Prevalence and co-occurrence of modifiable risk factors in adults and older people.

OBJECTIVE: To estimate the co-occurrence of the major risk factors for chronic diseases in adults (18-59 years old) and older people (≥ 60 years old) living in Brazilian state capitals and the Federal District. METHODS: Cross-sectional study with population-based data from 35,448 adults and 18,726 older people collected in the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (System of Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey - Vigitel) in 2015. The prevalence of each of the five risk factors (smoking, overweight, physical inactivity, alcohol and unhealthy diet) was estimated, as well as their co-occurrence for the different possible combinations, according to socioeconomic and health self-assessment variables. The independent associations were verified via multinomial logistic regression to obtain the estimates of the odds ratio (OR) and corresponding 95% confidence intervals. RESULTS: At least two risk factors were present in 38.5% of the adults and 37.0% of the older participants. The male adults and older participants who did not have private health insurance and classified their health as average or poor/very poor were more likely to have two or more concurrent risk behaviors. The greater chance of co-occurrence of smoking and alcohol abuse in adults (adjusted OR = 3.52) and older people (adjusted OR = 2.94) stands out. CONCLUSIONS: The subgroups with increased risk of developing multiple unhealthy behaviors and the most prevalent behaviors were identified. These findings are expected to contribute to the better targeting of health promotion and preventive care. It is worth noting that, for the adoption of healthy lifestyle habits, macro-social and inter-sectoral policies are more effective.

Prevalence and co-occurrence of modifiable risk factors in adults and older people / Prevalência e coocorrência de fatores de risco modificáveis em adultos e idosos

ABSTRACT OBJECTIVE To estimate the co-occurrence of the major risk factors for chronic diseases in adults (18-59 years old) and older people (≥ 60 years old) living in Brazilian state capitals and the Federal District. METHODS Cross-sectional study with population-based data from 35,448 adults and 18,726 older people collected in the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (System of Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey - Vigitel) in 2015. The prevalence of each of the five risk factors (smoking, overweight, physical inactivity, alcohol and unhealthy diet) was estimated, as well as their co-occurrence for the different possible combinations, according to socioeconomic and health self-assessment variables. The independent associations were verified via multinomial logistic regression to obtain the estimates of the odds ratio (OR) and corresponding 95% confidence intervals. RESULTS At least two risk factors were present in 38.5% of the adults and 37.0% of the older participants. The male adults and older participants who did not have private health insurance and classified their health as average or poor/very poor were more likely to have two or more concurrent risk behaviors. The greater chance of co-occurrence of smoking and alcohol abuse in adults (adjusted OR = 3.52) and older people (adjusted OR = 2.94) stands out. CONCLUSIONS The subgroups with increased risk of developing multiple unhealthy behaviors and the most prevalent behaviors were identified. These findings are expected to contribute to the better targeting of health promotion and preventive care. It is worth noting that, for the adoption of healthy lifestyle habits, macro-social and inter-sectoral policies are more effective.

RESUMO OBJETIVO Estimar a coocorrência dos principais fatores de risco para doenças crônicas não transmissíveis em adultos (18 a 59 anos) e idosos (≥ 60 anos) residentes nas capitais dos estados brasileiros e Distrito Federal. MÉTODOS Estudo transversal de base populacional com dados de 35.448 adultos e 18.726 idosos coletados no Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) em 2015. Estimaram-se as prevalências de cada um dos cinco fatores de risco (tabagismo, excesso de peso, inatividade física, uso de álcool e alimentação não saudável), assim como sua coocorrência para as diferentes combinações possíveis, segundo variáveis socioeconômicas e autoavaliação da saúde. As associações independentes foram verificadas por meio de regressão logística multinomial para obter as estimativas do odds ratio (OR) e respectivos intervalos de confiança de 95%. RESULTADOS Ao menos dois fatores de risco estavam presentes em 38,5% dos adultos e 37,0% dos idosos. Adultos e idosos do sexo masculino, que não possuíam plano de saúde privado e que avaliaram sua saúde como regular ou ruim/muito ruim apresentaram maiores chances de ter dois ou mais comportamentos de risco simultâneos. Destaca-se a maior chance de coocorrência de tabagismo e uso abusivo de álcool em adultos (OR ajustado = 3,52) e idosos (OR ajustado = 2,94). CONCLUSÕES Foram identificados subgrupos com maior risco de desenvolver múltiplos comportamentos não saudáveis e os comportamentos mais prevalentes. Almeja-se que esses resultados contribuam para o melhor direcionamento de ações de promoção de saúde e assistência preventiva. Destaca-se que, para a adoção de hábitos de vida saudáveis, as políticas macrossociais e intersetoriais são mais efetivas.

Common mental disorders in adult women: identifying the most vulnerable segments. / Transtorno mental comum em mulheres adultas: identificando os segmentos mais vulneráveis.

This study aimed to evaluate the socioeconomic and demographic factors, behaviors and morbidities related to common mental disorders in adult women. This was a cross-sectional population-based study with cluster sample. We analyzed 848 women from a household survey held in Campinas, in 2008/2009. We used the Self-Reporting Questionnaire (SRQ-20) to evaluate common mental disorders. We estimated prevalence ratios by Poisson regression in hierarchical model of three steps, considering the weights relating to the sampling design. The prevalence of common mental disorders was 18.7%. The hierarchical model showed that older women, with low education level, housewives, separated or widowed, who did not consume fruit/vegetables daily, who slept six or fewer hours per night, who presented several chronic diseases and health problems, and with report of some type of violence were more vulnerable to common mental disorders and, therefore, should be treated with priority by health services. Early diagnosing women with common mental disorders, as well as accompanying and treating them, contribute for reducing the impacts on female quality of life.

O objetivo deste estudo foi avaliar os fatores socioeconômicos e demográficos, os comportamentos e as morbidades associados ao transtorno mental comum em mulheres adultas. Trata-se de um estudo transversal de base populacional com amostra por conglomerados. Foram analisadas 848 mulheres por inquérito domiciliar realizado em Campinas, em 2008/2009. Foi usado o instrumento Self-Reporting Questionnare (SRQ-20) para avaliar o transtorno mental comum. Foram estimadas razões de prevalências por meio de regressão múltipla de Poisson em modelo hierárquico de três etapas, considerando as ponderações relativas ao desenho amostral. A prevalência de transtorno mental comum foi de 18,7%. O modelo hierárquico evidenciou que mulheres mais velhas, com baixa escolaridade, donas de casa, separadas ou viúvas, que não consumiam frutas/verduras/legumes diariamente, dormiam seis ou menos horas por noite, apresentavam várias doenças crônicas e problemas de saúde e com relato de algum tipo de violência foram mais vulneráveis ao transtorno mental comum e, por isso, devem ser tratadas com prioridade pelos serviços de saúde. Diagnosticar precocemente mulheres com transtorno mental comum, bem como acompanhá-las e tratá-las, contribuem para reduzir os impactos na qualidade de vida feminina.

Transtorno mental comum em mulheres adultas: identificando os segmentos mais vulneráveis / Common mental disorders in adult women: identifying the most vulnerable segments

Resumo O objetivo deste estudo foi avaliar os fatores socioeconômicos e demográficos, os comportamentos e as morbidades associados ao transtorno mental comum em mulheres adultas. Trata-se de um estudo transversal de base populacional com amostra por conglomerados. Foram analisadas 848 mulheres por inquérito domiciliar realizado em Campinas, em 2008/2009. Foi usado o instrumento Self-Reporting Questionnare (SRQ-20) para avaliar o transtorno mental comum. Foram estimadas razões de prevalências por meio de regressão múltipla de Poisson em modelo hierárquico de três etapas, considerando as ponderações relativas ao desenho amostral. A prevalência de transtorno mental comum foi de 18,7%. O modelo hierárquico evidenciou que mulheres mais velhas, com baixa escolaridade, donas de casa, separadas ou viúvas, que não consumiam frutas/verduras/legumes diariamente, dormiam seis ou menos horas por noite, apresentavam várias doenças crônicas e problemas de saúde e com relato de algum tipo de violência foram mais vulneráveis ao transtorno mental comum e, por isso, devem ser tratadas com prioridade pelos serviços de saúde. Diagnosticar precocemente mulheres com transtorno mental comum, bem como acompanhá-las e tratá-las, contribuem para reduzir os impactos na qualidade de vida feminina.

Abstract This study aimed to evaluate the socioeconomic and demographic factors, behaviors and morbidities related to common mental disorders in adult women. This was a cross-sectional population-based study with cluster sample. We analyzed 848 women from a household survey held in Campinas, in 2008/2009. We used the Self-Reporting Questionnaire (SRQ-20) to evaluate common mental disorders. We estimated prevalence ratios by Poisson regression in hierarchical model of three steps, considering the weights relating to the sampling design. The prevalence of common mental disorders was 18.7%. The hierarchical model showed that older women, with low education level, housewives, separated or widowed, who did not consume fruit/vegetables daily, who slept six or fewer hours per night, who presented several chronic diseases and health problems, and with report of some type of violence were more vulnerable to common mental disorders and, therefore, should be treated with priority by health services. Early diagnosing women with common mental disorders, as well as accompanying and treating them, contribute for reducing the impacts on female quality of life.

Are there differences in the quality of the diet of working and stay-at-home women?

OBJECTIVE To verify whether there is an association between the quality of the diet and the inclusion of women in the labor market and whether the education level would modify this association. We have analyzed the differences according to education level and evaluated whether the insertion or not in the market modifies the association between the quality of the diet and education level. METHODS This is a cross-sectional population-based study that has used data from the Campinas Health Survey (2008 ISACamp). We have evaluated the diet of 464 women, aged 18 to 64 years, using the Brazilian Healthy Eating Index - Revised. We have estimated the means of the total score and index components using simple and multiple linear regression. RESULTS We have observed no difference in the quality of diet of working and stay-at-home women. The analysis stratified by education level showed a lower intake of fruits among stay-at-home women in the segment of lower education level, in relation to working women. Among all women, a lower education level was associated with lower overall quality of the diet, higher intake of sodium, and lower intake of fruits, vegetables, whole grains, milk, and saturated fat. On the other hand, the inclusion in the labor market changed the effect of the education level on the quality of the diet. In the stay-at-home stratum, a low education level was associated with poorer quality of the diet and lower consumption of fruits, dark green and orange vegetables, and whole grains. Among the working women, a low education level was associated with higher intake of sodium and lower intake of vegetables, whole grains, and milk and dairy products. CONCLUSIONS The results show inequities in the profile of food in relation to education level and inclusion in the labor market, which shows the relevance of public policies that increase the access to education and provide guidance on a healthy diet.

Are there differences in the quality of the diet of working and stay-at-home women? / Há diferenças na qualidade da dieta de trabalhadoras remuneradas e donas de casa?

OBJECTIVE To verify whether there is an association between the quality of the diet and the inclusion of women in the labor market and whether the education level would modify this association. We have analyzed the differences according to education level and evaluated whether the insertion or not in the market modifies the association between the quality of the diet and education level. METHODS This is a cross-sectional population-based study that has used data from the Campinas Health Survey (2008 ISACamp). We have evaluated the diet of 464 women, aged 18 to 64 years, using the Brazilian Healthy Eating Index - Revised. We have estimated the means of the total score and index components using simple and multiple linear regression. RESULTS We have observed no difference in the quality of diet of working and stay-at-home women. The analysis stratified by education level showed a lower intake of fruits among stay-at-home women in the segment of lower education level, in relation to working women. Among all women, a lower education level was associated with lower overall quality of the diet, higher intake of sodium, and lower intake of fruits, vegetables, whole grains, milk, and saturated fat. On the other hand, the inclusion in the labor market changed the effect of the education level on the quality of the diet. In the stay-at-home stratum, a low education level was associated with poorer quality of the diet and lower consumption of fruits, dark green and orange vegetables, and whole grains. Among the working women, a low education level was associated with higher intake of sodium and lower intake of vegetables, whole grains, and milk and dairy products. CONCLUSIONS The results show inequities in the profile of food in relation to education level and inclusion in the labor market, which shows the relevance of public policies that increase the access to education and provide guidance on a healthy diet.

OBJETIVO Verificar se existe associação entre qualidade da dieta e inserção das mulheres no mercado de trabalho e se o nível de escolaridade modificaria essa associação; analisar as diferenças segundo escolaridade; e avaliar se a inserção ou não no mercado modifica a associação entre qualidade da dieta e escolaridade. MÉTODOS Trata-se de estudo transversal de base populacional, que utilizou dados do Inquérito de Saúde de Campinas (ISACamp 2008). A alimentação de 464 mulheres, de 18 a 64 anos, foi avaliada por meio do Índice de Qualidade da Dieta Revisado. Foram estimadas as médias do escore total e dos componentes do índice com o uso de regressão linear simples e múltipla. RESULTADOS Nenhuma diferença foi observada entre qualidade da dieta de donas de casa e trabalhadoras remuneradas. A análise estratificada por escolaridade mostrou menor ingestão de frutas entre as donas de casa no segmento de pior escolaridade, em comparação às trabalhadoras remuneradas. Entre as mulheres, a menor escolaridade esteve associada à pior qualidade global da dieta e à maior ingestão de sódio e menor ingestão de frutas, vegetais, grãos integrais, leite e gordura saturada. Em contraste, a inserção no mercado de trabalho modificou o efeito da escolaridade sobre a qualidade da dieta. No estrato de donas de casa, a baixa escolaridade foi associada à pior qualidade da dieta e ao menor consumo de frutas, vegetais verde-escuros e alaranjados e grãos integrais. Entre as trabalhadoras remuneradas, a baixa escolaridade mostrou-se associada à ingestão maior de sódio e menor de vegetais, cereais integrais e leite e laticínios. CONCLUSÕES Os resultados expõem iniquidades no perfil alimentar em relação à escolaridade e à inserção no mercado de trabalho, sinalizando a relevância de políticas públicas que ampliem o acesso à educação e à orientação sobre dieta saudável.

[Are there differences between paid women workers and housewives in health-related quality of life?]. / Ser trabalhadora remunerada ou dona de casa associa-se à qualidade de vida relacionada à saúde?

Considering the lack of Brazilian studies on the relationship between participation in the labor market and health-related quality of life (HRQL) in women, the objectives were to verify whether there is an association between paid work versus no paid work and HRQL in women, and whether socioeconomic status modifies this association. This was a population-based cross-sectional study with a sample of 668 women 18 to 64 years of age from the Campinas Health Survey (ISACamp 2008/2009), using SF-36 to assess HRQL. Being a housewife was associated with worse HRQL, especially in mental domains, but this association was modified by socioeconomic status. In the middle and low schooling and family income strata, housewives showed worse HRQL than paid women workers, but there was no difference between the two groups in the high schooling and high income strata. Housewives' worse HRQL emphasizes the importance of public policies to expand opportunities for women's participation in the labor market and access to education.

Ser trabalhadora remunerada ou dona de casa associa-se à qualidade de vida relacionada à saúde? / Are there differences between paid women workers and housewives in health-related quality of life? / ¿Ser trabajadora remunerada o ama de casa se asocia a la calidad de vida relacionada con la salud?

Resumo: Considerando que não há estudos brasileiros que avaliem a relação entre a inserção no mercado de trabalho e a qualidade de vida relacionada à saúde (QVRS) de mulheres, objetivou-se com a presente pesquisa verificar se existe associação entre ter ou não trabalho remunerado e a QVRS das mulheres, e, se o estrato socioeconômico modifica esta associação. Trata-se de estudo transversal de base populacional com amostra de 668 mulheres de 18 a 64 anos do Inquérito de Saúde de Campinas (ISACamp 2008/2009), utilizando-se o SF-36 para avaliar a QVRS. Ser dona de casa esteve associado à pior QVRS, sobretudo nos aspectos mentais, mas esta associação é modificada pelo nível socioeconômico. Nos segmentos de intermediária e baixa escolaridade e renda familiar, as donas de casa apresentaram pior QVRS que as trabalhadoras remuneradas, mas não houve diferença entre os dois segmentos nos estratos de alta escolaridade e renda. A pior QVRS das donas de casa enfatiza a importância de políticas públicas que visem a ampliar as oportunidades de inserção da mulher no mercado de trabalho e de acesso à educação.

Abstract: Considering the lack of Brazilian studies on the relationship between participation in the labor market and health-related quality of life (HRQL) in women, the objectives were to verify whether there is an association between paid work versus no paid work and HRQL in women, and whether socioeconomic status modifies this association. This was a population-based cross-sectional study with a sample of 668 women 18 to 64 years of age from the Campinas Health Survey (ISACamp 2008/2009), using SF-36 to assess HRQL. Being a housewife was associated with worse HRQL, especially in mental domains, but this association was modified by socioeconomic status. In the middle and low schooling and family income strata, housewives showed worse HRQL than paid women workers, but there was no difference between the two groups in the high schooling and high income strata. Housewives' worse HRQL emphasizes the importance of public policies to expand opportunities for women's participation in the labor market and access to education.

Resumen: Considerando que no existen estudios brasileños que evalúen la relación entre inserción en el mercado de trabajo y la calidad de vida relacionada con la salud (QVRS) de mujeres, el objetivo de la presente investigación fue verificar si existe asociación entre tener o no trabajo remunerado y la QVRS de las mujeres, y si el estrato socioeconómico modifica esta asociación. Se trata de un estudio transversal de base poblacional con una muestra de 668 mujeres de 18 a 64 años de la Encuesta de Salud de Campinas (ISACamp 2008/2009), siendo utilizado el SF-36 para evaluar la QVRS. Ser ama de casa se asoció con la peor QVRS, sobre todo en los aspectos mentales, pero esta asociación está modificada por el nivel socioeconómico. En los segmentos intermedios y baja escolaridad y renta familiar, las amas de casa presentaron un peor QVRS que las trabajadoras remuneradas, pero no hubo diferencia entre los dos segmentos en los estratos de alta escolaridad y renta. La peor QVRS de las amas de casa enfatiza la importancia de políticas públicas que tengan por objetivo ampliar las oportunidades de inserción de la mujer en el mercado de trabajo y de acceso a la educación.

[Rubella vaccination in women of childbearing age in Campinas, São Paulo State, Brazil]. / Vacinação contra rubéola em mulheres em idade reprodutiva no Município de Campinas, São Paulo, Brasil.

Women of reproductive age are the population of greatest interest for the prevention of congenital rubella syndrome. The aim of this study was to evaluate the prevalence of rubella vaccination in women and to identify factors associated and motives for non-adherence. A cross-sectional population-based study, in Campinas, São Paulo State, Brazil, in 2008/2009, was carried out with stratified random, two-stage cluster sampling. Of the 778 women aged 10 to 49 years, 83.8% (95%CI: 79.6-88.0) reported vaccination in life. Age group (20-39 years), per capita household income greater than 3 times the minimum wage and orientation of health care professionals about the vaccine, were positively associated with rubella vaccination. The main motives for non-adherence were lack of orientation of professionals about their importance (48.5%) and not consider it necessary (18.9%). The recommendation of professionals was the factor most strongly associated with women's adherence to vaccination. In this sense, an indication of vaccination by health care teams can increase the knowledge about the importance their and benefits.

Vacinação contra rubéola em mulheres em idade reprodutiva no Município de Campinas, São Paulo, Brasil / Rubella vaccination in women of childbearing age in Campinas, São Paulo State, Brazil / Vacunación contra la rubeola de mujeres en edad reproductiva en el municipio de Campinas, São Paulo, Brasil

As mulheres em idade reprodutiva são a população de maior interesse para a prevenção da síndrome da rubéola congênita. O objetivo do trabalho foi avaliar a prevalência de vacinação contra rubéola em mulheres e identificar fatores associados e motivos da não adesão. Trata-se de estudo transversal de base populacional, realizado em Campinas, São Paulo, Brasil, em 2008/2009, com amostra por conglomerados e em dois estágios. Das 778 mulheres de 10 a 49 anos, 83,8% (IC95%: 79,6-88,0) referiram vacinação em algum momento da vida. Faixa etária (30-39 anos), renda familiar per capita superior a três salários mínimos e a orientação de profissional de saúde estiveram positivamente associadas à vacinação contra a rubéola. Os principais motivos da não adesão foram a falta de orientação do profissional de saúde sobre sua importância (48,5%) e não considerá-la necessária (18,9%). A recomendação do profissional de saúde foi o fator mais fortemente associado à adesão das mulheres à vacinação. Nesse sentido, sua indicação pelas equipes de saúde pode ampliar o conhecimento sobre sua importância e seus benefícios.

Women of reproductive age are the population of greatest interest for the prevention of congenital rubella syndrome. The aim of this study was to evaluate the prevalence of rubella vaccination in women and to identify factors associated and motives for non-adherence. A cross-sectional population-based study, in Campinas, São Paulo State, Brazil, in 2008/2009, was carried out with stratified random, two-stage cluster sampling. Of the 778 women aged 10 to 49 years, 83.8% (95%CI: 79.6-88.0) reported vaccination in life. Age group (20-39 years), per capita household income greater than 3 times the minimum wage and orientation of health care professionals about the vaccine, were positively associated with rubella vaccination. The main motives for non-adherence were lack of orientation of professionals about their importance (48.5%) and not consider it necessary (18.9%). The recommendation of professionals was the factor most strongly associated with women's adherence to vaccination. In this sense, an indication of vaccination by health care teams can increase the knowledge about the importance their and benefits.

Las mujeres en edad reproductiva son la población de mayor interés para la prevención del síndrome de la rubeola congénita. El objetivo del trabajo fue evaluar la prevalencia de vacunación contra la rubeola en mujeres e identificar factores asociados y motivos de la no adhesión al programa de vacunación. Se trata de un estudio transversal de base poblacional, realizado en Campinas, São Paulo, Brasil, en 2008/2009, con una muestra por conglomerados y en dos fases. De las 778 mujeres, de 10 a 49 años, un 83,8% (IC95%: 79,6-88,0) informaron de vacunación en algún momento de la vida. La franja de edad (30-39 años), renta familiar per cápita superior a tres salarios mínimos y la orientación de un profesional de salud estuvieron positivamente asociadas a la vacunación contra la rubeola. Los principales motivos de la no adhesión fueron la falta de orientación del profesional de salud sobre su importancia (48,5%) y no considerarla necesaria (18,9%). La recomendación del profesional de salud fue el factor más fuertemente asociado a la adhesión de las mujeres a la vacunación. En este sentido, su indicación por los equipos de salud puede ampliar el conocimiento sobre su importancia y sus beneficios.

Social inequality in health among women in Campinas, São Paulo State, Brazil.

The aim of this study was to assess social inequalities in health status and use of health services according to level of schooling in women. This was a cross-sectional population-based study with a sample of 508 women from 20 to 59 years of age living in Campinas, São Paulo State, Brazil (ISA-Camp 2008). Women with less schooling showed higher prevalence of hypertension, circulatory problems, headache, dizziness, obesity, common mental disorders, worse self-rated health, use of dental prosthesis, and visual impairment, but lower prevalence for use of eyeglasses. There were no differences between the two schooling strata in prevalence of medical visits in the previous two weeks, use of medicines in the three previous days, Pap smear, breast self-examination, clinical breast examination, hospitalizations and surgeries in the previous year, and rubella vaccination any time in life. The only significant differences were in use of dental services and mammograms. The results show social inequalities in various health indicators and equity in access to various components of the health services.

Social inequality in health among women in Campinas, São Paulo State, Brazil / Desigualdades sociais na saúde de mulheres adultas no Município de Campinas, São Paulo, Brasil

The aim of this was study was to assess social inequalities in health status and use of health services according to level of schooling in women. This was a cross-sectional population-based study with a sample of 508 women from 20 to 59 years of age living in Campinas, São Paulo State, Brazil (ISA-Camp 2008). Women with less schooling showed higher prevalence of hypertension, circulatory problems, headache, dizziness, obesity, common mental disorders, worse self-rated health, use of dental prosthesis, and visual impairment, but lower prevalence for use of eyeglasses. There were no differences between the two schooling strata in prevalence of medical visits in the previous two weeks, use of medicines in the three previous days, Pap smear, breast self-examination, clinical breast examination, hospitalizations and surgeries in the previous year, and rubella vaccination any time in life. The only significant differences were in use of dental services and mammograms. The results show social inequalities in various health indicators and equity in access to various components of the health services.

Objetivou-se avaliar as desigualdades sociais no estado de saúde e uso de serviços de saúde segundo o nível de escolaridade entre mulheres adultas. Trata-se de um estudo transversal de base populacional com amostra de 508 mulheres de 20 a 59 anos, residentes em Campinas, São Paulo, Brasil (ISA-Camp 2008). Mulheres com menor escolaridade apresentam maior prevalência de hipertensão, problemas circulatórios, dor de cabeça, tontura, obesidade, transtorno mental comum, pior saúde autorreferida, uso de prótese dentária e deficiência visual, mas menor prevalência de uso de óculos. Não houve diferença entre os dois segmentos na prevalência de consultas nas duas últimas semanas, uso de medicamentos nos últimos três dias, exame de Papanicolaou, autoexame das mamas, exame clínico das mamas, hospitalizações e cirurgias no último ano e vacinação contra rubéola na vida. Diferenças significativas foram apenas em relação ao serviço odontológico e à mamografia. Há presença de desigualdades sociais em diversos indicadores de saúde e de equidade no acesso a vários componentes dos serviços de saúde.