for overall physical activity and moderate to vigorous physical activity. CONCLUSION: Rest-activity rhythm pattern was not associated with mortality when physical activity was considered, possibly because this pattern could be driven by regular exercise. Promoting physical activity remains a relevant strategy to improve population health.

Identifying and Characterizing the Poorest Urban Population Using National Household Surveys in 38 Cities in Sub-Saharan Africa.

Identifying and classifying poor and rich groups in cities depends on several factors. Using data from available nationally representative surveys from 38 sub-Saharan African countries, we aimed to identify, through different poverty classifications, the best classification in urban and large city contexts. Additionally, we characterized the poor and rich groups in terms of living standards and schooling. We relied on absolute and relative measures in the identification process. For absolute ones, we selected people living below the poverty line, socioeconomic deprivation status and the UN-Habitat slum definition. We used different cut-off points for relative measures based on wealth distribution: 30%, 40%, 50%, and 60%. We analyzed all these measures according to the absence of electricity, improved drinking water and sanitation facilities, the proportion of children out-of-school, and any household member aged 10 or more with less than 6 years of education. We used the sample size, the gap between the poorest and richest groups, and the observed agreement between absolute and relative measures to identify the best measure. The best classification was based on 40% of the wealth since it has good discriminatory power between groups and median observed agreement higher than 60% in all selected cities. Using this measure, the median prevalence of absence of improved sanitation facilities was 82% among the poorer, and this indicator presented the highest inequalities. Educational indicators presented the lower prevalence and inequalities. Luanda, Ouagadougou, and N'Djaména were considered the worst performers, while Lagos, Douala, and Nairobi were the best performers. The higher the human development index, the lower the observed inequalities. When analyzing cities using nationally representative surveys, we recommend using the relative measure of 40% of wealth to characterize the poorest group. This classification presented large gaps in the selected outcomes and good agreement with absolute measures.

Inequalities in Leisure-Time Physical Activity and Television Viewing According to Age Among a Brazilian Adult Population.

BACKGROUND: The present study aims to estimate leisure-time physical activity and television (TV) viewing curves according to age stratified by sex, area of residence, and socioeconomic position. METHODS: Using data from the Brazilian National Health Survey, we estimated the prevalence of leisure-time physical activity and TV viewing according to continuous age. The estimates were calculated using fractional polynomials and stratified by sex, wealth, skin color, and area of residence. RESULTS: The sample included 87,376 adults (aged 18 y or over). In general, leisure-time physical activity decreased according to age while TV viewing increased. Regarding behavior of curves according to stratifiers, for leisure-time physical activity the disadvantaged groups maintained a pattern of low physical activity across all age groups or presented the decrease earlier when compared to groups in social advantage. On the other hand, for TV viewing, women presented an increase in prevalence before men, and individuals living in the urban area and the wealthiest group were those with a higher increase according to age. CONCLUSIONS: Our findings may help researchers and policymakers further explore inequalities in physical activity across life in different settings, as well as develop sensitive cultural actions to support more vulnerable people to adopt public health recommendations.

Health inequalities in Brazilian adolescents: Measuring and mapping gaps in a cross-sectional school-based survey.

Background and Aims: This study aims to describe inequalities in health indicators according to gender, area of residence, and socioeconomic position among Brazilian adolescents. Methods: Cross-sectional study using data from a school-based survey carried out in Brazil in 2019. Twelve health outcomes were evaluated. Dimensions of inequality assessed were gender, area of residence, wealth and subnational region. Results: This study comprises a sample of 124,898 adolescents. The most prevalent outcome was physical inactivity (71.9%) followed by thinking life is worthless (52.6%) and bullying (51.8%). Gender inequalities were more marked for physical inactivity and thinking life is worthless with girls presenting a prevalence more than 20 p.p. higher than boys. In zero-dose HPV, however, the prevalence in girls was 17.7 p.p. lower than in boys. Area of residence and wealth inequalities were smaller than gender disparities. Context presented a relevant role in inequality with analysis stratified by states of the country, revealing high variability in estimates. Conclusions: We highlight the need for attention to disparities between subgroups of the adolescent population, especially for gender inequalities that were the most marked for this age group.

Sociodemographic inequalities in vegetables, fruits, and animal source foods consumption in children aged 6-23 months from 91 LMIC.

Introduction: No multi-country analysis described patterns and inequalities for the brand-new feeding indicators proposed by WHO/UNICEF: zero consumption of vegetables and fruits (ZVF) and consumption of eggs and/or flesh (EFF). Our aim was to describe patterns in the prevalence and social inequalities of ZVF and EFF among children aged 6-23 months in low-and middle-income countries. Methods: Data from nationally representative surveys (2010-2019) in 91 low-and middle-income countries were used to investigate within-country disparities in ZVF and EFF by place of residence, wealth quintiles, child sex and child age. The slope index of inequality was used to assess socioeconomic inequalities. Analyses were also pooled by World Bank income groups. Results: The prevalence of ZVF was 44.8% and it was lowest in children from upper-middle income countries, from urban areas, and those 18-23 months. The slope index of inequality showed that socioeconomic inequalities in the prevalence of ZVF were higher among poor children in comparison to richest children (mean SII = -15.3; 95%CI: -18.5; -12.1). Overall, 42.1% of children consumed egg and/or flesh foods. Being a favorable indicator, findings for EFF were generally in the opposite direction than for ZVF. The prevalence was highest in children from upper-middle income countries, from urban areas, and those 18-23 months of age. The slope index of inequality showed pro-rich patterns in most countries (mean SII = 15.4; 95%CI: 12.2; 18.6). Discussion: Our findings demonstrate that inequalities exist in terms of household wealth, place of residence, and age of the child in the prevalence of the new complementary feeding indicators. Moreover, children from low-and lower-middle countries had the lowest consumption of fruits, vegetables, eggs, and flesh foods. Such findings provide new insights towards effective approaches to tackle the malnutrition burden through optimal feeding practices.

Disparities in early initiation of breast feeding and prelacteal feeding: A study of low- and middle-income countries.

BACKGROUND: Early initiation of breast feeding (EIBF) reduces the risk of neonatal mortality. However, only 45% of newborns are breast-fed within the first hour after birth and prelacteal feeding (PLF) is widely prevalent in low- and middle-income countries (LMICs). OBJECTIVE: To assess within- and between-country disparities in EIBF and PLF practices by household wealth and place of birth and to investigate the national-level correlation between these feeding indicators in LMICs. METHODS: Data from Demographic Health Surveys and Multiple Indicator Cluster Surveys (2010-2019) in 76 LMICs were used to investigate within-country disparities in EIBF, any PLF, milk-based prelacteal feeding (MPLF), and water-based prelacteal feeding (WPLF) by wealth quintiles and place of childbirth (institutional [private or public sector] or in-home) for children under two years. We examined the between-country Pearson's correlation between EIBF and types of PLF, later adjusted for per capita gross domestic product (GDP). RESULTS: No clear wealth-related differences were found for EIBF and WPLF; however, any PLF and MPLF were significantly higher in children belonging to the richest 20% of households but are also prevalent among lower income groups. Prevalence of any PLF was higher among institutional births in all LMICs, but especially for MPLF in private sector deliveries in East Asia & the Pacific, Eastern Europe & Central Asia, and Latin America & the Caribbean. WPLF was more common in all African regions. EIBF was inversely correlated with any PLF (r = -0.59, 95% CI -0.72, -0.42), MPLF (r = -0.41, 95% CI -0.58, -0.21) and WPLF (r = -0.34, 95% CI -0.53, -0.13). Adjustment for log-GDP did not affect the magnitude and direction of the results. CONCLUSION: Clear prorich disparities exist in the prevalence of PLF, especially MPLF. Children born in private sector facilities are more likely to receive MPLF. EIBF is negatively associated with PLF practices in LMICs. The promotion of better early feeding practices is urgent to achieve the Sustainable Development Goal to reduce neonatal mortality to 12 deaths per 1000 live births.

Socioeconomic and Gender Inequalities in Leisure-Time Physical Activity and Access to Public Policies in Brazil From 2013 to 2019.

BACKGROUND: This study aims to describe changes in gender and wealth inequalities in leisure-time physical activity (PA) of Brazilians during a 6-year interval. It also aims to evaluate inequalities regarding PA public programs awareness, participation, and access to public spaces for PA. METHODS: Data from 2 population-based surveys conducted in 2013 and 2019 were used. Leisure-time PA prevalence was assessed considering those reporting ≥150 minutes per week. The authors evaluated gender inequalities calculating differences and ratios, and wealth inequalities using the slope index of inequality and the concentration index- assessing changes over time. RESULTS: National levels of leisure-time PA increased from 2013 to 2019, and an increase in inequalities was observed; women and the poorest groups still presented lower prevalence. A decline in socioeconomic inequalities was observed from 2013 to 2019 regarding the availability of public spaces and awareness about public programs. However, outcomes remained more common among the richest group. Inequalities did not vary for participation in public programs. CONCLUSION: Although leisure-time PA increased from 2013 to 2019 at a national level, there were no improvements in gender inequalities, and wealth inequalities worsened over time. Indicators of public strategies for PA increased for the population, but inequalities remain.

Age patterns in overweight and wasting prevalence of under 5-year-old children from low- and middle-income countries.

OBJECTIVES: To describe how overweight and wasting prevalence varies with age among children under 5 years in low- and middle-income countries (LMICs). METHODS: We used data from nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Overweight and wasting prevalence were defined as the proportions of children presenting mean weight for length/height (WHZ) more than 2 standard deviations above or below 2 standard deviations from the median value of the 2006 WHO standards, respectively. Descriptive analyses include national estimates of child overweight and wasting prevalence, mean, and standard deviations of WHZ stratified by age in years. National results were pooled using the population of children aged under 5 years in each country as weight. Fractional polynomials were used to compare mean WHZ with both overweight and wasting prevalence. RESULTS: Ninety national surveys from LMICs carried out between 2010 and 2019 were included. The overall prevalence of overweight declined with age from 6.3% for infants (aged 0-11 months) to 3.0% in 4 years olds (p = 0.03). In all age groups, lower prevalence was observed in low-income compared to upper-middle-income countries. Wasting was also more frequent among infants, with a slight decrease between the first and second year of life, and little variation thereafter. Lower-middle-income countries showed the highest wasting prevalence in all age groups. On the other hand, mean WHZ was stable over the first 5 years of life, but the median standard deviation for WHZ decreased from 1.39 in infants to 1.09 in 4-year-old children (p < 0.001). For any given value of WHZ, both overweight and wasting prevalence were higher in infants than in older children. CONCLUSION: The higher values of WHZ standard deviations in infants suggest that declining prevalence in overweight and wasting by age may be possibly due to measurement error or rapid crossing of growth channels by infants.

Objectively measured physical activity according to the periods of the day in the Pelotas Cohort / Medida objetiva de atividade física de acordo com períodos do dia em uma coorte de Pelotas

This study aims to describe objectively measured physical activity (PA) in different periods of the day in young adults according to sex, socioeconomic position and during weekdays and weekends. This is a cross-sectional analysis carried out with the participants of the 1993 Pelotas Birth Cohort at 22 years. PA was assessed by triaxial accelerometer. Descriptive analyses were performed presenting the time spent on light PA (LPA) and bouted moderate to vigorous PA (MVPA) in different periods of the day (morning - 6am to 11:59 am, afternoon ­ 12pm to 7:59 pm and night ­ 8pm to 11:59pm). The present study included 2,766 individuals (48.2% male and 51.8% female). LPA was higher among women, while bouted MVPA levels were higher among men. The median of PA was higher on weekdays compared to weekends for all intensities. The bouted MVPA medians in the morning and at night were zero minutes for all days and both sexes. The richest group presented a higher percentage of individuals with zero minutes. PA may vary according to different periods of the day and intensity. The absence of PA practice was markedly influenced by sex and socioeconomic position

Este estudo teve o objetivo de mensurar atividade física (AF) objetivamente em diferentes períodos do dia em adultos jovens de acordo com sexo, posição socioeconômica e dia de semana e final de semana. Esta é uma análise transversal conduzida com participantes da Coorte de Nascimentos de 1993 de Pelotas aos 22 anos. AF foi avaliada por um acelerômetro triaxial. Foram realizadas análises descritivas apresentando o tempo em AF leve (AFL) e moderada a vigorosa (AFMV ) em diferentes períodos do dia (manhã ­ 6h às 11:59h, tarde ­ 12h às 19:59h e noite ­ 20h às 0h). O presente estudo incluiu 2.766 individuos (48.2% homens e 51.8% mulheres). AFL foi maior entre as mulheres enquanto AFMV foi maior entre os homens. A mediana de AF foi maior nos dias de semana comparado aos dias de final de semana para qualquer intensidade. As medianas de AFMV pela manhã e noite foram zero minutos para todos os dias nos dois sexos. O grupo econômico mais alto apresentou maior percentual de individuos com zero minutos de AFMV. AF pode variar de acordo com diferentes períodos do dia e intensidades. A ausência de prática de AF foi marcadamente influenciada por sexo e posição socioeconômica

Is Brazil going to achieve the road traffic deaths target? An analysis about the sustainable development goals.

OBJECTIVE: To describe the temporal relationship between the road traffic mortality rate and gross domestic product (GDP) per capita in Brazil, and make an annual prediction of the evolution of both indicators until 2020, the end of the Sustainable Development Goals (SDGs) monitoring period. METHODS: Brazilian road traffic mortality rate official data were described from 2000 to 2015, while the GDP per capita official data were described from 2000 to 2013. GDP per capita and traffic mortality rate predictions were performed until 2020 using fractional polynomial analysis. Correlations were assessed using Pearson's correlation coefficient. RESULTS: From 2000 to 2015, there were over 446 000 road crashes fatal victims in Brazil. The road traffic mortality rate was positively related to the Brazilian GDP per capita, with a strong correlation (r=0.89; p<0.001) from 2000 to 2013 and a mild correlation (r=0.55; p<0.001) considering the whole period (2000-2020). The predictions show a reduction on the road traffic mortality rates in Brazil; however, if this same reduction pace continues, we estimate that the country will reach 12.4 road crash deaths per 100 000 inhabitants in 2020, a reduction of only 13.4% compared with 2015. CONCLUSION: If the same mortality reduction pace continues in Brazil, the country will not reach the proposed SDG, which is to reduce by half the number of deaths per 100 000 inhabitants. In addition, an intertwined conciliation between economical growth, sustainable development and public policies is needed in order to meet such an overwhelming goal.