ADOLESCENTS: HEALTH, DISEASE AND RISK

Este artigo tem por objetivo captar as concepções dos adolescentes que frequentam o Núcleo de Estudos da Saúde do Adolescente (NESAIUERJ) sobre saúde/doença e risco e contrapôlas ao entendimento acerca destas mesmas categorias encontradas nos documentos oficiais de atenção à saúde dos adolescentes produzidos por órgãos gestores nacionais (Ministério da Saúde) e internacionais (Organização  Panamericana de Saúde). Dedicamo-nos a decifrar o entendimento que os adolescentes possuem acerca das categorias delimitadas, utilizando os princípios metodológicos da História Oral, partindo sempre da premissa de que não é possível retirar- lhes suas historicidades e de que suas verbalizações constroem-se relacionadas à ambiência social que os circunda e, portanto, traduzem maneiras de ser e pensar construídas socialmente. Observamos que os adolescentes percebem a doença como um ‘problema” passível de resolução e concebem o risco como algo que existe no meio social do qual fazem parte, diferentemente dos documentos oficiais que os vislumbram permanentemente como sendo o próprio risco.This article is part of my master dissertation and its objective is to compare the understanding adolescents have about disease, health and risk with that presented by the official documents about adolescent health care produced by Brazilian and international organizations (Ministry of Health of Brazil; Pan American Health Organization). This work consisted of tryingto grasp the adolescents’ understanding of the concepts through the use of the Oral History methodology. A basic premise was that what was said could not be taken in the abstract, but was related to the surrounding environment - therefore expressing socially constructed ways of beingand thinking. I observed that disease was perceived as a “problem” to which there are solutions. Risk was seen as something that exists in the outer social environment, a rather different view from that of the of ficial documents, which understand adolescence itself as being the risk. I hopethat with the results of the comparison between these two ways of understanding the world, the proposal concerning adolescents care will come closer to the reality and needs of the adolescents themselves

ERICA: prevalência de tabagismo em adolescentes brasileiros

OBJECTIVE To estimate the prevalences of tobacco use, tobacco experimentation, and frequent smoking among Brazilian adolescents. METHODS We evaluated participants of the cross-sectional, nation-wide, school-based Study of Cardiovascular Risks in Adolescents (ERICA), which included 12- to 17-year-old adolescents from municipalities of over 100 thousand inhabitants. The study sample had a clustered, stratified design and was representative of the whole country, its geographical regions, and all 27 state capitals. The information was obtained with self-administered questionnaires. Tobacco experimentation was defined as having tried cigarettes at least once in life. Adolescents who had smoked on at least one day over the previous 30 days were considered current cigarette smokers. Having smoked cigarettes for at least seven consecutive days was an indicator for regular consumption of tobacco. Considering the complex sampling design, prevalences and 95% confidence intervals were estimated according to sociodemographic and socio-environmental characteristics. RESULTS We evaluated 74,589 adolescents. Among these, 18.5% (95%CI 17.7-19.4) had smoked at least once in life, 5.7% (95%CI 5.3-6.2) smoked at the time of the research, and 2.5% (95%CI 2.2-2.8) smoked often. Adolescents aged 15 to 17 years had higher prevalences for all indicators than those aged 12 to 14 years. The prevalences did not differ significantly between sexes. The highest prevalences were found in the South region and the lowest ones, in the Northeast region. Regardless of sex, the prevalences were found to be higher for adolescents who had had paid jobs, who lived with only one parent, and who reported having been in contact with smokers either inside or outside their homes. Female public school adolescents were found to smoke more than the ones from private schools. CONCLUSIONS Tobacco use among adolescents is still a challenge. Intending to reduce the prevalence of tobacco use among young people, especially the ones under socioeconomic vulnerability conditions, Brazil must consolidate and increase effective public health care measures.OBJETIVO Estimar as prevalências de tabagismo, experimentação e fumo frequente em adolescentes brasileiros. MÉTODOS Foram avaliados os participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), estudo transversal de base escolar e abrangência nacional. Participaram adolescentes de 12 a 17 anos de municípios com mais de 100 mil habitantes. A amostra foi estratificada e conglomerada e tem representatividade nacional, regional e para as 27 capitais. As informações foram obtidas usando-se questionário autopreenchível. Experimentação foi definida como: ter experimentado cigarros alguma vez na vida. Foram considerados fumantes atuais de cigarros aqueles que fumaram pelo menos um dia nos últimos 30 dias. Utilizou-se como indicador de uso frequente de tabaco ter fumado cigarros por pelo menos sete dias seguidos. Considerando-se o desenho complexo da amostra, prevalências e intervalos de confiança de 95% foram estimados segundo características sociodemográficas e socioambientais. RESULTADOS Foram avaliados 74.589 adolescentes; dentre esses, 18,5% (IC95% 17,7-19,4) fumaram pelo menos uma vez na vida, 5,7% (IC95% 5,3-6,2) fumavam no momento da pesquisa e 2,5% (IC95% 2,2-2,8) fumavam com frequência. Adolescentes de 15 a 17 anos tiveram prevalências mais elevadas de todos os indicadores comparados aos de 12 a 14 anos. As prevalências não apresentaram diferenças significativas entre sexos. Maiores prevalências foram observadas na região Sul e menores na região Nordeste. Independentemente de sexo, as prevalências foram maiores para adolescentes que tinham tido trabalho remunerado, nos que não moravam com os dois pais e que referiram ter tido contato com fumante em casa ou fora. Adolescentes do sexo feminino de escolas públicas fumavam mais do que as de escolas privadas. CONCLUSÕES O tabagismo entre adolescentes ainda é um desafio. Visando a redução da prevalência de tabagismo entre jovens, em especial os que se encontram em situação de vulnerabilidade socioeconômica, o Brasil deve consolidar e ampliar medidas de saúde pública efetivas

ERICA: prevalências de hipertensão arterial e obesidade em adolescentes brasileiros

OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.OBJETIVO Estimar as prevalências de hipertensão arterial e obesidade e a fração atribuível populacional de hipertensão arterial devida à obesidade em adolescentes brasileiros. MÉTODOS Foram avaliados dados dos participantes do Estudo de Riscos Cardiovasculares em Adolescentes, estudo seccional l nacional de base escolar. A amostra foi dividida em 32 estratos geográficos e conglomerados de escolas e turmas, com representatividade nacional, macrorregional e de capitais. Obesidade foi classificada pelo índice de massa corporal segundo idade e sexo. Considerou-se hipertensão arterial a média da pressão arterial sistólica ou diastólica maior ou igual ao percentil 95 da curva de referência. Foram estimadas prevalências e intervalos de confiança de 95% (IC95%) de hipertensão arterial e de obesidade, nacionais e nas macrorregiões do País, por sexo e grupo etário, assim como as frações de hipertensão atribuíveis à obesidade na população. RESULTADOS Foram avaliados 73.399 estudantes, 55,4% do sexo feminino, com média de idade 14,7 anos (DP = 1,6). A prevalência de hipertensão arterial foi 9,6% (IC95% 9,0-10,3); sendo as mais baixas observadas nas regiões Norte, 8,4% (IC95% 7,7-9,2) e Nordeste, 8,4% (IC95% 7,6-9,2) e a mais alta na região Sul, 12,5% (IC95% 11,0-14,2). A prevalência de obesidade foi 8,4% (IC95% 7,9-8,9), mais baixa na região Norte e mais alta na Sul. As prevalências de hipertensão arterial e obesidade foram maiores no sexo masculino. Adolescentes com obesidade tiveram prevalência de hipertensão arterial mais elevada, 28,4% (IC95% 25,5-31,2), do que aqueles com sobrepeso, 15,4% (IC95% 13,8-17,0), ou eutróficos, 6,3% (IC95% 5,6-7,0). A fração de hipertensão arterial atribuível à obesidade foi de 17,8%. CONCLUSÕES O ERICA foi o primeiro estudo brasileiro com representatividade nacional a estimar a prevalência de hipertensão arterial aferida em adolescentes. A fração da prevalência de hipertensão arterial atribuível à obesidade mostrou que cerca de 1/5 dos hipertensos poderiam não ser hipertensos se não fossem obesos

Erica: Prevalence Of Metabolic Syndrome In Brazilian Adolescents

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS: We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS: Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95% CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95% CI 2.4-3.2]), when compared with private schools (1.9% [95% CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS: ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.501Department of Science and Technology of the Secretariat of Science, Technology and Strategic Inputs of the Ministry of Health (Decit/SCTIE/MS)Health Sectorial Fund (Fundo Setorial de Saude - CT-Saude) of the Ministry of Science, Technology and Innovation (MCTI)FINEP [01090421]CNPq [2010/565037-2]Research Incentive Fund of the Hospital de Clinicas de Porto Alegre - (Fundo de Incentivo a Pesquisa do Hospital de Clinicas de Porto Alegre - FIPE-HCPA) [405.009/2012-7]Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Erratum to: The study of cardiovascular risk in adolescents – ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents

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Use of flavored cigarettes in the first few puffs: a step toward smoking initiation and nicotine addiction? Data from a national survey among Brazilian adolescents

Background Little is known about the importance of flavored cigarettes for initiation among youth in Brazil, which has amongst the greatest number of smokers in the world. This study aimed at analyzing the relationship between trying to smoke mainly mentholated and flavored cigarettes and initiation and intensity of smoking among Brazilian students. Methods A cross-sectional school-based survey that included a multistage probability sample of 12-17 years old students was conducted in cities with more than 100,000 inhabitants, who participated in the Study of Cardiovascular Risks Among Adolescents in 2013-2014 (ERICA) (n=70,589). Data was collected using self-administered questionnaires. Logistic models regressed current smoking (last 30 days) and days smoking (6 ore more vs 5 or fewer) on preference for flavored cigarettes, adjusting for gender, age, skin color, type of school (public vs private), family structure (with vs without two parents), having a paid job, time since experimentation, and geographic region. Results Among the 18.5% of adolescents who ever tried cigarettes, 26.4% (95% confidence interval, CI 24.1, 28.9) of males and 28.8% (CI 26.4, 31.4) of females had flavored cigarettes as their first choice brand. Of the 5.7% who smoked in the past 30 days, flavored cigarettes were the first choice in 54.7% of males (CI 49.9, 59.4) and 60.6% (CI 55.6, 65.4) of females. In adjusted models, experimenters who preferred flavored cigarettes were more likely to have smoked in the past 30 days (adjusted Odds Ratio, adjOR = 1.62, CI 1.36; 1.92), and to smoke 6 or more days ( vs 1-5 days) in the past 30 days (adjOR = 1.37, CI 1.01; 1.86) than experimenters who preferred non-flavor cigarettes. Conclusions Preferences for flavored cigarettes among Brazilian adolescents is very high. Banning flavored cigarettes could reducing the palatability of cigarettes for youth and thereby reduce smoking initiation and prevalence