Healthy communities

There is considerable knowledge of how to enhance the health of communities through reshaping their environments, particularly the urban environments in which people increasingly live. We have much less understanding of how to deliver these healthier urban environments. This paper reviews the research on four key urban health problematics – sanitation and wastewater treatment, transportation and mobility, the urban heat island impacts, and indoor air quality – and considers the implications for urban planning and management

Prevalência de atividade física em adolescentes e fatores associados

OBJECTIVE: To estimate the prevalence and identify correlates of physical activity among adolescents. METHODS: Cross-sectional study nested within a cohort of 4,325 subjects from the city of Pelotas, Southern Brazil, aged 14-15 years in 2008. Physical activity was analyzed using three different approaches: (1) prevalence of any leisure-time physical activity; (2) prevalence of any active commuting to school; and (3) prevalence of engaging in at least 300 minutes per week of both (1) and (2) combined. Independent variables included sociodemographic, behavioral, social, and biological characteristics, and number of different leisure-time physical activites practiced. Statistical analyses were carried out using Poisson regression. RESULTS: The proportion of adolescents involved in any type of leisure-time physical activity was 75.6%, while 73.4% displayed some form of active commuting to school. Prevalence of total physical activity score (>; 300 min/week) was 48.2%, being greater among boys (62.6%) than among girls (34.5%). Furthermore, prevalence increased along with the number of physical activity modalities practiced (pOBJETIVO: Estimar la prevalencia de actividad física entre adolescentes y identificar los factores asociados. MÉTODOS: Estudio transversal anidado en una cohorte con 4.325 individuos de 14-15 años en Pelota, Sur de Brasil, en 2008. La actividad física fue analizada por medio de tres diferentes abordajes: 1) prevalencia de alguna actividad física de ocio; 2) prevalencia de algún traslado activo para la escuela; 3) prevalencia de compromiso de por lo menos 300 minutos por semana en la combinación de ambos (1 y 2). Variables independientes incluyeron características demográficas, socioeconómicas, comportamentales, sociales y biológicas y número de actividades físicas practicadas en el tiempo de ocio. Los análisis estadísticos fueron hechos por la regresión de Poisson. RESULTADOS: La proporción de adolescentes envueltos en alguna actividad física de ocio fue 75,6% mientras que 73,4% presentaron alguna forma de traslado activo para la escuela. La prevalencia de actividad física total (escore ³ 300 min/sem) fue 48,2% siendo mayor para los niños (62,6%) que para las niñas (34,5%). Además, la prevalencia aumentó de acuerdo con el número de actividades físicas practicadas (pOBJETIVO: Estimar a prevalência de atividade física entre adolescentes e identificar fatores associados. MÉTODOS: Estudo transversal aninhado em uma coorte com 4.325 indivíduos de 14-15 anos em Pelotas, RS, em 2008. A atividade física foi analisada por meio de três diferentes abordagens: 1) prevalência de alguma atividade física de lazer; 2) prevalência de algum deslocamento ativo para a escola; 3) prevalência de engajamento em pelo menos 300 minutos por semana da combinação de ambos (1 e 2). Variáveis independentes incluíram características demográficas, socioeconômicas, comportamentais, sociais e biológicas e número de atividades físicas praticadas no tempo de lazer. As análises estatísticas foram feitas pela regressão de Poisson. RESULTADOS: A proporção de adolescentes envolvidos em alguma atividade física de lazer foi 75,6%, enquanto 73,4% apresentou alguma forma de deslocamento ativo para a escola. A prevalência de atividade física total (escore >; 300 min/sem) foi 48,2%, sendo maior para os meninos (62,6%) do que para as meninas (34,5%). Além disso, a prevalência aumentou de acordo com o número de atividades físicas praticadas (p < 0,001). Os fatores associados à maior prática de atividade física (lazer + deslocamento) nos níveis recomendados foram: cor de pele não-branca, ter repetido de ano na escola e jogar videogame. As variáveis menor nível socioeconômico, maior tempo de uso de computador e atividade física dos pais estiveram associadas ao desfecho apenas entre as meninas. CONCLUSÕES: Menos da metade dos adolescentes atingiu as recomendações para a prática de atividade física, e essa proporção tende a diminuir entre os sujeitos de maior nível socioeconômico. Os fatores associados diferiram entre lazer e deslocamento. Engajamento em uma ampla variedade de atividades físicas deve ser encorajado desde a infância

Adolescents' perception of causes of obesity: unhealthy lifestyles or heritage?

PURPOSE: To evaluate adolescents' perception of the causes of obesity, with emphasis on differences according to nutritional status and socioeconomic position. METHODS: We conducted qualitative research including 80 adolescents belonging to the 1993 Pelotas (Brazil) Birth Cohort Study, and their mothers. We classified adolescent boys and girls into four groups (girls-obese, girls-eutrophic, boys-obese, and boys-eutrophic) according to body mass index for age and sex, and systematically selected them according to family income at age 15 years. Research techniques included semistructured interviews and history of life. Topics covered in the interviews included early experiences with weight management, effect of weight on social relationships, family history, eating habits, and values. RESULTS: Low-income obese adolescents and their mothers perceive obesity as a heritage, caused by family genes, side effects of medication use, and stressful life events. However, low-income eutrophic adolescents emphasize the role of unhealthy diets on obesity development. Among the high-income adolescents, those who are obese attribute it to genetic factors and emotional problems, whereas those who are eutrophic mention unhealthy diets and lack of physical activity as the main causes of obesity. CONCLUSIONS: Perceptions of the causes of obesity in adolescents from a middle-income setting vary by gender, socioeconomic position, and nutritional status. Whereas some blame genetics as responsible for obesity development, others blame unhealthy diets and lifestyles, and others acknowledge the roles of early life experiences and family traditions in the process of obesity development.Helen Gonçalves, David A. González, Cora P. Araújo, Ludmila Muniz, Patrícia Tavares, Maria C. Assunção, Ana M.B. Menezes and Pedro C. Halla

Proximity to Sports Facilities and Sports Participation for Adolescents in Germany

Objectives - To assess the relationship between proximity to specific sports facilities and participation in the corresponding sports activities for adolescents in Germany. Methods - A sample of 1,768 adolescents aged 11–17 years old and living in 161 German communities was examined. Distances to the nearest sports facilities were calculated as an indicator of proximity to sports facilities using Geographic Information Systems (GIS). Participation in specific leisure-time sports activities in sports clubs was assessed using a self-report questionnaire and individual-level socio-demographic variables were derived from a parent questionnaire. Community-level socio-demographics as covariates were selected from the INKAR database, in particular from indicators and maps on land development. Logistic regression analyses were conducted to examine associations between proximity to the nearest sports facilities and participation in the corresponding sports activities. Results - The logisitic regression analyses showed that girls residing longer distances from the nearest gym were less likely to engage in indoor sports activities; a significant interaction between distances to gyms and level of urbanization was identified. Decomposition of the interaction term showed that for adolescent girls living in rural areas participation in indoor sports activities was positively associated with gym proximity. Proximity to tennis courts and indoor pools was not associated with participation in tennis or water sports, respectively. Conclusions - Improved proximity to gyms is likely to be more important for female adolescents living in rural areas

Life course association of maternal smoking during pregnancy and offspring's height: data from the 1993 Pelotas (Brazil) birth cohort

Health from birth to adolescence: findings from the 1993 Pelotas, Brazil, Birth Cohort StudyPURPOSE: To evaluate the effect of (1) maternal smoking during pregnancy; and (2) partner smoking on offspring's height in infancy, childhood, and adolescence. METHODS: All hospital live births from 1993 (5,249) were identified, and these infants were followed up at several ages. Height for age, expressed as z-scores using the World Health Organization growth curves, was measured at all follow-up visits. Maternal smoking during pregnancy was collected retrospectively at birth and analyzed as number of cigarettes/day smoked categorized in four categories (never smoked, <10, 10-19, and ≥ 20 cigarettes/day). Partner smoking was analyzed as a dichotomous variable (No/Yes). Unadjusted and adjusted analyses were performed by use of linear regression. RESULTS: The prevalence of self-reported maternal smoking during pregnancy was 33.5%. In the crude analysis, the number of cigarettes/day smoked by the mother during pregnancy negatively affected offspring's height in infancy, childhood, and adolescence. After adjustment for confounders and mediators, this association remained statistically significant, although the magnitude of the regression coefficients was reduced. Paternal smoking was not associated with offspring's height in the adjusted analyses. CONCLUSIONS: In addition to the well-known harmful effects of smoking, maternal smoking during pregnancy negatively affects offspring's height. Public health policies aimed at continuing to reduce the prevalence of maternal smoking during pregnancy must be encouraged.Jeovany Martínez-Mesa, Ana M.B. Menezes, David A. González, Bernardo L. Horta, Alicia Matijasevich, Denise P. Gigante, Pedro C. Halla

The theory of planned behaviour predicts self-reports of walking, but does not predict step count

Objectives This paper compares multiple measures of walking in two studies, and the second study compares how well Theory of Planned Behaviour (TPB) constructs perform in predicting these different measures. Methods In Study 1, 41 participants wore a New Lifestyles NL-2000 pedometer for 1 week. Subsequently, participants completed a questionnaire containing measures of the TPB constructs and two self-report measures of walking, followed by two interview measures of walking. For Study 2, 200 RAF trainee aircraftsmen wore pedometers for 2 weeks. At the end of each week, participants completed the questionnaire and interview measures of walking. Results Both studies found no significant association between questionnaire measures of walking and pedometer measures. In Study 1, the interview measures produced significant, large correlations with the pedometer measure, but these relationships were markedly weaker in the second study. TPB variables were found to explain 22% of variance in intention to walk in Study 1 and 45% of the variance in Study 2. In Study 2, prediction of subsequent measures of behaviour was found to be weak, except when using a single-item measure of walking. Conclusions Recall of walking is poor, and accurate measurement by self-report is problematic. Although the TPB predicts intentions to walk well, it does not predict actual amount of walking, as assessed by pedometer. Possible reasons for these findings include the unique nature of walking as an activity primarily used to facilitate higher order goals. The use of single-item measures may exaggerate the effectiveness of the TPB model for walking, and possibly other forms of physical activity.</p

Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America

The aim of the present study was to evaluate the association between history of tuberculosis and airflow obstruction.A population-based, multicentre study was carried out and included 5,571 subjects aged >= 40 yrs living in one of five Latin American metropolitan areas: São Paulo (Brazil); Montevideo (Uruguay); Mexico City (Mexico); Santiago (Chile); and Caracas (Venezuela). Subjects performed pre- and post-bronchodilator spirometry and were asked whether they had ever been diagnosed with tuberculosis by a physician.The overall prevalence of airflow obstruction (forced expiratory volume in one second/forced vital capacity post-bronchodilator < 0.7) was 30.7% among those with a history of tuberculosis, compared with 13.9% among those without a history. Males with a medical history of tuberculosis were 4.1 times more likely to present airflow obstruction than those without such a diagnosis. This remained unchanged after adjustment for confounding by age, sex, schooling, ethnicity, smoking, exposure to dust and smoke, respiratory morbidity in childhood and current morbidity. Among females, the unadjusted and adjusted odds ratios were 2.3 and 1.7, respectively.In conclusion, history of tuberculosis is associated with airflow obstruction in Latin American middle-aged and older adults.Univ Fed Pelotas, BR-96020220 Pelotas, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilNatl Inst Resp Dis, Mexico City, DF, MexicoUniv Republica, Montevideo, UruguayCatholic Univ Chile, Santiago, ChileCent Univ Venezuela, Caracas, VenezuelaUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Exploring the context of sedentary behaviour in older adults (what, where, why, when and with whom)

BACKGROUND: Older adults are the most sedentary segment of the population. Little information is available about the context of sedentary behaviour to inform guidelines and intervention. There is a dearth of information about when, where to intervene and which specific behaviours intervention should target. The aim of this exploratory study was to obtain objective information about what older adults do when sedentary, where and when they are sedentary and in what social context. METHODS: The study was a cross-sectional data collection. Older adults (Mean age = 73.25, SD ± 5.48, median = 72, IQR = 11) volunteers wore activPAL monitors and a Vicon Revue timelapse camera between 1 and 7 days. Periods of sedentary behaviour were identified using the activPAL and the context extracted from the pictures taken during these periods. Analysis of context was conducted using the Sedentary Behaviour International Taxonomy classification system. RESULTS: In total, 52 days from 36 participants were available for analysis. Participants spent 70.1 % of sedentary time at home, 56.9 % of sedentary time on their own and 46.8 % occurred in the afternoon. Seated social activities were infrequent (6.9 % of sedentary bouts) but prolonged (18 % of sedentary time). Participants appeared to frequently have vacant sitting time (41 % of non-screen sedentary time) and screen sitting was prevalent (36 % of total sedentary time). CONCLUSIONS: This study provides valuable information to inform future interventions to reduce sedentary behaviour. Interventions should consider targeting the home environment and focus on the afternoon sitting time, though this needs confirmation in a larger study. Tackling social isolation may also be a target to reduce sedentary time