Dispositivos eletrônicos para fumar nas capitais brasileiras: prevalência, perfil de uso e implicações para a Política Nacional de Controle do Tabaco / Electronic nicotine delivery systems in Brazilian state capitals: prevalence, profile of use, and implications for the National Tobacco Control Policy / Dispositivos electrónicos para fumar en las capitales brasileñas: prevalencia, perfil de uso e implicaciones para la Política Nacional de Control del Tabaco

Resumo: O objetivo deste estudo foi estimar a prevalência de uso de dispositivos eletrônicos para fumar (DEF) e explorar o fluxo lógico esperado do potencial impacto dos DEF na iniciação de cigarro convencional. Foram utilizados dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) de 2019, que entrevistou 52.443 indivíduos de 18 anos ou mais das 26 capitais brasileiras e do Distrito Federal. Foram calculados as prevalências pontuais e os intervalos de confiança (IC95%) de uso atual e na vida de DEF em cada capital brasileira, e avaliado o perfil dos usuários destes dispositivos. Estimou-se a prevalência de uso na vida em 6,7% (IC95%: 6,13-7,27) e uso atual em 2,32% (IC95%: 1,97-2,68). São 2,4 milhões de indivíduos que já usaram DEF e 835 mil que usam atualmente. Cerca de 80% das pessoas que já usaram DEF têm entre 18 e 34 anos. A prevalência de uso diário e uso dual entre jovens de 18 a 24 anos foi quase 10 vezes a prevalência nas faixas etárias superiores. Mais da metade dos indivíduos que usaram DEF na vida nunca fumaram. A proporção de mulheres e de indivíduos com escolaridade mais elevada foi maior no grupo de jovens que faz uso exclusivo de DEF do que entre os que usam cigarros convencionais exclusivamente. Também, usuários de dispositivos apresentaram maior consumo abusivo de álcool. Nossos achados vão em sentido oposto ao argumento da indústria do tabaco de que o público-alvo dos DEF são fumantes adultos. E, dado que grupos, a princípio, menos propícios ao uso de cigarros convencionais estão tendo sua iniciação com o DEF, os resultados alertam sobre o possível impacto negativo da disseminação dos dispositivos sobre a exitosa experiência do Brasil no combate ao tabagismo.

Abstract: The objectives of this study were to estimate the prevalence of use of electronic nicotine delivery systems (ENDS) and to explore the potential impact of ENDS use on smoking initiation with conventional cigarettes. We used data from the Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel), 2019 edition, which interviewed 52,443 individuals 18 years or older in Brazil's 26 state capitals and the Federal District. Point prevalence rates and confidence intervals (95%CI) were calculated for current and ever use of ENDS in each state capital, and the profile of ENDS users were described. Prevalence of lifetime use was estimated at 6.7% (95%CI: 6.13-7.27) and current use at 2.32% (95%CI: 1.97-2.68). A total of 2.4 million individuals had used ENDS any time in life, and 835,000 were currently using them. Approximately 80% of persons who had used ENDS were 18 to 34 years-old. Prevalence rates for daily use and dual use in individuals aged 18 to 24 years were nearly 10 times than prevalence in the older age groups. More than half of individuals who had ever used ENDS were never smokers. The proportion of women and individuals with high educational level were higher in the group of young people who only used ENDS than among those who only smoked conventional cigarettes. ENDS users also presented a higher proportion of binge drinking. Our findings are opposite to the tobacco industry's argument that the target public for ENDS is adult smokers. Considering that groups purportedly less prone to using conventional cigarettes are experiencing initiation with ENDS, our findings call attention to the possible negative impact of the dissemination of ENDS on Brazil's successful experience in the fight against tobacco.

Resumen: El objetivo de este estudio fue estimar la prevalencia del uso de dispositivos electrónicos para fumar (DEF) e investigar el flujo lógico esperado del potencial impacto de los DEF en la iniciación de para fumar cigarrillos convencionales. Se utilizaron datos de la Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas No Transmisibles por Entrevista Telefónica (Vigitel) de 2019, que entrevistó a 52.443 individuos de 18 años o más de las 26 capitales brasileñas y el Distrito Federal. Se calcularon prevalencias puntuales e intervalos de confianza (IC95%) de consumo actual y en la vida de DEF en cada capital brasileña, y se evaluó el perfil de los usuarios de DEF. Se estimó una prevalencia de consumo en la vida de 6,7% (IC95%: 6,13-7,27) y consumo actual 2,32% (IC95%: 1,97-2,68). Son 2,4 millones de individuos que ya usaron DEF y 835 mil que lo usan actualmente. Cerca de un 80% de las personas que ya usó DEF tiene entre 18 y 34 años. La prevalencia de uso diario y uso dual entre jóvenes de 18 a 24 años fue casi 10 veces la prevalencia en las franjas etarias superiores. Más de la mitad de los individuos que usaron DEF en la vida nunca fumaron. La proporción de mujeres y de individuos de escolaridad más elevada es mayor en el grupo de jóvenes que usa exclusivamente DEF, que entre los que consumen cigarrillos convencionales exclusivamente. También, los usuarios de DEF presentaron un mayor consumo abusivo de alcohol. Nuestros resultados van en el sentido opuesto al argumento de la industria del tabaco de que el público-objetivo de los DEF son fumadores adultos. Y, dado que grupos, en un principio menos propicios al consumo de cigarrillos convencionales, están iniciándose con el DEF, los resultados alertan sobre el posible impacto negativo de la diseminación de los DEF sobre la exitosa experiencia de Brasil en el combate al tabaquismo.

Inactive behavior in adolescent students of the brazilian western amazon / Comportamento inativo em estudantes adolescentes da amazônia ocidental brasileira

ABSTRACT Objective: To identify the prevalence of physical inactivity in adolescent students in the city of Porto Velho, RO, Northern Brazil, and its associated factors. Methods: School-based study, conducted with 2,694 adolescents. The self-reported variable for outcome was physical inactivity. Factors associated with inactive behavior were verified by multiple logistic regression. The independent variables were inserted into the model in hierarchical blocks. Results: The overall prevalence of inactive behavior was 39.5%. Females showed a higher prevalence of physical inactivity (46.2%) than males (31.4%). Adolescents in private schools and with reports of negative health perception had a high prevalence of physical inactivity. Regarding associated factors, the female sex showed a magnitude of association of 1.84 with physical inactivity. Being in a private school was associated with a 2.54 times greater chance of physical inactivity compared to public school students. Going to school by bus, car or motorcycle was associated with a 1.29 and 1.63 higher chance of physical inactivity respectively. Adolescents who reported having a negative health perception had 1.29 higher chance of physical inactivity, while having excess body fat showed magnitude of association of 1.36 in adolescents. Conclusions: There was a high prevalence of physical inactivity in the studied adolescents. Considering that the behavior of physical inactivity adopted during adolescence may continue in adulthood, the promotion of actions that can change this behavior may improve health in the future as well as quality of life.

RESUMO Objetivo: Identificar a prevalência do comportamento inativo de estudantes adolescentes da cidade de Porto Velho, RO, Brasil, e os fatores associados a ele. Métodos: Estudo de base escolar realizado com 2.694 adolescentes. A variável autorreferida à exposição ao desfecho foi a inatividade física. Verificam-se os fatores associados ao comportamento inativo pela regressão logística múltipla. As variáveis independentes foram inseridas no modelo em blocos hierarquizados. Resultados: A prevalência geral de comportamento inativo foi de 39,5%. O sexo feminino mostrou maior prevalência de comportamento inativo (46,2%) do que o masculino (31,4%). Adolescentes em escolas particulares e com relatos de percepção de saúde negativa apresentaram alta prevalência de comportamento inativo. Na verificação dos fatores associados, o sexo feminino mostrou magnitude de associação de 1,84 com o comportamento inativo. Estar institucionalizado em escola particular mostrou 2,54 vezes mais chance de ter comportamento inativo em comparação aos estudantes das escolas públicas. A locomoção para escola por ônibus e carro ou motocicleta revelou magnitudes de associação com o comportamento inativo de 1,29 e 1,63, respectivamente. Adolescentes que apontaram a percepção de saúde negativa tiveram 1,29 mais chance de ter comportamento inativo em relação ao relato de saúde positiva, enquanto ter excesso de gordura corporal mostrou magnitude de associação de 1,36 em adolescentes. Conclusões: A prevalência de comportamento inativo foi alta em estudantes adolescentes. Considerando que o comportamento inativo adotado durante a adolescência pode permanecer nos anos posteriores, sugere-se a promoção de ações para a modificação de comportamento visando à melhoria da saúde e qualidade de vida.

Multilevel Analysis of Socio-Demographic Disparities in Adulthood Obesity Across the United States Geographic Regions

OBJECTIVES: The objective of this study was to examine the socio-demographic disparities in obesity among US adults across 130 metropolitan and micropolitan statistical areas. METHODS: This study used data from the 2015 Behavioral Risk Factor Surveillance System and Selected Metropolitan/Micropolitan Area Risk Trend of 159,827 US adults aged 18 years and older. Data were analyzed using the multilevel linear regression models. RESULTS: According to individual level analyses, socio-demographic disparities in obesity exist in the United States. Individuals with low socioeconomic status were associated with a higher body mass index. The participants from the Midwest United States tend to have higher body mass index than those who from the South. According to metropolitan and micropolitan statistical area level analyses, secondly, there were significant differences in obesity status between different areas and the relation of obesity with 5 socio-demographic factors varied across different areas. According to geospatial mapping analyses, even though obesity status by metropolitan and micropolitan statistical area level has improved overtime, differences in body mass index between United States regions are increasing from 2007 to 2015. CONCLUSION: Socio-demographic and regional disparities in obesity status persist among US adults. Hence, these findings underscore the need to take socio-environmental factors into account when planning obesity prevention on vulnerable populations and areas.

Determinants of Potentially Unnecessary Cervical Cancer Screenings in American Women / 예방의학회지

OBJECTIVES: To identify factors responsible for potentially clinically unnecessary cervical cancer screenings in women with prior hysterectomy. METHODS: A retrospective cross-sectional study was conducted using the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS). This study targeted adult women and examined whether they received a both a Papanicolaou (Pap) test and undergone a hysterectomy in the last three years. We conducted multivariate analyses, including weighted proportions and odds ratios (ORs), based on the modified BRFSS weighting method (raking). The inclusion criteria were adult women (>18 years old) who reported having received a Pap test within the last 3 years. RESULTS: Of all women (n=252 391), 72 366 had received a Pap test, and 32 935 of those women (45%, or 12.5 million, weighted) had a prior hysterectomy. We found that age, race/ethnicity, marital status, family income, health status, time since last routine checkup, and health insurance coverage were all significant predictors. Black, non-Hispanic women were 2.23 times more likely to receive Pap testing after a hysterectomy than white women (OR, 2.23; 95% confidence interval [CI], 1.99 to 2.50). Similarly, the odds for Hispanic women were 2.34 times higher (OR, 2.34; 95% CI, 1.97 to 2.80). The odds were also higher for those who were married (OR, 1.17; 95% CI, 1.08 to 1.27), healthier (OR, 1.24; 95% CI, 1.14 to 1.35), and had health insurance (OR, 1.54; 95% CI, 1.28 to 1.84), after controlling for confounders. CONCLUSIONS: We conclude that women may potentially receive Pap tests even if they are not at risk for cervical cancer, and may not be adequately informed about the need for screenings. We recommend strategies to disseminate recommendations and information to patients, their families, and care providers.

Fatores ambientais e autoavaliação de saúde: análise multinível a partir do sistema de vigilância de fatores de risco e proteção para DCNTs' em uma área urbana / Environmental factors and self-assessment of health: multilevel analysis from the system of surveillance of risk factors and protection for DCNTs' in an urban area

A autoavaliação da saúde mede o nível do estado de saúde individual, sendo considerado um indicador composto por várias dimensões que engloba aspectos físicos, mentais, e bem-estar social da população. Os fatores individuais tendem a ser o principal determinante na autoavaliação da saúde seguido por outros fatores como o ambiente social e físico. O objetivo deste trabalho foi avaliar os fatores ambientais e individuais associados à autoavaliação de saúde em adultos residentes no município de Belo Horizonte, Minas Gerais (sudeste do Brasil). Trata-se de um estudo epidemiológico transversal, realizado com indivíduos com ≥18 anos de idade residentes em Belo Horizonte, Minas Gerais. Utilizou-se a base de dados do Sistema de Vigilância de Fatores de Risco e de Proteção para Doenças Crônicas por Inquérito Telefônico nos anos de 2008 a 2010. Foram definidos dois desfechos: a declaração de saúde como ruim e muito ruim, e muito ruim. Para caracterizar o ambiente físico e social utilizaram-se dados georreferenciados dos locais públicos e privados para prática de atividade física, estabelecimentos de vendas de alimentos saudáveis, não saudáveis e mistos, densidade residencial e populacional, taxa de homicídio, renda total das áreas de abrangência em quintil e o índice de vulnerabilidade em saúde. Como unidade de análise foi utilizada as Áreas de Abrangência das Unidades Básicas de Saúde (AA-UBS). Para a análise dos dados foi utilizado à regressão multinível. Foram avaliados 5.779 adultos, desses 3,4% avaliaram sua saúde como ruim ou muito ruim e 0,8% declaram ter autoavaliação muito ruim da saúde. Observou-se variabilidade da autoavaliação de saúde ruim entre as áreas de abrangência. Os dados mostraram, após ajuste pelas variáveis individuais e comportamentais, que a maior renda entre as AA-UBS diminuíram a chance da avaliação negativa da saúde. Conclusão: Fatores individuais, comportamentais e a renda entre as AA-UBS podem influenciar a avaliação positiva da autoavaliação da saúde.(AU)

The self-rated health measures the level of individual health status, being considered an indicator composed of several dimensions that involve physical, mental, and social well-being of the population. Individual factors tend to be the main determinant in the perception of health followed by other factors such as the social and physical environments. The aim of this study was to evaluate the environmental and individual factors associated with the perception of health in adults living in the municipality of Belo Horizonte, Minas Gerais (southeastern of Brazil). This is a cross-sectional epidemiological study conducted with individuals with ≥18 years, living in Belo Horizonte, Minas Gerais. The database of the Sistema de Vigilância de Fatores de Risco e de Proteção para Doenças Crônicas por Inquérito Telefônico was used from 2008 to 2010. Two outcomes were defined: the declaration of health as bad and very bad, and very bad. To characterize the physical and social environments, it's used georeferenced data from public and private places for physical activity, healthy, unhealthy and mixed food sales establishments, residential and population density, homicide rate, total income from coverage areas in quintile and the health vulnerability index. As a unit of analysis, the Coverage areas of Health Units (CA-BU) were used. Data analysis was used for multilevel regression. A total of 5,779 adults were evaluated, of whom 3.4% rated their health as bad or very bad and 0.8% reported having very bad health perception. Variability on the perception of negative self-rated health among the areas analyzed was observed. The data showed, after adjusting for the individual and behavioral variables, that the higher income among CA-HU decreased the chance of negative health evaluation. Conclusion: Individual, behavioral and income factors among CA-HU can influence the positive evaluation of health perception.(AU)

Speaking through pictures: Canvassing adolescent risk behaviours in a semi-rural community in KwaZulu-Natal Province, South Africa

Background. Adolescent risk behaviours, such as substance abuse and unprotected sex, are leading social and health challenges in South Africa (SA). Objective. To investigate adolescents' perspectives on the prevalence of adolescent risk behaviours in rural settings in SA. Method. Using a qualitative photovoice methodology, the current study explored adolescents' perspectives and experiences of living in a peri-urban community in KwaZulu-Natal Province. KwaZulu-Natal is the epicentre of the South African HIV epidemic, and adolescents ­ especially young girls ­ are at heightened risk for HIV infection. Male and female participants aged 15 - 18 years (N=33) were asked to respond to a series of questions by taking photographs that best describe their perspectives or experiences. Results. The photovoice methodology allowed adolescents to represent their perspectives and experiences as experts on their lives and needs. The participants reported that adolescents in their community engage in various risky behaviours, of which risky sexual behaviours and hazardous substance use emerged as significantly problematic. Risky sexual behaviours entailed unprotected sex, having multiple sexual partners, cellphone sharing of pornography, and sex while intoxicated. Problematic substance use involved harmful drinking behaviours such as binge drinking and illicit drug use. Conclusion. Contextually relevant interventions aimed at reducing adolescent engagement in risky sexual behaviours and harmful substance use need to be prioritised. Additional recommendations are discussed

Can Obesity Cause Depression? A Pseudo-panel Analysis / 예방의학회지

OBJECTIVES: The US ranks ninth in obesity in the world, and approximately 7% of US adults experience major depressive disorder. Social isolation due to the stigma attached to obesity might trigger depression. METHODS: This paper examined the impact of obesity on depression. To overcome the endogeneity problem, we constructed pseudo-panel data using the Behavioral Risk Factor Surveillance System from 1997 to 2008. RESULTS: The results were robust, and body mass index (BMI) was found to have a positive effect on depression days and the percentage of depressed individuals in the population. CONCLUSIONS: We attempted to overcome the endogeneity problem by using a pseudo-panel approach and found that increases in the BMI increased depression days (or being depressed) to a statistically significant extent, with a large effect size.

Método de projeção de indicadores das metas do Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas não Transmissíveis no Brasil segundo capitais dos estados e Distrito Federal / Method for projecting indicators for the goals of the Strategic Action Plan for Tackling Chronic Non-Communicable Diseases in Brazil according to Capitals and the Federal District / Método para la proyección de indicadores de los objetivos del Plan Estratégico de Acción para hacer frente a Enfermedades Crónicas No Transmisibles (ENT) en las capitales y distrito federal de Brasil

Resumo OBJETIVO: descrever o método de projeção dos indicadores de fatores de risco ou proteção do Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas não Transmissíveis no Brasil, nas capitais dos estados e no Distrito Federal, 2012-2022. MÉTODOS: utilizou-se regressão linear simples para as projeções dos indicadores com dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel). RESULTADOS: na maioria das capitais, houve crescimento da prevalência de obesidade (variação anual: 0,36%;1,29%), excesso de peso (variação anual: 1,11%;2,00%), consumo de frutas, legumes e verduras recomendado (variação anual: 1,45%;2,66%) e regular (variação anual 0,45%;1,46%), decréscimo do tabagismo (variação anual: -1,34%;-0,20%) e estabilidade da inatividade física, consumo abusivo de álcool e realização de mamografia e do exame de Papanicolau. CONCLUSÃO: a maioria das metas foi factível; contudo, são necessárias ações efetivas, especialmente para enfrentamento do excesso de peso e consumo abusivo de álcool.

Abstract OBJECTIVE: to present the indicators' projection method of the Strategic Action Plan for Tackling Chronic Non-Communicable Diseases (NCDs) in Brazilian State capitals and the Federal District, 2012-2022. METHODS: simple linear regression model was used to calculate the indicators' projections with data from the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel). RESULTS: in most of the capitals, there was an increase in the prevalence of obesity (annual change: 0.36%;1.29%), overweight (annual change: 1.11%;2.00%), recommended (annual change: 1.45%;2.66%) and regular (annual change: 0.45%;1.46%) consumption of fruits and vegetables; smoking presented a decreasing trend (annual change: -1.34%;-0.20%); whereas physical inactivity, heavy drinking and mammography and Pap smears examinations were stable. CONCLUSION: most of the goals are possible; however, effective actions are necessary, especially for tackling overweight and heavy drinking.

Resumen OBJETIVO: describir el método de proyección de factores de riesgo y protección del Plan de Acción para la Prevención y Control de Enfermedades no Transmisibles (ECNT) en Brasil, capitales y Distrito Federal, 2012-2022. MÉTODOS: utilizamos regresión lineal simple para las proyecciones de datos del Sistema de Vigilancia y factores de protección para enfermedades crónicas a través de entrevistas telefónicas (Vigitel). RESULTADOS: hubo un crecimiento de la obesidad (variación anual: 0,36%; 1,29%), sobrepeso (variación anual: 1,11%; 2,00%) y consumo de frutas y verduras recomendadas (variación anual: 1,45%; 2,66%) y regular (variación anual: 0,45%; 1,46%); disminución del tabaquismo (variación anual: -1,34%;-0,20%); y estabilidad del sedentarismo, abuso de alcohol, mamografía y Papanicolaou. CONCLUSIÓN: mayoría de los objetivos son factibles, pero acciones efectivas son necesarias, sobre todo para hacer frente al exceso de peso y abuso del alcohol.

Prevalência de fatores de risco e proteção para doenças crônicas não transmissíveis em adultos residentes em capitais brasileiras, 2013 / Noncommunicable chronic disease risk and protective factor prevalence among adults in Brazilian state capital cities, 2013 / Prevalencia de los factores de riesgo y protección para las enfermedades crónicas no transmisibles en la población adulta viviendo en las capitales brasileñas, 2013

OBJETIVO: descrever as prevalências dos fatores de risco e proteção para doenças crônicas na população adulta residente nas capitais brasileiras em 2013, e verificar os fatores sociodemográficos associados. MÉTODOS: foi realizado estudo transversal com 52.929 entrevistas pelo inquérito telefônico Vigitel, e investigadas associações mediante regressão de Poisson. RESULTADOS: as prevalência foram: tabagismo de 11,3% (IC95%:10,6%;11,9%); para consumo abusivo de bebidas alcoólicas, 16,4% (IC95%:15,7%;17,0%); consumo recomendado de frutas e hortaliças, 23,6% (IC95%:22,9%;24,3%); inatividade física, 16,2% (IC95%:15,6%;16,9%); excesso de peso, 50,8% (IC95%:49,9%;51,6%); elevado consumo de sal referido, 16,0% (IC95%:15,3;16,6); substituição do almoço ou jantar por lanches, 15,5% (IC95%:15,8%;17,1%); e consumo regular de doces, 19,5% (IC95%:18,8%;20,2%); a presença dos fatores de risco foi associada ao sexo masculino, maior idade e menor escolaridade. CONCLUSÃO: o monitoramento apoia o planejamento de políticas públicas de promoção da saúde visando à redução da morbimortalidade por doenças crônicas.

OBJETIVOS: describir la prevalencia de factores de riesgo y la protección para las enfermedades crónicas en la población adulta en las capitales brasileñas en 2013, y comprobar los factores sociodemográficos asociados. MÉTODOS: se realizó un estudio transversal con 52.929 entrevistas telefónicas; la prevalencia estimada de los factores de riesgo y la protección por sexo, edad y educación; las diferencias fueron investigadas por el modelo de Regresión de Poisson. RESULTADOS: la prevalencia de tabaquismo fue del 11,3% (IC95%:10,6%-11,9%); abuso de alcohol, 16,4% (IC95%:15,7%-17,0%); ingesta recomendada de frutas y verduras 23,6% (IC95%:22,9%-24,3%); inactividad física 16,2% (IC95%:15,6%-16,9%); sobrepeso 50,8% (IC95%:49,9%-51,6%); alto consumo de sal 16,0% (IC95%:15,3%-16,6%); reemplazo de comida o cena por aperitivos 15,5% (IC95%:15,8%-17,1%); consumo regular de golosinas 19,5% (IC95%:18,8%-20,2%), están asociadas al sexo masculino, a mayor edad y a menor nivel educativo. CONCLUSIÓN: el monitoreo apoya la planificación de políticas públicas para promover la salud mediante la reducción de la morbilidad y la mortalidad por enfermedades crónicas.

OBJECTIVE: to describe chronic disease risk andprotective factor prevalence among adults living in Brazilian state capital cities in 2013 and to verify associated sociodemographic factors. METHODS: this was a cross-sectional study involving 52,929 telephone interviews; risk and protective factor prevalence was estimated by sex, age and schooling; Poisson Regression was used to investigate associations. RESULTS: prevalence was as follows: smoking 11.3% (95%CI: 10.6%;11.9%); alcohol abuse 16.4% (95%CI: 15.7%;17.0%); recommended intake offruit and vegetables 23.6% (95%CI: 22.9%;24.3%);physical inactivity 16.2% (95%CI: 15.6%;16.9%); overweight 50.8% (95%CI: 49.9%;51.6%); high salt intake 16.0% (95%CI: 15.3%;16.6%); meals replaced with snacks 15.5% (95%CI: 15.8%;17.1%); regular consumption of confectionery 19.5% (95%CI: 18.8%;20.2%). Risk factor presence was associated with male gender, older age and lower schooling. CONCLUSIONS: monitoring supports planning public policies on health promotion by reducing morbidity and mortality from chronic diseases.

Exposición a fluidos corporales en trabajadores de salud del Hospital Universitario de Caracas: primer reporte: años 1991-1999 Caracas República de Venezuela / Exposure to body fluids in health workers the Hospital Universitario de Caracas: first report: years 1991-1999 Caracas República de Venezuela

Estudio prospectivo diseñado con el fin de evaluar a los trabajadores de salud del Hospital Universitario de Caracas que notificaran exposición a fluidos corporales al Sistema de Vigilancia de Virus de Inmunodeficiencia Humana y Hepatitis Viral, desde los años 1991 hasta 1999. Las variables estudiadas fueron: fecha y sitio del accidente, categoría del personal, edad, género, fluido involucrado, tipo de exposición, instrumento utilizado, serología basal para Virus de Inmunodeficiencia Humana y hepatitis viral del paciente índice y del TS, tipo de profilaxis antirretroviral, efectos adversos y seroconversión al Virus de Inmunodeficiencia Humana. Se utilizó el método descriptivo serie de casos los cuales fueron analizados por Epi-info. Versión 5. Durante el período de estudio fueron evaluados 242 trabajadores de la salud con exposición a fluidos corporales, 65% accidentes fueron notificados los dos últimos años. Ciento sesenta y tres femeninos y 79 masculinos, edad promedio 43 años (rango de 21-65 años). Los trabajadores de la salud que notificaron exposición a fluidos corporales procedían principalmente de los servicios de medicina interna, emergencia y cirugía. El mayor número de los accidentes correspondió a los médicos, principalmente residentes de posgrado. Exposición de tipo parenteral fue observada en 197 casos (179 percutáneas, y 18 salpicaduras en mucosas). Exposición cutánea se observó en 14 y combinada (piel y mucosas) 23 casos. El instrumento utilizado en 179 exposiciones percutáneas fue aguja con lumen en 48%. El fluido corporal involucrado fue la sangre en el 73% de los casos. La fuente fue conocida en 65% de las exposiciones. La profilaxis antirretroviral posexposición fue indicada inicialmente en 52% de los TS. Los efectos adversos se presentaron en 40%, en 7 casos fue motivo de abandono de tratamiento. El seguimiento se realizó en el 80% de los casos. Un trabajador de salud presentó Virus de Inmunodeficiencia Humana ocupacional...

Prospective study designed to assess the health workers at the Hospital Universitario de Caracas to notify body fluid exposure to Human Immunodeficiency Virus Surveillance System and Viral Hepatitis, from the years 1991-1999. The variables studied were: date and place of the accident, staff category, age, gender, fluid involved, type of exposure, instrument used, and baseline serology for Human Immunodeficiency Virus and Viral Hepatitis of health workers and index patient, type of prophylaxis antiretroviral, side effects and Human Immunodeficiency Virus seroconversion. Descriptive method was used series of cases which were analyzed by Epi-info. Version 5. During the study period were evaluated health workers 242 with body fluid exposure, 65% accidents were reported the past two years. 163 female and 79 male, mean age 43 years (range 21-65 years). Health workers who reported exposure to body fluids were mainly of Internal Medicine, Emergency and Surgery. The greatest numbers of injuries were doctors, mainly postgraduate residents. Parenteral exposure rate was observed in 197 cases (179 percutaneous, splash to mucous membranes 18). Dermal exposure was observed in 14 and combined (skin and mucosa) 23 cases. The instrument used in 179 percutaneous exposures was needle lumen in 48%. The body fluid blood was involved in 73% of cases. The source was known in 65% of exposures. Antiretroviral prophylaxis post exposure was initially indicated in 52% of the TS. Adverse events occurred in 40 %, in 7 cases was cause for withdrawals. The monitoring was performed in 80%. A case of Human Immunodeficiency Virus occupational in which it ruled out other risk factors

Violencia de pareja en el Departamento del Quindío, Colombia / Intimate partner violence in the Quindio, Department of Colombia

Objetivo Identificar los factores de riesgo para violencia de pareja mediante análisis de los datos del sistema de vigilancia epidemiológica para violencia intrafamiliar (SIVIF) en el Quindío del año 2009. Materiales y Métodos Se realizó un estudio descriptivo de corte transversal, sobre 1.906 notificaciones del (SIVIF) del departamento del Quindío, Colombia, del año 2009, donde 583 (n=583) corresponden a casos donde el agredido y agresor eran parejas. Resultados Los principales municipios generaron la mayoría de los casos. Las mujeres, las más agredidas. Son frecuentes la violencia física, múltiple y sexual; la agresión con el propio cuerpo; la influencia de la ira, consumo de alcohol y drogas, celos, y problemas emocionales y psicológicos; agredidos y agresores ≤35 años; las mujeres agredidas amas de casa e informales; violencia psicológica, verbal o grave negligencia y las mujeres ≥35 años agredidas de forma reiterativa, y que no convivían en la misma residencia ni tampoco estaban casadas. Conclusiones No existen muchos estudios ni antecedentes acerca del tema, es una necesidad regional imperiosa, contar con ulteriores estudios, pues éste es un fenómeno social urbano y repetitivo marcado por la violencia física, sexual o múltiple, con víctimas mujeres jóvenes, más frecuente en personas con educación superior.(AU)

Objective Identify risk factors for intimate partner violence by analyzing data from the surveillance system to domestic violence (SIVIF) in Quindio, 2009. Materials and Methods We conducted a cross- sectional descriptive study, about 1,906 notifications SIVIF database in the department of Quindío, Colombia, in 2009, of which 583 (n=583) correspond to cases where the independent of marital relationship between the victim-offender was married, a number that was taken as sample size, analyzing 100 % of such cases as to the origin, receipt of notification, type of coexistence of the couple, circumstances through aggression also features assaulted/aggressor. Results The two main municipalities generated most cases. Women, the most abused. More common types of physical violence, multiple sexual aggression with the body of the offender, the influence of anger, alcohol and drugs, jealousy, and emotional and psychological problems, the people attacked and attackers ≤ 35 years; battered women housewives and informal psychological violence, verbal or gross negligence and women ≥35 years so repeatedly assaulted, and who were not living in the same residence nor were married. Conclusions There are many studies on the subject, even unprecedented in the region and in the national literature. It is imperative for the department of Quindio, further studies have to extend the present. Dating violence in Quindio, is a purely social phenomenon with chronicity of the city, marked by physical, sexual or multiple, with victims young women, more common in people with higher education, although the elderly were more often victimized so psychological, verbal and gross negligence.(AU)

Methodology and early findings of the fourth survey of childhood and adolescence surveillance and prevention of adult non-communicable disease in Iran: the CASPIAN-IV study

The fourth survey of the surveillance system named ''childhood and adolescence surveillance and prevention of adult non-communicable disease'' [CASPIAN-IV study], was conducted among a national representative sample of Iranian students. This paper describes the methods and early findings of this survey. This nationwide school-based study was conducted in 2011-2012 in 30 provinces of Iran among 13,486 students, 6-18 years [6640 girls, 75.6% from urban areas] and one of their parents. Mean age of students was 12.5 years. Based on the World Health Organization growth curves, 12.2% were underweight, 9.7% overweight and 11.9% were obese. Abdominal obesity was observed in 19.1% of students. The dominant type of cooking oil in urban families was liquid oil and hydrogenated fat [39% and 32%], most rural families used hydrogenated fat [53%], respectively. A total of 18% of students had at least 30 min of daily physical activity; 41% of students used computer in weekdays and 44% used it in weekends. Almost 34.5% of students reported to have at least one cigarette smoker and 21.5% reported to have a waterpipe smoker in their relatives. Moreover, 20.3% of students reported that they had suffered an injury needing the help of school health providers during the year prior to the study. Current evidence on the health risky behaviors among Iranian children and adolescents confirms the importance of conducting comprehensive surveillance surveys to identify health risk behaviors. Data of this survey and the trend of variables provide necessary information for health policy makers to implement action-oriented interventions

Comparison of Preventive Health Behaviors in Adults Aged 50~64 in Korea and the United States

PURPOSE: The purpose of this study was to compare Preventive Health Behaviors (PHBs) in adults in Korea and the United States and identify factors influencing PHBs. METHODS: This was a secondary data analysis study using data from the 2008 Korean National Health and Nutrition Examination Survey and the 2008 USA Behavioral Risk Factor Surveillance System. The PHBs were predicted using multiple linear regression analysis. RESULTS: 1) The total score of PHBs was significantly higher in American males (5.11) than in Korean males (4.78). There was also a significant difference between Korean females' total score (6.57) and American females'(6.75). 2) Age, marriage, monthly income, subjective health status, and cardiovascular disease were significant factors of PHBs in Korean males (p<.001). However, age, marriage, education, monthly income, health insurance, subjective health status, and cardiovascular disease were significant factors in American males (p<.001). In Korean females, only age and education were significant predictors (p<.001). However, six variables(age, marriage, education, monthly income, health insurance, and subjective health status) were significant predictors in American females (p<.001). CONCLUSION: There were different variables in predicting PHBs between Koreans and Americans. Each country should focus on those significant predictors to promote the PHBs for adults.

An assessment of the risk factors for Type 2 diabetes among women in rural Jamaica / Valoración de los factores de riesgo en la diabetes tipo 2 entre las mujeres en Jamaica rural

This project examined risk factors (lifestyle, socio-economic and cultural) for Type 2 diabetes among 890 women in rural Jamaica in comparison to national and international trends via the Behavioural Risk Factor Surveillance System (BRFSS) and further analysis via the Kruskal Wallis and Mann-Whitney U tests. Nonparametric tests explored the relationship of body mass index (BMI) and risk factors. Women above age 36 years, sedentary women and women with health insurance showed a significant increase in BMI. Seventh Day Adventists had significantly lower BMIs compared to Protestants. Prevalence of Type 2 diabetes in rural Jamaica is complicated by the lack of adequate health insurance, health practitioners (including dieticians and social workers), and vigorous public awareness campaigns, as well as high healthcare costs. Recommendations include the establishment of a comprehensive plan targeting women to reduce their risk factors for Type 2 diabetes, including early diagnoses, continuing education for healthcare providers and community mobilization among churches, schools, banks, pharmacies and other entities.

Este trabajo examina los factores de riesgo de la diabetes tipo 2 (estilo de vida, condiciones socio-económicas y culturales) entre 890 mujeres de la zona rural de Jamaica, comparados con las tendencias nacionales e internacionales. Para ello se recurrió al Sistema de vigilancia de factores de riesgo conductuales (BRFSS), y un análisis posterior mediante la prueba de Kruskal-Wallis y la prueba U de Mann-Whitney. Se usaron pruebas no paramétricas para explorar la relación del IMC y los factores de riesgo de la diabetes. Las mujeres mayores de 36 años, las mujeres sedentarias, y las mujeres con seguro de salud, mostraron un aumento significativo del índice masa corporal (IMC). Las mujeres Adventistas de Séptimo Día, tenían índices IMC más bajos con relación a las protestantes. La prevalencia de la diabetes de tipo 2 en Jamaica rural, se complica por la falta de seguros de salud adecuados, insuficiente número de profesionales de la salud (incluyendo diteístas y trabajadores sociales), la escasa promoción de campañas vigorosas de concientización pública, y finalmente los altos costos de la atención a la salud. Las recomendaciones incluyen la implementación de un plan integral dirigido a las mujeres y encaminado a reducir los factores de riesgo de la diabetes de tipo 2. Dicho plan incluiría diagnósticos tempranos, educación continuada para los profesionales de la salud, y movilización de la comunidad en asociación con iglesias, escuelas, bancos, farmacias y otras entidades.

Vigilância de fatores de risco e proteção para doenças e agravos não transmissíveis em município de pequeno porte, Brasil, 2010 / Surveillance of risk and protective factors for non-communicable diseases and Injuries in a small municipality, Brazil, 2010

Objetivo: apresentar a metodologia e resultados da implantação da vigilância de fatores de risco e proteção para doenças e agravos não transmissíveis (DANT) em município de pequeno porte, Anchieta, no estado do Espírito Santo, Brasil, em 2010. Métodos: estudo transversal de base populacional com realização de exames bioquímicos, aferição da pressão arterial, avaliação antropométrica e eletrocardiograma da população-alvo. Resultados: aproximadamente 25,0 por cento dos entrevistados relataram consumo regular de refrigerante, 45,2 por cento, carne com gordura, e 22,5 por cento, abuso de bebida alcoólica; 14,1 por cento referiram ser inativos, 16,2 por cento, fumantes, 52,1 por cento apresentaram excesso de peso auto-referido, e 16,9 por cento, obesidade; sobre fatores de proteção, 5,0 por cento da população referiu consumir frutas e hortaliças conforme recomendado, e 3,6 por cento, atividade física no lazer; a prevalência de uso de cinto de segurança no banco da frente foi de 74,0 por cento, e 83,5 por cento dos motociclistas referiram utilizar capacete; entre os indivíduos que realizaram exames, 49,2 por cento apresentaram hipercolesterolemia, 46,0 por cento, lesão renal, 19,0 por cento, alteração em eletrocardiograma e 5,8 por cento, diabetes. Conclusão: a metodologia utilizada permitiu conhecer a prevalência dos fatores de risco e proteção para DANT em município de pequeno porte; ações de promoção da saúde, vigilância, prevenção e atenção estão sendo elaboradas com base nos resultados encontrados.

Objective: to present the methodology and results of the implementation of surveillance for risk and protective factors for non-communicable diseases (NCD) and injuries in a small city, Anchieta, in the State of Espírito Santo, Brazil, in 2010. Methods: a population-based cross sectional study with blood sample collection, blood pressure, anthropometric measurements and electrocardiogram of the target-population. Results: approximately 25.0 per cent adults interviewed reported drinking soft drinks regularly, 45.2 per cent, eat meat with visible fat, and 22.5 per cent, harmful use of alcohol; 14.1 per cent reported physical inactivity, 16.2 per cent, tobacco smoking, 52.1 per cent, self-reported overweight, and 16.9 per cent, obesity; among protective factors, 5.0 per cent reported fruit and vegetable intake as recommended, and 3.6 per cent, leisure time physical activity; prevalence of seat belt use in front seat was 74.0 per cent; helmet use was reported by 83.5 per cent of motorcyclists; among individuals who performed blood tests, 49.2 per cent had hypercholesterolemia, 46.0 per cent presented some stage of chronic kidney disease, 19.0 per cent, cardiovascular dysfunction according to electrocardiogram, and 5.8 per cent, diabetes. Conclusion: the methodology allowed to know the risk and protective factors for NCD in a small city of Brazil; actions on health promotion, surveillance, prevention and health care are being developed, based on the results of this study.

The Brazilian smoker: a survey in the largest cities of Brazil / Fatores associados ao hábito de fumar do brasileiro: um estudo nas maiores cidades do país

OBJECTIVE: To understand the sociodemographic factors associated with daily consumption of cigarettes and pattern of cigarette use among Brazilian smokers. METHOD: A cross-sectional study was performed in 2005 involving the 108 largest Brazilian cities. Data were collected through interviews with subjects aged 12 to 65 years in randomly selected households. Based on a questionnaire adapted to the Brazilian context, a logistic regression model was used to investigate the association between the sociodemographic characteristics of the sample and smoking. RESULTS: Of the 7,921 subjects interviewed, 16.4 percent reported daily use of cigarettes. The smoking prevalence was similar between genders, although women reported to start smoking at a later age and smoke fewer cigarettes per day. Almost 65 percent of the smokers were interested in quitting or reducing their smoking habit. The main sociodemographic characteristics associated with smoking were as follows: adult age (30-59 years old), unemployment, low education level, and low socioeconomic level. Alcohol abuse was also shown to be associated with smoking. CONCLUSIONS: Our findings suggest that adverse socioeconomic characteristics are implicated in increased susceptibility to smoking in Brazil. In our sample, a high proportion of smokers reported interest to quit or reduce smoking. These data suggest that sociodemographic factors should be considered in the elaboration of smoking prevention and treatment policies.

OBJETIVO: Conhecer fatores sociodemográficos associados ao consumo diário de cigarros, bem como o padrão de uso de cigarros do tabagista brasileiro. MÉTODO: Estudo transversal realizado em 2005 nas 108 maiores cidades brasileiras através de entrevistas a indivíduos de 12 a 65 anos em domicílios sorteados por amostragem representativa. Com base em questionário adaptado para o contexto brasileiro, as características sociodemográficas foram investigadas em modelo de regressão logística para verificar associação com o hábito de fumar. RESULTADOS: De 7.921 entrevistados, 16,4 por cento relataram uso diário de cigarros. A prevalência de uso entre os gêneros foi semelhante, embora as mulheres tenham relatado idade de início de uso superior e menores quantidades por dia. Quase 65 por cento dos fumantes manifestaram interesse em abandonar ou reduzir o hábito. As principais características sociodemográficas associadas ao tabagismo foram: idade adulta (30 a 59 anos), desemprego, menor escolaridade e menor poder aquisitivo. O uso abusivo de álcool também se mostrou associado ao fumo. CONCLUSÕES: Os achados sugerem características socioeconômicas desfavorecidas implicadas em maior vulnerabilidade ao tabagismo no Brasil. Houve um elevado relato de fumantes interessados em abandonar ou reduzir o hábito. Os dados apontam fatores sociodemográficos que devem ser considerados na elaboração de políticas de prevenção e tratamento.

[Behavioral surveillance survey [BSS] among injection drug users [IDUs] in Zanjan-Iran]

Injection Drug Users [IDUs] include more than 69.9% of known HIV/AIDS cases in Iran. The most important causes of HIV among them are syringe sharing and high risk behaviours such as sexual practice with different partners. Since IDUs are hard to reach and there is little information about them, this behavioural survey conducted to explore Zanjan district.s injection drug users in relation to HIV/AIDS. In this descriptive-cross sectional study, 61 IDUs, inhabitants of Zanjan, were selected in non-random sampling by referring to the most probable sites and places of their presence. Data was collected using a standard Family Health Behavioral Surveillance Survey [BSS] questionnaire designed especially for IDUs. Mean duration of non injected and injected drug use was 12.1 +/- 5 and 4.5 +/- 3.5 years respectively, and age of the first injection was 24 +/- 5.4 years. The most frequently injected drug was Heroin [96.7%] and the most noninjected one was Cannabis [85.2]. 55.7% of IDUs injected 4 or more times per day, and 32.8% reported needle sharing. 100% of the subjects knew the role of used syringe in HIV transmitting. 44.3% had taken an HIV test, and 70.4% knew about their HIV status. The early age of starting drug injection, needle sharing, coverage of voluntary HIV testing in less than 25%, and unawareness of 1/3 of them about their HIV test status indicate the significance of priority and service delivery to this most high risk group

HIV Protective Strategies Among College Students in Durban; South Africa

There is growing concern about the high level of HIV infection among young people in South Africa. The aim of the study is to examine the HIV protective strategies used by college students with specific emphasis on variations by race group. The data for the study come from a self-administrated survey that was conducted with 3 000 college students in Durban in order to understand the strategies they use to protect themselves against the risk of HIV infection. Overall; students perceived a far greater risk of pregnancy than HIV infection. The results show that abstinence is the most common protective factor among Indian and White students. Among African students; there is great concern about HIV but abstinence is less common. Among sexually active men and women; the majority report having more than one sexual partner (with the exception of Indian females). Female students among all groups were more likely than male students to report that they were faithful to their partners. In Africans the contrast is stark: 25 for women versus 6 for men. Condoms are the most commonly used method by students but are not used in every sexual encounter. Consistent condom use was highest among Indian males (46) and lowest among White females (13.7). More effort needs to be directed at promoting correct and consistent condom use in order to avoid the negative consequences associated with unprotected sexual intercourse including unwanted pregnancy and HIV/AIDS

Survey of American food trends and the growing obesity epidemic

The rapid rise in the incidence of obesity has emerged as one of the most pressing global public health issues in recent years. The underlying etiological causes of obesity, whether behavioral, environmental, genetic, or a combination of several of them, have not been completely elucidated. The obesity epidemic has been attributed to the ready availability, abundance, and overconsumption of high-energy content food. We determined here by Pearson's correlation the relationship between food type consumption and rising obesity using the loss-adjusted food availability data from the United States Department of Agriculture (USDA) Economic Research Services (ERS) as well as the obesity prevalence data from the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES) at the Centers for Disease Control and Prevention (CDC). Our analysis showed that total calorie intake and consumption of high fructose corn syrup (HFCS) did not correlate with rising obesity trends. Intake of other major food types, including chicken, dairy fats, salad and cooking oils, and cheese also did not correlate with obesity trends. However, our results surprisingly revealed that consumption of corn products correlated with rising obesity and was independent of gender and race/ethnicity among population dynamics in the U.S. Therefore, we were able to demonstrate a novel link between the consumption of corn products and rising obesity trends that has not been previously attributed to the obesity epidemic. This correlation coincides with the introduction of bioengineered corns into the human food chain, thus raising a new hypothesis that should be tested in molecular and animal models of obesity.

Validação do National College Health Risk Behavior Survey para utilização com universitários brasileiros / Validation of National College Health Risk Behavior Survey to be use with Brazilian college students

O objetivo deste estudo é traduzir, adaptar e validar o National College Health Risk Behavior Survey para utilização com universitários brasileiros. Participaram do estudo 208 universitários da UFPE e UPE. A validação foi realizada em cinco etapas: (1) tradução; (2) retrotradução; (3) correção e adaptação semântica (transculturalização); (4) validação de face; (5) teste e reteste. A tradução e retrotradução não apresentaram muitas discordâncias, tendo sido feitas as adaptações necessárias. Após a validação de face, o questionário foi reduzido de 96 para 52 questões. A reprodutibilidade foi avaliada através do teste de Kappa. Dos onze tópicos analisados, a maioria apresentou Kappa bom a perfeito: segurança e violência (Kappa=0,89); suicídio (Kappa=1,00); uso do tabaco (Kappa=0,90); bebida alcoólica (Kappa=0,78); consumo de cocaína e outras drogas (Kappa=0,70); comportamento sexual (Kappa=0,88) e peso corporal (Kappa=0,89). Apenas o tópico sobre alimentação apresentou Kappa fraco (Kappa = 0,26) e o tópico sobre informações em saúde apresentou Kappa moderado (Kappa=0,56). O Kappa médio para todos os tópicos foi 0,76, classificado como bom. A versão reduzida do instrumento pode ser considerada validada na língua portuguesa com nível de reprodutibilidade aceitável.

The objective of this article is to translate, to adapt and to validate the National College Health Risk Behavior Survey to apply at Brazilian college students. 208 college students from the Federal University of Pernambuco (UFPE) and University of Pernambuco (UPE) participated in the study. The validation was carried through in five stages: (1) translation; (2) retrotranslation; (3) correction and semantic adaptation (cultural adaptation); (4) face validation; (5) test-retest. Adaptations were done to deal with any semantic disagreements found between translation and retrotranslation. After face validation, the questionnaire was reduced from 96 to 52 questions. From the 11 items analyzed, the majority presented good and perfect Kappa: security and violence (Kappa=0.89); suicide (Kappa=1.00); use of the tobacco (Kappa=0.90); drinking consumption (Kappa=0.78); cocaine and other drugs consumption (Kappa=0.70); sexual behavior (Kappa=0,88) and corporal weight (Kappa=0.89). Only the item about feeding presented weak Inter-examiner Kappa (Kappa = 0.26) and the topic on health information presented moderate Kappa (Kappa=0.56). The average Kappa for all items was good (0.76). The instrument may be considered validated in the Portuguese language in Brazil with acceptable reproducibility.