@article{ref1,
title="Association between area-level education and the co-occurrence of behavior-related risk factors: a multilevel analysis",
journal="Revista Brasileira de Epidemiologia",
year="2019",
author="Boing, Antonio Fernando and Subramanian, S. V. and Boing, Alexandra Crispim",
volume="22",
number="",
pages="e190052-e190052",
abstract="INTRODUCTION: This study aimed to investigate the association of four different risk factors for chronic diseases and accumulation of these health behaviors with area-level education, regardless of individual-level characteristics in Brazil. <br><br>METHODS: A population-based cross-sectional study was carried out in Southern Brazil including 1,720 adults in 2009/2010. The simultaneous occurrence of tobacco smoking, abusive drinking, unhealthy eating habits, and physical inactivity was investigated. Using multilevel models, we tested whether area-level education was associated with each risk factor and with the co-occurrence of them after controlling sociodemographic individual-level variables. <br><br>RESULTS: We observed a between-group variance of 7.79, 7.11, 6.84 and 1.08% for physical inactivity, problematic use of alcohol, unhealthy eating habits, and smoking, respectively. The between-group variance for the combination of four behaviors was 14.2%. Area-level education explained a significant proportion of the variance observed in physical inactivity and unhealthy eating habits. Residents of low educational level neighborhoods showed a 2.40 (95%CI 1.58 - 3.66) times higher chance of unhealthy eating and 1.78 (95%CI 1.19 - 2.67) times higher chance of physical inactivity. The likelihood of individuals with two or three/four risk factors was simultaneously higher among residents of low educational level neighborhoods. <br><br>CONCLUSION: Public policies should consider the area-level characteristics, including education to control risk factors for chronic diseases.<p /> <p>Language: en</p>",
language="en",
issn="1415-790X",
doi="10.1590/1980-549720190052",
url="http://dx.doi.org/10.1590/1980-549720190052"
}