Study of Cardiovascular Risks in Adolescents (ERICA): factors associated with work in adolescence

Leon, Elisa Brosina de; Tavares, Bruno Mendes; Fernandes, Tiótrefis Gomes; Gonçalves, Roberta Lins; Franco, Fernanda Figueiroa Sanchez; Souza, Marina Batista Chaves Azevedo de; Fischer, Frida Marina; Barroso, Bárbara Iansã de Lima

doi:10.1590/1413-81232021267.08912021

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ARTICLE • Ciênc. Saúde Colet. 26 (07) • July 2021 • https://doi.org/10.1590/1413-81232021267.08912021 copy

Study of Cardiovascular Risks in Adolescents (ERICA): factors associated with work in adolescence

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to verify the association between work and sociodemographic factors, health behaviors, and cardiovascular risk in Brazilian adolescents. Data from the Study of Cardiovascular Risks in Adolescents (ERICA) were analyzed, with a sample of 37,815 adolescents aged 12-17 years and morning shift students. Considering complex sampling, crude and adjusted Prevalence Ratios (PR) were calculated with interval estimates for variables by Poisson multiple regression model with robust variance estimate. The sociodemographic factors associated with work among Brazilian adolescents were male gender (PR 1.34), aged 15-17 years, with maternal schooling up to elementary school (PR 1.26), public school students (PR 1.63), and from the rural area (PR 1.90). Regarding lifestyle habits and social behavior, the association was significant in physically active (PR 1.19) and alcohol-consuming students (PR 1.35). In conclusion, work among Brazilian adolescent morning shift students is still strongly linked to social issues. Work was associated with alcohol consumption, and there was no association with metabolic markers.

Key words:
Child labor; Cardiovascular diseases; Adolescent working students

Variables		Prevalence % (95%CI)					P*
Variables		Not working	Working up to 20 hours/week (1)	PR 1† (95%CI)	Working 21-40 hours/week (2)	PR 2†† (95%CI)
Total		82.5 (80.9 - 84.1)	15.2 (13.8 - 16.8)		1.0 (0.6 - 1.4)
Sociodemographic
Gender						<0.001	<0,001
	Female	85.7 (84.6 - 86.7)	12.5 (11.5 - 13.6)	1	1.8 (1.3 - 2.4)	1
	Male	79.4 (76.6 - 81.9)	18.0 (15.5 - 20.8)	1.45 (1.25 - 1.68)	2.6 (2.0 - 3.5)	1.55 (1.18 - 2.03)
Age						<0.001	<0,001
	12-14 years	87.7 (85.9 - 89.4)	11.9 (10.2 - 13.8)	1	0.3 (0.2 - 0.5)	1
	15-17 years	78.0 (76.1 - 79.8)	18.2 (16.5 - 19.9)	1.59 (1.40 - 1.81)	3.8 (2.9 - 5.0)	11.9 (6.90 - 20.50)
Maternal schooling						<0.001	<0,001
	Up to incomplete elementary school	76.4 (71.0 - 81.1)	22.5 (17.8 - 28.1)	1.67 (1.33 - 2.11)	1.1 (0.5 - 2.1)	0.46 (0.23 - 0.91)
	Elementary school to incomplete high school	78.7 (75.6 - 81.4)	18.3 (15.4 - 21.7)	1.38 (1.17 - 1.62)	3.0 (2.3 - 3.9)	1.29 (0.86 - 1.95)
	High school to incomplete higher education	84.3 (82.6 - 85.8)	13.3 (12.0 - 14.7)	1	2.4 (1.7 - 3.5)	1
School type						<0.001	<0,001
	Public	80.2 (78.4 - 82.0)	17.2 (15.4 - 19.0)	1.98 (1.60 - 2.44)	2.6 (1.9 - 3.5)	3.27 (1.61 - 6.65)
	Private	90.4 (88.4 - 92.1)	8.8 (7.4 - 10.4)	1	0.9 (0.5 - 1.5)	1
School geographic environment						<0.001	<0,001
	Urban	83.2 (82.0 - 84.4)	14.5 (13.4 - 15.6)	1	2.3 (1.8 - 3.0)	1
	Rural	66.9 (60.5 - 72.8)	32.8 (26.7 - 39.6)	2.20 (1.76 - 2.74)	0.3 (0.5 - 1.3)	0.15 - (0.03 - 0.75)
Region of Brazil						<0.001	<0,001
	Northeast	88.8 (87.4 - 90.0)	10.2 (9.0 - 11.4)	1	1.1 (0.6 - 2.0)	1
	North	87.0 (85.9 - 88.1)	12.0 (11.1 - 13.0)	1.18 (1.03 - 1.36)	0.9 (0.6 - 1.4)	0.89 (0.43 - 1.81)
	Southeast	80.9 (77.9 - 83.5)	16.7 (14.1 - 19.6)	1.67 (1.37 - 2.04)	2.4 (1.6 - 3.8)	2.52 (1.21 - 5.25)
	South	80.2 (77.0 - 83.0)	16.2 (13.9 - 18.7)	1.65 (1.36 - 2.00)	3.7 (2.7 - 5.0)	3.68 (1.84 - 7.38)
	Midwest	77.7 (74.4 - 80.7)	20.1 (16.9 - 23.9)	2.01 (1.64 - 2.47)	2.1 (1.2 - 3.5)	2.36 (1.12 - 4.97)
Lifestyle habits
Sleep on working days						<0.001	<0,001
	<6 hours	79.0 (76.3 - 81.5)	16.4 (14.0 - 19.2)	1.04 (0.83 - 1.32)	4.6 (3.1 - 6.8)	3.76 (2.40 - 5.89)
	≥6 hours and <8 hours	83.5 (81.8 - 85.0)	13.8 (12.4 - 15.3)	0.86 (0.70 - 1.06)	2.7 (1.9 - 3.9)	2.20 (1.40 - 3.47)
	≥8 hours	82.3 (80.9 - 84.1)	16.5 (13.7 - 19.6)	1	1.2 (0.9 - 1.6)	1
Sleep on weekends						0.003	0,003
	<8 hours	78.9 (75.9 - 81.6)	17.3 (14.6 - 20.5)	1.19 (1.00 - 1.40)	3.8 (1.6 - 5.4)	1.95 (1.25 - 3.05)
	≥8 hours	83.1 (81.4 - 84.6)	15.0 (13.4 - 16.6)	1	2.0 (1.5 - 2.7)	1
Physical activity						<0.001	<0,001
	Inactive (0 min/week)	85.0 (83.4 - 86.5)	12.4 (11.1 - 13.9)	1	2.6 (1.8 - 3.7)	1
	Insufficiently active (0-300 min/week)	85.0 (81.5 - 88.0)	12.8 (10.0 - 16.2)	1.02 (0.77 - 1.35)	2.2 (1.5 - 3.4)	0.86 (0.65 - 1.15)
	Active (≥300min/week)	79.6 (77.6 - 81.4)	18.5 (16.7 - 20.4)	1.48 (1.26 - 1.73)	2.0 (1.5 - 2.5)	0.78 (0.55 - 1.11)
Tobacco use						0,04	0,04
	Currently smoking	73.9 (66.2 - 80.3)	21.4 (16.0 - 28.0)	1.44 (1.07 - 1.93)	4.7 (1.6 - 13.0)	2.44 (0.85 - 7.05)
	Not currently smoking	82.7 (81.0 - 84.2)	15.1 (13. 6 - 16.8)	1	2.2 (1.7 - 2.8)	1
Alcohol use						<0.001	<0,001
	Drinking	75.1 (71.3 - 78.6)	21.3 (17.9 - 25.2)	1.62 (1.38 - 1.90)	3.6 (2.6 - 4.8)	2.05 (1.51 - 2.77)
	Not drinking	84.8 (83.7 - 85.8)	13.4 (12.3 - 14.5)	1	1.9 (1.4 - 2.5)	1
Health-related
Common mental disorder						0.15	0,15
	No	83.1 (81.2 - 84.9)	14.7 (12.9 - 16.6)	1	2.2 (1.6 - 3.0)	1
	Yes	81.2 (79.3 - 83.0)	16.6 (14.8 - 18.5)	1.12 (0.97 - 1.30)	2.2 (1.7 - 2.8)	0.99 (0.74 - 1.33)
Nutritional status						0.003	0,003
	Underweight	91.0 (85.9 - 94.4)	8.7 (5.3 - 13.9)	0.54 (0.33 - 0.87)	0.3 (0.2 - 0.7)	0.13 (0.06 - 0.29)
	Adequate	81.7 (80.0 - 83.2)	15.9 (14.4 - 17.6)	1	2.4 (1.8 - 3.1)	1
	Overweight	84.6 (82.0 - 86.8)	13.4 (11.3 - 15.7)	0.83 (0.73 - 0.96)	2.1 (1.3 - 3.2)	0.84 (0.59 - 1.19)
	Obese	83.2 (79.9 - 86.0)	15.1 (12.4 - 18.4)	0.94 (0.77 - 1.16)	1.7 (1.1 - 2.6)	0.69 (0.42 - 1.14)
High blood pressure						0.06	0,06
	No	82.5 (81.0 - 84.0)	16.1 (13.2 - 19.4)	1.05 (0.90 - 1.22)	1.3 (0.8 - 2.1)	0.52 (0.31 - 0.87)
	Yes	82.7 (79.4 - 85.5)	15.2 (13.7 - 16.7)	1	2.3 (1.8 - 3.0)	1
High blood glucose						0.06	0,06
	No	82.3 (80.7 - 83.9)	10.4 (7.8 - 13.8)	0.67 (0.49 - 0.92)	2.6 (1.2 - 5.6)	1.12 (0.51 - 2.45)
	Yes	87.0 (82.7 - 90.4)	15.5 (13.9 - 17.2)	1	2.2 (1.7 - 2.9)	1
Metabolic Syndrome						0.23	0,23
	No	82.5 (76.6 - 87.1)	15.2 (12.1 - 22.6)	1.07 (0.76 - 1.53)	0.8 (0.4 - 1.6)	0.33 (0.15 - 0.75)
	Yes	82.5 (80.8 - 84.0)	15.2 (13.7 - 16.9)	1	2.3 (1.7 - 3.0)	1
Total Cholesterol						0.21	0,21
	Adequate	81.7 (80.1 - 83.2)	15.7 (14.3 - 17.1)	1	2.6 (1.9 - 3.6)	1
	Borderline	83.3 (79.7 - 86.5)	14.9 (11.8 - 18.7)	0.95 (0.75 - 1.18)	1.8 (1.3 - 2.4)	0.69 (0.44 - 1.08)
	High	83.8 (81.7 - 85.8)	14.5 (12.5 - 16.7)	0.91 (0.79 - 1.05)	1.7 (1.1 - 2.5)	0.62 (0.43 - 0.89)
HDL						0.71	0,71
	Adequate	82.4 (80.0 - 84.5)	15.5 (13.4 - 17.9)	1	2.1 (1.5 - 2.9)	1
	Inadequate	82.8 (81.2 - 84.2)	14.9 (13.4 - 16.5)	0.96 (0.83 - 1.12)	2.3 (1.8 - 3.1)	1.11 (0.82 - 1.50)
LDL						0.46	0,46
	Adequate	82.1 (80.5 - 83.7)	15.5 (14.1 - 17.1)	1	2.4 (1.7 - 3.2)	1
	Borderline	83.6 (80.4 - 86.3)	14.6 (11.9 - 17.9)	0.94 (0.78 - 1.12)	1.8 (1.3 - 2.6)	0.76 (0.49 - 1.18)
	High	85.3 (80.8 - 88.8)	13.0 (9.9 - 17.0)	0.84 (0.63 - 1.11)	1.7 (0.8 - 3.8)	0.68 (0.31 - 1.48)
Triglycerides						0.26	0,26
	Adequate	82.0 (80.0 - 83.9)	15.6 (13.7 - 17.7)	1	2.4 (1.8 - 3.1)	1
	Borderline	84.9 (82.2 - 87.2)	13.6 (11.3 - 16.3)	0.86 (0.67 - 1.10)	1.5 (0.9 - 2.6)	0.62 (0.40 - 0.97)
	High	84.3 (81.4 - 86.2)	13.8 (11.4 - 16.6)	0.87 (0.70 - 1.09)	1.9 (1.0 - 3.5)	0.76 (0.39 - 1.47)
Waist circumference						0.61	0,61
	Adequate	82.5 (80.8 - 84.1)	15.2 (13.6 - 16.9)	1	2.3 (1.7 - 3.0)	1
	High	82.7 (80 - 85.0)	15.5 (13.2 - 18.2)	1.01 (0.86 - 1.20)	1.8 (1.3 - 2.6)	0.77 (0.51 - 1.17)

Variables		Crude PR	95%CI	Adjusted PR*	95%CI
Group 1 - Sociodemographic
Gender
	Female	1		1
	Male	1.43	(1.25 - 1.63)	1.34^a	(1.17 - 1.53)
Age
	12-14 years	1		1
	15-17 years	1.60	(1.41 - 1.81)	1.68^a	(1.45 - 1.94)
Maternal schooling
	Up to incomplete elementary school	1.47	(1.21 - 1.79)	1.26^a	(1.08 - 1.47)
	Elementary school to incomplete high school	1.36	(1.17 - 1.58)	1.08^a	(0.98 - 1.20)
	High school to incomplete higher education	1		1
School type
	Public	2.09	(1.71 - 2.56)	1.63^a	(1.34 - 1.99)
	Private	1		1
School geographic environment
	Urban	1		1
	Rural	2.07	(1.70 - 2.52)	1.9^a	(1.52 - 2.38)
Region of Brazil
	Northeast	1		1
	North	1.14	(0.94 - 1.39)	1.20^a	(1.04 - 1.38)
	Midwest	1.75	(1.41 - 2.16)	1.81^a	(1.55 - 2.12)
	Southeast	1.56	(1.23 - 1.98)	1.57^a	(1.34 - 1.84)
	South	1.57	(1.25 - 1.97)	1.57^a	(1.29 - 1.90)
Group 2 - Lifestyle habits
Physical activity
	Inactive (0 min/week)	1		1
	Insufficiently active (0-300 min/week)	1.02	(0.79 - 1.31)	1.03^a	(0.86 - 1.24)
	Active (≥300 min/week)	1.35	(1.18 - 1.54)	1.19^a	(1.06 - 1.33)
Alcohol use
	Drinking	1.57	(1.35 - 1.82)	1.35^a	(1.20 - 1.52)
	Not drinking	1		1
Tobacco use
	Currently smoking	1.61	(1.27 - 2.05)	1.14	(0.87 - 1.49)
	Not currently smoking	1		1
Sleep on weekends
	<8 hours	1.19	(1.05 - 1.33)	1.09	(0.96 - 1.24)
	≥8 hours	1		1
Group 3 - Health-related
Nutritional status
	Underweight	0.51	(0.34 - 0.76)	0.56^a	(0.35 - 0.89)
	Adequate	1		1
	Overweight	0.83	(0.75 - 0.93)	0.99^a	(0.86 - 1.13)
	Obese	0.91	(0.76 - 1.78)	1.16^a	(0.97 - 1.38)
Common mental disorder
	No	1		1
	Yes	1.11	(0.98 - 1.26)	1.11	(0.97 - 1.27)
LDL
	Adequate	1.14	(1.01 - 1.71)	1.13	(0.85 - 1.50)
	Borderline	1.01	(0.88 - 1.58)	0.99	(0.74 - 1.32)
	High	1		1
Triglycerides
	Adequate	1.14	(0.94 - 1.39)	1.04	(0.86 - 1.27)
	Borderline	1.01	(0.84 - 1.21)	1.00	(0.77 - 1.30)
	High	1		1

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[1] Collaborations

EB Leon: project design, data collection in the State of Amazonas, writing of the paper, and final approval of the version to be published. BM Tavares, TG Fernandes, FM Fischer, and BIL Barroso: project design, writing of the paper, and final approval of the version to be published. RL Gonçalves, FFS Franco, and MBCA Souza: design and writing of the paper and final approval of the version to be published.