How is smoking distributed in relation to socioeconomic status? Evidence from Brazil in the years 2013 and 2019.

The present study aimed to analyze income-related inequality in tobacco consumption in Brazil using data from the National Health Survey at two points in time (2013 and 2019). This study contributes to the growing literature analyzing socioeconomic inequalities in tobacco use by investigating income-related inequalities in the consumption of different tobacco products in Brazil. The inequality measure is the concentration index with an Erreygers correction (EI), and the analysis of its decomposition allows the identification of the factors that determine such inequality. There is inequality in smoking concentrated in the poorest persons, and this pattern also occurs for manufactured cigarettes and roll-your-own cigarettes (RYO), while inequality in smoking cessation is concentrated among the wealthiest. Smoking inequalities were greater in men, older age groups, and RYO. In terms of evolution, the overall results indicated a small decline in smoking inequality. For the decomposition analysis, the results show that the main factors that affect tobacco inequality in terms of concentration in the poorest are education, income, and having private health insurance. The region variable, by contrast, has a positive contribution, since the wealthiest regions have individuals who are more likely to smoke. These results have important implications that serve as a basis for formulating public health policies. For example, greater inequalities for men and older individuals can be targeted by public policies with a special focus on these cases.

Association between rural workers' sociodemographic and reproductive characteristics and their reproductive autonomy.

OBJECTIVES: to verify the association between sociodemographic and reproductive characteristics with rural workers' reproductive autonomy. METHODS: a cross-sectional study, with a sample of 346 women and application of the Reproductive Autonomy Scale. Multinomial regression was performed to analyze associations between independent variables and outcomes. RESULTS: in the analysis of subscales "Decision-making", "My sexual partner or someone else such as a parent", "Both me and my partner" and "Me", women experienced greater reproductive autonomy in relation to their partners. For outcomes "Decision about which method to use", "When to have a baby" or "About unplanned pregnancy", the highest prevalence was for category "Me", with statistically significant associations. CONCLUSIONS: the sociodemographic and reproductive characteristics among the most vulnerable women, in terms of the social, economic and cultural context in which they are inserted, may be associated with greater difficulties in exercising reproductive autonomy.

Socioeconomic inequality in health in older adults in Brazil.

Objective: This study analyzed socioeconomic inequality in self-rated health for older adults (aged fifty or over) in Brazil. Methods: Data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). Socioeconomic inequality in self-rated health was measured using the concentration index, which was decomposed to analyze the contribution of different factors. Results: This study revealed that 11.5% of the older adults interviewed reported their health as poor and very poor. For the complete sample, the estimated concentration index, -0.2434, indicated that there is a concentration of poor and very poor self-rated health among older and poorer adults. Income, education and having a private health insurance plan are the factors that contributed most to the observed inequality. Discussion: The decomposition showed that there are avoidable inequalities in relation to socioeconomic status for older adults in Brazil. These factors can guide the formulation of social and health policies aimed at reducing health inequalities.

Association between rural workers' sociodemographic and reproductive characteristics and their reproductive autonomy / Asociación entre características sociodemográficas y reproductivas con la autonomía reproductiva de trabajadoras rurales / Associação entre as características sociodemográficas e reprodutivas com a autonomia reprodutiva das trabalhadoras rurais

ABSTRACT Objectives: to verify the association between sociodemographic and reproductive characteristics with rural workers' reproductive autonomy. Methods: a cross-sectional study, with a sample of 346 women and application of the Reproductive Autonomy Scale. Multinomial regression was performed to analyze associations between independent variables and outcomes. Results: in the analysis of subscales "Decision-making", "My sexual partner or someone else such as a parent", "Both me and my partner" and "Me", women experienced greater reproductive autonomy in relation to their partners. For outcomes "Decision about which method to use", "When to have a baby" or "About unplanned pregnancy", the highest prevalence was for category "Me", with statistically significant associations. Conclusions: the sociodemographic and reproductive characteristics among the most vulnerable women, in terms of the social, economic and cultural context in which they are inserted, may be associated with greater difficulties in exercising reproductive autonomy.

RESUMEN Objetivos: verificar la asociación entre características sociodemográficas y reproductivas con la autonomía reproductiva de trabajadoras rurales. Métodos: estudio transversal, con una muestra de 346 mujeres y aplicación de la Escala de Autonomía Reproductiva. Se realizó una regresión multinomial para analizar las asociaciones entre las variables independientes y los resultados. Resultados: en el análisis de las subescalas "Toma de decisiones", "Mi pareja sexual o alguien de la familia tiene más que decir", "Mi pareja sexual y yo" y "Yo decido", las mujeres experimentaron mayor autonomía reproductiva en relación a su parejas. Para los desenlaces "Decisión sobre qué método utilizar", "Cuándo tener un hijo" o "Sobre el embarazo no planeado", las mayores prevalencias fueron para la categoría "Yo decido", con asociaciones estadísticamente significativas. Conclusiones: las características sociodemográficas y reproductivas de las mujeres más vulnerables, en función del contexto social, económico y cultural en el que se insertan, pueden estar asociadas a mayores dificultades en el ejercicio de la autonomía reproductiva.

RESUMO Objetivos: verificar a associação entre as características sociodemográficas e reprodutivas com a autonomia reprodutiva das trabalhadoras rurais. Métodos: estudo transversal, com amostra de 346 mulheres e aplicação da Escala de Autonomia Reprodutiva. Foi realizada regressão multinomial para análises de associações entre as variáveis independentes e desfechos. Resultados: na análise das subescalas "Tomada de decisão", "Meu parceiro sexual ou alguém da família tem mais a dizer", "Eu e meu parceiro sexual" e "Eu decido", as mulheres experimentaram maior autonomia reprodutiva em relação aos parceiros. Para os desfechos "Decisão sobre qual método utilizar", "Quando ter um bebê" ou "Sobre gravidez não planejada", as maiores prevalências foram para a categoria "Eu decido", com associações estatisticamente significante. Conclusões: as características sociodemográficas e reprodutivas entre mulheres mais vulneráveis, tratando-se do contexto social, econômico e cultural que estão inseridas, podem estar associadas a maiores dificuldades para exercerem a autonomia reprodutiva.

Socioeconomic inequalities in obesity in Brazil.

The aim of this work was to analyze the socioeconomic inequality in overweight and obesity for the Brazilian adult population and to determine the factors that contribute the most to the observed inequality. Data from the 2013 National Health Survey (Pesquisa Nacional de Saúde - PNS) were used and the inequality was calculated using the concentration index, which was decomposed to analyze the contribution of different factors (demographic, schooling, lifestyle, sanitation, among others). The analyses were stratified by gender and region, in order to identify some heterogeneity. The results for gender showed that the inequality in overweight and obesity in men is concentrated in the richest ones, whereas, for women, the indices did not show inequality. In the analyzes per region, the results showed the same pattern for men, and differences were found for women, suggesting that overweight is more concentrated in rich women in the less developed regions (North and Northeast) and in poor women in more developed regions (South, Southeast and Midwest). Income, demographics, schooling, and lifestyles are the factors that contributed most to the observed inequality. Public policy strategies should aim to reduce such persistence of overweight and obesity, but also seek equity and equality in health.

Does greater unemployment make people thinner in Brazil?

The study seeks to analyze the impact of macroeconomic conditions on weight measures, such as BMI, overweight, obesity, and severe obesity in Brazil. We examine this relationship in the specific context of a middle-income country that differs in many aspects from the high-income countries usually considered in the literature. The study uses the microdata of VIGITEL in the period from 2006 to 2014 and the state unemployment rate as a proxy for macroeconomic conditions. The results showed that the relationship is robust and presents a procyclical pattern-increases in the unemployment rate reduce BMI, and this reduction is observed throughout the entire distribution, with statistically significant effects for measures of overweight, obesity, and severe obesity. These results agree with the findings for the United States but contradict the results found for Finland and Canada.

Crises econômicas, mortalidade de crianças e o papel protetor do gasto público em saúde / Economic crises, child mortality and the protective role of public health expenditure

Resumo O objetivo do estudo foi analisar como as crises econômicas afetam a saúde infantil a nível global e entre subgrupos de países com diferentes níveis de renda. Foram utilizados dados do Banco Mundial e da OMS para 127 países entre os anos de 1995 e 2014. Foi utilizado um modelo de efeitos fixos, avaliando o efeito da mudança em indicadores macroeconômicos (PIB per capita, taxa de desemprego e de inflação, e taxa de desconforto) na taxa de mortalidade neonatal, infantil, e de menores de cinco anos. Adicionalmente, avaliou-se a modificação do efeito da associação de acordo com a renda dos países e também a influência do gasto público em saúde nessa relação. As evidências mostraram que piores indicadores econômicos (menor PIB per capita e maiores inflação, taxa de desemprego e taxa de desconforto) estão associados com maiores taxas de mortalidade infantil. Nas subamostras por estrato de renda, observa-se a mesma relação, porém com efeitos de maior magnitude entre os países de renda baixa e média. Verificou-se ainda que um maior percentual nos gastos públicos em saúde ameniza os efeitos dos indicadores econômicos nas taxas de mortalidade infantil. Desta forma, é necessário aumentar a atenção aos efeitos nocivos das crises macroeconômicas para garantir melhorias na saúde infantil.

Abstract The aim of the study was to analyze how economic crises affect child health globally and between subgroups of countries with different levels of income. Data from the World Bank and the World Health Organization were used for 127 countries between 1995 and 2014. A fixed effects model was used, evaluating the effect of the change on macroeconomic indicators (GDP per capita, unemployment and inflation rates and misery index) in neonatal, infant and under-five mortality rates. Moreover, we evaluated whether there was a change in the association effect according to the income of the countries and also analyzed the role of public health expenditure in this association. Evidence has shown that worse economic indicators (lower GDP per capita, higher inflation, unemployment rates and misery index) are associated with higher child mortality rates. In the subsamples by income strata, the same association is observed, but with effects of greater magnitude for low- and middle-income countries. We also verified that a higher percentage in public health expenditures alleviates the effects of economic indicators on child mortality rates. Thus, more attention needs to be paid to the harmful effects of the macroeconomic crises to ensure improvements in child health.

Association of risk behaviours, socio-economic characteristics and academic progress in adolescents: an analysis of the 1993 birth cohort in Pelotas, Brazil.

To analyze how socio-economic factors and behavioural characteristics are related to the failure of academic progress. Data of the 1993 Birth Cohort of the city of Pelotas, Brazil, were analyzed using four follow-up waves. As a measure of the failure of academic progress, we used indicators of the age-grade gap. We analyzed the association of demographic, socio-economic, and behavioural characteristics. Factors associated with failure of academic progress were assessed through logistic regression. There are a higher odds of the age-grade gap when the adolescent is not white, man, of low socio-economic status, whose parents have low schooling and living in large families. In relation to risk behaviours, alcohol and tobacco consumption represent higher odds of the age-grade gap at age 18. The results show that socio-economic factors and behavioural characteristics are important predictors of academic progress. Public policies that seek to promote education should be targeted at the most vulnerable groups, decreasing the observed inequalities.

Economic crises, child mortality and the protective role of public health expenditure. / Crises econômicas, mortalidade de crianças e o papel protetor do gasto público em saúde.

The aim of the study was to analyze how economic crises affect child health globally and between subgroups of countries with different levels of income. Data from the World Bank and the World Health Organization were used for 127 countries between 1995 and 2014. A fixed effects model was used, evaluating the effect of the change on macroeconomic indicators (GDP per capita, unemployment and inflation rates and misery index) in neonatal, infant and under-five mortality rates. Moreover, we evaluated whether there was a change in the association effect according to the income of the countries and also analyzed the role of public health expenditure in this association. Evidence has shown that worse economic indicators (lower GDP per capita, higher inflation, unemployment rates and misery index) are associated with higher child mortality rates. In the subsamples by income strata, the same association is observed, but with effects of greater magnitude for low- and middle-income countries. We also verified that a higher percentage in public health expenditures alleviates the effects of economic indicators on child mortality rates. Thus, more attention needs to be paid to the harmful effects of the macroeconomic crises to ensure improvements in child health.

O objetivo do estudo foi analisar como as crises econômicas afetam a saúde infantil a nível global e entre subgrupos de países com diferentes níveis de renda. Foram utilizados dados do Banco Mundial e da OMS para 127 países entre os anos de 1995 e 2014. Foi utilizado um modelo de efeitos fixos, avaliando o efeito da mudança em indicadores macroeconômicos (PIB per capita, taxa de desemprego e de inflação, e taxa de desconforto) na taxa de mortalidade neonatal, infantil, e de menores de cinco anos. Adicionalmente, avaliou-se a modificação do efeito da associação de acordo com a renda dos países e também a influência do gasto público em saúde nessa relação. As evidências mostraram que piores indicadores econômicos (menor PIB per capita e maiores inflação, taxa de desemprego e taxa de desconforto) estão associados com maiores taxas de mortalidade infantil. Nas subamostras por estrato de renda, observa-se a mesma relação, porém com efeitos de maior magnitude entre os países de renda baixa e média. Verificou-se ainda que um maior percentual nos gastos públicos em saúde ameniza os efeitos dos indicadores econômicos nas taxas de mortalidade infantil. Desta forma, é necessário aumentar a atenção aos efeitos nocivos das crises macroeconômicas para garantir melhorias na saúde infantil.

A gender analysis of the impact of physical education on the mental health of brazilian schoolchildren.

This paper investigates the effect of attending physical education classes on mental health indicators - loneliness and insomnia - of Brazilian schoolchildren. The identification strategy consists of separating the sample into two parts: people who practice physical activity and who attend physical education classes at school and people who, despite not attending physical education classes, practice physical activities. The data are from the 2015 National Adolescent School-based Health Survey (PeNSE), and the sample pairing method is the Propensity Score Matching with robustness analysis using the Bivariate Probit method and the sensitivity is tested using the method developed by Ichino, Mealli, and Nannicini (2008). For both girls and boys the results showed that physical education exerts a negative effect, reducing the probability of reporting problems of insomnia and loneliness among schoolchildren who attend the discipline. Although they show similar magnitudes, the observed effects are greater for boys, in both measures. The study investigates - in a rigorous and unprecedented way in the literature - the effect of physical education classes on the insomnia and loneliness of Brazilian school children. The results are important for the formulation of discipline maintenance policies in the curriculum of schoolchildren in Brazil.

Estilos de vida saudável e autoavaliação de saúde como boa: uma análise dos dados da PNS/2013 / Healthy lifestyles and self-rated health as good: an analysis of the PNS/2013

Objetivo: Avaliar a influência de cinco estilos de vida sobre a autoavaliação da saúde como boa no Brasil. Métodos: Estudo transversal utilizando dados da Pesquisa Nacional de Saúde (PNS) realizada em 2013, com amostra de 46.785 indivíduos. O desfecho principal foi a autoavaliação de saúde como boa e utilizou-se a regressão logística para analisar os estilos de vida saudáveis associados a melhor autoavaliação de saúde. Resultados: Encontramos que o tabagismo, o consumo de álcool, a atividade física e a alimentação saudável são comportamentos que estão associados à autoavaliação de saúde. Pessoas que apresentam múltiplos comportamentos saudáveis apresentam chances maiores de avaliar positivamente sua saúde. Conclusão: Políticas de conscientização devem ser realizadas informando a população dos benefícios da adoção de hábitos de vida saudáveis.

Objective: Evaluating the influence of five lifestyles on health self-assessment as good in Brazil. Methods: Cross-sectional descriptive study using data from the National Health Survey (PNS 2013) conducted in 2013, with a sample of 46,785 individuals. The main outcome was self-rated health as good and logistic regression was used to analyze healthy lifestyles associated with better self-rated health. Results: We found that smoking, drinking, physical activity and healthy eating are behaviors that are associated with self-rated health. People who have multiple healthy behaviors are more likely to positively evaluate their health. Conclusion: Awareness policies should be carried out to inform the population of the benefits of adopting a healthy lifestyle.

The sociodemographic, behavioral, reproductive, and health factors associated with fertility in Brazil.

High fertility rates among disadvantaged subgroups are a public health problem because fertility levels significantly affect socioeconomic conditions and a population's welfare. This paper aims to analyze the sociodemographic, behavioral, and reproductive factors associated with fertility rates among Brazilian women aged between 15-49 years. A Poisson regression was used to analyze data from the 2006 PNDS (Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher), which evaluates socioeconomic, demographic, geographic, reproductive, behavioral, and chronic disease variables. The results show that the following characteristics are positively associated with an increase in the number of children born: being aged 20-24, residing in the North, being nonwhite, not being in paid employment, having lower education levels, having lower socioeconomic status, being in a stable union, having the first sexual intercourse before the age of 16 and having the first child before the age of 20. Thus, it is important to implement efficient family planning policies targeting these subgroups in order to improve life conditions, reduce inequalities and avoid the adverse outcomes of high fertility.