BackgroundThere is a lack of evidence regarding clusters of health-related behaviors among adolescents from low, lower-middle, and upper-middle income countries. This study aimed to identify clustering patterns of health-related behaviors (diet, physical activity [PA] and sedentary behavior [SB]) and association with sociodemographic variables among a population-based sample of Brazilian adolescents.MethodsCross-sectional data from the 2015 National School-Based Health Survey (PeNSE). A total of 102,072 (females: 51.7%) students in ninth-grade (age: 14.3 ± 1.1 years-old) enrolled in public and private schools were investigated in this study. Healthy and unhealthy diet, PA and SB were measured using a validated questionnaire. Two-step cluster analysis was conducted to identify lifestyle patterns. The methodology for complex analysis and weighting was used to inferential statistical procedures. Multinomial logistic regression assessed associations between sociodemographic factors and the clusters.ResultsThree reliable and meaningful clusters were identified and labelled as follows: (1) health-promoting SB and diet (32.6%); (2) health-promoting PA and diet (44.9%), and (3) health-risk (22.5%). Compared to boys, girls were less likely to be in clusters 1 (OR = 0.85; 95% CI = 0.78–0.93, p < 0.001) and 2 (OR = 0.43; 95% CI = 0.40–0.46, p < 0.001) than the health-risk cluster. Higher socioeconomic status was positively associated with health-promoting PA and diet, and negatively related to health-promoting SB and diet. Older adolescents were more likely to be in cluster 1 than in cluster 3, compared to younger adolescents.ConclusionApproximately one-quarter of the population (health-risk cluster) reported engaging in multiple risk behaviors. Interventions may need to be tailored to specific adolescent groups, especially considering sociodemographic differences.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6203-1) contains supplementary material, which is available to authorized users.

Promoting healthy lifestyle factors (e.g., physical activity, healthy eating, less screen time) among young people is a relevant and challenging step toward reducing non-communicable diseases. This study aimed to evaluate the effect of a multicomponent intervention on lifestyle factors among adolescents from schools in low Human Development Index (HDI < 0.500) areas. The Fortaleça sua Saúde program was conducted with 548 adolescents aged 11–18 years old in the intervention group and 537 in the control group. The four-month intervention included strategies focused on training teachers, new opportunities for physical activity in the school environment, and health education strategies for the school community (including parents). Moderate- to-vigorous physical activity level (≥420 min/week), TV watching and computer use/gaming (<2 h/day), daily consumption of fruit juice, fruit, vegetables, soft drinks, savory foods and sweets, and current alcohol and tobacco use were measured before and after intervention. McNemar’s test and logistic regression (odds ratio [OR] and a 95% confidence interval [95% CI]) were used, considering p < 0.05. In the intervention schools, a significant increase occurred in the number of adolescents who met physical activity guidelines (5.3%; 95% CI = 0.8; 9.8) and who reported using computer for <2 h a day (8.6%; 95% CI = 3.8; 13.4) after intervention. No changes were observed in the control schools. At the end of the intervention, adolescents from intervention schools were more likely to practice physical activity at recommended levels (OR = 1.44; 95% CI = 1.00; 2.08) than adolescents from control schools. No significant change was observed for the other lifestyle factors. In conclusion, this multicomponent intervention was effective in promoting physical activity among adolescents from vulnerable areas. However, other lifestyle factors showed no significant change after intervention. This study is registered at Clinicaltrials.gov NCT02439827.

Background: A better understanding of how multicomponent school-based interventions work and their effects on health and education outcomes are needed. This paper described the methods of the Movimente Program, a school-based intervention that aims to increase physical activity (PA) and decrease sedentary behavior (SB) among Brazilian students. Methods: This is a cluster randomized controlled trial with adolescents from 7th to 9th grade in public schools from Florianopolis, Southern Brazil. After agreement, 6 schools were randomly selected to intervention or control groups (3 schools each), and all eligible students were invited to the study. The Movimente intervention program was performed during a school year and included 3 main components: Teacher training (including face-to-face meeting, social media platform, and handbook with lesson plans); improvements in the PA environment in school; and educational strategies. Control schools continued with their traditional schedule. Baseline (March/April 2017), postintervention (November/December 2017), and maintenance (June/July 2018) evaluations included PA and SB as primary outcomes (assessed by self-report and accelerometry). Secondary outcomes included psychosocial factors related to PA and SB (e.g., social support and self-efficacy), as well as health (e.g., quality of life and nutritional status) and education (e.g., academic achievement) outcomes. A program evaluation was performed based on the RE-AIM framework. Participants, intervention staffs, and evaluators were not blinded to group assignment, but a standardized evaluation protocol was applied independently of the trial allocation. Results: Statistical analyses will include a multilevel approach for repeated measurements and mediation analysis. Any side effects of the intervention will be recorded. The sample size close to that expected (n = 1090) was reached (n = 999). The results of this trial will involve valuable information about the effect and the evaluation of a multicomponent intervention carried out in a middle-income country. Conclusion: By creating opportunities for adolescents to be active at school using multicomponent strategies, the Movimente program has the potential to enhance students health and academic performance which may encourage the school community (e.g., teachers, principals) to adopt the program. Also, this trial will provide evidence for practitioners, policy makers, and researchers on how multicomponent program may be implemented in a school setting. Trial registration: The trial is registered at the Clinical Trial Registry (Trial ID: NCT02944318; date of registration: 18 October 2016).

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A large proportion of adolescents are in the pre-adoption stages and most of these have the intention to start regular physical activity. With the exception of school shift, the assessed variables were associated with stages in different ways, showing different profiles in relation to sociodemographic and economic characteristics in each subgroup.

LicenceAbstract -The association between health behaviors and sleep patterns in youths has been tested using cross-sectional data, and prospective evidence is needed. The aim of this study was to investigate the cross-sectional and prospective associations between behavioral variables and sleep quality and duration. A secondary analysis was conducted using data that were collected in March and December 2006 from a random sample of high school students (aged 14-24 years) from Recife and Florianopolis, Brazil, for the "Saúde na Boa" intervention. Data on the perception of sleep quality and duration and lifestyle variables were obtained through self-reported questionnaires. Data were analyzed using crude and adjusted binary logistic regressions. The percentages of students reporting poor sleep quality and insufficient sleep duration were 45.7% and 76.7%, respectively, considering the cross-sectional data, and 45.8% and 77.5%, respectively, considering the longitudinal data. There was a cross-sectional association between lower physical activity (OR = 0.74, 95% CI: 0.55, 0.99) and higher snack consumption (OR = 1.67, 95% CI: 1.18, 2.36) and negative sleep quality. Excessive TV watching (OR = 0.48, 95% CI: 0.30, 0.75) and higher levels of soft drink consumption (OR = 1.84, 95% CI: 1.19, 2.84) were associated with insufficient sleep duration. However, no behavioral variables were associated with sleep quality and duration in the prospective analysis. The prevalence of self-reported poor sleep quality and duration were similar in the cross-sectional and longitudinal analyses. Some behaviors were associated with sleep patterns in the cross-sectional analyses, but these findings were not confirmed in the prospective analyses. Key words: Adolescent, Adolescent behavior; Brazil; Prospective studies; Sleep. (OR = 0,74; IC 95%: 0,55; 0,99) e o maior consumo de salgados (OR = 1,67; IC 95%: 1,18;2,36) estiveram associados à qualidade negativa do sono, enquanto o tempo excessivo de televisão (OR = 0,48; IC 95%: 0,30; 0,75) Resumo -A associação entre comportamentos de saúde e sono tem sido testada em jovens com dados transversais, mas evidências prospectivas são necessárias. O objetivo do estudo foi verificar associações transversais e prospectivas entre variáveis comportamentais e percepções

Objective:Verify the prevalence and sociodemographic and economic factors associated with behavior change stages for habitual physical activity practice in adolescents from Santa Catarina.Methods:Secondary analysis of a study on the Behavior of Adolescents from Santa Catarina (CompAC 2). Cross-sectional school-based study of 6,529 high-school students (males, n=2,903) from the state of Santa Catarina public education system in 2011, aged 15 to 19 years. Multinomial logistic regression (crude and adjusted) was used to measure the association.Results:The highest and lowest prevalence rates were found in the maintenance (43.9%) and precontemplation stages (7.0%), respectively. The stages of action, preparation and contemplation showed similar results: 16.2%; 17.0% and 15.6%; respectively. Male adolescents show higher prevalence in the maintenance stage in relation to females and these show a higher prevalence in preparation, contemplation and precontemplation. All the assessed variables (gender, age, area of residence, employment status, family income, maternal education and school grade), with the exception of school shift, were associated with at least one of the stages.Conclusions:A large proportion of adolescents are in the pre-adoption stages and most of these have the intention to start regular physical activity. With the exception of school shift, the assessed variables were associated with stages in different ways, showing different profiles in relation to sociodemographic and economic characteristics in each subgroup.

Summary The effectiveness of physical activity interventions can be improved through examining the aspects related to their implementation. However, little such evidence has been collected, particularly in low- and middle-income countries. This study aimed to evaluate the implementation of a school-based physical activity intervention with qualitative and quantitative data from different actors (students, teachers and parents) involved in developing the program. The program was conducted in 2017 with three main components: (i) teacher training, (ii) environmental changes and (iii) educational actions. Mixed-method evaluation was performed by an independent evaluation team using a validated indicator matrix for the implementation process, including the self-reported information of students, teachers and parents, as well as interviews with teachers. In the 3 eligible schools, 350 adolescents (51% girls) answered the implementation questionnaire, as did 45 parents (84% mothers), and 47 teachers (70% female). In the qualitative analysis, 18 teachers participated. Categorical analysis found that the intervention was considered feasible by teachers. In general, teachers had a more positive perception of the implementation than did students. The lack of engagement from the school community and parents and the busy schedule of teachers were indicated to be the main difficulties. In conclusion, despite the teachers’ motivation, some barriers prevented the successful implementation of the program.