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 3 - Jul/Sep - 2019

Original Article Imprimir 

Páginas 40 a 50


Quality of life in adolescents in the environmental field: association with behavioral and sociodemographic factors

Calidad de vida en adolescentes relacionados con el medio ambiente: asociación con factores conductuales y sociodemográficos

Qualidade de vida em adolescentes no domínio meio ambiente: associação com fatores comportamentais e sociodemográficos

Autores: Maria Lucileide Costa Duarte1; Francisco Elizaudo Brito-Júnior2; Rafaela Bertoldi3; Naildo Santos Silva4; Paulo Felipe Ribeiro Bandeira5

1. Professional Master's Degree in Health Education (Child and Adolescent Health) from the State University of Ceará (UECE). Social Worker by the Federal Institute of Education, Science and Technology of Ceará (IFCE). Crato, CE, Brazil
2. Doctor in Biological Sciences (Toxicological Biochemistry) from the Federal University of Santa Maria (UFSM). Teacher at the Regional University of Cariri (URCA). Crato, CE, Brazil
3. Doctor in Human Movement Sciences from the Federal University of Rio Grande do Sul (UFRGS). Porto Alegre, RS, Brazil
4. Master in Human Movement Sciences from the Federal University of Rio Grande do Sul (UFRGS). Porto Alegre, RS, Brazil
5. Doctoral student in Human Movement Sciences from the Federal University of Rio Grande do Sul (UFRGS). Master in Human Movement Sciences from the Federal University of Rio Grande do Sul (UFRGS). Teacher at the Regional University of Cariri (URCA). Crato, CE, Brazil

Maria Lucileide Costa Duarte
(lucileideduarte@hotmail.com)
Instituto Federal de Educação, Ciência e Tecnologia do Ceará (IFCE), Departamento de Assuntos Estudantis, Campus Crato
Rodovia CE 292, Bairro Gisélia Pinheiro
Crato, CE, Brasil. CEP: 63115-500

Submitted on 12/14/2018
Approved on 19/03/2019

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How to cite this article

Keywords: Adolescent; Quality of Life; Environment.
Palabra Clave: Adolescente; Calidad de Vida; Medio Ambiente.
Descritores: Adolescente; Qualidade de Vida; Meio Ambiente.

Abstract:
OBJECTIVE: Evaluate the quality of life of the students of Technical courses integrated to the secondary education of a Federal Education Institution of Ceará of the municipality of Crato.
METHODS: This is a transversal, quantitative and census study with the participation of 202 adolescents aged 14 to 19 years. To measure the quality of life it was used the Whoqol-bref methodology, composed of the areas: Physical, Psychological, Social Relations and Environment. A sociodemographic and behavioral questionnaire was used to characterize the participants. Data were digitized in excel 2016. Data analysis was applied to descriptive statistics and regressions using structural equations modeling, using the maximum likelihood estimator. We adopted a significance level of p <0.05.
RESULTS: It was observed a significant association between the following variables: Income and Environmental Domain; Sex and the Environment Domain; Age and the Environment Domain.
CONCLUSION: Alternatives seeking to improve the style and quality of life of the adolescents researched can be traced within the school environment. Programs, projects and actions that aim to raise awareness and awareness of the harm of sedentary behavior, alcohol consumption, inadequate diet, excessive use of social networks, few hours of sleep involving not only students but also families, can be a way out to modify the daily attitudes of these individuals.

Resumen:
OBJETIVO: Evaluar la calidad de vida de los estudiantes de los cursos técnicos integrados a la escuela secundaria de una Institución Federal de Educación de Ceará de Crato.
MÉTODOS: Este es un estudio transversal, cuantitativo y censal que involucra a 202 adolescentes de 14 a 19 años. Para medir la calidad de vida utilizamos la metodología Whoqol-bref, compuesta por los dominios Físico, Psicológico, Relaciones Sociales y Medio Ambiente. También se utilizó un cuestionario sociodemográfico y de comportamiento para caracterizar a los participantes. Los datos se digitalizaron en Excel 2016. El análisis de datos se aplicó a estadísticas descriptivas y regresiones modelando ecuaciones estructurales utilizando el estimador de máxima verosimilitud. Se adoptó un nivel de significancia de p <0.05.
RESULTADOS: se encontró una asociación significativa entre las variables: ingresos y entorno del dominio; Consumo de alcohol y medio ambiente de dominio; Dominio del sexo y el medio ambiente; Dominio de la edad y el medio ambiente.
CONCLUSIÓN: Las alternativas que buscan mejorar el estilo de vida y la calidad de vida de los adolescentes encuestados pueden rastrearse dentro del entorno escolar. Los programas, proyectos y acciones dirigidos a crear conciencia sobre los efectos nocivos del comportamiento sedentario, el consumo de alcohol, la dieta inadecuada, el uso excesivo en las redes sociales, pocas horas de sueño que involucren no solo a los estudiantes sino también a las familias pueden ser una salida para cambiar las actitudes diarias actuales de estos individuos.

Resumo:
OBJETIVO: Avaliar a qualidade de vida dos escolares dos cursos Técnicos integrados ao ensino médio de uma Instituição Federal de Educação do Ceará do município do Crato.
MÉTODOS: Este é um estudo transversal, quantitativo e censitário com a participação de 202 adolescentes com idade entre 14 e 19 anos. Para mensurar a qualidade de vida utilizou-se a metodologia de Whoqol-bref, composto pelos domínios Físico, Psicológico, Relações Sociais e Meio Ambiente. Usou-se também um questionário sociodemográfico e comportamental para caracterização dos participantes. Os dados foram digitalizados em excell 2016. Na análise dos dados aplicou-se à estatística descritiva e regressões por meio de modelagem de equações estruturais, utilizando o estimador de máximo verossimilhança. Adotou-se um nível de significância de p< 0,05.
RESULTADOS: Encontrou-se uma associação significativa entre as variáveis: Renda e Domínio Meio Ambiente; Consumo de Álcool e Domínio Meio Ambiente; Sexo e o Domínio Meio Ambiente; Idade e o Domínio Meio Ambiente.
CONCLUSÃO: Alternativas que busquem melhorar o estilo e qualidade de vida dos adolescentes pesquisados podem ser traçadas dentro do ambiente escolar. Programas, projetos e ações que visem a sensibilização e conscientização dos malefícios do comportamento sedentário, consumo de bebidas alcóolicas, alimentação inadequada, uso excessivo nas redes sociais, poucas horas de sono envolvendo não apenas os discentes, mas também as famílias, podem ser uma saída para modificação das atuais atitudes cotidianas desses indivíduos.

INTRODUCTION

According to the World Health Organization (WHO), Quality of Life (QOL) is the "individual's perception of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concerns "1.

This construct has received more and more attention in the literature, gaining many meanings and approaches that permeate the most varied areas of knowledge, such as: sociology, education, medicine, nursing, psychology and others2.

In this sense, several instruments have been developed aiming to measure the QOL of the most varied populations, including adolescents. One of them is WHOQOL-Bref, developed by the WHO Quality of Life Group, and its Portuguese version validated in Brazil by Fleck et al.3-4.

Among its domains, the environment is constituted by the facets: physical security and protection; home environment; financial resources; health and social care: availability and quality; opportunities to acquire new information and skills; participation in, and recreation/leisure opportunities; physical environment: pollution/noise/traffic/climate) and transportation3.

In this context, Ayach et al.5 pointed out that despite technological advances, there is an absence of planning and environmental enhancement and quality of life focused on infrastructure and services directed to the sanitation sector, with the least favored classes being the hardest hit. He adds that in most poor countries, urbanization has led to difficulties in providing basic sanitation infrastructure, health services, job creation, decent housing and pollution control.

Given this situation, this study seeks to verify the relationship between sociodemographic and behavioral variables and the environmental domain of WHOQOL-bref in the adolescent population of a Federal Institute of Education in a city of Ceará State.


METHODS

The present study was developed based on the research database "Sociodemographic and behavioral determinants of lifestyle and quality of life in school adolescents". Participated in this study, 202 adolescents from 14 to 19 years of technical courses integrated to high school of a Federal Institution of Education of the city of Crato (CE). This is a cross-sectional, quantitative and census-based analysis. The study protocol was approved by the Ethics Committee of the State University of Ceará, under Opinion No. 2,421,758.

The Informed Consent Form (ICF) was given to underage adolescents for parental knowledge and authorization so that they could participate in the study. The Free and Informed Consent Terms were also delivered. For the adults, the document was delivered to those who wished to participate in the research. Upon return of the signed Terms, students were entered into the investigation. QOL was measured using the WHOQOL-Bref questionnaire validated in Brazil by Fleck et al.3 The document consists of four domains: Physical, Psychological, Social Relations and Environment.

For data analysis, Excel and Program R (Version 3.5.1) and Mplus (Version 8.0) were used. To describe sociodemographic and behavioral variables, lifestyle and quality of life, descriptive statistics of central tendency (mean and standard deviation) and frequency distribution (relative and absolute values) were used. Normality was assessed by asymmetry and kurtosis. To assess the presence of multivariate outliers, the Mahanalobilis distance6 was used. Results indicated univariate and multivariate normality of data.

To evaluate possible associations, regression analyzes were used through structural equation modeling, using the maximum likelihood estimator. Values of p<0.05 were considered significant.


RESULTS

This study had the participation of 202 adolescents, with male prevalence (55%). The age ranged from 14 to 19 years, especially the age of 15 years (36.6%). Most of the adolescents studied are from rural areas (51%), 46.5% are in the 1st grade and 57.9% declared brown. Family income of up to two minimum wages was reported by 84.2%. Not performing any occupational activity was cited by 92.6% of the students, and 12.9% expressed regular consumption of alcohol.

Regarding the WHOQOL-bref questionnaire, an average score of 58.6% was observed for Global Quality of Life. Alluding to the domains, the best result was seen in the Social Relations domain with an average of 66% and the worst in the physical domain (51.6%) (Table 1).




Regarding the association between sociodemographic and behavioral variables and quality of life, the following results were obtained: Income and Environmental Mastery (B = 0.198; p = 0.003); between Alcohol Consumption and Environment Domain (B = -0.157; p = 0.017); between the variable Sex and the Environment Domain (B = -0.175; p = 0.019); and between the variable Age and the Environment Domain (B = -0.141; p = 0.034) (Table 2).




DISCUSSION

It is relevant to identify factors associated with quality of life in adolescents, in order to adopt measures that corroborate their physical, mental and social well-being. Thus, we sought to verify in this analysis the association between sociodemographic and behavioral variables and environmental domain of the quality of life of the analyzed adolescents.

The present study revealed that females have a more negative environmental view than boys. These results coincide with the findings of Gordia et al.7, who assume that girls have a higher level of demand for QOL perception than boys. Benincasa8 also obtained this same result. The author draws on literature indicating that women are more complaining, use more medication, show higher levels of disability throughout their lives, feel more fragile than men, and are twice as likely to suffer from depression.

Corroborating these studies, Baumann et al.9, found that girls are more prone to a lower quality of life. The authors note that prevention to reduce the gender gap should consider the specific characteristics of boys and girls. Similarity also found in other investigations10-11-12. Contrary to these results, the study conducted by Biswas, Bhattacherjee and Mukherjee13 with adolescents from Siliguri - India indicates that girls had a better perception of the environment when compared to boys. Several studies using the WHOQOL-bref presented the environment domain with lower average in relation to the other spheres7,14-16.

It is good to emphasize that the aggravation of urban problems in contemporary times and the possibilities that the city offers for the execution of social projects, urged WHO and its regional agencies, such as the Pan American Health Organization (PAHO), to propose the strategy of cities healthy. The ideas that underlie this proposal assume that health depends not only on doctors or drugs, but on a set of factors - social interactions, policies, environmental interventions, among others17.

Considering that the social conditions in which the subject lives have a direct impact on the health and quality of life of citizens, several Brazilian municipalities have implemented interventionist actions in the areas of education, basic sanitation, medical care and work environments14. Nevertheless, the allusive commitment of the rulers to policies aimed at better living conditions for the population is still quite low7.

Referring to the issue of adolescence, it is worth noting that females make up a vulnerable group in relation to subjective aspects and health-related quality of life. It is a phase that coincides with menstrual cycles, emotional imbalance, prevalence of stressful events, specific coping mechanisms, differences in cultural demands, may present higher levels of depression and anxiety than boys and are more concerned with their well-being and more sensitive, making them more vulnerable to psychosomatic disorders and mental complaints18.

Still regarding the environment domain, age was statistically significant indicating that older adolescents demonstrated to have lower quality of life. These results are consistent with the outcomes of other studies8,15.

Al-Fayez and Ohaeri11 observed that QoL decreased with age in both genders in their analyzes in Kuwait - Arabia, mediated by difficulties in studies and social relationships, as older young people were overloaded with school and more in demand for relationships. In this line of thought, Benincasa8 assumes in his analyzes that the older students (3rd grade) are linked to the pressures of the period, because they are about to leave school and enter the job market or try the entrance exam.

However, other investigations have come across a different reality. Biswas, Bhattacherjee and Mukherjee13 observed that older students had better QoL than younger students. The authors believe that this may be due to the greater autonomy over their behaviors and company choices that the older teenager has. Similar situation found by Marinho and Vieira19, in their study with adolescents with special needs (physical, visual and hearing) from Petrolina - PE, where they realized that the older age group was more satisfied with their life.

These results alert to the need for greater care in relation to adolescents, regardless of age. Younger children need greater parental protection because they are still in the path of biopsychosocial transformation. Older, although more mature ones need protection as well as self-control in their attitudes so as not to engage in risky behaviors. Finally, both require support, attention, welcome and strategies to calm the levels of pressure/tension they suffer in daily life, either to enter a higher education or to enter the labor market.

Regarding alcohol consumption, it was observed that the consumption of this substance by adolescents had an influence on a lower quality of life. Given the construction of identity in adolescence, it is considered that the major conflict to be resolved at this stage is the so-called identity crisis. It is at this time that the adolescent seeks new identifications and this search for new experiences, sensations and curiosities induces the great concerns associated with the risks related to alcohol and other drugs consumption. More and more adolescents are experimenting and regularly using alcohol20.

In this sense, the present study evidenced the regular consumption of alcohol in a small extract of the students. Outcome lower than those found by the Global School - Based Student Health Survey20 with adolescents in East Timor (15.7%) and the Philippines (18.2%) and Youth Risk Behavior Surveillance - United States21 (32.8%). The national literature also confirms the use of this substance in adolescents22,27.

The WHO declares that alcohol is the most consumed psychoactive substance in the world and represents the main drug of choice for children and adolescents. In Brazil, alcohol is the most used product by the adult population and its consumption has increased among young people in recent decades, especially among those aged 12 to 15 years27.

It is noteworthy that episodic alcohol consumption occurs more frequently among adolescents and can occur abusively leading to potential health risks, such as alcohol intoxication28. In their opinion, alcohol during this period is a complex, multifactorial and socially determined phenomenon. Factors in the family, school, sociodemographic context, relationship with friends and peers participate in the explanatory chain of the use of this substance.

From this perspective, Benites and Schneider29 observed in a systematic review that the factors implicated in the use of alcohol in both sexes have distinct particularities, both regarding biological and socio-familial aspects. In this context, Silveira, Santos and Pereira27 reported that they are associated with alcohol use, increased intra and extra-family violence, traffic accidents, deficit and dropout, risk behaviors such as transmission of sexually transmitted diseases (STDs), aggressions, clinical depressions and unplanned pregnancy.

Neves, Teixeira and Ferreira20 also recalled that excessive alcohol consumption during this period causes a sharp drop in the teaching-learning process. There is a greater absence from classes and those who attend them have drowsiness, slowness and difficulties to assimilate the content taught by the teacher.

It is relevant to add that the use of alcohol is increasing in the female population. Information from the II National Alcohol and Drug Survey showed that there was an increase in habitual consumption (by five doses or more) among adolescents aged 14 to 17 years compared to 2006 and 2012. In these years, girls ingested more (from 11% to 20% respectively) than boys (from 31% to 24%) 30, a similar situation found in another study31.

Investigating the pattern of alcohol consumption in Brazilian adolescents regardless of gender, Coutinho et al.23 observed a high prevalence of alcohol use by adolescents, as well as early onset of use. These authors indicate that a systematic review of 28 population studies with adolescents aged 10-19 years found prevalence of alcohol consumption (according to different definitions) ranging from 23% to 68%. Gonçalves et al.32, in their study in Rio Grande do Sul, found in adolescents the experimental use of alcohol in 87.5% and intoxication in 20.5% in those with sexual activity before 15 years.

It is worth mentioning that there is a Brazilian legislation directed to the issue of alcohol use initiated in 2003, and in 2009, emerged the Emergency Plan to expand the above mentioned treatment and prevention in alcohol and other drugs33. It is also approached that the Statute of the Child and the adolescent (ECA) created in 1990, in its Art. 81 advocate the prohibition of the sale of alcoholic beverages for children and adolescents34.

Thus, there is a need for special attention to the adolescents in this study, in order to inhibit attitudes of consumption to alcohol and other drugs. As small as the average of young regular consumers of this product has been, it has had an impact on the quality of life of the group. The results point to the existence of family, health and social damages that culminate in the need for care and high costs to society.

The results observed in the analysis between sociodemographic variables and WHOQOL-bref showed that income was statistically significant in relation to the Environment Domain, indicating that a higher family income implies a better quality of life in this domain. Considering that a huge statement reported having a family income of up to two minimum wages, it can be inferred that this group falls into a worse quality of life when compared to its peers in other salary ranges.

This data corroborates with other studies already carried out, such as Biswas, Bhattacherjee and Mukherjee13, who found in the environmental domain that young people with lower family income had lower perception of QOL. Chazan and Campos10, analyzing the influence of some sociodemographic variables on students with an average age of 23 years, found a decreasing level in all QoL domains among the three economic classes (A, B, C), and this statistically significant difference was marked. in the environmental domain (p = 0.000).

Gordia et al.7 found that adolescents from classes B, C, D and E had lower levels of negative perception in the environmental domain than those from socioeconomic class A. Contrary to these results, Marinho and Vieira19 identified a positive perception of QOL in those whose families had incomes of up to two minimum wages when compared to those of three or more minimum wages. In another analysis, Torres and Vieira4 noticed that there is no difference in the age ranges between up to four salaries and five or more salaries.

Despite the divergence between outcomes, it is understood that household economic conditions interfere positively or negatively with their overall well-being. There is an understanding that low economic conditions may be related to a limitation in food and social care, inhibiting health and education, and significantly affecting people's quality of life35. Gordia et al.7 understand that adolescents from disadvantaged socioeconomic conditions are more likely to live in regions lacking infrastructure and services, resulting in lower QoL for this group.

Regarding the disadvantaged socioeconomic issue, it is worth remembering that the Brazilian federal government launched in 2003 the Bolsa Família Program, which offers benefits to extremely poor families and poor families, linked to health, education and social assistance policy conditionalities. Due to the dynamic nature of poverty, throughout 2006-2012, many families overcame monetary poverty while others entered this profile, with a regular inflow and outflow of families into the program so that it reaches its public. target36. In this scenario, Campello37 understands that through this program Brazil can refuse the trivialization and naturalization of poverty and hunger and establish a new level of social guarantees, which require recognition and expansion of minimum welfare standards to citizens.

In this scenario, Campello37 understands that through this program Brazil can refuse the trivialization and naturalization of poverty and hunger and establish a new level of social guarantees, which require the recognition and expansion of minimum welfare standards to citizens.


CONCLUSION

In this analysis, some aspects related to the habits and quality of life of the surveyed adolescents was verified that may help in the process of health surveillance policies and their well-being.

It was found that girls have a negative environmental view when compared to boys, which may be linked to a higher level of demand or to be more sensitive than boys. For the environmental domain, younger adolescents demonstrated better quality of life. These students are likely to have a less "demanding" family and social environment and at the same time not have a level of maturity that can understand which environmental characteristics can provide them with an ever better quality of life. Perhaps older participants are more empowered, mature, overworked and more autonomous, being able to visualize the future beyond what they already have. This data motivates the need for discussion and reflection with this population, for their own benefit and for the community itself.

With regard to income, it was found that students with lower family income had a lower quality of life and this fact contributed to a decrease in QOL in the environmental domain. This information confirms the need for public policies in the three spheres of government aimed at improving the living conditions of the population that are often held hostage by social programs such as Bolsa Família, for example.

Regarding alcohol, it can be concluded that there is a regular rate of alcohol consumption by the investigated (12.9%), which induces the need for interventions that combat the use of this substance in adolescence, to avoid damage to the health not only of the individual, but his family and society.

Based on these findings, alternatives that seek to improve the style and quality of life of the surveyed adolescents can be traced within the school environment. Programs, projects and actions aimed at raising awareness of the harmful effects of sedentary behavior, alcohol consumption, inadequate diet, excessive use in social networks, few hours of sleep involving not only students, but also families, can be a way out. to change the current daily attitudes of these individuals.

The results of this study provide valuable information on the predictors of quality of life of high school adolescents in the city of Crato-CE, thus contributing to the planning and development of programs/projects/services and actions in the area of health promotion of the school.

Regarding the strengths of this analysis, a good representation (around 60%) of adolescents enrolled in 2018 is highlighted. It is also relevant to highlight the limitations of this study. This is a cross-sectional study that does not allow inferences about cause and effect on this theme, and the WHOQOL-bref is an instrument marked by subjectivity. As for the findings, these refer to the adolescents from the technical courses integrated to the high school of a Federal Education Institution of the city of Crato/CE, and cannot be generalized to those who, for some reason, are out of school, to other high school students or for those who live in other areas or regions.


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