Multiple behavioral risk factors for non-communicable diseases among the adolescent population in Brazil: the analysis derived from the Brazilian national survey of school health 2019.

BACKGROUND: Health risk behaviors often emerge or intensify during adolescence and tend to co-occur, exposing individuals to an even greater risk for the development of non-communicable diseases (NCDs). The likelihood of exhibiting multiple health risk factors also increases throughout life and is associated with sociodemographic characteristics contributing to their escalation and severity. In this context, the objective of this study was to analyze the association between sociodemographic characteristics and multiple behavioral risk factors for non-communicable diseases among the adolescent population in Brazil. METHODS: This cross-sectional study utilized data from the Brazilian National Survey of School Health 2019. The sample comprised 121,580 adolescents aged 13 to 17. The analyzed variables included irregular intake of fruits and vegetables, regular consumption of soft drinks and treats, insufficient physical activity, sedentary lifestyle, cigarette smoking, and alcohol consumption. To analyze MBRFs, a classification ranging from zero to five was created, and associations were estimated using Odds Ratio (OR) with the respective 95% confidence interval (CI). The Backward method was employed for the multivariate regression model, utilizing ordinal logistic regression. RESULTS: Adolescents without behavioral risk factors for NCDs constituted only 3.9% (95% CI 3.7-4.1). The most prevalent categories were two and three MBRFs, accounting for 28.3% (95% CI: 27.7-28.8) and 27.0% (95% CI: 26.5-27.5), respectively. Adolescents aged 16 and 17 (ORadj: 1.39; 95% CI: 1.32-1.48), residing in the Brazilian Southeast (ORadj: 1.66; 95% CI: 1.52-1.81), and those reporting poor or very poor self-rated health (ORadj: 2.05; 95% CI: 1.87-2.25) were more likely to exhibit multiple behavioral risk factors. Conversely, male adolescents (adjusted OR: 0.65; 95% CI: 0.62-0.69), those of mixed race (adjusted OR: 0.92; 95% CI: 0.87-0.97), and residents of rural areas (adjusted OR: 0.76; 95% CI: 0.70-0.84) were less likely to manifest MBRFs for NCDs. CONCLUSION: The majority of adolescents displayed MBRFs for NCDs, positively associated with age, region, and perceived health status. This underscores the necessity for healthcare promotional interventions throughout the life cycle, as these behaviors may persist into adulthood.

Neighborhood environment is associated with unhealthy food intake in a Brazilian urban area.

Unhealthy food intake is one of the main risk factors for morbidity and mortality for non-communicable diseases (NCDs), and is associated with multiple factors, including the neighborhood environment. The present study aimed to examine the association between the neighborhood context and unhealthy food intake in adults. This is a cross-sectional study, carried out in Belo Horizonte, Brazil. This study used the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), which was georeferenced and linked to a database with information on the physical and social realities of a neighborhood context. The administrative boundary of the basic health units (ABBHU) was used as a neighborhood unit. Unhealthy food intake was assessed by the regular consumption of meat with excess fat, soft drinks, and red meat, as well as the irregular consumption of fruits and vegetables. To characterize the physical and social realities of a neighborhood, this study used georeferenced data of establishments selling foods, population density, homicide rates, health vulnerability Index, and total income. For data analysis, multilevel logistic regression was used. The sample consisted of 5783 adults. It was observed that younger, males, people with a lower-level education, who were inactive during leisure time, who had abusive alcohol consumption, and who were current smokers, were associated with a greater chance of having an unhealthy food intake. After adjusting for individual characteristics, it was observed that living in ABBHU, with a low mean income and an extremely high vulnerability, increases the individual's chances of having an unhealthy food intake. An unhealthy food intake is partially explained by demographic characteristics and socioeconomic conditions in the neighborhood. The present study can contribute to improving the understanding of the importance of the urban environment in food choices.

Associations of sedentary behaviours and incidence of unhealthy diet during the COVID-19 quarantine in Brazil.

OBJECTIVE: Our aim was to analyse the association of change patterns on TV-viewing and computer/tablet use and incidence of elevated consumption of ultra-processed food consumption and lower consumption of fruits and vegetables during the COVID-19 pandemic. DESIGN: Data of 39 208 Brazilian adults from a Behaviour Web Survey were used. Unhealthy nutrition habits were eating fruits or vegetables for <5 d/week and ultra-processed food (sugary foods, snacks, ready-to-eat frozen foods and embedded foods) for ≥5 d/week. For incidence indicators, we only considered participants without unhealthy behaviour before the quarantine. We created four categories of change in TV-viewing and computer/tablet use, considering a cut-off point of 4 h/d for each behaviour (1 - consistently low, 2 - become low during the quarantine, 3 - become high during the quarantine or 4 - consistently high). Analyses were adjusted for sex, age group, highest academic achievement, per capita income, working status during the quarantine, skin colour and adherence to the quarantine. SETTING: Brazil. PARTICIPANTS: Brazilian adults (nationally representative). RESULTS: Logistic regression models revealed that high TV-viewing and computer/tablet use incidence were associated with higher odds for elevated frequency of ultra-processed food consumption (TV-viewing: OR 1·70; 95 % CI 1·37, 2·12; computer/tablet: OR 1·73; 95 % CI 1·31, 2·27) and low consumption of fruit and vegetables (TV-viewing: OR 1·70; 95 % CI 1·29, 2·23; computer/tablet: OR 1·53; 95 % CI 1·08, 2·17) incidence. Consistent high computer/tablet use also presented higher odds for incidence of elevated frequency of ultra-processed food consumption. CONCLUSIONS: Participants with incidence of sedentary behaviours were also more likely to present incidence of unhealthy diet during the COVID-19 pandemic quarantine.

Food environment and fruit and vegetable intake in a urban population: a multilevel analysis.

BACKGROUND: Environmental, social and individual factors influence eating patterns, which in turn affect the risk of many chronic diseases. This study aimed to estimate associations between environmental factors and the consumption of fruit and vegetables among adults in a Brazilian urban context. METHODS: Data from the surveillance system for risk factors for chronic diseases (VIGITEL) of Brazilian Ministry of Health were used. A cross-sectional telephone survey (VIGITEL - 2008-2010) was carried out with 5826 adults in the urban area of Belo Horizonte. Individual variables were collected. The frequency of fruit and vegetables consumption was assessed from number of servings, weekly frequency and an intake score was calculated. Georeferenced variables were used to characterize the food environment. The density of healthy food outlets (stores specialized in selling fruit and vegetables), unhealthy food outlets (bars, snack bars and food trucks/trailers) and the neighborhood family income were investigated and associated with fruit and vegetables intake score. Weighted multilevel linear regression was used to evaluate the associations between the environment variables and the fruit and vegetables intake score. RESULTS: Higher fruit and vegetables intake scores were observed in neighborhoods with higher density of healthy food outlets and higher income. Lower scores were observed in neighborhood with higher density of unhealthy food outlets. These associations were adjusted by individual variables such as gender, age, physical activity, sugar sweetened beverages consumption, education level and smoking. DISCUSSION: The food environment might explain some of the socioeconomic disparities with respect to healthy food intake and health outcomes. Healthy food stores are less common in socially disadvantaged neighborhoods, and therefore, healthy foods such as fruits and vegetables are less available or are of a lower quality in lower income areas. CONCLUSION: Food environment characteristics and neighborhood socioeconomic level had significant associations with fruit and vegetable intake score. These are initial findings that require further investigation within the middle income world populations and the role of the environment with respect to both healthy and unhealthy food acquisition and intake.

Prevalence and incidence of insufficient physical activity in Brazilian adolescents during the pandemic: data from ConVid Adolescents. / Prevalência e incidência da prática insuficiente de atividade física em adolescentes brasileiros durante a pandemia: dados da ConVid Adolescentes.

OBJECTIVE: To evaluate the prevalence and incidence of insufficient physical activity in Brazilian adolescents and identify the most affected subgroups during the pandemic. METHODS: This study used data from the "ConVid Adolescents - Behavior Survey", which evaluated the behavior of 9,470 Brazilian adolescents during the period of social restriction due to the COVID-19 pandemic in 2020, through a self-administered online questionnaire. Participants were invited through a virtual "snowball" sampling procedure. Information was reported on the frequency of physical activity before and during the pandemic. The exposure variables used were gender, age group, race/skin color, region of Brazil, type of school, maternal education, financial difficulties during the pandemic, and social restrictions. Logistic regression models were used. RESULTS: Adolescents engaged in less physical activity during the pandemic, as the prevalence of insufficient physical activity increased from 71.3% in the previous period to 84.3% during the pandemic. The incidence of insufficient physical activity during the pandemic was 69.6%. The subgroups of adolescents most affected were those who self-declared as black or with dark skin color, reported financial difficulties during the pandemic, lived in the Southeast and South regions of the country, and practiced intense or complete social distancing. CONCLUSION: High incidences of insufficient physical activity were observed among Brazilian adolescents during the COVID-19 pandemic. It is recommended that further studies explore periods after those analyzed to identify the behavioral dynamics of adolescents upon returning to in-person activities.

OBJETIVO: Avaliar a prevalência e a incidência de atividade física insuficiente em adolescentes brasileiros e identificar os subgrupos mais afetados durante a pandemia. MÉTODOS: Este estudo utilizou dados da ConVid Adolescentes - Pesquisa de Comportamentos, que avaliou, por meio de um questionário online autopreenchido, o comportamento de 9.470 adolescentes brasileiros no período de restrição social, em virtude da pandemia da COVID-19 em 2020. Os participantes foram convidados por meio de um procedimento de amostragem em cadeia denominado "bola de neve" virtual. Foram relatadas informações sobre a frequência de atividade física antes e durante a pandemia. As variáveis de exposição utilizadas foram sexo, faixa etária, raça/cor da pele, região do Brasil, tipo de escola, escolaridade materna, dificuldades financeiras durante a pandemia e restrições sociais. Foram utilizados modelos de regressão logística. RESULTADOS: Os adolescentes praticaram menos atividade física durante a pandemia, visto que a prevalência de atividade física insuficiente aumentou de 71,3% no período anterior para 84,3% durante a pandemia. A incidência de atividade física insuficiente durante a pandemia foi de 69,6%. Os subgrupos de adolescentes mais afetados foram os que se autodeclararam da raça/cor da pele preta, que relataram dificuldades financeiras durante a pandemia, residentes nas regiões Sudeste e Sul do país e que realizaram restrição social intensa e total. CONCLUSÃO: Altas incidências de atividade física insuficiente foram observadas entre adolescentes brasileiros durante a pandemia da COVID-19. Recomenda-se que novos estudos explorem períodos posteriores aos analisados para identificar a dinâmica comportamental dos adolescentes a partir do retorno das atividades presenciais.

Prevalence and factors associated with possible cases of familial hypercholesterolemia in Brazilian adults: a cross-sectional study.

This study aimed to estimate the prevalence of possible cases of FH and analyze associated factors in the adult Brazilian population. Cross-sectional study with laboratory data from the Brazilian National Health Survey, with 8521 participants. Possible cases of FH were defined according to the Dutch Lipid Clinic Network criteria. The prevalence and 95% confidence intervals (95% CI) of possible cases of FH were estimated according to sociodemographic variables, lifestyle, diabetes, hypertension, altered tests, treatment and self-rated health. Logistic regression was used to analyze the associations. The prevalence of possible cases of FH was 0.96%, higher in women, between 45 and 59 years, white race/skin color and others, less education, people with diabetes, hypertension and total cholesterol ≥ 310 mg/dL. The presence of FH was positively associated with regular self-rated health (OR 1.96; 95% CI 0.99-3.84), poor/very poor (OR 3.02; 95% CI 1.30-7.03) and negatively with black race/skin color (OR 0.10; 95% CI 0.02-0.46) and complete elementary school, incomplete high school (OR 0.47; 95% CI 0.23-0.98) and complete high school and more (OR 0.45; 95% CI 0.21-0.95). FH affects 1:104 Brazilian adults, these findings contribute to understanding the burden of disease in Brazil. Due to the scarcity of studies on FH in low- and middle-income countries, further studies are desirable.

Smoking among Brazilian adolescents during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: The social distancing measures during the coronavirus disease 2019 (COVID-19) pandemic resulted in mental suffering among adolescents, leading to risky consumption of psychoactive substances such as tobacco. OBJECTIVE: To analyze the factors associated with tobacco use among adolescents during the COVID-19 social distancing period in Brazil. DESIGN AND SETTING: Cross-sectional study used data from ConVid Adolescentes survey in Brazil. METHODS: Tobacco use was assessed before and during social distancing. The explanatory variables investigated were sex, age, race/skin color, type of school, maternal education, region of residence, adherence to social restriction measures, number of close friends, sleep quality during the pandemic, mood, passive smoking, use of alcoholic beverages during the pandemic, sedentary behavior, and physical activity. A logistic regression model was used for the data analysis. RESULTS: Tobacco use by adolescents did not change during the pandemic (from 2.58% to 2.41%). There was a higher chance of tobacco use among adolescents aged between 16 and 17 years, self-reported black ones, residing in the South and Southeast regions, reported feeling sad and loneliness, had sleeping problems that worsened, were using alcoholic beverages during the pandemic, and were passive smokers at home. Adolescents whose mothers had completed high school or higher, had strict social restrictions, and increased their physical activity during the pandemic had a lower chance of tobacco use. CONCLUSION: Tobacco uses during the COVID-19 pandemic was higher in vulnerable groups, such as black adolescents and those with mental suffering.

The burden of Noncommunicable Diseases in Portuguese Language Countries. / Carga das Doenças Crônicas Não Transmissíveis nos Países de Língua Portuguesa.

The present study analyzed trends in premature mortality from Noncommunicable diseases (NCDs) between 1990 and 2019, the projections up to 2030, and the risk factors (RFs) attributable to these diseases in the Community of Portuguese Language Countries (CPLP). Estimates from the Global Burden of Disease (GBD) study and the analysis of the burden of premature mortality due to NCDs were used for nine CPLP countries, applying age-standardized rates, using RStudio. Portugal, Brazil, Equatorial Guinea, Angola, and Guinea Bissau showed declining premature mortality rates caused by NCDs, while East Timor, Cape Verde, São Tomé and Príncipe, and Mozambique showed an increase in rates. Projections indicate that none of the countries is expected to achieve the goals of reducing premature mortality due to NCDs by one third by 2030. The attributable burden of disease showed that the most important RFs in 2019 were: high systolic blood pressure (SBP), tobacco, dietary risks, high body mass index (BMI), and air pollution. It can therefore be concluded that there are profound differences in the burden of NCDs among the countries, with better results in Portugal and Brazil, and that no CPLP country is likely to reach the NCD reduction target by 2030.

Foram analisadas tendências da mortalidade prematura por doenças crônicas não transmissíveis (DCNT) entre 1990 e 2019, as projeções até 2030 e os fatores de risco atribuíveis a estas doenças na Comunidade dos Países de Língua Portuguesa (CPLP). Utilizou-se estimativas do estudo Carga Global de Doenças e análise da carga de mortalidade prematura por DCNT para nove países da CPLP, utilizando taxas padronizadas por idade, usando-se RStudio. Portugal, Brasil, Guiné Equatorial, Angola e Guiné Bissau apresentam taxas de mortalidade prematura por DCNT em declínio e; Timor Leste, Cabo Verde, São Tomé e Príncipe e Moçambique apresentaram aumento das taxas. As projeções indicam que nenhum dos países deverá atingir as metas de redução em um terço da mortalidade prematura por DCNT até 2030. A carga de doença atribuível mostrou que os fatores de riscos mais importantes em 2019 foram: pressão arterial sistólica elevada, tabaco, riscos dietéticos, índice de massa corporal elevado e poluição do ar. Conclui-se pelas profundas diferenças na carga de DCNT entre os países, com melhores resultados em Portugal e Brasil e que nenhum país do CPLP deverá atingir a meta de redução das DCNT até 2030.

Spatial distribution of sedentary behavior and unhealthy eating habits in Belo Horizonte, Brazil: the role of the neighborhood environment.

The study aimed to analyze the spatial distribution of sedentary behavior and unhealthy eating habits, and to assess its relationship with the neighborhood environment. Cross-sectional study with data of Surveillance System of Risk and Protective Factors for Chronic Diseases, carried out in Belo Horizonte, Minas Gerais. Watching television for four hours or more per day was identified as sedentary behavior. Unhealthy eating habits were defined based on regular consumption of sodas, excess fat meat, and red meat, and irregular consumption of fruits and vegetables. Georeferenced data of places for physical activity, food establishments, population and residential density, homicide rate, mean total income, and social vulnerability index were entered into the Vigitel database. The coverage area by basic health units was used as the geographical unit of neighborhood. SaTScan was used to analyze the spatial distribution. Spatial analysis identified a significant cluster of high prevalence of sedentary behavior and unhealthy eating habits, after adjusting for sociodemographic characteristics. The comparison of environmental characteristics inside and outside clusters showed significant differences in the physical and social environment. Physical and social environment might be related to clusters of high prevalence of sedentary behavior and unhealthy eating habits.

The use of cigarettes, hookahs, electronic cigarettes, and other tobacco indicators among Brazilian schoolchildren: data from National School Health Survey 2019. / O uso de cigarro, narguilé, cigarro eletrônico e outros indicadores do tabaco entre escolares brasileiros: dados da Pesquisa Nacional de Saúde do Escolar 2019.

OBJECTIVE: To describe the prevalence of smoking indicators among Brazilian students according to sociodemographic characteristics in 2019, and compare the prevalence between 2015 and 2019. METHODS: Data from the National Survey of School Health 2015 and 2019 were used. Indicators related to tobacco use were analyzed. Indicators were compared between the 2015 and 2019 editions. Prevalence and respective 95% Confidence Interval (95%IC) were calculated for the total population and according to sex, age group and type of school. RESULTS: 22.6% (95%CI 21.7-23.4) of the students had tried any cigarette and it was higher between 16 and 17 years of age (32.6%; 95% CI 31.4-33, 8) and in males (35.0%; 95%CI 33.6-36.4). The experimentation of hookah, electronic cigarette and other tobacco products are also high, with 26.9% (95%CI 26.0-27.8), 16.8% (95%CI 16.2-17.4) and 9.3% (95%CI 8.8-9.8), respectively, being higher among boys aged 16 to 17 years. It is noteworthy that there were no changes in the indicators of cigarette experimentation, smoking for the first time before the age of 13, smoking in the 30 days prior to the survey, and at least one of the smoking parents. CONCLUSION: Although smoked tobacco indicators are stable between 2015 and 2019, the high prevalence of experimentation with products such as hookah and electronic cigarettes is highlighted, drawing attention to the need for new regulatory measures.

OBJETIVO: Descrever a prevalência de indicadores do tabagismo entre escolares brasileiros segundo características sociodemográficas em 2019 e comparar as prevalências entre 2015 e 2019. MÉTODOS: Utilizaram-se dados da Pesquisa Nacional de Saúde do Escolar de 2015 e 2019. Foram analisados os indicadores referentes ao uso do tabaco, que foram comparados entre as edições de 2015 e 2019. Foram calculadas as prevalências e os respectivos intervalos de confiança de 95% (IC95%) para a população total e segundo sexo, faixa etária e tipo de escola. RESULTADOS: Dos escolares, 22,6% (IC95% 21,7-23,4) já experimentaram cigarro alguma vez, porcentagem mais elevada entre os de 16 a 17 anos de idade (32,6%; IC95% 31,4-33,8) e no sexo masculino (35,0%; IC95% 33,6-36,4). A experimentação de narguilé, cigarro eletrônico e outros produtos do tabaco também se mostra elevada, com 26,9% (IC95% 26,0-27,8), 16,8% (IC95% 16,2-17,4) e 9,3% (IC95% 8,8-9,8), respectivamente, sendo mais alta entre os escolares do sexo masculino de 16 a 17 anos. Destaca-se que não houve mudanças nos indicadores "experimentação do cigarro", "fumar pela primeira vez antes dos 13 anos", "fumar nos 30 dias anteriores à pesquisa" e "ter ao menos um dos pais fumantes" entre os anos indicados. CONCLUSÃO: Embora os indicadores de tabaco fumado estejam estáveis entre 2015 e 2019, destacam-se as elevadas prevalências de experimentação de produtos como narguilé e cigarro eletrônico, que chamam a atenção para a necessidade de novas medidas regulatórias.

Prevalence and factors associated with self-reported diagnosis of high cholesterol in the Brazilian adult population: National Health Survey 2019. / Prevalência e fatores associados ao diagnóstico autorreferido de colesterol alto na população adulta brasileira: Pesquisa Nacional de Saúde 2019.

OBJECTIVE: To estimate the prevalence of self-reported high cholesterol diagnosis and to analyze the factors associated with the prevalence in the Brazilian adult population. METHODS: Cross-sectional study, using data from the 2019 National Health Survey. The diagnosis of high cholesterol was self-reported. Poisson regression models yielded prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS: In the 88,531 adults, the prevalence of high cholesterol was 14.6%. Positively associated: female sex (PR = 1.44; 95%CI 1.40;1.52), age ≥ 60 years (PR = 3.80; 95%CI 3.06;4.71), health insurance (PR = 1.33; 95%CI 1.24;1.42), poor or very poor self-rated health (PR = 1.75; 95%CI 1.60;1.90), hypertension (PR = 1.78; 95%CI 1.68;-1.89), diabetes (RP = 1.54; 95%CI 1.45;1.65), renal failure (PR = 1.33; 95%CI 1.15;1.53), obesity (PR = 1.27; 95%CI 1.18;1.36), former smoker (PR = 1.13; 95%CI 1.07;1.20), alcohol abuse (PR = 1.11; 95%CI 1.01;1.21), physically active during leisure time (PR = 1.22; 95%CI 1.15;1.30). CONCLUSION: High cholesterol was associated with sociodemographic characteristics, health condition and lifestyle.

Physical violence against women by an intimate partner: analysis of VIVA Survey 2017. / Violência física contra mulheres perpetrada por parceiro íntimo: análise do VIVA Inquérito 2017.

This article aims to characterize physical violence by an intimate partner suffered by adult women treated in public urgency and emergency services in Brazil. This is a cross-sectional study using data from the VIVA Survey 2017. The proportions and 95% confidence intervals of the characteristics of the victim, violence, and perpetrator were calculated. The associations of characteristics were identified through Simple Correspondence Analysis (SCA). More than half of the assisted women self-declared their race/skin color to be black (70.2%) and were the victim of a male perpetrator (96.3%). Most violence occurred at home (71.1%) through physical force (74.1%). In the SCA, an association was found among the variables of age group, between 40 and 59 years; level of education, up to 08 years of study; alcohol consumption by the victim; and violence by weapons (Profile 2). An association was also found among the variables of age group, between 18 and 24 years; black race/skin color; lack of paid work; aggression on public places; and more serious injuries (Profile 4). There are different intimate partner violence (IPV) profiles for women in different contexts. Confronting IPV requires Public Policies that consider these differences in the construction of actions that focus on women and perpetrators of violence.

O objetivo deste artigo é caracterizar a violência física por parceiro íntimo sofrida por mulheres adultas atendidas nos serviços públicos de urgência e emergência do Brasil. Estudo transversal utilizando dados do VIVA Inquérito 2017. Foram calculados as frequências e os intervalos de confiança das características da vítima, da violência e do agressor. As associações das características foram identificadas por meio da análise de correspondência simples (ACS). A maioria das mulheres atendidas se autodeclarou da raça/cor da pele negra (70,2%) e foi vítima de agressor do sexo masculino (96,3%). A maioria das violências ocorreu em residência (71,1%) por meio de força corporal (74,1%). Na ACS, destaca-se a associação entre a faixa etária de 40 a 59 anos, escolaridade de até 08 anos de estudo, consumo de álcool pela vítima e violência por meio de armas (perfil 2); e a associação da faixa etária de 18 a 24 anos, raça/cor da pele negra, ausência de atividade remunerada, agressão em via pública e lesões de maior gravidade (perfil 4). Existem diferentes perfis de VPI para mulheres em diferentes contextos. O enfrentamento à VPI necessita de Políticas Públicas que considerem essas diferenças na construção de ações que foquem as mulheres e os perpetradores da violência.

Inequalities in health care and access to health services among adults with self-reported arterial hypertension: Brazilian National Health Survey.

This study compared indicators of care and access to health services by adults who self-reported hypertension in 2013 and 2019, analyzing those indicators according to gender, age group, schooling level, and race/color. This is an analytic study with data from the Brazilian National Health Survey (PNS), conducted in 2013 and 2019 in Brazil. The indicators to care and access to health services by individuals with arterial hypertension in both surveys were compared. For 2019, those indicators were analyzed according to sociodemographic characteristics. This study estimated the proportions, prevalence ratio (PR), and their respective 95% confidence intervals (95%CI). In total, 60,202 individuals were evaluated in 2013 and 88,531 in 2019, of these 24.4% reported arterial hypertension in 2013 and 23.9% in 2019. Women received more medical care for hypertension within the last year (PR = 1.07; 95%CI: 1.04; 1.11), had the last physician appointment at an basic health unit (PR = 1.11; 95%CI: 1.05; 1.17) than men. About race/color, black people had more hospitalization for hypertension or some complication (PR = 1.2; 95%CI: 1.05; 1.38) and intense or very intense degree of limitation in performing daily activities (PR = 1.37; 95%CI: 1.06; 1.76). In 2019, inequalities were evidenced and worse indicators were observed for males, black, with low education and young age. Therefore, investments in the Brazilian Unified National Health System, as well as public policies and strategic actions are essential to reduce inequalities, promote health care.

Indicators related to smoking cessation in Brazil, National Health Survey, 2013 and 2019 editions. / Indicadores referentes à cessação do comportamento de fumar no Brasil, Pesquisa Nacional de Saúde, edições 2013 e 2019.

OBJECTIVE: To describe the indicators of smoking cessation in 2013 and 2019 for Brazil and federative units, according to sociodemographic variables, collected in the National Health Survey (PNS). METHODS: Cross-sectional, population-based and descriptive study with data from the 2013 and 2019 PNS, a household survey collected by trained interviewers. The prevalence of ex-smokers and the proportion of smokers who tried to quit smoking in the 12 months prior to the interview, and respective confidence intervals (95%CI) were calculated, according to sociodemographic variables. Additionally, the percentage variation between the years was calculated. RESULTS: In 2013, the prevalence of ex-smokers was 17.5% (95%CI 16.9;18.0) and, in 2019, 26.6% (95%CI 26.1;27.2). In 2013, 51.1% tried to quit smoking (95%CI 49.3;52.9) and, in 2019, 46.6% (95%CI 45.0;48.3). CONCLUSION: It is important to strengthen and maintain strategies for coping with tobacco use in Brazil, to increase the current smoker's willingness and ability to quit smoking.

Burden of Cardiovascular diseases attributable to risk factors in Brazil: data from the "Global Burden of Disease 2019" study.

INTRODUCTION: To better understand trends in the main cause of death in Brazil, we sought to analyze the burden of cardiovascular risk factors (RF) and cardiovascular diseases (CVD) attributable to specific RFs in Brazil from 1990 to 2019, using the estimates from the GBD 2019 study. METHODS: To estimate RF exposure, the Summary Exposure Value (SEV) was used, whereas for disease burden attributed to RF, mortality and disability-adjusted life-years (DALY) due to CVD were used. For comparisons over time and between states, we compared age-standardized rates. The sociodemographic index (SDI) was used as a marker of socioeconomic conditions. RESULTS: In 2019, 83% of CVD mortality in Brazil was attributable to RF. For SEV, there was a reduction in smoking and environmental RF, but an increase in metabolic RF. High systolic blood pressure and dietary risks continue to be the main RF for CVD mortality and DALY. While there was a decline in age-standardized mortality rates attributable to the evaluated RF, there was also a stability or increase in crude mortality rates, with the exception of smoking. It is important to highlight the increase in the risk of death attributable to a high body mass index. Regarding the analysis per state, SEVs and mortality attributable to RF were higher in those states with lower SDIs. CONCLUSIONS: Despite the reduction in CVD mortality and DALY rates attributable to RF, the stability or increase in crude rates attributable to metabolic RFs is worrisome, requiring investments and a renewal of health policies.

Burden of disease attributable to Risk Factors in Brazil: an analysis of national and subnational estimates from the 2019 Global Burden of Disease study.

INTRODUCTION: Monitoring trends in risk factors (RFs) and the burden of diseases attributable to exposure to RFs is an important measure to identify public health advances and current inadequate efforts. Objective: Analyze the global burden of disease attributable to exposure RFs in Brazil, and its changes from 1990 to 2019, according to the sex and age group. METHODS: This study used data from the Global Burden of Disease study. The Summary Exposure Value, which represents weighted prevalence by risk, was used to estimate exposure to RFs. The mortality and DALYs (Disability Adjusted Life Years) measurements were used to estimate the burden of diseases. For comparisons by year and between Brazilian states, age-standardized rates were used. RESULTS: Arterial hypertension was the factor responsible for most deaths in both sexes. For DALYs, the most important RF was the high body mass index (BMI) for women and alcohol consumption for men. Smoking had a substantial reduction in the attributable burden of deaths in the period. An important reduction was identified in the exposure to RFs related to socioeconomic development, such as unsafe water, lack of sanitation, and child malnutrition. Metabolic RFs, such as high BMI, hypertension, and alcohol consumption showed an increase in the attributable burden. CONCLUSIONS: Our findings point to an increase in metabolic RFs, which are the main RFs for mortality and DALYs. These results can help to consolidate and strengthen public policies that promote healthy lifestyles, thus reducing disease and death.

Effect of chronic non-communicable diseases (CNCDs) on the sleep of Brazilians during the COVID-19 pandemic.

This study aimed to investigate the effect of Chronic Noncommunicable Diseases (CNCDs) on the onset or increase in sleep problems during the COVID-19 pandemic period. The role of the report of sadness or nervousness during the pandemic was also evaluated as a mediator of this association. Data from a behavior survey during COVID-19, conducted in Brazil with 45,161 people (18 years old or older), from April 24 to May 24, 2020, were used. The outcome variable was the onset or increase in sleep problems, and the exposure variable was the presence of CNCDs. The adjusted Odds Ratio of the association between CNCDs and sleep was estimated, and a mediation analysis was performed to test the effect of the report of sadness or nervousness on this association, using the Karlson Holm Breen method. The increase in sleep problems was reported by 44.9% of the population, and 33.9% reported at least one CNCD. The chance of sleep problems was higher among people with diabetes (1.34; 1.05-1.71), hypertension (1.26; 1.06-1.50), and with coronary heart diseases (1.36; 1.13-1.65) or respiratory diseases (1.42; 1.04-1.93). Compared to people without CNCDs, individuals with at least one CNCD had a 36% greater chance of impaired sleep (1.36; 1.19-1.55). The report of sadness or nervousness explained 45.1% of the association between CNCD and sleep. Our findings alert us to care for the emotional state and sleep of chronic patients during the waves of the COVID-19 pandemic, and indicate the need for sleep monitoring in this population.

Monitoring the goals of the plans for coping with Chronic Non-Communicable Diseases: results of the National Health Survey, Brazil, 2013 and 2019. / Monitoramento das metas dos planos de enfrentamento das Doenças Crônicas Não Transmissíveis: resultados da Pesquisa Nacional de Saúde, 2013 e 2019.

OBJECTIVE: To monitor the achievement of the action plans for the prevention and control of Non-Communicable Diseases agreed-upon targets. METHODS: Cross-sectional study, with data from the 2013 and 2019 National Health Survey. The following targets, up to 2025, were evaluated: physical inactivity, alcohol consumption, salt/sodium, tobacco use, high blood pressure, diabetes, overweight, obesity, cervical cytology testing, and drug therapy and counseling. To check whether the targets were achieved, the prevalence ratio was calculated (PR). RESULTS: 60,202 individuals were assessed in 2013, and 88,531 in 2019. The targets for physical inactivity (PR = 0.88; 95%CI 0.86;0.90) and cervical cytology coverage (79.4%; 95%CI 78.3;80.3) were achieved. Tobacco use was reduced, albeit below the target. The prevalence of hypertension, diabetes, overweight, obesity and alcohol consumption increased, and the targets will not be attained. CONCLUSION: Two indicators reached the agreed targets, however it is necessary to advance in actions and policies to meet the others.

Self-reported arterial hypertension, use of health services and guidelines for care in Brazilian population: National Health Survey, 2019. / Hipertensão arterial autorreferida, uso de serviços de saúde e orientações para o cuidado na população brasileira: Pesquisa Nacional de Saúde, 2019.

OBJECTIVE: To describe the prevalence of arterial hypertension according to sociodemographic characteristics in Brazil and to analyze the indicators related to access to health services and guidelines for controlling the disease in the country. METHODS: Cross-sectional descriptive study using the National Health Survey (PNS) conducted in 2019. The prevalence of hypertension was estimated with a 95% confidence interval, in addition to the proportions of hypertension indicators. RESULTS: There were 88,531 respondents, of which 23.9% self-reported hypertension, more prevalent among females (26.4%) and the elderly (55.0%). Among those who self-reported hypertension, 57.8% reported medical attention in the last six months; most received guidance on self-care; 66.1% were seen in public health services; and 45.8%, in primary health care units. CONCLUSION: The prevalence of hypertension in the Brazilian population was high, with most people who self-reported the condition being seen in services of the Brazilian National Health System (SUS), where they received guidance on health promotion.

Indicators of the line of care for people with diabetes in Brazil: National Health Survey 2013 and 2019. / Indicadores da linha de cuidado de pessoas com diabetes no Brasil: Pesquisa Nacional de Saúde 2013 e 2019.

OBJECTIVE: To compare health care indicators for adults with medical diagnosis of diabetes mellitus (DM) in Brazil, in 2013 and 2019, and analyze the indicators for 2019 according to sociodemographic characteristics. METHODS: Cross-sectional study using data from the 2013 and 2019 National Health Survey. Care indicators were evaluated in people with medical diagnosis of DM. RESULTS: DM prevalence increased from 6.2% (2013) to 7.7% (2019). Between 2013 and 2019, there was an increase in the use of medications (from 80.2% to 88.8%) and of medical care (from 73.2% to 79.1%), a reduction in the use of Popular Pharmacy Program medications (from 57.4% to 51.5%) and in follow-up with the same physician (from 65.2% to 59.4%). In 2019, poorer indicators were observed for individuals who were male, younger, Black and Brown, and with lower education and income. CONCLUSION: Most indicators remained similar in the last five years, with differences according to sociodemographic characteristics in 2019.