National School Health Survey Research Articles

Affect heuristics and peer effect on substance use among adolescents in Brazil

Significant changes are observed during adolescence with respect to health-related habits and risky behaviors. Among the behavioral changes, the consumption of substances such as alcoholic beverages, cigarettes, and illicit drugs, and social interactions are relevant factors for the intake of such substances. This study aims to analyze the relationship between the joint decisions of substance use by adolescents and their peers from the perspective of the affect heuristics. To this end, a multivariate probit model was estimated, based on microdata from the 2019 National School Health Survey. The results showed that substance use by adolescents was positively related to substance use by their peers; therefore, having friends who consume alcohol, illicit drugs, and cigarettes or having parents who consume alcohol or cigarettes increases the likelihood of an adolescent consuming these substances. The study also identified that the substance consumption decision was governed by an unobserved common factor compatible with the affect heuristic.

PREVENTING AND COMBATING BULLYING: AN ANALYSIS OF HELP TEAMS

Bullying is one of the biggest challenges faced by schools, deeply impacting students' emotional health and development. Recognized as a form of systematic violence by the World Health Organization (WHO), bullying has serious consequences, ranging from anxiety and social withdrawal to lasting psychological problems. In Brazil, the National School Health Survey (PENSE, 2022) reveals that one in five young people engages in bullying. This study aims to discuss strategies to prevent and combat bullying, focusing on the implementation of Help Teams, a form of youth leadership that promotes healthy coexistence and reduces violence. The research was conducted using a qualitative approach, based on a literature review and analysis of documentary and legislative data, including studies by Tognetta (2022), Loch et al. (2020), and Allen and Kern (2017). The results indicate that Help Teams are an effective strategy to improve school climate and student well-being, providing a reduction in cases of bullying. However, implementation faces challenges, such as a lack of resources and the need for ongoing training for educators. The study concludes that, for schools to become spaces for welcoming and preventing conflicts, a collective effort from the school community, institutional support and well-implemented public policies are necessary, with youth leadership as a fundamental tool.

Lack of knowledge about the human papillomavirus vaccine among Brazilian adolescents: A cross-sectional study.

To analyze the distribution and factors associated with lack of knowledge about the human papillomavirus (HPV) vaccine among Brazilian adolescents.Cross-sectional study using the 2019 National School Health Survey among 17,805 Brazilian students of public and private schools, aged 13-17 years. The outcome variable was "lack of knowledge about the HPV vaccine" and the explanatory variables were sociodemographic, behaviors, knowledge, and health conditions. Logistic regression model was used to calculate Odds Ratio (OR) and 95% confidence intervals (95%CI). Spatial analysis techniques were used to determine the formation of clusters in the federated units with similar proportions of adolescents who were unaware of the vaccine. The lack of knowledge about the HPV vaccine was reported by 45.54% of Brazilian students. There was a higher chance of lack of knowledge having had sexual intercourse (OR 1.43; 95% CI 1.20-1.70); attending public school (OR 1.72; 95%CI 1.47-2.02) and located in the Northeast Region (OR 1.35; 95%CI 1.08-1.69). The lower chance of lack of knowledge were female gender (OR 0.41; 95% CI 0.35-0.48), higher maternal education (OR 0.62; 95% CI 0.50-0.77) self-rated health as Poor/very poor (OR 0.64; 95% CI 0.49-0.86) and receiving contraceptive counseling (OR 0.77; 95% CI 0.65-0.91). The proportion of lack of knowledge about the HPV vaccine was higher with the formation of High-High spatial clusters in the states of Maranhão, Piauí, and Pernambuco. Sociodemographic, health, and behavioral conditions and knowledge of students, as well as school characteristics, were associated with lack of knowledge about the HPV vaccine. A higher frequency of lack of knowledge about the HPV vaccine among adolescents was found in the states of the Northeastern Region.

Analyzing the adolescents’ impaired physical health: prevalence and associated factors in more than 100,000 Brazilian schoolchildren

Introduction: Despite the vast evidence on different risk factors and their associations with behaviours that affect the development of young people, there is still a gap in the literature, the evidence bases that ad-dresses the components of health in an integral way. Objective: The present study aims to propose a combined indicator with the intention of concatenating risk behaviours into a single primary outcome, called Health Impaired Physics, and after that, identify socioeconomic indicators that can help to understand how this commitment affects the Brazilian students. Methods: This is a transversal-secondary analysis study of a Brazilian public database (National School Health Survey). The data are available from the Brazilian Institute of Geography and Statistics (https://www.ibge.gov.br/). We selected the information about physical activity, nutritional status perception, and “effort to change weight” from 108778 schoolchildren aged between 11 and 18 years. After proposing the “impaired physical health” variable, we use the Poisson logistic regression with p<0.05 of acceptable significance. Results: Impaired physical health was adopted based on the following composition and criteria: negative classification of physical activity, poor perception of nutritional status and lack of effort to change weight. Individual characteristics (gender and race), food (smoking and drug consumption), family (e.g. not living with parents), phone use and geographic characteristics showed a significant association with the prevalence of impaired physical health. Conclusion: Collectively, our evidence reinforces that physical health impairment is influenced by several factors, including lifestyle, family and demographic context, and technology use. This study provides important information for managers in planning efficient public policies to promote health for this population, especially in intervention in the social context.

Association between body dissatisfaction, physical activity and mental health indicators in Brazilian adolescents

This study aimed to verify the association between body dissatisfaction, physical activity and mental health indicators in Brazilian adolescents. This is a cross-sectional study, where the information that characterized and composed the variables was obtained from the education database of the National School Health Survey - Brazil - 2019. The sample consisted of 124,898 adolescents aged between 13 and 17 from public and private schools in all regions of Brazil. The data was analyzed using descriptive statistics and binary logistic regression, with a significance level of 0.05. All the analyses were carried out using the Jamovi® for Windows software, version 2.3. An association was found between body dissatisfaction and insufficient physical activity (OR = 1.17; 95%CI = 1.44; 1.21) and in all the indicators of the variables related to mental health that adolescents answered "most of the time, always": miscellaneous worries (OR = 1.43; 95%CI = 1.39; 1.48), feelings of sadness (OR = 1.97; 95%CI = 1.89; 2.04), perceived indifference (OR = 1.42; 95%CI = 1.37; 1.47), feelings of irritation (OR = 1.39; 95%CI = 1.35; 1.44), suicidal ideation (OR = 1.49; 95%CI = 1.43; 1.56), and adolescents who reported having "no close friends" (OR = 1.38; 95%CI = 1.27; 1.50). We conclude that there is a direct association between body dissatisfaction, insufficient physical activity and fragile mental health indicators in Brazilian adolescents. Keywords: Body Image; Body Dissatisfaction; Physical Activity; Mental Health, Adolescence.

An ecological view on the correlates of sedentary behavior in Brazilian adolescents: a cross-sectional study with network analysis

BackgroundSedentary behavior has been identified as a public health concern. The present study analyzed the correlates of sedentary behavior in Brazilian adolescents through network analysis, in the light of an ecological approach.MethodsThe sample consisted of 126,354 adolescents, participating in the fourth edition of the Brazilian National School Health Survey. The variables were grouped into domains, namely intrapersonal, interpersonal, perceived environment, school variables, food variables, active behavior domains, and leisure sedentary behavior. The data were analyzed using network analysis.ResultsThe results reinforce that sedentary behavior is independent of the assessed active behavior domains, despite being weakly related to physical activity outside physical education classes (− 0.073). The variable with the greatest closeness and one of the variables with the greatest expected influence in the model was having internet at home, which was associated with private schools (− 0.230), having a cell phone (0.378), having a computer or notebook at home (0.409), and a greater weekly frequency of watching television (0.169). Furthermore, having internet at home was strongly associated with an increase in sedentary behavior (− 0.197), which, in turn, was linked to greater consumption of treats (0.067) and sodas (0.052).ConclusionsWe concluded that having internet at home is associated with longer sedentary time, which, in turn, is associated with greater consumption of foods of poorer nutritional quality. Interventions on sedentary behavior should be specific for population subgroups and consider actions in different levels.

Physical activity of adolescents and the urban environment of Brazilian capitals: National School Health Survey, 2015

ABSTRACT This study aimed to evaluate the practice of physical activity (PA) among adolescents and its association with characteristics of the urban environment of Brazilian capitals. Study with adolescents from the 26 Brazilian capitals and the Federal District participating in the National School Health Survey, 2015 edition. The association between regular practice of PA (≥300 minutes/week) and the dimensions of urban well-being (urban mobility, urban environmental conditions, urban housing conditions, urban collective services, and urban infrastructure) was examined using multilevel logistic regression. A total of 50,904 adolescents were evaluated, among which 20.7% were active. It was observed in the multiple model that adolescents who live in capitals with better urban environmental conditions, such as the presence of tree coverage, less open sewage, and less accumulated garbage around the houses, are more likely to be active (OR = 1.06; 95% CI:1.01;1.12). Adolescents who live in cities with less urban disorder are more likely to be active.

Prevalence and factors associated with body image dissatisfaction among school student: National School Health Survey, 2019.

To estimate prevalence and analyze factors associated with body image dissatisfaction among Brazilian adolescent school students. Cross-sectional study with data from the 2019 National School Health Survey (PeNSE). Prevalence of self-reported body image dissatisfaction and respective 95% confidence intervals (95%CI) and its association with individual characteristics were estimated via odds ratios (OR) and 95% CI using logistic regression. Of the 159,245 students, 30.2% (95%CI 29.2;31.1) reported body image dissatisfaction, which was associated with all factors analyzed. Likelihood of dissatisfaction was greater among females (OR = 3.86; 95%CI 3.45;4.32), having internet at home (OR = 8.68; 95%CI 6.83;11.03), thinking that no one cares about them (OR = 3.02; 95%CI 2.60;3.50), that life is not worth it (OR = 3.27; 95%CI 2.88;3.72) and feeling irritated (OR = 2.87; 95%CI 2.53;3.26). Body image dissatisfaction is associated with various factors and requires an intersectoral approach. Prevalence of body image dissatisfaction was 30.2%. The greatest likelihood of dissatisfaction was more related to being female, having internet at home, frequently feeling that no one cares about them, that life is not worth it, and feeling irritated. We suggest that projects be carried out in schools encouraging physical activity, less screen time and good eating habits, in addition to providing psychological support to students, in order to guide care for their mental health. Projects are needed to encourage and instruct good physical and psychological health practices at school, involving the entire school community, training of education professionals and encouragement of adolescent mental health self-care.

Prevalence and factors associated with body image dissatisfaction among school student: National School Health Survey, 2019

RESUMO Objetivo Estimar a prevalência e analisar fatores associados à insatisfação com a imagem corporal de adolescentes escolares brasileiros. Métodos Estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2019. Estimou-se a prevalência de autorrelato da insatisfação com a imagem corporal e respectivos intervalos de confiança de 95% (IC95%) e sua associação com características individuais pela odds ratio (OR) e IC95% pela regressão logística. Resultados Dos 159.245 escolares, 30,2% (IC95% 29,2;31,1) reportaram insatisfação com a imagem corporal, que se associou a todos os fatores analisados. A chance de insatisfação esteve mais relacionada a ser do sexo feminino (OR = 3,86; IC95% 3,45;4,32), possuir internet em casa (OR = 8,68; IC95% 6,83;11,03), achar que ninguém se preocupa com ele(a) (OR = 3,02; IC95% 2,60;3,50), que a vida não vale a pena (OR = 3,27; IC95% 2,88;3,72) e se sentir irritado(a) (OR = 2,87; IC95% 2,53;3,26). Conclusão A insatisfação com a imagem corporal esteve associada a diversos fatores e requer uma abordagem intersetorial.

National School Health Survey: Methodological aspects changes and comparability with the Global School-based Student Health Survey.

To analyze the changes in the methodological aspects of the National Survey of School Health (PeNSE) and its comparability with the Global School-based Student Health Survey (GSHS). This evaluative study that utilized the PeNSE questionnaires from 2009, 2012, 2015, and 2019, and the GSHS questionnaires from 2013-2017 e 2018-2020. The variables analyzed included the sample size, representativeness and geographic stratification of PeNSE, the number of questions in PeNSE, the percentage similarity of the PeNSE 2019 relative to the 2015, and its comparability with GSHS. Over the four editions of PeNSE, the sample size increased (from 63,411 in 2009 to 125,123 in 2019). There were changes in educational levels (exclusion of the 6th grade and inclusion of the 7th and 8th grades of primary and secondary education), geographic stratification (expanded to large regions and federation units), and the number of questions increased by 46%. Regarding the similarity between the 2015 and 2019 editions, 48 questions were added, 35 were excluded, and 4 were changed. In 2019, PeNSE presented 11 modules that were partially comparable and 3 that were potentially not to those of 2015. The PeNSE 2015 edition was more similar to the GSHS, with 10 comparable modules, whereas in 2019, this number was reduced to five. Since its creation, PeNSE has undergone several changes, including increased sample representativeness and number of questions across editions. However, changes to the questionnaires must be analyzed with caution, as they may compromise comparability with previous editions and international surveys.

Global Physical Activity, Active Commuting to School, and Sedentary Behavior Among Latin American Adolescents: Global School-Based Student Health Survey and the National School Health Survey.

This study aimed to compare the overall prevalence, stratified by sex and age group of global physical activity (GPA), active commuting to school (ACS), and sedentary behavior (SB) among adolescents from ten Latin American countries, and to assess the correlation of Development Index with the indicators. This research is grounded on data from the Global School-Based Student Health Survey (2009-2015) and the 2015 Brazilian National School Health Survey. The prevalence and 95% confidence intervals for GPA (≥5d/wk), ACS (≥1d/wk), and SB (>2h/d) were calculated using the chi-square test to compare the sexes (male; female) and age group (≤13y; 14y; 15y; ≥16y). We also performed Pearson correlation analysis with the Human Development Index. The prevalence of indicators ranged from 16.1% to 28.2% for GPA, from 56.7% to 71.2% for ACS, and from 20.7% to 62.6% for SB. Boys generally had a higher prevalence of GPA and ACS, and girls had a higher prevalence of SB. The prevalence of the indicators by age group varied between countries, with significant differences observed in some, depending on each indicator. A positive correlation was observed between Human Development Index, GPA, and SB. Health promotion policies must include guidelines that encourage and promote a more active and less sedentary lifestyle among young people in Latin America, considering specific groups, the local socioeconomic context, and differences between countries.

FATORES ASSOCIADOS AO USO DE ÁLCOOL EM UMA AMOSTRA REPRESENTATIVA DE ADOLESCENTES DO BRASIL

ABSTRACT Objective: To analyze the factors associated with alcohol use among Brazilian school adolescents. Method: This analytical cross-sectional study uses secondary data from the 2019 National School Health Survey edition conducted by the Brazilian Institute of Geography and Statistics. The research evaluated 125,123 adolescents through the application of a questionnaire. For the final model, multiple logistic regression was used. Results: Lifetime cigarette use was strongly associated with alcohol use (Odds Ratio=3.25; 95% Confidence Interval 2.28-4.62), followed by friends’ alcohol use in the last 30 days (Odds Ratio=2.15; 95% Confidence Interval 1.52-3.05) and having parents who smoke (Odds Ratio=1.29; 95% Confidence Interval 1.13-1.48). Conclusion: Integrated actions and public policies involving young people and adolescents are important to ensure the health and well-being of healthy adults.

Healthy dietary patterns linked to Brazilian adolescents' school meal adherence.

This study aimed to verify the association between adherence to school meals provided by the National School Feeding Program and dietary patterns in adolescents from Brazilian public schools. Data from the 2019 National School Health Survey were used, with a nationally representative sample of Brazilian school adolescents (n=53,477; 13-17 years old). Food consumption of healthy and unhealthy food markers was obtained from a food consumption questionnaire. Regular consumption was considered ≥5 times/week. Latent class analysis was used to identify dietary patterns whose association with adherence to school meals was evaluated by multinomial logistic regression models, with adjustment for sociodemographic and eating behavior variables. Three dietary patterns were identified: "unhealthy" - higher consumption of soft drinks and sweets (9.2% of adolescents); "healthy" - higher consumption of beans, vegetables, and fruits (27.1%); and "monotonous" - higher consumption of beans (63.7%). High adherence to school meals (every day) and unsatisfactory adherence (1-4 times/week) were positively associated with the healthy pattern even after adjustment for possible potential confounders (OR 1.37, 95%CI 1.23-1.52; OR 1.20, 95%CI 1.10-1.30, respectively). The results showed that the consumption of school meals offered by the National School Feeding Program can contribute to healthy eating habits among Brazilian adolescents.

What are the correlates of intention to be physically active in Brazilian adolescents? A network analysis

ObjectiveThe current study aimed to explore the association of individual characteristics, social and environmental factors - school and region - in the intention to be physically active in Brazilian adolescents.MethodsThis is a cross sectional study based on the third edition of the National School Health Survey. The study included a total of 53,937 adolescents. To assess the intention to be physically active, only who engaged in less than 300 min of physical activity per week were included. Participants were asked: “If you had the opportunity to practice physical activity most days of the week, what would your attitude be?” Individual characteristics, physical activity domains, social factors, school, and regional environments were used as exposures. Network analysis was utilized to evaluate the associations.ResultsWe observed that boys had higher intentions to be physically active compared to their peers, as did adolescents who perceived themselves as fat. In addition, students from private schools show a higher intention to regularly engage in physical activities, and in general, private schools offer more extracurricular physical activities.ConclusionIn conclusion, individual factors such as sex and body image perception, and environmental factors such as school administrative dependency and availability of extracurricular activities had a significant contribution to the intention to be physically active among Brazilian adolescents.

Sedentary Behavior and School Bullying in Adolescents: An Analysis Based on a National Survey in Colombia.

Sedentarism has been associated with poorer mental health, greater likelihood of bullying and suicide risk; however, studies with national coverage are needed to characterize contexts and allow comparisons between nations. The aim of this study was to examine the association between sedentary lifestyles with bullying in the social context of Colombian adolescents. Cross-sectional study with 78,772 adolescents aged 13-17 years participating in the 2017 National School Health Survey. Sedentary behavior was defined as sitting for 3+ hours/day of leisure time, while bullying was identified by self-report of being victimized 1+ times/month. Relative frequencies were estimated and, using a log-binomial regression model, prevalence ratios (PR) were calculated. A total of 15.31% of students reported being victims of bullying. A higher probability to be bullied was estimated in sedentary adolescents (PR: 1.18; 95% CI: 1.09-1.29), as well as in females, ethnic minorities, those who went hungry in the last month due to lack of food, students with health problems, and private schools. Bullying was related with sedentary leisure time, gender, ethnicity, type of educational institution, and presence of health problems. Being a multicausal phenomenon, bullying demands policies and programs with a greater focus on the most vulnerable groups.

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

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

Main results and public health implications of the National School Health Survey (ENSE), Colombia 2017.

The school population represents a fundamental group for health promotion actions, given that the foundations of healthy behaviors in adult life are established in children and adolescents, who can be greatly influenced by the school. To describe the health-related behavioral factors of schoolchildren between 13 and 17 years of age in secondary and middle school in Colombia. A national cross-sectional study was conducted (i.e., School Health Survey -ENSE-) that recorded information on dietary practices, physical activity, alcohol and drug consumption, injuries and bullying, and oral, visual and hearing health. Sampling was probabilistic, cluster and multistage. Schoolchildren have low consumption of fruits, vegetables (13.1%) and dairy (76.5 %), high consumption of ultra-processed foods (82.4 %), sugary drinks (74.0 %) and fast foods (14.8 %), frequent addition of salt at the table (43.3 %), low compliance with physical activity recommendations (15.0 %) and high sedentary lifestyle (46.3 %), frequent consumption of alcohol (44.7 %) and psychoactive substances (14.7 %), in addition to prevalent situations of bullying (15.4 %), rejection (8.2 %) and verbal aggression (42.7 %). The ENSE shows critical inequalities by gender, ethnicity and social class, throughout the country. The indicators observed in schoolchildren are precursors of various chronic and degenerative diseases and mental illness, which requires the urgent attention of the different social actors in the country.

Prevalence of sexual violence in school children in Brazil: National School Health Survey 2019

Prevalence of sexual violence in school children in Brazil: National School Health Survey 2019

Association between Consumption of Ultra-Processed Foods and Sociodemographic Characteristics in Brazilian Adolescents

Background: The consumption of ultra-processed foods is associated with several negative health outcomes. Studies on adolescents have shown that this population has a high consumption of these foods, especially in high-income countries. However, there are no studies on the types of ultra-processed foods consumed. The present study evaluated secondary data from a representative sample of the National School Health Survey, the consumption of ultra-processed foods by 159,245 Brazilian adolescents. Methods: Data were collected via a self-administered questionnaire using a mobile device. A Poisson regression model was used to assess the prevalence of ultra-processed food consumption and its correlation with sociodemographic characteristics. Results: The consumption of ultra-processed foods was significant among Brazilian adolescents, and almost half of the participants reported consumption the day before. We observed that sociodemographic characteristics such as school type, race/skin color, region, municipality type, age, living with mother, living with father, and maternal education level were associated with greater or lesser consumption of ultra-processed foods. Adolescents who study in private schools, are female, white, and live in non-capital cities consume more ultra-processed foods. Conclusions: Access to in natura and minimally processed foods must be on the agenda of governments and encouraged by food and nutrition education to guarantee the right to adequate and healthy food.

Association between adolescents who are victims of bullying and weapon possession

ObjectiveTo verify the association between victims of bullying and weapon possession among school adolescents. MethodsThis cross-sectional study was carried out with 2,296 high school students aged 14–19 years. An instrument containing questions from the validated Youth Risk Behavior Survey questionnaire and the National School Health Survey was used. To describe the profile of interviewees, absolute and relative frequencies were calculated, and the chi-square test was applied to verify the existence of associations. To test the association of bullying with weapon possession, Poisson logistic regression (univariate and multivariate) was used. The significance level used for all analyses was 5%. ResultsAmong adolescents interviewed, 23.1% reported being victims of bullying. Among victims of bullying, 37.6% (PR = 1.68; 95% CI = 1.30 – 2.17) reported having already carried some type of weapon (knife, revolver, or truncheon) in the last 30 days, while the reported firearm possession was 38% (PR = 1.67; 95% CI = 1.16 – 2.40) and 47.5% of these adolescents carried some type of weapon (knife, revolver or truncheon) in the school environment (PR = 2.10; 95% CI = 1.50 – 2.93). ConclusionsIt could be observed that adolescents who are victims of bullying are twice as likely of carrying some type of weapon (knife, revolver, or truncheon) to the school environment, and are also more likely of carrying a firearm.