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

ABSTRACT: OBJECTIVES:Despite 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. DESIGN:We used cross-sectional data from the Brazilian National Survey of School Health carried out in 2009, 2012 and 2015. SETTING:Brazilian state capitals. PARTICIPANTS:Students 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 MEASURE:We 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. RESULTS:From 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). CONCLUSION:Socioeconomic 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.

SUBMITTER: Azeredo CM

PROVIDER: S-EPMC6475167 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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

Azeredo Catarina Machado CM de Rezende Leandro F M LFM Mallinson Poppy Alice Carson PAC Ricardo Camila Zancheta CZ Kinra Sanjay S Levy Renata B RB Barros Aluisio J D AJD

BMJ open 20190323 3

<h4>Objectives</h4>Despite 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.<h4>Design</h4>We used cross-sectional data from the Brazilian National Survey of School Health carried out in 2009, 2012 and 2015.<h4>Setting</h4>Brazilian state capitals.<h4>Participants</h4>Students atte ...[more]

PMID: 30904861

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Project description:BackgroundSocioeconomic inequalities in childhood body-mass index (BMI) have been documented in high-income countries; however, uncertainty exists with regard to how they have changed over time, how inequalities in the composite parts (ie, weight and height) of BMI have changed, and whether inequalities differ in magnitude across the outcome distribution. Therefore, we aimed to investigate how socioeconomic inequalities in childhood and adolescent weight, height, and BMI have changed over time in Britain.MethodsWe used data from four British longitudinal, observational, birth cohort studies: the 1946 Medical Research Council National Survey of Health and Development (1946 NSHD), 1958 National Child Development Study (1958 NCDS), 1970 British Cohort Study (1970 BCS), and 2001 Millennium Cohort Study (2001 MCS). BMI (kg/m2) was derived in each study from measured weight and height. Childhood socioeconomic position was indicated by the father's occupational social class, measured at the ages of 10-11 years. We examined associations between childhood socioeconomic position and anthropometric outcomes at age 7 years, 11 years, and 15 years to assess socioeconomic inequalities in each cohort using gender-adjusted linear regression models. We also used multilevel models to examine whether these inequalities widened or narrowed from childhood to adolescence, and quantile regression was used to examine whether the magnitude of inequalities differed across the outcome distribution.FindingsIn England, Scotland, and Wales, 5362 singleton births were enrolled in 1946, 17 202 in 1958, 17 290 in 1970, and 16 404 in 2001. Low socioeconomic position was associated with lower weight at childhood and adolescent in the earlier-born cohorts (1946-70), but with higher weight in the 2001 MCS cohort. Weight disparities became larger from childhood to adolescence in the 2001 MCS but not the earlier-born cohorts (pinteraction=0·001). Low socioeconomic position was also associated with shorter height in all cohorts, yet the absolute magnitude of this difference narrowed across generations. These disparities widened with age in the 2001 MCS (pinteraction=0·002) but not in the earlier-born cohorts. There was little inequality in childhood BMI in the 1946-70 cohorts, whereas inequalities were present in the 2001 cohort and widened from childhood to adolescence in the 1958-2001 cohorts (pinteraction<0·05 in the later three cohorts but not the 1946 NSHD). BMI and weight disparities were larger in the 2001 cohort than in the earlier-born cohorts, and systematically larger at higher quantiles-eg, in the 2001 MCS at age 11 years, a difference of 0·98 kg/m2 (95% CI 0·63-1·33) in the 50th BMI percentile and 2·54 kg/m2 (1·85-3·22) difference at the 90th BMI percentile were observed.InterpretationOver the studied period (1953-2015), socioeconomic-associated inequalities in weight reversed and those in height narrowed, whereas differences in BMI and obesity emerged and widened. These substantial changes highlight the impact of societal changes on child and adolescent growth and the insufficiency of previous policies in preventing obesity and its socioeconomic inequality. As such, new and effective policies are required to reduce BMI inequalities in childhood and adolescence.FundingUK Economic and Social Research Council, Medical Research Council, and Academy of Medical Sciences/the Wellcome Trust.

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

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

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