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

Original Article

Vol. 16 nº 3 - Jul/Sep - 2019
Pages:40-
50

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

Authors: ^¹, ^², ^³, ^⁴, ^⁵

¹Professional Master’s Degree in Health Education (Child and Adolescent Health) from the State University of Ceará (UECE). Social Worker from the Federal Institute of Education, Science and Technology of Ceará (IFCE). Crato, CE, Brazil

²PhD in Biological Sciences (Toxicological Biochemistry) from the Federal University of Santa Maria (UFSM). Professor at the Regional University of Cariri (URCA). Crato, CE, Brazil

³PhD in Human Movement Sciences from the Federal University of Rio Grande do Sul (UFRGS). Porto Alegre, RS, Brazil

⁴Master’s Degree in Human Movement Sciences from the Federal University of Rio Grande do Sul (UFRGS). Porto Alegre, RS, Brazil

⁵PhD student in Human Movement Sciences from the Federal University of Rio Grande do Sul (UFRGS). Master’s Degree in Human Movement Sciences from the Federal University of Rio Grande do Sul (UFRGS). Professor at the Regional University of Cariri (URCA). Crato, CE, Brazil

Correspondence:

Maria Lucileide Costa Duarte
( lucileideduarte@hotmail.com )
Federal Institute of Education, Science and Technology of Ceara (IFCE), Department of Student Affairs, Crato Campus,
CE Highway 292, Gisélia Pinheiro Neighborhood,
Crato, CE, Brazil. Postal Code: 63115-500

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

Keywords: Adolescent; Quality of Life; Environment.

Abstract

OBJECTIVE: To evaluate the quality of life of students enrolled in technical courses integrated into high school at a Federal Educational Institution in the city of Crato, Ceará.
METHODS: This is a cross-sectional, quantitative and census study with the participation of 202 adolescents aged between 14 and 19 years. To measure quality of life, the Whoqol-bref methodology was used, consisting of the Physical, Psychological, Social Relations and Environment domains. A sociodemographic and behavioral questionnaire was also used to characterize the participants. The data were digitized in Excel 2016. In the data analysis, descriptive statistics and regressions were applied through structural equation modeling, using the maximum likelihood estimator. A significance level of p < 0.05 was adopted.
RESULTS: A significant association was found between the variables: Income and Environment Domain; Alcohol Consumption and the Environment Domain; Sex and the Environment Domain; Age and the Environment Domain.
CONCLUSION: Alternatives that seek to improve the lifestyle and quality of life of the adolescents studied can be outlined within the school environment. Programs, projects and actions that aim to raise awareness and consciousness of the harm caused by sedentary behavior, alcohol consumption, inadequate diet, excessive use of social networks, and few hours of sleep, involving not only students but also their families, can be a way to change the current daily attitudes of these individuals.

INTRODUCTION According to the World Health Organization (WHO), Quality of Life (QoL) is “an individual’s perception of his or her position in life in the context of the culture and value system in which he or she lives and in relation to his or her goals, expectations, standards, and concerns” ¹ . This construct has received increasing 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 others ² . In this sense, several instruments have been developed to measure the QoL of the most varied populations, including adolescents. One of them is the WHOQOL- BREF , developed by the WHO Quality of Life Group, and its Portuguese version was validated in Brazil by Fleck et al. ^3-4 . Among its domains, the Environment domain is constituted by the following facets: physical safety and protection; home environment; financial resources; health and social care: availability and quality; opportunities to acquire new information and skills; participation in, and opportunities for recreation/leisure; physical environment: pollution/noise/traffic/climate) and transportation ³ . In this context, Ayach et al. ⁵ pointed out that despite technological advances, there is a lack of planning and environmental appreciation and quality of life focused on infrastructure and services directed at the sanitation sector, with the less favored classes being the most affected. They add that in most poor countries, urbanization has triggered difficulties in providing basic sanitation infrastructure, health services, job creation, decent housing and pollution control. In view of this situation, this study seeks to verify the relationship between sociodemographic and behavioral variables and the environment domain of the WHOQOL- bref in the adolescent population of a Federal Institute of Education in a city in the state of Ceará. METHODS This study was developed based on the database of the research “Sociodemographic and behavioral determinants of lifestyle and quality of life in adolescent students”. The study included 202 adolescents aged 14 to 19 years old from Technical Courses integrated into high school at a Federal Education Institution in 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 Free and Informed Consent Form (FICF) was given to the minors for their parents’ knowledge and authorization, so that they could participate in the study. The Free and Informed Assent Forms were also given. For the adults, the document was given to those who wished to participate in the research. After returning the signed Terms, the students were included in 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. In the data analysis, Excel and the R Program (Version 3.5.1) and Mplus (Version 8.0) were used. To describe the 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 through asymmetry and kurtosis. The Mahanalobilis distance ⁶ was used to assess the presence of multivariate outliers . The results indicated univariate and multivariate normality of the data. To assess possible associations, regression analyses were used through structural equation modeling, using the maximum likelihood estimator. Values of p<0.05 were considered significant. RESULTS This study included the participation of 202 adolescents, with a prevalence of males (55%). Age ranged from 14 to 19 years, with 15 years standing out (36.6%). Most of the adolescents studied are from rural areas (51%), 46.5% are in the 1st grade and 57.9% declared themselves to be brown. Family income of up to two minimum wages was reported by 84.2%. Not having any occupational activity was mentioned by 92.6% of the students, and 12.9% expressed regular alcohol consumption. Regarding the WHOQOL- bref questionnaire , an average score of 58.6% was observed for Global Quality of Life. In reference to the domains, the best result was perceived 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 Environment Domain (B= 0.198; p=0.003); between Alcohol Consumption and Environment Domain (B=-0.157; p=0.017); between the Sex variable and the Environment Domain (B=-0.175; p=0.019); and between the Age variable and the Environment Domain (B=-0.141; p=0.034) (Table 2).

DISCUSSION It is important to identify factors associated with quality of life in adolescents, so that measures can be adopted to contribute to their physical, mental and social well-being. Thus, this analysis sought to verify the association between sociodemographic and behavioral variables and the environmental domain of the quality of life of the adolescents analyzed. The present study revealed that females have a more negative view of the environment than boys. These results coincide with the findings of Gordia et al. ⁷ , who assumed that girls have a higher level of demand in the perception of QoL than boys. Benincasa ⁸ also obtained the same result. The author uses the literature that indicates that women are more complaining, consume more medications and show higher levels of disability throughout their lives, perceive themselves as 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 likely to have a lower quality of life. The authors state that prevention to reduce the gender gap should consider the specific characteristics of boys and girls. This similarity was also found in other studies ^10-11-12 . Contrary to these results, the study conducted by Biswas, Bhattacherjee and Mukherjee ¹³ with adolescents from Siliguri, India, indicates that girls had a better perception in the environmental domain when compared to boys. Several studies using the WHOQOL-bref showed the environmental domain with a lower average in relation to the other domains ^7,14-16 . It is important to emphasize that the worsening of urban problems in contemporary times and the possibilities that the city offers for the implementation of social projects prompted the WHO and its regional agencies, such as the Pan American Health Organization (PAHO), to propose the healthy cities strategy. The ideas that underpin this proposal are based on the principle that health does not depend solely on doctors or medicines, but on a set of factors – social interactions, policies, interventions in the environment, among others ¹⁷ . Considering that the social conditions in which individuals live 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 environments ¹⁴ . Nevertheless, the commitment of governments to policies aimed at improving living conditions for the population is still quite low ⁷ . Regarding the issue of adolescence, it is worth noting that females are 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, and differences in cultural demands. Females may have higher levels of depression and anxiety than males, and are more concerned about their well-being and more sensitive, making them more vulnerable to psychosomatic disorders and mental complaints ¹⁸ . Still on the environmental domain, age showed statistical significance, indicating that older adolescents demonstrated a lower quality of life. These results are consistent with the outcomes of other studies ^8,15 . Al-Fayez and Ohaeri ¹¹ observed that QoL decreased with age in both sexes in their analyses in Kuwait – Arabia, with difficulties in studies and social relationships as mediators, since older adolescents were overloaded with school and had greater demands for relationships. Along these lines, Benincasa ⁸ assumes in his analyses that older students (3rd grade) are subject to the pressures of the period, as they are about to leave school and enter the job market or take the college entrance exam. However, other studies have found a different reality. Biswas, Bhattacherjee and Mukherjee ¹³ observed that older students had a better QoL than younger ones. The authors believe that this fact may be due to the greater autonomy over their behavior and choices of their companions that older adolescents have. A similar situation was found by Marinho and Vieira ¹⁹ in their study of adolescents with special needs (physical, visual and auditory) from Petrolina – PE, in which they noticed that the older age group was more satisfied with their lives. These results highlight the need for greater care in relation to adolescents, regardless of their age. Younger students need greater protection from their parents because they are still undergoing biopsychosocial transformations. Elderly people, although more mature, also need protection and self-control in their attitudes so as not to engage in risky behavior. Ultimately, both require support, attention, acceptance and strategies to calm the levels of pressure/tension they experience in their daily lives, whether to enroll in higher education or to enter the job market. Regarding alcohol consumption, it was observed that the consumption of this substance by adolescents influenced a lower quality of life. Given the construction of identity in adolescence, it is considered that the great conflict to be resolved in this phase is the so-called identity crisis. It is at this time that adolescents seek new identifications and this search for new experiences, sensations and curiosities leads to great concerns associated with the risks related to the consumption of alcohol and other drugs. Adolescents are increasingly experimenting with and regularly using alcoholic beverages ²⁰ . In this sense, the present study evidenced the regular consumption of alcoholic beverages in a small sample of schoolchildren. This outcome is lower than those found by the Global School-Based Student Health Survey ²⁰ with adolescents in East Timor (15.7%) and the Philippines (18.2%) and by the Youth Risk Behavior Surveillance – United States ²¹ (32.8%). The national literature also confirms the use of this substance in adolescents ^22,27 . The WHO states that alcohol is the most widely consumed psychoactive substance in the world and is the main drug of choice for children and adolescents. In Brazil, alcohol is the most widely used product by the adult population and its consumption has increased among young people in recent decades, especially among those aged 12 to 15 years ²⁷ . It is noteworthy that episodic alcohol consumption is more frequent among adolescents and can occur in an abusive manner, leading to potential health risks, such as alcohol poisoning ²⁸ . In the opinion of these authors, alcohol use during this period is a complex, multifactorial and socially determined phenomenon. Factors in the family, school, sociodemographic context, and relationships with friends and peers participate in the explanatory chain of the use of this substance. From this perspective, Benites and Schneider ²⁹ observed in a systematic review that the factors involved in alcohol use in both sexes have distinct particularities, both with regard to biological and socio-familial aspects. In this context, Silveira, Santos and Pereira ²⁷ reported that the use of alcoholic beverages is associated with an increase in intra- and extra-family violence, traffic accidents, school deficits and dropouts, risk behaviors such as transmission of Sexually Transmitted Diseases (STDs), aggression, clinical depression and unplanned pregnancy. Neves, Teixeira and Ferreira ²⁰, also noted that excessive alcohol consumption during this period causes a sharp decline in the teaching-learning process. There is a greater absence from classes and those who attend them experience drowsiness, sluggishness and difficulty in assimilating the content taught by the teacher. It is important to add that the use of alcoholic beverages has been increasing among the female population. Information from the II National Survey of Alcohol and Drugs showed that there was an increase in habitual consumption (five doses or more) among adolescents aged 14 to 17 when compared to the years 2006 and 2012. In these years, girls consumed more (from 11% to 20% respectively) than boys (from 31% to 24%) ³⁰ , a similar situation found in another study ³¹ . Investigating the pattern of alcohol consumption among Brazilian adolescents regardless of gender, Coutinho et al. ²³ observed a high prevalence of alcohol use among adolescents, as well as early initiation of use. These authors indicate that a systematic review of 28 population studies with adolescents between 10 and 19 years of age found a 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, observed experimental alcohol use in 87.5% of adolescents and drunkenness in 20.5% of those who were sexually active before the age of 15. It is worth mentioning that there is Brazilian legislation aimed at the issue of alcohol use that began in 2003, and in 2009, the Emergency Plan was created to expand the aforementioned to treatment and prevention of alcohol and other drugs ³³ . It is also noted that the Statute of Children and Adolescents (ECA) created in 1990, in its Art. 81, recommends the prohibition of the sale of alcoholic beverages to children and adolescents ³⁴ . It is therefore clear that special attention needs to be paid to the adolescents in this study, in order to inhibit their consumption of alcohol and other drugs. Although the average number of young people who regularly consume this product was low, there was an impact on the group’s quality of life. The results indicate the existence of family, health and social damage that culminates in the need for care and high costs to society. The results observed in the analysis between the sociodemographic variables and the WHOQOL-bref, showed that income obtained statistical significance in relation to the Environment Domain, indicating that a higher family income implies a better quality of life in this domain. Considering that a large segment reported having a family income of up to two minimum wages, it can be inferred that this group is at a level of worse quality of life when compared to their peers in other salary ranges. This data corroborates other studies already carried out, such as that of Biswas, Bhattacherjee and Mukherjee ¹³ , who found that, within the environment domain, young people with lower family income had a lower perception of QoL. Chazan and Campos ¹⁰ , analyzing the influence of some sociodemographic variables in students with an average age of 23 years, found a decreasing level in all QoL domains among the three economic classes (A, B, C), with this difference being statistically significant in the environment domain (p=0.000). Gordia et al. ⁷ , found that adolescents from classes B, C, D and E, presented lower levels of negative perception in the environmental domain in relation to those from socioeconomic class A. Contrary to these results, Marinho and Vieira ¹⁹ identified a positive perception of QoL in those whose families had an income of up to two minimum wages when compared to those with three or more minimum wages. In another analysis, Torres and Vieira ⁴ , noticed that there was no difference in the age groups between up to four wages and five or more wages. Despite the divergence between the outcomes, it is understood that the economic conditions of families interfere positively or negatively in their general 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 life ³⁵ . Gordia et al. ⁷ understand that adolescents from disadvantaged socioeconomic backgrounds have a greater chance of living in regions lacking infrastructure and services, implying a lower QoL for this group. Regarding the issue of disadvantaged socioeconomic status, it is worth remembering that in 2003 the Brazilian federal government launched the Bolsa Família Program, which offers benefits to extremely poor families and poor families, linked to conditions of health, education and social assistance policies. Due to the dynamic nature of poverty, over the period 2006-2012, many families overcame monetary poverty while others entered this profile, with a periodic flow of families entering and leaving the program, so that it reaches its target audience ³⁶ . In this scenario, Campello ³⁷ believes that through this program, Brazil can reject the trivialization and naturalization of poverty and hunger and establish a new level of social guarantees, which require recognition and expansion of minimum standards of well-being for citizens. CONCLUSION In this analysis, some aspects related to the habits and quality of life of the adolescents surveyed were found that may assist 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 because they are more sensitive than boys. In the environmental domain, younger adolescents demonstrated a better quality of life. It is likely that these students have a family and social environment with fewer “demands” and at the same time do not have a level of maturity capable of perceiving which environmental characteristics can provide them with an increasingly better quality of life. Perhaps the older participants are more empowered, mature, overwhelmed and with more autonomy, being able to envision the future beyond what they already have. This data motivates the need for discussion and reflection with this population, for the benefit of themselves and the community itself. Regarding income, it was found that students with lower family income had a lower quality of life and that 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 that aim to improve the living conditions of the population that is often hostage to 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 participants (12.9%), which leads to the need for interventions to combat the use of this substance in adolescence, to avoid damage to the health not only of the individual, but also of their family and society. Based on these findings, alternatives that seek to improve the lifestyle and quality of life of the adolescents studied can be outlined within the school environment. Programs, projects and actions that aim to raise awareness and consciousness about the harmful effects of sedentary behavior, consumption of alcoholic beverages, inadequate diet, excessive use of social networks, and few hours of sleep, involving not only students but also their families, can be a way to change the current daily attitudes of these individuals. The results of this study provide valuable information on the predictors of the 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 promoting student health. Regarding the strengths of this analysis, it is worth highlighting a good representation (around 60%) of adolescents enrolled in 2018. It is also important to highlight the limitations of this study. This is a cross-sectional study that does not allow inferences about cause and effect on this topic, and the WHOQOL-bref is an instrument marked by subjectivity. As for the findings, they refer to adolescents in Technical courses integrated into high school at a Federal Education Institution in 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 to those who live in other areas or regions.

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