Co-occurrence of health risk behaviors and the family context among Brazilian adolescents, National Survey of School Health (2015)

Silva, Roberta Mendes Abreu; Andrade, Amanda Cristina de Souza; Caiaffa, Waleska Teixeira; Bezerra, Vanessa Moraes

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 24 • 2021 • https://doi.org/10.1590/1980-549720210023 copy

Co-occurrence of health risk behaviors and the family context among Brazilian adolescents, National Survey of School Health (2015)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To evaluate the association between the co-occurrence of risk behaviors (RB) and the family context in Brazilian adolescents.

Methods:

Cross-sectional study on 101,534 students from the 9^th grade of elementary school in the National Survey of School Health - PeNSE 2015. The co-occurrence of RB was estimated by the sum of the presence of sedentary behavior, low fruit consumption, regular consumption of alcohol and tobacco. Prevalence was assessed using the Venn diagram and multivariate analysis by the ordinal logistic regression model of partial proportional odds.

Results:

8.8% of the adolescents did not have RB; 34.5% had one; 42.7% had two; and 14.1%, three or four. The most prevalent combinations were between sedentary behavior and low fruit consumption (33.8%); sedentary behavior with low fruit consumption and regular consumption of alcohol (9.5%). Those who were more likely to present co-occurrence had mothers with higher education level in all models, did not live with their fathers [0, 1 and 2 vs. 3: (OR = 1.21; 95%CI 1.07-1.37)], had parents who sometimes, never or rarely understood their problems and concerns [0, 1 and 2 vs. 3: (OR = 1.62; 95%CI 1.49-1.76)] and monitored their homework [0, 1 and 2 vs. 3: (OR = 1.77; 95%CI 1.62-1.93)]; and had meals with parents or guardians <4 days/week for the three models.

Conclusion:

Health RB tend to cluster among Brazilian adolescents and are related to characteristics of the family context. These findings point to the need for health promotion actions focusing on simultaneity and not in isolation.

Keywords:
Adolescent; Health behavior; Risk factors; Adolescent health

Variables	%	95%CI	Co-occurrence of risk behaviors
Variables	%	95%CI	0	1	2	3 or 4	p-value*
Sex
Boys	48.7	48.1-49.3	48.3	50.4	48.8	44.3	<0.001
Girls	51.3	50.7-51.9	51.7	49.6	51.2	55.7	<0.001
Age (years)
13	17.9	16.9-18.9	17.8	18.4	19.4	12.8	<0.001
14	51.2	50.3-52.1	50.2	51.5	53.1	46.0
15	19.9	19.1-20.6	21.1	18.9	18.3	25.6
16-19	11.0	10.4-11.6	10.9	11.2	9.2	15.6
Income level
1^st tertile	32.4	31.4-33.4	37.5	36.5	29.3	28.1	<0.001
2^nd tertile	36.6	35.8-37.4	34.7	35.0	38.2	37.7
3^rd tertile	31.0	29.8-32.1	27.8	28.5	32.5	34.2
Maternal education level
No education	7.7	7.3-8.1	9.8	9.0	6.5	6.6	<0.001
Some elementary school	26.7	25.9-27.4	28.0	27.9	25.5	26.5
Elementary school/Some high school	17.2	16.6-17.8	17.0	17.4	17.3	16.9
High school/Some college	30.6	29.9-31.3	28.7	28.5	32	32.7
College	17.8	16.8-18.7	16.5	17.2	18.7	17.3
Family structure
Lives with father and mother	59.3	58.5-60	62.4	62.1	59.2	51	<0.001
Lives with father or mother	35	34.3-35.7	31.9	32.3	35.5	42
Does not live with the parents	5.7	5.5-6	5.7	5.6	5.3	7
Parents who understand problems*
Often/always	43.8	43.1-44.4	59.2	49	40.6	31	<0.001
Sometimes	22.8	22.3-23.3	19.9	22.3	23.9	22.6
Never/rarely	33.4	32.8-34.1	20.9	28.7	35.5	46.4
Parents monitoring homework*
Often/always	31.8	31.2-32.5	52.7	31.1	27	20.3	<0.001
Sometimes	23.8	23.3-24.2	20.6	24.4	24.9	20.7
Never/rarely	44.4	43.7-45.1	26.7	38.5	48.1	59
Having meals with parents or guardians*
Regularly (≥5 days/week)	74	73.4-74.7	83.5	78.5	72.1	63	<0.001
≤4 days a week	26	25.3-26.6	16.5	21.5	27.9	37	<0.001

Variables	Comparisons
	*0 versus* 1, 2 and 3 or more**		*0 and 1 versus* 2 and 3 or more**		*0, 1 and 2 versus* 3 or more**
	OR	95%CI	OR	95%CI	OR	95%CI
Family context*
Maternal education level
No education	1		1	-	1	-
Some elementary school	1.22	1.06-1.40	1.25	1.14-1.37	1.25	1.10-1.42
Elementary school/Some high school	1.29	1.10-1.50	1.30	1.18-1.44	1.22	1.06-1.41
High school/Some college	1.33	1.15-1.54	1.44	1.31-1.58	1.35	1.19-1.54
College	1.29	1.10-1.52	1.31	1.18-1.45	1.19	1.03-1.37
Family structure
Lives with father and mother	1	-	1	-	1	-
Lives with father or mother	1.09	1.01-1.19	1.21	1.15-1.27	1.36	1.26-1.46
Does not live with the parents	0.94	0.80-1.11	1.01	0.92-1.11	1.21	1.07-1.37
Parents who understand problems*
Often/always	1	-	1	-	1	-
Sometimes	1.35	1.22-1.50	1.27	1.20-1.35	1.28	1.17-1.41
Never/rarely	1.58	1.43-1.76	1.45	1.37-1.54	1.62	1.49-1.76
Parents monitoring homework
Often/always	1	-	1	-	1	-
Sometimes	1.87	1.69-2.07	1.48	1.39-1.58	1.29	1.16-1.43
Never/rarely	2.43	2.20-2.68	1.82	1.72-1.93	1.77	1.62-1.93
Having meals with parents or guardians*
Regularly (≥5 days/week)	1	-	1	-	1	-
≤4 days a week	1.44	1.29-1.61	1.39	1.31-1.47	1.43	1.33-1.54

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[1] Corresponding author: Roberta Mendes Abreu Silva. Rua Hormindo Barros, 58, Candeias, CEP: 45029-094, Vitória da Conquista, BA, Brazil. E-mail: roberta.m.abreu@hotmail.com