[In] Segurança alimentar e nutricional entre adolescentes do Programa Bolsa Família
Data
2022-09-14
Autores
Bernardes, Milena Serenini [UNIFESP]
Orientadores
Taddei, José Augusto de Aguiar Carrazedo [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: As políticas públicas brasileiras de combate à fome e de promoção da segurança alimentar nutricional são internacionalmente reconhecidas, e culminaram na saída do país do Mapa da Fome em 2014. O Programa Bolsa Família (PBF) foi uma das principais estratégias desta agenda, sendo estruturado para promover o acesso a direitos sociais como saúde e educação, e com foco nas famílias em situação de pobreza e extrema pobreza. No entanto, a sequência de decisões políticas ineficazes para a agenda de segurança alimentar dos últimos anos e o surgimento da pandemia da covid-19 agravaram a situação de insegurança alimentar (IA) no Brasil. Atualmente, 58,7% da população convive com algum grau de insegurança alimentar. Sabe-se que a IA vivenciada durante a adolescência associa-se a prejuízos físicos, mentais e emocionais e compromete o crescimento e desenvolvimento, com consequências que podem perdurar até a fase adulta. Objetivo: Analisar a situação de insegurança alimentar e seus efeitos na saúde de adolescentes participantes do Programa Bolsa Família do município de Lavras (MG). Métodos: Trata-se de um estudo transversal com abordagem quantitativa e qualitativa, com 188 adolescentes pertencentes a 114 famílias participantes do PBF. Foram coletados dados referentes ao estado nutricional dos adolescentes (peso, estatura, consumo alimentar, dosagem de hemoglobina), percepção e nível de IA a partir da ótica dos (as) responsáveis (Escala Brasileira de Insegurança Alimentar – EBIA) e dos (as) adolescentes (Escala Curta de Insegurança Alimentar validada para adolescentes brasileiros), características socioeconômicas e demográficas, e estratégias dos (as) adolescentes para lidar com a IA. O teste Kappa de Cohen (κ) foi utilizado para análise de concordância dos constructos de segurança alimentar. Para análise qualitativa foi utilizado o referencial teórico da Análise de Conteúdo. Esse estudo é parte integrante do projeto “Programa Bolsa Família: avaliação da Segurança Alimentar e Nutricional das famílias participantes e acompanhamento das condicionalidades de saúde sob a ótica dos profissionais”, financiado pelo CNPq e aprovado pelo Comitê de Ética. Resultados: Os resultados desta tese são apresentados em três artigos científicos. Artigo 1: Foi observada prevalência de anemia de 26% entre os (as) adolescentes, caracterizado como problema de saúde pública de grau moderado. A presença de anemia foi associada ao consumo de alimentos ultraprocessados. Artigo 2: A partir das entrevistas em profundidade chegou-se a quatro categorias: i) “A fome não é só a vontade de comer”: adolescentes percebem a variação da qualidade e da quantidade da alimentação ao longo do mês nos domicílios, e carne e frutas são citados como alimentos de difícil acesso; ii) “ O fantasma da fome: presente, passado e futuro”: todos os (as) adolescentes se preocupam com a possibilidade do alimento faltar em casa, e a vivência da fome na infância parece intensificar essa preocupação; iii) “Um por todos e todos por um: estratégias para alívio da insegurança alimentar”: os (as) adolescentes desenvolvem estratégias para mitigar a IA no domicílio, como por exemplo, reduzir a própria quantidade de alimentos ingeridos; iv) “Estamos seguros?”: as mães desconhecem a maior parte das estratégias desenvolvidas pelos adolescentes para lidar com a fome, e desacreditam que seus filhos se preocupem de forma significativa com a possibilidade do alimento acabar dentro de casa. Artigo 3: A prevalência de IA percebida pelos adolescentes foi de 42,7%, e de 79,8% entre os seus responsáveis. Houve associação positiva entre a IA percebida entre os adolescentes e a renda do domicílio (p=0,008), renda per capita (p=0,046) e consumo de macarrão (p=0,03). Observou-se concordância razoável (k=0,20) quanto à percepção domiciliar da IA dos adolescentes e de seus responsáveis. Conclusão: O aumento expressivo da fome no Brasil exige que a segurança alimentar e nutricional se torne prioridade na agenda de políticas públicas. Considerando a capilaridade e o papel da Atenção Primária à Saúde dentro dos territórios, destaca-se aqui sua posição estratégica no processo de articulação intersetorial e nas ações de vigilância alimentar e nutricional e de promoção à alimentação adequada e saudável. Além da implementação de instrumentos e escalas capazes de aferir a insegurança alimentar na população adolescente, ressalta-se a importância da escuta qualificada, do olhar para as práticas e valores de cada adolescente diante da insegurança alimentar e da fome.
Introduction: Brazilian public policies to combat hunger and promote nutritional food security are internationally recognized and culminated in the country's exit from the Hunger Map in 2014. The Bolsa Família Program (PBF) was one of the main strategies of this agenda, being structured to promote access to social rights such as health and education, and with a focus on families in poverty and extreme poverty. However, the sequence of ineffective political decisions for the food security agenda in recent years and the emergence of the covid-19 pandemic have worsened the food insecurity (FI) situation in Brazil. Currently, 58.7% of the population lives with some degree of food insecurity. It is known that the FI experienced during adolescence is associated with physical, mental and emotional damage and compromises growth and development, with consequences that can last into adulthood. Objective: To analyze the situation of food insecurity and its effects on the health of adolescents participating in the Bolsa Família Program in the city of Lavras (MG). Methods: This is a cross-sectional study with a quantitative and qualitative approach, with 188 adolescents belonging to 114 families participating in the BFP. Data were collected regarding the nutritional status of adolescents (weight, height, food consumption, hemoglobin dosage), perception and level of FI from the perspective of parents (Brazilian Scale of Food Insecurity - EBIA) and adolescents (Short Scale of Food Insecurity validated for Brazilian adolescents), socioeconomic and demographic characteristics, and strategies of adolescents to deal with FI. Cohen's Kappa test (κ) was used to analyze the concordance of food security constructs. For qualitative analysis, the theoretical framework of Content Analysis was used. This study is an integral part of the project “Bolsa Família Program: assessment of Food and Nutritional Security of participating families and monitoring of health conditionalities from the perspective of professionals”, funded by CNPq and approved by the Ethics Committee. Results: The results of this thesis are presented in three scientific articles. Article 1: the anemia prevalence of 26% was observed among adolescents, characterized as a moderate public health problem. The presence of anemia was associated with the consumption of ultra-processed foods. Article 2: From the in-depth interviews, four categories were arrived at: i) “Hunger is not just the desire to eat”: adolescents perceive the variation in the quality and quantity of food throughout the month in the households, and meat and fruits are cited as foods that are difficult to access; ii) “The ghost of hunger: present, past and future”: all adolescents are concerned about the possibility of food shortages at home, and the experience of hunger in childhood seems to intensify this concern; iii) “One for all and all for one: strategies to alleviate food insecurity”: adolescents develop strategies to mitigate FI at home, such as reducing the amount of food they eat; iv: “Are we safe?”: the mothers are unaware of most of the strategies developed by adolescents to deal with hunger, and they do not believe that their children are significantly concerned about the possibility of food running out at home. Article 3: The prevalence of FI perceived by adolescents was 42.7%, and 79.8% among those responsible for them. There was a positive association between perceived FI among adolescents and household income (p=0.008), per capita income (p=0.046) and pasta consumption (p=0.03). There was reasonable agreement (k=0.20) regarding the home perception of FI by adolescents and their guardians. Conclusion: The significant increase in hunger in Brazil requires that food and nutrition security become a priority on the public policy agenda. Considering the capillarity and role of Primary Health Care within the territories, its strategic position in the process of intersectoral articulation and in food and nutritional surveillance actions and in the promotion of adequate and healthy food is highlighted here. In addition to the implementation of instruments and scales capable of measuring food insecurity in the adolescent population, the importance of qualified listening, looking at the practices and values of each adolescent in the face of food insecurity and hunger is highlighted.
Introduction: Brazilian public policies to combat hunger and promote nutritional food security are internationally recognized and culminated in the country's exit from the Hunger Map in 2014. The Bolsa Família Program (PBF) was one of the main strategies of this agenda, being structured to promote access to social rights such as health and education, and with a focus on families in poverty and extreme poverty. However, the sequence of ineffective political decisions for the food security agenda in recent years and the emergence of the covid-19 pandemic have worsened the food insecurity (FI) situation in Brazil. Currently, 58.7% of the population lives with some degree of food insecurity. It is known that the FI experienced during adolescence is associated with physical, mental and emotional damage and compromises growth and development, with consequences that can last into adulthood. Objective: To analyze the situation of food insecurity and its effects on the health of adolescents participating in the Bolsa Família Program in the city of Lavras (MG). Methods: This is a cross-sectional study with a quantitative and qualitative approach, with 188 adolescents belonging to 114 families participating in the BFP. Data were collected regarding the nutritional status of adolescents (weight, height, food consumption, hemoglobin dosage), perception and level of FI from the perspective of parents (Brazilian Scale of Food Insecurity - EBIA) and adolescents (Short Scale of Food Insecurity validated for Brazilian adolescents), socioeconomic and demographic characteristics, and strategies of adolescents to deal with FI. Cohen's Kappa test (κ) was used to analyze the concordance of food security constructs. For qualitative analysis, the theoretical framework of Content Analysis was used. This study is an integral part of the project “Bolsa Família Program: assessment of Food and Nutritional Security of participating families and monitoring of health conditionalities from the perspective of professionals”, funded by CNPq and approved by the Ethics Committee. Results: The results of this thesis are presented in three scientific articles. Article 1: the anemia prevalence of 26% was observed among adolescents, characterized as a moderate public health problem. The presence of anemia was associated with the consumption of ultra-processed foods. Article 2: From the in-depth interviews, four categories were arrived at: i) “Hunger is not just the desire to eat”: adolescents perceive the variation in the quality and quantity of food throughout the month in the households, and meat and fruits are cited as foods that are difficult to access; ii) “The ghost of hunger: present, past and future”: all adolescents are concerned about the possibility of food shortages at home, and the experience of hunger in childhood seems to intensify this concern; iii) “One for all and all for one: strategies to alleviate food insecurity”: adolescents develop strategies to mitigate FI at home, such as reducing the amount of food they eat; iv: “Are we safe?”: the mothers are unaware of most of the strategies developed by adolescents to deal with hunger, and they do not believe that their children are significantly concerned about the possibility of food running out at home. Article 3: The prevalence of FI perceived by adolescents was 42.7%, and 79.8% among those responsible for them. There was a positive association between perceived FI among adolescents and household income (p=0.008), per capita income (p=0.046) and pasta consumption (p=0.03). There was reasonable agreement (k=0.20) regarding the home perception of FI by adolescents and their guardians. Conclusion: The significant increase in hunger in Brazil requires that food and nutrition security become a priority on the public policy agenda. Considering the capillarity and role of Primary Health Care within the territories, its strategic position in the process of intersectoral articulation and in food and nutritional surveillance actions and in the promotion of adequate and healthy food is highlighted here. In addition to the implementation of instruments and scales capable of measuring food insecurity in the adolescent population, the importance of qualified listening, looking at the practices and values of each adolescent in the face of food insecurity and hunger is highlighted.