Psychosocial mediators of screen time reduction after an intervention for students from schools in vulnerable areas: A cluster-randomized controlled trial.

OBJECTIVES: To investigate whether psychosocial variables mediate the effect of a multicomponent intervention on screen time reduction among Brazilian students from schools located in vulnerable areas. DESIGN: A cluster-randomized controlled trial with a 4-month follow-up. METHODS: This study was conducted with 1085 students (548 in the intervention group and 537 in the control group), aged 11-17years. The intervention strategies focused on training teachers, increasing opportunities for physical activity at school, and reducing screen time, as well as health education. The questionnaire was administered before and after intervention with questions about the amount of time spent on TV and computer/video games on weekdays and weekend days (combined screen time). The potential psychosocial mediators (attitude, self-efficacy, family and school support) were measured through validated scales. Socioeconomic status was used as control variable. Multilevel mediation analyses were conducted using a product-of-coefficients test. RESULTS: Psychosocial factors were not mediators of the effect of the intervention on screen time. The intervention significantly improved school support for both sexes (boys: 1.307; girls: 0.759; p<0.05) and older students (1.154; p<0.001). Attitude (boys: -0.228; 11-13years: -0.133; 14-17years: -0.152; p<0.05) and self-efficacy scales (boys: -0.040; girls: -0.104; 11-13years: -0.048; 14-17years: -0.100; p<0.05) were associated with reduced screen time. CONCLUSIONS: The intervention produced a significant improvement of school support for both sexes, as well as older students. Enhancing attitude and self-efficacy may be a useful strategy for reducing screen time among boys and students of any age groups. TRIAL REGISTRATION: ClinicalTrials.Gov: NCT02439827. Registration date: May 3, 2015.

Change in overweight and obesity over a decade according to sociodemographic factors in Brazilian adolescents.

The aims were to examine changes in the prevalence of overweight and obesity among students from 2001 to 2011, and to verify if these changes differ according to age group, area of residence, and family income. We analyzed two cross-sectional surveys conducted in 2001 and 2011 with brazilian adolescents. Sociodemographic and anthropometric characteristics were self-reported using a questionnaire. Multinomial logistic regression was used to analyze changes in overweight and obesity between the two surveys. The nutritional status was the outcome of the present study and the surveys (2001 and 2011) were the exposure. The odds of being overweight and obese were higher among boys and girls in urban areas in the 2011 survey compared to the 2001. Boys and girls with higher income were also more likely to present overweight and obesity in the second survey compared to the first. An increase of overweight and obesity was observed over a decade. We suggest that future interventions consider the area of residence and the family income to strengthen the effectiveness of actions developed to prevent and control these indicators among adolescents.

Change in overweight and obesity over a decade according to sociodemographic factors in Brazilian adolescents / Mudança no sobrepeso e obesidade após uma década de acordo com fatores sociodemográficos em adolescentes brasileiros

Abstract The aims were to examine changes in the prevalence of overweight and obesity among students from 2001 to 2011, and to verify if these changes differ according to age group, area of residence, and family income. We analyzed two cross-sectional surveys conducted in 2001 and 2011 with brazilian adolescents. Sociodemographic and anthropometric characteristics were self-reported using a questionnaire. Multinomial logistic regression was used to analyze changes in overweight and obesity between the two surveys. The nutritional status was the outcome of the present study and the surveys (2001 and 2011) were the exposure. The odds of being overweight and obese were higher among boys and girls in urban areas in the 2011 survey compared to the 2001. Boys and girls with higher income were also more likely to present overweight and obesity in the second survey compared to the first. An increase of overweight and obesity was observed over a decade. We suggest that future interventions consider the area of residence and the family income to strengthen the effectiveness of actions developed to prevent and control these indicators among adolescents.

Resumo Os objetivos do estudo foram examinar as mudanças na prevalência de sobrepeso e obesidade entre os estudantes de 2001 a 2011 e verificar se essas alterações diferem de acordo com a faixa etária, a área de residência e a renda familiar. Analisamos dois levantamentos transversais realizados em 2001 e 2011 com adolescentes brasileiros. As características sociodemográficas e antropométricas foram autorrelatadas por meio de um questionário. Regressão logística multinomial foi utilizada para analisar as mudanças no sobrepeso e obesidade entre os dois inquéritos. O estado nutricional foi considerado o desfecho do presente estudo e os inquéritos (2001 e 2011) foram as exposições. As razões de chance de sobrepeso e obesidade foram maiores entre os meninos e meninas em áreas urbanas no inquérito de 2011 em comparação com 2001. Meninos e meninas com maior renda também apresentaram maior chance de sobrepeso e obesidade no segundo inquérito. Sugerimos que futuras intervenções considerem a área de residência e a renda familiar para fortalecer a eficácia das ações desenvolvidas para prevenir e controlar esses indicadores entre os adolescentes.

Association between socio-economic status and physical activity is mediated by social support in Brazilian students.

This study evaluated whether the relationship between socioeconomic status (SES) and moderate-to-vigorous physical activity (MVPA) is mediated by social support of peers and parents. A cross-sectional study included students (n = 1182) aged 11 to 18 years who were recruited in 2014 from public schools in Fortaleza, Brazil. Participants completed a questionnaire to assess all variables. Mediation analyses were performed to determine the role of parental support and peer support on the relationship between SES and MVPA. Also, moderated-mediation analyses with estimating of conditional indirect effects were performed in order to identify whether gender is a moderator of the mediating effect. A positive and significant association between SES and MVPA was found among Brazilian students, and social support of parents and peers were significant mediators of this relationship. Conditional indirect effects showed that both parental and peer support had a significant indirect effect among boys; only parental support had a significant indirect effect among girls. These results suggest that improving social support can help reduce the impact of SES on physical activity among Brazilian adolescents.

Preference for leisure activities among adolescents in southern Brazil: What changed after a decade? / Preferencia para las actividades de ocio entre adolescentes en el sur de brasil: ¿Qué cambió después de una década? / Preferência por atividades de lazer em adolescentes do sul do brasil: o que mudou após uma década?

The preference for a specific activity during leisure time can directly influence its practice, both for active and sedentary behaviors. Thus, the purpose of this study was to identify changes after a decade in the preference for leisure activities according to gender and age group between two generations of adolescents from southern Brazil. It was a repeated cross-sectional study (2001-2011). Representative samples of high school students (aged 15-19 years) from public schools in the state of Santa Catarina were evaluated in 2001 (n = 5028) and 2011 (n = 6529). Students answered one question on the preferred leisure activity, organized into six groups of activities. Comparisons between surveys were based on the relative frequency and 95% condence intervals (95% CI). After a decade, there were signicant reductions (95% CI did not overlap) in the preference for practicing physical activities, cultural activities and other activities, while the preference for watching TV, playing video games and using computer increased over time. These trends were similar between boys and girls and between younger (15-16 years-old) and older (17-19 years-old) students. The magnitude of changes was bigger in the proportion of preference for using computer and for practicing physical activities. There was an increase in the preference for leisure activities that involve screen time use, but the preference for other leisure activities (e.g., physical and cultural activities) reduced after a decade. Reasons underlying the change in leisure preferences need to be examined to support future interventions

La preferencia por una actividad especíca en el ocio puede influir directamente en su práctica, tanto para los comportamientos activos como los sedentarios. Así, el objetivo de este estudio fue identicar cambios tras una década en la preferencia por actividades de ocio de acuerdo con el género y con la franja etaria entre dos generaciones de adolescentes del sur de Brasil. Para ello, se realizó un estudio transversal de repetición en 2001 y 2011. Se evaluaron muestras representativas de estudiantes de secundaria (15-19 años) de escuelas públicas del estado de Santa Catarina en 2001 (n = 5028) y 2011 (n= 6529). Los alumnos contestaron a una pregunta sobre la actividad de ocio preferida, organizada en seis grupos de actividades. Las comparaciones entre las encuestas se basaron en la frecuencia relativa y en los intervalos de conanza del 95% (IC95%). Después de una década, hubo reducciones significativas (IC95% no se solapó) en la preferencia por la practica de actividades físicas, actividades culturales y otras actividades, mientras que la preferencia por ver la televisión, jugar a los videojuegos y usar las computadoras aumentó con el paso del tiempo. Estas tendencias fueron similares entre niños y niñas y entre estudiantes más jóvenes (15-16 años) y mayores (17-19 años). La magnitud de los cambios fue mayor en la proporción de preferencia por el uso de las computadoras y por la práctica de actividades físicas. En conclusión, se observó un aumento en la preferencia por actividades de ocio que involucran el uso del tiempo de pantalla, pero la preferencia por otras actividades de ocio (por ejemplo, actividades físicas y culturales) se redujo tras una década. Las razones subyacentes al cambio en las preferencias de ocio deben ser examinadas para apoyar a futuras intervenciones

A preferência por uma atividade específica no lazer pode influenciar diretamente sua prática, tanto para comportamentos ativos quanto sedentários. Assim, o objetivo deste estudo foi identificar mudanças após uma década na preferência por atividades de lazer de acordo com o gênero e a faixa etária entre duas gerações de adolescentes do sul do Brasil. Para isso, um estudo transversal de repetição foi realizado em 2001 e 2011. Amostras representativas de estudantes do ensino médio (15-19 años) de escolas públicas do estado de Santa Catarina foram avaliadas em 2001 (n = 5028) e 2011 (n = 6529). Os alunos responderam a uma pergunta sobre a atividade de lazer preferida, organizada em seis grupos de atividades. As comparações entre as pesquisas foram baseadas na frequência relativa e nos intervalos de confiança de 95% (IC95%). Apósuma década, houve reduções significativas (IC95% não se sobrepôs) na preferência por praticar atividades físicas, atividades culturais e outras ativnidades, enquanto a preferência por assistir TV, jogar videogames e usar computador aumentou com o tempo. Essas tendências foram semelhantes entre rapazes e moças e entre estudantes mais jovens (15-16 anos) emais velhos (17-19 anos). A magnitude das mudanças foi maior na proporção de preferência pelo uso do computador e pela prática de atividades físicas. Como conclusão, houve um aumento na preferência por atividades de lazer que envolvem o uso do tempo de tela, mas a preferência por outras atividades de lazer (como atividades físicas e culturais) diminuiu após uma década. As razões subjacentes à mudança nas preferências de lazer precisam ser examinadas para apoiar futuras intervenções

Agregação de comportamentos de risco à saúde de escolares da rede pública de Jequié, Bahia, Brasil / Aggregation of health behaviors risk of schools of the public network of Jequié, Bahia, Brazil

O objetivo deste estudo foi estimar as prevalências de comportamentos de risco à saúde, de forma isolada e agregada, e analisar fatores associados. Tratou-se de estudo epidemiológico transversal, com amostra representativa de escolares de 14 a 20 anos de idade (n = 1.170) do ensino médio da rede pública, Jequié, Bahia, Brasil. Os comportamentos de risco observados foram: níveis insuficientes de atividade física, comportamento sedentário, consumo inadequado de frutas e verduras e consumo de bebidas alcoólicas e de tabaco. Os possíveis fatores associados foram: sexo, idade, estado civil, ocupação, escolaridade da mãe e renda familiar. A prevalência de nível insuficiente de atividade física foi mais elevada no sexo feminino (87,6% vs. 73,0%; p = 0,001), enquanto que o consumo de bebi-das alcoólicas (28,2% vs. 20,6%; p = 0,003) e de tabaco (8,7% vs. 3,8%; p = 0,001) foi superior no masculino. Para o sexo feminino houve 6,34 vezes maior a prevalência observada pela esperada (PO/PE), entre: níveis insuficientes de atividade física, comportamento sedentário e consumo de bebidas alcoólicas e de tabaco A prevalência de três ou mais comportamentos de risco foi de 7,9% (IC95%: 6,4-9,5) e os escolares que pertenciam às famílias com renda inferior a dois salários mínimos tiveram menor probabilidade de exposição (RP = 0,60; IC95%: 0,39-0,93). Os resultados indicaram elevada prevalência de insuficientemente ativos, de consumo inadequado de frutas e verduras e agregação de múltiplos comportamentos de risco para o sexo feminino

The aim of this study to estimate the health behaviors risks prevalence in isolated and aggregated way, and analyze associated factors. This was a cross-sectional epidemiological study, with a representative sample of public high school students, from 14 to 20 years of age (n = 1,170) from Jequié, Bahia, Brazil. The observed behaviors risks were: insufficient levels of physical activity, sedentary behavior, inadequate fruits and vege-table consumption, and alcoholic beverages and tobacco consumption. Possible associated factors were: gender, age, marital status, occupation, mother's education, and family income. The insufficient physical activity prevalence was higher in females (87.6% vs. 73.0%, p = 0.001), while alcohol consumption (28.2% vs. 20.6%; p = 0.003) and tobacco (8.7% vs. 3.8%, p = 0.001) was higher in males. For female sex, there was a 6.34-fold higher observed for the expected prevalence (OP/EP), between insufficient physical activity levels, sedentary behavior, and alcoholic beverages and tobacco consumption. The three or more risk behaviors prevalence was 7.9% (95%CI: 6.4-9.5) and schoolchildren belonging to families with incomes less than two minimum wages had a lower probability of exposure (PR = 0.60; 95%CI: 0.39-0.93). The results indicated a high prevalence of insufficiently active, inadequate fruits and vegetable consumption and the aggregation of multiple behaviors risk for the female sex

"For whom was it effective?" Moderators of the effect of a school-based intervention on potential physical activity determinants among Brazilian students.

Knowledge about the effects of school-based interventions on modifiable physical activity (PA) determinants (e.g., social support), and whether the intervention effect differs according to students' characteristics (e.g., age and gender) are relevant PA promotion topics. This study aims to answer these topics among Brazilian students. This cluster-randomized controlled trial was conducted with 548 students in the intervention group and 537 in the control group (51.5% of boys; aged 11-18years). The four-month intervention included strategies focused on training teachers, opportunities for PA in the school environment, and health education. Potential PA determinants (attitude, self-efficacy, support of friends, parents, and teachers, perceived neighborhood environment and PA facilities in school) and moderators (gender, age, socioeconomic status (SES), and PA level at baseline) were assessed using self-reported instrument. Height and weight were measured to estimate the students' body mass index (BMI) status. Generalized linear models were used. In general, there was a significant and positive intervention effect for attitude, support of friends and teachers for PA, as well as PA facilities in school; effect size was 0.29, 0.24, 0.34, and 0.29, respectively (P<0.05). Age (support of friends, parents and teachers, and PA facilities in school), SES (support of friends and PA facilities in school), and BMI status (support of friends) were moderators of the intervention effect on some outcomes. In conclusion, the intervention improved potential PA determinants, but some changes occurred differently according to students' characteristics. These findings should be considered in PA policies in the school context. TRIAL REGISTRATION: This study is registered at Clinicaltrials.govNCT02439827.

Behavior change stages related to physical activity in adolescents from Santa Catarina: prevalence and associated factors / Estágios de mudança de comportamento para atividade física em adolescentes catarinenses: prevalência e fatores associados

Abstract Objective: Verify the prevalence and sociodemographic and economic factors associated with behavior change stages for habitual physical activity practice in adolescents from Santa Catarina. Methods: Secondary analysis of a study on the Behavior of Adolescents from Santa Catarina (CompAC 2). Cross-sectional school-based study of 6,529 high-school students (males, n=2,903) from the state of Santa Catarina public education system in 2011, aged 15 to 19 years. Multinomial logistic regression (crude and adjusted) was used to measure the association. Results: The highest and lowest prevalence rates were found in the maintenance (43.9%) and precontemplation stages (7.0%), respectively. The stages of action, preparation and contemplation showed similar results: 16.2%; 17.0% and 15.6%; respectively. Male adolescents show higher prevalence in the maintenance stage in relation to females and these show a higher prevalence in preparation, contemplation and precontemplation. All the assessed variables (gender, age, area of residence, employment status, family income, maternal education and school grade), with the exception of school shift, were associated with at least one of the stages. Conclusions: A large proportion of adolescents are in the pre-adoption stages and most of these have the intention to start regular physical activity. With the exception of school shift, the assessed variables were associated with stages in different ways, showing different profiles in relation to sociodemographic and economic characteristics in each subgroup.

Resumo Objetivo: Verificar as prevalências e os fatores sociodemográficos e econômicos associados aos estágios de mudança de comportamento para prática habitual de atividade física em adolescentes catarinenses. Métodos: Análise secundária de estudo sobre o Comportamento do Adolescente Catarinense (CompAC 2). Estudo transversal de base escolar composto por 6.529 escolares (sexo masculino, n=2.903) do ensino médio da rede pública estadual de Santa Catarina em 2011, entre 15 a 19 anos. Para medida de associação, usou-se regressão logística multinomial (bruta e ajustada). Resultados: As prevalências mais elevadas e mais baixas foram verificadas nos estágios de manutenção (43,9%) e pré-contemplação (7%), respectivamente. Os estágios de ação, preparação e contemplação apresentaram resultados semelhantes entre si: 16,2%, 17% e 15,6%, respectivamente. Adolescentes do sexo masculino estão em maior prevalência no estágio de manutenção em relação aos do sexo feminino e essas apresentam maior prevalência em preparação, contemplação e pré-contemplação. Todas as variáveis investigadas (sexo, idade, área de moradia, situação ocupacional, renda familiar, escolaridade materna e série escolar), com exceção do turno de estudo, apresentaram associação com pelo menos um dos estágios. Conclusões: Grande parcela dos adolescentes encontra-se nos estágios de pré-adoção e a maioria desses tem a intenção de iniciar a prática regular de atividade física. Com exceção do turno de estudo, as variáveis investigadas estiveram associadas aos estágios de diferentes formas, apresentaram perfis distintos em relação às características sociodemográficas e econômicas em cada subgrupo.

Promoting physical activity for children and adolescents in low- and middle-income countries: An umbrella systematic review: A review on promoting physical activity in LMIC.

OBJECTIVE: It is unknown how much previous reviews on promoting physical activity (PA) for children and adolescents (aged 6-18years) take into account studies from low- and middle-income countries (LMIC, based on the World Bank definition) and the level of evidence of the effect of PA interventions in this population. This study aims to answer such questions using an umbrella systematic review approach. METHODS: We searched for peer-reviewed systematic reviews and original studies in eight electronic databases, screening of reference lists and expert contacts. Information in systematic reviews on PA interventions for children and adolescents from LMIC was discussed. Original studies on PA interventions (randomized-controlled trials [RCT], cluster-RCT and non-RCT) with children and adolescents from LMIC were eligible. We assessed the methodological quality in all studies, and the evidence level of effect on PA in intervention studies. RESULTS: Fifty systematic reviews (nine meta-analyses) and 25 original studies (20 different interventions) met eligibility criteria. Only 3.1% of mentioned studies in previous reviews were from LMIC. Strong and LMIC-specific evidence was found that school-based, multicomponent, and short-term (up to six months) interventions, focused on adolescents primarily (aged 13-18years), can promote PA in children and adolescents from LMIC. Other intervention characteristics had inconclusive evidence due to the low number of studies, low methodological quality, and/or small sample size. CONCLUSION: A minimal part of PA interventions mentioned in previous reviews are from LMIC. Our LMIC-specific analyses showed priorities of implementation and practical implication that can be used in public policies for PA promotion in LMIC.

Validity and reliability of scales on intrapersonal, interpersonal and environmental factors associated with physical activity in Brazilian secondary students / Validade e fidedignidade de escalas sobre fatores intrapessoais, interpessoais e ambientais associados à atividade física em escolares brasileiros do ensino fundamental

Abstract This study aimed to examine the validity and reliability of scales of intrapersonal, interpersonal, and environmental factors associated with physical activity (PA) in secondary students. Two cross-sectional studies were conducted with students in 7th to 9th grades form secondary schools in order to test the validity, internal consistency (n = 1,178, 51.4% were boys), and test–retest reproducibility (n = 194, 56.2% were boys) of the instrument. Factors associated with PA (attitude, self-efficacy, social support of friends, parents and the school’s teachers, as well as the perceived neighborhood environment and perceived school environment) were measured. The confirmatory factor analysis and Spearman correlation between the scales and the weekly time spent in moderateto-vigorous PA (measured by questionnaire) were applied to test the construct validity. For reliability, the Cronbach’s α (internal consistency), composite reliability (CR) and intraclass correlation coefficient (ICC for test–retest reproducibility) were applied. The confirmatory factorial analysis showed five one-dimensional and two two-dimensional (self-efficacy and perceived environment) scales, with factor loadings ranging from 0.46 to 0.85. Significant and positive correlations between almost all scale scores and moderateto-vigorous PA (p<0.05) were found. The Cronbach’s α and CR were greater than 0.70 in almost all scales (except perceived school environment, α and CR of 0.61) and the ICC ranged from 0.62 (parental social support) to 0.70 (self-efficacy). In conclusion, the scales showed acceptable validity and reliability and can be used for measuring of PA correlates in elementary students.

Resumo Este estudo analisou a validade e a fidedignidade de escalas de fatores intrapessoais, interpessoais e ambientais associados à atividade física (AF) em escolares do ensino fundamental. Estudos transversais incluíram escolares dos 7º ao 9º anos para análises de validade e consistência interna (n=1.178, 51,4% meninos), e reprodutibilidade teste-reteste (n=194, 56,2% meninos) do instrumento. Atitude, autoeficácia, apoio social dos amigos, pais e professores da escola, e o ambiente percebido do bairro e da escola relacionados à AF foram avaliados. A análise fatorial confirmatória e a correlação de Spearman entre os escores das escalas e o tempo semanal em AF moderada a vigorosa foram aplicadas para testar a validade de constructo das escalas. Utilizou-se o α de Cronbach e o índice de fidedignidade combinada (IFC) para avaliar a consistência interna, e o coeficiente de correlação intra-classe (CCI) para a reprodutibilidade teste-reteste. A análise fatorial confirmatória indicou cinco escalas unidimensionais e duas bi-dimensionais (autoeficácia e ambiente percebido para AF), com ajustes de modelo adequados e cargas fatoriais de 0.46 a 0.85. Houve correlações significativas entre os escores de quase todas as escalas e AF moderada a vigorosa (p<0,05). O a e o IFC foram maiores de 0.70 em quase todas as escalas (exceto ambiente percebido da escola, a e IFC de 0.61) e o CCI variou de 0.62 (apoio social dos pais para AF) a 0.70 (autoeficácia para AF). Em conclusão, as escalas apresentaram validade e fidedignidade aceitáveis e pode ser utilizado na mensuração de fatores associados à AF em escolares do ensino fundamental.

Leisure-time physical activity and associated factors among adolescents of Pernambuco, Brazil: From 2006 to 2011 / Mudanças na atividade física no lazer e fatores associados em adolescentes de Pernambuco, Brasil: de 2006 a 2011

Abstract Leisure-time physical activity (LTPA) has important implications in promoting physical activity among young people. The present study aimed to analyze variations occurred in the 2006-2011 period in LTPA and associated factors among high school boys and girls in the state of Pernambuco, Northeastern Brazil. A cross-sectional school-based and statewide survey was conducted in 2006 (n = 4,207) and 2011 (n = 6,264), and samples of adolescents (14-19 years) were compared. Data were collected through a questionnaire. The practice of LTPA was obtained by the question “Do you perform regularly, some kind of physical activity in your free time?” Poisson regression was used (confidence interval (CI) 95%) in crude and adjusted analyses stratified by gender. From 2006 to 2011, there was stability in the proportion of adolescents practicing LTPA both among boys (77.5% versus 78.9%) and girls (51.2%, versus 54.0%). The weekly frequency of physical education classes was directly associated with LTPA both in girls and boys, regardless of the survey year. Age, marital status, grade and computer use were significantly associated with LTPA, but there were distinctions between genders and surveys. In conclusion, there was a temporal variation between 2006 and 2011, but the reduction or increment in LTPA practice varied according to stratification of subgroups of adolescents. In general, physical education class was a factor that remained associated with LTPA in the investigated period.

Resumo A prática de atividades físicas no lazer (AFL) tem importante implicação na promoção da atividade física entre jovens. O presente estudo objetivou analisar variações ocorridas, de 2006 a 2011, na AFL e nos fatores associados em estudantes do ensino médio no estado de Pernambuco, Brasil. Foram comparados os resultados de dois inquéritos transversais de base escolar e abrangência estadual, realizados em 2006 (n= 4.207) e 2011 (n= 6.264), com amostras representativas de adolescentes (14 a 19 anos). Os dados foram coletados por meio de questionário. A prática de AFL foi obtida pela questão “Você realiza, regularmente, algum tipo de atividade física no seu tempo livre?”. Empregou-se a regressão de Poisson (IC de 95%) em análises bruta e ajustada estratificadas por sexo. De 2006 para 2011, houve estabilidade na proporção de adolescentes praticantes de AFL, tanto entre os rapazes (de 77,5%; IC95%: 75,5; 79,6 para 78,9%; IC95%: 77,2; 80,6), quanto entre as moças (de 51,2%; IC95%: 48,7; 53,6 para 54,0%; IC95%: 51,8; 56,2). A frequência semanal de aulas de Educação Física esteve diretamente associada à prática de AFL em moças e rapazes, tanto em 2006 quanto em 2011. Idade, estado civil, série de curso e possuir computador estiveram significativamente associados à AFL, mas com distinções entre sexos e inquéritos. Conclui-se que ocorreu variação temporal, entre 2006 e 2011, com redução ou aumento na prevalência de AFL, conforme estratificação dos subgrupos de adolescentes apresentados acima. De um modo geral, o fator aula de Educação Física se manteve associado à AFL no período investigado.

Isolated and combined presence of elevated anthropometric indices in children: prevalence and sociodemographic correlates.

This study analyzed the prevalence and sociodemographic factors associated to the isolated and combined presence of elevated anthropometric indices among children. A cross-sectional study was performed with 2,035 children (aged 6-11 years, 50.1% of girls) who were randomly selected in schools from Colombo, Brazil. Body Mass Index (BMI), Waist Circumference (WC) and Waist-to-Height Ratio (WHtR) were classified using reference values. Age, gender, type of school, shift, and residence area were potential risk factors. Binary logistic regression was used (p < 0.05). The prevalence of children with isolated presence of elevated BMI, WHtR or WC was observed in 9.4% (confidence interval [CI] of 95%: 3.3; 15.7), 8.7% (CI 95%: 1.7; 15.9) and 4.4% (CI 95%: 1.0; 7.9), 8.7% of children, respectively. The presence of one or more elevated anthropometric index was observed in 16.9% (CI 95%: 5.4; 28.5) of children. Boys (BMI), younger children (WC) and children from public schools (BMI, WC or WHtR) were high-risk subgroups to the isolated presence of elevated anthropometric indices. Children from public schools and rural areas were high-risk subgroup to the combined presence of elevated anthropometric indices. In conclusion, Public policies to combat childhood obesity may be more effective whether they targeted at children from public schools and rural areas.

Pressão arterial e fatores associados em adolescentes na região Sul do Brasil / Blood pressure and associated factors in adolescents from southern Brazil

Fundamento: A pressão arterial elevada é um dos principais fatores de risco para doenças cardiovasculares e está relacionada a fatores de risco modificáveis. Objetivo: Analisar a associação de fatores comportamentais e biológicos com a pressão arterial em adolescentes na região Sul do Brasil. Métodos: Estudo transversal de base escolar com amostra probabilística composta por 660 adolescentes de 14 a 19 anos de idade do município de Três de Maio, Rio Grande do Sul, Brasil. Foram analisadas variáveis comportamentais (atividade física moderada a vigorosa, comportamentos sedentários, tabagismo, consumo abusivo álcool, ingestão de lipídios, ácidos graxos saturados totais, colesterol, sódio, cálcio, potássio e fibras) e biológicas (índice de massa corporal, colesterol total, lipoproteína de alta densidade e glicemia).A associação entre as variáveis e a pressão arterial foi testada por meio da análise de regressão linear. Resultados: Os fatores positivamente associados à pressão arterial foram o índice de massa corporal (sistólica: ß=0,97; p<0,001; diastólica: ß=0,55; p<0,001), glicemia (sistólica: ß=0,16; p<0,001; diastólica: ß=0,13; p<0,001), colesterol total (sistólica: ß=0,04; p=0,001), consumo de sódio (sistólica: ß=0,001; p=0,002) e de ácidos graxos saturados (diastólica: ß=0,06; p=0,01), enquanto que a prática de atividade física moderada a vigorosa se associou de forma inversa (diastólica: ß=-0,93; p=0,05). Conclusões: Fatores modificáveis (comportamentais e biológicos) relacionados direta e indiretamente ao estilo de vida dos adolescentes estão associados à sua pressão arterial. Isso reforça a necessidade de desenvolver ações que promovam a adoção de hábitos saudáveis nesse grupo populacional

Background: High blood pressure is one of the main risk factors for cardiovascular diseases and is related to modifiable risk factors. Objective: The aim of this study was to analyze the association between behavioral and biological factors and blood pressure in adolescents from Southern Brazil. Methods: School-based cross-sectional study, with a probabilistic sample composed of 660 adolescents between the ages of 14 and 19 years from the municipality of Três de Maio, Rio Grande do Sul state, Brazil. The following variables were analyzed: behavioral (moderate to vigorous physical activity, sedentary behavior, smoking, abusive alcohol consumption, lipid, saturated fatty acid, cholesterol, sodium, calcium, potassium and fiber intake) and biological (body mass index, total cholesterol, high-density lipoprotein and glycemia). The association between the variables and blood pressure was tested by linear regression analysis. Results: Factors positively associated to blood pressure were body mass index (systolic: ß=0.97; p<0.001; diastolic: ß=0.55; p<0.001), glycemia (systolic: ß=0.16; p<0.001; diastolic: ß=0.13; p<0.001), total cholesterol (systolic: ß=0.04; p=0.001), sodium (systolic: ß=0.001; p=0.002) and saturated fatty acid intake (diastolic: ß=0.06; p=0.01), whereas moderate to vigorous physical activity was inversely associated (diastolic: ß=-0.93; p=0.05). Conclusions: Modifiable factors (behavioral and biological) directly and indirectly related to the lifestyle of adolescents, are associated with their blood pressure. This reinforces the need to develop measures that promote the adoption of healthy habits in this population group

Presença isolada e combinada de indicadores antropométricos elevados em crianças: prevalência e fatores sociodemográficos associados / Isolated and combined presence of elevated anthropometric indices in children: prevalence and sociodemographic correlates

Resumo Este estudo analisou a prevalência e os fatores sociodemográficos associados à presença isolada e combinada de indicadores antropométricos elevados em crianças. Estudo descritivo com 2.035 crianças (6–11 anos de idade, 50,1% de meninas), selecionadas de forma aleatória em escolas de Colombo, Brasil. O Índice de Massa Corporal (IMC), Circunferência da Cintura (CC) e Razão Cintura-Estatura (RCEst) foram classificadas conforme critérios de referência. As variáveis exploratórias foram idade, sexo, rede de ensino, turno e zona de moradia. A regressão logística binária foi utilizada (p < 0,05). As prevalências de crianças com IMC, RCEst ou CC elevados foram 9,4% (intervalo de confiança [IC] de 95%: 3,3; 15,7), 8,7% (IC95%: 1,7; 15,9) e 4,4% (IC95%: 1,0; 7,9), respectivamente. A prevalência de um ou mais indicadores antropométricos elevados foi de 16,9% (IC95%: 5,4; 28,5). Crianças do sexo masculino (IMC elevado), mais novas (CC elevada) e da rede pública (IMC, CC ou RCEst elevados) tiveram maior odds ratio à presença isolada de indicadores antropométricos elevados. A rede pública e a zona rural foram associados à presença combinada de indicadores antropométricos elevados. Em conclusão, o combate à obesidade infantil nesta população pode ser direcionado às crianças da zona rural e da rede pública.

Abstract This study analyzed the prevalence and sociodemographic factors associated to the isolated and combined presence of elevated anthropometric indices among children. A cross-sectional study was performed with 2,035 children (aged 6–11 years, 50.1% of girls) who were randomly selected in schools from Colombo, Brazil. Body Mass Index (BMI), Waist Circumference (WC) and Waist-to-Height Ratio (WHtR) were classified using reference values. Age, gender, type of school, shift, and residence area were potential risk factors. Binary logistic regression was used (p < 0.05). The prevalence of children with isolated presence of elevated BMI, WHtR or WC was observed in 9.4% (confidence interval [CI] of 95%: 3.3; 15.7), 8.7% (CI 95%: 1.7; 15.9) and 4.4% (CI 95%: 1.0; 7.9), 8.7% of children, respectively. The presence of one or more elevated anthropometric index was observed in 16.9% (CI 95%: 5.4; 28.5) of children. Boys (BMI), younger children (WC) and children from public schools (BMI, WC or WHtR) were high-risk subgroups to the isolated presence of elevated anthropometric indices. Children from public schools and rural areas were high-risk subgroup to the combined presence of elevated anthropometric indices. In conclusion, Public policies to combat childhood obesity may be more effective whether they targeted at children from public schools and rural areas.

Prevalência de tempo excessivo de tela e fatores associados em escolares de uma cidade do nordeste / Prevalence of excessive screen time and associated factors in a school from a city in the northeast of Brazil

INTRODUCTION: Studies about screen time and its correlates are generally determined by the sum of the duration of several behaviours. Studies that analysed behaviours separately highlighted different correlates OBJECTIVE: Estimate the prevalence of excessive screen time, through watching television and using computers or video games, and its correlates, in students in a city in North-eastern Brazil METHODS: An investigation in a high school located in the city of Jequie, Bahia state, Brazil, with a sample of 1163 students between 14 and 20 years. The dependent variables were excessive time watching television and using computers or video games, and the independent ones were socio-demographic and lifestyle variables. The magnitude of the association was determined by the Odds Ratio (OR) and by 95% of confidence intervals (CI RESULTS: The prevalence of excessive time watching television was estimated at 32.8% (95% CI: 29.9% - 35.5%) and using computer/videogames was 27.3% (95%CI: 24.5% - 29.5%). Those who did not work (OR = 1.940; 95%CI: 1.365 - 2.758); those students whose mothers had less than eight years of schooling (OR = 1.324; 95%CI: 1.023 - 1.714); and who did not regularly eat vegetables (OR = 1.423; 95%CI: 1.082-1.871) were more likely to be exposed to excessive television. On the other hand, those who had not reached the minimum consumption of fruits (OR = 0.712; 95% CI: 0.245 - 0.929) showed lower odds. Female students (OR = 0.694; 95%CI: 0.528 - 0.912) and students with family income lower than two minimum wages (OR = 0.630; 95% CI: 0.474 - 0.838) had lower chances of exposure to excessive time using computer/video games, while the insufficiently active (OR = 1,557; 95% CI: 1,076 - 1,972) showed higher chances CONCLUSIONS: About 1/3 of the students spent too much time in front of the television and computer/video games, with a different correlation relative to each of these behaviours

INTRODUÇÃO: Estudos sobre o tempo de tela e seus correlatos geralmente são determinados pelo somatório dos tempos de vários comportamentos. Pesquisas que analisaram comportamentos separadamente evidenciaram diferentes correlatos OBJETIVO: Estimar prevalência de tempo excessivo de tela (maior ou igual 2 horas/dia), durante os dias da semana, em televisão e uso de computador/videogame e verificar a associação aos fatores sociodemográficos e do estilo de vida em escolares MÉTODO: Levantamento com amostra de escolares do ensino médio (n=1.163), de 14 a 20 anos de idade, residentes em Jequié/BA, Brasil. As variáveis dependentes foram tempo excessivo assistindo televisão e usando computador/videogame, e as independentes foram, as sociodemográficas e do estilo de vida. A magnitude das associações foi determinada pela Odds Ratio(OR) e intervalos de confiança (IC) de 95% (IC95% RESULTADOS: A prevalência de tempo excessivo assistindo televisão foi estimada em 32,8% (IC95%: 29,9% - 35,5%) e usando computador/videogame 27,3% (IC95%: 24,5% - 29,5%). Os que não trabalhavam (OR = 1,940; IC95%: 1,365 - 2,758), aqueles cujas mães tinham menos de oito anos de estudo (OR = 1,324; IC95%: 1,023 - 1,714) e que não consumiam verduras regularmente (OR = 1,423; IC95%: 1,082 - 1,871) apresentaram maiores chances de exposição ao tempo excessivo televisão. Por outro lado, os que não atingiram o consumo mínimo de frutas (OR = 0,712; IC95%: 0,245 - 0,929) apresentaram menores chances. Escolares do sexo feminino (OR = 0,694; IC95%: 0,528 - 0,912) e aqueles com renda familiar inferior a dois salários mínimos (OR = 0,630; IC95%: 0,474 - 0,838), apresentaram menores chances de exposição ao tempo excessivo utilizando computador/videogame e os insuficientemente ativos (OR = 1,557; IC95%: 1,076 - 1,972), apresentaram maiores chances CONCLUSÕES: Cerca de 1/3 dos escolares passavam tempo excessivo à frente da televisão e do computador/videogame, tendo correlatos distintos para cada comportamento

Rationale and methods of a cluster-randomized controlled trial to promote active and healthy lifestyles among Brazilian students: the "Fortaleça sua Saúde" program.

BACKGROUND: Interventions on adolescents' lifestyle are important, but the main mechanisms that explain the changes (mediating variables) on lifestyle are unclear. This paper presents the rationale and methods of an intervention program focused on promoting active and healthy lifestyles (especially physical activity [PA] practice and reducing screen time) among Brazilian students-the Fortaleça sua Saúde program (Portuguese for "strengthen your health"). METHODS/DESIGN: This is a school-based cluster-randomized controlled trial. Three intervention and three control (no intervention) full-time public schools were randomly selected in Fortaleza, northeastern Brazil. Students (n = 1,272) from classes in Grades 7-9 were eligible, and 1,085 (548 in the intervention and 537 in control schools) completed the baseline and follow-up measures. The program duration was approximately four months and took place in 2014. Intervention strategies focused on teacher training, activities on health in the curriculum, active opportunities in the school environment (the availability of equipment for PA), and health education (health materials for students and parents). Data collection was undertaken before and immediately after the intervention. The primary variables included the practice of PA (weekly PA volume, PA behavior change stage and preference for PA during leisure-time) and screen time (TV and computer/video games). Potential intrapersonal, interpersonal and environmental mediators of PA and screen time were evaluated by a standardized questionnaire. Other lifestyle components (e.g., eating habits, substance use), psychological (e.g., self-rated health, body satisfaction) and biological (general and abdominal obesity) aspects, as well as academic performance were also evaluated in the total sample. Depressive symptoms, eating disorders, sleep quality, objectively-measured PA, and sedentary time were evaluated in obese students. DISCUSSION: If effective, this program will contribute to the development of public policies for the promotion of active and healthy lifestyles in youth, especially those from low- and middle-income countries. The main intrapersonal, interpersonal and/or environmental mediators of PA and screen time may also be indicated. Finally, we anticipate that the proposed strategies may be adaptable to public schools and may even be extended to the entire school system. TRIAL REGISTRATION: ClinicalTrials.Gov: NCT02439827 . Registration date: May 3, 2015.

Indicadores de qualidade de vida em professores: uma revisão sistemática de estudos descritivos / Indicators of quality of life among teachers: a systematic review of descriptive studies / Indicadores de calidad de vida en los maestros: una revisión sistemática de estudios descriptivos

O objetivo foi sistematizar informações sobre indicadores de qualidade de vida (QV) de professores do Ensino Fundamental e Médio. A busca foi realizada em cinco bases de dados e nas referências dos artigos. Dos 14 estudos resultantes, 57% eram com professores de Educação Básica e 43% de Educação Física. A maioria dos estudos ressaltou insatisfação com a remuneração, condições de trabalho inconvenientes, escassez de tempo, ambiente desfavorável e problemas vocais. Conclui-se que a estrutura física, salários e sistemas organizacionais se destacam na literatura como aspectos negativamente associados à QV de professores. Estas evidências servem para nortear políticas de gestão escolar voltadas à melhoria da QV no trabalho e saúde em profissionais do âmbito escolar.

The aim was systematize information about indicators of quality of life (QOL) in primary and secondary school teachers. The search was performed in five databases and reference list of articles. Of the resulting 14 studies, 57% were with primary and secondary teachers and 43% of Physical Education. Most of the study emphasized the dissatisfaction with the remuneration, inconvenient working conditions, lack of time, unfavorable environment and vocal problems. In conclusion, physical structure issues, wages and organizational systems stand out in the literature as negative aspects associated with QOL of teachers. These evidences serve to guide school management policies aimed at improving the quality of work and QOL and health for working professionals within schools.

Se objectivó sistematizar la información sobre los indicadores de calidad de vida (CV) de los docentes de la escuela primaria y secundaria. La búsqueda fue en cinco bases de datos y en las referencias de los artículos. De los 14 estudios resultantes, 57% fueran con docentes de la escuela primaria y 43% de la educación física. La mayoría resaltó la insatisfacción con la remuneración y condiciones de trabajo, falta de tiempo, ambiente desfavorable y problemas vocales. En conclusión, la estructura física, los salarios y los sistemas organizacionales se destacan en la literatura como aspectos negativos asociados a la CV. Estas pruebas sirven para orientar políticas de gestión en las escuelas destinadas a la mejoría de la CV en el trabajo y salud en profesionales del ámbito escolar.

Association between unhealthy behavior and sleep quality and duration in adolescents / Associação entre comportamento não saudável e qualidade e duração do sono em adolescentes

Abstract Inadequate sleep has been associated with unhealthy behavior in adolescence. This study aimed to estimate the prevalence of negative sleep indicators (perceived poor-quality sleep and insufficient sleep duration) among students and to identify unhealthy behaviors associated with this outcome. This study is part of a school-based, cross-sectional survey conducted in 2011 in adolescents from Santa Catarina State, Brazil. High school students aged 15 to 19 years (n = 6,529) and enrolled in state public schools participated in the study. The students responded to a questionnaire on the number of hours slept (insufficient: < 8 h, sufficient: ≥ 8 h); perceived sleep quality (good or poor); and behavioral variables. Multinomial logistic regression was performed using reports of positive sleep indicators, and negative reports of one or two sleep indicators. Approximately 30% of adolescents reported a negative perception of sleep, indicating poor quality and insufficient duration. The use of computers/videogames (≥ 4 h/d) and excessive consumption of alcoholic beverages, salty snacks or sweets were associated with negative sleep indicators. A high number of young people displayed one or two negative sleep indicators, and it was found an association between these indicators and a number of unhealthy behaviors.

Resumo O sono inadequado tem sido associado com o comportamento não saudável na adolescência. Este estudo teve como objetivo estimar a prevalência de indicadores negativos do sono (percepção da má qualidade e duração insuficiente do sono) entre os alunos e identificar comportamentos não saudáveis associados a este resultado. Este estudo é parte de uma pesquisa de base escolar, transversal, realizada em 2011, em adolescentes do Estado de Santa Catarina, Brasil. Estudantes do ensino médio com idades entre 15 a 19 anos (n = 6.529) e matriculados em escolas públicas estaduais participaram do estudo. Os alunos responderam a um questionário sobre o número de horas dormidas (insuficiente: <8 h, suficiente: ≥ 8 h); qualidade do sono percebida (boa ou má); e variáveis comportamentais. Regressão logística multinomial foi realizada, utilizando os relatos de indicadores positivos do sono e relatos negativos de um ou dois indicadores do sono. Cerca de 30% dos adolescentes relataram uma percepção negativa do sono, indicando má qualidade e duração insuficiente. O uso de computadores / videogames (≥ 4 h/d) e consumo excessivo de bebidas alcoólicas, salgadinhos ou doces foram associados a indicadores negativos do sono. Um elevado número de jovens apresentou um ou dois indicadores negativos do sono, e verificou-se uma associação entre estes indicadores e uma série de comportamentos não saudáveis.

[Anthropometric indices among schoolchildren from a municipality in Southern Brazil: a descriptive analysis using the LMS method]. / Índices antropométricos em escolares de um município no Sul do Brasil: análise descritiva utilizando o método LMS.

OBJECTIVE: To describe the percentile values for body mass index (BMI), waist circumference (WC) and waist-to-height (WHtR) of children from Colombo, Brazil, and compare them with data of children from other countries. METHODS: This was a cross-sectional study with a random sample of 2,035 children aged 6-11 years. Age-and sex-specific smoothed percentiles curves for BMI, WC and WHtR were created using the LMS method. Values of 10(th), 50(th) and 90(th) percentiles from Brazilian children were compared with data from other countries. RESULTS: There was a trend of increasing BMI and WC with age in both sexes. WHtR remained constant with advancing age in boys and girls. Comparison of the growth pattern among countries showed clear differences. Southern Brazil boys and girls had elevated 90(th) percentile values for BMI, which was similar to German children and higher than the North American and World Health Organization percentile values. However, children from this study had intermediate values for WC and WHtR in comparison to children from other countries. CONCLUSIONS: Elevated BMI values were observed among southern Brazilian children, but WC and WHtR percentile values were lower in southern Brazilian children than in children from other countries. Interventions at different levels should be made to avoid a probable increase of nutritional disorders (especially general obesity) in the next years.

Time spent by Brazilian students in different modes of transport going to school: changes over a decade (2001-2011).

To examine changes in the time spent in each mode of transportation used for going to school by gender and age among adolescents from Santa Catarina State, Brazil. Two school-based surveys were performed in 2001 (N = 5,028) and 2011 (N = 6,529) in high school students (15-19 years old). The mode of transportation (on foot; by bicycle; by bus; car/motorcycle) and the time spent for commuting to school were assessed. Active commuting increased for short trips in both genders (male: 25.1% to 36.7%; female: 18.8% to 29.2%) and in all ages (15-16 years: 21% to 32.7%; 17-19 years: 21.9% to 32.4%), and declined for longer trips in males (30.5% to 21.9%) and in 15-16 years old students (25.7% to 34.7%). Car/motorcycle use has doubled for short trips in males (38.1% to 65.9%) and in 17-19 years old students (37.7% to 62.7%), while the use of buses remained stable in both genders. Our findings contribute to discussions on public policy focusing on the design of safe environments to promote active commuting to schools, particularly to decrease the use of motorized transport for short trips.