Coexistence of risk factors for cardiovascular diseases among Brazilian adolescents: Individual characteristics and school environment

Cardiovascular diseases (CVD) share common and modifiable risk factors; among them, unhealthy eating, physical inactivity, alcohol intake and smoking habit. However, these factors are not observed in separate and, most often, they influence each other. Risk factors established during adolescence are highly likely to remain in adult life. The aims of the current study were to evaluate the prevalence and coexistence of risk factors for CVD, as well as to investigate individual characteristic of the adolescent and environmental factors associated with risk factors' coexistence profiles. This was a cross-sectional, national, school-based epidemiological study that estimated the prevalence of cardiovascular risk factors and metabolic syndrome in adolescents aged 12 to 17 years who attended public and private schools located in Brazilian counties with a population of more than 100 thousand. For this study, thematic blocks referring to alcohol consumption, eating habits, smoking, and physical activity were used. The grade of membership method was used to identify the coexistence of risk and protective factors for CVD among adolescents. The study analytical sample comprised 71,552 adolescents. Multilevel logistic regression was used to assess the association between factors influencing the coexistence profile of risk factors for CVD. Based on adolescent-level variables, has shown that meeting positive criterion for Common Mental Disorders and not consuming the meals provided by the school have significantly increased the likelihood of belonging to the CVD-risk profile. On the other hand, school-level variables, show that studying in private schools and living in economically favored Brazilian regions have increased adolescents' likelihood of belonging to the CVD-risk profile. These results can be used to substantiate the inclusion of food environment variables in public policies focused on preventing CVD development among Brazilian adolescents.