ABSTRACT

Objective:

To estimate the prevalence of chronic diseases and health conditions in adolescents from Campinas (São Paulo), investigating sex differences according to age group.

Methods:

This population-based study analyzed data from the ISACamp 2014/15 health survey, with a total of 1,022 adolescents interviewed. The interviewees consisted of 517 boys and 505 girls; 492 of them in the ten to 14 age group and 530 in the 15 to 19 age group. We verified the associations using the χ² test with Rao Scott adjustment and estimated prevalence ratios (PR) with multiple Poisson regression adjusted for age. Analyses were also stratified by age group.

Results:

Respiratory diseases, such as rhinitis (25.3%), sinusitis (15.7%), and asthma (10.9%), were the most prevalent among adolescents. Health complaints were high, especially headaches (39.5%), emotional conditions (34.5%), allergies (27.5%), and back pain (21.3%). More than 22.0% of adolescents reported having three or more health conditions. Girls declared a higher number of health conditions (three or more) than boys (PR=2.27).

Conclusion:

The study showed that adolescents presented a significant number of health conditions, particularly regarding complaints, indicating the need for clinical care and public policies aimed at controlling and preventing these diseases in this age group.

Keywords:
Adolescent; Chronic disease; Health status; Demography

INTRODUCTION

Adolescence is a life stage filled with changes in physical, cognitive, and emotional status and behaviors. Some factors involved in the process of transition to adulthood concern the consolidation of self-care and body notions. Thus, family spaces and school environments, as well as specific public policies, influence this journey¹1. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas. Proteger e cuidar da saúde de adolescentes na atenção básica. Brasília: Ministério da Saúde; 2017..

Health policies aimed at adolescents have been on the rise worldwide, despite the considerable challenges they face, among which the inattention of society for assuming this population has fewer care needs compared to other age groups, leading to negligence regarding complaints and chronic diseases in adolescents²2. Barbosa FNM, Casotti CA, Nery AA. Comportamento de risco à saúde de adolescentes escolares. Texto Contexto Enferm 2016; 25(4): e2620015. http://dx.doi.org/10.1590/0104-07072016002620015
http://dx.doi.org/10.1590/0104-070720160... –⁶6. Organização Pan-Americana da Saúde. Health agenda for the Americas 2008-2017 [Internet]. Panama: Pan-American Health Organization; 2007 [acessado em 01 abr. 2022]. Disponível em: https://iris.paho.org/handle/10665.2/34127
https://iris.paho.org/handle/10665.2/341... .

Recent data from the World Health Organization identified external causes, injuries, psychiatric disorders, maternal and contraception complications, and infectious diseases as the main causes of death among young people⁴4. World Health Organization. Adolescent and young adult health [Internet]. Genebra: World Health Organization; 2021 [acessado em 01 abr. 2022]. Disponível em: https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions
https://www.who.int/news-room/fact-sheet... . Preventable and external causes differed between sexes and regions, although road traffic accidents, infections, drowning, and depressive disorders were similar between high- and low-income countries⁷7. Organização Pan-Americana da Saúde. Ação global acelerada para a saúde de adolescentes (AA-HA!): guia de orientação para apoiar a implementação pelos países. Washington: Organização Pan-Americana da Saúde; 2018.. After analyzing mortality trends between ten and 24 years, from 1990 to 2019, using data from the Global Burden of Disease research, a Brazilian study reported that the main causes of death were external. Among women, they were: road injuries, followed by interpersonal violence, maternal deaths, and suicide. For men, interpersonal violence was the first cause of death, followed by road injuries, suicide, and drowning⁵5. Malta DC, Minayo MCS, Cardoso LSM, Veloso GA, Teixeira RA, Pinto IV, et al. Mortalidade de adolescentes e adultos jovens brasileiros entre 1990 e 2019: uma análise do estudo Carga Global de Doença. Ciênc Saúde Coletiva 2021; 26(9): 4069-86. https://doi.org/10.1590/1413-81232021269.12122021
https://doi.org/10.1590/1413-81232021269... .

Chronic noncommunicable diseases can affect individuals throughout their lives and are multifaceted, ranging from genetics to external factors⁸8. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação em Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022. Brasília: Ministério da Saúde; 2011. and lifestyle⁹9. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Genebra: World Health Organization; 2009.. Health risk behaviors, such as smoking, alcohol consumption, unhealthy eating, and physical inactivity, tend to start at an early age and strongly influence the development of diseases, health conditions, and multimorbidities²2. Barbosa FNM, Casotti CA, Nery AA. Comportamento de risco à saúde de adolescentes escolares. Texto Contexto Enferm 2016; 25(4): e2620015. http://dx.doi.org/10.1590/0104-07072016002620015
http://dx.doi.org/10.1590/0104-070720160... . Few population-based studies describe the prevalence of chronic diseases and other health complaints in this age group³3. Braz M, Barros Filho AA, Barros MBA. Saúde dos adolescentes: um estudo de base populacional em Campinas, São Paulo, Brasil. Cad Saúde Pública 2013; 29(9): 1877-88. https://doi.org/10.1590/0102-311X00169712
https://doi.org/10.1590/0102-311X0016971... ,¹⁰10. Oliveira-Campos M, Oliveira MM, Silva SU, Santos MAS, Barufaldi LA, Oliveira PPV, et al. Fatores de risco e proteção para as doenças crônicas não transmissíveis em adolescentes nas capitais brasileiras. Rev Bras Epidemiol 2018; 21(suppl 1): e180002. https://doi.org/10.1590/1980-549720180002.supl.1
https://doi.org/10.1590/1980-54972018000... ,¹¹11. Ribeiro IBS, Correa MM, Oliveira G, Cade NV. Transtorno mental comum e condição socioeconômica em adolescentes do Erica. Rev Saúde Pública 2020; 54: 4. https://doi.org/10.11606/S1518-8787.2020054001197
https://doi.org/10.11606/S1518-8787.2020... .

Headaches and musculoskeletal pain are usually significant in adolescence³3. Braz M, Barros Filho AA, Barros MBA. Saúde dos adolescentes: um estudo de base populacional em Campinas, São Paulo, Brasil. Cad Saúde Pública 2013; 29(9): 1877-88. https://doi.org/10.1590/0102-311X00169712
https://doi.org/10.1590/0102-311X0016971... , possibly due to or associated with emotional conditions¹²12. Alonso AC, Anunciação JL, Oliveira R. Prevalência de dor em adolescentes escolares. Fisioter Bras 2013; 14(4): 268-73.,¹³13. Okamura MN, Madeira W, Goldbaum M, Cesar CLG. Dor nas costas em adolescentes: prevalência e fatores associados. BrJP 2019; 2(4): 321-5. https://doi.org/10.5935/2595-0118.20190059
https://doi.org/10.5935/2595-0118.201900... . These emotional disorders can have multifactorial and pathological determinants¹⁴14. Costa CO, Branco JC, Vieira IS, Souza LDM, Silva RA. Prevalência de ansiedade e fatores associados em adultos. J Bras Psiquiatr 2019; 68(2): 92-100. https://doi.org/10.1590/0047-2085000000232
https://doi.org/10.1590/0047-20850000002... , affecting social and professional relationships in future ages. Pain in this age group, especially musculoskeletal ones, might result from physical development — inherent in growth —, exhausting efforts, or physical inactivity¹²12. Alonso AC, Anunciação JL, Oliveira R. Prevalência de dor em adolescentes escolares. Fisioter Bras 2013; 14(4): 268-73..

Adult women tend to report worse health conditions, while men die earlier, indicating gender paradoxes, as well as biological and self-care differences. Women usually declare more emotional conditions, the presence of diseases and other complaints, and access health services more often. On the other hand, men are prone to expose themselves to risk conditions, underestimate their symptoms, and do not recognize their own health conditions, leading to early deaths¹⁵15. Bastos TF, Canesqui AM, Barros MBA. “Healthy men” and high mortality: contributions from a population-based study for the gender paradox discussion. PLoS One 2015; 10(12): e0144520. https://doi.org/10.1371/journal.pone.0144520
https://doi.org/10.1371/journal.pone.014... ,¹⁶16. Perelman J, Fernandes A, Mateus C. Gender disparities in health and healthcare: results from the Portuguese National Health Interview Survey. Cad Saude Publica 2012; 28(12): 2339-48. https://doi.org/10.1590/S0102-311X2012001400012
https://doi.org/10.1590/S0102-311X201200... .

Brazilian studies addressing comprehensive and aggregated perspectives on health status and diseases in adolescents, according to sex, are scarce. Although some studies focus on adolescents in Brazil, such as the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes — ERICA) and the National Survey of School Health (Pesquisa Nacional de Saúde em Escolares — PeNSE), few analyses include the prevalence of a group of various chronic diseases and health conditions. Understanding gender inequalities in health and knowing whether they have been recurrent since adolescence is important for developing more efficient health actions and specific public policies¹⁷17. Raposo J, Costa AC, Silva M, Pereira J, Valença P, Franca C, et al. Condutas de saúde de adolescentes segundo o sexo: uma revisão sistematizada. Psicologia, Saúde & Doenças 2016; 17(2): 214-35. http://dx.doi.org/10.15309/16psd170209
http://dx.doi.org/10.15309/16psd170209... .

Therefore, this study aimed to present the prevalence of chronic diseases and the main health conditions reported by adolescents from Campinas, investigating the association according to sex, with stratifications by age group.

METHODS

This population-based cross-sectional study used data from the Campinas Health Survey, carried out in 2014/2015.

A total of 3,021 individuals were interviewed, with a random selection of 2,898, 950, and 3,326 households to find adolescent, adult, and older adult respondents, respectively. All residents of the age group selected from each household were interviewed.

The sampling plan for adolescents considered both sexes and the age range of ten to 19 years. The sample selection was estimated to be a thousand people, considering a 50% proportion, 0.5 variability, 95% confidence coefficient, and a design effect of 2. Initially, 70 census tracts were randomly selected, listing 14 of them in each of the municipal health districts of Campinas (east, northwest, north, southwest, and south), followed by the selection of households.

Information was gathered by a precoded questionnaire administered by trained interviewers. All interviewees signed the Informed Consent Form (ICF). Survey data were collected in a tablet and submitted for consistency evaluation.

The categorizations defined were: none, one, two, and three or more morbidities, which characterized the multimorbidities.

All morbidities and health conditions collected in the 2014/2015 survey and included in the checklist were investigated. However, only the most prevalent ones were analyzed and described (Tables 1 and 2). Sex analyses stratified by age group were also performed when the overall sex associations were significant (Table 3).

The independent variables of the study were sex (female and male) and age group (10–14 and 15–19 years). The sex analyses used continuous age for the proper adjustments.

We calculated prevalence estimates and 95% confidence intervals (95%CI) and tested associations using Pearson’s χ²2. Barbosa FNM, Casotti CA, Nery AA. Comportamento de risco à saúde de adolescentes escolares. Texto Contexto Enferm 2016; 25(4): e2620015. http://dx.doi.org/10.1590/0104-07072016002620015
http://dx.doi.org/10.1590/0104-070720160... test with Rao Scott adjustment for more robust corrections in complex samples. Prevalence ratios (PR) were estimated by applying multiple Poisson regression models with robust variance. Data analysis considered weightings and characteristics related to sample design using the Stata 15.0 Software.

The Ethics Committee of the School of Medical Sciences at Unicamp approved the ISACamp 2014/2015 survey, under Opinion no. 409,714/2013, and the current project, under no. 5,283,905/2022, according to Resolution no. 466 from December 12, 2012.

RESULTS

A total of 1,022 adolescents with a mean age of 14.5 years (95%CI 14.3–14.7) were interviewed. Among them, 50.9% (95%CI 47.4–54.2) were male (n=517) and 49.1% (95%CI 45.7–52.5) were female (n=505), 492 were aged 10 to 14 years and 530 were aged 15 to 19 years.

The most reported chronic diseases were those related to respiratory conditions, with a prevalence of 25.3% for rhinitis, 15.7% for sinusitis, and 10.9% for asthma. Other diseases presented percentages below 5% (high cholesterol, spinal conditions, bronchitis, and hypertension). The prevalence of high cholesterol was greater in girls (PR=2.01), while asthma was higher among boys (PR=0.65). The overall prevalence of health conditions in this age group was quite high, especially headaches (39.5%) and emotional conditions (34.5%). Allergies (27.5%) and back pain (21.3%) had percentages above 20.0%. Dizziness and insomnia were reported by over 10.0% of the adolescents, and two out of ten of them declared having three or more health conditions. Although little reported (4.2%), cystitis was a predominantly female symptom. Five of the seven health conditions analyzed showed statistically significant differences between sexes, with migraine/headache (PR=1.64), emotional/mental condition (PR=1.37), back pain (PR=1.76), dizziness or vertigo (PR=1.70), and urinary tract infection (PR=9.77) standing out among girls, who also reported three or more health conditions over twice as often as boys (PR=2.27) (Tables 1 and 2).

The prevalence of high cholesterol and dizziness/vertigo was greater in girls, but the differences were found only in the age range of 15 to 19 years. On the other hand, the asthma prevalence was lower in girls, with differences only among the youngest (ten to 14 years) (Table 3).

DISCUSSION

Adolescents from Campinas proved to have diagnoses of chronic diseases, particularly those related to the respiratory system, with prevalence ranging from 10.9% (asthma) to 25.3% (rhinitis). Health complaints and symptoms, as well as the clustering of health conditions, presented high frequencies, especially among girls, indicating that adolescents are getting sick and that females, since their youth, tend to express their health difficulties and needs more often.

Data from the National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios — PNAD) 2008 revealed at least one chronic disease in 11.2% of adolescents in Brazil³3. Braz M, Barros Filho AA, Barros MBA. Saúde dos adolescentes: um estudo de base populacional em Campinas, São Paulo, Brasil. Cad Saúde Pública 2013; 29(9): 1877-88. https://doi.org/10.1590/0102-311X00169712
https://doi.org/10.1590/0102-311X0016971... ,¹⁸18. Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciência Saúde Coletiva 2011; 16(9): 3755-68. https://doi.org/10.1590/S1413-81232011001000012
https://doi.org/10.1590/S1413-8123201100... , a number that has been rising alarmingly, with respiratory diseases being the most frequent¹⁹19. Viner R, Booy R. Epidemiology of health and illness. BMJ 2005; 330(7488): 411-4. https://doi.org/10.1136/bmj.330.7488.411
https://doi.org/10.1136/bmj.330.7488.411... . Morbidities such as rhinitis and sinusitis regularly affect adolescents worldwide³3. Braz M, Barros Filho AA, Barros MBA. Saúde dos adolescentes: um estudo de base populacional em Campinas, São Paulo, Brasil. Cad Saúde Pública 2013; 29(9): 1877-88. https://doi.org/10.1590/0102-311X00169712
https://doi.org/10.1590/0102-311X0016971... ,¹⁹19. Viner R, Booy R. Epidemiology of health and illness. BMJ 2005; 330(7488): 411-4. https://doi.org/10.1136/bmj.330.7488.411
https://doi.org/10.1136/bmj.330.7488.411... .

Information from ISACamp 2008 showed a 7.6% prevalence of asthma³3. Braz M, Barros Filho AA, Barros MBA. Saúde dos adolescentes: um estudo de base populacional em Campinas, São Paulo, Brasil. Cad Saúde Pública 2013; 29(9): 1877-88. https://doi.org/10.1590/0102-311X00169712
https://doi.org/10.1590/0102-311X0016971... . Among students, PeNSE showed a downward trend in the prevalence of asthma symptoms, such as wheezing, when comparing 2012 (25.2%) and 2015 (23.5%), with girls presenting the highest incidence of these symptoms (26.7%). Regarding medical diagnosis, ERICA 2013/2014 indicated 8.7% of asthma diagnoses between the ages of 12 and 17 years, a value higher in girls²⁰20. Kuschnir FC, Gurgel RQ, Solé D, Costa E, Felix MMR, Oliveira CL, et al. ERICA: prevalence of asthma in Brazilian adolescents. Rev Saude Publica 2016; 50(Suppl 1): 13s. https://doi.org/10.1590/S01518-8787.2016050006682
https://doi.org/10.1590/S01518-8787.2016... .

Results of this study pointed to asthma as the third most prevalent disease, reinforcing national and international findings of common diseases in the analyzed life stage²¹21. Solé D, Wandalsen GF, Camelo-Nunes IC, Naspitz CK. Prevalence of symptoms of asthma, rhinitis, and atopic eczema among Brazilian children and adolescents identified by the International Study of Asthma and Allergies in Childhood (ISAAC): phase 3. J Pediatr (Rio J) 2006; 82: 341-6. https://doi.org/10.1590/S0021-75572006000600006
https://doi.org/10.1590/S0021-7557200600... –²³23. Strachan D, Sibbald B, Weiland S, Ait-Khaled N, Anabwani G, Anderson HR, et al. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol 1997; 8(4): 161-76. https://doi.org/10.1111/j.1399-3038.1997.tb00156.x
https://doi.org/10.1111/j.1399-3038.1997... . Self-reported rhinitis and sinusitis were more predominant in girls, contrary to the asthma trend, which was mainly present in boys. These findings corroborate those of an Investigation carried out in educational institutions in Northeastern Brazil, whose results revealed a greater association of asthma in boys²⁴24. Assis EV, Santana MDR, Feitosa ANA, Sousa MNA, Isidório UA, Valenti VE, et al. Prevalência de sintomas de asma e fatores de risco em adolescentes. J Hum Growth Dev 2019; 29(1): 110-6. http://dx.doi.org/10.7322/jhgd.157758
http://dx.doi.org/10.7322/jhgd.157758... . Evidence indicates that asthma prevalence is higher in boys during childhood but tends to increase in girls throughout the hormonal changes of adolescence²⁵25. Lima WL, Lima EVNCL, Costa MRSR, Santos AM, Silva AAM, Costa ES. Asma e fatores associados em adolescentes de 13 e 14 anos em São Luís, Maranhão, Brasil. Cad Saúde Pública 2012; 28(6): 1046-56. https://doi.org/10.1590/S0102-311X2012000600004
https://doi.org/10.1590/S0102-311X201200... . These diseases, especially asthma and rhinitis, are associated and may unfold into symptoms such as insomnia and infections, leading to limitations and difficulties in adulthood.

Population data on abnormal lipid profiles in adolescents are scarce in the country. However, results from laboratory tests in adolescents collected by ERICA 2013/2014 showed a greater preponderance of high values in girls (24.9%) and a total mean of 20.1%, a figure five times higher than that found by this study (4.1%), representing important cardiovascular risks, even in children and adolescents. An evaluation of lipid profiles of children and adolescents in primary health care units of Campinas, conducted between 2008 and 2015, indicated increased frequencies of around 30.0% in cholesterol and 40.0% in triglycerides²⁶26. Gomes EIL, Zago VHS, Faria EC. Avaliação de perfis lipídicos infanto-juvenis solicitados nas unidades básicas de saúde em Campinas/SP, Brasil: um estudo laboratorial transversal. Arq Bras Cardiol 2020; 114(1): 47-56. https://doi.org/10.5935/abc.20190209
https://doi.org/10.5935/abc.20190209... . Given the low number of complications and mortality caused by dyslipidemias in adolescents, routine tests are unusual in this population, which can suggest underreporting and a lack of knowledge of the problem. The result found in Brazilian adults points to a 12.5% prevalence of dyslipidemia, according to the National Health Survey²⁷27. Faria-Neto JR, Bento VFR, Baena CP, Olandoski M, Gonçalves LGO, Abreu GA, et al. ERICA: prevalência de dislipidemia em adolescentes brasileiros. Rev Saúde Pública 2016; 50(supl 1): 10s. https://doi.org/10.1590/S01518-8787.2016050006723
https://doi.org/10.1590/S01518-8787.2016... ,²⁸28. Lotufo PA, Santos RD, Sposito AC, Bertolami M, Rocha-Faria Neto J, Izar MC, et al. Self-reported high-cholesterol prevalence in the brazilian population: analysis of the 2013 National Health Survey. Arq Bras Cardiol 2017; 108(5): 411-6. https://doi.org/10.5935/abc.20170055
https://doi.org/10.5935/abc.20170055... . This scenario prompts reflections on the need to educate the population on how to identify dyslipidemias early in children, adolescents and young adults, which does not seem to be the case, considering that the individual’s knowledge of diagnosis is less than the screening performed by laboratory tests.

Discussing chronic diseases in adolescents is complex, as the questions and indicators used in research do not coincide, and some do not include adolescents aged ten to 19 years, categorizing the participants into narrower age ranges or school ages. In addition, the methodologies of the questionnaires differ.

The analysis of complaints and symptoms shows even more distinct patterns, in which migraine or headache presented a high prevalence in 2015 (39.5%), with a much higher trend in girls (PR=1.64). In 2016, 40.8% of adolescents from a Northeastern cohort complained of headaches, a factor that negatively affects the quality of life and may relate to high screen time and emotional conditions, besides being a consequence of low sleep quality²⁹29. Simões VMF, Batista RFL, Alves MTSSB, Ribeiro CCC, Thomaz EBAF, Carvalho CA, et al. Saúde dos adolescentes da coorte de nascimentos de São Luís, Maranhão, Brasil, 1997/1998. Cad Saúde Pública 2020; 36(7): e00164519. https://doi.org/10.1590/0102-311X00164519
https://doi.org/10.1590/0102-311X0016451... , also reported by 11.7% of adolescents from Campinas who complained of insomnia, in our study.

Emotional conditions were significant in this Investigation (34.5%), with a high prevalence ratio in girls. The ERICA study used an assessment instrument for common mental disorders (CMD), the General Health Questionnaire (GHQ-12), revealing a 30.0% prevalence, similar to our findings, although estimated by different methodologies¹¹11. Ribeiro IBS, Correa MM, Oliveira G, Cade NV. Transtorno mental comum e condição socioeconômica em adolescentes do Erica. Rev Saúde Pública 2020; 54: 4. https://doi.org/10.11606/S1518-8787.2020054001197
https://doi.org/10.11606/S1518-8787.2020... . Brazil still needs to advance in mental health care for children and adolescents, who, although minimally supported by the Child and Adolescent Statute (Estatuto da Criança e do Adolescente — ECA) and the Child and Adolescent Psychosocial Care Centers (Centros de Atenção Psicossociais Infanto-juvenis — CAPSij), still do not seem to be sufficiently assisted¹1. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas. Proteger e cuidar da saúde de adolescentes na atenção básica. Brasília: Ministério da Saúde; 2017.,³⁰30. Assis SG, Avanci JQ, Pesce RP, Ximenes LF. Situação de crianças e adolescentes brasileiros em relação à saúde mental e à violência. Ciênc Saúde Coletiva 2009; 14(2): 349-61. https://doi.org/10.1590/S1413-81232009000200002
https://doi.org/10.1590/S1413-8123200900... . Additionally, studies tend to evaluate psychiatric diagnoses without connecting them to self-reported sensations, feelings, and suffering, which could improve care in this age group, with early interventions³¹31. Rossi LM, Marcolino TQ, Speranza M, Cid MFB. Crise e saúde mental na adolescência: a história sob a ótica de quem vive. Cad Saúde Pública 2019; 35(3): e00125018. https://doi.org/10.1590/0102-311X00125018
https://doi.org/10.1590/0102-311X0012501... –³³33. Munhoz TN, Nunes BP, Wehrmeister FC, Santos IS, Matijasevich A. A nationwide population-based study of depression in Brazil. J Affect Disord 2016; 192: 226-33. https://doi.org/10.1016/j.jad.2015.12.038
https://doi.org/10.1016/j.jad.2015.12.03... . Some works indicate important prevalence rates of emotional conditions in adolescence, indicating that these disorders can negatively influence physical and psychological development and persist in adulthood, leading to their worsening³⁴34. Just AP, Enumo SRF. Problemas emocionais e de comportamento na adolescência: o papel do estresse. Bol - Acad Paul Psicol 2015; 35(89): 350-70.,³⁵35. Lopes CS. Como está a saúde mental dos brasileiros? A importância das coortes de nascimento para melhor compreensão do problema. Cad Saúde Pública 2020; 36(2): e00005020. https://doi.org/10.1590/0102-311X00005020
https://doi.org/10.1590/0102-311X0000502... .

When assessing back pain, this study obtained very similar findings (21.3%) to those of a São Paulo survey of the same year (22.4%), which evaluated young people aged 15 to 19 years. As this complaint has a multifactorial nature and various origins, back pain is associated with many work leaves, resulting in severe limitations throughout life, which can worsen without proper treatment and care³⁶36. Okamura MN, Madeira W, Goldbaum M, Cesar CLG. Back pain in adolescents: prevalence and associated factors. BrJP 2019; 2(4): 321-5. https://doi.org/10.5935/2595-0118.20190059
https://doi.org/10.5935/2595-0118.201900... . In the country, the prevalence in adults ranged from 30.0 to more than 60.0%³⁷37. Iguti AM, Bastos TF, Barros MBA. Dor nas costas em população adulta: estudo de base populacional em Campinas, São Paulo, Brasil. Cad Saúde Pública 2015; 31(12): 2546-58. https://doi.org/10.1590/0102-311X00178114
https://doi.org/10.1590/0102-311X0017811... ,³⁸38. Ferreira GD, Silva MC, Rombaldi AJ, Wrege ED, Siqueira FV, Hallal PC. Prevalência de dor nas costas e fatores associados em adultos do Sul do Brasil: estudo de base populacional. Rev Bras Fisioter 2011; 15(1): 31-6. https://doi.org/10.1590/S1413-35552011005000001
https://doi.org/10.1590/S1413-3555201100... . International studies estimate reports of 37.0% back pain among the population aged nine to 17 years³⁷37. Iguti AM, Bastos TF, Barros MBA. Dor nas costas em população adulta: estudo de base populacional em Campinas, São Paulo, Brasil. Cad Saúde Pública 2015; 31(12): 2546-58. https://doi.org/10.1590/0102-311X00178114
https://doi.org/10.1590/0102-311X0017811... –³⁹39. Swain MS, Henschke N, Kamper SJ, Gobina I, Ottová-Jordan V, Maher CG. An international survey of pain in adolescents. BMC Public Health 2014; 14: 447. https://doi.org/10.1186/1471-2458-14-447
https://doi.org/10.1186/1471-2458-14-447... . Despite its regular appearance, this condition receives little attention, especially during adolescence, often identified as inadequate body postures and/or lack and excess activities⁴⁰40. Sjolie AN. Associations between activities and low back pain in adolescents. Scand J Med Sci Sport 2004; 14(6): 352-9. https://doi.org/10.1111/j.1600-0838.2004.377.x
https://doi.org/10.1111/j.1600-0838.2004... ,⁴¹41. Noll M, Candotti CT, Rosa BN, Loss JF. Back pain prevalence and associated factors in children and adolescents: an epidemiological population study. Rev Saude Publica 2016; 50: 31. https://doi.org/10.1590/S1518-8787.2016050006175
https://doi.org/10.1590/S1518-8787.20160... .

Many young people present dizziness and/or vertigo symptoms, that is, a sensation of movement, being off-balance, unsteadiness, and even falls, which can relate to various diseases and other health complaints such as headaches⁴²42. Bittar RSM, Oiticica J, Bottino MA, Ganança FF, Dimitrov R. Population epidemiological study on the prevalence of dizziness in the city of São Paulo. Braz J Otorhinolaryngol 2013; 79(6): 688-98. https://doi.org/10.5935/1808-8694.20130127
https://doi.org/10.5935/1808-8694.201301... . Quite prevalent in the female population, it tends to increase with advancing age⁴²42. Bittar RSM, Oiticica J, Bottino MA, Ganança FF, Dimitrov R. Population epidemiological study on the prevalence of dizziness in the city of São Paulo. Braz J Otorhinolaryngol 2013; 79(6): 688-98. https://doi.org/10.5935/1808-8694.20130127
https://doi.org/10.5935/1808-8694.201301... . In the present study, 12.9% of adolescents reported dizziness and/or vertigo. In 2011, a study conducted in Minas Gerais found that, among individuals who declared having some kind of health condition, 6.7% stated having dizziness symptoms⁴³43. Martins TF, Mancini PC, Souza LM, Santos JN. Prevalence of dizziness in the population of Minas Gerais, Brazil, and its association with demographic and socioeconomic characteristics and health status. Braz J Otorhinolaryngol 2017; 83(1): 29-37. https://doi.org/10.1016/j.bjorl.2016.01.015
https://doi.org/10.1016/j.bjorl.2016.01.... , but several authors indicate prevalence rates with wide ranges — from 11.0 to 42.0% —, influenced by subjectivity and underestimation of this perception⁴²42. Bittar RSM, Oiticica J, Bottino MA, Ganança FF, Dimitrov R. Population epidemiological study on the prevalence of dizziness in the city of São Paulo. Braz J Otorhinolaryngol 2013; 79(6): 688-98. https://doi.org/10.5935/1808-8694.20130127
https://doi.org/10.5935/1808-8694.201301... –⁴⁷47. Maarsingh OR, Dros J, Schellevis FG, van Weert HC, Bindels PJ, van der Horst HE. Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics. BMC Fam Pract 2010; 11: 2. https://doi.org/10.1186/1471-2296-11-2
https://doi.org/10.1186/1471-2296-11-2... .

The association between cystitis and sex (PR=9.77) was strong, with higher occurrence in girls, findings consistent with the evidence in the literature, as this population is more susceptible to typical urinary tract symptoms, and the condition may happen in parallel to vaginitis and sexually transmitted infections (STI), which should be satisfactorily investigated⁴⁸48. Silva ACS, Oliveira EA, Mak RH. Infecção do trato urinário em pediatria: uma visão geral. J Pediatr (Rio J.) 2020; 96(Suppl 1): 65-79. https://doi.org/10.1016/j.jped.2019.10.006
https://doi.org/10.1016/j.jped.2019.10.0... ,⁴⁹49. Schmidt B, Copp HL. Work-up of pediatric urinary tract infection. Urol Clin North Am 2015; 42(4): 519-26. https://doi.org/10.1016/j.ucl.2015.05.011
https://doi.org/10.1016/j.ucl.2015.05.01... .

A large number of these conditions can be associated with modifiable risk factors, such as inadequate diets, alcohol and tobacco use, as well a sedentary lifestyle, physical inactivity, and overweight¹⁰10. Oliveira-Campos M, Oliveira MM, Silva SU, Santos MAS, Barufaldi LA, Oliveira PPV, et al. Fatores de risco e proteção para as doenças crônicas não transmissíveis em adolescentes nas capitais brasileiras. Rev Bras Epidemiol 2018; 21(suppl 1): e180002. https://doi.org/10.1590/1980-549720180002.supl.1
https://doi.org/10.1590/1980-54972018000... . Implementing a healthy lifestyle to reduce negative effects in the future should be crucial even in this transition between childhood and adulthood.

A cohort study conducted in Pelotas (Rio Grande do Sul) identified a relationship between tobacco use and mental health conditions in adolescents aged 15 years, diagnosed with the Strengths and Difficulties Questionnaire (SDQ) instrument⁵⁰50. Menezes AMB, Dumith SC, Martinez-Mesa J, Silva AER, Cascaes AM, Domínguez GG, et al. Problemas de saúde mental e tabagismo em adolescentes do sul do Brasil. Rev Saúde Pública 2011; 45(4): 700-5. https://doi.org/10.1590/S0034-89102011005000030
https://doi.org/10.1590/S0034-8910201100... . PeNSE 2015 revealed an increased use of other tobacco products in Brazilian adolescents, especially waterpipe, demanding the monitoring of these risk factors in this population¹⁰10. Oliveira-Campos M, Oliveira MM, Silva SU, Santos MAS, Barufaldi LA, Oliveira PPV, et al. Fatores de risco e proteção para as doenças crônicas não transmissíveis em adolescentes nas capitais brasileiras. Rev Bras Epidemiol 2018; 21(suppl 1): e180002. https://doi.org/10.1590/1980-549720180002.supl.1
https://doi.org/10.1590/1980-54972018000... . Physical activity and sports have also been the object of national and international recommendations related to the prevention and control of chronic diseases⁵¹51. World Health Organization. WHO guidelines on physical activity and sedentary behavior [Internet]. Geneva: World Health Organization; 2020 [acessado em 05 abr. 2022]. Disponível em: https://www.who.int/publications/i/item/9789240015128
https://www.who.int/publications/i/item/... , as well as the reduction of complaints of pain and emotional conditions⁵²52. Schuch FB, Vancampfort D, Firth J, Rosenbaum S, Ward PB, Silva ES, et al. Physical activity and incident depression: a meta-analysis of prospective cohort studies. Am J Psychiatry 2018; 175(7): 631-48. https://doi.org/10.1176/appi.ajp.2018.17111194
https://doi.org/10.1176/appi.ajp.2018.17... .

PeNSE and ERICA results clearly showed males being more active in leisure and commuting to school than females, even though the percentage in the age group as a whole is low⁵³53. Ferreira RW, Varela AR, Monteiro LZ, Häfele CA, Santos SJ, Wendt A, et al. Desigualdades sociodemográficas na prática de atividade física de lazer e deslocamento ativo para a escola em adolescentes: Pesquisa Nacional de Saúde do Escolar (PeNSE 2009, 2012 e 2015). Cad Saúde Pública 2018; 34(4): e00037917. https://doi.org/10.1590/0102-311X00037917
https://doi.org/10.1590/0102-311X0003791... ,⁵⁴54. Cureau FV, Silva TLN, Bloch KV, Fujimori E, Belfort DR, Carvalho KMB, et al. ERICA: leisure-time physical inactivity in Brazilian adolescents. Rev Saude Publica 2016; 50(Suppl 1): 4s. https://doi.org/10.1590/S01518-8787.2016050006683
https://doi.org/10.1590/S01518-8787.2016... . Since childhood, boys tend to be urged to play sports and participate in active plays, while girls are encouraged not to go out without company, play at homes, and in a more sedentary way⁵⁵55. Conti MA, Frutuoso MFP, Gambardella AMD. Excesso de peso e insatisfação corporal em adolescentes. Rev Nutr 2005; 18(4): 491-7. https://doi.org/10.1590/S1415-52732005000400005
https://doi.org/10.1590/S1415-5273200500... .

When estimating the health conditions or symptoms reported, male adolescents presented lower percentages than female ones. This evidence shows that, even in adolescence, the male population tends to have more difficulties accepting their diseases, particularly when disclosing this information during medical visits or when requested on different occasions¹⁵15. Bastos TF, Canesqui AM, Barros MBA. “Healthy men” and high mortality: contributions from a population-based study for the gender paradox discussion. PLoS One 2015; 10(12): e0144520. https://doi.org/10.1371/journal.pone.0144520
https://doi.org/10.1371/journal.pone.014... ,⁵⁶56. Courtenay WH. Behavioral factors associated with disease, injury, and death among men: evidence and implications for prevention. Journal of Men’s Studies, 2000; 9(1): 81-142. https://doi.org/10.3149/jms.0901.81
https://doi.org/10.3149/jms.0901.81... .

Aside from physiological differences, since adolescence, the approach to masculinity is often linked to virility, power, and risk exposure, as well as difficult relationships with these individuals in healthcare facilities⁵⁷57. Santos RR, Junior NMG, Martins AM, Modena CM. Gênero e práticas de saúde: singularidades do autocuidado entre adolescentes. Rev Psicol Saúde 2017; 9(1): 37-57. http://dx.doi.org/10.20435/pssa.v9i1.463
http://dx.doi.org/10.20435/pssa.v9i1.463... . Launched in 2009, the National Policy for Comprehensive Male Health Care (Política Nacional de Atenção Integral à Saúde do Homem — PNAISH) proposed to work with primary health care units to qualify care for this population, favoring care and benefits for adult men⁵⁸58. Alves RF, Silva RP, Ernesto MV, Lima AGB, Souza FM. Gênero e saúde: o cuidar do homem em debate. Psicol Teor Prat 2011; 13(3): 152-66.. Therefore, making health education more flexible when these individuals are still boys might favor better health outcomes later⁵⁹59. Garcia LHC, Cardoso NO, Bernardi CMCN. Autocuidado e adoecimento dos homens: uma revisão integrativa nacional. Rev Psicol Saúde 2019; 11(3): 19-33. http://dx.doi.org/10.20435/pssa.v11i3.933
http://dx.doi.org/10.20435/pssa.v11i3.93... . The higher frequency of several health events reported in females may also relate to their wide demand for health services, while mortality rates show greater numbers in males, involving associated risk behaviors, such as alcohol abuse, tobacco use, and increased exposure to violent and vulnerable situations¹⁵15. Bastos TF, Canesqui AM, Barros MBA. “Healthy men” and high mortality: contributions from a population-based study for the gender paradox discussion. PLoS One 2015; 10(12): e0144520. https://doi.org/10.1371/journal.pone.0144520
https://doi.org/10.1371/journal.pone.014... . Understanding health and disease aspects in the domain of sex differences goes far beyond biological and genetic particularities between men and women, spanning social inequalities and various contexts of male cultural behaviors and reverberating in the fact that they seem to be healthier by not identifying conditions and/or diseases. On the other hand, women are constantly encouraged to take care of their health, in addition to being exposed to reinforcement in body awareness and demonstration of their weaknesses⁵⁷57. Santos RR, Junior NMG, Martins AM, Modena CM. Gênero e práticas de saúde: singularidades do autocuidado entre adolescentes. Rev Psicol Saúde 2017; 9(1): 37-57. http://dx.doi.org/10.20435/pssa.v9i1.463
http://dx.doi.org/10.20435/pssa.v9i1.463... ,⁶⁰60. Moura EC, Gomes R, Pereira GMC. Percepções sobre a saúde dos homens numa perspectiva relacional de gênero, Brasil, 2014. Ciênc Saúde Colet 2017; 22(1): 291-300. https://doi.org/10.1590/1413-81232017221.17482015
https://doi.org/10.1590/1413-81232017221... .

Considering the importance of sex differences in health, which begin in adolescence, fostering debates is necessary to deepen this theme in the various health, promotion, and protection policies for adolescents. Nonetheless, some publications alert to the issue of teenage pregnancy and potential risks, in addition to mentioning and giving attention to women’s health and to the importance of reproductive and sexual education aimed at adolescents⁶¹61. Brasil. Ministério da Saúde. Protocolos da atenção básica: saúde das mulheres. Brasília: Ministério da Saúde; 2016.–⁶³63. Brasil. Ministério da Saúde. Secretaria de Atenção em Saúde. Departamento de Ações Programáticas Estratégicas. Cuidando de adolescentes: orientações básicas para a saúde sexual e a saúde reprodutiva. 2a ed. Brasília: Ministério da Saúde; 2018..

Among the limitations of the work, we underline the use of information reported by adolescents on chronic diseases. This information may be related to memory bias and lack of knowledge of the problem due to the low access and use of services by the younger and most socially vulnerable population, and thus, the prevalence of reports of diagnosis of the health conditions described could be underestimated.

Notably, the scenario presented in this study is prior to the COVID-19 pandemic and records data for future comparisons on the prevalence of health conditions among adolescents in an important metropolis in the state of São Paulo, Brazil.

Chronic diseases, especially those involving the respiratory tract and health complaints, were very prevalent among adolescents from Campinas. The high frequency of reported complaints and symptoms may be linked to underreporting of diagnoses, exposure to stressful situations, and unhealthy lifestyles. Efforts to take strategic actions that consider heterogeneity in different dimensions of the health-disease process among adolescent boys and girls are essential since some morbidities are very significant in this population. Moreover, strengthening health promotion programs and policies is crucial to support and leverage health protection factors among adolescents.

ACKNOWLEDGEMENTS

We thank the São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo — FAPESP) for funding the ISACAMP survey; the Ministry of Health for the additional support; and the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico — CNPq) for the productivity grant to MBA Barros.

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