Underreporting of violence against women: an analysis of two data sources. / Subnotificação de violência contra as mulheres: uma análise de duas fontes de dados.

This article aims to estimate the underreporting of violence against women (VAW) in the Notifiable Diseases Information System (SINAN), based on data from the National Survey of Health (NSH), in Brazil and subnational units (SU). This work was an ecological study using SINAN and NSH, both from 2019. In SINAN, reports of sexual, physical, and psychological VAW, aged 18 years or older, were selected. In the NSH, women of the same age group who reported psychological, physical, or sexual violence, and who had sought health care due to consequences of the violence were selected. SINAN underreporting was calculated in reference to the NSH's estimated population, for Brazil and each SU. Underreporting of VAW in Brazil was 98.5%, 75.9%, and 89.4% for psychological, physical, and sexual violence, respectively. The North and Northeast states presented the lowest reporting rates among the states. VAW in Brazil is highly underreported by the health sector, showing the need for adequate training of health professionals to recognize situations of violence and raise awareness of the importance of reporting.

O objetivo do artigo é estimar a subnotificação da violência contra as mulheres (VCM) no Sistema de Informação de Agravos de Notificação (SINAN) a partir de dados da Pesquisa Nacional de Saúde (PNS), para o Brasil e as unidades federadas (UF). Estudo ecológico utilizando o SINAN e a PNS, ambos do ano de 2019. No SINAN, foram selecionadas as notificações de casos de violências sexual, física e psicológica contra mulheres com idade igual ou superior a 18 anos. Na PNS, foram selecionadas as mulheres da mesma faixa etária com relato de violência psicológica, física ou sexual que tenham procurado atendimento em saúde em razão de consequência relacionada à violência vivida. Calculou-se a subnotificação do SINAN a partir da estimativa da população da PNS para o Brasil e cada UF. A subnotificação de VCM no Brasil foi de 98,5%, 75,9% e 89,4% para as violências psicológica, física e sexual, respectivamente. Os estados do Norte e Nordeste apresentaram os menores índices de notificação entre as UF. A VCM no Brasil apresenta grande subnotificação no setor saúde, demonstrando a necessidade de capacitação dos profissionais de saúde para o reconhecimento de situações de violência e conscientização da importância da notificação.

Cyberbullying among Brazilian schoolchildren: data from the National Student Health Survey, 2019. / Cyberbullying entre escolares brasileiros: dados da Pesquisa Nacional de Saúde do Escolar, 2019.

This cross-sectional study assessed data from Brazil's 2019 National Student Health Survey to investigate associations between cyberbullying and sociodemographic, family, mental health, and behavioural factors among Brazilian schoolchildren. Multivariate analysis by Poisson regression found 13.2% prevalence of cyberbullying, which was higher among adolescents who felt nobody cared about them (PR=1.47; 1.36-1.59); felt sad (PR=1.5; 1.4-1.7); reported that life was not worth living (PR=1.71; 1.59-1.84); had no friends (PR=1.68; 1.50-1.87); suffered parental aggression (PR=1.54; 1.45-1.65); missed classes without permission (PR=1.13; 1.06-1.20); used tobacco (PR=1.19; 1.10-1.30); alcoholic beverages (PR=1.16; 1.08-1.25); or illicit drugs (PR=1.14; 1.04-1.25); or had sexual intercourse (PR=1.23; 1.14-1.33). Prevalence was lower among boys (PR=0.85; 0.80-0.91); those 16-17 years old (PR=0.88; 0.82-0.95); and who reported having parental supervision in their free time (PR=0.78; 0.73-0.83). Cyberbullying has a high prevalence, highlighting the importance of monitoring this practice and establishing prevention measures in schools.

O estudo analisou a associação entre Cyberbullying e fatores sociodemográficos, familiares, de saúde mental e comportamentais em escolares (13 a 17 anos) brasileiros. Trata-se de um estudo transversal com dados da PeNSE 2019. Realizou-se análise multivariada com regressão de Poisson. A prevalência de Cyberbullying foi de 13,2% e foi maior entre os adolescentes que sentiam que ninguém se preocupava com eles (RP=1,47; 1,36-1,59); se sentiam tristes (RP=1,5; 1,4-1,7); referiram que a vida não vale a pena (RP=1,71; 1,59-1,84); não tinham amigos (RP=1,68; 1,50-1,87); sofriam agressão dos pais (RP=1,54; 1,45-1,65); faltavam às aulas sem autorização (RP=1,13; 1,06-1,20); usavam tabaco (RP=1,19; 1,10-1,30); bebidas alcóolicas (RP=1,16; 1,08-1,25); drogas ilícitas (RP=1,14; 1,04-1,25); e tiveram relação sexual (RP=1,23; 1,14-1,33). Tiveram menor prevalência os adolescentes do sexo masculino (RP=0,85; 0,80-0,91), os mais velhos (16-17 anos) (RP=0,88; 0,82-0,95) e que reportaram ter supervisão dos pais no tempo livre (RP=0,78; 0,73-0,83). O Cyberbullying tem elevada prevalência e destaca-se a importância de monitorar a prática, estabelecendo ações de prevenção nas escolas.

Pregnancy in girls under 14 years old: Spatial analysis in Brazil, 2011-2021. / Gravidez em meninas menores de 14 anos: análise espacial no Brasil, 2011 a 2021.

The objective was to analyze the spatial distribution of pregnancy in children under 14 years and six months by Brazilian region and municipality and sociodemographic and health characteristics of pregnant women and live births. Ecological study analyzing the Live Birth Information System (SINASC) from 2011 to 2021 in three age groups (< 14 years and six months, 15-19 years, and 20 years and above) by demographic and birth variables. We applied the Global and Local Moran. A total of 127,022 live births to girls aged 10-14 years were identified during the period, most of whom were Black, 21.1% in common-law or married relationships, with a lower proportion of seven prenatal care appointments and enrollment in the first trimester, a higher proportion of low birth weight and low Apgar score, residing in the North and Northeast. The mean live birth rate for 10-to-14-year-old girls was significantly autocorrelated with space, especially in municipalities of the Midwest and North. Pregnancy from 10 to 14 years of age reveals several vulnerabilities suffered by these girls due to pregnancy at an early age, which is more common among Black women, with implications for morbimortality for them and their children and the presumed violence in these cases, including denied access to legal abortion.

O objetivo foi analisar a distribuição espacial da gravidez em menores de 14 anos e seis meses segundo regiões e municípios brasileiros e características sociodemográficas e de saúde das parturientes e nascidos vivos. Estudo ecológico, analisando o Sistema de Informação sobre Nascidos Vivos (SINASC), 2011-2021, em três grupos etários (<14 anos e 6 meses, 15-19 e 20 anos e mais), segundo variáveis demográficas e do parto. Foram aplicados os Índices Global e Local de Moran. No período foram 127.022 nascidos vivos de meninas 10-14 anos, na maioria negras, 21,1% em união estável ou casadas, com menor proporção de 7 consultas de pré-natal e captação no primeiro trimestre, maior proporção de baixo peso ao nascer e baixo índice de Apgar, residentes nas regiões Norte e Nordeste. A taxa média de nascidos vivos de 10-14 anos mostrou autocorrelação significativa com o espaço, especialmente em municípios do Centro-Oeste e Norte. A gravidez de 10 a 14 revela uma sequência de vulnerabilidades sofridas por essas meninas, pela gravidez em idade precoce, maior frequência entre negras, com implicações na morbimortalidade para ela e seus filhos; e pela violência presumida nesses casos, incluindo o acesso negado ao aborto legal.

Time trend analysis and impacts of the COVID-19 pandemic on mammography and Papanicolaou test coverage in Brazilian state capitals.

BACKGROUND: Breast and cervical cancer are major public health issues globally. The reduction in incidence and mortality rates of these cancers is linked to effective prevention, early detection, and appropriate treatment measures. This study aims to analyze the temporal trends in the prevalence of mammography and Papanicolaou test coverage among women living in Brazilian state capitals between 2007 and 2023, and to compare the coverage of these tests before and during the Covid-19 pandemic. METHODS: A time series study was conducted using data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey from 2007 to 2023. The variables analyzed included mammography and Papanicolaou test coverage according to education level, age group, race/skin color, regions, and Brazilian capitals. The Prais-Winsten regression model was used to analyze the time series, and Student's t-test was employed to compare the prevalence rates between 2019 and 2023. RESULTS: Between 2007 and 2023, mammography coverage showed a stationary trend (71.1% in 2007 and 73.1% in 2023; p-value = 0.75) with a declining trend observed among women with 12 years or more of education (APC= -0.52% 95%CI -1.01%; -0.02%). Papanicolaou test coverage for all women aged between 25 and 64 exhibited a downward trend from 82% in 2007 to 76.8% in 2023 (APC= -0.45% 95%CI -0.76%; -0.13%). This decline was also noticed among those with 9 years or more of education; in the 25 to 44 age group; among women with white and mixed race; and in the Northeast, Central-West, Southeast, and South regions. When comparing coverage before and during Covid-19 pandemic, a reduction was noted for both tests. CONCLUSIONS: Over the years, there has been stability in mammography coverage and a decline in Papanicolaou test. The COVID-19 pandemic negatively impacted the number of these tests carried out among women, highlighting the importance of actions aimed at increasing coverage, especially among the most vulnerable groups.

Cyberbullying entre escolares brasileiros: dados da Pesquisa Nacional de Saúde do Escolar, 2019 / Cyberbullying among Brazilian schoolchildren: data from the National Student Health Survey, 2019

Resumo O estudo analisou a associação entre Cyberbullying e fatores sociodemográficos, familiares, de saúde mental e comportamentais em escolares (13 a 17 anos) brasileiros. Trata-se de um estudo transversal com dados da PeNSE 2019. Realizou-se análise multivariada com regressão de Poisson. A prevalência de Cyberbullying foi de 13,2% e foi maior entre os adolescentes que sentiam que ninguém se preocupava com eles (RP=1,47; 1,36-1,59); se sentiam tristes (RP=1,5; 1,4-1,7); referiram que a vida não vale a pena (RP=1,71; 1,59-1,84); não tinham amigos (RP=1,68; 1,50-1,87); sofriam agressão dos pais (RP=1,54; 1,45-1,65); faltavam às aulas sem autorização (RP=1,13; 1,06-1,20); usavam tabaco (RP=1,19; 1,10-1,30); bebidas alcóolicas (RP=1,16; 1,08-1,25); drogas ilícitas (RP=1,14; 1,04-1,25); e tiveram relação sexual (RP=1,23; 1,14-1,33). Tiveram menor prevalência os adolescentes do sexo masculino (RP=0,85; 0,80-0,91), os mais velhos (16-17 anos) (RP=0,88; 0,82-0,95) e que reportaram ter supervisão dos pais no tempo livre (RP=0,78; 0,73-0,83). O Cyberbullying tem elevada prevalência e destaca-se a importância de monitorar a prática, estabelecendo ações de prevenção nas escolas.

Abstract This cross-sectional study assessed data from Brazil's 2019 National Student Health Survey to investigate associations between cyberbullying and sociodemographic, family, mental health, and behavioural factors among Brazilian schoolchildren. Multivariate analysis by Poisson regression found 13.2% prevalence of cyberbullying, which was higher among adolescents who felt nobody cared about them (PR=1.47; 1.36-1.59); felt sad (PR=1.5; 1.4-1.7); reported that life was not worth living (PR=1.71; 1.59-1.84); had no friends (PR=1.68; 1.50-1.87); suffered parental aggression (PR=1.54; 1.45-1.65); missed classes without permission (PR=1.13; 1.06-1.20); used tobacco (PR=1.19; 1.10-1.30); alcoholic beverages (PR=1.16; 1.08-1.25); or illicit drugs (PR=1.14; 1.04-1.25); or had sexual intercourse (PR=1.23; 1.14-1.33). Prevalence was lower among boys (PR=0.85; 0.80-0.91); those 16-17 years old (PR=0.88; 0.82-0.95); and who reported having parental supervision in their free time (PR=0.78; 0.73-0.83). Cyberbullying has a high prevalence, highlighting the importance of monitoring this practice and establishing prevention measures in schools.

Gravidez em meninas menores de 14 anos: análise espacial no Brasil, 2011 a 2021 / Pregnancy in girls under 14 years old: Spatial analysis in Brazil, 2011-2021

Resumo O objetivo foi analisar a distribuição espacial da gravidez em menores de 14 anos e seis meses segundo regiões e municípios brasileiros e características sociodemográficas e de saúde das parturientes e nascidos vivos. Estudo ecológico, analisando o Sistema de Informação sobre Nascidos Vivos (SINASC), 2011-2021, em três grupos etários (<14 anos e 6 meses, 15-19 e 20 anos e mais), segundo variáveis demográficas e do parto. Foram aplicados os Índices Global e Local de Moran. No período foram 127.022 nascidos vivos de meninas 10-14 anos, na maioria negras, 21,1% em união estável ou casadas, com menor proporção de 7 consultas de pré-natal e captação no primeiro trimestre, maior proporção de baixo peso ao nascer e baixo índice de Apgar, residentes nas regiões Norte e Nordeste. A taxa média de nascidos vivos de 10-14 anos mostrou autocorrelação significativa com o espaço, especialmente em municípios do Centro-Oeste e Norte. A gravidez de 10 a 14 revela uma sequência de vulnerabilidades sofridas por essas meninas, pela gravidez em idade precoce, maior frequência entre negras, com implicações na morbimortalidade para ela e seus filhos; e pela violência presumida nesses casos, incluindo o acesso negado ao aborto legal.

Abstract The objective was to analyze the spatial distribution of pregnancy in children under 14 years and six months by Brazilian region and municipality and sociodemographic and health characteristics of pregnant women and live births. Ecological study analyzing the Live Birth Information System (SINASC) from 2011 to 2021 in three age groups (< 14 years and six months, 15-19 years, and 20 years and above) by demographic and birth variables. We applied the Global and Local Moran. A total of 127,022 live births to girls aged 10-14 years were identified during the period, most of whom were Black, 21.1% in common-law or married relationships, with a lower proportion of seven prenatal care appointments and enrollment in the first trimester, a higher proportion of low birth weight and low Apgar score, residing in the North and Northeast. The mean live birth rate for 10-to-14-year-old girls was significantly autocorrelated with space, especially in municipalities of the Midwest and North. Pregnancy from 10 to 14 years of age reveals several vulnerabilities suffered by these girls due to pregnancy at an early age, which is more common among Black women, with implications for morbimortality for them and their children and the presumed violence in these cases, including denied access to legal abortion.

Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study.

The health impacts of intimate partner violence against women and childhood sexual abuse are not fully understood. Here we conducted a systematic review by comprehensively searching seven electronic databases for literature on intimate partner violence-associated and childhood sexual abuse-associated health effects. Following the burden of proof methodology, we evaluated the evidence strength linking intimate partner violence and/or childhood sexual abuse to health outcomes supported by at least three studies. Results indicated a moderate association of intimate partner violence with major depressive disorder and with maternal abortion and miscarriage (63% and 35% increased risk, respectively). HIV/AIDS, anxiety disorders and self-harm exhibited weak associations with intimate partner violence. Fifteen outcomes were evaluated for their relationship to childhood sexual abuse, which was shown to be moderately associated with alcohol use disorders and with self-harm (45% and 35% increased risk, respectively). Associations between childhood sexual abuse and 11 additional health outcomes, such as asthma and type 2 diabetes mellitus, were found to be weak. Although our understanding remains limited by data scarcity, these health impacts are larger in magnitude and more extensive than previously reported. Renewed efforts on violence prevention and evidence-based approaches that promote healing and ensure access to care are necessary.

Smoking among Brazilian adolescents during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: The social distancing measures during the coronavirus disease 2019 (COVID-19) pandemic resulted in mental suffering among adolescents, leading to risky consumption of psychoactive substances such as tobacco. OBJECTIVE: To analyze the factors associated with tobacco use among adolescents during the COVID-19 social distancing period in Brazil. DESIGN AND SETTING: Cross-sectional study used data from ConVid Adolescentes survey in Brazil. METHODS: Tobacco use was assessed before and during social distancing. The explanatory variables investigated were sex, age, race/skin color, type of school, maternal education, region of residence, adherence to social restriction measures, number of close friends, sleep quality during the pandemic, mood, passive smoking, use of alcoholic beverages during the pandemic, sedentary behavior, and physical activity. A logistic regression model was used for the data analysis. RESULTS: Tobacco use by adolescents did not change during the pandemic (from 2.58% to 2.41%). There was a higher chance of tobacco use among adolescents aged between 16 and 17 years, self-reported black ones, residing in the South and Southeast regions, reported feeling sad and loneliness, had sleeping problems that worsened, were using alcoholic beverages during the pandemic, and were passive smokers at home. Adolescents whose mothers had completed high school or higher, had strict social restrictions, and increased their physical activity during the pandemic had a lower chance of tobacco use. CONCLUSION: Tobacco uses during the COVID-19 pandemic was higher in vulnerable groups, such as black adolescents and those with mental suffering.

Tabagismo no Brasil: percepções dos resultados de pesquisas domiciliares / Smoking in Brazil: insights from the results of the household surveys / Tabaquismo en Brasil: percepciones de los resultados de encuestas en hogares

Introdução: o uso do tabaco em suas diferentes formas continua a ser uma das principais causas de morte evitáveis no Brasil. Com uma história de sucesso notável, o Brasil alcançou uma das maiores reduções significativas na prevalência do tabagismo desde 1990. No entanto, é preocupante que a taxa de declínio do consumo de tabaco tenha diminuído nos últimos anos, conforme sugerem as pesquisas. Objetivos: o presente estudo teve como objetivo comparar os resultados de três pesquisas domiciliares realizadas pelo Instituto Brasileiro de Geografia e Estatística (IBGE). Métodos: foi realizada a comparação da prevalência do uso de tabaco entre entrevistados com 18 anos ou mais, assim como foi avaliada a porcentagem de mudanças na prevalência entre 2008, 2013 e 2019, usando dados de três pesquisas: The Global Tobacco Adult Survey, do ano de 2008, e a Pesquisa Nacional de Saúde do Brasil, dos anos de 2013 e 2019. Além disso, analisamos a prevalência no Brasil e seus estados de acordo com idade, gênero, nível educacional e raça. Resultados: a prevalência do tabagismo ativo diminuiu 19% entre 2008 e 2013, passando de 18,2% (IC 95%: 17,7;18,7%), em 2008, para 14,7% (IC 95%: 14,2;15,2%), em 2013. No entanto, em 2019, a prevalência foi de 12,6% (IC 95%: 12,2;13,0%), revelando uma redução de 14,3%. O tabagismo foi maior entre a população com baixo nível de escolaridade, status de renda mais baixo e raça/cor da pele preta e parda. Conclusão: a prevalência do tabagismo diminuiu no Brasil nas últimas três décadas. No entanto, recentemente, houve uma redução na intensidade da queda, exigindo atenção e análise cuidadosa das estratégias de prevenção e abandono do tabagismo.(AU)

Alcohol consumption among adolescents during the COVID-19 pandemic, ConVid Adolescents - Behavior Research / O consumo de bebidas alcoólicas entre adolescentes durante a pandemia de COVID-19, ConVid Adolescentes — Pesquisa de Comportamentos

ABSTRACT Objective: To describe the prevalence of alcohol consumption before and during the COVID-19 pandemic and to analyze the factors associated with this behavior during the period of social distancing among Brazilian adolescents. Methods: Cross-sectional study using data from the ConVid Adolescents survey, carried out via the Internet between June and September 2020. The prevalence of alcohol consumption before and during the pandemic, as well as association with sociodemographic variables, mental health, and lifestyle were estimated. A logistic regression model was used to assess associated factors. Results: 9,470 adolescents were evaluated. Alcohol consumption decreased from 17.70% (95%CI 16.64-18.85) before the pandemic to 12.80% (95%CI 11.85-13.76) during the pandemic. Alcohol consumption was associated with the age group of 16 and 17 years (OR=2.9; 95%CI 1.08-1.53), place of residence in the South (OR=1.82; 95%CI 1.46-2.27) and Southeast regions (OR=1.33; 95%CI 1.05-1.69), having three or more close friends (OR=1.78; 95%CI 1.25-2.53), reporting worsening sleep problems during the pandemic (OR=1.59; 95%CI 1.20-2.11), feeling sad sometimes (OR=1,83; 95%CI 1,40-2,38) and always (OR=2.27; 95%CI 1.70-3.05), feeling always irritated (OR=1,60; 95%CI 1,14-2,25), being a smoker (OR=13,74; 95%CI 8.63-21.87) and a passive smoker (OR=1.76; 95%CI 1.42-2.19). Strict adherence to social distancing was associated with lower alcohol consumption (OR=0.40; 95%CI 0.32-0.49). Conclusions: The COVID-19 pandemic led to a decrease in consumption of alcoholic beverages by Brazilian adolescents, which was influenced by sociodemographic and mental health factors, adherence to social restriction measures and lifestyle in this period. Managers, educators, family and the society must be involved in the articulation of Public Policies to prevent alcohol consumption.

RESUMO Objetivo: Descrever as prevalências do consumo de bebidas alcoólicas por adolescentes brasileiros antes e durante a pandemia de COVID-19 e analisar os fatores associados a esse comportamento no período de distanciamento social. Métodos: Estudo transversal, utilizando dados da pesquisa ConVid Adolescentes, realizado via web entre junho e setembro de 2020. Foi estimada a prevalência do consumo de bebidas alcoólicas antes e durante a pandemia e a associação com variáveis sociodemográficas, de saúde mental e estilos de vida. Foi usado modelo de regressão logística para avaliar os fatores associados. Resultados: Avaliaram-se 9.470 adolescentes. O consumo de bebida alcoólica reduziu de 17,70% (IC95% 16,64-18,85), antes da pandemia, para 12,80% (IC95% 11,85-13,76), durante a pandemia. O consumo de bebidas alcoólicas esteve associado à faixa etária de 16 e 17 anos (OR=2,9; IC95% 1,08-1,53), morar na Região Sul (OR=1,82; IC95% 1,46-2,27) e Sudeste (OR=1,33; IC95% 1,05-1,69), ter três ou mais amigos próximos (OR=1,78; IC95% 1,25-2,53), relatar piora dos problemas de sono (OR=1,59; IC95% 1,20-2,11), sentir-se triste às vezes (OR=1,83; IC95% 1,40-2,38) e sempre (OR=2,27; IC95% 1,70-3,05), irritado sempre (OR=1,60; IC95% 1,14-2,25), ser fumante ativo (OR=13,74; IC95% 8,63-21,87) e fumante passivo (OR=1,76; IC95% 1,42-2,19). A adesão à restrição de forma muito rigorosa associou-se ao menor consumo de bebidas alcoólicas (OR=0,40; IC95% 0,32-0,49). Conclusão: A pandemia causada pela COVID-19 levou à diminuição no consumo de bebidas alcoólicas pelos adolescentes brasileiros, e o consumo durante a pandemia foi influenciado por fatores sociodemográficos, de saúde mental, adesão às medidas de restrição social e estilos de vida. Faz-se necessário o envolvimento de gestores, educadores, família e sociedade na articulação de políticas públicas para evitar o consumo de bebidas alcoólicas.