Browsing by Author "Gama, Augusta"
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- Children mental health after the 2008 global economic crisis: assessing the impact of austerity in PortugalPublication . Costa, Diogo; Cunha, Marina; Ferreira, Cláudia; Gama, Augusta; Machado-Rodrigues, Aristides M.; Rosado-Marques, Vítor; Nogueira, Helena; Silva, Maria Raquel; Padez, CristinaBackground: The austerity measures implemented in Europe after the 2008 global economic crisis, had a negative impact on the population health. The mental health of adults from southern Europe was particularly affected during this period, however, much less is known about the impact of austerity on the mental health of children. This study measured the impact on Portuguese children’s mental health of specific changes in family life during the 2008 economic crisis. Methods: In this study, a cross-sectional analysis of school-aged children (aged 7.5–11 years old, n = 1157) was conducted in 118 public and private schools of three Portuguese districts during 2016/2017. Parent reports of child’s psychosocial functioning (Strengths and Difficulties Questionnaire – SDQ) and children self-reports of depression, anxiety and stress symptoms (Depression, Anxiety and Stress Scales, Children version – DASS-C) and health-related quality of life (HRQoL - KIDSCREEN-27), were compared according to eight yes/no questions specifically developed about changes to normal life during the economic crisis (e.g. During the economic crisis did you: “Started buying cheaper food?” “Had to change to more economic housing?”). General linear regression models were fitted to estimate mean scores of the selected mental health outcomes according to the positive or negative answers to each question about the changes to life during the economic crisis. The models were adjusted for age, sex, socioeconomic status and district of residence. Results: Following the crisis 48.6% of the parents reported that they had to use their savings, and 6.8% reported that they had to change to a more economic housing. The questions about the changes to life that occurred during the crisis were associated with more frequent psychosocial problems, depression, anxiety and stress symptoms and with poorer HRQoL among children, after adjustment for potential confounders in the regression models. The effect sizes in mean differences for all mental health outcomes assessed according to the changes were small to moderate (Cohen’s d from 0.01 to 0.68). Conclusion: Specific changes to normal life attributed to the economic crisis seem to have an independent negative impact on the mental health outcomes of primary school-aged children. These results highlight the need to tackle early-life determinants of inequalities in children mental health, particularly among those that were exposed to the economic crisis.
- Home vs. bedroom media devices: socioeconomic disparities and association with childhood screen - and sleep-timePublication . Rodrigues, Daniela; Gama, Augusta; Machado-Rodrigues, Aristides M.; Nogueira, Helena; Rosado-Marques, Vítor; Silva, Maria Raquel; Padez, CristinaBackground: The literature has shown a widespread use of portable electronic devices among children over the last years. This study aimed to identify the availability of different media devices at home versus in children’s bedroom according to the socioeconomic status (SES), and analyze the association between that availability and children’s screen- and sleep-time on week and weekend days. Methods: Data from 3 to 10 year-old children (n=8430) from a cross-sectional study conducted in Portugal (2016/17) was used. Screen- and sleep-time, availability of media devices, father and mother education (as a proxy measured of SES) were assessed via questionnaire. Results: Available devices at home was significantly more common among high-SES families; while media devices in the bedroom were more frequent in low-SES families (p<0.001). In preschool and elementary school-aged children, media devices in the bedroom was associated with increase screen-time and shorter sleep per day. Also, mobile devices in the bedroom were shown to exert similar, or even more, influence on children’s screen- and sleep-time as television. Conclusions: Further research is needed to explore the pathways by which different electronic media negatively impacts on children’s sleep and screen-time and to develop effective strategies to minimize device access at bedtime.
- Influence of parental perceived environment on physical activity, TV viewing, active play and body mass Index among portuguese children: a mediation analysisPublication . Carmo, Ariene S.; Rodrigues, Daniela; Nogueira, Helena; Mendes, Larissa L.; Santos, Luana C.; Gama, Augusta; Machado‐Rodrigues, Aristides M.; Silva, Maria Raquel; Rosado‐Marques, Vítor; Padez, CristinaObjectives: The environment is believed to be key in obesity prevention, yet it is unclear how factors in the neighborhood influence weight-related behaviors. The present study aimed to investigate the influence of parental perceived environment on physical activity (PA), television (TV) time, active play and Body Mass Index (BMI) z score, and the mediating role of these weight-related behaviors on the relationship between neighborhood characteristics and children's BMI. Methods: Data of 8472 Portuguese preschool (aged 3-6, n = 3819) and schoolaged children (aged 7-11 years, n = 4653) were collected during 2016/2017. Structural equation modeling was used to estimate the associations between parents perceived neighborhood characteristics (latent variables: unsafety and built/physical environment) and child's BMI z score, PA and TV time. Results: Among preschoolers, the latent variables of the perceived environment were not associated with the BMI, TV time, extracurricular PA, and active play. Among schoolchildren, the unsafety environment was positively associated with both the BMI (SC = 0.050, P = .008) and the time spent watching TV (SC = 0.052, P = .031) and negatively associated with extracurricular PA (SC = −0.125, P < .001). The latent variable Favorable Built Environment for PA (ie, environmental facilitating elements) was positively associated with active play (SC = 0.041, P = .031). Moreover, the TV time was a marginally significant mediator of the relationship between the perceived unsafe environment and the BMI of school-aged children (B = 0.002, P = .096). Conclusions: In conclusion, changes in the environment to targeting parental perception of neighborhood safety could have positive effects on the promotion of healthy weight and the adoption of a healthy lifestyle in school-aged children.
- Self-reported symptoms of depression, anxiety and stress in portuguese primary school-aged childrenPublication . Costa, Diogo; Cunha, Marina; Ferreira, Cláudia; Gama, Augusta; Machado-Rodrigues, Aristides M.; Rosado-Marques, Vítor; Nogueira, Helena; Silva, Maria Raquel; Padez, CristinaBackground: Symptoms of depression, anxiety and stress experienced during childhood might have a negative impact on development. This study explores factors associated with such symptoms among Portuguese primary school-aged children. Methods: A sample of children (n = 1022, mean age = 8.77 years old) was recruited in public and private schools from the cities of Coimbra, Lisbon and Porto, Portugal. The children’s version of the Depression, Anxiety and Stress Scale (DASS-C) was self-administered. Multivariate logistic regression models were fitted to measure associations (expressed as Odds Ratio, OR and 95% Confidence Intervals, CI) between each DASS-C subscale, dichotomized by its 4th vs. 3rd or less quartiles (symptoms increase with scores), and covariates: child sex, age, socioeconomic status (SES), sports activity beyond school, children self-assessed health status, child and mother’s body mass index and mother’s DASS scores. Results: Age was negatively associated with anxiety symptoms (adjusted OR, 95% CI: 0.70, 0.57–0.87) and girls, compared to boys, presented lower odds of depressive and stress symptoms (adjusted OR, 95% CI: 0.65, 0.47–0.92 and 0.57, 0.41–0.80, respectively). A low socioeconomic status was associated with more frequent symptoms of stress (adjusted OR, 95%CI for low compared to high SES: 1.61, 1.01–2.56). Children with poorer self-assessed health status and whose mothers scored higher in the DASS also presented significantly higher odds of scoring in the 4th quartile (vs. 3rd or less) of the three DASS-C subscales. Conclusions: These results suggest the need to tailor preventive efforts targeting childhood mental health symptoms.
- Social inequalities in traditional and emerging screen devices among portuguese children: a cross-sectional studyPublication . Rodrigues, Daniela; Gama, Augusta; Machado-Rodrigues, Aristides M.; Nogueira, Helena; Silva, Maria Raquel; Rosado-Marques, Vítor; Padez, CristinaBackground: Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in pre-school and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP). Methods: A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children’s screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children’s age, gender and family SEP (classified using father’s educational degree). Results: Daily screen time was high both in children aged 3 to 5 and 6 to 10 years – 154 min/day (95% CI: 149.51–158.91) and 200.79 min/day (95% CI: 197.08–204.50), respectively – and the majority of children, independently of their gender, exceed the recommended 2 h/day of screen viewing. Children are still primarily engaging in screen time through television but the use of mobile devices, particularly tablets, were already high among 3 year-old children and increased with age. SEP was a negative predictor of screen time in the linear regression analysis, including after adjustment. Conclusions: Considering the negative health impacts of excessive screen time, recognizing subgroups at risk of excessive screen time and identifying how each device is used according to age is fundamental to enable appropriate future interventions. The screen time in children aged 3–10 years is longer than the recommended, particularly among boys and in those children from lower SEP. Parents and policymakers should have in mind that children spend most of their screen time watching television but mobile devices are becoming extremely popular starting at a young age.
- Socioeconomic inequalities in children's health‐related quality of life according to weight statusPublication . Costa, Diogo; Cunha, Marina; Ferreira, Cláudia; Gama, Augusta; Machado‐Rodrigues, Aristides M.; Rosado‐Marques, Vítor; Mendes, Larissa L.; Nogueira, Helena; Pessoa, Milene; Silva, Maria Raquel; Velasquez‐Melendez, Gustavo; Padez, CristinaObjectives: This study explores the association between socioeconomic position (SEP) and health-related quality of life (HRQoL) among Portuguese children according to their weight status. Methods: A total of 1215 primary school-aged children (mean age 8.78 years) from three Portuguese districts (Lisbon, Porto, Coimbra) were assessed during 2016/2017. Father and mother's education (low, medium, high) and work status (employed, unemployed/retired) were used as SEP indicators. Self-reported HRQoL was assessed with the KIDSCREEN-27. Height and weight were objectively measured and body mass index categorized in normal, overweight or obese. Age, sex, and district-adjusted linear regression models were fitted to estimate associations between SEP indicators and HRQoL dimensions, according to weight status. Results: We found that 24.9% of children were categorized as having overweight/obesity. The mean scores of the Physical Well-Being, and School Environment dimensions of HRQoL were lower among children classified with overweight/obesity compared to children with normal weight (57.21 vs 54.11, P < .001 and 57.85 vs 56.04, P = .010, respectively). Father's education was significantly associated with all HRQoL dimensions in children with a normal weight, but the same was not observed among children presenting overweight/ obesity. An increase in the level of maternal education was also significantly associated with all HRQoL dimensions among children classified with a normal weight, and only for the School Environment dimension among children classified with overweight/obesity. Conclusions: These results suggest the presence of socioeconomic inequalities in self-reported HRQoL from early age, particularly among children with normal weight.
- Socioeconomic inequalities in the prevalence of overweight and obesity among portuguese preschool‐aged children: changes from 2009 to 2016Publication . Rodrigues, Daniela; Costa, Diogo; Gama, Augusta; Machado‐Rodrigues, Aristides M.; Nogueira, Helena; Silva, Maria Raquel; Rosado‐Marques, Vítor; Padez, CristinaObjectives: We evaluated, for the first time in Portugal, the prevalence of overweight and obesity according to parental education in a population of preschool-aged Portuguese children in 2009/2010 and 2016/2017. Methods: Anthropometric data were collected in public and private preschools (n = 1996 in 2009/2010; n = 2077 in 2016/2017). Body mass index was calculated and weight status categories were based on the International Obesity Task Force cutoff points. Parental education level was self-reported. Results: Prevalence of overweight (17.1%–14.1%; p < 0.001) and obesity (6.6%–3.9%, p < 0.001) was lower in 2016/2017 than in 2009/2010, with higher rates being found in the north of the country. Parental education was significantly associated with childhood overweight and obesity and inequalities between low- and high-education increased between the two periods. Conclusions: While a decrease in childhood overweight and obesity were positive findings, the prevalence is still high and shows pronounced socioeconomic differences. Policies for obesity prevention need to be inclusive and tackle inequalities, with interventions tailored to suit local contexts.
- The economic crisis impact on the body mass index of children living in distinct urban environmentsPublication . Pereira, Margarida; Nogueira, Helena; Gama, Augusta; Machado-Rodrigues, Aristides; Rosado-Marques, Vitor; Silva, Maria Raquel; Padez, CristinaObjectives Little is known about the impact of the 2008 global economic recession on childhood obesity in Portugal. Thus, this study's goals were to compare weight status of children during and after the economic crisis according to their neighbourhood environment features and to assess changes in specific dietary habits during the economic crisis. Study design Cross-sectional study. Methods Data including weight, height, residence address to allow its geocoding and dietary habits changes during the crisis from children living in Lisbon municipality were collected in 2009 (N = 929) and in 2016 (N = 1751). A multidimensional environment index, with data of both built and socioeconomic nature collected at the statistical section level (areas comprised 300 dwellers) in the 2011 census, was used to characterize neighbourhoods. Results Overall, the proportion of children who are overweight or obese living in the socioeconomically vulnerable areas decreased in 2016. Families living in the latter areas stopped buying some food items, started to buy cheaper food items, cooked more meals at home and ate less in restaurants. In 2016, the risk for overweight and obesity increased in children who lived in the least advantageous areas. Living in areas with high socioeconomic status or most advantageous areas no longer represented a decreased risk of being overweight or obese in children in 2016 as it did in 2009. Conclusions This study suggests that the economic crisis enhanced the social inequalities regarding childhood obesity. These results aid the development of evidence-based strategies to lessen the social inequities in health outcomes created by the crisis.
- The environment contribution to gender differences in childhood obesity and organized sports engagementPublication . Nogueira, Helena; Costeira e Pereira, Margarida M.; Costa, Diogo; Gama, Augusta; Machado‐Rodrigues, Aristides; Silva, Maria Raquel; Marques, Vítor R.; Padez, Cristina M.Objective: This study aims to analyze gender-specific associations between sports activity outside of school and obesity, observing to what extent the local built environment contributes to the patterns found. Methods: A total of 2253 children aged 6.0-11.0 years were assessed: 49.3% girls and 50.7% boys. Children's weight and height were measured, age and sex-specific BMI cut-off points were used to define normal vs overweight/obesity. Children's organized sports (OS) activity was assessed by questionnaire, and local facilities for children's engagement in OS were analyzed. Logistic regression models were computed, adjusted for confounding variables. Results: Results showed greater overweight and obesity (25.1% vs 20.1%) and lower OS engagement (66.5% vs 73.8%) in girls as well as greater impact of OS engagement on weight status in girls (OR for having a normal weight = 1.434 in girls vs 1.043 in boys). Additionally, opportunities to engage in OS were scarce for girls. Conclusions: The gender gap in children's weight status and OS engagement might be enhanced by an environmental mismatch that undermines girls' opportunities to play sports. There should be more opportunities for girls to engage in their favorite sports as a means to tackle the obesity epidemic and to promote gender equality.