Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 1 - Jan/Mar - 2019

Original Article Imprimir 

Páginas 60 a 68


Exposure to sedentary behavior and factors associated with adolescents of the state of Sergipe, Brazil

Exposición al comportamiento sedentario y factores asociados en adolescentes del estado de Sergipe, Brasil

Exposição ao comportamento sedentário e fatores associados em adolescentes do estado de Sergipe, Brasil

Autores: Davi Soares Santos Ribeiro1; Lucas Souza Santos2; Aldemir Smith Menezes3

1. Master in Physical Education, Federal University of Sergipe (UFS). Aracaju, SE, Brazil. Lecturer at the University Center AGES (UniAGES). Paripiranga, BA, Brazil
2. Master in Physical Education by the Federal University of Sergipe (UFS). Teacher of Physical Education by the Municipal Networks of Basic Education of the Municipalities of Aracaju and Nossa Senhora de Lourdes. Aracaju, SE, Brazil
3. Doctoro in Physical Education by the Federal University of Santa Catarina (UFSC). Florianópolis, SC, Brazil. Professor at the Post-Graduation Program in Physical Education, Federal University of Sergipe (PPGEF/UFS). Aracaju, SE, Brazil

Davi Soares Santos Ribeiro
Rua Dr. Pedro Barreto, nº 348, Centro
Simão Dias, SE, Brasil. CEP: 49480-000
profdavi@live.com

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Keywords: Adolescent; Adolescent Behavior; Students.
Palabra Clave: Adolescente; Comportamiento del Adolescente; Estudiantes.
Descritores: Adolescente; Comportamento do Adolescente; Estudantes.

Abstract:
OBJECTIVE: Identify the level of exposure to sedentary behavior and analyze its association with demographic and socioeconomic indicators condition in adolescents from the State of Sergipe from 2011 and 2016.
METHODS: The study deals with two epidemiological surveys with a cross- conducted in 2011 and 2016, with a representative sample of students from the State Public Network of Sergipe, composed of 8,143 students (2011 = 3992, 2016 = 4151), age 14 to 19 years. Was investigated the exposure to sedentary behavior associated with demographic and socioeconomic condition indicators in adolescents. For the statistical analysis, descriptive and chi-square statistics were used. We used the raw and adjusted binary logistic regression.
RESULTS: The prevalence of SCS was 46.2% (2011) and 44.8% (2016) and it was associated with the age group of 14 to 15 years (OR = 1.45, 95% CI: 1, 19-1.78 / 2016 = OR: 1.58; 95% CI: 1.28-1.94); (95% CI: 1.27-1.68 / 2016 = OR: 1.22, 95% CI: 1.06-1.40), adolescents living in the urban area ( 2011 = OR: 1.22, 95% CI: 1.05-1.42 / 2016 = OR: 1.48, 95% CI: 1.27-1.72) and who have mothers with high school education (2011 = OR: 1.73, 95% CI: 1.32-2.28) and with higher education (2016 = OR: 1.57, 95% CI: 1.16-2.11).
CONCLUSION: There was a tendency to reduce the level of exposure to sedentary behavior. It is suggested interventions in urban areas and subgroups that are more vulnerable to CS, such as adolescents aged 14 to 15 years and females.

Resumen:
OBJETIVO: Identificar el nivel de exposición al comportamiento sedentario (ECS) y analizar su asociación con indicadores de condición demográfica y socioeconómica en adolescentes del Estado de Sergipe en los años 2011 y 2016.
MÉTODOS: El estudio trata de dos estudios epidemiológicos con delineamiento transversal, realizados en 2011 y 2016, con muestra representativa de estudiantes de la Red Pública Estadual de Sergipe, compuesta por 8.143 escolares (2011=3992; 2016=4151), con edad entre 14 y 19 años. Fue investigada la ECS asociada a indicadores de condición demográfica y socioeconómica en adolescentes. Para el análisis estadístico fue utilizada estadística descriptiva y el chi-cuadrado. Se recurrió a la regresión logística binaria bruta y ajustada.
RESULTADOS: La prevalencia de ECS fue de 46,2% (2011) y 44,8% (2016) y se asoció a franja etaria de 14 a 15 años (2011=OR: 1,45; IC 95%: 1,19-1,78 / 2016 = OR: 1,58; IC 95%: 1,28-1,94); sexo femenino (2011=OR: 1,46; IC 95%: 1,27-1,68/2016=OR: 1,22; IC 95%: 1,06-1,40), adolescentes residentes en el área urbana (2011=OR: 1,22; IC 95%: 1,05-1,42/2016=OR: 1,48; IC 95%: 1,27-1,72) y que poseen madres con enseñanza media (2011=OR: 1,73; IC 95%: 1,32-2,28) y con enseñanza superior (2016=OR: 1,57; IC 95%: 1,16-2,11).
CONCLUSIÓN: Hubo tendencia a la reducción del nivel de ECS. Se sugiere intervenciones en las áreas urbanas y en subgrupos más vulnerables al CS como en los adolescentes con franja etaria de 14 a 15 años y del sexo femenino.

Resumo:
OBJETIVO: Identificar o nível de exposição ao comportamento sedentário (ECS) e analisar sua associação com indicadores de condição demográfica e socioeconômica em adolescentes do Estado de Sergipe nos anos 2011 e 2016.
MÉTODOS: O estudo trata de dois levantamentos epidemiológicos com delineamento transversal, realizados em 2011 e 2016, com amostra representativa de estudantes da Rede Pública Estadual de Sergipe, composta por 8.143 escolares (2011=3992; 2016=4151), com idade entre 14 e 19 anos. Foi investigada a ECS associada a indicadores de condição demográfica e socioeconômica em adolescentes. Para a análise estatística foi utilizada estatística descritiva e o qui-quadrado. Recorreu-se à regressão logística binária bruta e ajustada.
RESULTADOS: A prevalência de ECS foi de 46,2% (2011) e 44,8% (2016) e associou-se a faixa etária de 14 a 15 anos (2011= OR: 1,45; IC 95%: 1,19-1,78 / 2016 = OR: 1,58; IC 95%: 1,28-1,94); sexo feminino (2011= OR: 1,46; IC 95%: 1,27-1,68 / 2016 = OR: 1,22; IC 95%: 1,06-1,40), adolescentes residentes na área urbana (2011= OR: 1,22; IC 95%: 1,05-1,42 / 2016= OR: 1,48; IC 95%: 1,27-1,72) e que possuem mães com ensino médio (2011= OR: 1,73; IC 95%: 1,32-2,28) e com ensino superior (2016= OR: 1,57; IC 95%: 1,16-2,11).
CONCLUSÃO: Houve tendência à redução do nível de ECS. Sugere-se intervenções nas áreas urbanas e em subgrupos mais vulneráveis ao CS como nos adolescentes com faixa etária de 14 a 15 anos e do sexo feminino.

INTRODUCTION

Sedentary behavior refers to a set of activities performed with the body in a sitting or reclining position and with energy expenditure close to rest values (<1.5 MET) 1. International recommendations recommend that children and adolescents should limit their time to sedentary behaviors, such as watching television, using the computer, playing video games, talking to friends or the like, 2 hours a day at most.

Sedentary behavior is recognized as a public health issue3 and is related to deleterious effects on health4. Studies have shown that exposure to sedentary behavior (ECS), in addition to associating obesity5, metabolic syndrome6, diabetes mellitus7 and cardiovascular diseases4,8 may be a risk factor for mortality regardless of the level of physical activity9. A national survey showed that 59.8% of adolescents were exposed to at least two hours of television per day10.

In this context, it is verified that, despite the recognition of the importance of low ECS as a factor for health promotion and disease prevention, several adolescents can´t reach the levels of SCHs recommended by international institutions11. In addition, studies show that young people tend to extend this behavior into adulthood12.

Therefore, this study is justified by the need to identify the level of physical activity and SSE and associated factors in adolescents. Demographic and socioeconomic characteristics may justify the possibility of differentiated outcomes between Brazilian states and subsidize the development of public health promotion policies for the adoption of healthy lifestyles in adolescents in the State of Sergipe, Brazil.

Thus, this study aimed to verify the prevalence of CSD and to analyze its association with indicators of demographic and socioeconomic conditions in adolescents from the State of Sergipe in the years 2011 and 2016.


METHODS

Epidemiological studies of secular trends, with a cross - sectional design, were carried out in high school students of the state education network, residents of the State of Sergipe, Brazil. In order to do so, two surveys were conducted entitled "Secular Trend in Health Risk Behaviors in Adolescents: CRiS_Adolescents Study" developed by the Research Group on Physical Education and Health of the Federal Institute of Education, Science and Technology of Sergipe (GPEFiS/IFS).

The population was made up of schoolchildren from 14 to 19 years of age, both boys and girls, regularly enrolled in the High School of the State Teaching Network, in the day and night shifts. For the sample calculation of the research was used StatCalc available in software Epi Info.

To estimate the sample size in the prevalence analysis, the population size was estimated, the prevalence estimated to be 50% as the highest, the 95% confidence interval, and a 5% tolerable sampling error. For the analysis of association was considered, in addition to the information previously described, statistical power of 80% and Odds Ratio (OR) of 1.2. In order not to lose sample representativeness, 20% of schoolchildren were added due to several reasons, such as: refusal of the participant, age greater or less than that established in this study, not answering important questions such as sex and age.

Stratified sampling was used in two stages: (1) stratified sampling process proportional to the size of the region, according to the size of the teaching unit (1 = 199 students, 2 = 200-499 students, 3 = 500 students or more). Thus, considering the size of the schools, the selection of 25% of the state teaching units (155 teaching units) was randomly selected, totaling 39 (2011) and 42 (2016) schools; (2) the classes were selected proportionally according to the series and the school shift, using the simple random process, considering 20 students per class. The final sample consisted of 8,143 adolescents (2011 = 3,992 adolescents, 2016 = 4,151 adolescents).

The criteria adopted to include the participants in the research were: to be regularly enrolled in the 1st to 3rd grade classes of the selected schools; be present at the time of application of the instrument; appropriately complete the distributed questionnaire. The adolescents' participation in the study was voluntary and anonymous.

Regarding the ethical aspects, the research was authorized by the State Secretary of Education, the directors of the Regional Directorates of Education and the directors of the Units of Education researched. In addition, signing of the Negative Term of Free and Informed Consent by the parents of the students and signing of the Students' Term of Assent. The surveys were approved by the Ethics Committee in Human Research CEP/CONEP/CNS, under protocol no. 177/2010 CEP/HU/UFS and no. 1,522,876/2016 CEP/IFS, respectively.

The questionnaire used was a version of the Global School-based Student Health Survey, proposed by the World Health Organization (GSHS/WHO) for collecting information regarding socio-demographic and economic aspects, physical activity level and exposure to sedentary behavior. The data collection was performed by means of a questionnaire by two duly trained researchers. The mean application time in each class was 45 minutes.

The outcome variable of the study was ECS; and the independent variables were: age, sex, place of residence, maternal schooling, monthly family income (minimum wage) and source of income. Adolescents who spent more than or equal to two hours on the screen, such as watching television, using the computer, playing video games, talking to friends or the like2 were considered "exposed to sedentary behavior."

For the statistical treatment, the variables were analyzed using descriptive and inferential procedures. In the bivariate association analysis, the chi-square test was used for heterogeneity. In the multivariate analysis, crude binary logistic regression was used, adjusted for the study outcomes.

The variables with p <0.20 in the crude analysis were inserted in the adjusted model and the level of significance adopted was 5%. The statistical program SPSS 22.0 was used.


RESULTS

The survey instrument answered 9,438 adolescents (2011 = 4,717, 2016 = 4,721). We excluded from the sample people aged over 19 (2011 = 709, 2016 = 549), aged less than 14 years (2011 = 08, 2016 = 12), who didn´t report age (2011 = 02, 2016 = 06), who didn´t report the gender (2011 = 03; 2016 = 12) and didn´t fill several questions in the collection instrument (2011 = 11; 2016 = 03). The final sample consisted of 8143 (2011 = 3.992, 2016 = 4.151).

Table 1 shows the demographic and socioeconomic characteristics of the sample. The majority of the students were 16 and 17 years old, female, resided in urban areas, had mothers with elementary education and had a source of income from the work of the father and/or mother. There was a reduction in the purchasing power of families with monthly income above 1 minimum wage.




Table 2 shows the relationship of ECS with demographic and socioeconomic characteristics. There was a higher prevalence among adolescents with 14 and 15-year-old females living in the urban area, who have mothers with high school and higher education, who have monthly family income above two minimum wages and a source of income from pensions in both surveys.




Table 3 shows the gross and adjusted association between ECS and demographic and socioeconomic conditions. In the adjusted analysis, the association with age, sex, place of residence, maternal schooling and monthly family income was verified in both surveys.




DISCUSSION

The study presented the prevalence of adolescents with SCD, besides the association of this behavior with socioeconomic and demographic indicators in the State of Sergipe. A considerable prevalence of adolescents exposed to sedentary behavior was observed, being higher in the female students aged 14 and 15 years, female residents of the urban area, who have mothers with high school and/or higher, with monthly family income above of two minimum wages and source of income from pension in both surveys.

It was verified that 46.2% (2011) and 44.8% (2016) among adolescents were exposed to more than two hours sitting, watching TV, using computer, talking with friends, playing cards or dominoes. The outcome is consistent with international research that reported high prevalence of screen-time youth in 34 countries of the American continent13. National studies also showed 40.9% of schoolchildren in Pernambuco14, in Pelotas-RS with 79.7% of adolescents15 and throughout the country with 60% of adolescents exposed to sedentary behavior10.

Adolescents aged 14 and 15 years had a higher prevalence for SCS (2011 = 52.7%, 2016 = 51.1%) and odds higher than SCS when compared to other ages. It has been observed that the percentage of adolescents for behavioral exposure decreases as they grow older, unlike investigations in Greece-Cyprus16 and in Pernambuco, Brazil14.

The girls had a high prevalence (2011 = 48.8%/2016 = 46.7%) for ECS, according to studies in Greece-Cyprus16 and in southern Brazil17. It was also verified that the female adolescents have a higher odds of CSD when compared to boys18. This can be explained by the sociocultural aspects that reduce girls' chances of practicing physical activity19.

Adolescents living in the urban area presented a higher prevalence (2011 = 50%, 2016 = 49.7%) and greater chances for ECS compared to rural residents, unlike investigations in Portugal20 and in Saudi Arabia21.

There was a relationship between higher maternal schooling (high school and higher education) and increased sedentary behavior, according to a study in the United Kingdom22. The fact that parents with a higher level of education encourage a longer period of study in adolescents23 may contribute to sedentary activities.

There was also a relationship between higher monthly family income (above two minimum wages) and increased sedentary behavior. The association between sedentary behavior and socioeconomic status was also verified in a cross-sectional study from Mato Grosso24.

The increase in family purchasing power is an important factor of sedentary behavior in children and adolescents15,25,26, as in the purchase of electronic devices for adolescents22, favoring sedentary activities. In this sense, a trend study showed an increase in the prevalence of computer and video game use between 2001 and 2011 in adolescents from Santa Catarina27.


CONCLUSION

It was concluded that there was a trend in the reduction of ECS in adolescents from a state in northeastern Brazil in the years 2011 and 2016. A higher prevalence of SCD was observed in adolescents aged 14 to 15 years, female and resident in the urban area. ECS in adolescents was associated with age, sex, place of residence and maternal schooling in both surveys. Thus, it is suggested the elaboration of public policies to reduce the ECS and to opportune the construction of healthy lifestyles to the adolescents.


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