Brazilian Adults Believe that Complete Dentures would be the Solution to the Oral Impacts Caused by Reduced Dentition

Abstract Objective: To evaluate the direct and oral impact-mediated association between reduced dentitions and the self-perceived need for complete dentures (CD) in dentate adults. Material and Methods: Data from the Brazilian Oral Health Survey (2010) were analyzed. The outcome was self-perceived need for CD. Functional dentition (FDClassV) was defined by the presence of the following criteria: level I - ≥1 tooth in each arch, level II - 10 teeth in each arch, level III - 12 anterior teeth, level IV - ≥ 3 posterior occluding pairs (POPs) of premolars and level V - ≥1 bilateral POPs of molars. Oral impacts were assessed with Oral Impacts on Daily Performances scale. Results: FDClassV was associated with a less self-perceived need for CD both directly and mediated by oral impacts. Dentitions without level V were associated with the outcome mediated by oral impacts. Between individuals with 10 teeth in each arch, self-perceived need for CD was similar for those who had or not anterior teeth and POPs. Individuals with <10 teeth in each arch and level III did not have a higher frequency of self-perceived need for CD compared to those with level II. Conclusion: Oral impacts mediated the association between reduced dentitions and self-perceived need for CD. Individuals with tooth loss may report need for CD, even when they have dental configurations compatible with functionality.

Binge drinking, alcohol outlet density and associated factors: a multilevel analysis among adolescents in Belo Horizonte, Minas Gerais State, Brazil / Consumo excessivo episódico de álcool, densidade de locais de venda de bebidas alcoólicas e fatores associados: uma análise multinível entre adolescentes em Belo Horizonte, Minas Gerais, Brasil / Consumo de alcohol compulsivo, densidad de locales de venta de alcohol y factores asociados: un análisis multinivel entre adolescentes procedentes de Belo Horizonte, estado de Minas Gerais, Brasil

Our study sought to evaluate the prevalence of binge drinking in adolescents and its association with density of alcohol outlets around schools. This cross-sectional study was conducted in Belo Horizonte, Minas Gerais State, Brazil, with 436 high-school students aged between 17 and 19 and enrolled in 18 public and private schools. The students completed the Alcohol Use Disorder Identification Test (AUDIT-C), consisting of questions about alcohol consumption by parents and siblings, and socioeconomic status (type of school, mother's education level). Data from geographic information systems were used to estimate the density of alcohol outlets around schools participating. The association between exploratory variables and binge drinking was investigated using multilevel logistic regression analysis (p < 0.05) with random intercepts and fixed slopes. A three-step sequential modeling strategy was adopted. The prevalence of binge drinking was 39.9%. The alcohol consumption among adolescents was lower for those studying in areas with low density of alcohol outlets around schools (OR = 0.32; 95%CI: 0.14; 0.73) and the consumption of alcohol by mothers was associated with binge drinking among adolescents (OR = 1.94; 95%CI: 1.14; 3.30). Our study concluded that binge drinking among adolescents was associated with density of alcohol outlets around the schools and mother's alcohol consumption.

O estudo teve como objetivo avaliar a prevalência de consumo excessivo episódico de álcool entre adolescentes e a associação com a densidade de locais de venda de bebidas alcoólicas no entorno das escolas. Um estudo transversal foi realizado em Belo Horizonte, Minas Gerais, Brasil, com 436 estudantes de segundo grau entre 17 e 19 anos de idade matriculados em 18 escolas públicas e privadas. Os estudantes responderam perguntas do Alcohol Use Disorder Identification Test (AUDIT-C) sobre consumo de álcool pelos pais e irmãos, além de características socioeconômicas (tipo de escola, escolaridade materna). Foram utilizados dados de sistemas de informações geográficas para calcular a densidade de locais de venda de bebidas alcoólicas em torno das escolas participantes. A associação entre variáveis independentes e consumo excessivo episódico de álcool foi investigada por análise de regressão logística multivariada (p < 0,05) com interceptos randômicos e inclinações fixas. Foi adotada uma estratégia de modelagem sequencial em três passos. A prevalência de consumo excessivo episódico de álcool foi de 39,9%. O consumo de álcool entre adolescentes foi mais baixo naqueles que estudavam em áreas com baixa densidade de locais de venda de bebidas alcoólicas em torno das escolas (OR = 0,32; IC95%: 0,14; 0,73), e o consumo de álcool pelas mães esteve associado ao consumo excessivo episódico de álcool pelos adolescentes (OR = 1,94; IC95%: 1,14; 3,30), Em conclusão, consumo excessivo episódico de álcool por adolescentes mostrou associação com a densidade de locais de venda de bebidas alcoólicas no entorno das escolas e com o consumo materno de álcool.

El objetivo de este estudio fue evaluar la prevalencia del consumo compulsivo de alcohol por parte de adolescentes y su asociación con la densidad de establecimientos de venta de alcohol próximos a escuelas. Este estudio transversal se realizó en Belo Horizonte, Minas Gerais, Brasil, con 436 estudiantes de escuelas secundarias con edades comprendidas entre los 17-19 años, inscritos en 18 escuelas públicas y privadas. Los estudiantes completaron con Alcohol Use Disorder Identification Test (AUDIT-C) preguntas sobre el consumo de alcohol por parte de padres y hermanos, así como de su estatus socioeconómico (tipo de escuela, nivel de escolarización de la madre). Los datos del sistema de informaciones geográficas se usaron para calcular la densidad de establecimientos de venta de alcohol en los alrededores de las escuelas participantes. La asociación entre las variables exploratorias y el consumo compulsivo de alcohol fue investigado usando un análisis de regresión logística multinivel (p < 0,05) con intersecciones aleatorias y curvas fijas. Se adoptó una estrategia de modelado secuencial en tres pasos. La prevalencia de consumo compulsivo de alcohol fue de 39,9%. El consumo de alcohol entre adolescentes fue más bajo entre quienes estudiaban en áreas con baja densidad de establecimientos de venta de alcohol alrededor de las escuelas (OR = 0,32; IC95%: 0,14; 0,73), además el consumo de alcohol en madres estuvo asociado con el consumo de alcohol en adolescentes (OR = 1,94; IC95%: 1,14; 3,30). La conclusión fue que el consumo compulsivo de alcohol en adolescentes estaba asociado con la densidad de establecimientos de venta de alcohol en los alrededores de las escuelas y el consumo de alcohol por parte de la madre.

Alcohol intake among adolescent students and association with social capital and socioeconomic status / Consumo de bebida alcoólica por estudantes adolescentes e sua associação com capital social e condição socioeconômica

Abstract The aim was to evaluate the prevalence of alcohol consumption, binge drinking and their association with social capital and socioeconomic factors among Brazilian adolescents students. A cross-sectional study was carried out with a randomly selected representative sample of 936 adolescents aged 15 to 19 years. Information on alcohol consumption, social capital and socioeconomic status was collected using the Alcohol Use Disorders Identification Test, the Integrated Questionnaire for the Measurement of Social Capital and Social Vulnerability Index, respectively. The prevalence of alcohol consumption was 50.3% and binge drinking 36% the last year. Adolescents who reported believing that people in their community could help solve a collective problem (with the water supply) and those classified as having high social vulnerability had lower likelihood of binge drinking (PR = 0.776 [95%CI:0.620 to 0.971] and PR = 0.660 [95%CI:0.542 to 0.803], respectively). The prevalence of alcohol consumption and binge drinking the last year is high among participants. Those with higher socioeconomic status as well as lower perceptions of community capital social are more likely to display binge-drinking behavior.

Resumo O objetivo foi avaliar prevalência do consumo de bebida alcoólica e associação com o capital social e fatores socioeconômicos em estudantes adolescentes. Estudo transversal realizado com amostra representativa aleatória de 936 adolescentes de 15 a 19 anos. Informações sobre o consumo de álcool no último ano, capital social e condição socioeconômica foram levantadas utilizando-se o Teste de Triagem para Abordar Problemas Relacionados com Álcool (AUDIT), Questionário Integrado para Medir Capital Social e Índice de Vulnerabilidade Social, respectivamente. Prevalência de consumo de bebida alcoólica foi de 50,3% e consumo abusivo de álcool 36,0%, no último ano. Os adolescentes que relataram acreditar que as pessoas em sua comunidade possam ajudar a resolver problemas coletivos (como o abastecimento de água) e os classificados como pertencentes ao grupo de alta vulnerabilidade social apresentaram menor probabilidade de consumo abusivo de álcool (RP = [IC95%:0,620-0,971] 0,776 e PR = [IC95%:0,542-,803] 0,660). As prevalências de consumo de bebidas alcoólicas e consumo abusivo de álcool no último ano foram altas. Adolescentes com melhor condição socioeconômica e menor percepção do capital social foram mais propensos a apresentar um comportamento de consumo abusivo de bebidas alcoólicas.

Correlates of binge drinking among Brazilian adolescents / Correlações do binge drinking entre adolescentes brasileiros

Abstract Adolescence is a vulnerable period for risk-taking tendencies, including binge drinking. The aim of this study was to examined the prevalence of binge drinking and its association with factors related to the consumption of alcoholic beverages by best friend, familial factors, socioeconomic status and religiosity. A Census of 633 students from public and private schools in Diamantina-MG was conducted. Participants completed a self-administered questionnaire, the Alcohol Use Disorders Identification Test-C (AUDIT-C) and, another on the consumption of alcohol by family and friends. Surveys inquiring about socioeconomic conditions were sent to parents/guardians. Descriptive and bivariate analyzes were performed (p < 0.05). The log-binomial model was used to calculate PR and 95% CI. The prevalence of binge drinking was 23.1%. The average age of onset of alcohol consumption was 10,8 years. Binge drinking was more prevalent among adolescents whose best friend [OR = 4.72 (95% CI 2.78-8.03)] and brother [PR = 1.46 (95% CI 1.10-1.92)] drink alcohol. Religiosity [PR = 0.40 (95% CI 0.27-0.62)] appeared as a possible protective factor. Our findings indicate that peer effects are important determinants of drinking and could be utilized as a potential target for interventions to reduce alcohol consumption rates.

Resumo A adolescência é um período vulnerável da tendência em assumir riscos, incluindo consumo excessivo de álcool. Avaliou-se a prevalência de "binge drinking" e sua associação com o consumo de bebidas alcoólicas pelo melhor amigo, fatores familiares, condição socioeconômica e religiosidade. Foi conduzido um censo de 633 alunos de escolas públicas e privadas em Diamantina-MG. Os participantes preencheram o Alcohol Use Disorders Identification Test-C (AUDIT-C) e um questionário sobre o consumo de álcool por familiares e amigos. Questionários com perguntas sobre condições socioeconômicas foram enviados aos pais/responsáveis. Foram realizadas análises descritivas e bivariadas (p < 0,05). O modelo log-binomial foi usado para calcular RP e 95% IC. A prevalência de consumo excessivo de álcool foi de 23,1%. A idade média de início do consumo de álcool foi de 10,8 anos. O "binge drinking" foi mais prevalente entre adolescentes cujo melhor amigo [OR = 4,72 (95% IC 2,78-8,03)] e irmão [RP = 01.46 (IC 95% 1,10-1,92)] consumiam álcool. A religiosidade [RP = 0,40 (IC 95% 0,27-0,62)] apareceu como um possível fator de proteção. Os efeitos de pares são importantes determinantes do consumo de álcool e poderiam ser utilizados como um alvo potencial em intervenções para reduzir as taxas deste.

Influência do grupo de pares e uso de drogas ilícitas entre adolescentes brasileiros: um estudo transversal / Peer group influence and illicit drug use among adolescent students in Brazil: a cross-sectional study / La influencia del grupo y el consumo de drogas ilícitas entre estudiantes adolescentes en Brasil: un estudio transversal

O estudo teve como objetivo examinar o uso de drogas ilícitas e as associações com fatores socioeconômicos e influência do grupo de pares entre adolescentes brasileiros de 15 a 19 anos de idade. Foi adotada uma amostra de clusters em dois estágios, com a seleção aleatória de escolas públicas e privadas entre os nove distritos administrativos de uma capital de estado, e a seleção aleatória de turmas em cada escola. A variável de desfecho foi o uso de drogas ilícitas, medido pela seguinte pergunta: "Você já usou drogas ilícitas (maconha, inalantes, hipnóticos, cocaína/crack, alucinógenos, anfetaminas e/ou opióides) alguma vez na vida?". Os grupos de pares foram classificados como: escola, família, atividades religiosas e esportes/cultura. O nível socioeconômico foi avaliado com o Índice de Vulnerabilidade em Saúde (IVS) baseado em área. Foram analisados os dados de 91 adolescentes com o teste do qui-quadrado e regressão logística. A proporção global de uso de drogas ilícitas foi 15,2%. A heterogeneidade por gênero dentro de grupos (OR = 3,14; IC95%: 1,63-6,06), amizades baseadas em religião (OR = 0,36; IC95%: 0,17-0,75) e amizades baseadas em esportes/cultura (OR = 0,44; IC95%: 0,22-0,87) permaneceram associadas significativamente com o uso de drogas ilícitas. Os adolescentes que residiam em áreas menos vulneráveis mostraram maior probabilidade de uso de drogas ilícitas, quando comparados aos jovens em áreas mais vulneráveis. As amizades baseadas em religião e esportes/cultura parecem ter um efeito protetor contra o uso de drogas ilícitas. A heterogeneidade de gênero dentro de grupos e a residência em áreas menos vulneráveis aumentaram as chances de uso de drogas ilícitas por adolescentes.

The aim of the present cross-sectional study was to examine illicit drug use and associations with socioeconomic factors as well as peer group influence among Brazilian adolescents aged 15 to 19 years. Two-stage cluster sampling was adopted, involving the random selection of public and private schools from the nine administrative districts of a Brazilian state capital and the random selection of classrooms at each school. Illicit drug use was the outcome and was measured through the question: "Have you ever used any illicit drugs (marijuana, inhalants, hypnotics, cocaine/crack, hallucinogens, amphetamines and opioids) in your life?". The most important group of friends was ranked as school, family, religious activities and sports/culture. The area-based Health Vulnerability Index (HVI) was used to assess socioeconomic status. Data from 891 adolescents were analyzed using the chi-squared test and logistic regression. The overall rate of illicit drug use was 15.2%. Gender heterogeneity within groups (OR = 3.14; 95%CI: 1.63-6.06), religion-based friendships (OR = 0.36; 95%CI: 0.17-0.75) and sports/culture-based friendships (OR = 0.44; 95%CI: 0.22-0.87) remained significantly associated with illicit drug use. Adolescents who lived in less vulnerable areas had higher chance of drug use in comparison with those living in more vulnerable areas. Religion-based and sports/culture-based friendships seem to demonstrate a protective effect against lifetime illicit drug use. Gender heterogeneity within groups and residing in a less vulnerable area increased the chances of adolescents reporting illicit drug use.

El objetivo del presente estudio transversal fue examinar el consumo de drogas ilícitas, y su asociación con factores socioeconómicos, así como con la influencia del grupo entre adolescentes brasileños de 15 a 19 años de edad. Se adoptó una muestra del grupo en dos etapas, considerando una selección aleatoria de escuelas públicas y privadas de nueve distritos administrativos de una capital de estado brasileña y una selección aleatoria de clases en cada escuela. El consumo ilícito era el resultado que se midió a través de la pregunta: "¿Has consumido alguna vez drogas legales (marihuana, inhalantes, hipnóticos, cocaína/crack, alucinógenos, anfetaminas y opioides) en tu vida?" El grupo más importante de factores protectores fue categorizado como: escuela, familia, religioso y deportes/cultura. El área, basada en el Índice de Vulnerabilidad de la Salud (IVS), se usó para evaluar el estatus socioeconómico. Se analizaron los datos de 891 adolescentes, usando el test chi-cuadrado test y regresión logística. El porcentaje global de consumo de drogas ilícitas fue de un 15.2%. La heterogeneidad de género en los grupos (OR = 3.14; 95%CI: 1.63-6.06), amistad basada en la religión (OR = 0.36; 95%CI: 0.17-0.75) y amistades basadas en deporte/cultura (OR = 0.44; 95%CI: 0.22-0.87) quedaron significativamente asociadas con el consumo de drogas ilícitas. Los adolescentes que vivían en áreas menos vulnerables tenían una oportunidad más alta de consumo de drogas, en comparación con aquellos que vivían en áreas más vulnerables. Las amistadas basadas en la religión y deporte/cultura parece que demuestran ser un factor protector contra el consumo de drogas a lo largo de la vida. La heterogeneidad de género en los grupos y residir en áreas menos vulnerables incrementó la oportunidad en el consumo de ilícito de drogas.

Binge drinking and associated factors among adolescents in a city in southeastern Brazil: a longitudinal study / Consumo excessivo de álcool e fatores associados entre adolescentes de cidade do Sudeste brasileiro: um estudo longitudinal / Consumo excesivo de alcohol y factores asociados entre adolescentes de ciudad del sudeste brasileño: un estudio longitudinal

Abstract: The aim of this study was to investigate changes in the frequency of binge drinking and associated factors in the city of Belo Horizonte, Minas Gerais State, Brazil. The sample consisted of 436 adolescents. Data collection involved the Alcohol Use Disorders Identification Test and the Alcohol, Smoking and Substance Involvement Screening Test. Ordinal logistic regression was used in the multivariate analysis. An increase in the frequency of binge drinking was found among adolescents who lived in areas of greater social vulnerability (OR = 1.64; 95%CI: 1.01-2.68), those whose mothers consumed alcoholic beverages (OR = 1.75; 95%CI: 1.05-2.92), those whose fathers consumed alcoholic beverages (OR = 2.02; 95%CI: 1.11-3.68), those with an increased risk of tobacco use (OR = 2.82; 95%CI: 1.07-7.42) and those who attended religious services (OR = 2.10; 95%CI: 1.30-3.38). Knowledge regarding factors associated with a change in the frequency of binge drinking among adolescents can assist in the establishment of public policies directed at health promotion and the prevention of adverse health conditions.

Resumo: Objetivou-se investigar mudanças na frequência de consumo excessivo de álcool (binge drinking) e fatores associados na cidade de Belo Horizonte, Minas Gerais, Brasil. A amostra incluiu 436 adolescentes. Os dados foram coletados com o Alcohol Use Disorders Identification Test e o Alcohol, Smoking and Substance Involvement Screening Test. A regressão logística multivariada foi usada na análise dos dados. Observamos um aumento na frequência de consumo excessivo de álcool entre adolescentes que viviam em áreas de maior vulnerabilidade social (OR = 1,64; IC95%: 1,01-2,68), com mães que consumiam bebidas alcoólicas (OR = 1,75; IC95%: 1,05-2,92), com pais que consumiam bebidas alcoólicas (OR = 2,02; IC95%: 1,11-3,68), expostos a risco aumentado de tabagismo (OR = 2,82; IC95%: 1,07-7,42) e que participavam de atividades religiosas (OR = 2,10; IC95%: 1,30-3,38). O conhecimento dos fatores associados a mudanças na frequência de consumo excessivo de álcool entre adolescentes pode auxiliar na elaboração de políticas públicas dirigidas à promoção da saúde e à prevenção de desfechos adversos.

Resumen: El objetivo fue investigar cambios en la frecuencia de consumo excesivo de alcohol (binge drinking) y sus factores asociados en la ciudad de Belo Horizonte, Minas Gerais, Brasil. La muestra incluyó a 436 adolescentes. Los datos fueron recogidos con el Alcohol Use Disorders Identification Test y el Alcohol, Smoking and Substance Involvement Screening Test. Se usó la regresión logística multivariada en el análisis de datos. Observamos un aumento en la frecuencia de consumo excesivo de alcohol entre adolescentes que vivían en áreas de mayor vulnerabilidad social (OR = 1,64; IC95%: 1,01-2,68), con madres que consumían bebidas alcohólicas (OR = 1,75; IC95%: 1,05-2,92), con padres que consumían bebidas alcohólicas (OR = 2,02; IC95%: 1,11-3,68), expuestos a riesgo aumentado de tabaquismo (OR = 2,82; IC95%: 1,07-7,42) y que practicaban una religión (OR = 2,10; IC95%: 1,30-3,38). El conocimiento de los factores asociados a cambios en la frecuencia de consumo excesivo de alcohol entre adolescentes puede ayudar en la elaboración de políticas públicas, dirigidas a la promoción de la salud y a la prevención de desenlaces adversos.

Oral health-related quality of life of children and teens with sickle cell disease

BACKGROUND: Children with sickle cell disease may have their quality of life affected by oral alterations. However, there is still little data on oral health-related quality of life in these children. The aim of this study was to investigate the influence of sickle cell disease, socioeconomic characteristics, and oral conditions on oral health-related quality of life of children and teens. METHOD: One hundred and six children and teens with sickle cell disease were compared to a similar sample of 385 healthy peers. Data were collected through oral examinations, interviews to assess quality of life (Child Perceptions Questionnaire for children aged 8-10 and 11-14) and questionnaires containing questions on socioeconomic status. RESULTS: There were no statistically significant differences in the total scores of the Child Perceptions Questionnaires or domain scores comparing sickle cell disease patients to control subjects. When sub-scales were compared, oral symptoms and functional limitations had a greater negative impact on the quality of life of adolescents with sickle cell disease (p-value <0.001 and p-value <0.01, respectively) when compared to healthy controls. The only statistically significant determinants of negative impact on oral health-related quality of life in the overall sample was home overcrowding (more than two people/room) in the younger children's group, and dental malocclusion among teens. CONCLUSION: There was no significant difference in the negative impact on the oral health-related quality of life between the group with sickle cell disease and the control group. Of the oral alterations, there was a significant difference in the oral health-related quality of life between adolescents with sickle cell disease and controls only in relation to malocclusion. Among the socioeconomic characteristics, only overcrowding was significantly associated with a negative impact on oral health-related quality of life.

The impact of the oral condition of children with sickle cell disease on family quality of life

Abstract The aim of this study was to assess the impact of oral conditions of children with sickle cell disease (SCD) on their parents' quality of life (QoL). A cross-sectional study was performed with parents of outpatients suffering from SCD at a hematology referral center in Belo Horizonte, MG. A qualified dentist performed an intraoral exam. The Family Impact Scale (FIS) was used to assess the parents' perception of QoL. The parents answered some questions regarding sociodemographic and medical information about their children. The dmft/DMFT score, DAI, gum bleeding and SCD severity were evaluated in terms of their impacts on the overall mean FIS scores and subscale scores. The chance of more frequent impacts was greater in parents of adolescents (OR = 2.04; 95%CI = 1.2, 3.4) than of younger children. Dental caries (dmft/DMFT ≥ 1) had a negative impact on the QoL of parents of younger children and adolescents (p < 0.05 and p < 0.01, respectively). Among the parents of younger children, dental caries and SCD severity significantly affected the subscales for parental activities (PA) and parental emotions (PE) (p < 0.01, p < 0.05, respectively). Among parents of adolescents, dental caries (DMFT) and severe malocclusion adversely affected the PE and PA subscales (p < 0.01, p < 0.05, respectively). SCD severity affected the overall FIS score among young children's parents (p < 0.05). In conclusion, dental caries, age and SCD severity were associated with a negative impact on the QoL of parents of children with SCD

Tobacco use and friendship networks: a cross-sectional study among Brazilian adolescents / Uso do tabaco e rede de amigos entre adolescentes brasileiros: um estudo transversal

Aim: To determine the prevalence of tobacco use and its association with types of friendship networks, socioeconomic status and gender among Brazilian adolescents. Methods: A cross-sectional study was carried out with a representative sample of 905 students aged 15 to 19 years. Information on social networks and tobacco use was collected by the self-administered questionnaire 'Alcohol, Smoking and Substance Involvement Screening Test" and the question "What is your most important group of close friends?'. Socioeconomic status was assessed using an area-based social vulnerability index and type of school. Multinomial logistic regression analysis was employed to test associations between tobacco use and the independent variables. Results: The overall prevalence of tobacco use was 18.9%. Female adolescents had 3.80-fold greater odds of reporting weekly to daily tobacco use compared to male adolescents. Participants who reported that their most important groups of close friends were from church had a lower risk of reporting weekly to daily tobacco use in comparison to those who reported that their best friends were from school. Conclusions: The prevalence of tobacco use was high and was associated with school-based (as compared to church-based) friendship networks, female gender and higher area-level socioeconomic status. .

Objetivo: Determinar a prevalência do uso do tabaco e sua associação com tipos de amigos, condições socioeconômicas e gênero entre adolescentes brasileiros. Métodos: Um estudo transversal foi conduzido com uma amostra representativa de 905 estudantes de 15 a 19 anos. Informações sobre as redes sociais e o uso do tabaco foram coletadas através do "Questionário para triagem do uso de álcool, tabaco e outras substâncias", e a questão "Qual é o seu grupo de amigos mais importante?". As condições socioeconômicas foram avaliadas através do Índice de vulnerabilidade social e do tipo de escola. Regressão logística multinomial foi utilizada para testar as associações entre o uso do tabaco e as variáveis independentes. Resultados: A prevalência do uso do tabaco foi de 18.9%. Meninas apresentaram 3.80 vezes mais chances de usarem tabaco na frequência semanalmente a diariamente comparado aos meninos. Os participantes que responderam ser o grupo de amigos da igreja o mais importante tiveram um risco menor de usarem tabaco com maior frequência em comparação aos adolescentes que consideraram o grupo de amigos da escola. Conclusões: A prevalência do uso de tabaco foi alta na amostra estudada e foi associada a rede de amigos da escola (em comparação aos amigos da igreja), gênero feminino e melhores condições socioeconômicas. .

The prevalence of inhalant use and associated factors among adolescents in Belo Horizonte, Brazil / Prevalência do uso de inalantes e fatores associados em adolescentes de Belo Horizonte, Brasil

The scope of this study was to establish the prevalence of inhalant use among adolescents and its association with marijuana use, alcohol consumption, socioeconomic status and gender. A cross-sectional study was performed with a representative sample of 891 adolescents from public and private schools in the city of Belo Horizonte, Brazil. Data were collected using two self-administered questionnaires: the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the Alcohol Use Disorders Identification Test (AUDIT C). The socioeconomic status was evaluated using the Social Vulnerability Index, mother's education level and type of school (public or private). The data were analyzed using the chi-square test (p < 0.05) and logistic regression analysis. The prevalence of inhalant use was 7.9%. No significant association was found between the use of inhalants and socioeconomic status after the logistic regression analysis. Inhalant use among adolescents was associated with marijuana use (OR: 4.61; 95% CI: 2.27 - 9.36) and with binge drinking (OR: 5.02; 95% CI: 2.57 - 9.81).

O objetivo deste estudo foi avaliar a prevalência do uso de inalantes em adolescentes e sua associação com o uso de maconha, consumo de álcool, condição socioeconômica e gênero. Um estudo transversal foi realizado em uma amostra representativa de 891 adolescentes de escolas públicas e privadas de Belo Horizonte, Brasil. Os dados foram coletados por meio de dois questionários autoaplicáveis: o Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) e o Alcohol Use Disorders Identification Test (AUDIT C). O Índice de Vulnerabilidade Social, o nível de escolaridade da mãe e o tipo de escola (pública ou privada) foram utilizados para determinar o nível socioeconômico. Os dados foram analisados utilizando o teste qui-quadrado (p < 0.05) e a análise de regressão logística. A prevalência do uso de inalantes foi de 7,9%. Não houve associação entre o uso de inalantes e o nível socioeconômico após a análise de regressão logística. O uso de inalantes por adolescentes esteve associado ao uso de maconha (OR: 4.61; 95% CI: 2.27 - 9.36) e ao consumo abusivo de álcool (OR: 5.02; 95% CI: 2.57 - 9.81).

Como incluir características dos distritos do município de São Paulo em estudos epidemiológicos?: análise da desigualdade de renda pelo uso do propensity score matching / How to include the characteristics of the distritos of the Municipality of São Paulo in epidemiologic studies?: an income inequality analysis using the propensity score matching approach

OBJETIVO: o padrão espacial de distribuição de renda do município de São Paulo, frequentemente generalizado como sendo "radial", tem sido muito questionado pela literatura recente. São Paulo tem uma complexa distribuição de características sociais e demográficas entre seus distritos, o que dificulta a análise por meio de modelos estatísticos que permitam a inclusão somente de algumas variáveis de cada vez, como as regressões lineares. O presente estudo objetiva identificar os distritos do município que possam ser considerados como "comparáveis" pelo uso da metodologia estatística conhecida como propensity score matching. METODOLOGIA: os 96 distritos do município de São Paulo foram analisados separadamente; foram incluídas 16 variáveis no modelo, sendo o índice de Gini a variável que permitiu a separação de distritos entre expostos (alta desigualdade) ou não expostos (baixa desigualdade). Do total de distritos, 27 foram considerados comparáveis com algum outro, isto é, possuíram valores de propensity score com uma distância menor de 0,1 de outro com tipo de exposição diferente. RESULTADOS: das 16 variáveis incluídas, 9 apresentaram diferenças estatisticamente significativas entre os distritos incluídos e excluídos, o que é esperado pela metodologia. Dos 17 pares de distritos formados, apenas 3 foram compostos por distritos de uma mesma região administrativa e apenas 1 por distritos que faziam fronteira entre si. CONCLUSÃO: a análise da diferença no padrão de distribuição das variáveis, permitida pelo uso do propensity score matching, indica a dificuldade de dividir a cidade segundo regiões. Para entender São Paulo é preciso considerar suas particularidades e suas complexas distribuições espaciais.

OBJECTIVES: The spatial pattern of income distribution in the Municipality of São Paulo, considered to be of a "radial" type, has been challenged by recent studies due to the complex distribution of social and demographic characteristics between its distritos. This demands an in-depth analysis that takes into consideration a multitude of variables in order to control for local heterogeneity. This study aims to identify the distritos of São Paulo that can be defined as "comparable" to another one, by using a statistical methodology known as propensity score matching.METHODOLOGY:The 96 distritos of the Municipality of São Paulo were analyzed separately. 16 variables were included in the model, and the Gini coefficient was used to define "exposure" (high inequality) and "non-exposure" (low inequality). Of the distritos, 27 were considered "comparable".RESULTS: Of the 16 variables inserted in the model, nine presented a statistically significant difference between included and excluded distritos, which is expected by this methodology. Of the 17 pairs of distritos considered to be comparable, only three were composed of distritos situated in the same administrative region, and only one was composed of bordering distritos.CONCLUSION: The complex spatial distribution of the propensity score in the Municipality of São Paulo indicates that it is very difficult to divide the city according to its geographical regions. In order to understand how the distritos of São Paulo affect the health of its residents, it is important to take into consideration its many particularities and how they are spatially distributed.

Cause-specific mortality and income inequality in São Paulo, Brazil / Mortalidade segundo causas básicas e desigualdade de renda no Município de São Paulo

OBJECTIVE: To analyze cause-specific mortality rates according to the relative income hypothesis. METHODS: All 96 administrative areas of the city of São Paulo, southeastern Brazil, were divided into two groups based on the Gini coefficient of income inequality: high (>0.25) and low (<0.25). The propensity score matching method was applied to control for confounders associated with socioeconomic differences among areas. RESULTS: The difference between high and low income inequality areas was statistically significant for homicide (8.57 per 10,000; 95%CI: 2.60;14.53); ischemic heart disease (5.47 per 10,000 [95%CI 0.76;10.17]); HIV/AIDS (3.58 per 10,000 [95%CI 0.58;6.57]); and respiratory diseases (3.56 per 10,000 [95%CI 0.18;6.94]). The ten most common causes of death accounted for 72.30% of the mortality difference. Infant mortality also had significantly higher age-adjusted rates in high inequality areas (2.80 per 10,000 [95%CI 0.86;4.74]), as well as among males (27.37 per 10,000 [95%CI 6.19;48.55]) and females (15.07 per 10,000 [95%CI 3.65;26.48]). CONCLUSIONS: The study results support the relative income hypothesis. After propensity score matching cause-specific mortality rates was higher in more unequal areas. Studies on income inequality in smaller areas should take proper accounting of heterogeneity of social and demographic characteristics.

OBJETIVO: Analisar causas básicas de óbito segundo a teoria de renda relativa. MÉTODOS: Os 96 distritos do Município de São Paulo, SP, foram divididos em dois grupos segundo desigualdade de renda, com base no índice de Gini (alta > 0,25 e baixa <0,25). Foi aplicada a metodologia propensity score matching para controlar por fatores de confusão referentes às diferenças socioeconômicas e demográficas entre os distritos. RESULTADOS: A diferença entre a mortalidade de distritos desiguais e mais igualitários foi estatisticamente significativa para homicídios (8,57 por 10.000 residentes [IC95% 2,60; 14,53]), doença isquêmica do coração (5,47 por 10.000 [IC95% 0,76; 10,17]), aids (3,58 por 10.000 [IC95% 0,58; 6,57]) e doenças respiratórias (3,56 por 10.000 [IC95% 0,18; 6,94]). As dez causas básicas mais frequentes foram responsáveis por 72,3% do total da diferença. A mortalidade infantil também foi estatisticamente maior para distritos mais desiguais (2,80 por 10.000 [IC95% 0,86; 4,74]), assim como mortalidade masculina (27,37 por 10.000 [IC95% 6,19; 48,55]) e feminina (15,07 por 10.000 [IC95% 3,65; 26,48]). CONCLUSÕES: Os resultados encontrados estão de acordo com o esperado pela teoria da renda relativa. A mortalidade por todas as causas básicas analisadas foi maior em distritos mais desiguais depois do uso da metodologia do propensity score matching. Estudos sobre a desigualdade de renda realizados em regiões menores precisam levar em consideração a distribuição heterogênea das características sociais e demográficas.

Capital social y promoción de la salud en América Latina / Social capital and health promotion in Latin America

América Latina enfrenta problemáticas de desarrollo y salud comunes. La equidad y la superación de la pobreza son cruciales en la búsqueda de soluciones integrales y de alto impacto. El artículo analiza el concepto de capital social, su relación con salud, sus limitaciones y potencialidades, desde una perspectiva de desarrollo comunitario y promoción de salud en América Latina. También, se identifican desafíos prioritarios, como la medición y fortalecimiento del capital social. Se discute cómo y por qué el capital social pudiera ser crítico en una estrategia global de promoción de la salud, donde el empoderamiento y la participación comunitaria, el trabajo interdisciplinario e intersectorial permitirían avanzar en los objetivos de salud pública y en la concreción de un cambio social sustentable. Igualmente, se identifican algunas de las potenciales limitaciones del concepto de capital social en el contexto de promoción de la salud en América Latina.

Latin America faces common development and health problems and equity and overcoming poverty are crucial in the search for comprehensive and high impact solutions. The article analyzes the definition of social capital, its relationship with health, its limitations and potentialities from a perspective of community development and health promotion in Latin America. High-priority challenges are also identified as well as possible ways to better measure and to strengthen social capital. Particularly, it is discussed how and why social capital may be critical in a global health promotion strategy, where empowerment and community participation, interdisciplinary and intersectorial work would help to achieve Public Health aims and a sustainable positive change for the global development. Also, some potential limitations of the social capital concept in the context of health promotion in Latin America are identified.

Alcohol drinking patterns by gender, ethnicity, and social class in Bahia, Brazil

OBJECTIVE: To study patterns of alcohol consumption and prevalence of high-risk drinking. METHODS: A household survey was carried out in a sample of 2,302 adults in Salvador, Brazil. Cases of High-Risk Drinking (HRD) were defined as those subjects who referred daily or weekly binge drinking plus episodes of drunkenness and those who reported any use of alcoholic beverages but with frequent drunkenness (at least once a week). RESULTS: Fifty-six per cent of the sample acknowledged drinking alcoholic beverages. Overall consumption was significantly related with gender (male), marital status (single), migration (non-migrant), better educated (college level), and social class (upper). No significant differences were found regarding ethnicity, except for cachaça (Brazilian sugarcane liquor) and other distilled beverages. Overall 12-month prevalence of high-risk drinking was 7 percent, six times more prevalent among males than females (almost 13 percent compared to 2.4 percent). A positive association of HRD prevalence with education and social class was found. No overall relationship was found between ethnicity and HRD. Male gender and higher socioeconomic status were associated with increased odds of HRD. Two-way stratified analyses yielded consistent gender effects throughout all strata of independent variables. CONCLUSIONS: The findings suggest that social and cultural elements determine local patterns of alcohol-drinking behavior. Additional research on long-term and differential effects of gender, ethnicity, and social class on alcohol use and misuse is needed in order to explain their role as sources of social health inequities.

Inequidad de ingreso y autopercepción de salud: un análisis desde la perspectiva contextual en las comunas chilenas / Income inequality and self rated health in Chile

Background: The correlation between income inequality and life expectancy was demonstrated 10 years ago, but later, several studies suggested that the negative impact of a low economic income on the health status was disappearing. Aim: To assess the independent effects of community income inequality on self rated health in Chile. Material and methods : Multilevel analysis of the 2000 National Socio Economic Characterization Survey (CASEN) data from Chile. Individual level information included self rated health, age, sex, ethnicity, marital status, education, income, type of health insurance and residential setting (urban/rural). Community level variables included the Gini coefficient and median income. The main outcome measure was dichotomized self rated health (0 if excellent, very good or good; 1 if fair or poor). Results: 101,374 individuals (at level 1) aged 18 and above, nested within 285 communities (at level 2) and 13 regions (at level 3) were studied. Controlling for a range of individual level predictors, a significant gradient was observed between income and poor self rated health, with very poor most likely to report poor health (10.5 percent) followed by poor (9.5 percent) low (9 percent) middle (7 percent), high (6 percent) and very high (4.5 percent) income earners. Controlling for individual and community effects of income, a significant non linear effect of community income inequality was observed, with the most unequal communities being associated with approximately 5 percent higher likelihood of reporting poor health compared to the most equal communities. Conclusions : Individual income does not explain any of the between community differences and neither does it wash the significant effects of income inequality on poor self rated health. The contextual effect of inequality is almost as large as the differential observed in poor health comparing the very poor to the very rich individual income categories