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Original Articles • Rev. Saúde Pública 51 (0) • 2017 • https://doi.org/10.1590/S1518-8787.2017051006709 copy

Health promotion in school environment in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

Evaluate the school environments to which ninth-year students are exposed in Brazil and in the five regions of the country according to health promotion guidelines.

METHODS

Cross-sectional study from 2012, with a representative sample of Brazil and its macroregions. We interviewed ninth-year schoolchildren and managers of public and private schools. We proposed a score of health promotion in the school environment (EPSAE) and estimated the distribution of school members according to this score. Crude and adjusted odds ratios (OR) were used, by ordinal regression, to determine the schoolchildren and schools with higher scores, according to the independent variables.

RESULTS

A student is more likely to attend a school with a higher EPSAE in the South (OR = 2.80; 95%CI 2.67–2.93) if the school is private (OR = 4.52; 95%CI 4.25–4.81) and located in a state capital, as well as if the student is 15 years of age or older, has a paid job, or has parents with higher education.

CONCLUSIONS

The inequalities among the country’s regions and schools are significant, demonstrating the need for resources and actions that promote greater equity.

Adolescent; School Health; Health Promotion; Socioeconomic Factors; Health Inequalities; Social Inequity

Variable	Distribution (%)*	95%CI*
Region of country where school is located
North	7.7	7.5–7.8
Northeast	25.7	25.2–26.1
Southeast	44.8	44.3–45.4
South	14.0	13.8–14.3
Midwest	7.8	7.7–8.0
School in state capital
No	79.4	79.1–79.8
Yes	20.6	20.2–20.9
Educational network
Public	83.5	83.1–83.9
Private	16.5	16.1–16.9
Maternal education
Basic education complete or not	61.2	60.7–61.7
High school education complete or not	25.8	25.4–26.3
Higher education complete or not	13.0	12.7–13.3
Paternal education
Basic education complete or not	67.8	67.4–68.3
High school education complete or not	21.1	20.6–21.5
Higher education complete or not	11.1	10.8–11.4
Age
14 years or less	51.1	50.6–51.6
15 years or more	48.9	48.4–49.4
Self-declared Caucasian
No	63.6	63.1–64.1
Yes	36.4	35.9–36.9
Has paid job
No	88.1	87.7–88.4
Yes	11.9	11.9–12.3

Variable	Brazil		North Region		Northeast Region		Southeast Region		South Region		Midwest Region

	%*	IC95%*	%*	IC95%*	%*	IC95%*	%*	IC95%*	%*	IC95%*	%*	IC95%*
School in violent area
Rarely or never	58.7	58.2–59.2	54.5	53.6–55.3	66.9	66.1–67.7	55.2	54.3–56.1	66.9	66.0–67.9	41.5	40.6–42.3
Sometimes or always	41.3	40.8–41.8	45.6	44.7–46.4	33.1	32.3–33.9	44.8	43.9–45.7	33.1	32.4–34.0	58.5	57.7–59.4
Library?
No	13.3	13.0–13.7	14.2	13.5–14.8	17.5	16.8–18.2	13.4	12.8–14.0	2.1	1.8–2.5	18.5	17.8–19.2
Yes	86.7	86.3–87.0	85.8	85.2–86.5	82.5	81.8–83.2	86.6	86.0–87.2	97.8	97.6–98.1	81.5	80.8–82.8
Video room?
No	41.0	40.5–41.5	50.3	49.4–51.1	49.3	48.5–50.2	32.7	31.8–33.5	43.4	42.3–44.4	48.1	47.2–49.0
Yes	59.0	58.5–59.5	49.7	48.9–50.6	50.7	49.8–51.5	67.3	66.5–68.2	56.6	55.6–57.7	51.9	51.0–52.8
Computer room?
No	11.8	11.5–12.1	20.3	19.5–21.0	17.9	17.2–18.6	7.3	6.8–7.7	8.2	7.6– 8.8	15.8	15.1–16.5
Yes	88.2	87.9–88.5	79.7	79.0–80.5	82.1	81.4–82.8	92.7	92.3–93.2	91.8	91.2–92.4	84.2	83.5–84.9
Internet access at school?
No	24.8	24.3–25.2	36.7	36.0–37.7	31.0	30.2–31.8	22.4	21.7–23.2	10.1	9.5–10.8	30.9	30.0–31.7
Yes	75.2	74.8–75.7	63.1	62.3–64.0	69.0	68.2–69.8	77.6	76.8–78.3	89.8	89.2–90.5	69.1	68.3–70.0
Sports court?
No	21.3	20.9–21.7	25.4	24.6–26.2	51.9	51.1–52.8	7.5	7.0– 7.9	3.8	3.5–4.2	27.4	26.6–28.2
Yes	78.7	79.3–79.1	74.6	73.8–75.4	48.1	47.2–48.9	92.5	92.1–93.0	96.2	95.8–96.5	72.6	71.8–73.4
Usable locker rooms?
No	71.7	71.2–72.1	83.3	82.7–83.9	85.9	85.4–86.4	57.8	56.9–58.7	79.8	79.0–80.7	78.7	78.0–79.3
Yes	28.3	27.9–28.8	16.7	16.1–17.3	14.1	13.6–14.6	42.2	41.3–43.1	20.2	19.3–21.0	21.3	20.7–22.0
Physical activity in courtyard with instructor?
No	47.5	47.0–48.0	49.6	48.8–50.5	54.7	53.8–55.5	45.1	44.2–46.0	44.1	43.1–45.2	42.5	41.7–43.4
Yes	52.5	52.0–53.0	50.4	49.5–51.2	45.3	44.5–46.2	55.0	54.0–55.8	55.9	54.8–56.9	57.5	56.6–58.3
Free after-hours sports?
No	40.0	39.5–40.5	40.7	39.8–41.5	39.9	39.0–40.8	42.0	41.1–42.9	29.5	28.6–30.5	47.0	46.2–47.9
Yes	60.0	59.5–60.5	59.3	58.4–60.2	60.1	59.2–61.0	58.0	57.1–58.9	70.5	69.5–71.4	53.0	52.1–53.8
Council meets once a month or more?
No	68.4	68.0–68.8	65.9	65.1–66.7	69.4	68.7–70.3	76.2	75.4–76.9	56.7	55.7–57.7	43.7	42.8–44.5
Yes	31.6	31.2–32.0	34.1	33.3–34.9	30.5	29.7–31.3	23.8	23.1–24.6	43.3	42.3–44.3	56.3	55.5–57.2
Smoking prohibited?
No	11.0	10.7–11.3	12.0	11.4–12.6	16.9	16.2–17.5	8.8	8.3–9.3	6.7	6.2–7.2	11.3	10.7–11.9
Yes	89.0	88.7–89.3	88.0	87.4–88.6	83.1	82.5–83.8	91.2	90.1–91.7	93.3	92.8–93.8	88.7	88.1–89.3
Smoking inside school?
No	70.7	70.3–71.1	75.1	74.4–75.8	66.8	66.0–67.7	74.6	73.8–75.4	71.1	70.2–72.0	55.8	54.9–56.7
Yes	29.3	28.9–29.7	24.9	24.2–25.6	33.2	32.3–34.0	25.4	24.6–26.2	28.9	28.0–29.8	44.2	43.3–45.1
Access to unhealthy foods?
No	10.0	9.6–10.3	5.4	5.0–5.7	6.3	5.9–6.7	15.8	15.1–16.5	1.4	1.2–1.6	8.6	8.1–9.2
Yes	90.0	89.7–90.4	94.6	94.3–95.0	93.5	93.3–94.1	84.2	83.5–84.9	98.6	98.4–98.8	91.4	91.0–91.9
Access to healthy foods?
No	53.4	52.3–53.9	49.0	48.1–50.0	63.1	62.3–63.9	48.1	47.2–49.0	57.3	56.2–58.3	48.8	48.0–49.7
Yes	46.6	46.1–47.2	51.0	50.1–51.9	36.9	36.1–37.7	51.9	51.0–52.8	42.7	41.7–43.8	51.2	50.3–52.0

Region	EPSAE^a		Structure dimension^a		Process dimension^a

	Mean	DP	Mean	DP	Mean	DP
Brazil	8.35	2.18	4.75	1.54	3.60	1.25
North	7.87^b	2.17	4.24^b	1.54	3.63^b	1.21
Northeast	7.42^b	2.27	4.13^b	1.52	3.29^b	1.39
Southeast	8.84^b	1.98	5.14^b	1.46	3.70^b	1.19
South	8.98^b	1.79	5.19^b	1.14	3.78^b	1.11
Midwest	7.93^b	2.35	4.22^b	1.74	3.71^b	1.23

Variable	Crude analysis*			Adjusted analysis*

	OR	IC95%	p	OR	IC95%	p
Region of the Country			< 0.001			< 0.001
North	1			1
Northeast	0.63	0.61–0.66		0.68	0.65–0.72
Southeast	2.24	2.14–2.34		2.38	2.27–2.49
South	2.43	2.32–2.54		2.80	2.67–2.93
Midwest	1.06	1.02–1.12		1.02	0.97–1.06
Municipal where located			< 0.001			< 0.001
Is not a capital	1			1
Is state capital	1.80	1.74–1.86		1.97	1.90–2.03
Educational network			< 0.001			< 0.001
Public	1			1
Private	5.56	5.26–5.87		4.52	4.25–4.81
Maternal education			< 0.001			< 0.001
Basic education complete or not	1			1
High school education complete or not	1.48	1.42–1.54		1.10	1.05–1.15
Higher education complete or not	2.97	2.81–3.13		1.39	1.30–1.47
Paternal education			< 0.001			< 0.001
Basic education complete or not	1			1
High school education complete or not	1.60	1.53–1.67		1.12	1.06–1.17
Higher education complete or not	3.04	2.87–3.23		1.29	1.21–1.37
Sex			< 0.001			0.521
Female	1			1
Male	1.08	1.04–1.11		1.01	0.98–1.05
Age			< 0.001			< 0.001
Up to 14 years	1			1
15 years or more	1.55	1.50–1.61		1.20	1.16–1.24
Self-declared Caucasian			< 0.001			0.367
No	1			1
Yes	1.51	1.46–1.57		1.02	0.98–1.06
Paid job			0.002			0.022
No	1			1
Yes	0.93	0.88–0.97		1.06	1.01–1.12

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