Protocol paper for the Movimente school-based program: A cluster-randomized controlled trial targeting physical activity and sedentary behavior among Brazilian adolescents.

BACKGROUND: A better understanding of how multicomponent school-based interventions work and their effects on health and education outcomes are needed. This paper described the methods of the Movimente Program, a school-based intervention that aims to increase physical activity (PA) and decrease sedentary behavior (SB) among Brazilian students. METHODS: This is a cluster randomized controlled trial with adolescents from 7th to 9th grade in public schools from Florianopolis, Southern Brazil. After agreement, 6 schools were randomly selected to intervention or control groups (3 schools each), and all eligible students were invited to the study. The Movimente intervention program was performed during a school year and included 3 main components: Teacher training (including face-to-face meeting, social media platform, and handbook with lesson plans); improvements in the PA environment in school; and educational strategies. Control schools continued with their traditional schedule. Baseline (March/April 2017), postintervention (November/December 2017), and maintenance (June/July 2018) evaluations included PA and SB as primary outcomes (assessed by self-report and accelerometry). Secondary outcomes included psychosocial factors related to PA and SB (e.g., social support and self-efficacy), as well as health (e.g., quality of life and nutritional status) and education (e.g., academic achievement) outcomes. A program evaluation was performed based on the RE-AIM framework. Participants, intervention staffs, and evaluators were not blinded to group assignment, but a standardized evaluation protocol was applied independently of the trial allocation. RESULTS: Statistical analyses will include a multilevel approach for repeated measurements and mediation analysis. Any side effects of the intervention will be recorded. The sample size close to that expected (n = 1090) was reached (n = 999). The results of this trial will involve valuable information about the effect and the evaluation of a multicomponent intervention carried out in a middle-income country. CONCLUSION: By creating opportunities for adolescents to be active at school using multicomponent strategies, the Movimente program has the potential to enhance students health and academic performance which may encourage the school community (e.g., teachers, principals) to adopt the program. Also, this trial will provide evidence for practitioners, policy makers, and researchers on how multicomponent program may be implemented in a school setting. TRIAL REGISTRATION: The trial is registered at the Clinical Trial Registry (Trial ID: NCT02944318; date of registration: 18 October 2016).

[Fruit and vegetable consumption over a decade among adolescents in the State of Santa Catarina, Brazil]. / Consumo de frutas e verduras por adolescentes catarinenses ao longo de uma década.

Understanding the changes in the trends of fruit and vegetable consumption among adolescents is important in order to implement public health actions. The scope of this article is to investigate the changes over a ten-year period in the daily fruit and vegetable consumption among adolescents from Santa Catarina, according to sex, age and housing area. It is a secondary analysis of a panel survey entitled "Lifestyle and Risk Behavior of Adolescents in the State of Santa Catarina, Brazil (ComPAC)." Adolescents (15-19 years of age) of state schools in 2001 (n=5.028) and 2011 (n=6.529) answered a questionnaire about fruit and vegetable consumption as well as about sociodemographic aspects. Descriptive statistics and logistic regression were applied, according to sex, age and housing area. There was a decrease in daily fruit (39.1% and 16.6%) and vegetable (40.1% and 20.6%) consumption. Different prevalence levels were observed when analyzing subgroups, mainly among girls. From 2001 to 2011, daily vegetable consumption among boys and adolescents in rural areas remained the same. The decrease in daily consumption of fruit and vegetables among adolescents aged 15 to 19 in Santa Catarina highlights the need for the development of strategies to reverse this scenario.

Compreender mudanças no consumo de frutas e verduras por adolescentes é importante para criação de ações de saúde pública. O objetivo deste artigo é investigar mudanças, em dez anos, no consumo diário de frutas e verduras por adolescentes, de acordo com sexo, idade e área de moradia. Estudo de painel (análise secundária) da pesquisa "Estilo de vida e comportamentos de risco de jovens catarinenses". Adolescentes (15-19 anos) de escolas estaduais, em 2001 (n = 5.028) e 2011 (n = 6.529), responderam questionário sobre consumo de frutas e verduras e aspectos sociodemográficos. Estatística descritiva e regressão logística (2001 vs 2011), estratificada para sexo, idade e área de moradia. Houve diminuição no consumo diário de frutas (39,1% e 16,6%) e de verduras (40,1% e 20,6%). Diferentes prevalências são observadas de acordo com subgrupos, principalmente entre moças. A chance para consumo diário de verduras entre rapazes e adolescentes de área rural continuou a mesma. A diminuição na prevalência do consumo diário de frutas e verduras por adolescentes catarinenses de 15 a 19 anos aponta necessidade de criação de estratégias para reversão deste cenário.

Consumo de frutas e verduras por adolescentes catarinenses ao longo de uma década / Fruit and vegetable consumption over a decade among adolescents in the State of Santa Catarina, Brazil

Resumo Compreender mudanças no consumo de frutas e verduras por adolescentes é importante para criação de ações de saúde pública. O objetivo deste artigo é investigar mudanças, em dez anos, no consumo diário de frutas e verduras por adolescentes, de acordo com sexo, idade e área de moradia. Estudo de painel (análise secundária) da pesquisa "Estilo de vida e comportamentos de risco de jovens catarinenses". Adolescentes (15-19 anos) de escolas estaduais, em 2001 (n = 5.028) e 2011 (n = 6.529), responderam questionário sobre consumo de frutas e verduras e aspectos sociodemográficos. Estatística descritiva e regressão logística (2001 vs 2011), estratificada para sexo, idade e área de moradia. Houve diminuição no consumo diário de frutas (39,1% e 16,6%) e de verduras (40,1% e 20,6%). Diferentes prevalências são observadas de acordo com subgrupos, principalmente entre moças. A chance para consumo diário de verduras entre rapazes e adolescentes de área rural continuou a mesma. A diminuição na prevalência do consumo diário de frutas e verduras por adolescentes catarinenses de 15 a 19 anos aponta necessidade de criação de estratégias para reversão deste cenário.

Abstract Understanding the changes in the trends of fruit and vegetable consumption among adolescents is important in order to implement public health actions. The scope of this article is to investigate the changes over a ten-year period in the daily fruit and vegetable consumption among adolescents from Santa Catarina, according to sex, age and housing area. It is a secondary analysis of a panel survey entitled "Lifestyle and Risk Behavior of Adolescents in the State of Santa Catarina, Brazil (ComPAC)." Adolescents (15-19 years of age) of state schools in 2001 (n=5.028) and 2011 (n=6.529) answered a questionnaire about fruit and vegetable consumption as well as about sociodemographic aspects. Descriptive statistics and logistic regression were applied, according to sex, age and housing area. There was a decrease in daily fruit (39.1% and 16.6%) and vegetable (40.1% and 20.6%) consumption. Different prevalence levels were observed when analyzing subgroups, mainly among girls. From 2001 to 2011, daily vegetable consumption among boys and adolescents in rural areas remained the same. The decrease in daily consumption of fruit and vegetables among adolescents aged 15 to 19 in Santa Catarina highlights the need for the development of strategies to reverse this scenario.

Smoking among industrial workers in Brazil: association with sociodemographic factors, alcohol consumption, and stress levels.

OBJECTIVE: To determine the prevalence of smoking, as well as its association with sociodemographic factors, alcohol consumption, and stress levels, among industrial workers in Brazil. METHODS: This was a nationwide survey, conducted in 24 capitals in Brazil through the application of a pre-tested questionnaire. The response to the question "What is your smoking status?" was the outcome variable. To determine the associations, we performed Poisson regression analyses in which the inputs were blocks of variables: block 1 (age and marital status); block 2 (level of education and gross family income); block 3 (geographic region); and block 4 (alcohol consumption and stress level). All analyses were stratified by gender. RESULTS: The sample consisted of 47,328 workers ≥ 18 years of age, of whom 14,577 (30.8%) were women. The prevalence of smoking was 13.0% (15.2% in men and 7.9% in women). Advancing age, alcohol consumption, and a high stress level were positively associated with smoking. A lower risk of smoking was associated with being married, having a higher level of education, and living in the northeastern region of the country (versus the southern region). CONCLUSIONS: The prevalence of smoking was greater in men than in women. Alcohol consumption and high stress levels appear to promote smoking.

The effect of an intervention on physical activity of moderate-and-vigorous intensity, and sedentary behavior during adolescents' time at school. / Efeito de uma intervenção sobre atividade física moderada a vigorosa e comportamento sedentário no tempo escolar de adolescentes.

INTRODUCTION: This study evaluated the effect of an intervention on the engagement in physical activity (PA) and sedentary behavior (SB) of sixth to ninth grade students during school-time, physical education (PE) classes, and recesses at two public schools in Florianopolis, SC, Brazil. METHOD: Schools were divided into control and experimental groups. Participants wore accelerometers during school-time, and PA and SB were estimated for school-time, PE classes and recesses at the baseline and after the intervention. The intervention was composed of four components: changes were made in the PE classes, including giving instruction to teachers; sports equipment was made available for use during recesses; educational sessions on the format of classes were conducted; folders and posters were distributed. Data was analyzed using an Analysis of Covariance for repeated measures comparing baseline data with post intervention data, and for independent samples when comparing control and intervention groups. RESULTS: A low proportion of engagement in PA and a large engagement in SB was observed on the baseline. PA decreased in the intervention group during PE classes, while it increased in the control group with regard to school-time, PE classes, and recess. The intervention group accumulated more SB during school-time and PE classes after the intervention, while a decrease in the control group's SB during school-time was observed. CONCLUSION: The intervention was not effective in increasing PA or decreasing SB. Environmental and school's organizational factors impact how interventions are conducted, and should be considered beforehand.

INTRODUÇÃO: Este estudo objetivou avaliar o efeito de uma intervenção sobre o engajamento em atividade física (AF) e comportamento sedentário (CS) no período escolar, em aulas de educação física (EF) e nos recreios em estudantes do sexto ao nono ano de escolas públicas de Florianópolis, Santa Catarina. MÉTODOS: Duas escolas foram alocadas em grupo experimental e controle. Os participantes utilizaram acelerômetros no período escolar e o tempo em AF e CS foram estimados no período escolar, aulas de EF e recreios antes e após a intervenção. A intervenção foi composta de quatro componentes: mudanças nas aulas de EF, com formação dos professores; disponibilização de materiais esportivos no recreio; sessões educativas no formato de aulas; e distribuição de folders e cartazes com informações sobre os desfechos da intervenção. Foram empregadas análises de covariância para medidas repetidas comparando a linha de base e pós-intervenção e para amostras independentes, comparando o grupo controle com o grupo intervenção. RESULTADOS: Observou-se uma baixa proporção de AF na escola na linha de base e um elevado volume de CS. O grupo intervenção diminuiu a AF em aulas de EF, enquanto o grupo controle aumentou em todos os períodos. O grupo intervenção também acumulou mais o CS no período escolar e em aulas de EF após a intervenção, enquanto o controle diminuiu o CS no período escolar. CONCLUSÃO: A intervenção proposta não foi efetiva em aumentar a AF e diminuir o CS. Fatores ambientais e de organização escolar podem ter impactado os resultados e devem ser considerados no planejamento de intervenções.

Clustering of unhealthy food habits and its association with socioeconomic factors among Brazilian workers / Agrupamento de hábitos alimentares não saudáveis e sua associação com fatores socioeconômicos entre trabalhadores brasileiros

ABSTRACT Objective Investigate the clustering of four unhealthy food habits (low intake of fruits, low intake of vegetables, high intake of candy, and high intake of fried snacks), and to identify the association between the number of these clustered habits and sociodemographic variables. Methods This was a cross-sectional representative study of industrial workers from 24 Federative Units in Brazil conducted between 2006 and 2008. The low weekly intake of fruits and vegetables (<5 days/week) and high weekly intake of candy and fried snacks (≥5 days/weeks) were evaluated using a validated questionnaire. Simultaneity was analyzed with stratification by sex, calculating the Observed (O) and Expected (E) prevalence and the O/E ratio for each of the 16 possible food intake combinations. Results Among the 47,477 workers studied, in both men and women, the simultaneous presence of high weekly intake of candy and fried snacks(O/E=3.58; 95%CI=3.12-4.10 and O/E=2.17; 95%CI=1.76-2.62) and of the four unhealthy food habits (O/E=2.32; 95%CI=2.01-2.66 and O/E=4.02; 95%CI=3.44-4.65) exceeded the expected percentages if these foods were consumed separately. When compared to subjects without or with only one unhealthy food habit, the combination of the four negative dietary behaviors was more frequent among women, workers with a lower education level, and those living without a partner. Conclusion Unhealthy food habits tend to cluster together in both sexes, suggesting a strong interaction, particularly for the four unhealthy food habits together, especially among women, less educated workers and without a partner.

RESUMO Objetivo Investigar o agrupamento de quatro hábitos alimentares não saudáveis (baixo consumo de fruta, baixo consumo de verdura, alto consumo de doce e alto consumo de salgadinho), e identificar a associação entre a quantidade desses hábitos agrupados e variáveis sociodemográficas. Métodos Esse foi um estudo transversal e representativo de trabalhadores das indústrias de 24 Unidades Federativas do Brasil, realizado de 2006 e 2008. Os baixos consumos semanais de fruta e verdura (<5 dias/semana) e os altos consumos semanais de doce e salgadinho (>5 dias/semana) foram avaliados por questionário validado. A simultaneidade foi analisada com estratificação por sexo, conforme a prevalência Observada (O), Esperada (E), Razão (O/E) para cada uma das 16 combinações possíveis de consumo alimentar. Resultados Nos 47.477 trabalhadores investigados, tanto em homens quanto em mulheres, respectivamente, a presença simultânea alto consumo semanal de doce e salgadinho (O/E=3,58; IC95%=3,12-4,10 e O/E=2,17; IC95%=1,76-2,62) e dos quatro hábitos alimentares não saudáveis juntos (O/E=2,32; IC95%=2,01-2,66 e O/E=4,02; IC95%=3,44-4,65) foram aquelas que mais excederam os percentuais esperados, caso esses alimentos fossem ingeridos de forma independente. Comparados aos sujeitos com nenhum ou um hábito alimentar não saudável, a combinação de quatro comportamentos alimentares negativos foi mais frequente entre as mulheres, trabalhadores com menor nível de escolaridade e que viviam sem companhia. Conclusão Hábitos alimentares não saudáveis tendem a se agrupar em ambos os sexos, sugerindo uma forte interação, especialmente para os quatro hábitos alimentares não saudáveis em conjunto, principalmente nas mulheres, trabalhadores com menor escolaridade e que vivem sem parceiro.

ESCALA DE AVALIAÇÃO DO PERFIL DO ESTILO DE VIDA POR MEIO DA TEORIA DA RESPOSTA AO ITEM / RATING SCALE FOR THE PROFILE LIFESTYLE BY ITEM RESPONSE THEORY

O objetivo do estudo foi criar uma escala para avaliar o perfildo estilo de vida, por meio da Teoria da Resposta ao Item, a partir do questionário "Perfil do Estilo de Vida". Para a criação da escala foi utilizado o modelo de resposta gradual proposto por Samejima. Participaram do estudo 580 docentes efetivos de Educação Física no magistério público estadual de Santa Catarina. O modelo mostrou-se adequado para avaliar o estilo de vida das pessoas e a interpretação da escala ficou robusta, principalmente para pessoas com estilo de vida quase positivo.

The objective of the study was to createa scale to measure the profile lifestyle through Item Response Theory in the questionnaire "Profile Lifestyle". For the creation of the scale we used the model graded response proposed by Samejima. The study included 580 effective teachers of physical education in state public teaching of Santa Catarina. The model was adequate for evaluating the lifestyle of the people and the interpretation of the scale was robust, especially for people with almost positive life style.

Criação de uma escala de satisfação com a vida por meio da Teoria da Resposta ao Item / Development of a life satisfaction scale by Item Response Theory

RESUMO Objetivo A satisfação com a vida é um julgamento cognitivo de alguns domínios específicos na vida e depende de uma comparação entre as circunstâncias de vida do indivíduo e um padrão por ele estabelecido. O objetivo deste estudo foi construir uma escala de satisfação com a vida por meio da Teoria da Resposta ao Item (TRI). Métodos Para a criação da escala, foi utilizado o questionário “Estilo de Vida e Hábitos de Lazer de Trabalhadores da Indústria” e a Teoria da Resposta ao Item com base no modelo de resposta gradual proposto por Samejima. Participaram do estudo 47.477 trabalhadores brasileiros da indústria. Resultados A escala contou com sete itens do bloco de perguntas “indicadores de saúde e comportamentos preventivos”, com assuntos relacionados ao estado de saúde, qualidade de sono, nível de estresse, sentimento de tristeza ou depressão e percepção de vida no lar, no trabalho e no lazer. Conclusão São poucos os estudos que tiveram seu foco direcionado à satisfação com a vida no Brasil, e aqueles que de alguma forma o abordaram incluíram somente uma questão específica sobre felicidade ou satisfação de vida, principalmente em estudos sobre o bem-estar subjetivo. Os resultados mostraram que a TRI foi eficiente para criar a escala, medindo principalmente aqueles indivíduos com valores intermediários de satisfação com a vida.

ABSTRACT Objective Life satisfaction is a cognitive judgment of some specific areas in life and depends on a comparison between the life circumstances of the individual and a standard established by it. The objective of this study was to construct a scale of satisfaction with life by Item Response Theory (IRT). Methods For the creation of the scale we used the questionnaire “Life Style and Habits Leisure Industry Workers” and Item Response Theory based on the graduated response model proposed by Samejima. The study enrolled 47,477 Brazilian workers in the industry. Results The scale had seven items the questions of the “health indicators and preventive behaviors” with issues related to health status, quality of sleep, stress level, feelings of sadness or depression and perception of life at home, at work and play. Conclusion There are few studies that have their focus directed to life satisfaction in Brazil, and those who somehow discussed, only included a specific question about happiness or life satisfaction, especially in studies on subjective well-being. The results show that IRT was efficient to create the scale, especially those individuals with intermediate measuring life satisfaction.

Overweight in Brazilian industry workers: Prevalence and association with demographic and socioeconomic factors and soft drink intake / Excesso de peso em trabalhadores de indústrias no Brasil: prevalência e associação com fatores demográficos, socioeconômicos e consumo de refrigerantes

Objective: To estimate the prevalence of overweight in industry workers and its association with demographic and socioeconomic factors and soft drink intake (including type). Methods: This is a nationwide cross-sectional cohort survey of "Lifestyle and leisure habits of industry workers" conducted between 2006 and 2008 in 24 Brazilian federate units. The participants answered a previously tested questionnaire and self-reported their weight and height. Statistical analyses consisted of crude and adjusted Poisson regression. Results: Males and females had overweight prevalences of 45.7% (95%CI=45.1; 46.2) and 28.1% (95%CI=27.4; 28.9) respectively. Older and married individuals and those working in medium-sized and large factories were more likely to be overweight. Males with higher education levels and gross family incomes were also more likely to be overweight, but not females. Finally, men (PR=1.24; 95%CI=1.13; 1.36) and women (PR=1.40; 95%CI=1.22; 1.61) who consumed diet/light soft drinks were also more likely to be overweight than those who did not consume soft drinks. Conclusion: More than one-third of the workers were overweight according to their self-reported weight and height, and the prevalence of overweight was higher in males. Demographic and socioeconomic variables and diet/light soft drink intake were associated with overweight. These data may be helpful for the development of actions that reduce the risk of overweight in this population. .

Objetivo: Estimar a prevalência de excesso de peso e sua associação com fatores demográficos, socioeconômicos e com o consumo e tipo de refrigerante ingerido. Métodos: Trata-se de um inquérito nacional, de corte transversal, sobre o "Estilo de vida e hábitos de lazer de trabalhadores da indústria", realizado nos anos de 2006 a 2008, em 24 unidades federativas do Brasil. As informações foram obtidas por meio de um questionário previamente testado, inclusive a informação sobre o excesso de peso (autorrelato do peso e da estatura). Regressões de Poisson bruta e ajustada foram realizadas. Resultados: A prevalência de excesso de peso foi de 45,7% (IC95%=45,1; 46,2) nos homens e 28,1% (IC95%=27,4; 28,9) nas mulheres. Identificou-se que o aumento da idade, ser casado e o tamanho das empresas (médio e grande porte) associaram-se a maiores probabilidades para o excesso de peso. Quanto maior a escolaridade e a renda familiar bruta entre os homens, maior a probabilidade de excesso de peso, tendo sido observada situação contrária entre as mulheres. Homens (RP=1,24; IC95%=1,13; 1,36) e mulheres (RP=1,40; IC95%; 1,22; 1,61) que relataram consumir refrigerantes diet/light também apresentaram maior excesso de peso quando comparados àqueles que relataram não consumir refrigerantes. Conclusões: Em seus autorrelatos, mais de um terço dos trabalhadores foram classificados com excesso de peso, com maior prevalência entre os homens. Variáveis demográficas, socioeconômicas e consumo de refrigerantes diet/light se mostraram associados ao excesso de peso. Tais informações podem auxiliar na elaboração de ações direcionadas para redução da probabilidade do excesso de peso nesse grupo. .