[Adolescence and reproduction in Brazil: the heterogeneity of social profiles]

Adverse maternal outcomes of adolescent pregnancy in Northwest Ethiopia: A prospective cohort study

BACKGROUND

Adolescent pregnancy is considered a major contributor to maternal and child morbidity and mortality, the greatest concern of developing countries and an important public health issue globally. Adolescents are responsible for eleven percent of births worldwide and they face several pregnancy and childbirth related complications. However, in low-income countries like Ethiopia, there are limited researches conducted to investigate outcomes of adolescent pregnancy. Therefore, this study was conducted to assess the adverse maternal outcomes of adolescent pregnancy in Northwest Ethiopia.

METHODS

A prospective cohort study was conducted in 12 health facilities from seven districts in East Gojjam zone, Northwest Ethiopia. A total of 418 adolescents (15-19 years old) and 836 adult women (20-34 years old) who attended randomly selected health facilities in East Gojjam zone were included. Data were collected starting from admission to the maternity ward for labor and delivery, and postnatal depression was measured at six weeks' postpartum period using the Edinburgh Postnatal Depression Scale. Generalized estimating equations (GEE) was used to account for the within subject correlation and assess the effect of different known factors that could influence the outcome of this study.

RESULTS

A lower percentage of adolescent (58.4%) than adult (71.2%) women had their first antenatal care booking before 16 weeks of gestation. After adjusting for different confounding factors, the adverse outcome that was significantly associated with adolescent pregnancy was postpartum depression (AOR: 2.29; 95% CI, 1.42, 3.7, p-value = 0.001). Assisted vaginal delivery (AOR: 0.44; 95% CI, 0.23, 0.86, p-value 0.016) and cesarean section (AOR: 0.43; 95% CI, 0.19, 0.97, p-value = 0.042) were significantly lower among adolescent women.

CONCLUSIONS

Adolescent pregnancy is associated with higher odds of postpartum depression, and lower odds to undergo cesarean section and assisted vaginal delivery than adult women. Perinatal care services should be more adolescent-friendly to ensure early diagnosis and treatment of postpartum depression. School and community-based awareness programs regarding use of contraception to prevent unwanted adolescent pregnancy, early antenatal care booking and adverse pregnancy outcomes of adolescent pregnancy and provision of psychosocial support are recommended.

Associated factors with spatial variation of adolescent pregnancy in Brazil, 2014: an ecological study of spatial clusters

OBJECTIVE

To identify socioeconomic and health care determinants of spatial variation in adolescent pregnancy in Brazil in 2014.

METHODS

This was a spatial ecological study having municipalities as units of analysis. Spatial linear regression was used to verify association between the fertility rate in 15-19 year-old women and socioeconomic and health variables.

RESULTS

The adolescent fertility rate was negatively associated with higher Family Health Strategy coverage (β = -0.011 - 95%CI -0.017;-0.005), an adequate number of prenatal consultations (β = -0.122 - 95%CI -0.132;-0.224) and low average family income per capita (β = -0.104 - 95%CI -0.105;-0.103). Association was positive in relation to the Gini index (β = 7.031 - 95%CI 4.793;9.269), low income (β = 0.127 - 95%CI 0.108;0.145), higher household density (β = 6.292 - 95%CI 5.062;7.522) and less schooling (β = 0.260 - 95%CI 0.224;0.295).

CONCLUSION

Reduced access to primary care and lower income are associated with higher adolescent fertility rates. Poorer socioeconomic and health care indicators are associated with higher adolescent fertility rates.

Maternal sensitivity in interactions with their 2-month-old infants in Rio de Janeiro - Brazil

This paper reports on a study of maternal sensitivity in 22 primiparous women and their infants from Rio de Janeiro, Brazil. Sociodemographic risk was assessed through an interview, and videotaped naturalistic home observations were used to assess maternal sensitivity, and its relation with warmth, verbal and physical engagement, and camera awareness. A K-means cluster analysis was performed to examine patterns of risk in relation to maternal sensitivity. Compared to the 15 mothers with higher sensitivity scores, the seven mothers with lower sensitivity scores were characterized by lower educational levels, lower income, lower age, slum residence, unplanned and unwanted pregnancies, and later onset of prenatal care. Whether father was resident did not appear to distinguish between the lower and higher sensitivity groups. The pattern of social-contextual risk for Brazilian mothers showing less sensitive caregiving to their infants provide direction for future research in this cultural context.

Sociodemographic, sexual, and reproductive variables associated with pregnancy among adolescents from low socioeconomic background

Adolescent pregnancy remains a public health concern in both developed and developing countries. Portugal and Brazil represent some of the best examples of this phenomenon. The present study aimed to identify sociodemographic, sexual, and reproductive health-related variables associated with adolescent pregnancy among students from low socioeconomic backgrounds in both countries. The sample included 984 female adolescents, among whom 215 became pregnant. Living with a partner and lack of information about sex and contraception from the family were the best explicative factors for pregnancy occurrence in both countries. Country-specific variables were also identified. Our results may contribute to developing global preventive interventions, addressing the school as an ideal setting for primary intervention and considering culture-specific characteristics of high-risk populations.

The Resilience of Adolescent Participants in Social Projects for Sport

The aim of this study was to evaluate the resilience of adolescents participants and non-participants of social projects for sports relating it to their sociodemographic profile. Cross-section Study, comparative and analytical, covered 134 adolescents, from ages 12 to 17, residing in a social zone of high vulnerability in a Northeastern Brazilian city. The data collected was obtained through structured interviews and a questionnaire/resilience scale, developed by Wagnild and Young (1993). The descriptive and inferential statistical analysis was used, especially the Student 'T' Test for the independent samples and the chi-square test. In both cases, the statistical significance level adopted was p < 0.05. The overall mean resilience was 110.6 (±15.9) and the participants in social projects demonstrated better resilience (p = 0.063), with a predominance of male gender, age group 15 to 17 years old, without health problems, parents (father/mother) self-employed, retired, pensioner or unemployed with income less than 1 minimum wage, without alcohol/cigarette and other drugs. The participants of the social projects presented a better level of resilience, even though there were several unfavorable situations and many risks presented as well.

Abortion and health in Brazil: challenges to research within a context of illegality

Abortion research faces great challenges, even more so in contexts in which it is illegal. Women tend to omit the voluntary termination of pregnancy or to declare having miscarried, which results in an underestimation of abortions. Research on this subject is indispensable because it enables us to estimate the incidence of abortion and its complications, and to identify unmet demands and more vulnerable groups so as to subsidize health actions and policies. In this article, we seek to describe the main challenges faced by researchers through a review of original studies on abortion and our reflections based on empirical studies we have conducted. We discuss the difficulties in obtaining information, strategies and techniques used to increase accuracy and reliability and their limits and advantages, and strategies for estimating the occurrence of abortion and its complications, using direct (interviews and data from medical charts) and indirect (secondary data on mortality and morbidity) methods. When investigating abortion complications, we address studies on mortality and morbidity, emphasizing the specificities of abortion among obstetric causes. We discuss the main indicators used by researchers and methodological aspects of their construction. We make recommendations for overcoming methodological problems and conducting new studies. In the conclusion, we reiterate the relevance of research on abortion and the need for approaches that contemplate its complexity.

Maternal sensitivity in interactions with their 2-month-old infants in Rio de Janeiro - Brazil

This paper reports on a study of maternal sensitivity in 22 primiparous women and their infants from Rio de Janeiro, Brazil. A semi-structured interview was conducted about sociodemographic risk, as and videotaped home observations to assess maternal sensitivity, and its relation with warmth, verbal and physical engagement, and camera awareness. A K-means cluster analysis was performed to examine patterns of risk in relation to maternal sensitivity. Compared to the 15 mothers with higher sensitivity scores, the seven mothers with lower sensitivity scores were characterized by lower educational levels, lower income, lower age, living in a slum, unplanned and unwanted pregnancies, and later onset of prenatal care. Whether father was resident did not appear to distinguish between the lower and higher sensitivity groups. The pattern of social-contextual risk for Brazilian mothers showing less sensitive caregiving to their infants provide a clear direction for future research in this cultural context.

Factors associated with family, school and behavioral characteristics on sexual initiation: A gender analysis for Brazilian adolescents

Adolescence is a period of transition between childhood and adulthood. The article aims to study the individual, family and school characteristics of adolescents beginning their sexual lives. The database we used was the 2015 PeNSE (National Adolescent School-based Health Survey) and the methodology was the survival analysis. The results show that boys initiate sexual activity before girls and risky behaviors associated with the use of licit and illicit drugs increase the chance of having early sex. In addition, this work highlights the importance of parental practices in reducing the chances of beginning sexual activity, as well as the presence of school workshops on the risks of pregnancy. It should be noted that intervention strategies need to be differentiated according to gender in order to increase effectiveness.

Experimentação e aprendizagem na trajetória afetiva e sexual de jovens de uma favela do Rio de Janeiro, Brasil, com experiência de aborto clandestino

Resumo Este artigo aborda o tema da iniciação sexual na adolescência, com foco nas narrativas de dez jovens com experiência de aborto induzido, moradoras de uma favela do Rio de Janeiro. A análise lança mão da descrição do processo de entrada na sexualidade como estratégia para elucidar o contexto da gravidez e do primeiro aborto clandestino na trajetória afetivo-sexual das jovens aqui entrevistadas. Considera-se a iniciação um domínio da sexualidade e da vida social que envolve socialização, interpretação de regras e significados, sistema de atitudes, formas de aproximação, controle e modelação dos afetos, das emoções e das relações de gênero. Os resultados mostraram que a diferença de idade entre os pares na iniciação amorosa sexual é significativa, clarificando o contexto em que ocorreram as decisões sobre métodos contraceptivos, gravidez e aborto. Notou-se que as adolescentes se submetem a difíceis decisões sobre sua sexualidade e reprodução, em um momento de vida em que ainda lhes falta experiência sexual e reprodutiva. A partir dos dados, demonstra-se a importância do fortalecimento de políticas públicas, discussões sobre gênero e direitos sexuais e reprodutivos na adolescência em diversos âmbitos da sociedade, como escola, família e demais instituições.

Adolescent pregnancy and transition to adulthood in young users of the SUS

OBJECTIVE

The objective of this study is to contextualize adolescent pregnancy from milestones associated with the process of transition from youth to adulthood.

METHODS

This is a cross-sectional study conducted with 200 adolescents, users of the Brazilian Unified Health System. The sample size for the estimation of proportions has been calculated assuming a population ratio of 0.50 and 95% confidence level. The dependent variables – planned pregnancy, living with a partner, and having left the parents’ house – have been considered as markers of transition from dependence to independence, from youth to adulthood. In the analysis of the associated factors, we have used the Poisson model with robust variance.

RESULTS

Average age was 17.3 years, and most adolescents lived with a partner; approximately half of the adolescents got pregnant from their first partner and the average age of first sexual intercourse was 14.6 years. Only 19% of the adolescents were studying and most dropped out of school before the beginning of the pregnancy. In the bivariate and multiple analysis, we could see that the relationship with a partner for more than two years was associated with the three dependent variables.

CONCLUSIONS

The path of transition to adulthood has been the establishment of a link with a partner and consequent pregnancy, suggesting a clear pattern of male guardianship. The changing role of women in society observed in recent decades, which means choosing a professional career, defining the number of children, and choosing their partner(s), has not reached these young persons.

Sexual initiation among adolescents (10 to 14 years old) and health behaviors

OBJECTIVE

To assess the prevalence of sexual initiation until the age of 14 years old, as well as sociodemographic and behavioral factors.

METHODS

In 2008, 4,325 from the 5,249 adolescents of the 1993 birth cohort in Pelotas, Rio Grande do Sul, were interviewed. Sexual initiation was defined as the first intercourse up to the age of 14 years old. The information was obtained by interviewing adolescents in their houses, during the 2008 follow-up. The analyzed variables were: skin color, asset index, maternal and adolescents' schooling, experimental use of tobacco and alcohol, drunkenness episode, use of any illicit drug, illegal drug use by friends and involvement in fights during the past year. Use of condoms and contraceptive methods, number of partners and the age of sexual initiation were also analyzed.

RESULTS

The prevalence of sexual initiation by the age of 14 was of 18.6%. Lower schooling, asset index and maternal education were related to higher prevalence of sexual initiation until the age of 14, as well as being male or being born to adolescent mothers. Sexual intercourse was also related to the behavioral variables analyzed. Among adolescent girls who had intercourse up to the age of 14, 30% did not use contraception and 18% did not use condoms in the last sexual intercourse. Boys reported a higher number of sexual partners than girls.

CONCLUSION

The results suggest a relationship between sexual intercourse (≤ 14 years) and some health-risk behaviors. The non-use of condoms and contraceptives may make them vulnerable to experiencing unwanted situations. Education and sociocultural strategies for health should be implemented from the beginning of adolescence.

[Nutritional status, metabolic changes and white blood cells in adolescents]

OBJECTIVE

To analyze the relationship between the peripheral blood white cells, metabolic changes, and nutritional status of adolescents with and without excess weight and body fat.

METHODS

This cross-sectional study evaluated the body mass index (BMI) and percentage body fat (%BF) in 362 adolescents from 15 to 19 years of age, of both sexes. White blood cell count, platelet count, uric acid, fasting glucose, insulin, and lipid profile were measured. The inclusion criteria were agreement to participate in the study and signature of the informed consent. Exclusion criteria were: presence of chronic or infectious disease; use of medications that could cause changes in biochemical tests; pregnancy; participation in weight reduction and weight control programs; use of diuretics and laxatives; or the presence of a pacemaker. The following statistical tests were applied: Kolmogorov-Smirnov test, Student's t or Mann-Whitney test, Pearson or Spearman correlation tests, and chi-squared test, considering p<0.05.

RESULTS

Overweight was observed in 20.7% of adolescents. The total cholesterol (TC) had a higher percentage of inadequacy (52.2%), followed by high-density lipoprotein (HDL) (38.4%). There was a positive correlation between white cells and serum lipids, insulin, body fat, and BMI. Monocytes were negatively correlated with BMI, and rods with BMI, body fat, and insulin.

CONCLUSIONS

Nutritional status is related to an inflammatory process, and adolescents with excess weight or body fat presented higher amounts of white blood cells.

Estado nutricional, alterações metabólicas e células brancas na adolescência1

OBJECTIVE:

To analyze the relationship between the peripheral blood white cells, metabolic changes, and nutritional status of adolescents with and without excess weight and body fat.

METHODS:

This cross-sectional study evaluated the body mass index (BMI) and percentage body fat (%BF) in 362 adolescents from 15 to 19 years of age, of both sexes. White blood cell count, platelet count, uric acid, fasting glucose, insulin, and lipid profile were measured. The inclusion criteria were agreement to participate in the study and signature of the informed consent. Exclusion criteria were: presence of chronic or infectious disease; use of medications that could cause changes in biochemical tests; pregnancy; participation in weight reduction and weight control programs; use of diuretics and laxatives; or the presence of a pacemaker. The following statistical tests were applied: Kolmogorov-Smirnov test, Student's t or Mann-Whitney test, Pearson or Spearman correlation tests, and chi-squared test, considering p<0.05.

RESULTS:

Overweight was observed in 20.7% of adolescents. The total cholesterol (TC) had a higher percentage of inadequacy (52.2%), followed by high-density lipoprotein (HDL) (38.4%). There was a positive correlation between white cells and serum lipids, insulin, body fat, and BMI. Monocytes were negatively correlated with BMI, and rods with BMI, body fat, and insulin.

CONCLUSIONS:

Nutritional status is related to an inflammatory process, and adolescents with excess weight or body fat presented higher amounts of white blood cells.

Maternidade na adolescência: indicadores emocionais negativos e fatores associados em mães de 14 a 16 anos em Porto Alegre, RS, Brasil

Verificou-se a prevalência de indicadores emocionais negativos e fatores associados em 430 mães adolescentes de 14 a 16 anos de Porto Alegre, RS. Foram estudadas variáveis sociodemográficas, relações sociais e familiares, aspectos reprodutivos, abuso e violência. As razões de prevalência (RP) foram obtidas por regressão de Poisson mediante análise hierarquizada. A prevalência de sofrimento psíquico intenso foi 32,6%, estando associado à baixa classe social, à não repetência escolar, ao relacionamento ruim com a mãe, à não aceitação da gestação pelo parceiro e à falta de apoio da família frente à gestação. A prevalência de autovalorização negativa foi 15,4%, permanecendo associada ao relacionamento ruim com a mãe e a não possuir uma pessoa confidente. Pouca ou nenhuma expectativa em relação ao futuro foi encontrada em 7,5% das adolescentes, estando associada à repetência escolar, à criação pela mãe biológica, à idade precoce da primeira relação sexual e à ocorrência de abuso físico. A alta prevalência de sofrimento psíquico, encontrada nas mães adolescentes, merece atenção especial das políticas públicas de saúde para a inclusão de profissionais habilitados ao manejo dos aspectos emocionais no atendimento da maternidade precoce.

[Perinatal mortality in the municipality of Salvador, Northeastern Brazil: evolution from 2000 to 2009]

OBJECTIVE

To describe and analyze the evolution of perinatal mortality with regards the scale and extent of the problem.

METHODS

A descriptive time trend study with 10,994 perinatal deaths to mothers living in Salvador, Bahia, Northeastern Brazil, with a gestational age of ≥ 22 weeks, newborn age of up to six days and birth weight of 500 grams or more, recorded from 2000 to 2009. Data from the Information Systems on Live Births and Mortality of DATASUS/Ministry of Health available on the website were used. Rates of perinatal and fetal mortality per 1,000 births and early neonatal mortality per 1,000 live births were calculated. The Pearson's Qui-square test for differences in proportions, sequence (runs) test, the calculation of moving averages and linear coefficient of determination (R²) were used for trend analysis. The Wigglesworth classification of causes of death was used.

RESULTS

The rates of perinatal mortality showed a decreasing trend, of -42.0% in the period (from 33.1 (2000) to 19.2 (2009)), with a greater share of rates of neonatal mortality (-56.3%). Fetal mortality accounted for a large proportion (61.9%) of rates of perinatal mortality in 2009. The classification of deaths showed the following most frequent causes of perinatal deaths: intrapartum asphyxia (8.8/1,000), immaturity (7.1/1,000) and congenital malformations (1.3/1,000).

CONCLUSIONS

Perinatal mortality remains high despite the downward trend, and the predominance of fetal mortality indicates recent changes in the profile of causes of death and impact on prevention activities. The quality of prenatal care with risk control and improving care during the delivery may reduce the occurrence of preventable causes of death.

As experiências de mulheres jovens no processo do aborto clandestino – uma abordagem sociológica

Este artigo, baseado em pesquisa qualitativa, compatível com o tratamento do tema do abortamento clandestino como fenômeno social complexo, apresenta a experiência de mulheres jovens que recorreram ao aborto clandestino. Entrevistas semiestruturadas foram realizadas com 16 mulheres jovens, de 18 a 29 anos, atendidas em serviço público de saúde da família. Das 44 gravidezes dessas jovens, a metade foi ao aborto. Os resultados mostraram que a ocorrência dos casos de aborto foi maior em gravidezes resultantes de relações instáveis e com parceiros diferentes, em condições de dificuldades financeiras, podendo este ser considerado como o fim da linha de um processo da “desfiliação”, em contextos nos quais o desemprego e a pobreza fragilizam as relações familiares, e essas não conseguem ter sustentabilidade.

Sexual and reproductive health of women living with HIV in Southern Brazil

This cross-sectional study focused on the sexual and reproductive health of women living with HIV, by age group, in the city of Porto Alegre, Rio Grande do Sul State, Brazil. The sample consisted of 691 women. Differences were observed in number of pregnancies and number of children. History of illicit drug use was more frequent in the 18-34-year age group, and exchanging sex for money was more frequent among women 18-29 years of age. This sample of women living with HIV treated in specialized public services in Southern Brazil showed a socioeconomic profile and sexual behavior that did not match the pattern typically identified in the process of "feminization" of the epidemic (with a majority of poor women with low schooling and a limited number of sexual partners). The study provides evidence of factors characterizing women's vulnerability to HIV infection, differing by age and raising specific demands for healthcare services.

Is adolescent pregnancy a risk factor for low birth weight?

OBJECTIVE

The objective of this study was to evaluate whether adolescent pregnancy is a risk factor for low birth weight (LBW) babies.

METHODS

This was a cross-sectional study of mothers and their newborns from a birth cohort in Aracaju, Northeastern Brazil. Data were collected consecutively from March to July 2005. Information collected included socioeconomic, biological and reproductive aspects of the mothers, using a standardized questionnaire. The impact of early pregnancy on birth weight was evaluated by multiple logistic regression.

RESULTS

We studied 4,746 pairs of mothers and their babies. Of these, 20.6% were adolescents (< 20 years of age). Adolescent mothers had worse socioeconomic and reproductive conditions and perinatal outcomes when compared to other age groups. Having no prenatal care and smoking during pregnancy were the risk factors associated with low birth weight. Adolescent pregnancy, when linked to marital status "without partner", was associated with an increased proportion of low birth weight babies.

CONCLUSIONS

Adolescence was a risk factor for LBW only for mothers without partners. Smoking during pregnancy and lack of prenatal care were considered to be independent risk factors for LBW.

Ser adolescente e ser pai/mãe: gravidez adolescente em uma amostra brasileira

O estudo teve por objetivo investigar as características associadas à gravidez adolescente em uma amostra de adolescentes brasileiros de ambos os sexos. Estudo transversal (N = 226) com 64,2% dos participantes do sexo feminino. A média de idade dos participantes foi 18,86 anos (DP = 1,35). Os participantes responderam a um questionário que investigava aspetos como: (1) vida sexual; (2) sentimentos com relação à gravidez; (3) relações com escola; (4) trabalho; e (5) família. Não foram encontradas diferenças de sexo para idade de início da vida sexual nem para o número de gravidezes relatadas. Constatou-se, no entanto, que a gravidez gerou mais sentimentos de vergonha nas meninas (p < 0,01) e indicação de necessidade de buscar trabalho para os meninos (p < 0,001). Os meninos revelaram maior número de repetições de ano e de expulsões da escola em relação às meninas (p < 0,05). Esses resultados sugerem que gravidez adolescente toma diferentes significados para os adolescentes, em função do seu sexo.

Childbearing in adolescence: intergenerational dejà-vu? Evidence from a Brazilian birth cohort

Background

Pregnancy in adolescence tends to repeat over generations. This event has been little studied in middle and low-income societies undergoing a rapid epidemiological transition. To assess this association it is important to adjust for socioeconomic conditions at different points in lifetime. Therefore, the aim of this study is to analyze the independent effect of adolescent childbearing in a generation on its recurrence in the subsequent generation, after adjusting for socioeconomic status at different points in life.

Methods

The study was conducted on a prospective cohort of singleton liveborn females from the city of Ribeirão Preto, Brazil, evaluated in 1978/79, and their daughters assessed in 2002/04. A total of 1059 mother-daughter pairs were evaluated. The women who had their first childbirth before 20 years of age were considered to be adolescent mothers. The risk of childbearing in adolescence for the daughter was modeled as a function of the occurrence of teenage childbearing in her mother, after adjustment for socio-demographic variables in a Poisson regression model.

Results

The rate of childbearing during adolescence was 31.4% in 1978/79 and 17.1% in 2002/04. Among the daughters of the 1st generation adolescent mothers, this rate was 26.7%, as opposed to 12.7% among the daughters of non adolescent mothers. After adjustments the risk of adolescent childbearing for the 2nd generation was 35% higher for women whose mothers had been pregnant during adolescence – RR = 1.35 (95% CI 1.04-1.74).

Conclusion

Adolescent childbearing in the 1st generation was a predictor of adolescent childbearing in the 2nd, regardless of socioeconomic factors determined at different points in lifetime.

Sexualidade, reprodução e saúde: experiências de adolescentes que vivem em município do interior de pequeno porte

O objetivo deste artigo é escrever experiências de adolescentes escolares de ambos os sexos, de um município do interior do Rio de Janeiro, referentes à vida afetivo-sexual, à reprodução e à saúde sexual e reprodutiva. Estudo transversal com 200 adolescentes de escolas públicas de Silva Jardim, de 15 a 19 anos, com aplicação de questionário estruturado. A iniciação sexual das meninas ocorreu entre 15 e 19 anos e dos meninos entre 12 a 14 anos. Eles se iniciaram com parceiros de 12 a 19 anos e elas com parceiros mais velhos. Meninas receberam mais informações sobre relações sexuais do que meninos e conversaram mais com parceiros sobre prevenção de gravidez na ocasião da iniciação sexual. Fontes de informações sobre sexualidade e contracepção são principalmente os pais. A farmácia é o principal local de aquisição de contraceptivos. Informações sobre doenças sexualmente transmissíveis provêm principalmente da escola. A comparação desses resultados com os de outros estudos com adolescentes escolares de grandes centros urbanos e populações que incluem jovens fora da escola evidencia aproximações e distanciamentos entre suas experiências. Fatores relacionados ao contexto sociocultural e institucional de pequenos municípios, diferenciais de gênero e escolaridade ajudam a compreendê-las.

Maternal age at first birth and adolescent education in Brazil

BACKGROUND

Brazil has witnessed dramatic changes in its fertility patterns in recent decades. The decline to below-replacement fertility has been accompanied by increases in the proportion of children born to young mothers. Yet we know little about the well-being of children born to young mothers in Brazil.

OBJECTIVE AND METHODS

Using data from the 2006 Pesquisa Nacional de Demografia e Saúde and a quasi-natural experimental approach, this study examines the implications of maternal age at first birth for the education of Brazilian adolescents.

RESULTS

We find that being born to a young mother is associated with educational disadvantages in adolescence, but that these disadvantages are attenuated once we account for mothers' selection into early childbearing. We also find that, in southern Brazil, adolescents born to young mothers have poorer educational outcomes compared with their peers born to older mothers, but that in northern Brazil no such disparities exist.

CONCLUSIONS

Adolescent educational disadvantages associated with being born to a young mother are not an artifact of selectivity, at least in southern Brazil. Regional variation in the effect of maternal age at first birth on adolescent education suggests the important role of the extended family and the father's presence as mechanisms through which disadvantages operate.

Direitos sexuais e reprodutivos na escola: avaliação qualitativa de um estudo piloto

Este artigo descreve a avaliação de um programa preventivo para adolescentes, professores e familiares, focado em direitos sexuais e reprodutivos, resiliência e habilidades sociais assertivas. Foram conduzidas dez sessões psicoeducacionais com os adolescentes (N = 54), três oficinas com os docentes (N = 11) e duas visitas domiciliares às famílias (N = 7). Os resultados, avaliados por medidas qualitativas de autorrelato, mostram que os familiares buscaram serviços da comunidade recomendados na intervenção, os docentes relataram disposição para atuar no fortalecimento da rede social dos adolescentes e estes relataram melhoria na qualidade da comunicação com os pais, prática de sexo seguro e tolerância à diversidade. São discutidas as limitações e possibilidades de intervenções ecológicas e uma agenda de pesquisa na área.

Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes

OBJECTIVES

The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes.

METHODS

A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction.

RESULTS

Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes.

CONCLUSION

Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines.

Programa de habilidades interpessoais e direitos sexuais e reprodutivos para adolescentes: um relato de experiência

Este artigo relata a experiência de aplicação de um programa de promoção de habilidades interpessoais e direitos sexuais e reprodutivos para adolescentes. Participaram 93 adolescentes, de ambos os sexos, estudantes de uma escola pública. A intervenção foi do tipo prevenção universal conduzida na escola, em 15 sessões semanais, agrupadas em três módulos: (I) identidade e resiliência, (II) habilidades sociais e manejo das emoções e (III) sexualidade, gênero e direitos sexuais e reprodutivos. Os resultados apontaram a adequação do uso de procedimentos vivenciais e de seu embasamento na cultura adolescente e a necessidade de alterar a ordem das sessões em versões futuras dessa intervenção. São discutidas direções para o replanejamento do programa.

Relações conjugais e familiares de adolescentes após o término da gestação

OBJETIVO: Analisar as percepções de mães adolescentes a respeito das relações familiares e conjugais desenvolvidas, após o término da gestação. MÉTODOS: Estudo transversal com 202 adolescentes, 3 meses após internação em uma das quatro maternidades de Teresina-PI, incluídas no estudo. RESULTADOS: A maioria das adolescentes entrevistadas percebeu mudanças positivas nas relações familiares (60,4%) e conjugais (50,5%), após o término da gestação. Observou-se associação estatística entre o desejo do pai pelo recém-nascido e a predisposição para cuidá-lo (p<0,01) e entre as modificações nas relações conjugais e o apoio paterno durante os cuidados do filho (p<0,01). CONCLUSÕES: Embora o estudo tenha mostrado relacionamentos predominantemente favoráveis entre as jovens e sua família e com o cônjuge após a gestação, espera-se que tais resultados norteiem os profissionais de saúde para que possam estimular o aumento do vínculo entre a mãe adolescente e as pessoas de seu convívio durante e após a gestação.

A new look at teenage pregnancy in Brazil

This paper brings a synthesis of some of the main results provided by GRAVAD survey (Teenage pregnancy: multicentric study about youth, sexuality and reproduction in Brazil). GRAVAD is a study about sexual and reproductive behavior among Brazilian youth that interviewed 4,634 individuals in a population survey with a random sample. Women and men between 18 and 24 years old were interviewed in three capitals—Porto Alegre, Rio de Janeiro and Salvador. “Teen pregnancy” is not the consequence of promiscuous sexual activities, as popular beliefs currently state. It is often ignored that amidst the poorer social segments parenthood is seen as a sign of social status, given the lack of professional perspectives. Among the middle class, other sociocultural horizons give parenthood the status of an experience to be lived in later moments of live, when one's professional and financial lives have been consolidated.

Saberes e atitudes dos adolescentes frente à contracepção

OBJETIVO: Descrever e analisar os saberes e atitudes dos adolescentes sobre a contracepção. MÉTODOS: Estudo descritivo com análise quantitativa, compreendendo uma amostra de 499 adolescentes de cinco escolas estaduais de Cuiabá, MT, utilizando-se um questionário fechado. Os dados foram processados e analisados pelo programa Epi-Info, com análises bivariadas. RESULTADOS: Entre os adolescentes estudados, constatou-se que 36% têm vida sexual ativa, sendo o uso atual de algum método contraceptivo presente em 77% das meninas e 66% dos meninos; com relação aos métodos contraceptivos mais conhecidos pelos adolescentes, 55% declararam conhecer o preservativo juntamente com os anticoncepcionais orais e injetáveis; identificou-se entre os adolescentes sexualmente ativos que apenas 40% dos meninos e 58% das meninas conversam sempre com seus namorados(as)/parceiros(as) sobre maneiras de evitar a gravidez; 54% das meninas e 40% dos meninos declararam que quem deve usar o método contraceptivo deve ser tanto o homem quanto a mulher; a fonte de indicação dos métodos contraceptivos foram os amigos(as) para 22% dos meninos e os médicos para 36% das meninas. CONCLUSÕES: Apesar de os adolescentes apresentarem alguns conhecimentos e atitudes adequadas em relação à contracepção, ainda há a necessidade de ações de prevenção e orientação sexual, tendo em vista o relato de pouco diálogo entre os parceiros, a não adoção de métodos de prevenção em todas as relações sexuais e a ocorrência de gravidez.

Aspectos da sexualidade na adolescência

O estudo envolveu 920 adolescentes entre 12 e 19 anos de idade em escolas de ensino fundamental e médio da região de Santo Eduardo do município de Embu, São Paulo. Teve por objetivo identificar aspectos da sexualidade de adolescentes de ambos os sexos. Os dados foram obtidos por meio de um questionário estruturado, cujos resultados demonstraram a equivalência entre garotas e rapazes com relação à busca de informações específicas sobre sexualidade; 39% dos rapazes e 17% das garotas tinham prática sexual, destes, 77% dos rapazes e 84% das garotas utilizavam preservativo.

[Social support to pregnant adolescents: clarifying perceptions]

This descriptive-exploratory study using a qualitative approach was undertaken to describe the perceptions of pregnant adolescents in relation to social support provided during pregnancy. Twelve adolescents in their first pregnancy who frequented the outpatient health service in Passo Fundo in the state of Rio Grande do Sul (Brazil) participated in the study. The data was obtained by semi-structured interviews, genograms and ecomaps and was assessed by thematic analysis. It highlighted the need for support to overcome the fears and challenges of motherhood. The mothers and partners were perceived as the main sources of support in affective and material terms. Common sense knowledge prevailed in the information dimension and pregnancy as a mediator in the reconciliation with the father fulfilled the emotional dimension. The perception of the dimension of positive social interaction was blurred by self-imposed isolation. Thus the adolescent's perception of the social support received is clear in relation to the family nucleus and includes the people in the family circle. The network of care outside the family, including the healthcare services, is tenuous and generated the perception of psychosocial difficulties. This reveals the need for greater investment of primary healthcare professionals in the inclusion of first-time-pregnancy adolescents in social care groups, which ensure the healthy progress of the pregnancy.

Elementos de vulnerabilidade individual de adolescentes ao HIV/AIDS

A adolescência é caracterizada pela experimentação e descoberta, pelo desenvolvimento da autonomia e pela sexualidade. O objetivo desse estudo foi identificar as evidências científicas da literatura sobre os elementos da dimensão individual da vulnerabilidade de adolescentes ao HIV/AIDS. Através da revisão sistemática integrativa, em bases e bancos de dados eletrônicos (Cinahl PubMed, Scopus, LILACS, Adolec, Dedalus, BDTD e Portal de Teses da Universidade de São Paulo) rastrearam-se trabalhos publicados entre 1996 e 2006. Compuseram a amostra final 41 estudos. O elemento da vulnerabilidade individual mais freqUente nos estudos foi o grau e qualidade do conhecimento sobre HIV/AIDS. A revisão permitiu identificar evidências científicas da vulnerabilidade individual relevantes para o planejamento das ações de prevenção à infecção pelo HIV em adolescentes.

Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the VSP-A (Vécu et Santé Perçue de l'Adolescent), a health-related quality of life (HRQoL) instrument for adolescents, in a healthy Brazilian population

Background

Health-related quality of life (HRQoL) assessment, encompassing the adolescents' perceptions of their mental, physical, and social health and well-being is increasingly considered an important outcome to be used to identify population health needs and to provide targeted medical care. Although validated instruments are essential for accurately assessing HRQoL outcomes, there are few cross-culturally adapted tools for use in Brazil, and none designed exclusively for use among adolescents. The Vécu et Santé Perçue de l'Adolescent (VSP-A) is a generic, multidimensional self-reported instrument originally developed and validated in France that evaluates HRQoL of ill and healthy adolescents.

Purpose

To cross-culturally adapt and validate the Brazilian-Portuguese version of the VSP-A, a generic HRQoL measure for adolescents originally developed in France.

Methods

The VSP-A was translated following a well-validated forward-backward process leading to the Brazilian version. The psychometric evaluation was conducted in a sample of 446 adolescents (14-18 years) attending 2 public high schools of São Gonçalo City. The adolescents self-reported the Brazilian VSP-A, the validated Psychosomatic Symptom Checklist and socio-demographic information. A retest evaluation was carried out on a sub-sample (n = 195) at a two-week interval.

The internal construct validity was assessed through confirmatory factor analysis (CFA), multi-trait scaling analyses, Rasch analysis evaluating unidimensionality of each scale and Cronbach's alpha coefficients. The reproducibility was evaluated by intra-class correlation coefficients (ICC). Zumbo's ordinal logistic regression analysis was used to detect differential item functioning (DIF) between the Brazilian and the French items. External construct validity was investigated testing expected differences between groups using one-way analysis of variance (ANOVA), Mann-Whitney tests and the univariate general regression linear model.

Results

CFA showed an acceptable fit (RMSEA=0.05; CFI=0.93); 94% of scaling success was found for item-internal consistency and 98% for item discriminant validity. The items showed good fit to the Rasch model except 3 items with an INFIT at the upper threshold. Cronbach's Alpha ranged from 0.60 to 0.85. Test-retest reliability was moderate to good (ICC=0.55-0.82). DIF was evidenced in 4 out of 36 items. Expected patterns of differences were confirmed with significantly lower physical, psychological well being and vitality reported by symptomatic adolescents.

Conclusions

Although DIF in few items and responsiveness must be further explored, the Brazilian version of VSP-A demonstrated an acceptable validity and reliability in adolescents attending school and might serve as a starting point for more specific clinical investigations.

[Contraceptive practices among university students: the use of emergency contraception]

This study investigated contraceptive practices and especially the use of emergency contraception by 487 young students at a public university in São Paulo State. A structured questionnaire was sent by e-mail and completed online in December 2007. Contraceptive methods and use of emergency contraception were investigated. Female and male students reported a high proportion of contraceptive use, mainly condoms and the pill. Half of the students had already used emergency contraception, often when already using some other highly effective method. Among female students, multiple regression analysis showed that current age, age at sexual initiation, not having used condoms in sexual relations, condom failure, and knowing someone that has used emergency contraception were associated with use of the latter. The option for emergency contraception proved to be more closely related to inconsistencies in the use of regular methods than to lack of their use, and can thus be considered a marker for discontinuity in regular contraception.

Caracterização das mães, partos e recém-nascidos em Campinas, São Paulo, 2001 e 2005

OBJETIVO: Comparar dados pré-natais, dos partos e dos recém-nascidos de Campinas em 2001 e 2005. MÉTODOS: Estudo transversal que analisou 13.656 documentos do Sistema de Informações sobre Nascidos Vivos (Sinasc) de 2005, comparando-as aos resultados de 2001. Analisou-se o local de moradia e parto, idade materna, estado civil, escolaridade, ocupação, paridade, consultas de pré-natal, tipo de parto, duração da gestação e peso ao nascer. Para avaliar a associação entre as variáveis, utilizou-se o teste de qui-quadrado, sendo significante p<0,05. RESULTADOS: Os nascidos nos Distritos de Saúde (DS) com piores índices de condições de vida (ICV) diminuíram em relação a 2001. A taxa de adolescentes passou de 17,7% para 14,7%. Em 2001, 39,4% das mães trabalhavam e, em 2005, 42,9%. Quanto à presença de companheiro, 35,9 e 54,3% não o referiam em 2001 e 2005, respectivamente. A escolaridade passou de 37,8% de mães com até sete anos de estudo para 25,7%, com aumento das que estudaram entre oito e 11 anos e 12 anos ou mais. O comparecimento a mais de seis consultas no pré-natal passou de 74,4 para 86,6%. Houve aumento de cesáreas (54,9 para 60,3%) e de prematuridade (7,1 para 8,9%). Não houve alteração no perfil de peso ao nascimento. CONCLUSÕES: Verificou-se queda da paridade nos DS com piores ICV e no percentual de mães adolescentes. Elevou-se o número de trabalhadoras, mulheres sem companheiro, escolaridade e frequência ao pré-natal.

[Contraceptive practices and sexual initiation among young people in three Brazilian State capitals]

This study investigated contraceptive use during first sexual intercourse among 2.790 young men and women. The GRAVAD household survey in three Brazilian capital cities involved interviews in a probabilistic sample. A hierarchical logistic regression analysis was used. Variables grouped as: macro-social, socialization and sexual initiation, context of sexual initiation, and characteristics of the interviewee and his or her partner. The prevalence of contraceptive use was 68.3% for women and 65.3% for men. Among women, contraception use was associated to: per capita monthly family income, color/race, and the use of women's magazines as a source of information on pregnancy and contraception. For both genders, use was more frequent when partners discussed pregnancy prevention before intercourse, when sexual initiation was delayed and in a motel, and when the partner was patient. The interval between the start of the relationship and sexual initiation appeared associated to use during sexual initiation for men. Results suggest that macro-social factors determine more frequent contraception use during sexual initiation for women, while for men the relational context is more important.

Mãe é tudo igual? Enunciados produzindo maternidade(s) contemporânea(s)

Este artigo analisa os enunciados relativos à maternidade que configuram o que chamamos de "norma" da maternidade. Seguimos as reflexões de Foucault, principalmente no que se refere à genealogia como forma de pensar o presente. Utilizamos o relato das trajetórias de mulheres que são mães e trabalhadoras para a produção dos materiais de análise. Os materiais possibilitaram a problematização de alguns enunciados que constituem a maternidade na contemporaneidade. Descrevemos a intensificação do investimento em um padrão de mulher mãe que tem como produto uma norma da maternidade. Essa norma da maternidade, apesar de ser produzida socialmente, passa a ser naturalizada. Ela funciona associando algumas características a um modo de ser mãe considerado mais adequado, tais como tempo e idade certos para ser mãe, número de filhos, condições financeiras. A partir dela, outros modos de ser mãe são avaliados e hierarquizados.

Perfil epidemiológico de adolescentes atendidas no pré-natal de um hospital universitário

Estudo exploratório, descritivo, quantitativo, que objetivou identificar características sociodemográficas de adolescentes grávidas, delineando o perfil epidemiológico. Realizado em um hospital universitário no Rio de Janeiro, foram analisadas 112 fichas do período 2004-2006. Os resultados evidenciam que a maioria das adolescentes (68,7%) tinha idade entre 15 e 17 anos e ensino fundamental completo (69,5 %); eram estudantes (64,3%), tinham renda familiar de 1 a 3 salários mínimos (66,9%). Tiveram sexarca 1 a 3 anos após a menarca (55,3%); eram primigestas (79,4%) e, embora 75% não tivessem planejado a gestação, esta foi bem aceita (em 58,9%). Apesar de 49,1% das jovens terem feito uso de métodos contraceptivos, 88,3% nunca praticaram aborto. Não havia registro de intercorrências obstétricas em 72 fichas, evidenciando que a maioria das jovens apresentou uma gestação fisiológica, embora a gravidez na adolescência seja considerada de risco. Conclui-se que a insuficiência de adesão aos métodos contraceptivos contribui para a elevação da incidência da gestação não planejada neste contingente populacional.

Conhecimento objetivo e percebido sobre contraceptivos hormonais orais entre adolescentes com antecedentes gestacionais

A elevada freqüência de gestação precoce no Brasil e, particularmente, em Teresina (21,5%), Piauí, motivou o presente estudo, cuja meta foi identificar os níveis de conhecimento objetivo e percebido sobre contraceptivos hormonais orais, bem como variáveis reprodutivas e sócio-demográficas preditoras de elevado conhecimento. Realizou-se estudo transversal com 278 adolescentes com idade de 15 a 19 anos de idade, com antecedentes reprodutivos, internadas em quatro maternidades de Teresina, em 2006. Regressão logística foi a base da análise estatística. Quase 98% das adolescentes apresentaram baixo conhecimento tanto objetivo quanto percebido. Apenas o maior número de gestações foi preditor de elevado conhecimento objetivo para anticoncepcionais orais. Os baixos níveis de conhecimento objetivo e percebido das adolescentes sobre o uso de anticoncepcionais orais revelam a suscetibilidade das jovens ao comportamento sexual de risco. Sugere-se a utilização de abordagem mais interativa com os adolescentes para elevar o nível de conhecimento tanto objetivo quanto percebido deles, e assim reduzir a incidência e reincidência da gravidez indesejada na adolescência e suas conseqüências negativas na vida destas jovens e de sua prole.

[Sexual initiation, masculinity and health: narratives of young men]

The main objective of this study was to analyze the narratives of young university students about the experience of sexual initiation. The theoretical and conceptual references used were the sexual scripts of our society that inform people about when, how, where and with whom they should have their sexual experiences, indicating how to act sexually and the reasons why they have to practice some kind of sexual activity. The method used was a qualitative study of narratives from the perspective of dialectic hermeneutics. The methodological design involves the comprehension of sceneries, contexts, environments and characters of the narratives about sexual initiation. The analysis refers to narratives of university students in the city of Rio de Janeiro. Among the meanings of sexual initiation, we emphasize sexual intercourse, the demarcation of a stage of life, the awakening to the opposite sex and the discovery of the body. We observed that the young men's narratives were coherent with what is considered masculine, present in the discourse of different generations. It is concluded that the young men should be encouraged to participate in actions combining health and education aimed at promotion of sexual and reproductive health.

Adolescent fertility and religion in Rio de Janeiro, Brazil in the year 2000: the role of Protestantism

Social transformations in Brazil in recent years have included a substantial increase in adolescent fertility, a dramatic rise in membership of Protestant religious denominations, and an accompanying decline in the number of Catholics. We used the 2000 Brazil Census to examine differentials in fertility and family formation among adolescents living in Rio de Janeiro by the following religious denominations: Catholic; Baptist; other mainline Protestant; Assembly of God Church; Universal Church of the Kingdom of God; other Pentecostal Protestant; and no religion. Results from logistic regression models show that the majority of the Protestants are at a lower risk of adolescent fertility than Catholics, and that among adolescents who have had a child, most Protestants are more likely than Catholics to be in a committed union. Our findings offer some support for the hypothesis that Protestant churches are more effective than the Catholic Church in discouraging premarital sexual relations and childbearing among adolescents.

[Teenage pregnancy and frequent use of alcohol and drugs in the home environment]

OBJECTIVE

To assess individual and family factors associated to teenage pregnancy, including frequent use of alcohol and illicit drugs by family members.

METHODS

Case-control study conducted with a sample of 408 sexually active female adolescents (aged 13-17 years) in school from the city of Marília (Southeastern Brazil) in 2003-2004. Cases consisted of 100 primigravid teenagers assisted in prenatal care programs in health units. Controls were 308 nulligravid students from state public schools. Standardized instruments identified demographic and educational factors, contraceptive behavior, mental health problems, and family characteristics. Statistical analysis included chi-square tests and logistic regression models.

RESULTS

Low paternal education (p=0.01), lack of information on sexuality and fertilization (p=0.001) and the use of illicit drugs by a resident family member (p=0.006) were independent risk factors. Family income per capita and asking the partner to use a condom were confounders.

CONCLUSIONS

The frequent use of illicit drugs by a resident family member is a factor strongly associated to teenage pregnancy, regardless of other risk factors. The expectation of going to college constitutes a protective factor, mainly in the presence of low maternal education.

Atuação fonoaudiológica em bebês pré-termos de mães adolescentes: uma nova realidade

OBJETIVO: investigar os aspectos do sistema sensório motor oral de recém-nascidos pré-termos de mães adolescentes, comparando-os com os de mães não adolescentes. MÉTODOS: a amostra foi constituída de 15 mães e 18 recém-nascidos, já que duas das puérperas tiveram gravidezes múltiplas, dos quais, quatro bebês pré-termos são de mães adolescentes e 11 de mães não adolescentes na mesma condição, internos na Maternidade do Hospital das Clínicas da Universidade Federal de Pernambuco. RESULTADOS: ficou evidente que existe uma inadequada assistência ao pré-natal, tanto das mães adolescentes quanto das mães não adolescentes, podendo estar relacionado a fatores socioeconômicos. Os recém-nascidos que apresentaram muito baixo peso ao nascer têm maior dificuldade quanto à transição da alimentação por sonda para via oral, tanto no grupo de mães adolescentes quanto no de mães não adolescentes. CONCLUSÃO: a imaturidade biológica dos recém-nascidos pré-termos pode levar na sua maioria à imaturidade do sistema sensório motor oral, independente da idade da mãe. As alterações do sistema sensório motor oral encontradas podem ter acontecido devido à quantidade de aparelhos utilizados pelos recém-nascidos. Não houve diferença no peso ao nascimento entre os bebês de mães adolescentes e não adolescentes, podendo ser explicado pela faixa etária das mães adolescentes que se encontraram entre 16 a 19 anos, o que definiu uma homogeneidade do grupo.

Iniciação sexual de homens adolescentes

Trata-se de pesquisa quantitativa que teve como objetivo investigar a iniciação sexual de adolescentes do sexo masculino em Concórdia, Santa Catarina. Participaram da mesma 340 adolescentes do sexo masculino, com idades entre 14 e 19 anos, que freqüentavam o ensino médio em seis instituições de ensino do município de Concórdia, que aceitaram participar e que trouxeram o Termo de Consentimento Livre e Esclarecido assinado pelos pais ou responsáveis. Destes, 69,7% afirmaram ter relações sexuais, sendo que a média de idade da primeira relação foi de 14,4 anos, menor que a média nacional de 15 anos. A primeira relação sexual ocorreu com uma ficante para 45,1% e 64,2% afirmaram que o principal motivo para a mesma foi vontade/tesão. A maioria (74,2%) qualificou a experiência como boa ou muito boa. O uso da camisinha foi apontado como método utilizado na primeira relação sexual por 73,8% dos adolescentes e como método usado em todas as relações por 72,5%. Alguns adolescentes relataram não conversar sobre sexualidade, mas a maioria aponta os amigos como principal fonte de informações sobre sexo. Frente ao exposto, fica claro que apesar de terem sua primeira relação sexual cada vez mais precocemente, o diálogo sobre prevenção tem surtido efeito, o que é reforçado pelo uso expressivo do preservativo entre os adolescentes.

Maternidade adolescente

A maternidade adolescente impõe à jovem novas demandas familiares, educacionais e laborais, além daquelas próprias da adolescência. O objetivo deste trabalho foi revisar estudos sobre a gravidez e a maternidade adolescente, com base em cinco temas: fatores associados à gravidez adolescente, impacto para a jovem, vivência da maternidade, interação mãe-bebê e apoio familiar. Em cada tema, os estudos foram analisados e comparados quanto aos aspectos metodológicos e seus principais achados, o que revelou diversos aspectos contraditórios. Grande parte dos estudos é descritiva, com delineamento transversal e quantitativo, comparando adolescentes e adultas, revelando uma vivência predominantemente negativa da gravidez e da maternidade. Já os estudos qualitativos indicam alguns aspectos positivos. Relatos negativos foram particularmente comuns na gestação, ocorrendo uma adaptação da jovem à maternidade após o nascimento do bebê. Sugere-se que a gravidez e a maternidade na adolescência sejam mais bem examinadas no contexto nacional, para a elaboração de intervenções e políticas públicas que contemplem a heterogeneidade deste grupo.

Neurobehavioral profile of healthy full-term newborn infants of adolescent mothers

BACKGROUND

The Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is used to assess neurological integrity, behavioral function and the existence of stress and abstinence signs in newborn infants.

AIM

To determine the neurobehavioral profile of healthy term neonates of adolescent mothers.

DESIGN

Cross-sectional study with prospective collection of data.

SUBJECTS

419 healthy newborns without analgesic/sedative use at labor, intra-uterine drug exposure, multiple gestation, congenital malformations or infections. The NNNS was applied with 33+/-7 hours of life in a quiet and dark room, between feedings.

OUTCOME MEASURES

Mean, SD, and 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles for each of 13 NNNS variables were determined and compared according to maternal age (12-14 years vs. 15-17 years vs. 18-19 years) by ANOVA.

RESULTS

Mothers had 17+/-1.5 years, 50% white, 7.1+/-2.2 years of education, prenatal care in 96%, vaginal delivery in 73%, and local/regional anesthesia in 75%. Neonates had birth weight 3205+/-299 g, gestational age 39.4+/-1.1 weeks, 55% male, 1 min Apgar 8.2+/-1.3, and 5 min Apgar 9.6+/-0.6. NNNS scores (mean+/-SD): habituation: 6.86+/-1.49; attention: 5.73+/-1.32; arousal: 3.70+/-0.70; regulation: 6.06+/-0.74; orientation handling procedures: 0.36+/-0.26; quality of movements: 5.11+/-0.49; excitability: 2.48+/-1.68; lethargy: 4.04+/-1.82; non-optimal reflexes: 3.67+/-1.35; asymmetry: 0.71+/-0.94; hypertonicity: 0.18+/-0.39; hypotonicity: 0.13+/-037; and stress/abstinence signs: 0.07+/-0.05. Infants of younger adolescent mothers were less lethargic than infants of older ones.

CONCLUSION

The description of the neurobehavioral profile of healthy term newborns of adolescent mothers is important to establish normal standards for this population.

Relações de gênero e iniciação sexual de mulheres adolescentes

Trata-se de estudo transversal conduzido com 222 adolescentes mulheres, entre 15 e 19 anos de idade, moradoras da área de uma unidade de saúde da família na zona leste da cidade de São Paulo, cujo objetivo foi descrever as motivações para iniciar ou não a vida sexual e os fatores associados a tal evento. As adolescentes que já haviam iniciado a vida sexual eram mais velhas, não coabitavam com os pais, estavam ausentes do sistema educacional, habitavam domicílios ocupados e namoravam em maior proporção do que as sem experiência sexual. Observou-se também que, na opinião das entrevistadas, a iniciação sexual, independente do matrimônio, pareceu ser aceita, mas foi largamente relatado o desejo da existência de vínculo afetivo-amoroso com o parceiro da primeira prática sexual, reforçando que o tradicional papel atribuído à sexualidade feminina, pelas relações de gênero, ainda forma a base do comportamento sexual dessas garotas.

Educação sexual e primeira relação sexual: entre expectativas e prescrições

Este artigo está baseado em uma pesquisa etnográfica desenvolvida em uma escola municipal do Rio de Janeiro, entre agosto de 2002 e julho de 2003. Ele analisa como as meninas idealizam sua primeira relação sexual e como a escola se refere a esse aspecto da vida dos/as jovens e intervém sobre isso. Essa passagem está envolta por uma série de preocupações e planejamentos, principalmente para as meninas, que demonstram valorizar menos a virgindade em si e mais a primeira relação sexual. No plano das intenções expressas, elas reproduzem os ensinamentos escolares, que prescrevem não só o uso de um preservativo, mas também certo tipo ideal de relação entre garotos e garotas. Diante disso, percebem-se alguns limites na intervenção escolar.