Progress and setbacks in socioeconomic inequalities in adolescent health-related behaviours in Brazil: results from three cross-sectional surveys 2009–2015

Abstract

ObjectivesDespite some progress, Brazil is still one of the most unequal countries, and the extent of socioeconomic inequalities in adolescent health is unclear. We assessed trends in socioeconomic inequalities in adolescent’s health-related behaviours in Brazil between 2009 and 2015.DesignWe used cross-sectional data from the Brazilian National Survey of School Health carried out in 2009, 2012 and 2015.SettingBrazilian state capitals.ParticipantsStudents attending ninth grade from public and private schools in Brazilian state capitals in 2009 (60 973 students), 2012 (61 145 students) and 2015 (51 192 students).Main outcome measureWe assessed 12 health-related behaviours (irregular fruit, vegetables and bean consumption; regular soft drink consumption; irregular physical activity; alcohol, drug and tobacco use; unsafe sex; involvement in gun fights; bullying victimisation and domestic violence victimisation), under the broad domains of lifestyle risk behaviours, engagement in risky activities and exposure to violence. Socioeconomic status was assessed through an asset-based wealth index derived from principal component analysis. Absolute and relative inequalities in these health behaviours and inequalities trends were investigated.ResultsFrom 2009 to 2015, prevalence of certain harmful health-related behaviours increased, such as unsafe sex (21.5% to 33.9%), domestic violence (9.5% to 16.2%), bullying victimisation (14.2% to 21.7%) and irregular consumption of beans (37.5% to 43.7%). Other indicators decreased: alcohol use (27.1% to 23.2%), irregular physical activity (83.0% to 75.6%) and consumption of soft drinks (37.2% to 28.8%). Over the period, we found consistent evidence of decreasing health inequalities for lifestyle behaviours (fruit, bean and soft drink consumption) and alcohol use, set against increasing inequalities in violence (domestic violence, fights using guns and bullying victimisation).ConclusionSocioeconomic inequality increased in the violence domain and decreased for lifestyle behaviours among Brazilian adolescents. Widening gaps in violence domain urge immediately policy measures in Brazil.

Co-occurrence and clustering of the four major non-communicable disease risk factors in Brazilian adolescents: Analysis of a national school-based survey

“…Intervention-focused studies are needed to assess the impact of comprehensive actions on the reduction of cluster of risk factors. Even though NCD are a problem faced mainly by adults and the elderly, it is increasingly occurring at a much younger age [55, 56], impacting lower socioeconomic groups in a disproportionate manner [36]. Thus, prevention strategies should consider the first stages of life and be directed towards the population most exposed to the main risk factors.…”

“…For dietary risk factors, we have used the concept of ‘regular consumption’ (≥5 times in the past week), which was validated using 24-hour recall among adolescents [34]. Low consumption of fruits and vegetables is strongly recognized by WHO as a risk factor for NCD [35], therefore, we used the complementary idea of irregular consumption (<5 times in the past week) as the risk factor [36]. On the other hand, the consumption of ultra-processed food has been recently suggested to be related to low quality diet, obesity, and NCD [37–39].…”

The health-related determinants of eating pattern of high school athletes in Goiás, Brazil

“…The eight available response options were "I did not eat in the last 7 days," "I ate on 1 day (2, ..., 6 days) of the last 7 days," and "I ate on all of the last 7 days" [21]. For data analysis purposes, they were categorized as regularly consumed (for at least 5 days in the previous 7 days) or not [22][23][24][25][26]. All athletes are regularly enrolled in school and study in the mornings, so we consider breakfast between 6 and 8:59 am [27].…”

Physical activity patterns in a representative sample of adolescents from the largest city in Latin America: a cross-sectional study in Sao Paulo

“… 16 17 In Brazil, previous studies have suggested that socioeconomic inequalities in access to leisure PA have decreased between 2009 and 2015, although it remains high. 18 In addition, few studies have shown the pattern of total and domain-specific PA in adolescents living in megacities in low-income to middle-income countries. 19 …”

“…16 17 In Brazil, previous studies have suggested that socioeconomic inequalities in access to leisure PA have decreased between 2009 and 2015, although it remains high. 18 In addition, few studies have shown the pattern of total and domain-specific PA in adolescents living in megacities in low-income to middleincome countries. 19 In the urban context of Sao Paulo, characterised by social fragmentation and inequalities in opportunities to engage in PA, the New Master Plan has emerged as an effective initiative to promote active life.…”