Social determinants of health associated with the experience of hunger among Brazilian adolescents

Vale, Diôgo; Santos, Thais Teixeira dos; Dantas, Rebekka Fernandes; Cabral, Natália Louise de Araújo; Lyra, Clélia de Oliveira; Oliveira, Angelo Giuseppe Roncalli da Costa

doi:10.1590/1413-81232022277.17792021EN

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FREE THEMES • Ciênc. saúde coletiva 27 (7) • July 2022 • https://doi.org/10.1590/1413-81232022277.17792021EN copy

Social determinants of health associated with the experience of hunger among Brazilian adolescents

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question “In the last 30 days, how often have you been hungry because there wasn’t enough food at home?” The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

Key words:
Hunger; Adolescents; Social determinants of health

Dimension/characteristic/variable	Description
Socioeconomic status and individual and family characteristics
Sociodemographic
Sex	Male or female
Color/race	Self-declares white or non-white (black, yellow, brown or indigenous).
Age group	10-14 years or 15-19 years at the time of data collection.
Work	Working at the time of data collection.
Family
Maternal education level	Maternal education level at the time of data collection: no basic qualifications, literate, junior high, high school, higher education.
Number of people living in the household	Living in a household with five or more people, or up to four people.
Sociopolitical and economic context
Sample area
Macro region	Region of residence at the time of data collection: North, Northeast, Southeast, South, Mid-west.
Physical, behavioral and psychosocial factors
Nutritional status
Thinness	Thinness or extremely thin (BMI/A < Z-score -2)³⁵35 Brasil. Ministério da Saúde (MS). Orientações para a coleta e análise de dados antropométricos em serviços de saúde: Norma Técnica do Sistema de Vigilância Alimentar e Nutricional. Brasília: MS; 2011..
Excess weight	Overweight and obese (BMI/A ≥ Z-score +1) ³⁵.
Short stature	Short or very short stature-for-age or extremely thin (H/A < Z-score -2) ³⁵.
Food consumption
Regular consumption of beans	Eats beans at least five days a week.
Regular consumption of legumes and vegetables	Eats legumes or vegetables at least five days a week. Examples: lettuce, squash, broccolis, onion, carrots, kale, spinach, cucumber, tomato etc. Potatoes and cassava not included
Regular consumption of fruit	Eats fresh fruit or fruit salad at least five days a week.
Regular consumption fried savory snacks	Eats fried savory snacks at least five days a week. Examples: French fries (not including chips) or fried savory snacks such as chicken thighs, fried kibbeh, fried pasty, been fritter, etc.
Regular consumption of sweets	Eats sweets (candy, chocolate, gum, bonbons or lollipops) at least five days a week.
Regular consumption soft drinks	Eats soft drinks at least five days a week.
Regular consumption of savory ultra-processed foods	Eats industrialized/ultra-processed foods (hamburger, ham, mortadella, salami, sausage, hotdog, instant noodles, packaged savory snacks, and crackers) at least five days a week.
Eating routines
Regularly eats breakfast	Eats breakfast at least five days a week.
Regularly eats lunch or dinner with parents or guardians	Eats lunch or dinner with mother, father or guardian at least five days a week.
Eats while watching television or studying	Eats while watching TV or studying at least five days a week.
Ate fast food in the last week	Eats in fast food restaurants (diners, hotdog stands, pizza parlor, etc.) at least five days a week.
Body image
Body satisfaction	Satisfaction with their body at the time of data collection: satisfied/very satisfied, indifferent, dissatisfied/very dissatisfied.

Variables	Population	Prevalence of the experience of hunger
Variables	%	n	%	95%CI	p-value
Socioeconomic status and individual and family characteristics
Sociodemographic
Sex					0.099
Female	49.2	8,258	22.0	20.7-23.3
Male	50.8	8,268	23.5	22.2-24.9
Color/race					0.018
White	36.4	6,565	21.3	19.9-22.8
Non-white	63.6	9,940	23.6	22.4-24.8
Age group					0.343
10-14 years	46.1	9,376	22.3	21.1-23.5
15-19 years	53.9	7,150	23.2	21.8-24.6
Working					0.734
No	82.0	14,056	22.7	21.7-23.7
Yes	18.0	2,465	23.1	20.9-25.5
Family
Maternal education level					< 0.001
No basic qualifications	5.9	748	30.4	25.6-35.6
Literate	20.0	2,734	25.3	23.2-27.7
Junior high	13.1	2,000	21.8	19.5-24.2
High school	22.5	3,765	21.5	19.7-23.5
Higher education	13.4	3,098	20.0	17.9-22.3
Don’t know	25.3	4,160	22.0	20.3-23.8
Number of people living in the household					0.109
5 or more	40.1	6,348	23.7	22.2-25.3
Up to 4	59.9	10,171	22.1	21.0-23.3
Sociopolitical and economic context
Region					0.008
North	9.5	3,186	27.0	24.8-29.3
Northeast	29.5	3,462	23.0	21.2-24.9
Southeast	40.2	3,267	21.7	20.1-23.4
South	13.2	3,201	23.1	21.5-24.8
Mid-west	7.7	3,410	21.4	19.8-23.2
Brasil		16,526	22.8	21.9-23.7
Physical, behavioral and psychosocial factors
Nutritional status
Thinness					0.27
No	97.3	16,132	22.7	21.8-23.6
Yes	2.7	393	26.2	20.3-33.1
Excess weight					0.258
Yes	26.6	4,825	21.9	20.2-23.7
No	73.4	11,700	23.1	22.0-24.2
Short stature					0.076
No	97.6	16,273	22.6	21.7-23.5
Yes	2.4	253	29.6	22.0-38.5
Food consumption
Regular consumption of beans					< 0.001
Yes	58.1	9,167	19.7	18.5-20.9
No	41.9	7,335	27.0	25.5-28.4
Regular consumption of legumes and vegetables					< 0.001
Yes	37.9	6,636	18.4	17.1-19.8
No	62.1	9,871	25.4	24.2-26.6
Regular consumption of fruit					< 0.001
Yes	32.3	5,591	17.9	16.4-19.5
No	67.7	10,914	25.1	23.9-26.3
Regular consumption of fried savory snacks					0.966
Yes	13.5	2,171	22.8	20.5-25.4
No	86.5	14,332	22.8	21.8-23.8
Regular consumption of sweets					0.288
Yes	38.4	6,097	22.1	20.7-23.7
No	61.6	10,407	23.2	22.0-24.4
Regular consumption of soft drinks					0.183
Yes	26.1	4,214	23.9	22.0-25.8
No	73.9	12,297	22.4	21.4-23.5
Regular consumption of savory ultra-processed foods					0.068
Yes	30.2	4,980	21.5	19.9-23.1
No	69.8	11,514	23.3	22.2-24.5
Eating routines
Regularly eats breakfast					0.092
Yes	53.5	7,231	23.6	22.2-25.0
No	52.1	9,291	22.0	20.8-23.3
Regularly eats lunch or dinner with parents or guardians					< 0.001
Yes	69.6	11,913	19.7	18.7-20.8
No	30.4	4,599	29.8	27.9-31.7
Regularly eats while watching TV or studying					0.092
No	52.1	9,291	22.0	20.8-23.3
Yes	47.9	7,231	23.6	22.2-25.0
Regularly eats fast food					0.194
No	53.5	8,709	23.3	22.1-24.7
Yes	46.5	7,798	22.1	20.8-23.5
Body image
Satisfied with their body					< 0.001
Satisfied/very satisfied	71.1	11,521	20.7	19.7-21.8
Indifferent	10.6	1,806	28.9	26.0-32.1
Dissatisfied/very dissatisfied	18.3	3,038	26.9	24.7-29.2

Variables		Model 1			Model 2
Variables		Crude PR	p-value	Adjusted PR	p-value
Socioeconomic status and individual and family characteristics
Sociodemographic
Sex
	Female	Ref		Ref
	Male	1.07 (1.01-1.12)	0.026	1.12 (1.07-1.16)	< 0.001
Color/race
	White	Ref
	Non-white	1.11 (0.99-1.23)	0.065
Age group
	10-14 years	Ref
	15-19 years	1.04 (0.92-1.17)	0.515
Working
	No	Ref
	Yes	1.02 (0.93-1.12)	0.696
Family
Maternal education level
	No basic qualifications	Ref		Ref
	Literate	0.83 (0.75-0.93)	0.002	0.84 (0.76-0.92)	0.001
	Junior high	0.72 (0.57-0.91)	0.006	0.73 (0.59-0.90)	0.004
	High school	0.71 (0.62-0.81)	< 0.001	0.70 (0.62-0.80)	< 0.001
	Higher education	0.66 (0.56-0.77)	< 0.001	0.67 (0.58-0.77)	< 0.001
	Don’t know	0.72 (0.64-0.82)	< 0.001	0.75 (0.66-0.84)	< 0.001
Number of people living in the household
	5 or more	Ref
	Up to 4	0.93 (0.86-1.02)	0.126
Sociopolitical and economic context
Region
	North	Ref		Ref
	Northeast	0.85 (0.78-0.0.93)	0.001	0.82 (0.76-0.87)	< 0.001
	Southeast	0.80 (0.74-0.87)	< 0.001	0.85 (0.77-0.94)	0.003
	South	0.86 (0.80-0.92)	< 0.001	0.86 (0.79-0.92)	< 0.001
	Mid-West	0.79 (0.74-0.85)	< 0.001	0.86 (0.79-0.93)	< 0.001
Physical, behavioral and psychosocial factors
Nutritional status
Thinness
	No	Ref
	Yes	1.15 (0.85-1.57)	0.354
Excess weight
	Yes	Ref		Ref
	No	1.05 (1.00-1.10)	0.042	1.08 (1.04-1.13)	<0.001
Short stature
	No	Ref
	Yes	1.31 (0.98-1.75)	0.069
Food consumption
Regular consumption of beans
	Yes	Ref		Ref
	No	1.27 (1.22-1.32)	< 0.001	1.20 (1.13-1.26)	< 0.001
Regular consumption of legumes and vegetables
	Yes	Ref		Ref
	No	1.27 (1.22-1.32)	< 0.001	1.16 (1.09-1.22)	< 0.001
Regular consumption of fruit
	Yes	Ref		Ref
	No	1.29 (1.24-1.33)	< 0.001	1.19 (1.13-1.24)	< 0.001
Regular consumption of fried savory snacks
	Yes	Ref
	No	1.00 (0.89-1.09	0.959
Regular consumption of sweets
	Yes	Ref
	No	1.04 (0.98-1.11)	0.199
Regular consumption of soft drinks
	Yes	Ref
	No	0.93 (0.83-1.03)	0.185
Regular consumption of savory ultra-processed foods
	Yes	Ref
	No	1.08 (1.01-1.14)	0.026
Eating routines
Regularly eats breakfast
	Yes	Ref
	No	0.93 (0.86-1.01)	0.072
Regularly eats lunch or dinner with parents or guardians
	Yes	Ref		Ref
	No	1.51 (1.40-1.63)	<0.001	1.41 (1.32-1.52)	< 0.001
Eats while watching TV or studying
	No	Ref
	Yes	1.07 (0.99-1.16)	0.072
Ate fast food in the last week
	No	Ref
	Yes	0.95 (0.87-1.03)	0.196
Body image
Satisified with body
	Satisfied/very satisfied	Ref		Ref
	Indifferent	1.40 (1.25-1.56)	< 0.001	1.33 (1.18-1.49)	< 0.001
	Dissatisfied/very dissatisfied	1.30 (1.20-1.41)	< 0.001	1.26 (1.18-1.35)	< 0.001

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[1] Collaborations

D Vale: study conception and design, data analysis and interpretation, drafting the article and revising it critically for important intellectual content, and approving the final version to be published. TT Santos: data interpretation; revising the article critically for important intellectual content, and approving the final version to be published. RD Fernandes: data interpretation, revising the article critically for important intellectual content, and approving the final version to be published. NLA Cabral: data interpretation, revising the article critically for important intellectual content, and approving the final version to be published. CO Lyra: data interpretation, revising the article critically for important intellectual content, and approving the final version to be published. AGRC Oliveira: study conception and design, data analysis and interpretation, drafting the article and revising it critically for important intellectual content, and approving the version to be published.