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1. Efetividade de uma intervenção educacional em tabagismo entre adolescentes escolares

Author

Malcon, Maura C., Menezes, Ana M. B., Assunção, Maria Cecília F., Neutzling, Marilda B., and Challal, Pedro

Subjects
Tabagismo, Tabaco, Adolescent, Randomized controlled trial, Estudos de intervenção, Smoking, Tobacco, Cotinina, Intervention studies, Cotinine, Ensaio clínico controlado aleatório, Adolescente
Abstract

O objetivo do estudo foi avaliar a efetividade de um programa educacional sobre tabagismo desenvolvido pelo Instituto Nacional do Câncer em adolescentes escolares de Pelotas, RS. Das 46 escolas públicas da cidade, 32 foram sorteadas aleatoriamente e, posteriormente, randomizadas em grupo controle ou intervenção. Em ambas as fases do estudo (pré e pós-intervenção), os estudantes de 7ª e 8ª série responderam a um questionário, e uma amostra de urina foi coletada para análise de cotinina. A intervenção educativa teve duração de seis meses. Os desfechos estudados foram: "auto-relato de uso de cigarros nos últimos 30 dias" e "concentração de cotinina na urina (categorizada em > 10 ng/ml e > 30 ng/ml)". A intervenção não provocou mudança na prevalência de tabagismo, tanto mensurado por auto-relato como pela concentração de cotinina. No entanto, o conhecimento dos alunos acerca dos malefícios do cigarro aumentou no grupo intervenção. Em resumo, não houve efetividade da intervenção educacional para mudanças de comportamento, mas houve melhora no conhecimento dos prejuízos do fumo. The aim of the present study was to evaluate the effectiveness of an educational program on smoking developed by the Brazilian Institute of Cancer among adolescents from Pelotas, Brazil. Out of 46 public schools in the city, 32 were sampled and randomized into an intervention and a control group. In both phases of the study (pre and post intervention), 7th and 8th grade students answered to a questionnaire and had a sample of urine collected for cotinine analysis. The educational intervention lasted six months. Outcome variables were: "self-reported smoking within the previous 30 days" and "cotinine concentration in urine (classified into > 10 ng/ml and > 30 ng/ml). No effects of the intervention were observed for any of the behavioral outcomes, although knowledge on the harmful effects of smoking increased in the intervention group. In summary, the intervention was not effective to produce behavioral changes, but led to an increase in the knowledge about smoking.

Published
2011

2. Hospital admissions from birth to early adolescence and early-life risk factors: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

Author

Menezes,Ana M. B., Noal,Ricardo B., Cesar,Juraci A., Hallal,Pedro C., Araújo,Cora Luiza, Dumith,Samuel C., Barros,Fernando C., and Victora,Cesar G.

Subjects
Hospitalization, Cohort Studies, Hospitalização, Estudos de Coortes, Adolescent, Criança, Child, Adolescente
Abstract

The aim of this prospective analysis was to describe the cumulative incidence of hospital admissions in the first year of life and between 1 and 11 years of age and to explore associated factors. Hospital admissions were collected through regular monitoring in the first year of life, and through maternal report on admissions between 1 and 11 years. Analyses were stratified by sex and adjusted for confounding factors. 18.1% of children were hospitalized in the first year of life, and 30.7% between ages 1 and 11 years. Among boys, hospital admission in the first year was associated with low family income, paternal smoking during pregnancy, preterm delivery, and low birthweight. Among girls, in addition to the variables described for boys, black/mixed skin color was also a risk factor for hospital admission. For admissions between 1 and 11 years of age, low family income and gestational age > 37 weeks were found to be significant risk factors. Com o objetivo de descrever a incidência cumulativa de hospitalizações no primeiro ano de vida e entre 1-11 anos de idade, e identificar fatores de risco precoces, foi realizado um estudo de coorte de nascimento de 1993 a 2004-2005. As hospitalizações foram coletadas por meio de monitoramento hospitalar até 1 ano de idade, e relato das mães sobre internações ocorridas de 1-11 anos. As análises foram estratificadas por sexo e ajustadas para fatores de confusão. Os percentuais de hospitalizações de 0-1 ano e de 1-11 anos foram 18,1% e 30,7%, respectivamente. As variáveis associadas com internações de 0-1 ano em meninos foram: baixa renda familiar, tabagismo paterno na gestação, prematuridade e baixo peso ao nascer. No sexo feminino, além dos fatores de risco descritos entre os meninos, observou-se associação com cor da pele preta/parda. Quanto às hospitalizações de 1-11 anos, no sexo masculino, encontrou-se associação com baixa renda familiar e idade gestacional > 37 semanas.

Published
2010

3. Experimental use of alcohol in early adolescence: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

Author

Noal, Ricardo B., Menezes, Ana M. B., Araújo, Cora Luiza, and Hallal, Pedro C.

Subjects
Cohort Studies, Adolescent, Alcoholic Beverages, Estudos de Coorte, Adolescente, Bebidas Alcoólicas
Abstract

The aim of this study was to estimate the prevalence of experimental alcohol intake and associated factors in early adolescence. The overall sample consisted of 4,452 adolescents (mean age = 11.3 years; SD = 0.3) from the 1993 birth cohort in Pelotas, Rio Grande do Sul State, Brazil. Experimental use of alcohol was reported by 17.5% of the interviewees (95%CI: 16.3-18.6), and 5% reported having tried alcohol at nine years of age or younger. Prevalence of experimental alcohol use was higher among adolescents whose mothers had consumed alcohol during pregnancy, whose parents consumed alcohol, who worked outside the home themselves, and who had ever tried smoking. Family strife, parental alcohol intake, and adolescent smoking were strong predictors of experimental alcohol use in early adolescence. Special attention should be targeted to these groups in order to avoid heavy and premature alcohol use in early adolescence. Este trabalho teve como objetivo avaliar a prevalência de uso experimental de bebidas alcoólicas e fatores associados no início da adolescência. Compuseram a amostra 4.452 adolescentes (média = 11,3 anos; DP = 0,3) da coorte de nascimentos de 1993 de Pelotas, Rio Grande do Sul, Brasil. O uso experimental de álcool foi referido por 17,5% dos entrevistados (IC95%: 16,3-18,6) e 5% referiram ter experimentado com nove anos ou menos. O risco de uso experimental de álcool foi maior nos adolescentes cujas mães referiram ter bebido na gestação, quando ambos os pais usavam bebidas alcoólicas, entre os adolescentes que trabalhavam fora e naqueles que já experimentaram cigarro ou outras drogas. As relações familiares, o uso de álcool pelos pais, e o tabagismo do adolescente são os fatores fortemente associados ao uso experimental de álcool no início da adolescência. Mais atenção deveria ser dada especialmente a esses grupos, a fim de combater o consumo precoce de álcool.

Published
2010

4. Medicine use among adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

Author

Bertoldi, Andréa D., Tavares, Noemia U. L., Hallal, Pedro C., Araújo, Cora Luiza, and Menezes, Ana M. B.

Subjects
Cohort Studies, Estudos de Coortes, Pharmaceutical Preparations, Adolescent, Medicamentos, Adolescente
Abstract

The aim of this study was to investigate medicine use and associated factors among adolescents. This was a prospective cohort study including 4,452 adolescents born in Pelotas, Rio Grande do Sul State, Brazil, in 1993. Information on medicine use in the 15 days prior to the interviews was collected from the mothers. Overall prevalence of medicine use was 30.9%, and 64.7% of the medicines had been prescribed by a physician. The most frequently used pharmacological groups were medicines for the nervous (35.9%) and respiratory systems (25.7%). Medicine use was directly associated with socioeconomic status, maternal schooling, complications during pregnancy or delivery, and neonatal problems resulting in the need for intensive care. Underweight and obese adolescents were more likely to use medicines as compared to those with normal body mass index. A direct association was observed between maternal use of hypnotic drugs and sedatives and adolescent medicine use. It is essential to implement educational policies aimed at promoting rational use of medicines by adolescents. O objetivo deste estudo foi investigar o uso de medicamentos e fatores associados em adolescentes. Trata-se de estudo de coorte prospectivo, incluindo 4.452 adolescentes nascidos em Pelotas, Rio Grande do Sul, Brasil, em 1993. As informações sobre o uso de medicamentos pelo adolescente nos 15 dias anteriores à entrevista foram fornecidas pelas mães. A prevalência global de uso de medicamentos foi de 30,9%, sendo que destes, 64,7% foram indicados por médicos. Os grupos farmacológicos mais utilizados foram os medicamentos que atuam nos sistemas nervoso (35,9%) e respiratório (25,7%). O uso de medicamentos esteve diretamente associado ao nível econômico, escolaridade da mãe, intercorrência na gravidez ou parto que gerou doença até a adolescência, problema de saúde no momento do nascimento que levou o recém-nascido à UTI, magreza e obesidade. Foi observada uma relação direta entre uso de medicamentos hipnóticos e sedativos pela mãe e uso de medicamentos pelo adolescente. É fundamental que medidas educativas sejam voltadas à promoção do uso racional de medicamentos nesta faixa etária.

Published
2010

5. Sedentary behavior in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

Author

Dumith, Samuel C., Hallal, Pedro C., Menezes, Ana M. B., and Araújo, Cora Luiza

Subjects
Cohort Studies, Estudos de Coortes, Adolescent, Sedentary Lifestyle, Estilo de Vida Sedentário, Adolescente
Abstract

The aim of this study was to estimate the prevalence of sedentary behavior and investigate associated factors in adolescents 11 years of age from the 1993 birth cohort in Pelotas, Rio Grande do Sul State, Brazil. Sedentary behavior was investigated with a questionnaire, and was defined as spending more than two hours per day watching television, playing videogames, or using the computer. Of the 4,452 adolescents interviewed, 98% reported watching television, 44% playing videogames, and 22% using the computer. The average time spent on each of these electronic media was 197, 36, and 17 minutes per day, respectively. Prevalence of sedentary behavior was 79.7% (95%CI: 78.6; 80.9) and showed a positive association with socioeconomic level and nutritional status and a negative association with well-being. These 11-year-olds spent extensive time at TV viewing, videogames, and the computer. Special attention should be given to the most exposed groups of adolescents, including the more affluent, overweight, and those with limited schooling. O objetivo deste estudo foi determinar a prevalência e investigar os fatores associados ao comportamento sedentário em adolescentes de 11 anos, pertencentes à coorte de nascimentos de 1993 de Pelotas, Rio Grande do Sul, Brasil. O comportamento sedentário foi coletado por meio de questionário, e definido como ficar mais de duas horas por dia assistindo à televisão, jogando videogame ou usando computador. Dos 4.452 adolescentes entrevistados, 98% assistiam à televisão, 44% jogavam videogame e 22% usavam computador. O tempo médio na frente de cada um desses meios eletrônicos foi, respectivamente, 197, 36 e 17 minutos por dia. A prevalência de comportamento sedentário foi de 79,7% (IC95%: 78,6; 80,9), e teve uma associação positiva com nível socioeconômico e com estado nutricional, e negativa com a escala de bem-estar. O tempo despendido em atividades como ver televisão, jogar videogame e usar computador foi elevado (média superior a 4 horas/dia). Maior atenção deve ser dada aos grupos mais expostos, tais como adolescentes de classe alta, acima do peso e com menor nível de bem-estar.

Published
2010

6. Adverse childhood experiences and consumption of alcohol, tobacco and illicit drugs among adolescents of a Brazilian birth cohort.

Author

Gonçalves, Helen, Gonçalves Soares, Ana Luiza, Gomes dos Santos, Ana Paula, Ribeiro, Camila Garcez, Bierhals, Isabel Oliveira, Vieira, Luna Strieder, Hellwig, Natália Limões, Wehrmeister, Fernando C., and Menezes, Ana M. B.

Abstract

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Published
2016
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7. Oral health follow-up studies in the 1993 Pelotas (Brazil) birth cohort study: methodology and principal results.

Author

Peres, Marco A., Barros, Aluísio Jardim, Peres, Karen Glazer, Araújo, Cora Luiza, Menezes, Ana M. B., Hallal, Pedro C., and Victora, Cesar G.

Abstract

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Published
2010
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8. Hospital admissions from birth to early adolescence and early-life risk factors: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study.

Author

Menezes, Ana M. B., Noal, Ricardo B., Cesar, Juraci A., Hallal, Pedro C., Araújo, Cora Luiza, Dumith, Samuel C., Barros, Fernando C., and Victora, Cesar G.

Abstract

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2010
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9. Concurrent determinants of blood pressure among adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study.

Author

Menezes, Ana M. B., Hallal, Pedro C., Araújo, Cora Luiza, Barros, Fernando C., and Victora, Cesar G.

Abstract

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2010
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10. Resting pulse rate among adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study.

Author

Hallal, Pedro C., Menezes, Ana M. B., Bertoldi, Andréa D., Dumith, Samuel C., and Araújo, Cora Luiza

Abstract

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2010
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11. Early determinants of attention and hyperactivity problems in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study.

Author

Anselmi, Luciana, Menezes, Ana M. B., Barros, Fernando C., Hallal, Pedro C., Araújo, Cora Luiza, Domingues, Marlos R., and Rohde, Luis A.

Abstract

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Published
2010
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12. Self-reporting versus parental reporting of physical activity in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study.

Author

Reichert, Felipe F., Menezes, Ana M. B., Araújo, Cora Luiza, and Hallal, Pedro C.

Abstract

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2010
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13. Intake of fat and fiber-rich foods according to socioeconomic status: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study.

Author

Neutzling, Marilda B., Araújo, Cora Luiza, Vieira, Maria de Fátima A., Hallal, Pedro C., Menezes, Ana M. B., and Victora, Cesar G.

Abstract

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Published
2010
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14. Nutritional status of adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study.

Author

Araújo, Cora Luiza, Dumith, Samuel C., Menezes, Ana M. B., Hallal, Pedro C., Vieira, Maria de Fátima A., Madruga, Samanta W., and Victora, Cesar G.

Abstract

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Published
2010
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15. Well-being in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study.

Author

Hallal, Pedro C., Dumith, Samuel C., Bertoldi, Andréa D., Scalco, Diogo L., Menezes, Ana M. B., and Araújo, Cora Luiza

Abstract

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2010
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16. Prevalence and correlates of physical activity among adolescents from Southern Brazil.

Author

Dumith, Samuel C., Domingues, Marlos R., Gigante, Denise P., Hallal, Pedro C., Menezes, Ana M. B., and Kohl, Harold W.

Abstract

Copyright of Revista de Saúde Pública is the property of Faculdade de Educacao da Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2010
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17. Prevalência de retenção escolar e fatores associados em adolescentes da coorte de nascimentos de 1993 em Pelotas, Brasil.

Author

Vieira, Maria de Fátima A., Matijasevich, Alicia, Damiani, Magda F., Madruga, Samanta W., Neutzling, Marilda B., Menezes, Ana M. B., Araújo, Cora L., and Hallal, Pedro C.

Subjects
*SCHOOL dropout prevention, *GRADE levels, *SCHOOL children, *EMPLOYMENT, *TEENAGERS
Abstract

Objective. To evaluate the occurrence of grade retention until 11 years of age and the factors associated with retention. Methods. This prospective study included 4 452 adolescents from the 1993 city of Pelotas birth cohort (state of Rio Grande do Sul, Brazil). This sample represents 87.5% of the original cohort. Grade retention was defined as the repetition of at least one school grade until the date of the interview. The following independent variables were analyzed: sex, skin color, birth weight, ownership of goods, age, maternal schooling, type of school (private, state, or city), age at school entry, and employment. Results. The overall frequency of grade retention was 36.3%, vs. 42.8% for boys and 30.0% for girls. The adjusted analysis showed that the lower the level of maternal schooling, ownership of goods, and birth weight, the higher the risk of grade retention for both boys and girls. Black/brown adolescents, those studying in public schools, and those who were 7 years of age or older at school entry had a higher risk of grade retention. For boys, childhood labor was associated with grade retention. Conclusions. Low socioeconomic and low maternal schooling levels were the factors most strongly associated with grade retention. Strategies to reduce this situation must take into account demographic and socioeconomic characteristics. [ABSTRACT FROM AUTHOR]

Published
2012
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18. Discriminação autorrelatada por adolescentes de uma coorte de nascimentos brasileira: prevalência e associações.

Author

Gonçalves, Helen, Dumith, Samuel C., González, David Alejandro, Menezes, Ana M. B., Araújo, Cora L. P., Hallal, Pedro C., and Bastos, João Luiz

Subjects
*SELF-evaluation, *DISCRIMINATION (Sociology), *DEMOGRAPHIC characteristics, *NUTRITION, ADOLESCENT psychology research
Abstract

Objective. To evaluate the prevalence of and factors associated with discrimination self-reported by adolescents. Methods. Cross-sectional analysis of adolescents belonging to a cohort of live births in 1993 in the city of Pelotas, Brazil. From the 5 249 members of the cohort, information was collected from 4 452 adolescents in 2004 and 2005 regarding self-reported discrimination, sociodemographic variables, physical attributes, and nutritional status. A Poisson regression was utilized in the raw and adjusted analyses to estimate prevalence rates (RP). Results. The global prevalence of self-reported discrimination was 16.4%. In the adjusted analysis, discrimination was reported more by the following groups: girls (RP = 1.27, 95%CI: 1.10-1.48), people identified by others as black (RP = 1.28, 95%CI: 1.04-1.57), poorer adolescents (RP = 1.58, 95%CI: 1.23-2.02), those who perceived themselves to be very thin or very fat (RP = 1.81 and 1.54 respectively), those whose families had financial trouble (RP = 1.76, 95%CI: 1.49-2.08), those who wore glasses (RP = 1.74, 95%CI: 1.45-2.10), those who thought their teeth looked bad (RP = 1.58, 95%CI: 1.21-2.07), those who had been reprimanded in school (RP = 1.23, 95%CI: 1.01- 1.51), and those who had been involved in fights in the past year (RP = 1.62, 95%CI: 1.36-1.94). The association between discrimination and nutritional status varied by sex (interaction P = 0.009). Thin children reported greater discrimination than those who were overweight or obese. Discrimination on the basis of obesity was higher among girls, with this effect more strongly felt among rich girls than among poor ones. Conclusions. Self-reported discrimination was prevalent and unequally distributed among the population. Actions to reduce experiences of discrimination must be implemented during the initial stages of life. [ABSTRACT FROM AUTHOR]

Published
2012

19. The impact of sociodemographic conditions on quality of life among adolescents in a Brazilian birth cohort: a longitudinal study.

Author

Gonçalves, Helen, González, David A., Araújo, Cora Luiza, Anselmi, Luciana, and Menezes, Ana M. B.

Subjects
*QUALITY of life, *SOCIOECONOMIC factors, *POVERTY, *MATHEMATICAL variables, *GENDER
Abstract

Objective. To examine associations between certain aspects of self-reported Quality of Life (QoL) in early adolescence, and gender, skin color, maternal education at birth, and changes in socioeconomic position (SEP) occurring from 0-11 years of age. Methods. A longitudinal study of a birth cohort composed of 5 249 individuals born in 1993 in Pelotas, Brazil, who were followed periodically from birth to age 11. Socioeconomic variables were collected at birth in 1993, and again, in 2004. The following eight variables were analyzed: relationship with mother, relationship with father, family conflicts, physical punishment by parents, family relationship problems, discrimination, academic failure, and fear of neighborhood of residence. Adjustments were made using a hierarchical model. Results. Skin color was related to all the variables (more so for nonwhites than for whites), except in family conflicts. Physical punishment and academic failure were more frequent in males. Discrimination and fear of neighborhood were more prevalent in females. Maternal education at birth was inversely associated, especially with failing/repeating a grade in school (19.5 times more frequent in the lower maternal education group than in the highest). A similar pattern was found with the SEP change: worse QoL in the group that was always poor (at birth and at 11 years of age) than in the group that was never poor. Fear of neighborhood was not related to maternal education or SEP change. Conclusions. Gender, skin color, maternal education, and SEP change were related to various measured aspects of QoL. These results should be considered in policymaking that seeks to minimize inequities at birth, across the life-course, and for future generations. [ABSTRACT FROM AUTHOR]

Published
2010

20. Fatores socioculturais e nível de atividade física no início da adolescência.

Author

Gonçalves, Helen, Hallal, Pedro C., Amorim, Tales C., Araújo, Cora L. P., and Menezes, Ana M. B.

Subjects
*PHYSICAL fitness, *EXERCISE, *TEENAGERS, *SOCIOCULTURAL factors, *LIFESTYLES
Abstract

Objective. To describe the level of physical activity in adolescents born in 1993 in the city of Pelotas, Brazil, and to evaluate the effect of sociocultural variables on those levels. Methods. A combined ethno-epidemiological methodology was employed. In the epidemiological study, 4 452 adolescents born in 1993 were interviewed. Physical ac- tivity level was evaluated by means of a questionnaire. Adolescents with fewer than 300 minutes of physical activity per week were classified as sedentary. The ethrio- graphic study included 69 adolescents randomly selected from among all cohort par- ticipants. On average, three in-depth interviews were carried out (about one every 6 months), with mothers and adolescents being interviewed separately. Results. The prevalence of a sedentary lifestyle was 48.7% (95%CI: 46.5 to 50.8) in boys and 67.5% (95%CI: 65.6 to 69.5) in girls (P < 0.001). The independent variable pre- senting the strongest association with physical activity level was the weekly fre- quency with which the adolescent met friends outside of school. The ethnographic study showed that boys have more social and family support to engage in physical activities in adolescence, but that many parents associate poor school performance with the amount of time spent outside the home. Conclusions. This study suggests that physical activity is often viewed as compet- ing with family values in adolescence. This perspective should be explored in future studies and discussed with families so that physical activity may be adopted as a cul- tural norm. [ABSTRACT FROM AUTHOR]

Published
2007

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