FACTORS ASSOCIATED WITH ASTHMA IN BRAZILIAN ADOLESCENTS: NATIONAL ADOLESCENT SCHOOL-BASED HEALTH SURVEY (PENSE-2012)

Cross-sectional study based on data from the 2012 National Adolescent School-based Health Survey (PeNSE), a Brazilian survey applied by a self-reported questionnaire in a representative sample of 9^th-grade students. Descriptive and inferential analysis was made based on the demographic, socioeconomic, clinical, food consumption and environmental characteristics potentially associated with asthma. Adolescents who presented wheezing in the last 12 months were considered asthmatic. A multiple logistic regression model was adjusted for confounding factors. Significance was defined as p≤0.05.

Results:

A total of 106,983 adolescents were studied. The prevalence of asthma was 23.2%. The final model was composed of 11 variables that were independently associated with asthma: female sex (OR=1.17), <14 years old (OR=1.12), not living with parents (OR=1.06), the highest number of days consuming ultra-processed foods (OR=1.16), lunch or dinner time without presence of parents or guardians (OR=1.13), meals in front of the TV or while studying (OR=1.18), not having breakfast frequently (OR=1.22), having smoked cigarettes (OR=1.36), having tried alcoholic beverage (OR=1.37), having used illicit drugs (OR=1.29) and having sought health care in the last year (OR=1.67).

Conclusions:

The results of the present study reinforce the multifactorial characteristic of asthma diagnosis. Prevention and control strategies should focus on groups of adolescents living in inadequate conditions when it comes to family dynamics, food consumption and behavior (drug use).

Keywords:
Asthma; Adolescent; Epidemiological surveys; Logistic models

Characteristics		n	%	95%CI
Socioeconomic/demographic
Macro-region	North	108,350	8.0	7.5-8.4
	Northeast		25.3	23.7-27.1
	Mid-West		7.9	6.7-9.2
	Southwest		44.3	41.6-47.0
	South		14.6	13.4-15.8
School	Public	108,350	82.8	77.8-86.9
School	Private	108,350	17.2	13.1-22.2
Child’s sex	Female	108,350	52.2	50.2-54.3
Child’s sex	Male	108,350	47.8	45.7-49.8
Child’s ethnicity	Others	108,296	63.2	57.8-68.3
Child’s ethnicity	White-Caucasian	108,296	36.8	31.7-42.2
Child’s age	≤14 years	108,350	68.5	59.4-76.4
Child’s age	>14 years	108,350	31.5	23.6-40.6
Living with parents	No	108,191	37.8	35.9-39.8
Living with parents	Yes	108,191	62.2	60.2-64.2
Mother’s education	No study	90,035	10.0	8.4-12.0
Mother’s education	Study	90,035	90.0	83.0-91.6
Father’s education	No study	83,539	15.2	13.1-17.4
Father’s education	Study	83,539	84.8	82.6-86.9
Eating habits
Intake of fresh food in the past 7 days	<5 days	107,792	82.1	80.9-83.3
Intake of fresh food in the past 7 days	≥5 days	107,792	17.9	16.7-19.1
Intake of ultra-processed food in the past 7 days	>2	107,792	64.4	63.0-65.8
Intake of ultra-processed food in the past 7 days	≤2	107,792	35.6	34.2-37.0
Lunch time or dinner time in the presence of parents or guardians in the past week	≤4 days	108,281	28.5	26.5-30.5
	>4 days	108,281	71.5	69.5-73.5
Meals in front of the TV or while studying	Yes	108,221	81.2	78.7-83.4
Meals in front of the TV or while studying	No	108,221	18.8	16.6-21.3
Breakfast in the past week	≤4 days	108,251	38.1	35.8-40.5
Breakfast in the past week	>4 days	108,251	61.9	59.5-64.2
Drug use history
Cigarette	Yes	108,329	19.6	17.1-22.3
Cigarette	No	108,329	80.4	77.7-82.9
Alcohol	Yes	108,350	66.6	64.0-69.2
Alcohol	No	108,350	33.4	30.8-36.0
Illicit drugs	Yes	108,327	7.0	5.3-9.4
Illicit drugs	No	108,327	93.0	90.6-97.7
Respiratory problems
History of asthma*	Yes	108,115	12.4	11.4-13.5
History of asthma*	No	108,115	87.6	86.5-88.6
Health service history
Has sought health care service in the last 12 months	Yes	108,227	48.2	46.1-50.2
Has sought health care service in the last 12 months	No	108,227	51.8	49.8-53.9

Characteristics		%	OR (95%CI)	p-value	Adjusted OR (95%CI)	p-value
Socioeconomic/demographic
School	Private	24.8	1.12 (1.07-1.17)	<0.001
School	Public	22.7	1.12 (1.07-1.17)	<0.001
Sex	Female	24.6	1.19 (1.13-1.25)	<0.001	1.17 (1.12-1.22)	<0.001
Sex	Male	21.5	1.19 (1.13-1.25)	<0.001	1.17 (1.12-1.22)	<0.001
Ethnicity	White-Caucasian	23.2	1.01 (0.97-1.03)	0.60
Ethnicity	Others	23.1	1.01 (0.97-1.03)	0.60
Age	≤14 years	23.3	1.04 (1.00-107)	0.046	1.12 (1.08-1.15)	<0.001
Age	>14 years	22.7	1.04 (1.00-107)	0.046	1.12 (1.08-1.15)	<0.001
Living with both parents	Yes	21.9	1.18 (1.15-1.21)	<0.001	1.06 (1.03-1.08)	<0.001
Living with both parents	No	24.9	1.18 (1.15-1.21)	<0.001	1.06 (1.03-1.08)	<0.001
Mother is educated	Yes	23.7	1.10 (1.03-1.16)	<0.001
Mother is educated	No	22.0	1.10 (1.03-1.16)	<0.001
Father is educated	Yes	23.7	1.06 (1.00-1.12)	<0.001
Father is educated	No	22.7	1.06 (1.00-1.12)	<0.001
Eating habits
Intake of fresh food in the past 7 days	<5 days	23.2	1.04 (0.90-1.09)	0.144
Intake of fresh food in the past 7 days	≥5 days	22.6	1.04 (0.90-1.09)	0.144
Intake of ultra-processed food in the past 7 days	>2 days	24.9	1.33 (1.28-1.37)	<0.001	1.16 (1.11-1.19)	<0.001
Intake of ultra-processed food in the past 7 days	≤2 days	20.0	1.33 (1.28-1.37)	<0.001	1.16 (1.11-1.19)	<0.001
Lunch time or dinner time in the presence of parents or guardians in the past week	≤4 days	25.9	1.24 (1.20-1.28)	<0.001	1.13 (1.08-1.16)	<0.001
	>4 days	21.9	1.24 (1.20-1.28)	<0.001	1.13 (1.08-1.16)	<0.001
Meals in front of the TV or while studying	Yes	24.0	1.30 (1.24-1.35)	<0.001	1.18 (1.13-1.22)	<0.001
Meals in front of the TV or while studying	No	19.6	1.30 (1.24-1.35)	<0.001	1.18 (1.13-1.22)	<0.001
Breakfast in the past week	≤4 days	26.5	1.36 (1.32-1.40)	<0.001	1.22 (1.17-1.26)	<0.001
Breakfast in the past week	>4 days	20.9	1.36 (1.32-1.40)	<0.001	1.22 (1.17-1.26)	<0.001
Drug use history
Cigarette	Yes	31.2	1.71 (1.64-1.77)	<0.001	1.36 (1.30-1.41)	<0.001
Cigarette	No	21.0	1.71 (1.64-1.77)	<0.001	1.36 (1.30-1.41)	<0.001
Alcohol	Yes	26.1	1.67 (1.59-1.74)	<0.001	1.37 (1.31-1.44)	<0.001
Alcohol	No	17.0	1.67 (1.59-1.74)	<0.001	1.37 (1.31-1.44)	<0.001
Illicit drugs	Yes	34.4	1.85 (1.76-1.92)	<0.001	1.29 (1.22-1.36)	<0.001
Illicit drugs	No	22.2	1.85 (1.76-1.92)	<0.001	1.29 (1.22-1.36)	<0.001
Health service history
Has sought health care service in the last 12 months	Yes	27.9	1.71 (1.65-1.76)	<0.001	1.67 (1.62-1.72)	<0.001
Has sought health care service in the last 12 months	No	18.5	1.71 (1.65-1.76)	<0.001	1.67 (1.62-1.72)	<0.001

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[1] *Corresponding author. E-mail: tkmed@uol.com.br (T. Konstantyner).