Factors associated with family violence against adolescents based on the results of the National School Health Survey (PeNSE)

The Association Between Child Maltreatment and Loneliness Across the Lifespan: A Systematic Review and Multilevel Meta-Analysis

While there is evidence that child maltreatment is positively associated with loneliness, the strength of this association is not yet clear. It is also unclear whether the magnitude and statistical significance of this association varies across groups of individuals. Therefore, this meta-analysis examines whether there are differences in loneliness between individuals with and without maltreatment histories, and which factors may influence the association between child maltreatment and loneliness. A three-level meta-analysis was conducted on 52 studies reporting 116 effect sizes (N = 1,705,493; Mage = 30.93; 49.6% females). Results showed a medium overall effect (g = 0.45, p < .001, 95% CI [0.36, 0.53]), indicating that individuals with maltreatment histories, on average, feel lonelier than individuals without maltreatment histories. Moderator analyses showed that effect sizes were larger for emotional abuse and emotional neglect as compared to other types of child maltreatment and decreased when participants were older at the time of loneliness assessment. These findings suggest that individuals with maltreatment histories, especially those who have been emotionally abused and/or emotionally neglected, are vulnerable to experiencing loneliness across the lifespan. The results also suggest that feelings of loneliness warrant attention in prevention and intervention programs for individuals with maltreatment histories.

Effects of education and age on the experience of youth violence in a very low-resource setting: a fixed-effects analysis in rural Burkina Faso

OBJECTIVE

The study aimed to investigate the effects of education and age on the experience of youth violence in low-income and middle-income country settings.

DESIGN

Using a standardised questionnaire, our study collected two waves of longitudinal data on sociodemographics, health practices, health outcomes and risk factors. The panel fixed-effects ordinary least squares regression models were used for the analysis.

SETTINGS

The study was conducted in 59 villages and the town of Nouna with a population of about 100 000 individuals, 1 hospital and 13 primary health centres in Burkina Faso.

PARTICIPANTS

We interviewed 1644 adolescents in 2017 and 1291 respondents in 2018 who participated in both rounds.

OUTCOME AND EXPOSURE MEASURES

We examined the experience of physical attacks in the past 12 months and bullying in the past 30 days. Our exposures were completed years of age and educational attainment.

RESULTS

A substantial minority of respondents experienced violence in both waves (24.1% bullying and 12.2% physical attack), with males experiencing more violence. Bullying was positively associated with more education (β=0.12; 95% CI 0.02 to 0.22) and non-significantly with older age. Both effects were stronger in males than females, although the gender differences were not significant. Physical attacks fell with increasing age (β=-0.18; 95% CI -0.31 to -0.05) and this association was again stronger in males than females; education and physical attacks were not substantively associated.

CONCLUSIONS

Bullying and physical attacks are common for rural adolescent Burkinabe. The age patterns found suggest that, particularly for males, there is a need to target violence prevention at younger ages and bullying prevention at slightly older ones, particularly for those remaining in school. Nevertheless, a fuller understanding of the mechanisms behind our findings is needed to design effective interventions to protect youth in low-income settings from violence.

Indicators of Eating Disorders in Sexually Abused Brazilian Adolescents: Family and School Contexts

Eating disorders, characterized by abnormal eating behaviors, are among a wide variety of psychiatric conditions that mainly affect children and adolescents. These disorders have a multifactorial origin and can be associated with restrictive diets, negative feelings, harmful family relationships, and post-traumatic stress. Thus, this study's objective was to evaluate the association between indicators of eating disorders and family and school contexts in Brazilian adolescents who previously experienced sexual abuse and examine the findings based on sex. National School Health Survey data were utilized. Among 102,301 students between 11 and 19 years of age, 4124 reported having experienced sexual abuse and were included in this study. Self-report questionnaires were used to assess participants' health status and the presence of risk behaviors, which were examined through multivariate analysis using a Poisson regression model. The results indicated positive relationships between self-induced vomiting, laxative misuse, and other purgative methods and infrequent meals with family, hunger, and the presence of violence in students' daily lives, regardless of sex (p < 0.05). In addition, body dissatisfaction and negative feelings about one's body were associated with having been bullied or teased by schoolmates for both sexes (p < 0.05). Distant relationships with parents were associated with purgative methods and body dissatisfaction among female students (p < 0.05). In conclusion, body dissatisfaction, negative feelings about one's body, laxative misuse, self-induced vomiting, and purgative methods were found to be associated with factors in family and school contexts such as hunger, infrequent meals with family, family violence, distant relationships with parents, and bullying at school in adolescents who have previously experienced sexual abuse.

A saúde mental dos adolescentes brasileiros

Objetivo: descrever as prevalências dos indicadores de saúde mental entre os escolares brasileiros. Método: estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2019. Estimou-se as prevalências e intervalos de confiança de 95% (IC95%) dos indicadores de saúde mental dos adolescentes brasileiros de 13 a 17 anos, segundo idade, sexo, dependência administrativa da escola e Unidade da Federação. Resultados: dos 125.123 escolares de 13 a 17 anos investigados, 4,0% (IC95% 3,7-4,3) mencionaram que não tinham amigos próximos; 50,6% (IC95% 49,8-51,4) sentiram-se preocupados com as coisas comuns do dia a dia; 31,4% sentiram-se tristes na maioria das vezes ou sempre; 30,0% (IC95% 29,4 - 30,6) achavam que ninguém se preocupava com eles; 40,9% (IC95% 40,2 - 41,5) ficaram irritados, nervosos ou mal-humorados; 21,4% (IC95% 20,9 - 22,0) sentiam que a vida não vale a pena ser vivida; e 17,7% (IC95% 17,2 - 18,2) apresentou autoavaliação em saúde mental negativa. A maioria desses indicadores foram mais frequentes em escolares de 16 e 17 anos, no sexo feminino e em escolas públicas. Conclusão: evidenciou-se o aumento do sofrimento mental entre os adolescentes brasileiros pelos indicadores de saúde mental da PeNSE edição 2019. Os resultados revelaram relações de desigualdades estruturais de gênero e classe social. É necessário maior investimento em políticas públicas a fim de diminuir as consequências do sofrimento mental entre os adolescentes brasileiros.

Asking youth and adults about child maltreatment: a review of government surveys

OBJECTIVES

In this review we: (1) identify and describe nationally representative surveys with child maltreatment (CM) questions conducted by governments in low-income, middle-income and high-income countries and (2) describe procedures implemented to address respondents' safety and minimise potential distress.

DESIGN

We conducted a systematic search across eight databases from 1 January 2000 to 5 July 2021 to identify original studies with information about relevant surveys. Additional information about surveys was obtained through survey methods studies, survey reports, survey websites or by identifying full questionnaires (when available).

RESULTS

Forty-six studies representing 139 surveys (98 youth and 41 adult) conducted by governments from 105 countries were identified. Surveys implemented a variety of procedures to maximise the safety and/or reduce distress for respondents including providing the option to withdraw from the survey and/or securing confidentiality and privacy for the respondent. In many surveys, further steps were taken such as providing information for support services, providing sensitivity training to survey administrators when interviews were conducted, among others. A minority of surveys took additional steps to empirically assess potential distress experienced by respondents.

CONCLUSIONS

Assessing risk and protective factors and developing effective interventions and policies are essential to reduce the burden of violence against children. While asking about experiences of CM requires careful consideration, procedures to maximise the safety and minimise potential distress to respondents have been successfully implemented globally, although practices differ across surveys. Further analysis is required to assist governments to implement the best possible safety protocols to protect respondents in future surveys.

[Lack of awareness of the HPV vaccination campaign among Brazilian students: a multilevel analysis]

The scope of this article is to analyze the association between lack of awareness of the HPV vaccination campaign among Brazilian adolescents and individual and contextual factors. It involved a cross-sectional study with data from the National Student Health Survey (2015). Bivariate analysis was performed and Prevalence Ratios were calculated, in a multilevel Poisson Regression (95%CI) to verify the effect of variables on the outcome. The outcome was significantly associated with being 15-19 years old (PR=1.36), studying during the afternoon/night shift (PR=1.05), having already had sexual intercourse (PR=1.10), with self-perceived poor or very poor health status (PR=1.23), dissatisfied (PR=1.14) or indifferent (PR=1.15) regarding their body image, playing truant from classes without parental consent (PR=1.10) and studying at a public school (PR=1.24). There was less prevalence of the outcome among females (PR=0.24) and in states with greater income inequality (PR=0.80). The lack of awareness about the HPV vaccination campaign among adolescents was associated with individual characteristics, the context of the school and the unit of the federation. These findings indicate the importance of enhancing health promotion for vulnerable young people.

Prevalence of sexual abuse and its association with health-risk behaviors among Brazilian adolescents: A populational study

BACKGROUND

Analysis of sexual abuse has usually been neglected in research at developing countries despite its everlasting consequences. This study examined the prevalence of sexual abuse among Brazilian adolescents according to data from the National School Health Survey (PeNSE) and analyzed it based on Brazilian regions, sociodemographic aspects, health information, and health-risk behaviors among Brazilian adolescents who reported having experienced sexual abuse previously.

PARTICIPANTS AND SETTING

The PeNSE data were utilized, and the sample included 102,072 students from all over Brazil, aged between 11 and 19 years.

METHODS

Data were collected by questionnaires and were analyzed by multivariate analysis using the Poisson regression model.

RESULTS

The results denoted a relation between sexual abuse, social determinants of health variables (i.e., black, indigenous, and mixed skin color/ethnicity; Brazilian region public school, age between 15 and 18 years, and low education level of the mother), and health-risk behaviors (i.e., early sexual intercourse, having multiple sexual partners, unprotected sexual intercourse, use of tobacco, alcohol, and illicit drugs).

CONCLUSION

Therefore, reports of sexual abuse are associated with risky behaviors. Given these findings, targeted interventions on sexual abuse are essential for the health of adolescents and the prevention of risky behaviors, and can also facilitate programs to prevent sexual abuse.

Prevalence and co-occurrence of Adverse Childhood Experiences: a school-based survey in Rio de Janeiro

This study aimed to estimate the prevalence of categories of adverse childhood experiences (ACE) among high school students in Rio de Janeiro, investigate the ACE co-occurrence profile, and examine the distribution of exposure to ACE according to individual, family, socioeconomic, and school characteristics. A cross-sectional study was conducted with 681 individuals selected using a complex random sampling design. Exposure to ACE categories was identified using a cross-culturally adapted version of the Childhood Trauma Questionnaire (CTQ) and direct questions. We calculated prevalence and correlation between ACE pairs and determined the co-occurrence profile of childhood adversities. The findings reveal that the most common adversities were emotional abuse and neglect and biparental family dissolution. Seventy percent of the sample reported having been exposed to at least one ACE and 9% had been exposed to four or more. Around 20% of respondents reported exposure to abuse and neglect and 9% to the co-occurrence of abuse, neglect, and absence of at least one parent during childhood. The most vulnerable subgroups were girls and respondents who were born to teenage mothers, not living with both parents, studying at public schools, and from low-income families. The high prevalence and co-occurrence profile of ACE reveals the need for wide-ranging intersectoral policies designed to prevent adverse childhood experiences and provide victim support.

Alcoholic beverage purchase by Brazilian adolescents: individual and contextual factors associated in a multilevel analysis

OBJECTIVE

To analyze the individual and contextual factors associated with the purchase of alcoholic beverages by adolescents in Brazil.

METHODOLOGY

A cross-sectional study with data from the National Adolescent Health Survey (2015). The study sample consisted of 21,125 adolescents who reported having consumed alcohol in the 30 days before the survey. Bivariate and multivariate analysis was performed by calculating the Prevalence Ratios in a multilevel Poisson Regression (95%CI) to verify the effect of individual variables, school context, and Brazilian federation units on the outcome.

RESULTS

17.54% (95%CI 17.03-18.06) bought the alcoholic beverage for their consumption. The outcome was associated with male gender (PR 1.69; 95%CI 1.56-1.83), the age group from 15 to 17 years old (PR 1.52 95%CI 1.41-1.65), who ingested alcohol more than six times in 30 days (PR 1.47; 95%CI 1.37-1.61), who work (PR 1.26 95%CI 1.16-1.37), who are children of women with low education, who study in public schools (RP 1.16 95%CI 1.04-1.30), who missed classes (RP 1.14 95%CI 1.05-1.23) and who do not have a follow-up responsible in their free time (PR 1.13 95%CI 1.04-1.21) and who live in states with higher illiteracy rates of people aged 25 years old and over (PR=1.19; 95%CI 1, 02-1.39).

CONCLUSION

The adolescents' access to alcohol purchase was associated with individual factors, the school context, and the federation unit. These findings indicate the importance of strengthening health promotion aimed at vulnerable youth people.

Unhealthy life habits associated with self-induced vomiting and laxative misuse in Brazilian adolescents

Adolescence is a stage in life characterized by important social, cognitive, and physical changes. Adolescents are vulnerable to various psychosocial disorders, including eating disorders. We aimed to investigate the association between unhealthy habits, sociodemographic characteristics, and the practice of self-induced vomiting or laxative misuse in a representative sample of Brazilian adolescent girls and boys. Data from 102,072 students who participated in the National Adolescent School-based Health Survey were analyzed using the dependent variable: presence or absence of self-induced vomiting and/or laxative misuse; independent variables: consumption of unhealthy and high-calorie food items, age during first sexual intercourse, and the use of tobacco, alcohol, and/or illicit drugs. Associations between exposure and outcome were estimated using Poisson's regression models stratified by sex, and including region, school, age group, and mother's educational history as adjustment variables. Eating ultra-processed foods and age during first sexual intercourse were associated with self-induced vomiting and laxative misuse only for girls; all other variables (consuming unhealthy foods and using legal or illicit substances) were associated with these behaviors for both sexes after applying adjustment variables. Early interventions focusing on changing unhealthy behaviors may prevent development of eating disorders in adolescents. Our findings demonstrate a strong association of many unhealthy habits with laxative misuse and self-induced vomiting practices in Brazilian adolescents.

Prevalence and factors associated with bullying: differences between the roles of bullies and victims of bullying

OBJECTIVE

To identify the differences between the prevalence and factors associated with involvement in bullying among schoolchildren from Recife, in the role of victim and perpetrator.

METHOD

This is an epidemiological, cross-sectional, analytical study, with a probabilistic cluster sample of 1,402 students enrolled in high schools in Recife. Data analysis consisted of a descriptive analysis, followed by the application of Pearson's chi-squared test with statistical significance of 0.05 and 95% confidence interval. For the association analysis, multilevel modeling was used to control the cluster effect.

RESULTS

It was observed that adolescents who feel different from other peers were associated with bullying, regardless of the role played. Being a victim was associated with being female, having low self-esteem, and using tranquilizers; being a transgressor was a protective factor. As for the role of perpetrator, being male, excessive alcohol consumption, having poor school performance, being a transgressor, and accepting peer violence were the associated variables; in turn, not defending their ideas when among friends showed to be a protective factor for bullying.

CONCLUSION

The differences between the adolescents, whether in the role of victim or perpetrator, indicate that the advocacy and prevention actions should focus on these aspects, mainly in the school environment.