Association of macro-level determinants with adolescent overweight and suicidal ideation with planning: A cross-sectional study of 21 Latin American and Caribbean Countries.
Association of macro-level determinants with adolescent overweight and suicidal ideation with planning: A cross-sectional study of 21 Latin American and Caribbean Countries.
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DOI：
10.1371/journal.pmed.1003443
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发表时间：
2020-12
期刊：
影响因子：
15.8
通讯作者：
Harding S
中科院分区：
文献类型：
--
作者：
Elia C;Karamanos A;Dregan A;O'Keeffe M;Wolfe I;Sandall J;Morgan C;Cruickshank JK;Gobin R;Wilks R;Harding S
拉丁美洲和加勒比 (LAC) 地区的青少年（10-24 岁）约占该地区人口的 25%。自2008年全球经济危机以来，拉丁美洲和加勒比地区减少贫困和收入不平等的步伐陷入停滞。该地区的特点是高度不平等，而且容易遭受许多自然灾害的影响。随着包装食品、快餐和含糖饮料的供应和营销的增加，食品系统正在发生变化。青春期是生命历程的一个形成阶段，存在多种身体、情感和社会变化，使他们容易受到健康问题的影响。我们评估了宏观决定因素、人类和经济发展以及收入不平等对青少年营养和心理健康两个最重要的区域优先事项的潜在影响，使用了超重和自杀意念和计划的衡量标准，其中一些已证明与此相关。全球校本健康调查 (GSHS) 是一项具有全国代表性的自我管理、校本调查。 2009 年至 2013 年间，我们根据人均国内生产总值 (GDP) 或人类发展指数 (HDI) 对来自 21 个拉美和加勒比国家的 10-19 岁青少年的超重/肥胖和自杀意念进行了调查。样本规模从安圭拉的 943 人到阿根廷的 27,988 人不等。共有 55,295 名青少年测量了超重/肥胖状况，59,061 名青少年报告了有计划的自杀意念。调查中性别比例相同（52% 为女孩，48% 为男孩）。共有 28.8% 的男孩和 28.1% 的女孩超重/肥胖，7.5% 的男孩和 17.5% 的女孩在过去 12 个月内有自杀意念和计划。根据个人社会经济和风险行为进行调整，相对于最高人均 GDP 三分位数，中间三分位数与 42%（95% 置信区间 (CI) 59% 至 17%，p = 0.003）和 32%（95% CI 60% 至 5%，p = 0.023）相关，最低三分位数与 40%（95% CI 55% 至女孩和男孩超重/肥胖的几率分别降低 19%，p = 0.001）和 46%（95% CI 59% 至 29%，p < 0.001）。 HDI 也出现了类似的积极影响，与最高三分位数相比，两性最低三分位数的超重几率最低。超重/肥胖与女孩的自杀意念呈正相关（比值比 (OR) 1.12，95% CI 1.02 至 1.22，p = 0.009），而与男孩的自杀意念呈弱相关（OR 1.09，95% CI 0.96 至 1.24，p = 0.182）。与超重/肥胖状况相反，有计划的自杀意念与宏观指标无关，尽管这两种结果具有共同的个人社会经济和风险行为相关性。局限性包括阿根廷人在样本中占主导地位（40％），排除了辍学的弱势青少年，以及由于心理健康相关问题的耻辱而造成的报告偏见。这项研究表明，经济和人类发展与青少年超重/肥胖呈正相关，但与计划自杀意念无关。我们还观察到女孩超重/肥胖和自杀意念与计划之间的相互关联。这些发现凸显了涉及上游和下游决定因素的策略对于改善青少年营养和心理健康的重要性。拉丁美洲和加勒比 (LAC) 地区的青少年（10-24 岁）占该地区人口的四分之一以上。青少年营养和心理健康是该地区的关键政策重点。尽管拉丁美洲和加勒比地区在经济发展、福利和卫生系统方面存在很大差异，但人们对国家发展水平或国家层面收入不平等对超重和肥胖青少年或有自杀意念和计划的影响知之甚少。利用 21 个拉美和加勒比国家 2009 年至 2013 年的数据，我们发现生活在经济较发达的拉美和加勒比国家的青少年超重和肥胖的风险较高。自杀意念和计划与发育水平无关，但与超重和肥胖有关。这项研究表明，超重和肥胖的风险不仅限于个人或家庭层面的影响，还包括更广泛的社会影响。拉丁美洲和加勒比地区国家在青少年从低收入状态向中等收入和高收入状态过渡的过程中需要监测和预防青少年超重/肥胖。
Adolescents and young people (10–24 years old) in the Latin America and the Caribbean (LAC) region represent approximately 25% of the region’s population. Since the 2008 global economic crisis, the pace of reduction in poverty and income inequality in the LAC region has stalled. The region is characterised by high levels of inequities and is also vulnerable to many natural disasters. Food systems are changing with increased availability and marketing of packaged and fast foods and sugar-sweetened drinks. Adolescence is a formative phase of the life course with multiple physical, emotional and social changes which can make them vulnerable to health problems. We assess the potential impact of macro-determinants, human and economic development as well as income inequality, on 2 top-ranking regional priorities for adolescent nutrition and mental health, using measures of overweight and suicidal ideation and planning which some have shown to be associated. The Global School-based Health Survey (GSHS) is a nationally representative self-administered, school-based survey. We examined overweight/obesity and suicidal ideation with planning by gross domestic product (GDP) per capita or human development index (HDI) in 10–19-year-old adolescents from 21 LAC countries between 2009 and 2013. Sample sizes varied from 943 in Anguilla to 27,988 in Argentina. A total of 55,295 adolescents had a measure of overweight/obesity status, and 59,061 adolescents reported about suicidal ideation with planning. There was equal representation by sex in the surveys (52% girls and 48% boys). A total of 28.8% of boys and 28.1% of girls had overweight/obesity, and 7.5% of boys and 17.5% of girls reported suicidal ideation with planning over the last 12 months. Adjusted for individual socioeconomic and risk behaviours, and relative to the highest GDP per capita tertile, the middle tertile was associated with 42% (95% confidence interval (CI) 59% to 17%, p = 0.003) and 32% (95% CI 60% to 5%, p = 0.023), and the lowest tertile with 40% (95% CI 55% to 19%, p = 0.001) and 46% (95% CI 59% to 29%, p < 0.001) lower chances of overweight/obesity for girls and boys, respectively. A similar positive effect was seen with HDI, with lowest chances of overweight in the lowest tertile compared with the highest tertile for both sexes. Overweight/obesity was positively related with suicidal ideation with planning for girls (odds ratio (OR) 1.12, 95% CI 1.02 to 1.22, p = 0.009) and weakly related for boys (OR 1.09, 95% CI 0.96 to 1.24, p = 0.182). In contrast to overweight/obesity status, suicidal ideation with planning was not related to macro-level indices despite both outcomes sharing common individual socioeconomic and risk behaviour correlates. Limitations include the dominance of Argentinians in the sample (40%), the exclusion of vulnerable adolescents who dropped out of school, and reporting bias due to stigma of mental health–related issues. This study shows that economic and human development were positively associated with adolescent overweight/obesity but not with suicidal ideation with planning. We also observed an interconnectedness between overweight/obesity and suicide ideation with planning among girls. These findings highlight the importance of strategies that engage with both upstream and downstream determinants to improve adolescent nutrition and mental health. Adolescents and young people (10–24 years old) in the Latin America and the Caribbean (LAC) region represent over 1 quarter of the region’s population. Adolescent nutrition and mental health are key policy priorities in the region. Despite the considerable diversity across the LAC region in economic development, welfare and health systems, little is known about the influence of level of national development or country-level income inequality on adolescent with overweight and obesity or suicidal ideation and planning. Using data from 21 LAC countries between 2009 and 2013, we found that adolescents living in more economically developed LAC countries were at higher risk of overweight and obesity. Suicidal ideation and planning was not associated with the level of development, but it was associated with overweight and obesity. This study shows that the risk of overweight and obesity is not only limited to individual or household level influences, but also to wider societal influences. Countries in the LAC region need to monitor and prevent adolescent overweight/obesity as they transition from lower to middle- and higher-income status.
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影响因子：
11.1
作者：
McKinnon B;Gariépy G;Sentenac M;Elgar FJ
通讯作者：
Elgar FJ
DOI：
10.1111/j.1467-789x.2012.01017.x
发表时间：
2012-11
期刊：
Obesity reviews : an official journal of the International Association for the Study of Obesity
影响因子：
--
作者：
Dinsa GD;Goryakin Y;Fumagalli E;Suhrcke M
通讯作者：
Suhrcke M
DOI：
10.1176/ps.2010.61.3.218
发表时间：
2010-03-01
期刊：
Psychiatric services (Washington, D.C.)
影响因子：
--
作者：
Caldas de Almeida, Jose Miguel;Horvitz-Lennon, Marcela
通讯作者：
Horvitz-Lennon, Marcela
影响因子：
4.6
作者：
Pan, Yi-Ju;Juang, Kai-Dih;Wang, Shuu-Jiun
通讯作者：
Wang, Shuu-Jiun
影响因子：
7.4
作者：
John A;Glendenning AC;Marchant A;Montgomery P;Stewart A;Wood S;Lloyd K;Hawton K
通讯作者：
Hawton K