Co-occurrence of Smoking and Unhealthy Diet in the Brazilian Adult Population

Francisco, Priscila Maria Stolses Bergamo; Assumpção, Daniela de; Malta, Deborah Carvalho

doi:10.5935/abc.20190222

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Original Article • Arq. Bras. Cardiol. 113 (4) • Oct 2019 • https://doi.org/10.5935/abc.20190222 copy

Co-occurrence of Smoking and Unhealthy Diet in the Brazilian Adult Population

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Smoking and an inadequate diet are behavioral risk factors that contribute to the majority of deaths and disabilities caused by noncommunicable diseases.

Objectives:

To estimate the prevalence of the co-occurrence of smoking and inadequate diet and identify associated factors in adults.

Methods:

A cross-sectional population-based study was conducted with a sample of 28,950 Brazilian adults (18 to 59 years old). Data were obtained from Sistema de Vigilância por Inquérito Telefônico (Vigitel [Brazilian Health Surveillance Telephone Survey]) in 2014. Independent associations were investigated using Poisson hierarchical regression analysis with 5% significance level.

Results:

The prevalence of the co-occurrence of smoking and unhealthy eating was 8.6% (95% CI: 7.9-9.3) and was higher among individuals residing in the southern region of the country than in those living in the central western region (PR = 1.50; 95% CI: 1.18-1.89), those with no private health insurance (PR = 1.14; 95% CI: 1.03-1.25), those who drank alcohol abusively (binge drinkers) (PR = 3.22; 95% CI: 2.70-3.85) and those who self-rated their health as fair (PR = 1.65; 95% CI: 1.36-1.99) or poor/very poor (PR = 1.70; 95% CI: 1.18-2.44). The prevalence of both factors was lower among individuals residing in the northeastern region of the country, women, individuals with brown skin color, those with a spouse, the more educated ones and those with overweight or obesity.

Conclusion:

The more vulnerable segments to the co-occurrence of the risk factors studied were men residing in the southern region of the country, individuals with a lower socioeconomic status and those who reported binge drinking. Interventions addressing multiple behavioral risk factors adapted to specific contexts could have a greater impact on the Brazilian population.

Keywords
Tobacco Use Disorders; Feeding; Risk Factors; Risk reduction Behavior; Chronic Disease; Adult Health; Health Status Disparities

Foods	0	1	2	3	4
Beans	Every day	5 to 6 days a week	3 to 4 days a week	1 to 2 days a week	Never or hardly ever
Fruits	Every day	5 to 6 days a week	3 to 4 days a week	1 to 2 days a week	Never or hardly ever
Raw vegetables¹ 1 Lettuce and tomato salad or salad with any other raw vegetable.	Every day	5 to 6 days a week	3 to 4 days a week	1 to 2 days a week	Never or hardly ever
Cooked vegetables² 2 Consumption of vegetables cooked with food or in soup, such as collards, carrot, eggplant, zucchini, except potato, cassava or yam.	Every day	5 to 6 days a week	3 to 4 days a week	1 to 2 days a week	Never or hardly ever
Milk	Every day	5 to 6 days a week	3 to 4 days a week	1 to 2 days a week	Never or hardly ever
Red meat³ 3 Red meat: beef, pork, goat	Never or hardly ever	1 to 2 days a week	3 to 4 days a week	5 to 6 days a week	Every day
Sweetened soft drink or artificial juice	Never orhardly ever	1 to 2 days a week	3 to 4 days a week	5 to 6 days a week	Every day
Sweets⁴ 4 Consumption of sweets, such as ice cream, chocolate, cakes, cookies, etc.	Never or hardly ever	1 to 2 days a week	3 to 4 days a week	5 to 6 days a week	Every day

Variable/categories	n	(%)	Smoking	p^* * p-value of chi-square test with Rao-Scott correction. BMI: body mass index	Unhealthy diet	p^* * p-value of chi-square test with Rao-Scott correction. BMI: body mass index
Geographic region
Central West	4,068	11.8	9.9	< 0.001	70.3	0.005
Northeast	9,912	25.7	7.8		68.4
North	8,267	10.6	7.8		72.6
Southeast	4,110	44.1	13.3		69.8
South	2,593	7.8	15.6		72.2
Sex
Male	11,704	47.0	13.2	< 0.001	76.6	< 0.001
Female	17,246	53.0	9.2	< 0.001	64.2	< 0.001
Age group (in years)
18 to 39	13,960	59.4	10.2	0.005	75.3	< 0.001
40 to 59	14,990	40.6	12.4	0.005	62.4	< 0.001
Skin color/ethnicity
White	10,780	41.9	11.9	< 0.001	69.6
Black	2,713	11.7	12.8		70.1
Yellow	790	3.0	9.0		82.0	0.002
Brown	12,015	41.8	9.1		69.9
Indigenous	411	1.6	16.8		72.6
Marital status
With spouse	13,565	50.7	12.1	0.012	73.2	< 0.001
Without spouse	15,052	49.3	10.1	0.012	67.0	< 0.001
Education (in years)
0 to 8	5,720	29.7	16.3	< 0.001	66.4	< 0.001
9 to 11	12,325	42.0	10.5		71.6
12 or more	10,905	28.3	6.6		71.2
Private health insurance
No	13,923	51.9	13.6	< 0.001	70.9	0.102
Yes	14,954	48.1	8.5		69.1
BMI (kg/m²)
< 25	13,651	48.9	11.9	0.136	70.8	0.196
≥ 25 to < 30	10,122	33.9	10.4		68.7
≥ 30	5,177	17.2	10.3		70.1
Physical inactivity
No	25,363	87.6	11.1	0.908	69.2	< 0.001
Yes	3,587	12.4	11.0	0.908	75.7	< 0.001
Binge drinking
No	24,048	81.5	8.0	< 0.001	67.8	< 0.001
Yes	4,902	18.5	2.5	< 0.001	79.3	< 0.001
Self-rated health
Very good/good	19,214	67.4	9.5		69.2
Fair	8,328	28.5	13.4	< 0.001	71.8	0.028
Poor/very poor	1,193	4.1	18.7		73.8
Arterial hypertension
No	22,887	81.7	11.1	0.743	71.1	< 0.001
Yes	6,063	18.3	11.4	0.743	65.2	< 0.001
Diabetes mellitus
No	27,356	94.9	11.1	0.811	70.9	< 0.001
Yes	1,594	5.1	11.4	0.811	53.3	< 0.001
Dyslipidemia
No	22,835	83.0	11.1	0.630	70.6	0.029
Yes	6,115	17.0	10.4		67.6

Variables/categories	n	Smoking/Inadequate diet	PR_crude (95% CI)	PR^* * PRadjusted: prevalence ratio adjusted for sex and age. 95% CI: 95% confidence interval. _adjusted (95% CI)
Geographic region		< 0.001
Central West	3,929	8.0	1	1
Northeast	9,200	5.8	0.73 (0.59-0.89)	0.73 (0.60-0.90)
North	7,791	6.2	0.78 (0.61-0.99)	0.78 (0.62-0.99)
Southeast	3,878	10.3	1.29 (1.04-1.59)	1.28 (1.03-1.57)
South	2,481	12.2	1.53 (1.23-1.90)	1.51 (1.21-1.87)
Sex		< 0.001
Male	10,983	10.8	1	1
Female	16,296	6.7	0.61 (0.52-0.72)	0.60 (0.51-0.71)
Age group (in years)		0.167
18 to 39	12,985	8.2	1	1
40 to 59	14,294	9.2	1.12 (0.95-1.31)	1.15 (0.98-1.34)
Skin color/ethnicity		0.008
White	10,263	9.5	1	1
Black	2,534	9.3	0.98 (0.76-1.25)	0.98 (0.76-1.25)
Yellow	733	6.8	0.71 (0.44-1.16)	0.75 (0.46-1.22)
Brown	11,283	7.2	0.75 (0.61-0.92)	0.76 (0.62-0.93)
Indigenous	389	13.3	1.40 (0.84-2.32)	1.38 (0.85-2.24)
Marital status		0.062
Without spouse	12,621	9.3	1	1
With spouse	14,351	8.0	0.85 (0.72-1.01)	0.72 (0.60-0.87)
Education (in years)		< 0.001
0 to 8	5,227	12.4	1	1
9 to 11	11,526	8.4	0.67 (0.56-0.81)	0.70 (0.58-0.85)
12 or more	10,526	5.3	0.42 (0.33-0.53)	0.45 (0.35-0.56)
Private health insurance		< 0.001
Yes	14,324	6.7	1	1
No	12,886	10.5	1.25 (1.15-1.36)	1.24 (1.14-1.35)
BMI(kg/m²)		0.055
<25	12,867	9.5	1	1
≥25 to < 30	9,564	7.8	0.82 (0.68-0.98)	0.73 (0.61-0.89)
≥30	4,848	7.9	0.83 (0.66-1.03)	0.75 (0.60-0.94)
Physical inactivity		0.993
No	23,992	8.6	1	1
Yes	3,287	8.6	1.00 (0.78-1.28)	0.97 (0.75-1.25)
Binge drinking		< 0.001
No	22,644	6.0	1	1
Yes	4,635	19.9	3.30 (2.81-3.88)	3.17 (2.68-3.76)
Self-rated health		< 0.001
Very good/good	18,312	7.3	1	1
Fair	730	11.1	1.53 (1.28-1.82)	1.57 (1.31-1.87)
Poor/very poor	1,048	13.1	1.80 (1.31-2.48)	1.91 (1.40-2.61)
Arterial hypertension		0.815
No	21,559	8.6	1	1
Yes	5,720	8.4	0.97 (0.79-1.19)	0.88 (0.71-1.08)
Diabetes mellitus		0.658
No	25,780	8.6	1	1
Yes	1,499	8.0	0.92 (0.63-1.33)	0.83 (0.57-1.21)
Dyslipidemia		0.475
No	21,485	8.7	1	1
Yes	5,794	8.1	0.93 (0.75-1.13)	0.87 (0.70-1.06)

Variables/categories	PR^a a adjusted for geographic region and socio-demographic characteristics; _adjusted (95% CI)	PR^b b adjusted for geographic region, socio-demographic characteristics, behavioral factors and health conditions. _adjusted (95% CI)
Geographic region
Central West	1	1
Northeast	0.67 (0.54-0.83)	0.68 (0.55-0.84)
North	0.78 (0.61-1.00)	0.84 (0.65-1.08)
Southeast	1.24 (1.00-1.55)	1.30 (1.05-1.61)
South	1.40 (1.11-1.77)	1.50 (1.18-1.89)
Sex
Male	1	1
Female	0.63 (0.53-0.75)	0.77 (0.65-0.92)
Skin color/ethnicity
White	1	1
Black	0.89 (0.69-1.15)	0.84 (0.65-1.09)
Yellow	0.72 (0.42-1.21)	0.71 (0.42-1.18)
Brown	0.73 (0.59-0.89)	0.70 (0.57-0.85)
Indigenous	1.26 (0.78-2.05)	1.40 (0.87-2.26)
Marital status
Without spouse	1	1
With spouse	0.78 (0.65-0.93)	0.85 (0.71-1.02)
Education (in years)
0 to 8	1	1
9 to 11	0.62 (0.51-0.76)	0.60 (0.49-0.72)
12 or more	0.41 (0.32-0.53)	0.39 (0.30-0.51)
Private health insurance
Yes	1	1
No	1.16 (1.05-1.27)	1.14 (1.03-1.25)
Body mass index (kg/m²)
< 25		1
≥ 25 to < 30		0.73 (0.60-0.89)
≥ 30		0.76 (0.60-0.97)
Binge drinking
No		1
Yes		3.22 (2.70-3.85)
Self-rated health
Very good/good
Fair		1.65 (1.36-1.99)
Poor/very poor		1.70 (1.18-2.44)

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[1] Mailing Address: Priscila Maria Stolses Bergamo Francisco, Universidade Estadual de Campinas - Saúde Coletiva - Rua Tessália Vieira de Camargo, 126. Postal Code 13083-887, Cidade, Universitária Zeferino Vaz, Campinas, SP - Brazil. E-mail: primaria@unicamp.br