O efeito da vulnerabilidade social sobre indicadores antropométricos de obesidade: resultados de estudo epidemiológico de base populacional / Social vulnerability effect over obesity anthropometric indexes: results from population-based epidemiological study

RESUMO: Objetivo: O estudo teve por objetivo avaliar o efeito da vulnerabilidade social sobre os indicadores antropométricos de obesidade global e central em adultos (30 anos ou mais) de Ribeirão Preto (SP), 2006. Métodos: Estudo transversal de base populacional com amostra complexa, desenvolvida em três estágios. Modelos lineares multinível foram construídos em dois níveis: ecológico e individual. Os 81 setores censitários sorteados para a amostra compuseram o nível ecológico e foram classificados segundo o Índice Paulista de Vulnerabilidade Social (IPVS). Resultados: Fatores de nível individual que apresentaram relação direta com o índice de massa corporal (IMC): idade, antecedentes familiares e pessoais de excesso de peso e consumo de lipídios, com exceção de sexo e escolaridade (relação inversa). Fatores de nível individual que apresentaram relação direta com a circunferência da cintura (Ccint): idade, antecedentes familiares de acidente vascular cerebral (AVC), história pessoal de excesso de peso, IMC, número de medicamentos, tempo de tabagismo e energia total da dieta, com exceção da variável sexo (relação inversa). Para ambos os desfechos (IMC e Ccint), a variância do IPVS nos modelos finais apresentou significância estatística (p < 0,05) revelando o efeito contextual (rho ≈ 8%) da vulnerabilidade social sobre os indicadores de obesidade, mesmo após ajustamento para variáveis de nível individual. Conclusão: Os achados apontam para a necessidade de ações de promoção de hábitos saudáveis e de prevenção da obesidade, direcionadas não apenas aos fatores de nível individual, mas ao contexto socioambiental onde os indivíduos estão inseridos.

ABSTRACT: Objectives: The study aimed at evaluating the contextual effects of social vulnerability over anthropometric indexes related to global and central obesity in adults living in Ribeirão Preto (SP), Brazil, in 2006. Methods: In a population-based cross-sectional study using multistage sampling, multilevel linear models were applied considering two levels: ecological and individual. The 81 census tracts drafted for sample composition were considered the ecological level and classified according to Paulista Social Vulnerability Index (IPVS). Results: Individual correlates to body mass index (BMI) were age, familial and personal antecedents of overweight, and total fat consumption (direct relationship), exception to gender and schooling (inverse relationship). Individual correlates to waist circumference were age, familial antecedents of stroke, personal antecedent of overweight, BMI, number of medicines taken, time of smoking, and diet total energy (direct relationship), exception to gender (inverse relationship). Considering both outcomes (BMI and waist circumference), in the final models, the variance of IPVS showed statistical significance (p < 0.05), depicting the contextual effect (rho ≈ 8%) over global and central obesity, even after the adjustment for individual correlates. Conclusion: Results showed that interventions to promote healthy behaviors and to prevent obesity might be focused not only on individual factors but also on socioenvironmental context in which people are inserted.

Effects of socioeconomic level on dental scaling experience in the community: a multilevel analysis / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to investigate the associations between a community-level factor and dental scaling experience and to confirm the associations with individual factors in Korea. METHODS: In total, 203,088 individuals from 243 communities participated in the 2013 Community Health Survey. A dichotomized response of experiences with dental scaling was used as the outcome and the regional deprivation index was used as the explanatory community-level factor. In addition, various individual factors were included as covariates. In the bivariate analysis, the chi-square test was used. Multilevel multivariate logistic regression was also performed where in four models were applied. The bivariate analysis showed that all factors at the individual and community level showed significant associations with an individual's experience with dental scaling. RESULTS: The factors that were significantly associated with the dental scaling experience were being male, being 40-49 years old, having a higher income level, being economically active, having a higher education level, being a non-smoker, being a drinker, having good periodontal health, using oral hygiene products, tooth-brushing after lunch, and residing in less deprived regions (P<0.01). As with the results of multilevel logistic regression analysis, the regional deprivation index was significantly associated with scaling experience after adjusting for individual factors with an adjusted odds ratio of 0.98 (95% CI: 0.97-0.99), demonstrating an association between a lack of experience with scaling and lower socioeconomic status in the community. CONCLUSIONS: This study indicated that the scaling experience was affected not only by individual factors, but also by factors at the community level. Future studies are required to examine the detailed relationships between oral health and other community factors such as medical and social capital.

Affecting Factors of Secondhand Smoke Exposure in Korea: Focused on Different Exposure Locations

Exposure to secondhand smoke (SHS) not only can cause serious illness, but is also an economic and social burden. Contextual and individual factors of non-smoker exposure to SHS depend on location. However, studies focusing on this subject are lacking. In this study, we described and compared the factors related to SHS exposure according to location in Korea. Regarding individual factors related to SHS exposure, a common individual variable model and location-specific variable model was used to evaluate SHS exposure at home/work/public locations based on sex. In common individual variables, such as age, and smoking status showed different relationships with SHS exposure in different locations. Among home-related variables, housing type and family with a single father and unmarried children showed the strongest positive relationships with SHS exposure in both males and females. In the workplace, service and sales workers, blue-collar workers, and manual laborers showed the strongest positive association with SHS exposure in males and females. For multilevel analysis in public places, only SHS exposure in females was positively related with cancer screening rate. Exposure to SHS in public places showed a positive relationship with drinking rate and single-parent family in males and females. The problem of SHS embodies social policies and interactions between individuals and social contextual factors. Policy makers should consider the contextual factors of specific locations and regional and individual context, along with differences between males and females, to develop effective strategies for reducing SHS exposure.