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A questionnaire composed of questions was administered in two different seasons to parents of children attending 18 primary schools in five Italian cities Torino, Brescia, Pisa, Perugia and Lecce to obtain information regarding the criteria for exclusion from the study, demographic, anthropometric and health information on the children, as well as some aspects on their lifestyles and parental characteristics.
The results were analyzed in order to assess the frequency of specific conditions among the different seasons and cities and the association between lifestyles and socio-economic factors.
The final cohort was composed of 1, children The socio-economic level seems to affect the lifestyles of children enrolled in the study including those that could cause health effects. Many factors are linked to the geographical area and may depend on environmental, cultural and social aspects of the city of residence. Peer Review reports. Lifestyles include living conditions editable since they are determined by the choices made by each individual in the course of its existence [ 3 ] and can be divided into health-risk behaviors and health-promoting behaviors.
Health-risk behaviors e. In contrast, health-promoting behaviors physical activity, proper nutrition, etc. The socio-economic context, namely that resulting from the interaction of several factors such as culture, education, income, family structure, home and work environment, can affect many behavioral and decision-making aspects playing a role on health literacy, or on the availability of goods and services [ 8 ].
Life quality and health in adulthood often depends on the living habits adopted since early years. Many studies revealed that health-risk beaviours in childhood may have short-term consequences [ 9 ] and could be carried into adulthood determining also long-term consequences [ 9 , 10 ], as well as being a substantial economic burden [ 11 — 13 ].
Therefore, many diseases in adulthood are avoidable if health-risk behaviors are identified and improved at an early stage of life [ 7 ]. The study was conducted in five Italian cities Fig. Torino TO , inhabitants [ 16 ] is situated in the north-west of the Pianura Padana, the Plain of the river Po, in a metropolitan area with more than two million inhabitants which is one of the most important economic and industrial sites in Italy [ 17 ].
Torino is the coldest of the cities included in the study [ 20 ], with an average annual temperature in the last 10 years of Brescia BS about , inhabitants is part of an extensive metropolitan area, highly industrialized, with a high level of motor vehicle traffic.
It is situated in the high Pianura Padana, one of the most highly polluted areas in Europe [ 21 , 22 ] and has a humid subtropical climate [ 23 ]. It is characterized by one of the highest rates of immigration in Lombardia and the highest number of foreign residents.
A recent study [ 24 ] includes it with Pisa among cities characterized by high levels of economic development, well-being and cultural activity. Pisa PI , with just under 90, inhabitants, is the smallest of the cities in the study.
It lies a few kilometers from the mouth of the river Arno in a flat area that hosts a large industrial estate. The climate is affected by the vicinity of the sea, which tends to mitigate both the rigors of winter and the heat of summer. The social fabric is influenced by a large number of foreign residents and the presence of many university students. Perugia PG about , inhabitants is in central Italy at an altitude of more than m above the sea level. The economy is mainly based on the tertiary sector while the industrial sector is composed above all of textiles and food processing.
In PG too, a large part of the population is accounted for by foreigners and students, although the old age index percentage ratio between population aged 65 years and over and population aged 0—14 years is much higher Lecce LE has just over 90, inhabitants and is situated in south-east Italy, in the center of the Salento peninsula.
It has a Mediterranean climate, with mild winters and hot humid summers. Like PE it is a city with a solid but largely static economy [ 24 ], based essentially on food processing, handicrafts, tourism and services, and is characterized by the tendency towards an ageing population.
Recruitment was conducted randomly among the children attending first, second and third year classes of 18 primary schools located in the five cities of the study selected in order to recruit at least children from at least three schools per city, located in the urban area and in different neighborhoods, far from point sources of contamination, and free from radioactive indoor pollution in accordance with a protocol [ 14 ] shared by the Research Units of the Universities of Brescia, Salento LE , Perugia, Pisa and Torino.
The parents who had agreed to participate in the study gave the approval to the recruitment of their children by signing the consent form. The parents of each child filled in the questionnaire twice in two different seasons Season I, winter —, and Season II, late spring , directly on a specially created web platform or in paper format. In the latter case the completed questionnaires were returned to the teachers and uploaded to the web platform by the personnel of the various Research Units.
The software supporting the web platform assigned an alphanumeric identification code to each questionnaire and related data were transferred automatically to spreadsheets for processing. The final cohort was composed of all children whose parents completed valid questionnaires in both seasons. In total, children, 3. The exact age at testing was measured by calculating the time interval between the date of birth given on the questionnaire and the date of filling the questionnaire.
The data thus obtained were statistically processed using MedCalc Software version In addition, the association between certain behavioral factors e. According to the Italian school system, we assigned 0 years when parents reported not having any degree; 5 years to primary school certificate; 3 years to junior high school diploma; 5 years to high school diploma; and 5 years to graduate. The employment level of the father was divided into four categories: level I businessmen, managers, professionals ; level II office worker ; level III manual worker, craftsman ; level IV unemployed.
The study was approved by the competent Ethical Committees in each involved city. The results of the recruitment and questionnaire administration activities are illustrated in Table 1. A total of 3, parcels were distributed to parents of children attending first, second and third year classes in selected schools in the five towns; 1, Overall, 1, questionnaires In the second season 1, questionnaires were handed in.
Of these, 1, final cohort were found to be valid, with an average loss with respect to the first season of Children included in the final cohort Table 2 were Their mean age at the time of recruitment was 7. Regarding their weight status large number of children were overweight The average rate of use of medicines in addition to common remedies such as antibiotics, antipyretics and anti-inflammatory agents in the 6 months before sampling was 5.
Frequency of main respiratory disorders in the two seasons. Frequency of main respiratory disorders that occurred in children in the month preceding the survey carried out in the season I and season II. Concerning physical activity, Significantly different frequencies among the cities were recorded. The level of education is highest among the parents of PG, where Overall, the mothers were more likely than the fathers to have this level of education In contrast, the rate of employment is higher among the fathers In addition, the fathers are more likely to be smokers The type of fuel used for domestic heating varies significantly among the various cities Table 4.
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