Tempo de tela no lazer no Brasil: tendência temporal e coocorrência com a atividade física

Abstract

Introduction: Sedentary behavior is associated with several adverse health outcomes, especially non-communicable chronic diseases (NCDs). In this context, screen time has been frequently adopted as an indicator of sedentary behavior, since populations are increasingly using screens, such as television (TV) and cell phones, computers and other screens passively, particularly for their discretionary activities. It is known that sedentary screen time has increased worldwide in recent decades, in parallel with low levels of physical activity, enhancing adverse health outcomes. This situation has worsened even more in recent years, due to the COVID-19 (coronavirus disease 2019) pandemic and its repercussions on the lifestyle of individuals. Objectives: To analyze the temporal trends of the prevalence of leisure screen time indicators, possible impact of the COVID-19 pandemic, and the co-occurrence of leisure screen use and physical activity among adults in Brazil. Methods: Study with a mixed design, consisting of time-series analysis of cross-sectional surveys and a cross-sectional study. Article 1 and manuscript 2 are based on data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) (n=265,252). Estimates of the annual prevalence of screen time watching TV and using cell phone, computer or tablet (CCT) during leisure time were used to identify the temporal trend of such indicators from 2016 to 2021, among Brazilians (≥ 18 years old). Regression models were used to identify increasing or decreasing linear trends. Then, based on the 2016/19 trend, data for the years 2020 and 2021 were predicted (using regression models). Then, these data were compared to those observed in 2020 and 2021 (the most critical period of the COVID-19 pandemic), using the 95% confidence interval (CI). Additionally, data were predicted for the period from 2022 to 2025. In manuscript 3, data from the National Health Survey (NHS) 2019 (n=88,531) were used to analyze the co-occurrence of screen use during leisure time and practice of physical activity in the Brazilian adult population (≥ 18 years old). Clusters of screen time (TV and CCT during leisure) and physical activity (leisure, commuting, household and occupation) indicators were identified through cluster analysis (non-hierarchical K-means method), for the total population and stratified by sex. Multinomial logistic regression models were used to verify associations between the clusters and socioeconomic, demographic and health characteristics of the population. Results: Between 2016 and 2021, mean TV time and frequency of adults watching TV ≥ 3 hours/day remained stable, while CCT time and frequency of adults using CCT in their leisure time ≥ 3 hours/day increased, in the total population and in all investigated subgroups, especially in women, young adults (18-34 years) and with intermediate education (9-11 years) (article 1). In the period prior to the COVID-19 pandemic, between 2016 and 2019, there was a reduction in the habit of watching TV and a greater increase in the use of CCT during leisure in the country. Our findings indicate that the 2016/19 trend of screen exposure by the Brazilian population had its trajectory modified in the years 2020 and 2021, especially for TV, in the face of COVID-19. Considering the post-pandemic context, it is suggested that there will be a convergence to the trend observed in the pre-pandemic period in the near future (manuscript 2). Four clusters of screen use during leisure time and practice of physical activity in different domains were identified in the Brazilian population in 2019. Cluster 1 was characterized by low use of screens and active individuals (especially in occupation), cluster 2 by prolonged time of TV and predominance of inactive individuals, cluster 3 by prolonged time of CCT and predominance of active individuals (especially in leisure) and cluster 4 by low use of screens and predominance of active individuals. Although, in general, a large portion of Brazilians proved to be insufficiently active. Unlike cluster 1, represented in greater proportion by men and those of lower socioeconomic status, the other clusters were associated with women (cluster 2 with greater magnitude) and those with higher education and per capita income (cluster 3 with greater magnitude). Cluster 2 was more strongly associated with older individuals and cluster 3 with younger ones. Cluster 2 was the most strongly associated with individuals with obesity and NCDs, but clusters 3 and 4 also showed associations. Cluster 3 was more associated with those who did not live in rural areas and cluster 4 with those who did not live in the South, Southeast and Central-West regions. Socioeconomic and demographic factors reveal social and health inequalities in the country (manuscript 3). Conclusions: A considerable portion of the Brazilian population has shown prolonged exposure to screens during leisure, with a greater increase during the COVID-19 pandemic (especially for TV). Four clusters of screen use during leisure and practice of physical activity were identified, each associated with a specific set of socioeconomic, demographic and health characteristics.