Abstract

Objective

To verify the association between negative self-perception of health and school violence in adolescent students of the Municipality of Olinda (PE), Brazil.

Methods

This is a cross-sectional, analytical and school-based study with a sample consisting of 2,614 adolescents selected through a strategy of random sampling in conglomerates. The information was obtained through the questionnaire “Youth Risk Behavior Survey” from which the issues of violence and self-perceived health were retrieved. Data were tabulated by Epi-data version 3.1 program and transcribed for SPSS version 22. The Chi-square test and the stepwise binary logistic regression model were used for data analysis.

Results

We observed that 26.7% of adolescents had a negative self-perception of health, and this was greater among girls. Concerning school violence, negative self-perception was associated with feelings of sadness, suicidal thoughts, bullying at school, robbery at school and safety at school. Gender and age were also associated (p < 0.05).

Conclusion

We reinforce the need for culture and peace actions in adolescence, involving the school environment to reflect on poor health assessed by adolescents and reduce the rate of violence.

Diagnostic self-evaluation; Adolescent health; Violence; Adolescent

Introduction

Modern society is increasingly appreciating the different facets in which the phenomenon called violence is characterized. Violence is defined as (...) “intentional use of physical force or power that is real or threatened, self-inflicted, interpersonal or collective, which results in or is highly likely to result in injury, death, psychological harm, developmental disability or deprivation, and the violent act may be of a physical, sexual, psychological or negligent nature¹1. Organização Mundial da Saúde (WHO). World Report on Violence and Health. Geneva: World Health Organization Press; 2002..”Somehow, violence is very much related to the characteristic of power over the other, personal achievements or superiority, which portrays various forms of violence²2. Marriel LC, Assis SG, Avanci JQ, Oliveira RVC. Violência escolar e autoestima de adolescentes. Cad Pesqui 2006: 36(127):35-50..

The World Health Organization (WHO)³3. Organização Mundial de Saúde (OMS). Informe mundial sobre la violencia e la salud. Organización Panamericana de la Salud para la Organización Mundial de la Salud. Washington: OMS; 2002. states that “violence is a constant event in the lives of a large number of people throughout the world, from all generations, social and cultural groups, denouncing their presence from public to private spaces, traversing workplaces, the family core, besides various social interaction institutions, including schools”. In this regard, a school environment is a place that is in charge of educating and reporting knowledge and also tends to assist the students’ full development, promotion of values and interpersonal relationships⁴4. Ferraz S, Pereira B. Comportamentos de bulling: Estudo numa escola técnico profissional. In: Condessa I, Pereira B, Carvalho C, coordenadores. Atividade física, saúde e lazer. Educar e Formar. Braga: Universidade do Minho; 2012. p. 93-99.

5. Gonçalves MH. Bullying - A violência nas organizações escolares, quando os professores são as vítimas: Um estudo descritivo na Região Autónoma da Madeira [dissertação]. Funchal: Universidade da Madeira; 2011.-⁶6. Haber J, Glatzer J. Bullying - Manual anti-agressão - Proteja o seu filho de provocações, abusos, insultos. Alfragide: Casa das Letras; 2009..

A cultural exchange occurs at school, resulting in interaction and acceptance of differences, where students learn to share their interests, joys and sorrows, especially in adolescence. According to Jacobson et al.⁷7. Jacobson LSV, Andrade CLT, Carmo CN, Mourão DS, Hacon SS. Trend in mortality due to external causes in the State of Espírito Santo, Brazil, from 1994 to 2005. Rev Bras Epidemiol 2009; 12(1):82-91., adolescence is a stage of acquiring healthy habits, as well as being exposed to risk situations with significant repercussion in the present and the future. Currently, school violence has been the object of scientific investigations²2. Marriel LC, Assis SG, Avanci JQ, Oliveira RVC. Violência escolar e autoestima de adolescentes. Cad Pesqui 2006: 36(127):35-50.,⁸8. Martins MJ. Agressão e vitimização entre adolescentes, em contexto escolar: Um estudo empírico. Análise Psicológica 2005; 4 (23):401-425.,⁹9. Priotto EP, Boneti LW. Violência escolar: na escola, da escola e contra a escola. Revista Diálogo Educacional 2009; 9(26):161-179. whether by assaulting others or self-harm¹⁰10. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar (PeNSE) 2009. Rio de Janeiro: IBGE; 2009.,¹¹11. Villela LCM, Moraes SA, Suzuki CS, Freitas ICM. Tendência da mortalidade por homicídios em Belo Horizonte e região metropolitana: 1980-2005. Rev Saude Publica 2010; 44(3):486-95..

Concerning the high levels of school violence, research on a specific theme travels the world, also studying school violence through the facet known as bullying¹²12. World Health Organization (WHO). Inequalities in young people’s health. Health behavior in school-aged children international report from the 2005/2006 survey. Copenhagen: WHO; 2008.

13. Smith-Khuri E, Iachan R, Scheidt PC, Overpeck MD, Gabhainn SN, Pickett W, Harel Y. A cross-national study of violence-related behaviors in adolescents. Arch Pediatr Adolesc Med 2004; 158(6):539-544.-¹⁴14. Rudatsikira E, Muula AS, Siziya S. Prevalence and correlates of physical fighting among school-going adolescents in Santiago, Chile. Rev Bras Psiquiatr 2008; 30(3):197-202.. In his study, Lopes Neto¹⁵15. Lopes Neto AA. Bulling: comportamento agressivo entre estudantes. Jornal de Pediatra 2005; 81(5):164-172. aimed to alert the high prevalence of bullying, pointing to awareness for prevention, and characterized bullying as repeated acts of oppression, tyranny, (physical or verbal) abuse and domination of people¹⁵15. Lopes Neto AA. Bulling: comportamento agressivo entre estudantes. Jornal de Pediatra 2005; 81(5):164-172.. Araújo et al.¹⁶16. Araújo LS, Coutinho MPL, Miranda RS, Saraiva ERA. Universo consensual de adolescentes acerca da violência escolar. Psico-USF 2012; 17(2):243-251. complete this information, indicating that it is a set of aggressive, physical or psychological behavior that also takes place in schools¹⁶16. Araújo LS, Coutinho MPL, Miranda RS, Saraiva ERA. Universo consensual de adolescentes acerca da violência escolar. Psico-USF 2012; 17(2):243-251.. Focusing again on school-related violence, suicide is also a type of violence that affects the adolescent population. It is a type of self-inflicted violence from external causes and has increased in the young population of the Brazilian cities, causing impact in public health¹⁷17. Castro ML, Cunha SS, Souza DPO. Comportamento de violência e fatores associados entre estudantes de Barra do Garças, MT. Rev Saude Publica 2011; 45(6):1054-1061., and may be influenced by the school environment.

While violence already appears as an alarming event, it is essential, in the adolescent population, to know how adolescents suffering some type of violence rate their health. Self-perceived health has been widely used in population-based studies and is itself a useful and simple tool for assessing health conditions that is also portrayed as a safe method¹⁸18. Oliveira CCC, Scheuer CI, Scivoletto S. Alopecia secundária ao uso inibidor seletivo da recaptação da serotonina: relato de dois casos. Rev Bras Psiquiatr 2006; 28(4):339-342.,¹⁹19. Kasmel A, Helasoja V, Lipand A, Prattala R, Klumbiene J, Pudule I. Association between health behaviour and selfreported health in Estonia, Finland, Latvia and Lithuania. Eur J Public Health 2004; 14(1):32-36. and is usually linked to some risk factors or behaviors²⁰20. Meireles AL, Xavier CC, De Souza Andrade AC, Proietti FA, Caiaffa WT. Self-rated health among urban adolescents: The roles of age, gender, and their associated factors. PLoS One 2015; 10(7):1-14.,²¹21. Sousa TFS, Silva KS, Garcia LMT, Del Duca GF, Oliveira ESA, Nahas MV. Autoavalição de saúde e fatores associados em adolescentes do Estado de Santa Catarina, Brasil. Rev Paul Pediatr 2010; 28(4):333-339..In a study conducted in Iran with 3,827 students to evaluate the predictors of self-perceived health, it was possible to observe an association between increased exposure to violence and a negative self-perceived health⁷7. Jacobson LSV, Andrade CLT, Carmo CN, Mourão DS, Hacon SS. Trend in mortality due to external causes in the State of Espírito Santo, Brazil, from 1994 to 2005. Rev Bras Epidemiol 2009; 12(1):82-91.,¹³13. Smith-Khuri E, Iachan R, Scheidt PC, Overpeck MD, Gabhainn SN, Pickett W, Harel Y. A cross-national study of violence-related behaviors in adolescents. Arch Pediatr Adolesc Med 2004; 158(6):539-544.. Given this context, it is plausible that violence that affects Brazilian adolescents so profoundly by interfering in different social, psychological and physical aspects is a crucial determinant of self-perceived health. In this regard, this study aims to verify the association between negative health self-perception and school violence in adolescent students of the city of Olinda (PE), Brazil.

Methods

This is a cross-sectional, descriptive, analytical and school-based study that is part of a larger project, entitled Adolescent healthcare in the public services of Olinda, in which health-related behaviors are evaluated among adolescents. The Human Research Ethics Committee of the University of Pernambuco approved the study, as recommended by CONEP, following Resolution of the National Health Council Nº 466/2012, which addresses human research, safeguarding the ethical principles of justice, beneficence and non-maleficence. Furthermore, this research was approved by the regional education management office – Metropolitana Norte, also providing us with data about the 2016 school census.

The target population of this study was limited to the students of the public high school of the city of Olinda (PE), aged 14-19 years. The following parameters were adopted to calculate the sample: estimated population of 8,319 students; 95% confidence interval; maximum error tolerance of 4%; and sample design effect of 4.0. Because it was a study covering the analysis of multiple risk behaviors and with different frequency of occurrence, the estimated prevalence was defined as 50%.We decided to increase the number of the sample by 20%to reduce the losses (refusals) in the application of the study, arriving at a mean sample target of 2,236 students.

As the municipality of Olinda does not have a territorial division of education, the ten political-administrative health regions were considered for geographical distribution to ensure that students represented the target population, as well as the size of the school and the shift (morning/evening). Schools were ranked according to the number of students enrolled, in small (under 200 students), medium (200-499 students) and large (500⁺ students) schools. All students from the randomized groups were invited to participate in the study.

We used two-stage random sampling stratified by conglomerates to select subjects, and “school” and “class” were the sample units in the first and second stages, respectively. In the first stage, school size was adopted. In the second stage, we considered the number of classes in the schools drawn by study shift (morning/afternoon) and education levels (1^st, 2^nd and 3^rd year of high school).

Regarding data collection, we used an adapted version of the structured and validated questionnaire adapted for this study, built for the adolescent population, namely, the “Youth Risk Behavior Survey” (YRBS), version 2013. The questionnaire was applied in the classroom, without the presence of teachers, to all students who agreed to participate in the study present on the day of collection. The students were accompanied by two duly trained applicators who assisted in clarifying issues and completing the questionnaire. The students were informed that their participation was voluntary and that questionnaires did not contain any personal identification, as well as that they could drop out at any moment of data collection. A consent form was used to obtain parental permission for students under the age of 18 to participate in the study. Also, all the students who participated in the study signed the Informed Consent Form and indicated their agreement to participate in the research.

The dependent variable of this study was the “negative self-perception of health,” which results from the following question: “In general, how do you rate your health?” And the answer is given as follows: Extremely Unhealthy; Not Very Healthy; Healthy; Very Healthy; Extremely Healthy. For purposes of analysis, the alternatives were categorized dichotomously: Positive (Healthy / Very Healthy / Extremely Healthy) and negative (Extremely Unhealthy/Not Very Healthy).

The sociodemographic variables analyzed in this study were: Gender (male/female); (12-15/16-19) and household income (< 1 minimum wage / > 1 minimum wage). Regarding the independent variables, we obtained the categorized questions as follows: feeling of sadness (yes/no); suicidal thoughts (yes/no); lack of safety at school (yes/no); threats at school (yes/no); robbery at school (yes/no); physical fight at school (yes/no) and bullying at school (yes / no).

Data were tabulated in EpiData (version 3.1). The double entry was used to check data entry errors, which, when identified, were corrected based on the original values of the variables. The statistical analyses were performed in the Statistical Package for the Social Sciences (SPSS) version 22.0 for Windows. The differences between the category variables were assessed using Pearson’s chi-square test (χ²2. Marriel LC, Assis SG, Avanci JQ, Oliveira RVC. Violência escolar e autoestima de adolescentes. Cad Pesqui 2006: 36(127):35-50.).Binary stepwise logistic regression was performed to analyze the factors associated with self-perception of health (0: no risk, 1 risk group) that was the dependent variable, and all variables with “p-value” less than 0.25 in the Chi-square test entered the regression model as independent variables. In the final regression model (adjusted model II), gender and age were considered as covariates. Statistical significance was set at α = 0.05.

Results

The final sample of the study consisted of 2,614 adolescents. Of these, 65.6% (n = 1,655) were aged 16-19 years, 55% (n = 1,390) were females and 39.1% (n = 615) had a household income less than or equal to one minimum wage. The prevalence of negative self-perceived health was 26.7% (32.9% for girls and 19.1% for boys p < 0.001). Table 1 shows negative self-perception data associated with other independent variables analyzed in this study.

Negative self-perception of health was associated with gender (p < 0.001), income (p < 0.001), as well as with adolescents who felt sad (p < 0.001); who had already thought of suicide (p < 0.001); who suffered bullying at school (p < 0.001); who do not feel safe at school (p < 0.001) and who have already been robbed at school (p < 0.001). Table 2 shows data from the binary logistic regression, performed with values associated with p < 0.020, and provides us with information from the gross logistic regression, adjusted logistic regression I (using negative self-perceived health adjusted for risk behaviors) and adjusted logistic regression II (that besides risk behaviors used gender and ageas adjustment).

In the crude model, only the independent variable “robbed at school” (p < 0.047) did not remain associated with negative self-perceived health in adolescents. In the adjusted model I, variables “lack of safety at school” and “robbed at school” (p < 0.59) did not remain associated. In the adjusted model II, after inclusion of variables gender and age, they remained associated with variables feeling of sadness, suicidal thought and bullying at school (p < 0.001).

Discussion

This study analyzed the prevalence of negative self-perception of health and its association with school violence in 2,614 adolescents enrolled in high school of public schools in the city of Olinda (PE). The prevalence of negative self-perceived health was 26.7%, and was higher than the prevalence found in national studies²⁰20. Meireles AL, Xavier CC, De Souza Andrade AC, Proietti FA, Caiaffa WT. Self-rated health among urban adolescents: The roles of age, gender, and their associated factors. PLoS One 2015; 10(7):1-14.

21. Sousa TFS, Silva KS, Garcia LMT, Del Duca GF, Oliveira ESA, Nahas MV. Autoavalição de saúde e fatores associados em adolescentes do Estado de Santa Catarina, Brasil. Rev Paul Pediatr 2010; 28(4):333-339.

22. Mendonça G, Cazuza JFJ. Percepção de saúde e fatores associados em adolescentes. Rev. Bras. Atividade Física e Saúde 2012; 17(3):174-180.-²³23. Farias Júnior JC, Lopes ADS, Mota J, Hallal PC. Prática de atividade física e fatores associados em adolescentes no Nordeste do Brasil. Rev Saude Publica 2012; 46(3):505-515., even in studies carried out in the Northeast, such as the study by Mendonça and Cazuza²²22. Mendonça G, Cazuza JFJ. Percepção de saúde e fatores associados em adolescentes. Rev. Bras. Atividade Física e Saúde 2012; 17(3):174-180., which pointed that 15.8% of adolescents of João Pessoa (PB) have a negative self-perception of health.

Regarding gender, negative self-perception of health was higher for females than for males (32.9% versus 19.1% – p < 0.001), a result that is frequently found in other studies²⁰20. Meireles AL, Xavier CC, De Souza Andrade AC, Proietti FA, Caiaffa WT. Self-rated health among urban adolescents: The roles of age, gender, and their associated factors. PLoS One 2015; 10(7):1-14.,²³23. Farias Júnior JC, Lopes ADS, Mota J, Hallal PC. Prática de atividade física e fatores associados em adolescentes no Nordeste do Brasil. Rev Saude Publica 2012; 46(3):505-515.,²⁴24. Spein AR, Pedersen CP, Silviken AC, Melhus M, Kvernmo SE, Bjerregaard P. Self-rated health among Greenlandic Inuit and Norwegian Sami adolescents: associated risk and protective correlates. Int J Circumpolar Health 2013; 72:19793.. One reason for this result is that girls are more sensitive to detect physiological changes and consider habits that are inappropriate for health²⁵25. Meurer LN, Layde PM, Guse CE. Self-rated health status: a new vital sign for primary care? WMJ 2001; 100(7):35-39., and because they are more attentive to health care (for example, periodically performing routine exams) and perceive health more broadly, considering physical, mental, and social aspects²¹21. Sousa TFS, Silva KS, Garcia LMT, Del Duca GF, Oliveira ESA, Nahas MV. Autoavalição de saúde e fatores associados em adolescentes do Estado de Santa Catarina, Brasil. Rev Paul Pediatr 2010; 28(4):333-339..

The literature points to data that disregard the age of adolescents, reporting that older adolescents tend to have a higher percentage of negative self-perception of health when compared to younger adolescents²⁰20. Meireles AL, Xavier CC, De Souza Andrade AC, Proietti FA, Caiaffa WT. Self-rated health among urban adolescents: The roles of age, gender, and their associated factors. PLoS One 2015; 10(7):1-14.,²²22. Mendonça G, Cazuza JFJ. Percepção de saúde e fatores associados em adolescentes. Rev. Bras. Atividade Física e Saúde 2012; 17(3):174-180.,²⁶26. Richter M, Moor I, van Lenthe FJ. Explaining socioeconomic differences in adolescent self-rated health: the contribution of material, psychosocial and behavioural factors. J Epidemiol Community Health 2012; 66(8):691-697.. In this study,this was not different. While it showed a non-significant p-value (p < 0.047), it is important to note that adolescents aged 16-19 years had a higher rate of negative self-perception of health when compared to adolescents aged 12-15 years (28.0% vs. 24.3%). It is believed that, with age, adolescents begin to conceive health as a construct that exceeds the lack of diseases²⁰20. Meireles AL, Xavier CC, De Souza Andrade AC, Proietti FA, Caiaffa WT. Self-rated health among urban adolescents: The roles of age, gender, and their associated factors. PLoS One 2015; 10(7):1-14.,²⁷27. Galán I, Boix R, Medrano MJ, Ramos P, Rivera F, Pastor-Barriuso R, Moreno C. Physical activity and self-reported health status among adolescents: a cross-sectional population-based study. BMJ Open 2013; 3:5..

Adolescents with low household income are more likely to rate their health negatively²⁶26. Richter M, Moor I, van Lenthe FJ. Explaining socioeconomic differences in adolescent self-rated health: the contribution of material, psychosocial and behavioural factors. J Epidemiol Community Health 2012; 66(8):691-697.,²⁸28. Afridi AAK, Motwani K, Khawaja S, Khoja AA, Fatmi Z, Azam I, Kadir MM. Self-perceived health among school going adolescents in Pakistan: influence of individual, parental and life style factors? Glob J Health Sci 2013; 5(4):71-78.. It is known that income is a determining component in greater access to other forms of leisure activities, education, housing and health services. Consequently, higher purchasing power tends to act as a mediator of the perceived health level²¹21. Sousa TFS, Silva KS, Garcia LMT, Del Duca GF, Oliveira ESA, Nahas MV. Autoavalição de saúde e fatores associados em adolescentes do Estado de Santa Catarina, Brasil. Rev Paul Pediatr 2010; 28(4):333-339.. Concerning adolescents in Olinda (PE), those with a monthly household income of up to one minimum wage were shown to be associated with adverse self-perceived health (p < 0.001).

Regarding the behavior of school violence, the consequences of this act can be severe, with a negative reflection on health including overall health²⁹29. Pena GG, Mendes JCL, Silveira AP, Martins TCR, Vieira RG, Silva NSS, Silva RRV. Comportamentos de risco para a saúde de adolescentes da rede pública de ensino. Adolesc. Saude, Rio de Janeiro 2016; 13(1):36-50.. Violent behaviors associated with negative self-perceived health of this study were feeling of sadness; suicidal thoughts; bullying at school; lack of safety at school and robbed at school. Adolescents who claimed to have felt sad in the last 12 months leading to discontinuation of their usual activities were 2.60 times more likely to have a negative self-perception of health than adolescents who did not feel sad in the last 12 months (95% CI 2.15-3.14). High indexes of feelings of sadness in adolescents are also described in other studies¹1. Organização Mundial da Saúde (WHO). World Report on Violence and Health. Geneva: World Health Organization Press; 2002.,²⁹29. Pena GG, Mendes JCL, Silveira AP, Martins TCR, Vieira RG, Silva NSS, Silva RRV. Comportamentos de risco para a saúde de adolescentes da rede pública de ensino. Adolesc. Saude, Rio de Janeiro 2016; 13(1):36-50..

Suicide is increasingly affecting the young population and other people when it occurs at school and has had a massive impact on public health²⁹29. Pena GG, Mendes JCL, Silveira AP, Martins TCR, Vieira RG, Silva NSS, Silva RRV. Comportamentos de risco para a saúde de adolescentes da rede pública de ensino. Adolesc. Saude, Rio de Janeiro 2016; 13(1):36-50.. In their data, Spein et al.²⁴24. Spein AR, Pedersen CP, Silviken AC, Melhus M, Kvernmo SE, Bjerregaard P. Self-rated health among Greenlandic Inuit and Norwegian Sami adolescents: associated risk and protective correlates. Int J Circumpolar Health 2013; 72:19793. showed that adolescents who think about committing suicide are 4.57 times more likely to have a negative self-perception of health (95% CI 2.48-8.44). In our results, adolescents who thought about suicide in the last 12 months were 3.68 times more likely to have a negative self-perception of their health.

Current literature shows little information related to bullying in association with self-perceived health. However, essential data are available addressing the development of health problems in adolescents who suffer from bullying³⁰30. Bandeira CM, Hutz CS. As implicações do bulling na autoestima dos adolescentes. Rev. Semestral Psic. Escolar e Educacional - SP 2010; 14(1):131-138., which has a direct connection with self-assessed health status and adolescent mental health¹1. Organização Mundial da Saúde (WHO). World Report on Violence and Health. Geneva: World Health Organization Press; 2002.. Adolescents who experienced bullying at school showed a prevalence of 20.2% (n = 493) and remained associated with negative self-perception of health p < 0.001 (OR = 1.85, 1.50-2.29). According to Lopes Neto¹⁵15. Lopes Neto AA. Bulling: comportamento agressivo entre estudantes. Jornal de Pediatra 2005; 81(5):164-172., reducing the prevalence of bullying in schools can be a highly effective public health measure for the 21^stcentury.

According to PeNSE data, Malta et al.³¹31. Malta DC, Souza ER, Silva MMA, Silva CDS, Andreazzi MAR, Crespo C, Mascarenhas MDM, Porto DL, Figueroa ALG, Morais Neto OL, Penna GO. Vivência de violência entre escolares brasileiros: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE). Cien Saude Colet 2010; 15(30):53-63. pointed out that 6.4% of adolescents in schools in large Brazilian capitals feel insecure about going to school. School lack of safety results are also portrayed in Montes Claros, with a prevalence of 9.2%²⁹29. Pena GG, Mendes JCL, Silveira AP, Martins TCR, Vieira RG, Silva NSS, Silva RRV. Comportamentos de risco para a saúde de adolescentes da rede pública de ensino. Adolesc. Saude, Rio de Janeiro 2016; 13(1):36-50.. For adolescents from Olinda (PE), 17.1% (N = 430) reported that they feel insecure about being in school because of its lack of safety. These data remained associated with negative self-perception of health p < 0.001.Adolescents robbed at school were 1.63 times more likely to have a negative self-perception of health p < 0.001. The prevalence of being robbed at school was 19.7% (N = 494), which is slightly higher than the study by Pena et al.²⁹29. Pena GG, Mendes JCL, Silveira AP, Martins TCR, Vieira RG, Silva NSS, Silva RRV. Comportamentos de risco para a saúde de adolescentes da rede pública de ensino. Adolesc. Saude, Rio de Janeiro 2016; 13(1):36-50., which had a prevalence of 18.7% of adolescents being robbed at schools in Montes Claros. The sense of inferiority after having been robbed may develop some psychological problems that are harmful to the mental health of adolescents.

Regarding the adjusted analysis of factors of violence associated with adverse self-perceived health in adolescents, variables feeling of sadness, suicidal thoughts and bullying remained associated with our outcome. A particular observation goes for variable “bullying at school,” which showed increased risk from 1.48 to 1.51 (95% CI 1.19-1.91) after adjusting for gender and age.

This study has some limitations: because it is a school-based study, it is not possible to generalize data for all adolescents in the municipality of Olinda (PE). Regarding the cross-sectional design, it is important to note that a causal bias may occur in the responses. It is also emphasized that self-perception of health is the way in which physical health is perceived; other aspects such as self-esteem, pessimism/optimism may interfere in the responses on that occasion. Before hand, this study shows positive points that are worth highlighting. A representative sample of high school adolescents with a wide age range (14-19 years) and different sociodemographic characteristics was used. It should be noted that all methodological procedures were applied ethically, as well as the use of previously tested and validated tools with acceptable levels of reproducibility, implemented by trained people, standing out as yet another strong point of this study.

Conclusion

The association between negative self-perception of health and violent behaviors feeling of sadness, suicidal thoughts, bullying at school, lack of safety at school and robbed at school remained present in our findings. We expect that results of this study will contribute to the understanding of school violence, filling a gap related to the problems that it can cause vis-à-vis adolescents’ self-perception of their health. Data shown here indicate the need for culture and peace actions in adolescence, involving the school environment, so that we may reflect on the analysis of adolescents’ health, thus changing this high level of violence in adolescence, reinforcing the idea that this is not something trivial and expected for this age group.

References

Publication Dates

History