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Epidemiologia e Serviços de Saúde

versión impresa ISSN 1679-4974versión On-line ISSN 2237-9622

Epidemiol. Serv. Saúde vol.29 no.3 Brasília jun. 2020  Epub 06-Jul-2020

http://dx.doi.org/10.5123/s1679-49742020000300019 

Original article

Sociodemographic determinants associated with physical activity level of quilombolas in the Brazilian state of Bahia: 2016 survey*

Deyvis Nascimento Rodrigues (orcid: 0000-0002-8688-6716)1  , Ricardo Franklin de Freitas Mussi (orcid: 0000-0003-1515-9121)2  , Cláudio Bispo de Almeida (orcid: 0000-0001-9486-7163)2  , José Roberto Andrade Nascimento Junior (orcid: 0000-0003-3836-6967)1  , Sérgio Rodrigues Moreira (orcid: 0000-0002-3068-5093)1  , Ferdinando Oliveira Carvalho (orcid: 0000-0003-0306-5910)1 

1Universidade Federal do Vale do São Francisco, Programa de Pós-Graduação em Educação Física, Petrolina, PE, Brazil

2Universidade do Estado da Bahia, Departamento de Educação, Guanambi, BA, Brazil

Abstract

Objective

to analyze sociodemographic variables associated with insufficient physical activity level in Bahian quilombolas.

Methods

this was a cross-sectional study with data on sociodemographic characteristics and level of physical activity using a standardized form, administered through interviews with a representative sample of adults living in quilombos in the geographical region of Bahia; crude and adjusted logistic regression was used.

Results

850 participants were included whose average age was 45.0+17.0 years; 61.2% were female; prevalence of physical inactivity was 21.9% (95%CI 19.1; 24.7); insufficient physical activity level among adult quilombolas was higher among the elderly (OR 2.12; 95%CI 1.29; 3.49) and individuals who did not work (OR 1.47; 95%CI 1.01; 2, 14).

Conclusion

being elderly and not working is associated with insufficient physical activity in quilombolas.

Key words: African Continental Ancestry Group; Motor Activity; Health Surveys

Introduction

Chronic noncommunicable diseases (NCDs) are the leading set of prevalent diseases and causes of death among the different socio-economic segments of the population.1 In 2011, these diseases were responsible for the deaths of more than 850,000 Brazilians, corresponding to 72.7% of deaths recorded on the Mortality Information System (SIM).3

Diverse factors can influence reduced occurrence of NCDs among the Brazilian population.4 In this sense, doing physical activity (PA) is an important behavior that impacts on primary prevention and/or treatment of diverse chronic diseases,5 and adopting a physically active lifestyle reduces NCD occurrence by 6% to 10%.6

Regular PA is directly related to improved and/or continuing good health in people of all ages,7 and is inversely associated with different health risk factors (increased blood pressure, lipid and blood glucose levels), reducing premature mortality from all causes by around 30% to 35%.8

However, assessing PA level (PAL) still raises methodological issues that hinder its measurement in representative samples of the population.9 The main difficulty consists of divergence as to a universally standardized technique for measuring the diverse domains of PAL.10

Questionnaires are among the instruments widely used to determine PAL in population-based epidemiological studies, due to the ease and low cost of administering them. As such, the International Physical Activity Questionnaire (IPAQ) has been widely used in studies worldwide.12

High prevalence rates of insufficient practice of PA have been found in different populations and are present in around 23% of adults 18 years old,7 so that globally it is the fourth leading mortality risk factor. In the Brazilian state capitals, 13.7% of adults are insufficiently physically active, especially females and people with lower schooling levels.14

PAL is also subject to environmental influences. Those who live in rural communities are seen to adhere more to global recommendations on PA; research15 suggests that this disparity could be related to the structural conditions imposed on these people (geographic isolation; restricted access to health services, education, transport services and income).

A study with surviving quilombo (settlements originally formed by escaped slaves) communities in the north of Minas Gerais state identified that 63% did less PA than is recommended for ensuring health benefits.17 A study with quilombolas (maroons) in a municipality in the southeast of Bahia state indicated that they are more active when at work than in their free (or leisure) time, scoring 42.1% and 13.1%, respectively.18 Mussi et al.19also identified a low amount of PA in the free time of a Bahian quilombola community living on the banks of the São Francisco river.

Despite the recognized benefits for health of practicing PA,5 research with quilombolas has indicated low PA levels.17 However, considering local,19 municipal18 and regional17 samples, availability of information on its negative impacts on the health of the quilombola population is still limited. As such, this study seeks to analyze sociodemographic variables associated with insufficient PAL among Bahian quilombolas.

Methods

This analysis is part of the population-based cross-sectional study entitled “Epidemiological Profile of Bahian Quilombolas”, conducted between February and November 2016.

The empirical field is the geographical region of Guanambi, Bahia, which had 42 certified contemporary quilombos in 2016, distributed over ten municipalities. In view of no prior official information being available as to the number of people living in the quilombos of this Bahian microregion, the population was estimated assuming 80 families per quilombo, with two adults (>18 years old) per family in each community, totaling 6,720 adults.

The sample size calculation considered: finite population correction, 46% outcome prevalence20 (<150 minutes of PA a week considering the following domains: leisure; work; domestic/household; and movement between one place and another), 95% confidence interval, sample error of 5 percentage points (p.p.), 1.5 times effect for conglomerates, additional 30% for refusals and 20% for losses and confounders, resulting in a sample size of 813 subjects.

The sample design had two stages: random selection of the quilombos (conglomerates) and, following this, census gathering. Initially the quilombos were selected randomly. Through their respective residents’ associations, 14 of the selected units allowed visits for the study to be conducted, while three refused to take part.

Considering all the adults in the eligible quilombos, the residents’ associations stated that there were 1,025 adults living there during the collection period. They were all invited and were informed about the aspects of the study, ensuring equal probability of participation (Figure 1).

Figure 1 Steps for executing data collection 

Individuals with cognitive disabilities or unable to communicate independently were excluded from the interviews. Those who were bedridden, had amputated limbs, limbs in plaster, pregnant and breastfeeding mothers (up to six months after childbirth) were excluded from the anthropometric measurements. Losses were defined as a measurement or examination not being performed or an unanswered interview question.

Data collection took place by means of interviews, conducted by teams comprised of health professionals and/or undergraduates according to their qualifications, after having been trained. Data collection was done in mass at weekends and on public holidays.

The dependent variable, PA level, was determined in accordance with the International Physical Activity Questionnaire (IPAQ short version).21 IPAQ classification was done in a binary manner, whereby individuals classified as being “very active” and/or “active” were grouped together as “active”; and individuals classified as being “irregularly active” and/or “inactive” were grouped together as “insufficiently active”.22

The sociodemographic variables were: sex (female, male), age group (adults=18-59 years; elderly= 60 years or over), marital status (married; separated/divorced; widowed and single), literate (yes, no), family income (<1 minimum wage, ≥ 1 minimum wage), currently working (yes, no), religious affiliation (yes, no).

The population studied was characterized according to the absolute and relative frequencies of the sociodemographic, lifestyle and PA status variables.

Odds ratios (OR) were estimated based on logistic regression to analyze association between predictors and PAL. Crude ORs were checked initially. Variables with a p-value <0.20 were included in the adjusted analysis. A 5% significance level was used. All the analyses were performed using the Statistical Package for Social Sciences (SPSS), version 22.0.

The project was submitted to the Bahia State University Human Research Ethics Committee on 09/01/2016, and was approved as per Opinion No. 1.386.019/2016. All participants signed a Free and Informed Consent form.

Results

The final sample was comprised of 850 quilombolas who attended the activities and agreed to take part in the study, either by signing or putting their fingerprint on the individual Free and Informed Consent form (Figure 1). Refusals accounted for 17% of those who were invited, but did not attend the activities. Mean age of the participants was 45.0 (±17.0) years; 61.2% were female; 80.6% were adults; 74.6% were in a marital relationship; 71.9% were literate; 49.1% were currently working; and 79.0% had family income below the minimum wage (Table 1).

Table 1 – Description of the sociodemographic characteristics of adult quilombolas, Bahia, Brazil, 2016 

Variables N %
Sex    
Female 520 61.2
Male 330 38.8
Age group    
Adults 685 80.6
Elderly 165 19.4
Marital status    
Married 634 74.6
Separated/divorced 29 3.4
Widowed 41 4.8
Single 122 14.4
Literate    
Yes 595 71.9
No 232 28.1
Currently working    
Yes 406 49.1
No 421 50.9
Family income    
< 1 minimum wage 579 79.0
v≥ 1 minimum wage 154 21.0
Religious affiliation    
Yes 804 96.5
No 28 3.5

With regard to PAL, 21.9% (95%CI 19.1;24.7) were classified as being insufficiently active. Insufficiently active lifestyle was associated with participants’ age group, literacy and work (Table 2).

Table 2 – Distribution of physical activity level (PAL) of Bahian quilombolas, by sociodemographic characteristics, Bahia, Brazil, 2016 

  Nível de atividade física (NAF) p-valor
Insuficientemente ativo Ativo
% (n) % (n)
Sex      
Female 22.4 (114) 77.6 (394)  
Male 21.0 (68) 79.0 (256) 0.621
Age group      
Adults 18.2 (123) 81.8 (551)  
Elderly 37.3 (59) 62.7 (99) <0.001
Marital status      
Married 21.5 (136) 78.5 (498)  
Separated/divorced 20.7 (6) 79.3 (23)  
Widowed 26.8 (11) 73.2 (30)  
Single 18.2 (22) 81.8 (99) 0.615
Literate
Yes 19.5 (116) 80.5 (479)  
No 26.3 (61) 73.7 (171) 0.032
Family income      
< 1 minimum wage 20.2 (91) 79.8 (359)  
≥ 1 minimum wage 25.4 (72) 74.6 (211) 0.098
Currently working      
Yes 16.0 (65) 84.0 (641)  
No 26.6 (112) 73.4 (309) <0.001
Religious affiliation      
Yes 21.5 (173) 78.5 (631)  
No 32.1 (9) 67.9 (19) 0.181

The binary logistic regression analyses indicated that being elderly (OR=2.67; 95%CI 1.83;3.89), illiterate (OR=1.47; 95%CI 1.03;2.10) and not working (OR=1.90; 95%CI 1.35;2.68) were associated with an insufficiently active lifestyle (Table 3).

Table 3 – Crude and adjusted binary logistic regression analysis of physical activity level (PAL) and sociodemographic correlates among quilombolas, Bahia, Brazil, 2016 

  Insufficiently active N (%) Crude analysis OR (95%CI) p-value Adjusted analysis OR (95%CI) p-value
Sex          
Female 114 (22.4) 1      
Male 68 (21.0) 0.92 (0.65;1.29) 0.621    
Age group          
Adults 123 (18.2) 1   1  
Elderly 59 (37.3) 2.67 (1.83;3.89) <0.001* 2.12 (1.29;3.49) 0.003*
Marital status          
Married 136 (21.5) 1      
Separated/divorced 6 (20.7) 0.96 (0.38;2.39) 0.922    
Widowed 11 (26.8) 1.34 (0.66;2.75) 0.420    
Single 22 (18.2) 0.81 (0.49;1.34) 0.418    
Literate          
Yes 116 (19.5) 1   1  
No 61 (26.3) 1.47 (1.03;2.10) 0.033* 1.03 (0.67;1.56) 0.903
Family income          
< 1 Minimum wage 91 (20.2) 1   1  
≥ 1 Minimum wage 72 (25.4) 1.35 (0.95;1.92) 0.099 1.01 (0.68;1.50) 0.947
Currently working          
Yes 65 (16.0) 1   1  
No 112 (26.6) 1.90 (1.35;2.68) <0.001* 1.47 (1.01;2.14) 0.047*
Religious affiliation          
Yes 173 (21.5) 1   1  
No 9 (32.1) 1.73 (0.77;3.89) 0.186* 1.09 (0.35;3.41) 0.880

OR (odds ratio) for prevalence, using a 95% confidence interval (CI).

* p<0.05.

Variables with p<0.20 in the crude analysis (age group; literacy; family income; currently working; and having religious affiliation were included in the adjusted analysis. Insufficient PA level among adult quilombolas remained associated with the elderly age group (OR=212; 95%CI 1.29; 3.49) and with those who were not working (OR=1.47; 95%CI 1.01; 2.14) (Table 3).

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*Article derived from the Master’s Degree dissertation entitled “Factors associated with physical activity level and physical fitness in surviving quilombo communities, Bahia, Brazil”, defended by Deyvis Nascimento Rodrigues at the Physical Education Postgraduate Program of the Federal University of the São Francisco Valley in 2019.

Received: March 12, 2019; Accepted: February 25, 2020

Correspondence: Deyvis Nascimento Rodrigues - Universidade do Estado da Bahia, AV. Contorno, S/N, Bairro São José, Caetité, Bahia, Brazil. Postcode: 46.400-000. E-mail: rodriguesdeyvis@gmail.com

Associate Editor: Suele Manjourany Duro - orcid.org/0000-0001-5730-0811

Authors’ contributions

Rodrigues DN and Carvalho FO were responsible for the study concept and design; Rodrigues DN, Carvalho FO, Mussi RFF, Almeida CB, Nascimento Junior JRA and Moreira SR were responsible for analysis and interpretation of the results, drafting and critically reviewing the contents. All the authors have approved the final version of the manuscript and declare themselves to be responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Creative Commons License  This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.