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Wendt A, Machado AKF, da Silva BGC, Costa CS, Ricardo LIC, da Silva SG. Inequalities in Leisure-Time Physical Activity and Television Viewing According to Age Among a Brazilian Adult Population. J Phys Act Health 2024; 21:146-154. [PMID: 37939706 DOI: 10.1123/jpah.2022-0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 05/02/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The present study aims to estimate leisure-time physical activity and television (TV) viewing curves according to age stratified by sex, area of residence, and socioeconomic position. METHODS Using data from the Brazilian National Health Survey, we estimated the prevalence of leisure-time physical activity and TV viewing according to continuous age. The estimates were calculated using fractional polynomials and stratified by sex, wealth, skin color, and area of residence. RESULTS The sample included 87,376 adults (aged 18 y or over). In general, leisure-time physical activity decreased according to age while TV viewing increased. Regarding behavior of curves according to stratifiers, for leisure-time physical activity the disadvantaged groups maintained a pattern of low physical activity across all age groups or presented the decrease earlier when compared to groups in social advantage. On the other hand, for TV viewing, women presented an increase in prevalence before men, and individuals living in the urban area and the wealthiest group were those with a higher increase according to age. CONCLUSIONS Our findings may help researchers and policymakers further explore inequalities in physical activity across life in different settings, as well as develop sensitive cultural actions to support more vulnerable people to adopt public health recommendations.
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Affiliation(s)
- Andrea Wendt
- Graduate Program in Health Technology, Polytechnic School, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Adriana K F Machado
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Bruna G C da Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Caroline S Costa
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Luiza I C Ricardo
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Shana Ginar da Silva
- Postgraduate Program in Biomedical Science, School of Medicine, Federal University of Fronteira Sul, Passo Fundo, SC, Brazil
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Araujo RHO, Werneck AO, Silva DR, Jesus GM. Sociodemographic inequalities in the trends of different types of leisure-time physical activity among Brazilian adults between 2006 and 2019. Int J Equity Health 2022; 21:120. [PMID: 36038936 PMCID: PMC9426210 DOI: 10.1186/s12939-022-01728-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background The current study aimed to describe the trends in gender, ethnicity, and education inequalities of types of leisure-time physical activity (LTPA) practiced by Brazilian adults from 2006 to 2019. Methods We used data from 2006 to 2019 of the Brazilian Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey, which is an annual survey with a representative sample of adults (≥ 18y) living in state capital cities. The types of LTPA considered were walking, running, strength/gymnastics, sports, other LTPA, and no LTPA participation. Gender (women or men), ethnicity (white, black, brown, or yellow/indigenous), and years of formal education were also self-reported. We used relative frequencies and their respective 95% confidence intervals to analyze trends. The absolute and relative differences between the proportions were used to assess the inequalities. Results We observed increases in inequalities related to gender and education (running and strength/gymnastics), while gender inequalities for sports, other types, and no LTPA participation decreased. There were persistent inequalities related to gender (walking) and education (sports, other types, and no LTPA participation). Considering ethnicity, we noted increases in inequality for strength/gymnastics, where white adults were more active than black and brown adults. In addition, white adults reported more access to LTPA than brown adults over the years analyzed. Conclusion Women, black and brown people, and subjects with less schooling were the most unfavored groups. While some inequalities persisted over the years, others increased, such as ethnicity and education inequalities for strength/gymnastics. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01728-y.
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Affiliation(s)
- Raphael H O Araujo
- Graduation Program in Health Sciences, Londrina State University (UEL), Londrina, Brazil.
| | - André O Werneck
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, Brazil
| | - Danilo R Silva
- Department of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Brazil.,Department of Sports and Computer Science, Universidad Pablo de Olavide (UPO), Seville, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - Gilmar M Jesus
- Department of Health, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
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Snége A, da Silva AADP, Mielke GI, Rech CR, Siqueira FCV, Rodriguez-Añez CR, Fermino RC. Sedentary Behavior Counseling Received from Healthcare Professionals: An Exploratory Analysis in Adults at Primary Health Care in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9963. [PMID: 36011594 PMCID: PMC9407836 DOI: 10.3390/ijerph19169963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Counseling by health professionals has promising results in behavior change and is recommended as part of integrated community interventions. However, the knowledge about sedentary behavior (SB) counseling is incipient. The study aimed to identify the prevalence and explore the associated factors with SB counseling received from healthcare professionals by adults in primary health care (PHC) in Brazil. A cross-sectional study was conducted in 2019 that included a representative sample of 779 users in all 15 basic health units (BHU) in São José dos Pinhais, Paraná. We identified those who reported having received SB counseling during a consultation. The association between the sociodemographic factors, chronic diseases, access to health services, physical activity, SB, and counseling were analyzed using Poisson regression in a hierarchical model. The prevalence of counseling was 12.2% (95% CI: 10.1-14.7%); it was higher in women (PR: 1.77; 95% CI: 1.10-2.83), those aged ≥60 yrs (PR: 1.84; 95% CI: 1.14-2.98), BMI ≥ 30 kg/m2 (PR: 2.60; 95% CI: 1.31-5.17), who consume ≥3 medications (PR: 2.21; 95% CI: 1.06-4.59), and those who spend a prolonged period of the day engaged in SB (4th quartile PR: 3.44; 95% CI: 1.88-6.31). The results highlight that SB counseling is underutilized and incipient in PHC. Understanding these results can help managers and healthcare professionals in BHU teams to implement and direct specific actions to reduce SB in adults through counseling.
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Affiliation(s)
- André Snége
- Research Group on Environment, Physical Activity and Health, Federal University of Technology-Paraná, Curitiba 81310-900, Brazil
| | - Alexandre Augusto de Paula da Silva
- Postgraduate Program in Health Sciences, Research Group on Physical Activity and Quality of Life, Pontifical Catholic University of Paraná, Curitiba 80215-901, Brazil
| | - Grégore Iven Mielke
- School of Public Health, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Cassiano Ricardo Rech
- Research and Study Group in Urban Environment and Health, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil
| | | | - Ciro Romelio Rodriguez-Añez
- Research Group on Environment, Physical Activity and Health, Federal University of Technology-Paraná, Curitiba 81310-900, Brazil
| | - Rogério César Fermino
- Research Group on Environment, Physical Activity and Health, Federal University of Technology-Paraná, Curitiba 81310-900, Brazil
- Postgraduate Program in Physical Education, Federal University of Paraná, Curitiba 81531-980, Brazil
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Association of public physical activity facilities and participation in community programs with leisure-time physical activity: does the association differ according to educational level and income? BMC Public Health 2022; 22:279. [PMID: 35148696 PMCID: PMC8832843 DOI: 10.1186/s12889-022-12593-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Our aim was to analyze the association of the presence of public physical activity (PA) facilities and participation in public PA programs with leisure-time PA, with an emphasis on the moderating role of educational level and income. Methods We used data of 88,531 adults (46,869 women), with a mean age of 47.2 ± 17.1y, from the 2019 Brazilian National Health Survey. Leisure-time PA (dichotomized considering 150 min/week), the presence of a public PA facility near the household (yes or no), participation in public PA programs (yes or no), educational level (divided into quintiles) and per capita income (divided into quintiles) were all self-reported through interviews. Adjusted logistic regression models were used for the analyses. Results The presence of public PA facilities near the household and the participation in public PA programs were associated with higher leisure-time PA among all quintiles of income and educational level. However, multiplicative interactions revealed that participating in PA programs [Quintile (Q)1: OR: 13.99; 95%CI: 6.89–28.38 vs. Q5: OR: 3.48; 95%CI: 2.41–5.01] and the presence of public PA facilities near the household (Q1: OR: 3.07; 95%CI: 2.35–4.01 vs. Q5: OR: 1.38; 95%CI: 1.22–1.55) were more associated with higher odds of being active in the leisure-time among the lowest quintile of educational level. Conclusions The presence of public PA facilities and participation in public PA programs are environmental correlates that may be relevant for designing effective public health interventions to reduce social inequalities in leisure-time PA among adults in low-income areas.
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Papini CB, Campos LD, Nakamura PM, Brito BTGD, Kokubun E. Cost-analysis and cost-effectiveness of physical activity interventions in Brazilian primary health care: a randomised feasibility study. CIENCIA & SAUDE COLETIVA 2021; 26:5711-5726. [PMID: 34852103 DOI: 10.1590/1413-812320212611.27142020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/08/2020] [Indexed: 11/22/2022] Open
Abstract
Physical exercise programs have been carried out in primary health care in Brazil and have provided good results in terms of effectiveness, their economic contribution has not been investigated yet. The aim of the study is to verify the feasibility of brief counseling physical activity intervention and to compare its economic cost and cost-effectiveness with supervised physical exercise intervention in primary care. A multi-arm parallel feasibility trial, with equal randomization [1:1:1] was conducted in Basic Health Units in Brazil. 61 participants were randomized in Brief Counseling Intervention (BCI), Supervised Physical Exercise Intervention (SPEI) and Control Group (CG). Interventions lasted one year. The BCI is more economical than the SPEI, costing around 50% less in the economic comparisons (session cost, annual cost and cost per participant annually). At leisure time, the cost to move one person to the physically active category at 12 months is estimated in R$369.00 for BCI and R$426.21 for the SPEI. The Incremental Cost-effectiveness Ratio (ICER) is R$310.32. The BCI is feasible and more economic, however, the cost effective is not that different. Thus, it is strongly recommended that the two interventions be offered at primary care in Brazil.
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Affiliation(s)
- Camila Bosquiero Papini
- Departamento de Ciências do Esporte, Universidade Federal do Triângulo Mineiro (UFTM). Av. do Tutunas 490, Vila Celeste. 38061-500 Uberaba MG Brasil.
| | - Leonardo de Campos
- Programa de Pós-Graduação em Educação Física, Universidade Estadual Paulista (UNESP). Rio Claro SP Brasil
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dos Santos LP, da Silva AT, Rech CR, Fermino RC. Physical Activity Counseling among Adults in Primary Health Care Centers in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5079. [PMID: 34064953 PMCID: PMC8151541 DOI: 10.3390/ijerph18105079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
Physical activity (PA) counseling by health professionals has promising results in behavior change. However, few studies have evaluated its prevalence in Primary Health Care in Latin American countries. This study aimed to describe the prevalence and analyze the associated factors of PA counseling in adults in Primary Health Care in Brazil. This is a cross-sectional study with a representative sample of 779 adults (70% women). Counseling was identified among those who reported having received PA counseling during a health professional consultation in the last 12 months. Sociodemographic factors, health conditions, and leisure-time PA were analyzed with Poisson regression. The prevalence of counseling was 43% (95% Confidence Interval [CI]: 39.5-46.4%), higher in people aged ≥40 years (Prevalence Ratio [PR]: 1.44; 95% CI: 1.19-1.75], who are married (PR: 1.27; 95% CI: 1.07-1.59), obese (PR: 1.53; 95% CI: 1.23-1.90), take prescription medication (PR: 1.83; 95% CI: 1.47-2.27), and walk for leisure (PR: 1.28; 95% CI: 1.06-1.54). People with more education were less likely to receive PA counseling (PR: 0.82; 95% CI: 0.68-0.99). In conclusion, 4 out of 10 users reported receiving PA counseling and this was associated with sociodemographic factors, health conditions, and walking for leisure. These results can guide PA promotion in Primary Health Care.
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Affiliation(s)
- Letícia Pechnicki dos Santos
- Research Group in Environment, Physical Activity and Health, Federal University of Technology—Parana, Curitiba 81310-900, Brazil; (L.P.S.); (A.T.S.)
| | - Alice Tatiane da Silva
- Research Group in Environment, Physical Activity and Health, Federal University of Technology—Parana, Curitiba 81310-900, Brazil; (L.P.S.); (A.T.S.)
- Postgraduate Program in Physical Education, Federal University of Parana, Curitiba 81531-980, Brazil
| | - Cassiano Ricardo Rech
- Physical Education Department, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil;
| | - Rogério César Fermino
- Research Group in Environment, Physical Activity and Health, Federal University of Technology—Parana, Curitiba 81310-900, Brazil; (L.P.S.); (A.T.S.)
- Postgraduate Program in Physical Education, Federal University of Parana, Curitiba 81531-980, Brazil
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The Profile of Bicycle Users, Their Perceived Difficulty to Cycle, and the Most Frequent Trip Origins and Destinations in Aracaju, Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217983. [PMID: 33143067 PMCID: PMC7662362 DOI: 10.3390/ijerph17217983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/31/2020] [Accepted: 09/03/2020] [Indexed: 01/10/2023]
Abstract
The objective of this study was to describe the profile of bicycle users, their perceived difficulty to cycle, and the most frequent trip origins and destinations in Aracaju, Northeast Brazil. Our cross-sectional study sampled 1001 participants and we collected information through structured interviews. Aged ≥15 years, participants were residents of all Aracaju’s neighborhoods and used a bicycle for commuting to work or for leisure. We observed that bicycle users in Aracaju are predominantly employed male subjects, aged between 18 and 40 years, and were the heads of their households. Most of the them reported “work” as the main reason for their bicycle trips and, “health” and “practicality” aspects as their main motivations for using bicycles. In general, the neighborhoods in the north and center of the city were identified as the most difficult for cycling, and the easiest trips occurred in places with cycle paths. As a conclusion of this study, we reaffirm the need for intersectoral actions that create favorable environments for active commuting and more sustainable cities.
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Gomes GADO, Papini CB, Nakamura PM, Teixeira IP, Kokubun E. Barreiras para prática de atividade física entre mulheres atendidas na Atenção Básica de Saúde. REVISTA BRASILEIRA DE CIÊNCIAS DO ESPORTE 2019. [DOI: 10.1016/j.rbce.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Ferreira RW, Caputo EL, Häfele CA, Jerônimo JS, Florindo AA, Knuth AG, Silva MCD. [Access to public physical activity programs in Brazil: National Health Survey, 2013]. CAD SAUDE PUBLICA 2019; 35:e00008618. [PMID: 30785483 DOI: 10.1590/0102-311x00008618] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 11/05/2018] [Indexed: 11/22/2022] Open
Abstract
The article sought to describe awareness of public physical activity programs, practice of physical activity in public programs and barriers related to non-participation in these programs in a national representative sample according to sex, age, skin color, income, state and having been visited by a family health team (EqSF, in Portuguese) in the previous year. This is a cross-sectional survey with data from the Brazilian National Health Survey, 2013. We carried out descriptive analyses using the distribution of relative frequencies and their respective 95% confidence intervals, weighted in the sample design. We included 60,202 individuals. We found a 20% prevalence of awareness and, of these, 9.7% reported practicing physical activity in public programs. Most commonly reported barriers were lack of time (41.4%) and lack of interest in available activities (29.7%). Women have greater awareness when compared with men, but levels of physical activity were similar in both sexes. Awareness and physical activity were higher in the older age groups. Awareness increased with income, but the poorest participate more in public physical activity programs when compared with the other income categories. Awareness and physical activity were similar among those who were and were not visited by EqSF. Prevalences of awareness and participation in public physical activity programs are not expressive, with nearly 30% of individuals disinterested in current programs. Local-regional efforts are needed so that physical activity can be established as a health promotion tool.
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Proportion of cancer cases and deaths attributable to lifestyle risk factors in Brazil. Cancer Epidemiol 2019; 59:148-157. [PMID: 30772701 DOI: 10.1016/j.canep.2019.01.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Lifestyle risk factors (tobacco smoking, alcohol consumption, overweight and obesity, unhealthy diet, and lack of physical activity) have been associated with increased risk of at least 20 types of cancer. We estimated the proportion of cancer cases and deaths that could be potentially avoided by eliminating or reducing lifestyle risk factors in Brazil. METHODS We obtained the distribution of lifestyle risk factors by sex and age groups from recent representative health surveys in Brazil; relative risks from pooled analyses of prospective studies and meta-analyses; and cancer cases and deaths in 2012 from GLOBOCAN. RESULTS We found that 26.5% (114,497 cases) of all cancer cases and 33.6% (63,371 deaths) of all cancer deaths could be potentially avoided by eliminating lifestyle risk factors in Brazil. Plausible reductions in these exposures based on policy targets and cancer prevention recommendations could have potentially avoided 4.5% (19,731 cases) and 6.1% (11,480 deaths) of all cancer cases and deaths, respectively. Tobacco smoking accounted for most of the preventable cancer cases and deaths, followed by high body mass index and alcohol consumption. Larynx, lung, oropharynx, esophagus and colorectum cancer cases and deaths could be at least halved by eliminating these lifestyle risk factors. CONCLUSION Findings from this study may be useful to inform strategies for cancer prevention and control across Brazil.
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Adherence, Adhesion, and Dropout Reasons of a Physical Activity Program in a High Social Vulnerability Context. J Phys Act Health 2019; 16:149-156. [PMID: 30626259 DOI: 10.1123/jpah.2017-0606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND One of the most important health determinants is social vulnerability, which can interfere in the practice of physical activity (PA). This study aimed at analyzing adherence to a PA program in a high social vulnerability context. METHODS A longitudinal study with a 6-month intervention period was conducted. The program offered monitored walks associated with behavioral change educational campaigns. Sociodemographic characteristics, occupation, PA level, noncommunicable chronic diseases, participants' frequency of participation in the program, and intervention dropout reasons were evaluated. Descriptive and survival analyses were accomplished. RESULTS Among the 106 participants, 88.0% were female and 21.7% were older adults. The most mentioned participation reasons were health improvement (23.0%), weight loss (19.0%), disease control (17.0%), and social living (12%). The mean frequency of participation in the program was 27.4%. Dropout rate was 52.7%. The main reported reasons for dropping out were work hours (27.8%), health problems (25.9%), personal reasons (22.2%), and lack of time (11.1%). Factors associated with remaining in the program were being older adults and presenting body mass index <25 kg/m2. CONCLUSIONS Results showed that in a high social vulnerability context, adherence to PA programs is low, and adult-life-related commitments and high levels of obesity are factors associated with lower adherence.
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Cruz MSD, Bernal RTI, Claro RM. [Trends in leisure-time physical activity in Brazilian adults (2006-2016)]. CAD SAUDE PUBLICA 2018; 34:e00114817. [PMID: 30365744 DOI: 10.1590/0102-311x00114817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 06/14/2018] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze time trends in leisure-time physical activity in adults in Brazilian state capitals and the Federal District from 2006 to 2016. The study was based on data from the Risk and Protective Factors Surveillance System for Chronic Noncommunicable Diseases Through Telephone Interview (VIGITEL), collected by the Ministry of Health from 2006 to 2016 (n = 572,437). VIGITEL conducts interviews annually with more than 50,000 adults (≥ 18 years) living in households with hardline telephones. The main relevant VIGITEL questions for this study deal with leisure-time physical activity. We estimated the annual percentage of leisure-time physical activity in the three months prior to the interview, in addition to sufficient levels of such activit (≥ 150 minutes/week), available from 2009 to 2016 for the adult population as whole and according to sex, age, and schooling. There was an increase (p < 0.05) both in the percentage of leisure-time physical activity in the three months prior to the interview (from 44.0 to 53.6%, or 0.97 percentage points per year) and in the percentage of individuals that achieved recommended levels of physical activity, from 30.3 to 37.6% (1.20 percentage points per year) from 2009 to 2016. The increases were more frequent in women, younger adults, and those with more schooling. There was an increase in physical activity in the majority of the situations studied. Although this increase reduces the differences between men and women, the differences increased between young people and older individuals and between those at the extremes of educational levels.
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Affiliation(s)
| | | | - Rafael Moreira Claro
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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de Almeida ML, Casemiro FG, Baba CT, Monteiro D, Fornazieri M, Cerri N, Fernandes DFM, de Oliveira Gomes GA. Studies About Physical Activity Interventions Including Follow-Up Analysis: A Systematic Review. J Phys Act Health 2018; 15:462-467. [PMID: 29542365 DOI: 10.1123/jpah.2016-0580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Some studies have used the follow-up method to analyze real behavioral changes in research involving physical activity (PA) interventions. This has great scientific value; however, it is hard to apply without satisfactory resources and research funding. Little is known about how many studies have used this method to analyze PA interventions in low-income and middle-income countries, especially Brazil. PURPOSE To describe Brazilian studies using follow-up analysis after PA interventions. METHODS A systematic review was performed including Brazilian studies with follow-up analysis after PA interventions; the analyzed papers were from the previous 10 years. The search was carried out in Portuguese, English, and Spanish in the following databases: SciELO, Latin American and Caribbean Health Science Literature, PubMed, and Scopus. The Preferred Reporting Items for Systematic Review and Meta-Analysis method was used. RESULTS In total, 6 of the 7 studies analyzed were from the southeast region, with the intervention time ranging from 2 to 12 months, carrying out follow-up every 5.3 months with 2.2 observations on average. The interventions had a behavioral approach and were generally carried out in universities, hospitals, and ambulatory care. CONCLUSION Studies on PA interventions using follow-up analysis are scarce. Considering the relevance of follow-up studies to measure behavior changes, the results suggest that more studies about this topic are essential in Brazil.
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Baba CT, Oliveira IM, Silva AEF, Vieira LM, Cerri NC, Florindo AA, de Oliveira Gomes GA. Evaluating the impact of a walking program in a disadvantaged area: using the RE-AIM framework by mixed methods. BMC Public Health 2017; 17:709. [PMID: 28915827 PMCID: PMC5603090 DOI: 10.1186/s12889-017-4698-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 08/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background The positive health impact of physical activity (PA) is well known, yet a large proportion of the world’s population remains sedentary. General PA programs are common as health promotion initiatives. However, effectiveness evaluations of such PA programs on individual and organizational aspects, which could inform the decision-making process of public health bodies are still lacking, particularly in the most socially disadvantaged areas, where health promotion schemes are particularly needed. The aim of this study was to assess the effectiveness of a Guided Walking Program in a high social vulnerability context. Methods A quasi-experimental, mixed methods study was conducted. The program had a duration of 6 months and a 6-month follow-up period after the intervention. Session frequency was five times a week, where sessions consisted of supervised PA combined with educational sessions. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was followed to assess the program. The International Physical Activity Questionnaire (IPAQ) and accelerometers were used to measure levels of PA. Focus groups were conducted to gain a comprehensive insight on the implementation domain. Results Most subjects in the intervention (IG) (n = 74) and control (CG) (n = 74) groups were female (IG:90.5%; CG:95.9%), aged 18–49 years (IG:44.6%; CG:43.2%), received less than 1 minimum wage (IG:74.3%; CG:83.7%) and had 0–4 years of formal education (IG:52.1%; CG:46.1%). The reach of the intervention was 0.3%. The IG showed increased levels of PA at post-intervention and 6-month follow-up. However, the difference between groups was not statistically significant. Adoption data revealed that 89.5% of the professionals in the Primary Health Care Center (health center) team perceived the benefits of the program for the population. The program was independently promoted by the health center team for a further 4 months post-intervention. The qualitative data revealed that the program was discontinued due to participants’ low adherence and human resource limitations in the unit’s operational dynamics. Conclusions A health promotion intervention in a socially deprived setting faces challenges but can be effective and feasible to implement. The present study informs the development of future health promotion initiatives in this context. Trial registration NCT02857127. Registered: 30 July 2016 (retrospectively registered).
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Affiliation(s)
- Camila Tiome Baba
- Federal University of São Carlos, Washington Luís Highway, 235 km, São Carlos, São Paulo, 13565-905, Brazil.
| | | | | | - Leonardo Moreira Vieira
- Federal University of São Carlos, Washington Luís Highway, 235 km, São Carlos, São Paulo, 13565-905, Brazil
| | - Natalia Caroline Cerri
- Federal University of São Carlos, Washington Luís Highway, 235 km, São Carlos, São Paulo, 13565-905, Brazil
| | - Alex Antonio Florindo
- University of São Paulo, Arlindo Bettio Street, 1000, São Paulo, São Paulo, 03828-000, Brazil
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Ribeiro EHC, Garcia LMT, Salvador EP, Costa EF, Andrade DR, Latorre MDRDDO, Florindo AA. Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System. Rev Saude Publica 2017; 51:56. [PMID: 28678906 PMCID: PMC5477737 DOI: 10.1590/s1518-8787.2017051006654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 05/09/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the effect of interventions on the levels of physical activity of healthy adults, users of the Brazilian Unified Health System and attended by the Family Health Strategy. METHODS Non-randomized experimental study with 157 adults allocated in three groups: 1) physical exercise classes (n = 54), 2) health education (n = 54), 3) control (n = 49). The study lasted for18 months, with 12 months of interventions and six months of follow-up after intervention. Assessments took place at the beginning, in the 12 months, and in the 18 months of study. Physical activity has been assessed by questionnaires and accelerometry. For the analyses, we have used the intention-to-treat principle and generalized estimating equations. RESULTS After 12 months, both intervention groups have increased the minutes of weekly leisure time physical activity and annual scores of physical exercise, leisure and transport-related physical activity. The exercise class group has obtained the highest average annual physical exercises score when compared to the other groups (p < 0.001). In the follow-up period, the exercise class group reduced its annual score (average: -0.3; 95%CI -0.5–-0.1), while the health education group increased this score (average: 0.2; 95%CI 0.1–0.4). There have been no differences in the levels of physical activity measured by accelerometry. CONCLUSIONS The interventions have been effective in increasing the practice of physical activity. However, we have observed that the health education intervention was more effective for maintaining the practice of physical activity in the period after intervention. We recommend the use of both interventions to promote physical activity in the Brazilian Unified Health System, according to the local reality of professionals, facilities, and team objectives.
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Affiliation(s)
- Evelyn Helena Corgosinho Ribeiro
- Programa de Pós-Graduação em Nutrição em Saúde Pública. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil.,Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Leandro Martin Totaro Garcia
- Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Emanuel Péricles Salvador
- Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde. Universidade de São Paulo. São Paulo, SP, Brasil.,Departamento de Educação Física. Universidade Federal do Maranhão. São Luís, MA, Brasil
| | - Evelyn Fabiana Costa
- Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Douglas Roque Andrade
- Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde. Universidade de São Paulo. São Paulo, SP, Brasil.,Escola de Artes, Ciências e Humanidades. Universidade de São Paulo. São Paulo, SP, Brasil
| | | | - Alex Antonio Florindo
- Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde. Universidade de São Paulo. São Paulo, SP, Brasil.,Escola de Artes, Ciências e Humanidades. Universidade de São Paulo. São Paulo, SP, Brasil
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16
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Correia PCI, Goulart PM, Furtado JP. A avaliabilidade dos Núcleos de Apoio à Saúde da Família (Nasf). SAÚDE EM DEBATE 2017. [DOI: 10.1590/0103-11042017s25] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Os Núcleos de Apoio à Saúde da Família (Nasf) vêm se constituindo enquanto objeto de indagações e pesquisas. Com base em revisão de literatura e no discurso oficial expresso nos documentos do Ministério da Saúde, realizou-se o presente estudo de sua avaliabilidade, apontando algumas das estratégias de avaliação mais adequadas à iniciativa. A proposta Nasf se mostrou, portanto, avaliável, e a avaliação de sua lógica e estratégia, abordando sua concepção e hipóteses teóricas, ganha relevância no atual estágio em que a iniciativa se encontra.
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17
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Hidalgo KD, Mielke GI, Parra DC, Lobelo F, Simões EJ, Gomes GO, Florindo AA, Bracco M, Moura L, Brownson RC, Pratt M, Ramos LR, Hallal PC. Health promoting practices and personal lifestyle behaviors of Brazilian health professionals. BMC Public Health 2016; 16:1114. [PMID: 27776496 PMCID: PMC5078940 DOI: 10.1186/s12889-016-3778-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 10/15/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study was conducted to examine the lifestyle behaviors and health promoting practices of physicians, nurses, and community health workers in Brazil. METHODS A random sample of primary health care units in Brazil was selected, and a pretested questionnaire was administered via phone interviews, in 2011, to 182 physicians, 347 nurses, and 269 community health workers, totaling 798 health professionals. The total initial sample included 1600 eligible health professionals. Variables measured included physical activity, alcohol intake, hours of sleep, diet, and perceived self-efficacy to provide preventive counseling on related lifestyle behaviors. RESULTS More than 25 % of physicians, nurses, and community health workers reported eating 0-2 portions of fruits and vegetables per day. In terms of cervical and breast cancer, nurses reported to be 'very prepared' to advise patients on these topics more frequently than physicians. The prevalence of smoking ranged from 4.9 % among nurses to 7.4 % among community health workers. The proportion of physical inactivity ranged from 40.3 % among nurses to 52.1 % among community health workers. CONCLUSION A reasonably high proportion of physicians, nurses, and community health workers report not engaging in healthy lifestyle behaviors that impact chronic diseases, thus, they may be less likely to encourage such behaviors in their patients.
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Affiliation(s)
- Karen D. Hidalgo
- JFK Johnson Rehabilitation Institute, JFK Medical Center, Edison, NJ USA
| | - Grégore I. Mielke
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Diana C. Parra
- Program in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Eduardo J. Simões
- School of Medicine, Department of Health Management and Informatics, University of Missouri, Columbia, MO USA
| | - Grace O. Gomes
- Gerontology Department, Federal University of Sao Carlos, São Carlos, SP Brazil
| | - Alex A. Florindo
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Brazil
| | - Mário Bracco
- Center of Studies and Research Dr. João Amorim, CEJAM, São Paulo, SP Brazil
| | | | - Ross C. Brownson
- Prevention Research Center in St. Louis, Washington University in St. Louis, Brown School, St. Louis, MO USA
- School of Medicine, Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO USA
| | - Michael Pratt
- Department of Family Medicine and Public Health, University of California, San Diego, CA USA
| | - Luiz R. Ramos
- Department of Preventive Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Pedro C. Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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18
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Lin X, Alvim SM, Simoes EJ, Bensenor IM, Barreto SM, Schmidt MI, Ribeiro AL, Pitanga F, Almeida MCC, Liu S, Lotufo PA. Leisure Time Physical Activity and Cardio-Metabolic Health: Results From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Am Heart Assoc 2016; 5:JAHA.116.003337. [PMID: 27412901 PMCID: PMC4937275 DOI: 10.1161/jaha.116.003337] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Although increasing effort has been devoted to the promotion of a healthy lifestyle such as leisure time physical activity for cardio‐metabolic health, specific evidence supporting health policy remains sparse, particularly in those ethnically diverse populations where cardio‐metabolic diseases are reaching epidemic proportion and yet are grossly understudied. Methods and Results We conducted a cross‐sectional analysis of the baseline data from 10 585 participants aged 35 to 74 free of cardiovascular diseases in the Brazilian Longitudinal Study of Adult Health. Leisure time physical activity status was defined by the American Heart Association and the World Health Organization recommendations (≥150 min/week moderate activities or 75 min/week vigorous activities). In total, 1183 (21%) women and 1387 (29%) men were active. After accounting for covariates, the favorable effects of leisure time physical activity on cardio‐metabolic parameters were evident. Specifically, the average blood pressure, heart rate, and Framingham Risk Score for cardiovascular diseases of the active were significantly lower within each sex. The ORs comparing the active versus the inactive women were 0.78 (95% CI: 0.66–0.92) for hypertension and 0.78 (95% CI: 0.65–0.93) for cardiovascular diseases in 10 years. Among men, the ORs were 0.75 (95% CI: 0.65–0.87) for hypertension and 0.73 (95% CI: 0.61–0.87) for diabetes. The 10‐year risk of cardiovascular diseases was significantly lower among the active men with a 33% reduction (OR=0.67, 95% CI: 0.57–0.78). Conclusions We observed beneficial effects of leisure time physical activity on cardio‐metabolic health in this large Brazilian population that are consistent with studies in North America and Europe.
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Affiliation(s)
- Xiaochen Lin
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Sheila M Alvim
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Eduardo J Simoes
- Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, MO
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, University of São Paulo, Brazil
| | - Sandhi M Barreto
- Faculty of Medicine and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria I Schmidt
- Hospital de Clínicas and Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Antonio L Ribeiro
- Hospital das Clínicas and Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Pitanga
- Departamento de Educação Física, Faculdade de Educação, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Simin Liu
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI Center for Global Cardio-metabolic Health, Brown University, Providence, RI Division of Endocrinology, Department of Medicine, Alpert School of Medicine and Rhode Island Hospital, Providence, RI
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University of São Paulo, Brazil
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Mpofu JJ, de Moura L, Farr SL, Malta DC, Iser BM, Ivata Bernal RT, Robbins CL, Lobelo F. Associations between noncommunicable disease risk factors, race, education, and health insurance status among women of reproductive age in Brazil - 2011. Prev Med Rep 2016; 3:333-7. [PMID: 27419033 PMCID: PMC4929178 DOI: 10.1016/j.pmedr.2016.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Noncommunicable disease (NCD) risk factors increase the risk of adverse reproductive health outcomes and are becoming increasingly common in Brazil. METHODS We analyzed VIGITEL 2011 telephone survey data for 13,745 Brazilian women aged 18-44 years in a probabilistic sample from 26 Brazilian state capitals and the Federal District. We examined associations between NCD risk factors (fruit and vegetable intake, leisure time physical activity, alcohol consumption, smoking status, BMI and hypertension status) and race, education, and insurance using chi-square tests and multivariable logistic regression models, estimating the average marginal effects to produce adjusted relative risk ratios (aRRs). Analyses were conducted using SAS 9.3 survey procedures and weighted to reflect population estimates. RESULTS Women with less than a college education were more likely to report physical inactivity (adjusted relative risk (aRR) and 95% confidence interval = 1.1 (1.1-1.2)), smoking (aRR = 1.7 (1.3-2.2)), and self-reported diagnoses of hypertension (aRR = 2.0 (1.6-2.5)) compared to women with a college education or greater. Similarly, women without health insurance were more likely to report physical inactivity (aRR = 1.1 (1.1-1.2)), smoking (aRR = 1.4 (1.1-1.8)), and self-reported diagnoses of hypertension aRR = 1.4 (1.1-1.7)) compared to women with health insurance. Less variation was found by race and NCD risk factors. CONCLUSION Targeted public health strategies and policies are needed to increase healthcare access and decrease educational and racial disparities in NCD risk factors among women of reproductive age in Brazil.
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Affiliation(s)
- Jonetta Johnson Mpofu
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-74, Atlanta, GA 30341, United States
- U.S. Public Health Service Commissioned Corps, 1101 Wooten Parkway, Rockville, MD 20852, United States
| | - Lenildo de Moura
- Pan-Americana Health Organization, Brasilia, Distrito Federal, Brazil
| | - Sherry L. Farr
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-74, Atlanta, GA 30341, United States
| | - Deborah Carvalho Malta
- Ministry of Health of Brazil, Section 2, Lots 05/06, Premium Building, Block F, Tower 1, Brasilia, DF, Brazil
| | - Betine Moehlecke Iser
- Ministry of Health of Brazil, Section 2, Lots 05/06, Premium Building, Block F, Tower 1, Brasilia, DF, Brazil
| | - Regina Tomie Ivata Bernal
- Ministry of Health of Brazil, Section 2, Lots 05/06, Premium Building, Block F, Tower 1, Brasilia, DF, Brazil
| | - Cheryl L. Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-74, Atlanta, GA 30341, United States
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Mailstop 1518-002-7BB, Atlanta, GA 30322, United States
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Galaviz KI, Lee RE, Bergeron K, Lévesque L. Assessing the physical activity environment in Mexican healthcare settings. SALUD PUBLICA DE MEXICO 2015; 57:403-11. [PMID: 26545001 DOI: 10.21149/spm.v57i5.7620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/23/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To assess the informational, educational and instrumental environments among Mexican healthcare settings for their potential to promote physical activity (PA). MATERIALS AND METHODS The Environmental Physical Activity Assessment Tool for Healthcare Settings (EPATHS) was developed to assess the PA environments of 40 clinics/hospitals representing the three Mexican healthcare systems in Guadalajara. The EPATHS assessed the presence and quality of PA enhancing features in the informational (e.g. signage), educational (e.g. pamphlets), and instrumental (e.g. stairs) environments of included clinics/hospitals. RESULTS 28 (70%) clinics/hospitals had more than one floor with stairs; 60% of these had elevators. Nearly 90% of stairs were visible, accessible and clean compared to fewer than 30% of elevators. Outdoor spaces were observed in just over half (55%) of clinics/hospitals, and most (70%) were of good quality. Only 25% clinics/hospitals had educational PA materials. CONCLUSIONS The PA instrumental environment of Mexican healthcare settings is encouraging. The informational and educational environments could improve.
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Affiliation(s)
- Karla I Galaviz
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, Estados Unidos de América
| | - Rebecca E Lee
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, Estados Unidos de América
| | - Kim Bergeron
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canadá
| | - Lucie Lévesque
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canadá
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21
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Ramos LR, Malta DC, Gomes GADO, Bracco MM, Florindo AA, Mielke GI, Parra DC, Lobelo F, Simoes EJ, Hallal PC. Prevalence of health promotion programs in primary health care units in Brazil. Rev Saude Publica 2015; 48:837-44. [PMID: 25372175 PMCID: PMC4211580 DOI: 10.1590/s0034-8910.2014048005249] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 06/17/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil's health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.
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