Desigualdade e interseccionalidade em domínios da atividade física e tempo de tela entre adolescentes de Belém

Abstract

Inequities influence various aspects of health, including physical activity and sedentary behaviors among adolescents. In Belém, these disparities may be exacerbated by the socioeconomic and demographic conditions characteristic of the Amazon region. This study investigated inequalities across different domains of physical activity and screen time among adolescents in Belém (PA), considering the wealth index, sex, and school administrative dependency, while also exploring the intersectionality of vulnerabilities across multiple dimensions. Data from 1,719 adolescents (49% girls, 58% from public schools) were analyzed. Prevalence rates were calculated for school-based physical education (≥1 day/week and ≥30 minutes), active transport (≥5 days/week), leisure-time physical activity (≥60 minutes/day), and excessive screen time (≥4 hours/day). Inequalities were assessed using the Slope Index of Inequality (SII) and absolute differences, with 95% confidence intervals obtained via bootstrap. Determinants included the wealth index (quintiles), sex, school administrative dependency, and the Jeopardy Index for multiple risk factors. Adolescents in the fourth quintile of the wealth index had higher prevalence rates for leisure-time activities (32.9%) and participation in physical education classes (39.9%), while active transport was more frequent among those in the first quintile (58.7%). Excessive screen time was more prevalent among girls (57.0%) and private school students (72.3%), whereas boys (46.5%) and public-school students (54.4%) had higher prevalence rates for active transport. Analysis using the Jeopardy Index revealed greater inequality in excessive screen time (66.2%) among girls attending private schools with higher socioeconomic levels, while boys in the same group showed higher prevalence of leisure-time activities (44.4%). Conversely, students with greater vulnerability according to the Jeopardy Index demonstrated a higher prevalence of active transport (57.0%). The greatest magnitude of inequality was observed for active transport (SII = 0.398; 95% CI: 0.324 to 0.466) and screen time (SII = -0.328; 95% CI: -0.405 to -0.258). Leisure-time activities (SII = -0.180; 95% CI: - 0.244 to -0.110) and physical education (SII = -0.104; 95% CI: -0.182 to -0.026) also exhibited significant inequalities, albeit with lower magnitudes, disproportionately affecting more vulnerable adolescents. In conclusion, physical activities and screen time are influenced by various layers of inequality, with boys of higher socioeconomic status being more active in leisure-time activities and girls more exposed to excessive screen time. Among the most vulnerable groups, higher rates of active transport were observed, potentially reflecting a need rather than a choice.