Describing studies on childhood obesity determinants by Socio-Ecological Model level: a scoping review to identify gaps and provide guidance for future research.

Childhood obesity is increasing worldwide and is a major public health concern once children with obesity are at higher risk for several diseases and are often stigmatized. Children with obesity are more likely to become adults with obesity with greater needs of healthcare. Determinants of childhood obesity might be grouped in five levels according to the Socio-Ecological Model (SEM): individual, interpersonal, institutional, community and policies. This scoping review emerged from the need to identify which determinants of childhood obesity have been more frequently studied (and how) and which require more investigation. The main objectives were to quantify studies on the determinants of childhood obesity by SEM level addressed, to identify gaps in the literature regarding the studied SEM level(s), to describe the studies' characteristics and to provide guidance for SEM levels that need further investigation. This scoping review follows the five-stage protocol methodology proposed by Arksey and O'Malley in 2005. PubMed database was systematically searched, and hand-searches also took place. The search yielded 975 results from which 552 were excluded after title and abstract reading. The remaining 423 results were fully read and information about methodologic aspects, namely study design, sample size, sample constitution (children, dyads or/and parents) and children's age as well as the SEM level determinants addressed was retrieved. Despite the consensus about the appropriateness of SEM as a framework to comprehensively examine childhood obesity determinants, studies addressing all SEM levels determinants jointly or the policies level determinants alone were not found. Other gaps shown were: the small number of studies that included the policies level determinants alongside determinants from other levels (N = 10) and studies using cohorts study design (ranging from 2 to 28 per SEM level). These gaps should be considered when planning future research.

Geographic and socioeconomic distribution of food vendors: a case study of a municipality in the Southern Brazil.

The objective of this study was to identify the food vendor distribution profile of the city of Florianópolis, Santa Catarina State, Brazil, and investigate its association with the socioeconomic and demographic characteristics of different municipal regions. This descriptive, cross-sectional study obtained the location of food vendors from secondary data from different institutional sources. The density of different types of food vendors per 1,000 inhabitants in each municipal weighted area was calculated. The Kruskal-Wallis test compared the mean density of food vendors and the weighted income areas. The lowest-income regions had the lowest density of butchers, snack bars, supermarkets, bakeries/pastry shops, natural product stores, juice bars, and convenience stores. The identification of these areas may encourage the creation of public policies that facilitate healthy food startups and/or maintenance of healthy food vendors, especially in the lowest-income regions.

Geographic and socioeconomic distribution of food vendors: a case study of a municipality in the Southern Brazil / Distribuição geográfica e socioeconômica de comerciantes de alimentos: um estudo de caso de um município no Sul do Brasil / Distribución geográfica y socioeconómica de comerciantes de alimentos: un estudio de caso de un municipio en el sur de Brasil

Abstract: The objective of this study was to identify the food vendor distribution profile of the city of Florianópolis, Santa Catarina State, Brazil, and investigate its association with the socioeconomic and demographic characteristics of different municipal regions. This descriptive, cross-sectional study obtained the location of food vendors from secondary data from different institutional sources. The density of different types of food vendors per 1,000 inhabitants in each municipal weighted area was calculated. The Kruskal-Wallis test compared the mean density of food vendors and the weighted income areas. The lowest-income regions had the lowest density of butchers, snack bars, supermarkets, bakeries/pastry shops, natural product stores, juice bars, and convenience stores. The identification of these areas may encourage the creation of public policies that facilitate healthy food startups and/or maintenance of healthy food vendors, especially in the lowest-income regions.

Resumo: Os objetivos desse estudo foram identificar o perfil de distribuição de comerciantes de alimentos no Município de Florianópolis, Santa Catarina, Brasil, e investigar a associação com as características das diferentes regiões do município. O estudo transversal, descritivo, obteve a localização dos comerciantes de alimentos a partir de dados secundários de diferentes fontes institucionais. Foi calculada a densidade dos diferentes tipos de comerciantes por mil habitantes em cada área ponderada do município. O teste de Kruskal-Wallis foi usado para comparar a densidade média de comerciantes de alimentos com as regiões do município, ponderadas por renda. As áreas de menor renda tiveram a menor densidade de açougueiros, lanchonetes, supermercados, padarias/pastelarias, lojas de produtos naturais, lojas de sucos e lojas de conveniência. A identificação dessas áreas pode incentivar a elaboração de políticas públicas que facilitem empreendimentos novos de comercialização de alimentos saudáveis e/ou a manutenção dos estabelecimentos de alimentos saudáveis, principalmente nas áreas de menor renda.

Resumen: Los objetivos de este estudio fueron identificar el perfil de distribución de comerciantes de alimentos en el municipio de Florianópolis, Santa Catarina, Brasil, e investigar la asociación con las características de las diferentes regiones del municipio. El estudio transversal, descriptivo, obtuvo la localización de los comerciantes de alimentos, a partir de datos secundarios de diferentes fuentes institucionales. Se calculó la densidad de los diferentes tipos de comerciantes por 1.000 habitantes en cada área ponderada del municipio. El test de Kruskal-Wallis se usó para comparar la densidad media de comerciantes de alimentos con las regiones del municipio, ponderadas por renda. Las áreas de menor renta tuvieron la menor densidad de carnicerías, bares de aperitivos, supermercados, panaderías/bocaterías, tiendas de productos naturales, tiendas de zumos y tiendas 24hrs. La identificación de esas áreas puede incentivar la elaboración de políticas públicas que faciliten emprendimientos nuevos de comercialización de alimentos saludables y/o el mantenimiento de los establecimientos de alimentos saludables, principalmente en las áreas de menor renta.

Association between the perceived environment and overweight in adults and elderly: a cross-sectional study

BACKGROUND: Overweight is a global issue of epidemic proportions, and its negative influence on individual health is clear. However, the relation between environment and overweight is not thoroughly clear, especially concerning to the perceived environment and the physical and social aspects. Therefore, this study aimed to analyze potential associations between the perceived environment and overweight in adults and elderly in a medium-sized city. METHODS: A cross-sectional population-based study was conducted with 808 adult and elderly individuals. Overweight was defined as body mass index≥25 kg/m2based on the World Health Organization criteria. The Neighborhood Environment Walkability Scale was used evaluating the perceived environment. Poisson regression was performed evaluating the relationships between the perceived environment and overweight .RESULTS: The frequency of overweight was 50.4 %. Adjusted models showed association between overweight and the variable of surrounding neighborhood as follows:"1- to 3-story apartments or condos"(most category; PR = 0.30; CI 0.12­0.76) and"4- to 6-story apartments or condos"(all categories) (PR ranged 0.40 to 0.46;p< 0.05), and also,"l and-use mix-diversity" was associated with overweight in this population (PR 0.81; CI 0.66­0.99).CONCLUSIONS: In addition to individual characteristics, the environmental aspects are relevant to the occurrence of overweight in this population. Population-based studies using primary data on overweight remain scarce in Brazil. Finally, this study contributes to improve the understanding of the complex relationship between perceived environment and overweight, and we believe that our findings provide further justification for the development of future interventions and health promotion strategies.

Multiple risk behaviors for non-communicable diseases and associated factors in adolescents / Múltiplos comportamentos de risco para doenças não transmissíveis em adolescentes e fatores associados

Objective: To estimate the prevalence of risk behaviors for non-communicable diseases and analyze their associated factors in adolescents. Methods: A school-based cross-sectional study was conducted in 2008 with 1,139 adolescents aged 14 to 19 years attending public and private high schools in Cuiabá, Midwestern Brazil. Data were collected using a selfadministered questionnaire, including a semiquantitative Food Frequency Questionnaire. The prevalence of tobacco smoking, alcohol experimentation, physical inactivity, unsatisfactory meal pattern, and excessive intake of saturated fat and sodium were evaluated. The associations between risk behaviors and socioeconomic variables, weight status, and self-perceived health status were evaluated. Results: The most common risk behaviors were excessive sodium intake (88%), unsatisfactory meal pattern (72%), excessive intake of saturated fat (39%), and alcohol experimentation (39%). Four of 10 adolescents were exposed to two risk behaviors simultaneously. Among male adolescents, the main factors associated with risk behaviors were: type of school, class schedule, education level of the household head, weight status, and self-perceived health status. Among female adolescents, age, type of school, class schedule, and education level of the household head were the main factors associated with risk behaviors. Conclusion: The prevalence of exposure to risk behaviors for non-communicable diseases was high, highlighting the simultaneous presence of tobacco smoking and experimentation of alcoholic beverages. Special attention should be given to educational activities to minimize the effects of the simultaneous occurrence of multiple risk behaviors.

Objetivo: Estimar a prevalência de comportamentos de risco para doenças não transmissíveis e analisar seus fatores associados em adolescentes. Métodos: Estudo transversal de base escolar realizado em 2008 com 1.139 estudantes do ensino médio, entre 14 e 19 anos de idade, de escolas públicas e privadas de Cuiabá, Mato Grosso. Aplicou-se questionário autoadministrado, incluindo Questionário de Frequência Alimentar. Avaliou-se a prevalência de tabagismo, experimentação de álcool, inatividade física, padrão de refeições e ingestão excessiva de gordura saturada e sódio. Foram analisadas as associações entre os comportamentos de risco e variáveis socioeconômicas, status de peso e autopercepção do estado de saúde. Resultados: Os comportamentos de risco mais comuns foram: ingestão excessiva de sódio (88%), padrão de refeições insatisfatório (72%), consumo excessivo de gordura saturada (39%) e experimentação de álcool (39%). Quatro em cada 10 adolescentes foram expostos a dois comportamentos de risco simultaneamente. Entre os meninos, os principais fatores associados aos comportamentos de risco foram: tipo de escola, turno de aula, escolaridade do chefe da família, status de peso e autopercepção do estado de saúde. Entre as meninas, a idade, o tipo de escola, o turno de estudo e a escolaridade do chefe da família foram os principais fatores associados aos comportamentos de risco. Conclusão: A prevalência de exposição a comportamentos de risco para doenças não transmissíveis foi elevada, destacando a presença simultânea de tabagismo e experimentação de bebidas alcoólicas. Deve ser dada especial atenção às atividades educativas, visando minimizar os efeitos da ocorrência simultânea de múltiplos comportamentos de risco.

Built environment and social environment: associations with overweight and obesity in a sample of Brazilian adults.

The aim of this study was to assess associations between the built environment and social environment and excess weight in an urban population. Participants were selected from the Surveillance System for Risk Factors for Chronic Diseases (VIGITEL). The study used data from the city of Belo Horizonte, Minas Gerais State, Brazil. A total of 3,425 interviews from the years 2008 and 2009 were used. Georeferenced data on parks, squares, and locations for physical exercise, population density, and food stores were used to assess the built environment. Description of the social environment used income and homicide rate for the neighborhood. Environmental variables associated independently with excess weight were population density, presence of parks, squares, and locations for physical exercise, and self-reported presence of locations for physical exercise. The findings show that residential neighborhood characteristics are associated with excess weight in urban adults.

Built environment and social environment: associations with overweight and obesity in a sample of Brazilian adults / Ambiente construído e ambiente social: associações com o excesso de peso em adultos / Ambiente construido y ambiente social: asociaciones con el exceso de peso en adultos

The aim of this study was to assess associations between the built environment and social environment and excess weight in an urban population. Participants were selected from the Surveillance System for Risk Factors for Chronic Diseases (VIGITEL). The study used data from the city of Belo Horizonte, Minas Gerais State, Brazil. A total of 3,425 interviews from the years 2008 and 2009 were used. Georeferenced data on parks, squares, and locations for physical exercise, population density, and food stores were used to assess the built environment. Description of the social environment used income and homicide rate for the neighborhood. Environmental variables associated independently with excess weight were population density, presence of parks, squares, and locations for physical exercise, and self-reported presence of locations for physical exercise. The findings show that residential neighborhood characteristics are associated with excess weight in urban adults.

O objetivo deste estudo foi avaliar as associações das variáveis do ambiente construído e social com o excesso de peso em uma população urbana. Os participantes foram selecionados com base no Sistema de Vigilância de Fatores de Risco para Doenças Crônicas (VIGITEL). O trabalho foi realizado com dados da cidade de Belo Horizonte, Minas Gerais, Brasil. Foram utilizadas 3.425 entrevistas referentes aos anos de 2008 e 2009. Informações georreferenciadas de parques, praças, lugares para a prática de atividade física, densidade populacional e estabelecimentos alimentares foram usadas para avaliar o ambiente construído. Para caracterizar o ambiente social foi utilizada renda e taxa de homicídio da vizinhança. As variáveis ambientais associadas independentemente com excesso de peso foram densidade populacional, presença de parques, praças e locais para a prática de atividade física e o autorrelato de locais para a prática de atividade física. As evidências deste estudo mostram que as características das vizinhanças onde as pessoas residem estão associadas ao excesso de peso de adultos do meio urbano.

El objetivo de este estudio fue evaluar asociaciones entre variables de ambiente construido y social con el exceso de peso en una población urbana. Los participantes fueron seleccionados a partir de un Sistema de Vigilancia de las Enfermedades Crónicas (VIGITEL). El estudio utilizó 3.425 entrevistas, realizadas en 2008 y 2009 ,en la ciudad de Belo Horizonte, Minas Gerais, Brasil. Adicionalmente, para evaluar el ambiente físico se incorporó a la base de datos información georreferenciada de los parques, lugares para la actividad física, densidad de población, establecimientos de venta de alimentos y aspectos de ambiente social mediante tasas de homicidio en el vecindario. Las variables ambientales que fueron asociadas de forma independiente al sobrepeso fueron: densidad poblacional, presencia de parques, plazas y lugares para la actividad física y también el autorrelato de presencia de lugares para la práctica de actividad física. Este estudio muestra evidencias que las características de la vecindad, donde residen las personas, pueden estar asociadas al exceso de peso en adultos.