National Adolescent School-based Health Survey Research Articles

Usual source of care and Brazilian adolescent access to Primary Health Care (PHC) services

We analyzed the association between the recognition of a usual source of care (USC) of Primary Health Care (PHC) and access to services among Brazilian adolescents. This is a cross-sectional study using data from the National Adolescent School-based Health Survey with 68,968 Brazilian adolescents and cluster sampling. Descriptive analyses were carried out with Pearson's χ2 and prevalence ratios (PR) using logistic regression models between access and recognition of USC. It was observed that 74.6% reported access, and this was higher among females (79.3%). In the multivariate analysis, there was a positive association (PR: 1.25; 95%CI: 1.24-1.26); and, when stratified by sex, positive associations for both sexes, (PR: 1.30; 95%CI: 1.28-1.31) male and (PR: 1.21; 95%CI: 1.20-1.23) female. The majority of Brazilian adolescents demonstrated PHC as a USC and were able to access services, but lack of access was more frequent among the most economically vulnerable and those with risk behaviors, indicating potentially avoidable inequities with more equitable and longitudinal PHC services.

Clustering of physical activity, sedentary behavior, and diet associated with social isolation among brazilian adolescents

BackgoundAlthough obesogenic behaviors have been found to be related to social isolation, evidence-based person-centered approaches are lacking. This study investigated the association between clusters of obesogenic behavior – derived from a data-driven process – and social isolation among Brazilian adolescents.MethodsData from the National Adolescent School-based Health Survey (PeNSE) 2015 were analyzed. A total of 100,794 9th-grade students (51.3% females; 14.3 ± 0.1 years old) enrolled in 3,040 public and private high schools participated in the study. Social isolation was assessed by two outcomes (i.e., perceived loneliness and lack of close friends). A two-step cluster analysis was conducted to identify patterns of obesogenic behaviors with the input of leisure-time physical activity (PA), sitting time as a proxy of sedentary behavior (SB), and the weekly consumption of healthy and unhealthy food. Crude and adjusted binary logistic regression models were applied to evaluate the associations between the clusters of obesogenic behaviors and social isolation variables in adolescents. ResultsThree clusters were identified. Adolescents in the “Health-promoting SB and diet” (32.6%; OR = 0.69; 95% CI = 0.62–0.76) and “Health-promoting PA and diet” (44.9%; OR = 0.73; 95% CI = 0.67–0.79) clusters had lower odds of loneliness compared to those in the “Health-risk” cluster (22.5%). Those belonging to the “Health-promoting PA and diet” cluster were more likely to report having close friends (OR = 1.19; 95% CI = 1.00–1.41) than those in the “Health-risk” cluster.ConclusionAdolescents in clusters where positive behaviors outweighed negative ones were less likely to perceive themselves as lonely and without close connections.

What factors matter in the amount of alcohol consumed? An analysis among Brazilian adolescents.

Alcohol consumption in the under-18 age group has been growing in recent years, leading to various health risks. Considering the problems this habit brings, the present study contributes to the literature dedicated to categorizing different types of drinkers. The study objective is to verify the factors associated with the intensity of alcohol use among elementary school students in the year 2015. The dataset came from the National Adolescent School-based Health Survey (PeNSE). The applied methodology was a logit model of sequential response (continuation ratio). The main results are as follows. It was found that being female is associated with a lesser chance of having consumed alcohol in the reference period, however, with a greater chance of consuming five or more doses. Economic condition and formal paid employment are positively associated with alcohol consumption, which increases with the progression of the student's age. The number of friends who drink alcohol and consumption of products originating from tobacco and illicit drugs, are good predictors of alcohol use by students. The time spent practicing physical activities increased the chance of male students consuming alcohol. The results showed that, in general, the characteristics associated with different alcohol consumption profiles remain similar but differ between genders. Intervention strategies aimed at preventing alcohol consumption by minors are suggested in order to reduce the negative effects of substance use and abuse.

Violent behavior, perceived safety, and assault experiences among adolescents: results from the Brazilian National Adolescent School-based Health Survey.

To investigate factors associated with violent behavior in a large nationally representative sample of Brazilian adolescents. The data were derived from the 2015 National Adolescent School-based Health Survey (Pesquisa Nacional de Saúde do Escolar [PeNSE]). The independent variables of interest included feelings of safety while on the way to and at school. The outcome was violent behavior, including bullying. Logistic regression models were developed to examine the relationship between violent behavior and each independent and control variable. In the adjusted regression model, male sex (aOR: 1.75; 95%CI 1.65-1.86), being assaulted by a family member (aOR: 1.74; 95%CI 1.59-1.90), and being assaulted in the past year (aOR: 1.70; 95%CI 1.57-1.85) all increased the chance of violent behavior. Feeling safe on the way to school (aOR: 0.82; 95%CI 0.74-0.92) and at school (aOR: 0.82; 95%CI 0.73-0.92) reduced the chance of violent behavior. This study extends the body of literature on violent behavior among adolescents, demonstrating a correlation between school, domestic, family, or community violence and violent behavior. Our research supports the idea that adolescents who experience violence act violently with greater frequency. This finding has significant implications for pediatricians, child psychiatrists and psychologists, other health care professionals, school professionals, and other professionals involved in adolescent health. School professionals must be prepared to identify adolescents with violent behavior due to its potential consequences for their mental and physical health.

Parental supervision and sexual behavior among Brazilian adolescents.

to evaluate the association between parental supervision and sexual behaviors among Brazilian adolescents. Cross-sectional study with data from 102,072 adolescents who responded to the National Adolescent School-based Health Survey. We estimated the prevalence of sexual behaviors (initiation, use of condoms, contraception, and number of partners). Parental supervision was evaluated using a score considering five indicators. We calculated prevalence ratios (PR) adjusted by age and sex in order to estimate the association between parental supervision score and sexual behaviors of adolescents. Prevalence of risky sexual behavior for adolescents with minimum and maximum parental supervision were: sexual initiation (min.: 58.0%; max.: 20.1%), condom use in the last sexual intercourse (min.: 50.9%; max.: 80.2%), use of contraceptives (min.: 40.8; max.: 49.1%), and mean number of partners (min.: 3.25; max.: 2.88). Parental supervision was greater among girls. Those with higher supervision scores had higher prevalence of condom use in the first and last sexual intercourse and of contraceptive methods, and a smaller mean number of partners, even after adjustments for sex and age. The greater the parental supervision, the better the sexual behavior for both sexes, although supervision seems to occur differently between girls and boys. These findings point to the role of the family in providing adolescents with monitoring, along with dialogue and affection, conditions that encourage healthy and risk-free sexual behavior.

What does Google Trends reveal about the proportion of waterpipe users in the Brazilian population?

To analyze the relationship between internet search volume and the prevalence of waterpipe use among young Brazilians in 2019. This was a descriptive study with data from Brazil in 2019, using the relative search volume on waterpipes extracted from Google Trends and the proportion of waterpipe users aged between 15 and 24 years, as measured by the National Health Survey (Pesquisa Nacional de Saúde - PNS), and aged between 13 and 17 years, as measured by the National Adolescent School-based Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE). The relationship was assessed by means of Spearman's correlation. The point prevalence of waterpipe use across the Brazilian Federative Units (FUs) showed a moderate (r = 0.51; PNS) to strong correlation (r = 0.74 and r = 0.80; PeNSE) with the relative search volume (p-value < 0.05). Google Trends can support the monitoring system on waterpipe use in the FUs, providing additional information to existing population-based surveys. The search volume for waterpipes by states in Brazil, as measured by Google Trends, showed a moderate to high correlation with the respective proportions of current use and experimentation of waterpipe among the adolescent/young adult population. The use of Google Trends as a support to the monitoring system for waterpipe consumption in Brazil warrants further exploration in terms of the validity of additional information to existing population surveys. Expanding the use of Google Trends searches to assess its potential in monitoring other health risk products and detecting (or predicting) incidence or seasonality of health-related events.

Prevalence of sexual initiation and associated factors in school adolescents in Piauí, Brazil, 2015.

to analyze prevalence of sexual initiation and associated factors in adolescents in Piauí. this was a cross-sectional study, with secondary data from the 2015 National Adolescent School-based Health Survey. Hierarchical analysis was performed using robust Poisson regression. a total of 3.872 adolescents were interviewed. Prevalence of sexual initiation was 24.2%; risk factors for sexual initiation were being male [prevalence ratio (PR) = 2.18; 95% confidence interval (95%CI) 1.90;2.47], being 15 years old or over (PR = 2.49; 95%CI 2.18;2.76), living with mother (PR = 0.68; 95%CI 0.54;0.82), working (PR = 1.82; 95%CI 1.55;2.10), attending a public school (PR = 1.39; 95%CI 1.09;1.75), practicing bullying (PR = 1.50; 95%CI 1.31;1.72), using alcohol (PR = 2.35; 95%CI 2.09;2.64), using cigarettes (PR = 1.46; 95%CI 1.22;1.70) and using illicit drugs (PR = 1.40; 95%CI 1.15;1.66). prevalence of sexual initiation was high and associated with sociodemographic characteristics and vulnerable health behaviors, indicating the need for health promotion strategies.

Violent Behavior and Substance Use Among Adolescents—Results from the National Adolescent School-based Health Survey (PeNSE)

Violent Behavior and Substance Use Among Adolescents—Results from the National Adolescent School-based Health Survey (PeNSE)

Quality of education and adolescents' oral health-related behaviours: a multilevel analysis.

The school environment may positively influence student health behaviours and learning. This study aimed to investigate the association between cities' quality of education and adolescent students' oral health-related behaviours. Cross-sectional study using data of the 2015 Brazilian National Adolescent School-Based Health Survey and other public databases. The sample was composed of adolescents (N = 23,674) from public schools of the 27 Brazilian state capitals. Outcomes were four oral health-related behaviours: toothbrushing, sweets and soft-drink consumption, and dental visits. The explanatory variable was the cities' quality of education, measured by the Brazilian Basic Education Development Index. Covariates were individual (sociodemographic) and contextual (socioeconomic, oral health coverage and oral health-promoting schools). Multilevel logistic regression was performed considering two levels: individual (adolescents) and contextual (city). The prevalence of the outcomes were: low daily toothbrushing frequency 6.7% (95% CI 6.0-7.4); high weekly sweets consumption 41.5% (95% CI 40.3-42.7); high weekly soft-drink consumption 28.5% (95% CI 27.2-29.9); and low frequency of annual dental visits 31.2% (95% CI 30.1-32.3). In the adjusted models, cities whose schools had higher scores of education quality were more likely to have students with low toothbrushing frequency and high frequency of sweets consumption. The cities' quality of education was associated with unhealthy oral health-related behaviours, particularly the frequency of toothbrushing and sweets consumption. Therefore, appropriate health promotion strategies as well as high-quality education are needed in schools.

Educational quality and oral health promotion in Brazilian schools: a multilevel analysis of national data.

The aim of this study was to investigate whether educational quality is associated with schools' potential support for oral health promotion in Brazil, using a multilevel model. An ecological study was carried out using data from 940 public schools (school level) from the 27 Brazilian state capitals (city-level). The explanatory variable was educational quality, measured by the Basic Education Development Index (IDEB) for each city, and the four dependent variables referred to the Oral Health Promotion School Environment (OHPSE) indicator and its dimensions: Dimension 1 (In-school aspects), Dimension 2 (Aspects of the school surroundings), and Dimension 3 (Prohibitive policies at school). The OHPSE was developed using categorical principal components analysis (CATPCA) of data from the 2015 National Adolescent School-Based Health Survey (PeNSE). Covariates were human development index and oral health care coverage of cities. Multilevel Poisson regression models with robust variance were undertaken (p < 0.05). Bivariate associations were found between the IDEB and each Total OHPSE and OHPSE-Dimension 1 (In-school aspects: sale of foods with added sugar and health promotion actions/programs). After adjustment, IDEB (PR: 1.38, 95%CI: 1.01-1.90; p = 0.045) and oral health care coverage (PR: 1.01; 95%CI: 1.00-1.02; p = 0.001) remained associated with the OHPSE Dimension 1. It was concluded that educational quality measured by the IDEB was associated with schools' potential support for oral health promotion regarding the sale of foods with added sugar and health promotion actions/programs in schools.

Characteristics of Brazilian school food and physical activity environments: PeNSE 2015.

ABSTRACTOBJECTIVE To characterize the food and physical activity environments in Brazilian public and private schools, and develop indicators to evaluate them.METHODS This is a cross-sectional study conducted with data from a questionnaire on school characteristics of the 2015 National Adolescent School-based Health Survey, answered by principals or coordinators, referring to 3040 public and private schools throughout the country. The variables related to food and physical activity environments were described in isolation, and an indicator was developed for each environment, with scores ranging from 0 to 100. The frequency and mean score of each variable were described according to the administrative sphere (public or private).RESULTS The public sector showed a predominance of school meals offer (97.8%), whereas the private sector, of canteens (89.8%). Both had a similar frequency of alternative food outlets in the surroundings. Private schools provided all markers of healthy and unhealthy eating in canteens more frequently. Public schools scored higher in “Food and beverage availability” (64.9) than private schools (55.8). The characteristics of physical activity environments showed that sports courts and sports or games equipment were common in public (69.2% and 90.7%, respectively) and private schools (94.1% and 99.8%, respectively), though at a significantly higher frequency in the second group. Private schools scored higher in “Structures and materials availability” than public schools (63.3 and 41.6, respectively).CONCLUSIONS Public schools provide a more favorable food environment, whereas private schools, a physical activity environment.

Body image is associated with leisure-time physical activity and sedentary behavior in adolescents: data from the Brazilian National School-based Health Survey (PeNSE 2015).

Objective:To evaluate the association of leisure-time physical activity and sedentary behavior with body image concern and satisfaction in Brazilian adolescents.Methods:Data were extracted from the 2015 Brazilian National Adolescent School-based Health Survey (Pesquisa Nacional de Saúde do Escolar [PeNSE]). Information regarding body image concern and satisfaction, as well as exposures (physical activity and sedentary behavior) and covariates (maternal education, age, smoking, and alcohol intake), were assessed through a questionnaire.Results:Logistic regression analysis revealed that engagement in recommended levels of physical activity (≥ 300 min/week) was associated with a decreased concern with body image and a high satisfaction in boys. Four or more hours spent in sedentary activities were associated with increased concern with body image and dissatisfaction among boys and girls.Conclusion:These findings support the relevance of programs aiming to promote physical activity and reduce sedentary behavior in the adolescent population. Such programs play a protective role against body dissatisfaction and are important for the development of a healthy body image in adolescence.

Intersection of Race and Gender in Self-Reports of Violent Experiences and Polyvictimization by Young Girls in Brazil.

ObjectiveTo explore racial disparities in self-reports of violent victimization and polyvictimization among young girls in Brazil and to analyze the distribution of prevalence rates across race groups and the estimated odds of exposure.DesignData from girls ages 15 and above (N=14,809) from the 2015 edition of PeNSE (National Adolescent School-based Health Survey) were analyzed. Survey weighted proportions and bivariate and multivariate logistic regressions were used to address the objectives.ResultsIndependent of the girls’ age, socioeconomic status, and region of residence, black, indigenous, mixed, and Asian descendant girls (relative to Whites) were more likely to report past experiences of being bullied, suffering physical violence, forced sexual intercourse, and polyvictimization (reporting all three events). Blacks had the highest rates of reporting being bullied and polyvictimization. Asian descendants had the highest reports of physical violence. Indigenous girls had the highest reports of forced sexual intercourse.ConclusionsThis study documented disproportionate risks of violent victimization for young women of color among Brazilian students. The risks were significantly greater for those of darker skin tones and from ethnic minorities.ImplicationsThese findings can inform the development of programs to protect young women from violence in Brazil and highlight the importance of including anti-racism strategies in such programs.

Loneliness and associated factors among Brazilian adolescents: results of national adolescent school-based health survey 2015

ObjectiveTo identify the associated factors to loneliness among Brazilian adolescents, considering this is a knowledge gap and given its severity. The United Nations estimates that mental health problems affect approximately 20% of adolescents worldwide. MethodsThis is a cross-sectional study with data from the National Adolescent School-based Health Survey 2015, conducted with students aged 13-17 in Brazil. The statistical analysis was performed with the calculation of the prevalence of feeling loneliness reported. Poisson regression with the adjusted Prevalence Ratio was used to evaluate the association between sociodemographic characteristics, family context, mental health and lifestyles, and feelings of loneliness. Results15,5% of Brazilian students reported loneliness in the last 12 months. Female gender, higher maternal education, insomnia and be bullying victims rarely or sometimes and most of the time or always had a higher prevalence rate of loneliness. Having friends, having a meal with parents or guardians 5 days or more a week and having understanding parents showed a lower prevalence ratio for loneliness. ConclusionLoneliness feeling is frequent among adolescents and is associated with female gender, less social and family support, intra-family violence and risk behaviors such as alcohol consumption and bullying. Policies to promote physical and mental well-being in this age group, stimulating friendship and family participation in the lives of adolescents should be made .

Unhealthy life habits associated with self-induced vomiting and laxative misuse in Brazilian adolescents

Adolescence is a stage in life characterized by important social, cognitive, and physical changes. Adolescents are vulnerable to various psychosocial disorders, including eating disorders. We aimed to investigate the association between unhealthy habits, sociodemographic characteristics, and the practice of self-induced vomiting or laxative misuse in a representative sample of Brazilian adolescent girls and boys. Data from 102,072 students who participated in the National Adolescent School-based Health Survey were analyzed using the dependent variable: presence or absence of self-induced vomiting and/or laxative misuse; independent variables: consumption of unhealthy and high-calorie food items, age during first sexual intercourse, and the use of tobacco, alcohol, and/or illicit drugs. Associations between exposure and outcome were estimated using Poisson’s regression models stratified by sex, and including region, school, age group, and mother's educational history as adjustment variables. Eating ultra-processed foods and age during first sexual intercourse were associated with self-induced vomiting and laxative misuse only for girls; all other variables (consuming unhealthy foods and using legal or illicit substances) were associated with these behaviors for both sexes after applying adjustment variables. Early interventions focusing on changing unhealthy behaviors may prevent development of eating disorders in adolescents. Our findings demonstrate a strong association of many unhealthy habits with laxative misuse and self-induced vomiting practices in Brazilian adolescents.

Can the school environment influence oral health-related behaviours? A multilevel analysis of the Brazilian National Adolescent School-Based Health Survey 2015.

To investigate the association between the potential support of schools for oral health promotion and a set of oral health-related behaviours among adolescent students in Brazilian state capitals. A cross-sectional study using individual and school environment data from the 2015 Brazilian National Adolescent School-Based Health Survey (PeNSE) was conducted. The sample consisted of 51192 students from 1339 public and private schools in the 27 Brazilian State Capitals, aged 11-19years old. The outcomes were six oral health-related behaviours: dental visits; toothbrushing frequency; soft drink and sweets consumption; smoking and alcohol consumption. The explanatory variable was the Oral Health Promotion School Environment index (OHPSE). Covariates were the adolescents' sociodemographic characteristics and organizational aspects of the schools. A two-level multilevel mixed-effects Poisson regression analysis with fixed slopes and random intercepts was performed, considering the complex sample design. The prevalence of risk behaviours was 28.0% for 'low frequency of annual dental visits', 6.9% for 'low daily toothbrushing frequency', 28.8% for 'high weekly soft drink consumption', 41.7% for 'high weekly sweet consumption', 18.9% for 'cigarette experimentation' and 52.6% for 'alcoholic beverage experimentation'. The schools were classified as low (36.3%), intermediate (30.4%) and high (33.3%) OHPSE. In the adjusted model, schools with 'high OHPSE' had lower prevalence of 'low frequency of annual dental visits' (PR=0.94 [95% CI 0.90; 0.99]), 'high weekly frequency of soft drink consumption' (PR=0.94 [95% CI 0.89; 0.99]) and 'sweet consumption' (PR=0.96 [95% CI 0.93; 1.00]) than those with 'low OHPSE'. In addition, schools with 'intermediate OHPSE' had higher prevalence's of 'low daily toothbrushing frequency' (PR=1.12 [95% CI 1.03; 1.23]) and 'cigarette experimentation' (PR=1.08 [95% CI 1.01; 1.16]) than those with 'low OHPSE'. 'Alcoholic beverage experimentation' was not associated with OHPSE. The potential support of schools for oral health promotion was associated with most of the oral health-related behaviours among adolescent students. Those attending schools with higher OHPSE scores reported a higher annual frequency of dental visits and a lower weekly frequency of soft drink and sweet consumption, while those in schools with intermediate OHPSE had a lower daily toothbrushing frequency and a higher rate of cigarette experimentation.

What Determine Physical (In)Activity In Brazilian Adolescents?

Increases in physical inactivity has being pointed as one of the most relevant public health problems, especially among youth. Once physical (in)activity is a multifactorial trait, determined by different variables, such as biological and environmental, understanding the role of these variables in youth physical activity (PA) guidelines compliance seems to be of relevance, especially in Brazilian context, given the diversity observed among its region. PURPOSE: To describe differences in adolescent’s PA guidelines compliance among Brazilian regions and to investigate the determinants related to these differences. METHODS: Data comes from the National Adolescent School-based Health Survey (PENSE). Sample comprises 99570 Brazilian students (51.7% girls), enrolled in the 9th grade of Elementary School (mean age 14.29±0.93y). Information related to daily PA guidelines compliance was self-reported (based on the number of days, in last week, adolescents were engaged in at least 60 minutes of moderate to vigorous PA), as well as mother educational level; further, school context information (school size and availability of sports court) was obtained. Logistic regression analysis was computed in SPSS 24, with a significance level of 95%. RESULTS: More than 2/3 of the adolescents did not comply the PA guidelines on any given day of the week; more, the North region presented the highest compliance percentage (9.8%), followed by the Midwest (9.6%), South (8.6%), Southeast (8.3%), and Northeast (7.8%) regions. Regarding predictors of PA guidelines achievement, boys (OR: 3.33, p<0.001), older adolescents (OR: 1.08, p<0.001), those with mother with higher educational level (OR: 1.33, p<0.001), and those enrolled in schools without sports court (OR: 0.92, p=0.007) were more prone to be active than girls, young adolescents, those with mothers with lowest educational level, and those enrolled in schools with sports court, respectively. No significant result was found for school size (p = 0.558). CONCLUSIONS: Sex, age, mother educational level, and the presence of sports court at school were significant predictors for compliance of PA guidelines among Brazilian adolescents. These results reinforce that biological and environmental characteristics, namely school context, play important roles in youth health habits.

Vaccination coverage rates and predictors of HPV vaccination among eligible and non-eligible female adolescents at the Brazilian HPV vaccination public program

BackgroundSince March 2014, the quadrivalent HPV vaccine has been incorporated into the Brazilian Unified Health Care System and began to be offered, without direct costs, for girls from 9 to 13 years of age. Older female adolescents would have the option to be vaccinated at private health care system being responsible for the payment of HPV vaccine. The present study aimed to evaluate the coverage rates and predictors of HPV vaccination in Brazil among two groups of female adolescents: eligible and non-eligible for the HPV vaccination public program.MethodsWe used data from the 2015 Brazilian National Adolescent School-Based Health Survey, which involved a probabilistic sample of 5404 female adolescents students at public and private schools. Using a questionnaire, we gathered information on sociodemographic characteristics, sexual behavior, and respondent perception of parental supervision and have been vaccinated for HPV. Age-specific vaccination rates were analyzed in girls aged 9 to 13 at the time of public vaccination (eligible for public policy), as well among those 14 to 17 years old not eligible by the Ministry of Health for vaccination. We used Poisson regression models to investigate associated factors.ResultsHPV vaccine coverage was 83.5 and 21.8% among eligible and non-eligible populations, respectively. In both populations, the chance of being vaccinated decreased with older age. In the eligible population there is a greater chance of being vaccinated among ethnic group “pardas” but not with other indicators of socioeconomic status. In the non-eligible population, there was a clear association between higher vaccine coverage and greater maternal education and living with the mother.ConclusionOur findings highlight the importance of public policies to minimize inequities in access to cancer prevention measures in vulnerable adolescents. A public policy of HPV vaccination for older female adolescents would increase coverage with possible reduction of HPV-related diseases in this group of women.

National Adolescent School-based Health Survey - PeNSE 2015: Sedentary behavior and its correlates.

ObjectiveTo investigate the association between sedentary behavior (SB) and sociodemographic, social support, behavioral, and health variables among Brazilian adolescents.MethodsThe 2015 National Adolescent School-based Health Survey (PeNSE) was a cross-sectional study consisting of 102,072 Brazilian ninth-graders (mainly aged 13–15 years). SB was defined as the time (in hours) watching television, using a computer, playing video games, talking to friends, or doing other activities in a sitting position. For analysis purposes, SB was categorized into different cut-offs as per the sample distribution quartiles: >2 versus <2 (25th percentile); >4 versus <4 (50th 26 percentile) and >6 versus <6 (75th 27 percentile). We employed Poisson univariate and multivariate regression analyses with robust variance and hierarchical entry of variables for each cut-off point.ResultsThe prevalence rates of each SB cut-off point were 68.15% (CI: 67.44–68.86), 44.15% (CI: 43.40–44.90) and 24.97% (CI:24.37–25.57) for >2, >4 and >6 hours, respectively. The following characteristics were positively and significantly associated with each SB cut-off point in the final models: females, current employment, higher household economic status and higher maternal schooling, lower levels of parents checking homework, tobacco and alcohol use, soft drink and fruit consumption, and regular, poor or very poor self-assessed health status. Conversely, students who self-declared brown were less likely to be classified as a SB cut-off point. Significant associations with age, report of close friends, and physical activity varied by different SB cut-off points.ConclusionUnderstanding the SB correlates in their different dimensions contributes to the identification of subgroups of adolescents with higher SB prevalence, which is crucial in the development and improvement of public policies. The demographic and behavioral characterization of these groups can guide the development of future intervention strategies, considering the school and family contexts of these adolescents.

FACTORS ASSOCIATED WITH ASTHMA IN BRAZILIAN ADOLESCENTS: NATIONAL ADOLESCENT SCHOOL-BASED HEALTH SURVEY (PENSE-2012).

ABSTRACTObjective: To identify factors associated with asthma in Brazilian adolescents.Methods: Cross-sectional study based on data from the 2012 National Adolescent School-based Health Survey (PeNSE), a Brazilian survey applied by a self-reported questionnaire in a representative sample of 9th-grade students. Descriptive and inferential analysis was made based on the demographic, socioeconomic, clinical, food consumption and environmental characteristics potentially associated with asthma. Adolescents who presented wheezing in the last 12 months were considered asthmatic. A multiple logistic regression model was adjusted for confounding factors. Significance was defined as p≤0.05.Results: A total of 106,983 adolescents were studied. The prevalence of asthma was 23.2%. The final model was composed of 11 variables that were independently associated with asthma: female sex (OR=1.17), <14 years old (OR=1.12), not living with parents (OR=1.06), the highest number of days consuming ultra-processed foods (OR=1.16), lunch or dinner time without presence of parents or guardians (OR=1.13), meals in front of the TV or while studying (OR=1.18), not having breakfast frequently (OR=1.22), having smoked cigarettes (OR=1.36), having tried alcoholic beverage (OR=1.37), having used illicit drugs (OR=1.29) and having sought health care in the last year (OR=1.67).Conclusions: The results of the present study reinforce the multifactorial characteristic of asthma diagnosis. Prevention and control strategies should focus on groups of adolescents living in inadequate conditions when it comes to family dynamics, food consumption and behavior (drug use).