Risk and protection factors for chronic noncommunicable diseases in adolescents in Brazilian capitals. / Fatores de risco e proteção para as doenças crônicas não transmissíveis em adolescentes nas capitais brasileiras.

OBJECTIVE: To analyze trend estimates on the prevalence of risk and protective behaviors for chronic noncommunicable diseases in adolescents, according to data from the National School Health Survey in 2009, 2012 and 2015. METHODS: Data from the three cross-sectional studies in Brazilian capitals and the Federal District were used. In total, 173,310 adolescents enrolled in the ninth grade of elementary school were interviewed, with average age of 14 years. The prevalence of indicators of protective (consumption of beans and fruit; physical education classes at school; practice of physical activity for 60 minutes or more) and risk factors (consumption of candies and soft drinks; use of cigarettes and alcohol in the last 30 days; drug testing) were estimated through linear regression. RESULTS: There was a significant increase (p < 0.05) in the prevalence of fruit consumption and in the reduction of bean, soft drinks and candies consumption, as well as the consumption of alcoholic beverages and cigarettes. However, an increase in the prevalence of illicit drug experimentation was observed. Discussion: Despite the tendency to reduce risk factors, prevalences are high when compared with other sociocultural realities. CONCLUSION: The school is an important area of access to the adolescent public, and it is necessary to encourage school health promotion programs to reduce health risk behaviors, as well as to stimulate protective ones.

OBJETIVO: Analisar as estimativas de tendência sobre a prevalência de comportamentos de risco e proteção para doenças crônicas não transmissíveis em adolescentes, segundo dados da Pesquisa Nacional de Saúde do Escolar em 2009, 2012 e 2015. MÉTODOS: Foram utilizados dados dos três estudos transversais nas capitais brasileiras e no Distrito Federal. No total, entrevistaram-se 173.310 adolescentes matriculados no 9º ano do ensino fundamental, com idade média de 14 anos. Foram estimadas pelo modelo de regressão linear as prevalências dos indicadores de fatores de proteção (consumo de feijão e frutas; aulas de educação física na escola; prática de 60 minutos ou mais de atividade física) e de risco (consumo de guloseimas e refrigerantes; uso de cigarro e álcool nos últimos 30 dias; experimentação de drogas). RESULTADOS: Houve aumento significativo (p < 0,05) da prevalência do consumo de frutas e redução de consumo de feijão, refrigerantes e guloseimas, assim como do uso de bebidas alcoólicas e cigarro, entretanto foi observado aumento na prevalência de experimentação de drogas ilícitas. DISCUSSÃO: Apesar da tendência de redução em alguns fatores de risco, as prevalências encontradas são altas ao comparar com outras realidades socioculturais. CONCLUSÃO: A escola é um importante espaço de acesso ao público adolescente, e faz-se necessário estimular programas de promoção da saúde escolar para reduzir comportamentos de risco à saúde, assim como incentivar comportamentos protetores.

Use of psychoactive substances among Brazilian adolescents and associated factors: National School-based Health Survey, 2015. / Uso de substâncias psicoativas em adolescentes brasileiros e fatores associados: Pesquisa Nacional de Saúde dos Escolares, 2015.

AIM: To analyze the consumption of tobacco, alcohol and illicit drugs among schoolchildren according to demographic factors, family context and mental health. METHODS: We used data from the National School-based Health Survey 2015 and included in the sample 102,301 schoolchildren in the 9th grade. We estimated the prevalence of tobacco and alcohol use in the last 30 days and drug experimentation according to demographic, mental health and family context variables. Then, a bivariate analysis was performed using Pearson's χ2 test and the unadjusted odds ratio (OR) was calculated. Finally, we conducted a multivariate analysis including independent variables with an unadjusted association (p < 0.20), for each outcome, estimating the adjusted OR with a 95% confidence interval. RESULTS: The prevalence of tobacco consumption was 5.6%; alcohol consumption, 23.8%; and drug experimentation, 9.0%. Multivariate analysis has indicated that living with parents, having meals with parents or guardian, and family supervision were associated with lower substance consumption; whereas missing classes without parental consent has increased the chances of substance use. Increased chance of substance use was also associated with white skin color, increasing age, to work, feeling lonely and having insomnia. Not having friends was associated with drug and tobacco use, but this was protective for alcohol consumption. CONCLUSIONS: Family supervision was protective for psychoactive substance use among Brazilian schoolchildren, whereas work, loneliness and insomnia have increased their chances of use.

OBJETIVO: Analisar o uso de substâncias psicoativas (tabaco, álcool e drogas ilícitas) em escolares em relação a fatores sociodemográficos, contexto familiar e saúde mental. MÉTODOS: Foram utilizados dados da amostra de 102.301 escolares do nono ano da Pesquisa Nacional de Saúde do Escolar de 2015. Realizou-se o cálculo da prevalência de uso de tabaco e de álcool nos últimos 30 dias e experimentação de drogas, segundo variáveis sociodemográficas, contexto familiar e saúde mental. Procedeu-se a análise univariada, por teste do χ2 de Pearson e cálculo das odds ratios (OR) não ajustadas. Por fim, realizou-se análise multivariada para cada desfecho com as variáveis que apresentaram associação com os desfechos (p < 0,20), calculando-se as OR ajustadas com intervalo de confiança de 95%. RESULTADOS: A prevalência de uso de tabaco foi de 5,6%; do uso de álcool, 23,8%; e da experimentação de drogas, 9,0%. A análise multivariada apontou que, no contexto familiar, morar com os pais, fazer refeição com pais ou responsável e a supervisão familiar foram associados a menor uso de substâncias; enquanto faltar às aulas sem consentimento dos pais aumentou a chance de uso. Maior chance do uso de substâncias esteve ainda associada a cor branca, aumento da idade, trabalhar, sentir-se solitário e ter insônia. Não ter amigos foi associado com uso de drogas e tabaco, porém foi protetor para o uso de álcool. CONCLUSÕES: A supervisão familiar foi protetora do uso de substâncias psicoativas em escolares brasileiros, enquanto trabalhar, sentir-se solitário e ter insônia aumentaram suas chances de uso.

Prevalence and factors associated with illicit drug use throughout life: National School Health Survey 2015. / Prevalência e condições associadas ao uso de drogas ilícitas na vida: Pesquisa Nacional de Saúde do Escolar 2015.

INTRODUCTION: The use of illicit drugs is a public health concern. This paper describes the prevalence and factors associated with the use of illicit drugs throughout life among 9th grade students attending public and private schools in daylight period in Brazil. METHOD: Data from the Brazilian Adolescent School-based Health Survey (PeNSE) were analyzed. Use of illicit drugs at some point in life was assessed considering marijuana, cocaine, crack, solvent-based glue, ether-based inhalants, ecstasy, and oxy. Data were analized descriptively and by the Poisson's regression model. RESULTS: The use of illicit drugs at least once in life was reported by 9,0% of participants, being more prevalent among girls and associated with alcohol or tobacco use, active sexual life, feeling of loneliness, little or no contact between school and parents, and the experience of familial aggressions. The outcome was inversely associated with close contact with parents and their supervision. Prevalence was higher among participants whose mothers had higher educational levels and had, who had a payed job, and who attended public schools. DISCUSSION: The prevalence of lifetime use of illicit drugs was stable when the three PeNSE samples were compared, but it resulted more common among girls in 2015 for the first time and was associated with the same conditions found in prior studies. CONCLUSION: Family and school appear to be protective factors, especially when there is direct supervision and care. It is important that both girls and boys are given the same attention when it comes to this this subject.

INTRODUÇÃO: O uso de substâncias ilícitas é uma preocupação em saúde pública. O estudo descreve sua prevalência entre estudantes do nono ano do turno diurno de escolas públicas e privadas do Brasil, identificando fatores associados. MÉTODO: Foram analisados dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2015. A experimentação de drogas ilícitas (maconha, cocaína, crack, cola, loló, lança perfume, ecstasy ou oxy) alguma vez na vida foi avaliada. Os dados foram submetidos à análise descritiva e regressão de Poisson para estimativa de razões de prevalência brutas e ajustadas. RESULTADOS: O uso na vida de drogas ilícitas foi relatado por 9,0% dos escolares, foi mais prevalente entre as meninas e relacionado ao uso de álcool e tabaco, à atividade sexual e também à percepção de solidão, pouco vínculo/responsabilização entre escola e pais e vivências de agressões no ambiente familiar. O desfecho esteve inversamente associado ao contato próximo e à supervisão dos pais. O desfecho também foi mais prevalente entre escolares com maior escolaridade materna e inserção no mercado de trabalho e entre jovens de escolas públicas. DISCUSSÃO: A prevalência do uso na vida de drogas ilícitas mantém-se estável entre as edições da PeNSE, mas em 2015 o comportamento predominou entre as meninas, ainda associado às mesmas condições de estudos anteriores. CONCLUSÃO: Família e escola se expressam de modo protetor, especialmente quando há supervisão e cuidados diretos. É preciso estar igualmente atento a meninas e meninos com relação a esse tema.

Analysis of sexual and reproductive health indicators of Brazilian adolescents, 2009, 2012 and 2015. / Análise dos indicadores de saúde sexual e reprodutiva de adolescentes brasileiros, 2009, 2012 e 2015.

OBJECTIVE: To analyze sexual and reproductive health indicators of adolescents based on data from the National School-based Health Survey (PeNSE) in 2015, comparing them to the data from 2009 and 2012. METHODS: Cross-sectional study that has analyzed data from 9th grade students from PeNSE 2015, 2012 and 2009. We estimated prevalence and 95% confidence intervals for the following indicators: sexual initiation, condom use in the last sexual intercourse, counseling for pregnancy, sexually transmitted infections and free condoms in the three rounds of the survey. Prevalence of all indicators accessed in 2015 was estimated according to sex, type of school and region. Pearson's χ2 test was used. RESULTS: The prevalence of sexual initiation reported by adolescents has decreased from 30.5%, in 2009, to 27.5%, in 2015, as well as the use of condom in the last intercourse, from 75.9 to 66.2%, respectively. In respect to counseling, there was a reduction regarding pregnancy prevention in public schools, from 81.1 to 79.3% and in relation to free condom in private schools, from 65.4 to 57.3%. About 30% reported using both condom and another contraceptive method, and 19.5% did not use any method. Boys presented greater prevalence of sexual initiation, higher number of partners and reduced prevalence of condom use. Adolescents living in North, Northeast and Central-West regions presented worse indicators. CONCLUSION: There was a reduction in sexual initiation and condom use among Brazilian adolescents, boys were more vulnerable to sexually transmitted infections, and girls from public schools were more vulnerable to pregnancy.

OBJETIVO: Analisar indicadores de saúde sexual e reprodutiva de adolescentes com base nos dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) em 2015, comparando-os aos de 2009 e 2012. MÉTODOS: Estudo transversal que analisou dados de escolares do nono ano da PeNSE 2015, 2012 e 2009. Estimou-se a prevalência com intervalos de confiança de 95% para indicadores de iniciação sexual, uso do preservativo na última relação sexual, ter recebido orientação para gravidez, infecções sexualmente transmissíveis e preservativo grátis nas três edições. Prevalências dos indicadores de 2015 foram estimadas segundo sexo, dependência administrativa da escola e região. Utilizou-se o teste do χ2 de Pearson para diferenças estatísticas. RESULTADOS: A prevalência de iniciação sexual apresentou queda, de 30,5% em 2009 para 27,5% em 2015, assim como do uso de preservativo, de 75,9 para 66,2%. Notou-se queda da orientação para prevenção de gravidez nas escolas públicas, de 81,1 para 79,3% e de preservativo gratuito nas escolas privadas, de 65,4 para 57,3%. Cerca de 30% relataram uso combinado de preservativo e outro método e 19,5% não fizeram uso de método algum. Observou-se que meninos apresentaram maior prevalência de iniciação sexual, maior número de parceiros e menor uso de preservativo. As regiões norte, nordeste e centro-oeste apresentaram pior desempenho dos indicadores. CONCLUSÃO: Evidenciou-se diminuição da iniciação sexual e do uso de preservativo entre adolescentes, maior vulnerabilidade às infecções sexualmente transmissíveis nos meninos e à gravidez entre as adolescentes de escolas públicas.

Asthma trend in adolescence in Brazil: results of the National Adolescent School-based Health Survey (PeNSE 2012-2015). / Tendência da asma na adolescência no Brasil: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2012 e 2015.

OBJECTIVE: To compare the evolution of asthma indicators in the editions of the National School Health Survey (PeNSE 2012 and 2015). METHODS: Cross-sectional study including Brazilian 9th grade students from public and private schools. Wheezing was assessed through the question: "In the past 12 months, did you have wheezing (or chirping) chest? (yes/no)", and to assess lifetime presence of asthma, the question was "Have you ever had asthma? (yes/no)". RESULTS: Of the students, 23,52% reported wheezing or chirping chest in the past 12 months, with prevalences ranging from 16,80% (in Salvador, Bahia) to 27,43% (in Porto Alegre, Rio Grande do Sul). Lifetime presence of asthma was reported by 17,92% of the students, ranging from 13,98% (in Campo Grande, Mato Grosso do Sul) to 30,35% (in Porto Alegre, Rio Grande do Sul). There was also a decrease in the prevalence of self-report of wheezing/chirping chest in the last 12 months between the two editions of the survey (2012/2015) in 20 of the 27 Brazilian state capitals, especially in Belo Horizonte, Florianópolis, Cuiabá and Goiânia. However, prevalence of lifetime diagnostic of asthma increased from 2012 to 2015 in 26 of the 27 Brazilian state capitals. CONCLUSION: There was a decrease in the prevalence of self-report of asthma symptoms and an increase of self-reported lifetime presence of asthma. Certainly, monitoring indicators of asthma prevalence is of high importance for health knowledge and the development of public policies.

OBJETIVO: Comparar a evolução dos indicadores referentes à asma nas edições da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2012 e 2015. MÉTODOS: Estudo transversal em que foram incluídos escolares do nono ano de escolas públicas e privadas das capitais brasileiras. Para saber se o escolar teve chiado no peito nos 12 meses anteriores ao inquérito, foi feita a pergunta: "Nos últimos 12 meses, você teve chiado (ou piado) no peito?" (sim/não). E para saber se teve asma alguma vez na vida foi questionado: "Você teve asma alguma vez na vida?" (sim/não). RESULTADOS: Verificou-se que 23,52% dos estudantes relataram chiado ou piado no peito nos ultimos 12 meses, variando de 16,80% em Salvador (Bahia) a 27,43% em Porto Alegre (Rio Grande do Sul). Ter asma alguma vez na vida foi relatado por 17,92% dos estudantes, variando de 13,98% em Campo Grande (Mato Grosso do Sul) a 30,35% em Porto Alegre (Rio Grande do Sul). Também foi verificada redução da prevalência de chiado (ou piado) no peito nos últimos 12 meses, entre as duas pesquisas (PeNSE 2012 e 2015) em 20 das 27 capitais do Brasil, com destaque para Belo Horizonte, Florianópolis, Cuiabá e Goiânia. Por outro lado, houve aumento da prevalência daqueles que relataram asma alguma vez na vida em 26 das 27 capitais do país. CONCLUSÃO: Houve tendência à redução dos sintomas de asma nos últimos 12 meses, enquanto se observa aumento na proporção de adolescentes em que a asma foi referida alguma vez na vida. De certo que o monitoramento da asma ao longo dos anos é imprescindível para gerar conhecimentos e embasar políticas públicas de controle da asma.

Fatores de risco e proteção para as doenças crônicas não transmissíveis em adolescentes nas capitais brasileiras / Risk and protection factors for chronic noncommunicable diseases in adolescents in Brazilian capitals

RESUMO: Objetivo: Analisar as estimativas de tendência sobre a prevalência de comportamentos de risco e proteção para doenças crônicas não transmissíveis em adolescentes, segundo dados da Pesquisa Nacional de Saúde do Escolar em 2009, 2012 e 2015. Métodos: Foram utilizados dados dos três estudos transversais nas capitais brasileiras e no Distrito Federal. No total, entrevistaram-se 173.310 adolescentes matriculados no 9º ano do ensino fundamental, com idade média de 14 anos. Foram estimadas pelo modelo de regressão linear as prevalências dos indicadores de fatores de proteção (consumo de feijão e frutas; aulas de educação física na escola; prática de 60 minutos ou mais de atividade física) e de risco (consumo de guloseimas e refrigerantes; uso de cigarro e álcool nos últimos 30 dias; experimentação de drogas). Resultados: Houve aumento significativo (p < 0,05) da prevalência do consumo de frutas e redução de consumo de feijão, refrigerantes e guloseimas, assim como do uso de bebidas alcoólicas e cigarro, entretanto foi observado aumento na prevalência de experimentação de drogas ilícitas. Discussão: Apesar da tendência de redução em alguns fatores de risco, as prevalências encontradas são altas ao comparar com outras realidades socioculturais. Conclusão: A escola é um importante espaço de acesso ao público adolescente, e faz-se necessário estimular programas de promoção da saúde escolar para reduzir comportamentos de risco à saúde, assim como incentivar comportamentos protetores.

ABSTRACT: Objective: To analyze trend estimates on the prevalence of risk and protective behaviors for chronic noncommunicable diseases in adolescents, according to data from the National School Health Survey in 2009, 2012 and 2015. Methods: Data from the three cross-sectional studies in Brazilian capitals and the Federal District were used. In total, 173,310 adolescents enrolled in the ninth grade of elementary school were interviewed, with average age of 14 years. The prevalence of indicators of protective (consumption of beans and fruit; physical education classes at school; practice of physical activity for 60 minutes or more) and risk factors (consumption of candies and soft drinks; use of cigarettes and alcohol in the last 30 days; drug testing) were estimated through linear regression. Results: There was a significant increase (p < 0.05) in the prevalence of fruit consumption and in the reduction of bean, soft drinks and candies consumption, as well as the consumption of alcoholic beverages and cigarettes. However, an increase in the prevalence of illicit drug experimentation was observed. Discussion: Despite the tendency to reduce risk factors, prevalences are high when compared with other sociocultural realities. Conclusion: The school is an important area of access to the adolescent public, and it is necessary to encourage school health promotion programs to reduce health risk behaviors, as well as to stimulate protective ones.

Tendência da asma na adolescência no Brasil: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2012 e 2015 / Asthma trend in adolescence in Brazil: results of the National Adolescent School-based Health Survey (PeNSE 2012-2015)

RESUMO: Objetivo: Comparar a evolução dos indicadores referentes à asma nas edições da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2012 e 2015. Métodos: Estudo transversal em que foram incluídos escolares do nono ano de escolas públicas e privadas das capitais brasileiras. Para saber se o escolar teve chiado no peito nos 12 meses anteriores ao inquérito, foi feita a pergunta: "Nos últimos 12 meses, você teve chiado (ou piado) no peito?" (sim/não). E para saber se teve asma alguma vez na vida foi questionado: "Você teve asma alguma vez na vida?" (sim/não). Resultados: Verificou-se que 23,52% dos estudantes relataram chiado ou piado no peito nos ultimos 12 meses, variando de 16,80% em Salvador (Bahia) a 27,43% em Porto Alegre (Rio Grande do Sul). Ter asma alguma vez na vida foi relatado por 17,92% dos estudantes, variando de 13,98% em Campo Grande (Mato Grosso do Sul) a 30,35% em Porto Alegre (Rio Grande do Sul). Também foi verificada redução da prevalência de chiado (ou piado) no peito nos últimos 12 meses, entre as duas pesquisas (PeNSE 2012 e 2015) em 20 das 27 capitais do Brasil, com destaque para Belo Horizonte, Florianópolis, Cuiabá e Goiânia. Por outro lado, houve aumento da prevalência daqueles que relataram asma alguma vez na vida em 26 das 27 capitais do país. Conclusão: Houve tendência à redução dos sintomas de asma nos últimos 12 meses, enquanto se observa aumento na proporção de adolescentes em que a asma foi referida alguma vez na vida. De certo que o monitoramento da asma ao longo dos anos é imprescindível para gerar conhecimentos e embasar políticas públicas de controle da asma.

ABSTRACT: Objective: To compare the evolution of asthma indicators in the editions of the National School Health Survey (PeNSE 2012 and 2015). Methods: Cross-sectional study including Brazilian 9th grade students from public and private schools. Wheezing was assessed through the question: "In the past 12 months, did you have wheezing (or chirping) chest? (yes/no)", and to assess lifetime presence of asthma, the question was "Have you ever had asthma? (yes/no)". Results: Of the students, 23,52% reported wheezing or chirping chest in the past 12 months, with prevalences ranging from 16,80% (in Salvador, Bahia) to 27,43% (in Porto Alegre, Rio Grande do Sul). Lifetime presence of asthma was reported by 17,92% of the students, ranging from 13,98% (in Campo Grande, Mato Grosso do Sul) to 30,35% (in Porto Alegre, Rio Grande do Sul). There was also a decrease in the prevalence of self-report of wheezing/chirping chest in the last 12 months between the two editions of the survey (2012/2015) in 20 of the 27 Brazilian state capitals, especially in Belo Horizonte, Florianópolis, Cuiabá and Goiânia. However, prevalence of lifetime diagnostic of asthma increased from 2012 to 2015 in 26 of the 27 Brazilian state capitals. Conclusion: There was a decrease in the prevalence of self-report of asthma symptoms and an increase of self-reported lifetime presence of asthma. Certainly, monitoring indicators of asthma prevalence is of high importance for health knowledge and the development of public policies.

Prevalência e condições associadas ao uso de drogas ilícitas na vida: Pesquisa Nacional de Saúde do Escolar 2015 / Prevalence and factors associated with illicit drug use throughout life: National School Health Survey 2015

RESUMO: Introdução: O uso de substâncias ilícitas é uma preocupação em saúde pública. O estudo descreve sua prevalência entre estudantes do nono ano do turno diurno de escolas públicas e privadas do Brasil, identificando fatores associados. Método: Foram analisados dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2015. A experimentação de drogas ilícitas (maconha, cocaína, crack, cola, loló, lança perfume, ecstasy ou oxy) alguma vez na vida foi avaliada. Os dados foram submetidos à análise descritiva e regressão de Poisson para estimativa de razões de prevalência brutas e ajustadas. Resultados: O uso na vida de drogas ilícitas foi relatado por 9,0% dos escolares, foi mais prevalente entre as meninas e relacionado ao uso de álcool e tabaco, à atividade sexual e também à percepção de solidão, pouco vínculo/responsabilização entre escola e pais e vivências de agressões no ambiente familiar. O desfecho esteve inversamente associado ao contato próximo e à supervisão dos pais. O desfecho também foi mais prevalente entre escolares com maior escolaridade materna e inserção no mercado de trabalho e entre jovens de escolas públicas. Discussão: A prevalência do uso na vida de drogas ilícitas mantém-se estável entre as edições da PeNSE, mas em 2015 o comportamento predominou entre as meninas, ainda associado às mesmas condições de estudos anteriores. Conclusão: Família e escola se expressam de modo protetor, especialmente quando há supervisão e cuidados diretos. É preciso estar igualmente atento a meninas e meninos com relação a esse tema.

ABSTRACT: Introduction: The use of illicit drugs is a public health concern. This paper describes the prevalence and factors associated with the use of illicit drugs throughout life among 9th grade students attending public and private schools in daylight period in Brazil. Method: Data from the Brazilian Adolescent School-based Health Survey (PeNSE) were analyzed. Use of illicit drugs at some point in life was assessed considering marijuana, cocaine, crack, solvent-based glue, ether-based inhalants, ecstasy, and oxy. Data were analized descriptively and by the Poisson's regression model. Results: The use of illicit drugs at least once in life was reported by 9,0% of participants, being more prevalent among girls and associated with alcohol or tobacco use, active sexual life, feeling of loneliness, little or no contact between school and parents, and the experience of familial aggressions. The outcome was inversely associated with close contact with parents and their supervision. Prevalence was higher among participants whose mothers had higher educational levels and had, who had a payed job, and who attended public schools. Discussion: The prevalence of lifetime use of illicit drugs was stable when the three PeNSE samples were compared, but it resulted more common among girls in 2015 for the first time and was associated with the same conditions found in prior studies. Conclusion: Family and school appear to be protective factors, especially when there is direct supervision and care. It is important that both girls and boys are given the same attention when it comes to this this subject.

Uso de substâncias psicoativas em adolescentes brasileiros e fatores associados: Pesquisa Nacional de Saúde dos Escolares, 2015 / Use of psychoactive substances among Brazilian adolescents and associated factors: National School-based Health Survey, 2015

RESUMO: Objetivo: Analisar o uso de substâncias psicoativas (tabaco, álcool e drogas ilícitas) em escolares em relação a fatores sociodemográficos, contexto familiar e saúde mental. Métodos: Foram utilizados dados da amostra de 102.301 escolares do nono ano da Pesquisa Nacional de Saúde do Escolar de 2015. Realizou-se o cálculo da prevalência de uso de tabaco e de álcool nos últimos 30 dias e experimentação de drogas, segundo variáveis sociodemográficas, contexto familiar e saúde mental. Procedeu-se a análise univariada, por teste do χ2 de Pearson e cálculo das odds ratios (OR) não ajustadas. Por fim, realizou-se análise multivariada para cada desfecho com as variáveis que apresentaram associação com os desfechos (p < 0,20), calculando-se as OR ajustadas com intervalo de confiança de 95%. Resultados: A prevalência de uso de tabaco foi de 5,6%; do uso de álcool, 23,8%; e da experimentação de drogas, 9,0%. A análise multivariada apontou que, no contexto familiar, morar com os pais, fazer refeição com pais ou responsável e a supervisão familiar foram associados a menor uso de substâncias; enquanto faltar às aulas sem consentimento dos pais aumentou a chance de uso. Maior chance do uso de substâncias esteve ainda associada a cor branca, aumento da idade, trabalhar, sentir-se solitário e ter insônia. Não ter amigos foi associado com uso de drogas e tabaco, porém foi protetor para o uso de álcool. Conclusões: A supervisão familiar foi protetora do uso de substâncias psicoativas em escolares brasileiros, enquanto trabalhar, sentir-se solitário e ter insônia aumentaram suas chances de uso.

ABSTRACT: Aim: To analyze the consumption of tobacco, alcohol and illicit drugs among schoolchildren according to demographic factors, family context and mental health. Methods: We used data from the National School-based Health Survey 2015 and included in the sample 102,301 schoolchildren in the 9th grade. We estimated the prevalence of tobacco and alcohol use in the last 30 days and drug experimentation according to demographic, mental health and family context variables. Then, a bivariate analysis was performed using Pearson's χ2 test and the unadjusted odds ratio (OR) was calculated. Finally, we conducted a multivariate analysis including independent variables with an unadjusted association (p < 0.20), for each outcome, estimating the adjusted OR with a 95% confidence interval. Results: The prevalence of tobacco consumption was 5.6%; alcohol consumption, 23.8%; and drug experimentation, 9.0%. Multivariate analysis has indicated that living with parents, having meals with parents or guardian, and family supervision were associated with lower substance consumption; whereas missing classes without parental consent has increased the chances of substance use. Increased chance of substance use was also associated with white skin color, increasing age, to work, feeling lonely and having insomnia. Not having friends was associated with drug and tobacco use, but this was protective for alcohol consumption. Conclusions: Family supervision was protective for psychoactive substance use among Brazilian schoolchildren, whereas work, loneliness and insomnia have increased their chances of use.

Análise dos indicadores de saúde sexual e reprodutiva de adolescentes brasileiros, 2009, 2012 e 2015 / Analysis of sexual and reproductive health indicators of Brazilian adolescents, 2009, 2012 and 2015

RESUMO: Objetivo: Analisar indicadores de saúde sexual e reprodutiva de adolescentes com base nos dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) em 2015, comparando-os aos de 2009 e 2012. Métodos: Estudo transversal que analisou dados de escolares do nono ano da PeNSE 2015, 2012 e 2009. Estimou-se a prevalência com intervalos de confiança de 95% para indicadores de iniciação sexual, uso do preservativo na última relação sexual, ter recebido orientação para gravidez, infecções sexualmente transmissíveis e preservativo grátis nas três edições. Prevalências dos indicadores de 2015 foram estimadas segundo sexo, dependência administrativa da escola e região. Utilizou-se o teste do χ2 de Pearson para diferenças estatísticas. Resultados: A prevalência de iniciação sexual apresentou queda, de 30,5% em 2009 para 27,5% em 2015, assim como do uso de preservativo, de 75,9 para 66,2%. Notou-se queda da orientação para prevenção de gravidez nas escolas públicas, de 81,1 para 79,3% e de preservativo gratuito nas escolas privadas, de 65,4 para 57,3%. Cerca de 30% relataram uso combinado de preservativo e outro método e 19,5% não fizeram uso de método algum. Observou-se que meninos apresentaram maior prevalência de iniciação sexual, maior número de parceiros e menor uso de preservativo. As regiões norte, nordeste e centro-oeste apresentaram pior desempenho dos indicadores. Conclusão: Evidenciou-se diminuição da iniciação sexual e do uso de preservativo entre adolescentes, maior vulnerabilidade às infecções sexualmente transmissíveis nos meninos e à gravidez entre as adolescentes de escolas públicas.

ABSTRACT: Objective: To analyze sexual and reproductive health indicators of adolescents based on data from the National School-based Health Survey (PeNSE) in 2015, comparing them to the data from 2009 and 2012. Methods: Cross-sectional study that has analyzed data from 9th grade students from PeNSE 2015, 2012 and 2009. We estimated prevalence and 95% confidence intervals for the following indicators: sexual initiation, condom use in the last sexual intercourse, counseling for pregnancy, sexually transmitted infections and free condoms in the three rounds of the survey. Prevalence of all indicators accessed in 2015 was estimated according to sex, type of school and region. Pearson's χ2 test was used. Results: The prevalence of sexual initiation reported by adolescents has decreased from 30.5%, in 2009, to 27.5%, in 2015, as well as the use of condom in the last intercourse, from 75.9 to 66.2%, respectively. In respect to counseling, there was a reduction regarding pregnancy prevention in public schools, from 81.1 to 79.3% and in relation to free condom in private schools, from 65.4 to 57.3%. About 30% reported using both condom and another contraceptive method, and 19.5% did not use any method. Boys presented greater prevalence of sexual initiation, higher number of partners and reduced prevalence of condom use. Adolescents living in North, Northeast and Central-West regions presented worse indicators. Conclusion: There was a reduction in sexual initiation and condom use among Brazilian adolescents, boys were more vulnerable to sexually transmitted infections, and girls from public schools were more vulnerable to pregnancy.

Health promotion in school environment in Brazil.

OBJECTIVE: Evaluate the school environments to which ninth-year students are exposed in Brazil and in the five regions of the country according to health promotion guidelines. METHODS: Cross-sectional study from 2012, with a representative sample of Brazil and its macroregions. We interviewed ninth-year schoolchildren and managers of public and private schools. We proposed a score of health promotion in the school environment (EPSAE) and estimated the distribution of school members according to this score. Crude and adjusted odds ratios (OR) were used, by ordinal regression, to determine the schoolchildren and schools with higher scores, according to the independent variables. RESULTS: A student is more likely to attend a school with a higher EPSAE in the South (OR = 2.80; 95%CI 2.67-2.93) if the school is private (OR = 4.52; 95%CI 4.25-4.81) and located in a state capital, as well as if the student is 15 years of age or older, has a paid job, or has parents with higher education. CONCLUSIONS: The inequalities among the country's regions and schools are significant, demonstrating the need for resources and actions that promote greater equity. OBJETIVO: Avaliar os ambientes escolares aos quais estão expostos estudantes do nono ano no Brasil e nas cinco regiões do país segundo diretrizes de promoção da saúde. MÉTODOS: Estudo transversal, de 2012, com amostra representativa do Brasil e suas macrorregiões. Escolares do nono ano e gestores de escolas públicas e privadas foram entrevistados. Foi proposto o Escore de Promoção de Saúde no Ambiente Escolar (EPSAE) e foi estimada a distribuição dos escolares segundo esse escore e segundo odds ratio (OR) brutas e ajustadas, por regressão ordinal, para exposição dos escolares a escolas com escores mais elevados, segundo as variáveis independentes. RESULTADOS: Um escolar tem mais probabilidade de frequentar escola com EPSAE elevado na região Sul (OR = 2,80; IC95% 2,67-2,93) se a escola for privada privada (OR = 4,52; IC95% 4,25-4,81) e estiver localizada em capital de estado e se o escolar tiver 15 anos de idade ou mais, exercer atividade remunerada ou tiver mãe ou pai com escolaridade superior. CONCLUSÕES: São importantes as desigualdades entre regiões do país e entre redes de ensino, tornando clara a necessidade de alocação de recursos e ações que promovam maior equidade.

Health promotion in school environment in Brazil / Promoção da saúde no ambiente escolar no Brasil

ABSTRACT OBJECTIVE Evaluate the school environments to which ninth-year students are exposed in Brazil and in the five regions of the country according to health promotion guidelines. METHODS Cross-sectional study from 2012, with a representative sample of Brazil and its macroregions. We interviewed ninth-year schoolchildren and managers of public and private schools. We proposed a score of health promotion in the school environment (EPSAE) and estimated the distribution of school members according to this score. Crude and adjusted odds ratios (OR) were used, by ordinal regression, to determine the schoolchildren and schools with higher scores, according to the independent variables. RESULTS A student is more likely to attend a school with a higher EPSAE in the South (OR = 2.80; 95%CI 2.67–2.93) if the school is private (OR = 4.52; 95%CI 4.25–4.81) and located in a state capital, as well as if the student is 15 years of age or older, has a paid job, or has parents with higher education. CONCLUSIONS The inequalities among the country’s regions and schools are significant, demonstrating the need for resources and actions that promote greater equity.

RESUMO OBJETIVO Avaliar os ambientes escolares aos quais estão expostos estudantes do nono ano no Brasil e nas cinco regiões do país segundo diretrizes de promoção da saúde. MÉTODOS Estudo transversal, de 2012, com amostra representativa do Brasil e suas macrorregiões. Escolares do nono ano e gestores de escolas públicas e privadas foram entrevistados. Foi proposto o Escore de Promoção de Saúde no Ambiente Escolar (EPSAE) e foi estimada a distribuição dos escolares segundo esse escore e segundo odds ratio (OR) brutas e ajustadas, por regressão ordinal, para exposição dos escolares a escolas com escores mais elevados, segundo as variáveis independentes. RESULTADOS Um escolar tem mais probabilidade de frequentar escola com EPSAE elevado na região Sul (OR = 2,80; IC95% 2,67–2,93) se a escola for privada privada (OR = 4,52; IC95% 4,25–4,81) e estiver localizada em capital de estado e se o escolar tiver 15 anos de idade ou mais, exercer atividade remunerada ou tiver mãe ou pai com escolaridade superior. CONCLUSÕES São importantes as desigualdades entre regiões do país e entre redes de ensino, tornando clara a necessidade de alocação de recursos e ações que promovam maior equidade.

[Healthy behavior patterns and levels of schooling in Brazil: time trend from 2008 to 2013]. / Comportamentos saudáveis e escolaridade no Brasil: tendência temporal de 2008 a 2013.

This study analyzed data from the telephone-based Surveillance System of Risk and Protective Factors for Chronic Non-Communicable Diseases (VIGITEL) to assess the prevalence of clusters of healthy behavior patterns (non-smoker, non-alcohol-drinker, regular leisure-time physical activity and recommended consumption of fruit and vegetables) and the temporal trend between 2008 and 2013. Additionally, we evaluated whether the association between level of schooling and clustering of three or more healthy behavior patterns decreased in this same period. Prevalence ratios were obtained using Poisson regression. We found that between 2008 and 2013, the clustering prevalence of three or more healthy behavior patterns increased from 20% to 25% in men, and from 26% to 32% in women, suggesting an increase in the prevalence of healthy behavior patterns in Brazil. This increase was found at all levels of schooling. However, the association between levels of schooling and the prevalence of clustering of three or more healthy behavior patterns remained constant during the period. Thus, the results suggest that educational disparities in clustering of three or more healthy behavior patterns did not change over time, despite the social improvements observed in the country in recent years.

Comportamentos saudáveis e escolaridade no Brasil: tendência temporal de 2008 a 2013 / Healthy behavior patterns and levels of schooling in Brazil: time trend from 2008 to 2013

Resumo Este estudo analisou dados do Sistema de Vigilância por Inquérito Telefônico (Vigitel) com o objetivo de estimar a prevalência de aglomeração de comportamentos saudáveis (não fumar, consumo não abusivo de álcool, prática de atividade física regular no lazer e consumo recomendado de frutas e hortaliças) e sua tendência temporal entre 2008 e 2013. Adicionalmente, avaliamos se a associação entre a escolaridade e a aglomeração de 3 ou mais comportamentos saudáveis reduziu em magnitude nesse mesmo período. Razões de prevalências foram obtidas por regressão de Poisson. Encontramos que entre 2008 e 2013, a prevalência de aglomeração de 3 ou mais comportamentos saudáveis aumentou de 20% para 25% entre os homens, e passou de 26% para 32% entre as mulheres, sugerindo um aumento da prevalência de padrões de comportamentos saudáveis no Brasil. Esse aumento foi evidenciado em todas as faixas de escolaridade. Entretanto, a magnitude da associação entre escolaridade e prevalência da aglomeração dos 3 ou mais comportamentos saudáveis permaneceu constante no período. Assim, os resultados sugerem que as disparidades por escolaridade na aglomeração de 3 ou mais comportamentos saudáveis não se alteraram ao longo do tempo, apesar das melhorias sociais observadas no país nos últimos anos.

Abstract This study analyzed data from the telephone-based Surveillance System of Risk and Protective Factors for Chronic Non-Communicable Diseases (VIGITEL) to assess the prevalence of clusters of healthy behavior patterns (non-smoker, non-alcohol-drinker, regular leisure-time physical activity and recommended consumption of fruit and vegetables) and the temporal trend between 2008 and 2013. Additionally, we evaluated whether the association between level of schooling and clustering of three or more healthy behavior patterns decreased in this same period. Prevalence ratios were obtained using Poisson regression. We found that between 2008 and 2013, the clustering prevalence of three or more healthy behavior patterns increased from 20% to 25% in men, and from 26% to 32% in women, suggesting an increase in the prevalence of healthy behavior patterns in Brazil. This increase was found at all levels of schooling. However, the association between levels of schooling and the prevalence of clustering of three or more healthy behavior patterns remained constant during the period. Thus, the results suggest that educational disparities in clustering of three or more healthy behavior patterns did not change over time, despite the social improvements observed in the country in recent years.

Lifetime use of illicit drugs and associated factors among Brazilian schoolchildren, National Adolescent School-based Health Survey (PeNSE 2012).

OBJECTIVE: This study aimed at describing the prevalence of illicit drug use among 9th grade students in the morning period of public and private schools in Brazil, and assessing associated factors. METHOD: The Brazilian survey PeNSE (National Adolescent School-based Health Survey) 2012 evaluated a representative sample of 9th grade students in the morning period, in Brazil and its five regions. The use of illicit drugs at least once in life was assessed for the most commonly used drugs, such as marijuana, cocaine, crack, solvent-based glue, general ether-based inhalants, ecstasy and oxy. Data were subjected to descriptive analysis, and Pearson's χ² test and logistic regression was used in the multivariate analysis. RESULTS: The use of illicit drugs at least once in life was reported by 7.3% (95%CI 5.3 - 9.4) of the respondents. Logistic regression was used for multivariate analysis and the evidences suggest that illicit drug use is associated to social conditions of greater consumption power, the use of alcohol and tobacco, behaviors related to socialization, such as having friends or sexual activity, and also the perception of loneliness, loose contact between school and parents and experiences of abuse in the family environment. The outcome was inversely associated with close contact with parents and parental supervision. CONCLUSION: In addition to the association with the processes of socialization and consumption, the influence of family and school is expressed in a particularly protective manner in different records of direct supervision and care.

Psychoactive substance use, family context and mental health among Brazilian adolescents, National Adolescent School-based Health Survey (PeNSE 2012).

OBJECTIVE: To evaluate the association between the consumption of psychoactive substances (tobacco, alcohol and illicit drugs) and demographic variables, mental health and family context among school-aged children. METHODS: The National Adolescent School-based Health Survey was held with a national sample of 109,104 students. Data regarding demographic variables, family background and mental health were collected. Logistic regression was used to evaluate the associations of interest. RESULTS: Multivariate analyses showed that alcohol consumption was higher among girls, drug experimentation was more frequent among boys and that there was no difference between sexes for smoking. Being younger and mulatto were negatively associated with the use of tobacco, alcohol and illicit drugs. Also negatively associated with such risk behaviors were characteristics of the family context represented by: living with parents, having meals together and parental supervision (when parents know what the child does in their free time). Moreover, characteristics of mental health such as loneliness and insomnia were positively associated with use of tobacco, alcohol and illicit drugs. Not having friends was positively associated with use of tobacco and illicit drugs and negatively associated with alcohol use. CONCLUSIONS: The study shows the protective effect of family supervision in the use of tobacco, alcohol and drugs and, on the contrary, the increasing use of substances according to aspects of mental health, such as loneliness, insomnia and the fact of not having friends. The study's findings may support actions from health and education professionals, as well as from the government and families in order to prevent the use of these substances by adolescents.

Experimentation and use of cigarette and other tobacco products among adolescents in the Brazilian state capitals (PeNSE 2012).

INTRODUCTION: Nicotine dependence establishes itself more rapidly among adolescents than among adults. Tobacco occupies the fourth place in the rank of main risk factors for non-communicable diseases in the continent. Studies reveal that other forms of tobacco use have increased among adolescents. METHODS: Were included the 9th grade students from the 26 State Capitals and the Federal District. who were participants of the National Adolescent School-based Health Survey (PeNSE), in 2012. Factors independently associated with experimentation and regular use of cigarettes were investigated by means of multinomial logistic regression, using as reference "never tried a cigarette". The use of other tobacco products included cigar, pipe, narghile and others. RESULTS: Of the in the 61,037 participants in the 26 Brazilian capitals and the Federal District, 22.7% (95%CI 21.7 - 23.5) had experimented cigarettes, 6.1% (95%CI 5.6 - 6.6) are regular smokers and 7.1% (95%CI 6.5 - 7.7) had used other tobacco products, with half of them also being regular smokers. The chances of experimenting and being a regular smoker increased with age and according to the frequency of weekly exposure to other smokers. These chances were also higher among students who worked, who lived in monoparental families or without their parents, and those who felt that their parents would not mind if they smoked. CONCLUSION: Results reinforce the association between social disadvantages and experimenting and regular smoking. In addition, the use of other tobacco products is worthy of attention and may lead to regular smoking.

Trend of the risk and protective factors of chronic diseases in adolescents, National Adolescent School-based Health Survey (PeNSE 2009 e 2012).

OBJECTIVE: To compare the prevalence of major risk and protection factors for chronic non-communicable diseases in school-aged children in Brazilian capitals surveyed in the National Adolescent School-based Health Survey in its two editions, 2009 and 2012. METHODS: The frequencies, with Confidence Interval of 95%, of the following demographic variables were compared: food intake, body image, physical activity, smoking, alcohol and other drugs. Prevalence was compared in the two editions of the survey. RESULTS: The proportion of students who attend two physical education classes a week was maintained at 49% between 2009 and 2012, increasing in public schools from 50.6% (95%CI 49.8 - 51.4) to 52.5% (95%CI 49.2 - 55.7), and decreasing in private schools. There was no change in the proportion of students who watch two hours or more of television daily, about 80%. As for body image, there was no change between the two editions, and about 60% considered themselves being of normal weight. There was a reduction in the percentage of adolescents who experienced cigarettes, from 24.2% (95%CI 23.6 - 24.8) to 22.3% (95%CI 21.4 - 23.2), and the prevalence of smoking was maintained at about 6% (there was no statistical difference between 2009 and 2012). The consumption of beans, fruits, sweets and soft drinks also decreased. Frequency of drug experimentation was of 8.7% (95%CI 8.3 - 9.1) in 2009, and 9.6% (95%CI 9.0 - 10.3) in 2012, with no difference between confidence intervals, and the frequency of alcohol experimentation was maintained at about 70%; the percentage of use in the past 30 days was also maintained at around 27%. CONCLUSION: In the Brazilian capitals, the vast majority of prevalence of risk factors were kept stable in the two editions of the National Survey of School. These data generate evidence to guide the implementation of public policies to minimize the exposure of adolescents to risk factors.

Prevalence of asthma symptoms among adolescents in Brazil: National Adolescent School-based Health Survey (PeNSE 2012).

OBJECTIVE: This study aims to describe the prevalence rates of asthma symptoms in Brazil, its Regions and State capitals, according to data from the National Adolescent School-based Health Survey, 2012. Furthermore, it aims to compare the prevalence of asthma in the capitals evaluated by PeNSE 2012 with previous results of the International Study of Asthma and Allergies in Childhood (ISAAC). METHODS: Cross sectional study of 9th grade students at public and private schools of all Brazilian states and the Federal District (Brasília). A self reported questionnaire containing items from the ISAAC was applied in order to identify the presence of asthma symptoms. RESULTS: The results of PeNSE indicate a high prevalence of asthma symptoms (23.2%) and of reports of a previous medical diagnosis of asthma (12.4%). Of the five state capitals in which the PeNSE results were compared to the ISAAC, São Paulo, Curitiba and Porto Alegre presented an increase in the prevalence of asthma symptoms. In Salvador, there was a reduction. CONCLUSION: Brazil is among the countries with the highest prevalence of asthma in the world, and the prevalence is still growing.

Sexual behavior among Brazilian adolescents, National Adolescent School-based Health Survey (PeNSE 2012).

OBJECTIVE: This study describes the sexual behavior among students who participated in the National Adolescent School-based Health Survey (PeNSE) 2012 and investigates whether social inequalities, the use of psychoactive substances and the dissemination of information on sexual and reproductive health in school are associated with differences in behavior. METHODOLOGY: The response variable was the sexual behavior described in three categories (never had sexual intercourse, had protected sexual intercourse, had unprotected sexual intercourse). The explanatory variables were grouped into socio- demographic characteristics, substance use and information on sexual and reproductive health in school. Variables associated with the conduct and unprotected sex were identified through multinomial logistic regression, using "never had sexual intercourse" as a reference. RESULTS: Over nearly a quarter of the adolescents have had sexual intercourse in life, being more frequent among boys. About 25% did not use a condom in the last intercourse. Low maternal education and work increased the chance of risky sexual behavior. Any chance of protected and unprotected sex increased with the number of psychoactive substances used. Among those who don't receive guidance on the prevention of pregnancy in school, the chance to have sexual intercourse increased, with the largest magnitude for unprotected sex (OR = 1.41 and OR = 1.87 ). CONCLUSION: The information on preventing pregnancy and STD/AIDS need to be disseminated before the 9th grade. Social inequalities negatively affect risky sexual behavior. Substance use is strongly associated with unprotected sex. Information on the prevention of pregnancy and STD/AIDS need to be disseminated early.