Prevalence of sexual violence and associated factors among primary school students – Brazil, 2015

Marconi de Jesus Santos Márcio Dênis Medeiros Mascarenhas Deborah Carvalho Malta Cheila Marina Lima Marta Maria Alves da Silva About the authors

Abstract

The objective of this study was to describe and analyze factors associated with sexual violence (SV) among primary school students in Brazil. Data from the National School Health Survey (PeNSE in Portuguese) in 2015 was analyzed. The prevalence of total and disaggregated SV was calculated according to variables such as sociodemographic data, family context, mental health, risk behaviors, safety, and physical activity. The Odds Ratios of suffering SV were estimated according to variables that were statistically associated (p < 0.05) by means of multivariate analysis. The prevalence of SV was 4.0%. SV among school-age adolescents was associated with characteristics such as: age of < 13 years old; female; black skin color; working; being assaulted by family members; having insomnia; feeling lonely; not having friends; consuming tobacco / alcohol regularly; having tried drugs; having started sexual activity; feeling insecure on the way to or at school; and having suffered bullying. Studying in a private school, having a mother with higher education, living with parents, and supervision by relatives were protective factors to SV. It was possible to identify students’ vulnerabilities to SV, which can support researchers, professionals, and families in the prevention of this type of violence.

Key words
Adolescents; School health; Sexual violence; Health survey

Introduction

Sexual violence against adolescents is very common and threatens the health and well-being of millions of young people throughout the world, which represent a significant portion of the population, and should be prioritized in public policies to prevent such harm11. Minayo MCS. Conceito, teorias e tipologias de violência: a violência faz mal a saúde. In: Njaine K, Assis SG, Constantino P, organizadores. Impacto da violência na saúde. Rio de Janeiro: Fiocruz; 2009. p. 21-42.

2. Paludo SS, Schiro EDBD. Um estudo sobre os fatores de risco e proteção associados à violência sexual cometida contra adolescentes e jovens adultos. Estudos de Psicologia 2012; 17(3):397-404.
-33. Justino LCL, Nunes CB, Gerk MAS, Fonseca SSO, Ribeiro AA, Paranhos Filho ACP. Violência sexual contra adolescentes em Campo Grande, Mato Grosso do Sul. Rev Gaúcha Enferm 2015; 36(esp):239-246.. Owing to the importance of the subject, it is paramount to cast an attentive eye on the situations of sexual violence experienced by adolescents in their everyday life, which occur as much in the inter-family sphere as outside of it, such as in school or in the school environment11. Minayo MCS. Conceito, teorias e tipologias de violência: a violência faz mal a saúde. In: Njaine K, Assis SG, Constantino P, organizadores. Impacto da violência na saúde. Rio de Janeiro: Fiocruz; 2009. p. 21-42.,33. Justino LCL, Nunes CB, Gerk MAS, Fonseca SSO, Ribeiro AA, Paranhos Filho ACP. Violência sexual contra adolescentes em Campo Grande, Mato Grosso do Sul. Rev Gaúcha Enferm 2015; 36(esp):239-246.,44. Organização Mundial da Saúde (OMS). Relatório Mundial Sobre a Prevenção da Violência 2014. São Paulo: OMS; 2015..

Among different types of violence55. Dahlberg LL, Krug EG. Violence: a global public health problem. Cien Saude Colet 2006; 11(Supl.):1163-1178.,66. Krug EG, editor. World report on violence and health. Geneva: World Health Organization; 2002., sexual abuse is defined as any unwanted sexual act or attempt to carry one out, undesired sexual commentaries or advances, acts aimed at sexual trafficking or in some way against the sexuality of a person using coercion, practiced by any person independent of their relation to the victim, in any scenario including at home or at work, but not limited to these66. Krug EG, editor. World report on violence and health. Geneva: World Health Organization; 2002..

Not all physical, psychological, and social harm caused by sexual violence against adolescents results in injuries, disability, or death. Thus, its consequences can be immediate or can manifest years after the occurence66. Krug EG, editor. World report on violence and health. Geneva: World Health Organization; 2002.,77. Modin CT, Cardoso TA, Jansen K, Konradt CE, Zaltron RF, Behenck MO, Mattos LD, Silva RA. Sexual violence, mood disorders and suicide risk: a populations-based study. Cien Saude Colet 2016; 21(3):853-860.. Many victims are children or young people who do not know how to protect themselves, while others – in spite of being older – are forced to remain silent and do not seek help due to social pressures or conventions, causing even greater suffering77. Modin CT, Cardoso TA, Jansen K, Konradt CE, Zaltron RF, Behenck MO, Mattos LD, Silva RA. Sexual violence, mood disorders and suicide risk: a populations-based study. Cien Saude Colet 2016; 21(3):853-860.,88. Hébert M, Lavoie F, Blais M. Post Traumatic Stress Disorder/PTSD in adolescent victims of sexual abuse: resilience and social support as protection factors. Cien Saude Colet 2014; 19(3):685-694..

For a long time, sexual violence as a research topic was neglected nearly everywhere in the world66. Krug EG, editor. World report on violence and health. Geneva: World Health Organization; 2002.. However, since its effects disrupted the life of people across a long time period, the topic came to be investigated in recent times as a public health problem on a grand scale. It is known that in addition to physical harm, it can lead to inappropriate consumption of alcohol and other drugs, depression, suicide, dropping out of school, unemployment, and recurring difficulties with relationships55. Dahlberg LL, Krug EG. Violence: a global public health problem. Cien Saude Colet 2006; 11(Supl.):1163-1178.

6. Krug EG, editor. World report on violence and health. Geneva: World Health Organization; 2002.

7. Modin CT, Cardoso TA, Jansen K, Konradt CE, Zaltron RF, Behenck MO, Mattos LD, Silva RA. Sexual violence, mood disorders and suicide risk: a populations-based study. Cien Saude Colet 2016; 21(3):853-860.

8. Hébert M, Lavoie F, Blais M. Post Traumatic Stress Disorder/PTSD in adolescent victims of sexual abuse: resilience and social support as protection factors. Cien Saude Colet 2014; 19(3):685-694.
-99. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Hawkins J, Queen B, Lowry R, Olsen EO, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, Zaza S. Youth Risk Behavior Surveillance-United States, 2015. MMWR Surveill Summ 2016; 65(6):1-174..

Studies that evaluate the prevalence of sexual abuse among school-aged adolescents are still in short supply. One study recently carried out in the United States indicated that 6.7% of students reported being forced to have sexual relations against their will, with greater frequency among girls (10.3%) compared to boys (3.1%)99. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Hawkins J, Queen B, Lowry R, Olsen EO, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, Zaza S. Youth Risk Behavior Surveillance-United States, 2015. MMWR Surveill Summ 2016; 65(6):1-174.. In a study done with 6,709 public school students in ten Brazilian capital cities, 1.6% of adolescents interviewed affirmed they have suffered sexual violence inside of school, and 5.6% stated knowledge of sexual violence that occurred in the school environment1010. Abramovay M, Castro MG, Silva AP, Cerqueira L. Diagnóstico participativo das violências nas escolas: falam os jovens. Brasília: FLACSO – Brasil, MEC; 2016.. It is known that exposure to health risk factors is much greater in the adolescent phase, a period of life that shows an association of multiple factors that strengthen and mutually reinforce the phenomenon of sexual violence66. Krug EG, editor. World report on violence and health. Geneva: World Health Organization; 2002.,1111. Ribeiro IMP, Ribeiro AST, Pratese R, Gondolf L. Prevalência das várias formas de violência entre escolares. Acta Paul Enferm 2015; 28(1):54-59.,1212. Oliveira JR, Costa COM, Amaral MRT, Santos CA, Assis SG, Nascimento OC. Violência sexual e concorrências em crianças e adolescentes: estudo das incidências ao longo de uma década. Cien Saude Colet 2014; 19(3):759-771..

Faced with the absence of statistics on a national scale regarding sexual abuse among school-aged adolescents, the National School Health Survey (‘Pesquisa Nacional de Saúde do Escolar’ or PeNSE) included the theme of sexual violence in their 2015 publication. with the intention of better understanding this serious problem, as well as to furnish data for the planning of strategies to confront it. Thus, this article has the aim of describing the prevalence of sexual violence among school-aged adolescents, and of identifying factors associated with this phenomenon.

Methodology

This was a cross-sectional study, with data from the National School Health Survey (PeNSE) conducted in 2015. PeNSE investigated issues concerning socioeconomic aspects; family situation; physical activity; experimentation with and consumption of alcohol, tobacco, and other drugs; mental and sexual health; and safety, among other topics. The study's population encompassed students between 13 and 17 years of age attending the 9th year of primary schooling, as the World Health Organization (WHO) considers this age range as a reference for carrying out surveys with students, and because in Brazil this grade concentrates more than 80% of students from 13 to 15 years old1313. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar, 2015. Rio de Janeiro: IBGE; 2016..

The sample was comprised of students enrolled in the 9th grade of primary education in the school year of 2015, and regularly attending public and private schools in the urban and rural areas, designed to estimate the population parameters (proportions or prevalence) in different geographic domains. These were the 26 municipalities of the capital cities and the Federal District (DF), the 26 federative units or states, and the five greater regions of Brazil, totaling 53 strata.

In each of the 53 strata, a sample of schools was identified and chosen. Following this, a sample of the classes of each school was selected, obtaining an independent sample of students in each of the strata. In these geographic strata, 207 allocation strata were created with probabilities proportional to the size of the school. The size of the sample of each geographic stratum was calculated to furnish estimates of the proportions of some characteristics of interest, with a maximum sample error of approximately 3% and confidence level of 95%. The sample was comprised of 675 municipalities, 3160 schools, and 4159 classes. The researchers administered 102,301 questionnaires, and 102,072 of these were validated and analyzed.

Data collection was carried out between April and September of 2015, using smartphones in which the structured questionnaires were inserted and self-administered. The data was collected in the schools during the students’ class time.

Data on the prevalence of sexual violence was obtained via the question: “Have you been forced to have sexual relations at some time in your life?” (Analyzed categories: Yes. No). In addition to estimating the prevalence of sexual violence in the studied population, associations of this phenomenon with other variables were identified, such as sociodemographic aspects, family situation, mental health, risk behavior, safety, and the practice of physical activity.

The prevalence of sexual violence was initially calculated with its respective confidence intervals of 95% (CI95%). To verify these associated factors, bivariate analyses were carried out with estimates of the Odds Ratio (OR) and its respective CI95% to the significance level of 0.05. Following this, a multivariate analysis was conducted for an outcome inserted into the model of independent variables that presented association with the outcomes at a significance level inferior to 0.20, calculating the adjusted ORs (ORa) and its respective CI95%. All of the analyses were done in the program SPSS version 2.0, utilizing procedures of the Complex Samples Modules, suitable for analysis of data obtained by a complex sampling plan.

The study was approved by the National Committee on Research Ethics (‘Comissão Nacional de Ética em Pesquisa’, or CONEP), and by the National Health Council (‘Conselho Nacional de Saúde’, or CNS), which oversees and approves health research involving human beings, by Decision Number 1.006.467 of March 30. 2015.

Findings

As seen in Table 1, it is possible to identify the prevalence of sexual violence among students of the 9th grade of primary education in Brazil in 2015, and its association with the aspects explored in this analysis. The total prevalence of sexual violence was 4.0%, and was higher among students < 13 years old and 16 or older. The significantly highest rates of sexual violence were observed among female students of black skin color in public schools, who were children of mothers without schooling. Sexual violence was reported in greater proportions among students that did not live with their mother and/or father, and among those that worked and received remuneration for their work (Table 1).

Table 1
Prevalence of sexual violence among students of the 9th year of primary school and raw OR, according to sociodemographic aspects and variables of family context, mental health, risk behaviors, safety, and physical activity. Brazil, 2015.

Regarding the family context, reporting of sexual violence was greater among students that missed classes, were unsupervised by family members, and among those physically assaulted by a relative. Sexual violence was most frequent among students that reported insomnia, feeling alone, and not having friends. This type of violence was most reported among students with risk behaviors such as smoking, alcohol consumption, experimentation with drugs, and having begun their sexual life. The chances of suffering sexual violence were greater for students that felt unsafe in the route between school and their home and in the school itself, as well as those that reported having suffered bullying. There was no difference according to amount of physical exercise or activity (Table 1).

Drawing on the calculation of the raw OR (Table 1) and the multivariate analysis with adjusted OR for all the variables in the model (Table 2), we verified that the chance of suffering sexual violence was greatest among female students with <13 years of age. Other risk factors for sexual violence were also identified, such as having black skin, being a child of a mother without education, working, and being assaulted by family members. In the mental health context, the chance to suffer sexual violence was greater for students that reported insomnia, and among those that related feeling alone or not having friends. Regular consumption of tobacco and alcohol, experimentation with drugs, and the beginning of sexual activity were confirmed as risk factors for sexual violence. The chances of suffering sexual violence were greater for students that felt unsafe on the route between home and school and in the school itself, as well as those that reported having suffered bullying (Table 2).

Table 2
Risk factors associated with sexual violence among students in the 9th year of primary school. Brazil, 2015.

Associated and protective factors in relation to the occurrence of sexual violence included studying in a private school, being the child of a mother with a high education level, living with their mother and/or father, and having family supervision (Table 2).

Discussion

Any person can experience sexual violence, independent of socioeconomic condition, skin color, or culture22. Paludo SS, Schiro EDBD. Um estudo sobre os fatores de risco e proteção associados à violência sexual cometida contra adolescentes e jovens adultos. Estudos de Psicologia 2012; 17(3):397-404.,1414. Trindade LC, Linhares SM, Vanrell J, Godoy DCA, Martins J, Barbas SM. Sexual violence against children and vulnerability. Rev Assoc Med Bras 2014; 60(1):70-74.. Nevertheless, some factors can be associated with the vulnerability of adolescents to this type of violence. The findings of this study show that female adolescents younger than 13 years old, of black skin color, who engage in remunerated work present a greater chance of being victims of sexual violence. However, studying in private schools and having a mother with a high level of education are shown to be protective factors.

The relation between suffering violence and age demonstrates that children under 13 are more vulnerable to victimization. This can be related to the issue of not knowing how to react during such a situation, lack of maturity, not really understanding what is happening, shame, and fear of the aggressor, aspects that are confirmed by other studies66. Krug EG, editor. World report on violence and health. Geneva: World Health Organization; 2002.,1515. Lugão KV, Gonçalves GE, Gomes JM, Silva VP, Jacobson LSV, Cardoso CAA. Abuso sexual crônico: estudos de uma série de casos ocorridos na infância e na adolescência. DST – J Bras Doenças Sex Transm 2012; 24(3):179-182..

In accord with other research1212. Oliveira JR, Costa COM, Amaral MRT, Santos CA, Assis SG, Nascimento OC. Violência sexual e concorrências em crianças e adolescentes: estudo das incidências ao longo de uma década. Cien Saude Colet 2014; 19(3):759-771.,1515. Lugão KV, Gonçalves GE, Gomes JM, Silva VP, Jacobson LSV, Cardoso CAA. Abuso sexual crônico: estudos de uma série de casos ocorridos na infância e na adolescência. DST – J Bras Doenças Sex Transm 2012; 24(3):179-182.

16. Assis SG, Gomes R, Oliveira TP. Adolescência, comportamento sexual e fatores de risco à saúde. Rev Saude Publica 2014; 48(1):43-51.

17. Facuri, CO, Fernandes AMDS, Oliveira K D, Andrade TDS, Azevedo RCSD et al. Violência sexual: estudo descritivo sobre as vítimas e o atendimento em um serviço universitário de referência no Estado de São Paulo, Brasil. Cad Saúde Pública 2013; 29(5):889-898.
-1818. Lima CA, Deslandes SF. Violência sexual contra mulheres no Brasil: conquistas e desafios do setor saúde na década de 2000. Saúde Soc 2014; 23(3):787-800., the greater prevalence of sexual violence in females can be explained by cultural factors that, across time, place women in situations of abuse and degradation, a condition perpetuated in society. On the other hand, records of sexual violence among male adolescents can appear lesser in proportion to females owing to embarrassment, fear, stereotypes, and shame of the parents and of society. This was demonstrated in a study on the vulnerability of adolescence in which 3% of boys reported having suffered sexual violence, but only 33% of those searched for assistance in the health sector33. Justino LCL, Nunes CB, Gerk MAS, Fonseca SSO, Ribeiro AA, Paranhos Filho ACP. Violência sexual contra adolescentes em Campo Grande, Mato Grosso do Sul. Rev Gaúcha Enferm 2015; 36(esp):239-246..

Adolescents that work are more vulnerable to risk factors such as using alcohol and other drugs, having sexual relations1919. Giatti L, Campos MO, Crespo CD, Andrade SSCDA, Barreto SM. Labor in early life, vulnerability for health in Brazilian schoolchildren: National Adolescent School-based Health Survey (PeNSE 2012). Rev Bras Epidemiol 2014; 17(Supl. 1):17-30., as well as suffering sexual violence, as indicated in this study. The greater the intensity of the work, the more time young people spend in activities considered at risk for sexual violence1919. Giatti L, Campos MO, Crespo CD, Andrade SSCDA, Barreto SM. Labor in early life, vulnerability for health in Brazilian schoolchildren: National Adolescent School-based Health Survey (PeNSE 2012). Rev Bras Epidemiol 2014; 17(Supl. 1):17-30..

Suffering harm by family members and missing classes without parental permission is associated with suffering sexual violence, while living with a mother or father and receiving family supervision are considered protective factors. In this sense, some studies1414. Trindade LC, Linhares SM, Vanrell J, Godoy DCA, Martins J, Barbas SM. Sexual violence against children and vulnerability. Rev Assoc Med Bras 2014; 60(1):70-74.,2020. Justino LCL, Ferreira SRP, Nunes CB, Barbosa MAM, Gerk MADS, Freitas SLFD. Violência sexual contra adolescentes: notificações nos conselhos tutelares, Campo Grande, Mato Grosso do Sul, Brasil. Rev Gaúcha Enferm 2011; 32(4):781-787. emphasize the fact the children accompanied by their parents are less susceptible to suffering various types of violence. Other studies22. Paludo SS, Schiro EDBD. Um estudo sobre os fatores de risco e proteção associados à violência sexual cometida contra adolescentes e jovens adultos. Estudos de Psicologia 2012; 17(3):397-404.,2121. 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.,2222. Zappe JG, Dell Aglio DD. Variáveis pessoais e contextuais associadas a comportamentos de risco em adolescentes. J Bras Psiquiatr 2016; 65(1);44-52. demonstrate that sexual violence against adolescents is more likely to occur in a family context of negligence, with a prevalence of authoritarian parental styles, relations of subordination between family members, and carried out by persons close to the victim. The results presented here confirm this perspective and show the importance of healthy familial relationships.

Among the mental health variables, adolescents that feel alone, have insomnia, and do not have friends present the greatest chance of suffering sexual violence. Studies22. Paludo SS, Schiro EDBD. Um estudo sobre os fatores de risco e proteção associados à violência sexual cometida contra adolescentes e jovens adultos. Estudos de Psicologia 2012; 17(3):397-404.,2121. 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.,2222. Zappe JG, Dell Aglio DD. Variáveis pessoais e contextuais associadas a comportamentos de risco em adolescentes. J Bras Psiquiatr 2016; 65(1);44-52. report that a good mood, joy, happiness and satisfaction with life are characteristics with a positive effect for mental health and, therefore, allow for less exposure to situations of tension and violence, diminishing risks of involvement in circumstances favorable to violence. Hence, if the family protects the adolescent, their development will be complete and healthy. Family relations have importance in the mental health of students, and the influence on the psychological, emotional, and interpersonal relations of adolescents.

In relation to risk behaviors, the regular use of alcohol, drug experimentation, and the practice of sexual relations are also associated with sexual violence. The literature77. Modin CT, Cardoso TA, Jansen K, Konradt CE, Zaltron RF, Behenck MO, Mattos LD, Silva RA. Sexual violence, mood disorders and suicide risk: a populations-based study. Cien Saude Colet 2016; 21(3):853-860. indicates a strong association between sexual abuse and episodes of depression. Various psycho-social consequences can be related to sexual abuse in the long turn, such as psychological disorders including depression, suicidal ideation, anxiety disorders, and post-traumatic stress disorder (PTSD), as well as problems of physical health and sexual risk77. Modin CT, Cardoso TA, Jansen K, Konradt CE, Zaltron RF, Behenck MO, Mattos LD, Silva RA. Sexual violence, mood disorders and suicide risk: a populations-based study. Cien Saude Colet 2016; 21(3):853-860.,88. Hébert M, Lavoie F, Blais M. Post Traumatic Stress Disorder/PTSD in adolescent victims of sexual abuse: resilience and social support as protection factors. Cien Saude Colet 2014; 19(3):685-694.,2323. Sasaki RSA, Leles CR, Malta DC, Sardinha LMV, Freire MDCM. Prevalência de relação sexual e fatores associados em adolescentes escolares de Goiânia, Goiás, Brasil. Cien Saude Colet 2015; 20(1):95-104.. Maternal and parental support contributed to the diminishing of PTSD88. Hébert M, Lavoie F, Blais M. Post Traumatic Stress Disorder/PTSD in adolescent victims of sexual abuse: resilience and social support as protection factors. Cien Saude Colet 2014; 19(3):685-694.. In one study2424. Malta DC, Mascarenhas MDM, Porto DL, Barreto SM, Morais Neto OLD. Exposição ao álcool entre escolares e fatores associados. Rev Saude Publica 2014; 48(1):52-62. on the consumption of alcohol among adolescents, it was proven that its regular use makes the individual vulnerable to being a victim of various types of violence, among them sexual violence22. Paludo SS, Schiro EDBD. Um estudo sobre os fatores de risco e proteção associados à violência sexual cometida contra adolescentes e jovens adultos. Estudos de Psicologia 2012; 17(3):397-404.,2121. 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.,2323. Sasaki RSA, Leles CR, Malta DC, Sardinha LMV, Freire MDCM. Prevalência de relação sexual e fatores associados em adolescentes escolares de Goiânia, Goiás, Brasil. Cien Saude Colet 2015; 20(1):95-104., corroborating the findings of this study.

The variables of feeling unsafe on the route between the home and school, feeling unsafe in the school itself, and having suffered bullying demonstrated association with sexual violence. Bullying that commonly occurs in the school and its environment can push away students, provoking skipping or dropping out of school, or creating fragile links with the school. This increases the risk of involvement in situations of sexual violence among already persecuted or emotionally fragile young people1010. Abramovay M, Castro MG, Silva AP, Cerqueira L. Diagnóstico participativo das violências nas escolas: falam os jovens. Brasília: FLACSO – Brasil, MEC; 2016.,2121. 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..

Available evidence shows that children and adolescents who are victims of sexual violence face more health problems, incur significantly higher costs in healthcare, visit health services for consultations more times during their life, and are hospitalized more frequently and for longer durations than those that have not suffered sexual violence44. Organização Mundial da Saúde (OMS). Relatório Mundial Sobre a Prevenção da Violência 2014. São Paulo: OMS; 2015..

Economic inequality, abuse of alcohol, and inappropriate parental practices increase the probability of interpersonal violence, which includes sexual violence. Adolescents that suffer this type of violence are exposed to greater risk of involvement in aggressive and antisocial behavior in their adult life44. Organização Mundial da Saúde (OMS). Relatório Mundial Sobre a Prevenção da Violência 2014. São Paulo: OMS; 2015..

The offering of high quality services for the attendance and support of victims is important to reduce trauma, aid in recovering, and prevent new acts of sexual violence. Any broad strategy of violence prevention must identify means to attenuate these risks, or offer protection against them, including via public policies and specific services2525. Kappel VB, Gontijo DT, Medeiros M, Monteiro EMLM. Enfrentamento da violência no ambiente escolar na perspectiva dos diferentes atores. Interface (Botucatu) 2014; 18(51):723-735..

To reduce the vulnerability of young people in relation to sexual violence, strategies must be developed, such as fostering safe, stable, and protective relationships between children and young people and their parents and caretakers. Strategies can also be pursued that develop life skills in children and adolescents; reduce the availability and the harmful use of alcohol; promote gender equality; change cultural and societal norms that support violence; and create programs for serving victims, including their identification and care44. Organização Mundial da Saúde (OMS). Relatório Mundial Sobre a Prevenção da Violência 2014. São Paulo: OMS; 2015..

Conclusion

The results of this study indicate that sexual violence among school-aged adolescents is associated with individual characteristics such as: age <13 and ≥16 years, female sex, black skin, working, being harmed by relatives, having insomnia, feeling alone, not having friends, regular tobacco and alcohol consumption, having experimented with drugs and sexual relations, feeling unsafe on the route between school and home as well as in the school itself, and to have suffered bullying. Such associations can help professionals in health, safety, and education, as well as the parents and community as they seek measures to confront the prevention of this type of violence.

It is hoped that the data can serve as a base of support for the strengthening of public policies regarding sexual violence, in light of the fact that they offer indicators that can contribute for the development of inter-sectorial and interdisciplinary actions. We emphasize the need for further studies for a better understanding of the complexity of the phenomenon of sexual violence.

References

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    Minayo MCS. Conceito, teorias e tipologias de violência: a violência faz mal a saúde. In: Njaine K, Assis SG, Constantino P, organizadores. Impacto da violência na saúde Rio de Janeiro: Fiocruz; 2009. p. 21-42.
  • 2
    Paludo SS, Schiro EDBD. Um estudo sobre os fatores de risco e proteção associados à violência sexual cometida contra adolescentes e jovens adultos. Estudos de Psicologia 2012; 17(3):397-404.
  • 3
    Justino LCL, Nunes CB, Gerk MAS, Fonseca SSO, Ribeiro AA, Paranhos Filho ACP. Violência sexual contra adolescentes em Campo Grande, Mato Grosso do Sul. Rev Gaúcha Enferm 2015; 36(esp):239-246.
  • 4
    Organização Mundial da Saúde (OMS). Relatório Mundial Sobre a Prevenção da Violência 2014 São Paulo: OMS; 2015.
  • 5
    Dahlberg LL, Krug EG. Violence: a global public health problem. Cien Saude Colet 2006; 11(Supl.):1163-1178.
  • 6
    Krug EG, editor. World report on violence and health Geneva: World Health Organization; 2002.
  • 7
    Modin CT, Cardoso TA, Jansen K, Konradt CE, Zaltron RF, Behenck MO, Mattos LD, Silva RA. Sexual violence, mood disorders and suicide risk: a populations-based study. Cien Saude Colet 2016; 21(3):853-860.
  • 8
    Hébert M, Lavoie F, Blais M. Post Traumatic Stress Disorder/PTSD in adolescent victims of sexual abuse: resilience and social support as protection factors. Cien Saude Colet 2014; 19(3):685-694.
  • 9
    Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Hawkins J, Queen B, Lowry R, Olsen EO, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, Zaza S. Youth Risk Behavior Surveillance-United States, 2015. MMWR Surveill Summ 2016; 65(6):1-174.
  • 10
    Abramovay M, Castro MG, Silva AP, Cerqueira L. Diagnóstico participativo das violências nas escolas: falam os jovens Brasília: FLACSO – Brasil, MEC; 2016.
  • 11
    Ribeiro IMP, Ribeiro AST, Pratese R, Gondolf L. Prevalência das várias formas de violência entre escolares. Acta Paul Enferm 2015; 28(1):54-59.
  • 12
    Oliveira JR, Costa COM, Amaral MRT, Santos CA, Assis SG, Nascimento OC. Violência sexual e concorrências em crianças e adolescentes: estudo das incidências ao longo de uma década. Cien Saude Colet 2014; 19(3):759-771.
  • 13
    Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar, 2015 Rio de Janeiro: IBGE; 2016.
  • 14
    Trindade LC, Linhares SM, Vanrell J, Godoy DCA, Martins J, Barbas SM. Sexual violence against children and vulnerability. Rev Assoc Med Bras 2014; 60(1):70-74.
  • 15
    Lugão KV, Gonçalves GE, Gomes JM, Silva VP, Jacobson LSV, Cardoso CAA. Abuso sexual crônico: estudos de uma série de casos ocorridos na infância e na adolescência. DST – J Bras Doenças Sex Transm 2012; 24(3):179-182.
  • 16
    Assis SG, Gomes R, Oliveira TP. Adolescência, comportamento sexual e fatores de risco à saúde. Rev Saude Publica 2014; 48(1):43-51.
  • 17
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History

  • Received
    28 May 2017
  • Reviewed
    10 June 2017
  • Accepted
    12 June 2017
  • Publication
    Feb 2019
ABRASCO - Associação Brasileira de Saúde Coletiva Rio de Janeiro - RJ - Brazil
E-mail: revscol@fiocruz.br