Ambiente escolar promotor de saúde, qualidade educacional e saúde bucal de adolescentes das capitais brasileiras: estudo com base na Pesquisa Nacional de Saúde do Escolar (PeNSE 2015)

• Ano de defesa: 2020
• Autor(a) principal: Nery, Newillames Gonçalves
• Orientador(a): Freire, Maria do Carmo Matias
• Banca de defesa: Freire, Maria do Carmo Matias, Costa, Luciane Ribeiro de Rezende Sucasas da, Novais, Tatiana Oliveira, Weiss, Veruska Prado Alexandre, Faria, Patrícia Corrêa de
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Goiás
• Programa de Pós-Graduação: Programa de Pós-graduação em Odontologia (FO)
• Departamento: Faculdade de Odontologia - FO (RMG)
• País: Brasil
• Palavras-chave em Português: Saúde bucal; Saúde do adolescente; Saúde escolar; Determinantes sociais da saúde; Promoção da saúde
• Palavras-chave em Inglês: Oral health; Adolescent health; School health; Social determinants of health; Health promotion
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::ODONTOLOGIA
• Link de acesso: http://repositorio.bc.ufg.br/tede/handle/tede/13262

Evidence about the influence of contextual factors of schools and municipalities on the oral health of adolescents is scarce, with important gaps in relation to the school environment. The aim of this study was to investigate associations between the potential support of schools for oral health promotion, the educational quality of the school and oral health outcomes among adolescents in the Brazilian State Capitals. The study was cross-sectional, with individual and aggregated approaches. Data were obtained from the Brazilian National Adolescent School-Based Health Survey (PeNSE) and the Basic Education Development Index (IDEB), conducted in 2015, in addition to other secondary sources. The individual variables referred to students in the 9th grade of elementary schools: sociodemographic, prevalence of dental pain and oral health-related behaviours (frequencies of dental visits, toothbrushing, and soft drinks and sweets consumption, cigarette and alcoholic beverages experimentation). The contextual variables were related to schools, Brazilian capitals and regions (educational quality of the school – measured by IDEB, Human Development Index - HDI and Gini Index). The analyses were carried out in three steps. In step 1, the Oral Health Promoting School Environment (OHPSE) indicator was obtained using the Categorical Principal Components Analysis (CATPCA), to measure the potential support of school environment for oral health promotion in public and private schools of the capitals. Bivariate associations (Chi-square test) between OHPSE and contextual variables were verified. In step 2, associations between OHPSE (explanatory variable) and dental pain and oral health-related behaviours (outcome variables) were tested in two-level multi-level mixed-effects Poisson regression. And in step 3, with data aggregated by capitals, associations were verified between IDEB and the outcomes: the OHPSE indicator and its dimensions (in public schools), dental pain and oral health-related risk behaviours. In all steps, the level of significance was 5%. The results were: Step 1 - There was a higher frequency of schools with higher OHPSE in the public schools (58.1%), and in regions and capitals with a lower Gini Index (52.8% / 55.7%) and higher HDI (57.4% / 61.0%), respectively. Step 2 - In the adjusted model, private and public schools with higher OHPSE had 6%, 6% and 4% lower prevalence rates of a “low frequency of annual dental visits” [PR = 0.94 (95%CI 0.90; 0.99)], “high weekly soft drinks consumption” [PR = 0.94 (95%CI 0.89; 0.99)] and “high weekly sweets consumption” [PR = 0.96 (95%CI 0.93; 1.00)], respectively. Schools with intermediate OHPSE had 12% and 8% higher prevalence ratios of a “low daily toothbrushing frequency” [PR = 1.12 (95%CI 1.03; 1.23)] and “cigarette experimentation” [PR = 1.08 (95%CI 1.01; 1.16)]. OHPSE was not associated with dental pain and "alcoholic beverages experimentation". Step 3: IDEB correlated with the OHPSE dimension referred to within-school aspects, with “low daily toothbrushing frequency” and with “low frequency of annual dental visits”. In the adjusted regression model, capitals with the higher IDEB were associated with “low daily toothbrushing frequency” [B = 1.560 (95% CI 0.360; 2.760), p = 0.013; β = 0.519]. It was concluded that were associations between the potential support of school environment for oral health promotion and some oral health outcomes of adolescents in the Brazilian capitals. Higher potentials for oral health promotion (in private and public schools) were related to more favorable behaviours regarding dental visits and consumption of food with added sugars, and less favorable for toothbrushing frequency and cigarette experimentation, while better educational quality (in public schools) was related to low toothbrushing frequency among adolescents. Inequalities among schools regarding oral health promotion were also found, indicating the need to reorient public policies for the oral health of schoolchildren.