Implementação do Programa Saúde na Escola: relação com aspectos da saúde bucal dos estudantes / Implementation of the School Health Program: relationship with aspects of students' oral health

RESUMO O estudo objetivou investigar a associação entre a implementação do Programa Saúde na Escola (PSE) e aspectos relacionados com a saúde bucal de adolescentes escolares que frequentam escolas públicas no Brasil. Foi realizado estudo transversal exploratório utilizando dados da Pesquisa Nacional de Saúde Escolar (PeNSE) 2015 em uma amostra de 81.154 estudantes de 13 a 15 anos frequentando escolas públicas das capitais, Distrito Federal e interior. Os dados foram obtidos por meio de questionários respondidos pelos alunos e responsáveis pelas escolas. Foi realizada análise bivariada de associação entre a variável 'implementação das ações do PSE pela escola' (Sim/Não) e aspectos relativos à saúde bucal dos estudantes. Em comparação com escolas sem implementação do PSE, as que haviam implementado o Programa apresentavam melhores indicadores de comportamento (consumo de alimentos com açúcar adicionado, cigarro e álcool); venda de alimentos saudáveis ou com açúcar adicionado; existência de grupo/comitê de saúde, ações do Programa Mais Educação e ações em conjunto com a Unidade Básica de Saúde (p<0,05). Concluiu-se que houve associação entre a implementação do PSE e aspectos mais favoráveis relacionados com a saúde bucal, referentes a alimentação, uso de cigarro e álcool entre os escolares, e ações de saúde e educação nas escolas.

ABSTRACT This study aimed to investigate the association between the School Health Program (PSE) implementation and aspects related to the oral health of adolescent students attending public schools in Brazil. An exploratory cross-sectional study was conducted using data from the 2015 National School Health Survey (PeNSE) in a sample of 81,154 students aged 13 to 15 in the capitals, Federal District, and inland cities. Data were retrieved from questionnaires answered by students and those responsible for the schools. We performed a bivariate analysis of the association between the variable 'implementation of PSE actions by the school' (Yes/No) and aspects related to the students' oral health. Compared to schools without PSE implementation, those that had implemented the Program had better behavioral indicators (consumption of sugar-added foods, cigarettes, and alcohol); selling healthy or sugar-added foods; availability of a health group/committee, and actions of the More Education Program and with Primary Health Care Units (p<0.05). We concluded that there was an association between the implementation of the PSE and more favorable aspects related to oral health regarding the students' diet, tobacco use, and alcohol consumption, and school health and education actions.

Educational quality and oral health promotion in Brazilian schools: a multilevel analysis of national data

Abstract: The aim of this study was to investigate whether educational quality is associated with schools' potential support for oral health promotion in Brazil, using a multilevel model. An ecological study was carried out using data from 940 public schools (school level) from the 27 Brazilian state capitals (city-level). The explanatory variable was educational quality, measured by the Basic Education Development Index (IDEB) for each city, and the four dependent variables referred to the Oral Health Promotion School Environment (OHPSE) indicator and its dimensions: Dimension 1 (In-school aspects), Dimension 2 (Aspects of the school surroundings), and Dimension 3 (Prohibitive policies at school). The OHPSE was developed using categorical principal components analysis (CATPCA) of data from the 2015 National Adolescent School-Based Health Survey (PeNSE). Covariates were human development index and oral health care coverage of cities. Multilevel Poisson regression models with robust variance were undertaken (p < 0.05). Bivariate associations were found between the IDEB and each Total OHPSE and OHPSE-Dimension 1 (In-school aspects: sale of foods with added sugar and health promotion actions/programs). After adjustment, IDEB (PR: 1.38, 95%CI: 1.01-1.90; p = 0.045) and oral health care coverage (PR: 1.01; 95%CI: 1.00-1.02; p = 0.001) remained associated with the OHPSE Dimension 1. It was concluded that educational quality measured by the IDEB was associated with schools' potential support for oral health promotion regarding the sale of foods with added sugar and health promotion actions/programs in schools.

School environment and oral health promotion: the National Survey of School Health (PeNSE) / Ambiente escolar e promoção de saúde bucal: a Pesquisa Nacional de Saúde do Escolar (PeNSE)

ABSTRACT OBJECTIVE To evaluate the potential support of schools for oral health promotion and associated factors in Brazilian capitals. METHODS Data from 1,339 public and private schools of the 27 Brazilian capitals were obtained from the National Survey of School Health (PeNSE) 2015. Data from the capitals were obtained from the United Nations Development Program and the Department of Informatics of the Brazilian Unified Health System (Datasus). The indicator " ambiente escolar promotor de saúde bucal " (AEPSB - oral health promoting school environment) was designed from 21 variables of the school environment with possible influence on students' oral health employing the categorical principal components analysis (CATPCA). Associations between the AEPSB and characteristics of schools, capitals and regions were tested (bivariate analysis). RESULTS Ten variables comprised CAPTCA, after excluding those with low correlation or high multicollinearity. The analysis resulted in a model with three dimensions: D1. Within-school aspects (sales of food with added sugar in the canteen and health promotion actions), D2. Aspects of the area around the school (sales of food with added sugar in alternative points) and D3. prohibitive policies at school (prohibition of alcohol and tobacco consumption). The sum of the scores of the dimensions generated the AEPSB indicator, dichotomized by the median. From the total of schools studied, 51.2% (95%CI 48.5-53.8) presented a more favorable environment for oral health (higher AEPSB). In the capitals, this percentage ranged from 36.6% (95%CI 23.4-52.2) in Rio Branco to 80.4% (95%CI 67.2-89.1) in Florianópolis. Among the Brazilian regions, it ranged from 45.5% (95%CI 40.0-51.2) in the North to 67.6% (95%CI 59.4-74.9) in the South. Higher percentages of schools with higher AEPSB were found in public schools [58.1% (95%CI 54.9-61.2)] and in capitals and regions with higher Human Development Index [61.0% (95%IC 55.8-66.0) and 57.4% (95%CI 53.2-61.4), respectively] and lower Gini index [55.7% (95%CI 51.2-60.0) and 52.8 (95%CI 49.8-55.8), respectively]. CONCLUSIONS The potential to support oral health promotion in schools in Brazilian capitals, assessed by the AEPSB indicator, was associated with contextual factors of schools, capitals and Brazilian regions.

RESUMO OBJETIVO Avaliar o potencial de suporte do ambiente escolar para a promoção da saúde bucal e fatores associados nas capitais brasileiras. MÉTODOS Os dados de 1.339 escolas públicas e privadas das 27 capitais brasileiras foram obtidos da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2015. Os dados das capitais foram obtidos do Programa das Nações Unidas para o Desenvolvimento e do Datasus. Foi elaborado o indicador "ambiente escolar promotor de saúde bucal" (AEPSB), a partir de 21 variáveis do ambiente escolar com possível influência na saúde bucal dos escolares empregando a análise de componentes principais para dados categóricos (CATPCA). Associações entre o AEPSB e características das escolas, das capitais e das regiões foram testadas (análises bivariadas). RESULTADOS Dez variáveis compuseram a CAPTCA, após exclusão daquelas com baixa correlação ou alta multicolinearidade. A análise resultou em modelo com três dimensões: D1. aspectos intraescolares (venda de alimentos com açúcar adicionado na cantina e ações de promoção de saúde), D2. aspectos do entorno escolar (venda de alimentos com açúcar adicionado em pontos alternativos) e D3. políticas proibitivas na escola (proibição do consumo de álcool e tabaco). A soma dos escores das dimensões gerou o indicador AEPSB, dicotomizado pela mediana. Do total de escolas estudadas, 51,2% (IC95% 48,5-53,8) apresentaram ambiente mais favorável à saúde bucal (maior AEPSB). Nas capitais, esse percentual variou de 36,6% (IC95% 23,4-52,2) no Rio Branco a 80,4% (IC95% 67,2-89,1) em Florianópolis. Entre as regiões brasileiras, variou de 45,5% (IC95% 40,0-51,2), no Norte a 67,6% (IC95% 59,4-74,9) no Sul. Percentuais maiores de escolas com maior AEPSB foram encontrados na rede pública [58,1% (IC95% 54,9-61,2)] e em capitais e regiões com maior índice de desenvolvimento humano [61,0% (IC95% 55,8-66,0) e 57,4% (IC95% 53,2-61,4), respectivamente] e menor índice de Gini [55,7% (IC95% 51,2-60,0) e 52,8 (IC95% 49,8-55,8), respectivamente]. CONCLUSÕES O potencial de suporte à promoção da saúde bucal de escolas das capitais brasileiras, avaliado pelo indicador AEPSB, foi associado a fatores contextuais das escolas, das capitais e das regiões brasileiras.

Simultaneidade de comportamentos de risco à saúde bucal em adolescentes: evidência da Pesquisa Nacional de Saúde do Escolar / Simultaneous oral health risk behaviors among adolescents: evidence from the National School-based Student Health Survey

RESUMO: Objetivo: Identificar a prevalência da presença simultânea de comportamentos de risco à saúde bucal em adolescentes brasileiros e fatores associados. Métodos: Foram utilizados dados de 109.104 escolares provenientes da Pesquisa Nacional de Saúde do Escolar (PeNSE). A presença simultânea de baixa frequência de escovação dentária (E), uso recente de cigarros (C), baixa frequência de ida ao dentista (D), baixo consumo de frutas (F) e alto consumo de alimentos que contêm açúcar adicionado (A) foi avaliada pela razão entre as prevalências observada e esperada (PO/PE). Regressão logística foi utilizada para avaliar a associação entre as combinações de comportamentos e as variáveis sociodemográficas e do contexto familiar. Resultados: A ocorrência de dois ou mais comportamentos de risco à saúde bucal foi de 60,40%. As combinações mais prevalentes com razão PO/PE acima de 1,20 foram EDF, CFA e EDFA. A chance de concentrar dois ou mais comportamentos foi maior para adolescentes sem supervisão familiar dos deveres de casa, de escolas públicas, do sexo masculino e das raças indígena ou amarela (odds ratio - OR > 1,00; p < 0,05). O nível de afluência familiar baixo atuou como risco para a combinação ECDFA (OR = 2,58; p = 0,009), enquanto para a combinação CFA os níveis médio e baixo atuaram como proteção (OR = 0,71; p < 0,001 e OR = 0,76; p = 0,011). Conclusão: A prevalência da presença simultânea de comportamentos de risco à saúde bucal foi baixa e associada negativamente a fatores sociodemográficos e do contexto familiar. Intervenções que busquem reduzir os comportamentos de risco em saúde bucal em adolescentes devem priorizar os grupos identificados.

ABSTRACT: Objective: To investigate the prevalence of simultaneous oral health risk behaviors and associated factors among Brazilian adolescents. Methods: The study comprised data of 109,104 adolescents participating in the Brazilian National School-based Student Health Survey. The simultaneous presence of less frequent toothbrushing (E), current smoking (C), no visits to the dentist (D), low fruit intake (F), and high sugar intake (A) was assessed by comparison of observed/expected prevalence (OP/EP). Logistic regression was used to assess sociodemographic and family factors associated with the clustering patterns of oral health risk behaviors. Results: The simultaneous occurrence of two or more oral health risk behaviors was of 60.40%. The highest prevalence values were found for the following patterns with OP/EP over 1.20: EDF, CFA, and EDFA. The odds for two or more combined oral health risk behaviors were higher for adolescents whose parents did not participate in homework, from public schools, males, and of Asian or Indigenous ethnicity (OR > 1.00; p < 0.05). Low family affluence level (FAL) acted as a risk factor for the pattern ECDFA (OR = 2.58; p = 0.009), while low and mean FAL functioned as protection factors for the pattern CFA (OR = 0.71; p < 0.001, and OR = 0.76; p = 0.011). Conclusion: The prevalence of simultaneous oral health risk behaviors was low and negatively associated with sociodemographic and family factors. Interventions aiming at reducing these behavior patterns should prioritize the groups that have been identified as being at most risk.

Dental fluorosis: prevalence and associated factors in 12-year-old schoolchildren in Goiânia, Goiás / Fluorose dentária: prevalência e fatores associados em escolares de 12 anos de Goiânia, Goiás

To describe the prevalence of dental fluorosis, to investigate its association with individual and contextual variables among 12-year-old schoolchildren, and to determine whether there were changes in the prevalence of this condition from 2003 to 2010.

Descrever a prevalência de fluorose dentária e investigar sua associação com fatores individuais e contextuais entre escolares de 12 anos, além de verificar se houve mudanças na prevalência dessa condição no período de 2003 a 2010.

Individual and contextual determinants of malocclusion in 12-year-old schoolchildren in a Brazilian city

The aim of this study was to describe malocclusion prevalence and its association with individual and contextual factors among Brazilian 12-year-old schoolchildren. This cross-sectional study included data from an oral health survey carried out in Goiânia, Brazil (n = 2,075), and data from the files of the local health authority. The data were collected through oral clinical examinations. The Dental Aesthetic Index (DAI) was used to assess occlusion. The presence of malocclusion (DAI > 25) was used as the dependent variable. The individual independent variables consisted of adolescents’ sex and race and their mothers’ level of schooling. The clinical variables were caries experience and presence of adverse periodontal condition (calculus and/or gingival bleeding). The contextual variables included type of school and the location of schools in the city’s health districts. The Rao-Scott test and multilevel logistic regression were performed. The prevalence of malocclusion was 40.1%. In the final model, significantly higher rates of malocclusion were found among those who attended schools located in less affluent health districts and whose mothers had fewer years of education. Rates were also higher among those presenting calculus and/or gingival bleeding. Malocclusion demonstrated a high prevalence rate and the inequalities in its distribution were determined by individual and contextual factors.

Socioeconomic inequalities and changes in oral health behaviors among Brazilian adolescents from 2009 to 2012 / Desigualdades socioeconômicas e mudanças nos comportamentos em saúde bucal de adolescentes brasileiros de 2009 a 2012

OBJECTIVE To analyze oral health behaviors changes over time in Brazilian adolescents concerning maternal educational inequalities.METHODS Data from the Pesquisa Nacional de Saúde do Escolar(Brazilian National School Health Survey) were analyzed. The sample was composed of 60,973 and 61,145 students from 26 Brazilian state capitals and the Federal District in 2009 and 2012, respectively. The analyzed factors were oral health behaviors (toothbrushing frequency, sweets consumption, soft drink consumption, and cigarette experimentation) and sociodemographics (age, sex, race, type of school and maternal schooling). Oral health behaviors and sociodemographic factors in the two years were compared (Rao-Scott test) and relative and absolute measures of socioeconomic inequalities in health were estimated (slope index of inequality and relative concentration index), using maternal education as a socioeconomic indicator, expressed in number of years of study (> 11; 9-11; ≤ 8).RESULTS Results from 2012, when compared with those from 2009, for all maternal education categories, showed that the proportion of people with low toothbrushing frequency increased, and that consumption of sweets and soft drinks and cigarette experimentation decreased. In private schools, positive slope index of inequality and relative concentration index indicated higher soft drink consumption in 2012 and higher cigarette experimentation in both years among students who reported greater maternal schooling, with no significant change in inequalities. In public schools, negative slope index of inequality and relative concentration index indicated higher soft drink consumption among students who reported lower maternal schooling in both years, with no significant change overtime. The positive relative concentration index indicated inequality in 2009 for cigarette experimentation, with a higher prevalence among students who reported greater maternal schooling. There were no inequalities for toothbrushing frequency or sweets consumption.CONCLUSIONS There were changes in the prevalences of oral health behaviors during the analyzed period; however, these changes were not related to maternal education inequalities.

OBJETIVO Analisar a evolução de comportamentos em saúde bucal em adolescentes em relação às desigualdades da escolaridade materna.MÉTODOS Foram analisados dados da Pesquisa Nacional de Saúde do Escolar. A amostra foi composta por 60.973 e 61.145 escolares do nono ano das 26 capitais brasileiras e do Distrito Federal em 2009 e 2012, respectivamente. Foram analisados comportamentos em saúde bucal (frequência de escovação dentária, consumo de guloseimas, consumo de refrigerantes e experimentação de cigarros) e variáveis sociodemográficas (idade, sexo, raça/cor, tipo de escola e escolaridade materna). Compararam-se os comportamentos em saúde bucal e os fatores sociodemográficos nos dois anos (teste de Rao-Scott) e calcularam-se medidas de desigualdades socioeconômicas absolutas e relativas em saúde (coeficiente angular de desigualdade e índice de concentração relativa), utilizando-se como indicador a escolaridade materna expressa em anos de estudo (> 11; 9-11; ≤ 8).RESULTADOS Quando comparado 2012 em relação a 2009, para todas as categorias de escolaridade materna, observou-se aumento da proporção de pessoas com baixa frequência de escovação, e diminuição do consumo de guloseimas e refrigerantes e da experimentação de cigarros. Em escolas privadas, o coeficiente angular de desigualdade e o índice de concentração relativa positivos indicaram maior consumo de refrigerantes em 2012 e maior experimentação de cigarros nos dois anos entre aqueles cujas mães tinham maior escolaridade, sem mudança significativa das desigualdades. Em escolas públicas, o coeficiente angular de desigualdade e o índice de concentração relativa negativos indicaram maior consumo de refrigerantes entre aqueles cujas mães tinham, nos dois anos estudados, menor escolaridade, sem mudança significativa. Já o índice de concentração relativa positivo indicou desigualdade em 2009 para experimentação de cigarros, com maior prevalência entre aqueles cujas mães tinham maior escolaridade. Não houve desigualdade para frequência de escovação e consumo de guloseimas.CONCLUSÕES As prevalências dos comportamentos em saúde bucal apresentaram mudanças no período investigado. No entanto, tais mudanças não foram relacionadas às desigualdades de escolaridade materna.

Condição de saúde bucal, comportamentos, autopercepção e impactos associados em estudantes universitários moradores de residências estudantis / Oral health status, behaviours, self-perception and associated impacts among university students living in student residences

Introdução: Na perspectiva dos projetos de Universidade Saudável, uma estratégia importante é a avaliação da condição de saúde dos estudantes universitários. No Brasil, um dos grupos vulneráveis é o que reside em moradias estudantis institucionais. Objetivo: Este estudo transversal investiga a condição de saúde bucal, os comportamentos, a autopercepção e os impactos associados em moradores de residências estudantis em uma universidade pública. Material e método: A amostra foi constituída de 68 residentes das quatro Casas de Estudantes Universitários da Universidade Federal de Goiás (UFG), em Goiânia. Os dados foram coletados por meio de exame clínico bucal e entrevista. Resultado: A condição bucal mais prevalente foi a cárie, sendo que 74,6% dos estudantes necessitavam de tratamento para essa condição. A pior condição periodontal observada foi a presença de cálculo (50,8%). A maioria dos estudantes informou que escovava os dentes três vezes ao dia, usava fio dental e necessitava de tratamento odontológico. Dor de dente nos seis meses anteriores à pesquisa foi relatada por 33,8% da amostra; sangramento gengival ao escovar, por 41,2%, e 19,1% afirmaram procurar o serviço odontológico da universidade. O relato de consumo de açúcares entre as refeições foi muito alto e quase 18% fumavam. Mais da metade dos estudantes (51,4%) relatou estar indiferente ou insatisfeita em relação à sua boca e aos seus dentes. O maior impacto da condição bucal foi a dificuldade para comer ou beber, e 19,1% relataram ter faltado à aula em razão de problemas bucais. Conclusão: Os estudantes apresentaram alto percentual de necessidades de tratamento para cárie, bons hábitos de higiene bucal e autopercepção da sua saúde bucal com características negativas.

Introduction: In regard to Healthy University projects, an important strategy is the assessment of university students? health status. In Brazil, a vulnerable group is the one living in university student residences. Objective: This descriptive cross-sectional study aims to investigate the oral health status, behaviors, self-perception and its associated impacts among public university students living in student residences. Material and method: The study population consisted of 68 students who live in four university residences from the Federal University of Goiás in the city of Goiânia. Data were collected through oral clinical examination and interviews. Result: The most prevalent buccal condition was dental caries, and 74.6% of the students had treatment needs for this condition. The worst periodontal condition observed was dental calculus (50.8%). Most of the students reported that they brush their teeth three times a day, use dental floss and need for dental treatment. Dental pain in the last six months was reported by 33.8%, gingival bleeding by 41.2%, and 19.1% had sought the university dental service for treatment. Sugar consumption between meals was very high and almost 18% were smokers. More than half of the students (51.4%) reported being indifferent or dissatisfied with their mouth and teeth. The greatest oral health impact was difficulty for eating or drinking, and 19.1% reported to have missed classes due to oral disorders. Conclusion: Students presented high percentage of treatment needs for caries, good oral hygiene habits, and negative self-perception of their oral health condition.