In spite of the prohibition according to Brazilian laws, 27.1% of ninth-grade students, aged 13 and 15, declared to have driven a motor vehicle in the 30 days prior to the survey, and 19.3% declared to have ridden a motorcycle without wearing a helmet. These are some of the data presented by the National Survey of School Health 2012, which interviewed more than one hundred thousand teenagers in 2,482 schools located all over the country.

By means of an electronic questionnaire which keeps secret the identity of interviewees, IBGE obtained a diversity of information on the life of students: 28.7% of them declared to have had a sexual intercourse, and 75.3% of them, to have used a condom in the last time.  These percentages have reached similar levels as those of other surveys like PeNSE, conducted by the WHO in other countries.

Violence is also part of the everyday lives of several students: 6.4% of them declared to have been into fights with firearms, and 10.6% said they had been assaulted by an adult family member.  In this case, girls (11.5%) are more often victims of assault than boys (9.6%).  In addition to that, 7.2% of the students declared they have always or very usually felt humiliated by bullying in school, whereas 20.8% have been responsible for bullying against their peers in the 30 days prior to the survey.  

Illegal drugs such as marijuana, cocaine, crack, contact glue, loló (a mixture of ether and chloroform), lança-perfume (ethyl chloride, plus a scent), or ecstasy have been used by 7.3% of the students, and 21.8% of the teenagers interviewed declared to have been drunk at least once.  Consumption of cigarettes in the 30 days prior to the survey was informed by 5.1% of the students and 26.1% of them consumed alcohol in the same period.

About one third (31.1%) of the school girls was trying to lose weight, and 6.4% of those interviewed declared to have provoked vomiting or taken laxatives to reach that purpose.  See below a summary of the information presented by PeNSE 2012.

The second edition of IBGE's National Survey of School Health (PeNSE) was conducted from April to September 2012, and resulted from a partnership between the Brazilian Institute of Geography and Statistics (IBGE) and the Ministry of Health, with support from the Ministry of Education. PeNSE interviewed 109,104 9th-grade students - 86% of them aged 13 to 15 - and also directors or other professionals in charge of schools. The survey sample was formed by school with more than 15 students enrolled in the 9th grade, in regular daytime classes.  In 2012, the geographic coverage of the survey was expanded and included the country and its five Major Regions. The 2009 edition brought information about the 27 capitals only.

In Brazil, PeNSE was the first survey to have an electronic questionnaire, which is answered directly by the teenagers themselves on a handheld computer, without interference of the interviewer, keeping secret the identity of interviewees. The following themes are investigated: socioeconomic aspects; family context; eating habits; practice of physical activity; sedentary habits; consumption of cigarettes, alcohol and other drugs; sexual and reproductive health; violence, security; and perception of body image.

New themes, such as work, hygiene; mental health; use of health services and prevalence of ashthma, among others were introduced in 2012.  Questions were added or changed, in order to facilitate answers and/or allow international comparisons. Besides, there was a second questionnaire, about the structure and the surroundings of schools aimed at the directors or other professionals in charge of schools. 

PeNSE 2012 has some level of international comparability. There are currently more than 100 countries monitoring the health of their students. Two examples of such monitoring are the Health Behavior in School Aged Children (HSBC) (http://www.hbsc.org) and the Global School-based Student Health Survey (GSHS), promoted by the World Health Organization (WHO) with the participation of more than 40 countries, besides the American Youth Risk Behavior Survey (YRBS) (http://www.cdc.gov/Healthyyouth/yrbs/index.htm). 

 

Start of sex life

The results of PeNSE for Brazil in 2012 showed that 28.7% of the students have had a sexual relationship once in life.  The frequency of this indicator was 40.1%, among boys, and 18.3%, among girls. Considering the type of school administration, 30.9% of public school students and about 18% of private school students declared to have had a sexual relationship. The North region had the highest percentage (38.2%) of students in this indicator, followed by the Central West (32.1%), Southeast Region (29.1%), South (27.3%) and Northeast (24.9%). 

In other countries, the surveys have shown that the sex life among male teenagers starts at an earlier age than among female ones.  A survey conducted in the state of Lara, in Venezuela, with 2,070 students from the 7th to the 9th grade, in the period 2003/04, showed that 27% of the boys and 3.8% of the girls had already had a sexual relationship. From this total figure, 54.9% of the male students and 23.5% of the female ones had their first sexual relationship at the age of 12. The Global School-based Student Health Survey (GSHS), conducted in Europe and in North America showed that 26% of the students aged 15 had already had a sexual relationship.

 

Use of condoms

The results of PeNSE 2012 showed that, concerning the use of condoms by students, among those who had had a sexual relationship once in life, 75.3% declared to have used a condom the last time. From this total, 77.1% are male students and 71.8% are female ones. Studies released by the WHO, conducted in more than 40 countries, in 2005 and 2006, showed that among teenagers aged 15, 77% informed the use of condoms in their last sexual relationship.  

 

Access in school to information about sexuality

PeNSE 2012 showed that 89.1% of the students declared they had received information about sexually-transmitted diseass and AIDS in school. A total 69.7% of the students interviewed had received in school some information on how to get condoms free of charge.  About 82.9% of the students declared they had received in school some information on pregnancy prevention.

 

Driving motor vehicles

A total 27.1% of the students declared they had driven a motor vehicle in the 30 days preceding. It is important to highlight that most of students who answered PeNSE were teenagers aged 13 to 15. In the country, the minimum age for having a driver's license is 18 years, according to the laws which regulate the Brazilian Traffic Code. The proportion of male students who had driven a motor vehicles (38.6%) was more than twice as that of the female ones (16.6%).

 

Safety belt and use of helmets on motorcycles

Approximately 16.0% of the students declared not to have worn a safety belt when they were in a motor vehicle driven by another person.  It was observed that 17.5% of the girls and 14.6% of the boys had not worn a safety belt in the 30 days prior to the survey.  The results of both PeNSE 2009 and PeNSE 2012 showed that a significant part of the students in elementary school did not use to respect traffic laws or exposed themselves to risks, facts which are in accordance with the high mortality rates of youngsters caused by car accidents.

In the 30 days preceding the survey, 22.9% of the students overall were transported in motor vehicles driven by persons who had drunk alcohol. Students of private schools were more exposed to this kind of risk, 25.8%, than students of public schools, 22.3%.

Approximately 19.3% of the students declared not to have worn a helmet when riding a motorcycle, in the 30 days preceding the survey. The lack of use was highest among female students (21.7%) than among male ones (16.9%).

 

Participation in fights with firearms

Participation in fights with firearms was declared by 6.4% of the students, being also most frequent among male students (8.8%), than among female ones (4.3%), with 6.7% of students of public school and 4.9% of students of private schools.  he Central West recorded the highest proportion 98.0%).

With reference to fights with white weapons, 7.3% of the students declared participation, in the 30 days preceding the survey, and higher occurrences were registered among male students (10.1%) than among female ones (4.8%).

A study conducted in Europe and in the United States showed that 14% of the students aged 11 had been involved in a fight with physical violence at least three times in the 12 months preceding the survey.

 

Assault by adult family member

Information on physical violence inflicted by an adult family member, in the 30 days preceding the survey, was mentioned by 10.6% of the students in the country.  This type of violence was reported by 11.5% of the girls and 9.6% of the boys

The Southeast Region presented the highest proportion (12.0%) of teenagers assaulted by someone from their own family. In all the Major Regions, the proportion of girls who were assaulted by a family member was higher than that of boys. In the South and Southeast, about 13% of the teenagers informed to have been victims of assault by someone from their family at least once, in the 30 days preceding the survey. 

 

Bullying

Data of HSBC, conducted in Europe and North America showed that 13% of the students aged 11 had been victims of bullying in school, at least twice in the two months preceding the survey: 12% at the age of 13 and 9.0% at the age of 15 

About the fact of suffering bullying from school mates, 7.2% of the students all over the country declared they always or very usually felt humiliated by this kind of behavior. These percentages were higher among male students (7.9%) than among female ones (6.5%).

The results of PeNSE showed that 20.8% had practiced some kind of bullying against their school mates (ridicule, mock, make fun of, intimidate or the like) causing them to be hurt, bothered or angry, in the 30 days preceding the survey.  

 

Security on the way to school and in its surroundings

The proportion of students who did not go to school, in the 30 days preceding the survey, for not feeling safe on the way to school from home was 8.8%. This percentage was bigger among public school students than among private school ones (5.0%). The proportion of students who did not go to school because they did not feel safe in that environment reached 8.0%, with a prevalence of students from public schools (9.1%) than of private ones (4.4%).

PeNSE also investigated the risk of violence in the surroundings of school in the questionnaire answered by the director or person in charge of it. Considering those who informed the school was located in a dangerous area, in most of or all the last 12 months, 17.9% of the students in the 9th grade were studying in such areas; this proportion was 5.5% in private schools and 20.4% in public ones. The capitals with the biggest proportions were Belo Horizonte (46.2%), Maceió (45.9%) and Salvador (41.6%) and the smallest ones, Cuiabá (8.2%), Rio Branco (10.9%) and Rio de Janeiro (11.0%).

 

Use of illegal drugs at leasts once in life

PeNSE 2012 investigated the use of illegal drugs such as: marijuana, cocaine, crack, contact glue, loló (a mixture of ether and chloroform), lança-perfume (ethyl chloride, plus a scent), or ecstasy, and the data show that 7.3% of the students have already used this kind of substance. Considering the Major Regions of the country, the highest figure was registered by the Central West, 9.3%. The analysis of results by capital shows the biggest percentage were those of Florianópolis (17.5%), Curitiba 914.4%) and the smallest ones, of Palmas and Macapá (5.7% in both). 

Considering the students who had used drugs before the age of 13, the percentage for the whole country was 2.6%, ranging from 1.2% in the Northeast to 4.4% in the South.

 

Use of marijuana and crack

Among the 7.3% of students who had used illegal drugs at least once in life, the current consumption of marijuana (in the last 30 days) was 34.5%. In relation to the total number of students, it was 2.5%. Students living in the South registered a higher level of marijuana consumption (3.6%). The lowest percentage was found in the Northeast, 0.9%. Considering the capitals, Florianópolis presented the highest level of current marijuana consumption (10.1%).  

Among the  7.3% of students who had used illegal drugs at least once in life, 6.4% had used crack once in the 30 days precedding the survey, meaning 0.5% of the students overall in the 9th grade.

Some themes of PeNSE are also investigated in other countries. According to the Health Behavior in School Aged Children (HSBC), 17% of the teenagers aged 15 in Europe and North America reported having used marijuana at least once in life, and 8% at least once in the 30 days prior to the survey (recent use). 

In the United States, 30% of the boys and 26% of the girls had smoked marijuana at least once in life and and 16% of the boys and 12% of the girls had smoked marijuana in the 30 days preceding the survey.

 

Experience with alcoholic drinks

PeNSE 2012 included a new question in order o measure experience with a dose of any alcoholic drink (which corresponds to a bottle of beer or a glass of wine or a dose of cachaça or whiskey): Have you ever had at least a dose of any alcoholic drink?  This way, the questionnaire gained international comparability and the indicator became more specific.  Affirmative answers were given by 50.3% of the students, ranging from 56.8% in the South and 47.3% in the Northeast. The proportion of girls (51.7%) was bigger than that of boys (48.7%).

 

 

Current consumption of alcoholic drinks 

The current consumption of alcoholic drinks among the students (consumption in the last 30 days) was 26.1% in Brazil, and there were not significant differences between the male (25.2%) and female (26.9%) groups. The capitals with the highest percentage of students who had drunk alcohol in the 30 days prior to the survey were Porto Alegre (34.6%) and Florianópolis (34.1%) and the lowest percentages were those of Belém (17.3%) and Fortaleza (17.4%).

Among the students who consumed alcoholic drinks in the 30 days preceding the survey, the most common situations were to have this drink at parties (39.7), to get it from with friends (21.8%), or to buy it in grocery stores, liquor stores, bars or supermarkets (15.6%). Another 10.2% of the students had consumed alcoholic drinks in the last 30 preceding in their own home. 

 

Episodes of drunkenness

It is worth mentioning that 21.8% of the students had been drunk at least once in life.  Students from the South Region made up the highest percentage (27.4%) and those from the Northeast, the lowest (17.3%). The proportion of students who had already gotten drunk was bigger in public than in private schools (22.5% versus 18.6%).

Concerning alcohol, 10% of the students reported having had problems with their family or friends, or to have missed classes because they got into fight after alcohol consumption. The percentage of students who reported these problems was bigger among girls (10.4%) than among boys (9.5%).

 

Cigarette and other tobacco products

The data of PeNSE for Brazilian capitals showed that the number of students who had tried cigarette once in life fell from 24.2% to 22.3%, between 2009 and 2012.  Nevertheless, 5.1% of the students had smoked a cigarette in the 30 preceding days. The cities with the biggest proportions of smoking students were Campo Grande, with 12.4% and Florianópolis, with 9.7%.

Comparing data of 2009 and 2012, the percentage of students who had smoked cigarettes in the 30 days preceding the survey remained stable, at about 6%. According to PeNSE 2012, 29.8% of the Brazilian students who were attending the 9th grade informed that at least one of their parents was a smoker.  A total 89.3% of the students attended schools which adopted non-smoking policies.

 

Attitude concerning Body Weight

Approximately one third (31.1%) of the school girls were trying to lose weight and 16.0% of them were trying to put on weight, whereas among boys a smaller percentage (21.0%) was focused on losing weight and 19.6% was trying to put on weight.

It is important to notice that 19.1% of the female 9th-graders considered themselves very fat but a bigger proportion (31.1%) said they were trying to lose weight. 

Considering public and private schools, it was possible to detect a difference of more than 12 percentage points between private school students who were trying to lose weight (36.4%) and public school students pursuing the same objective (24.2%). 

 

Vomit provoking or ingestion of laxatives

The proportion of students who, in the 30 preceding days, used the method of provoking vomit or taking laxatives was about 6.0%, versus 6.2% who used medicines, formulas or other products in order to put on weight or gain muscles. 

For the country overall, the procedure of vomit provoking or taking laxatives was a little more common among girls than among boys, 6.4% and 5.7%, respectively.

 

Using formulas or another product

The analysis of results about ingestion of medicines, formulas or another kind of product intended to help one put on weight or gain muscles, without proper monitoring by a doctor, showed that 6.2% of the students had followed this procedure. An interesting fact was that 8.4% of the male students declared to have adopted this procedure, whereas half of this percentage (4.2%) of female students declared to have done it, in the 30 days preceding PeNSE 2012.

 

Consumption of healthy food markers

The data of PeNSE 2012 indicated that 69.9% of the students consumed beans, 43.4%, leafy vegetables, 30.2%, fresh fruit and 51.5%, milk, whereas 41.3% of the students had eaten delicacies five or more days in the week preceding the survey. 

Almost all (98%) public schools students in the country mentioned that the school offered food, while the food offer by private schools was significantly lower (41.4%).  However, the habit of consuming the food offered (1) did not increase, and was 22.8% among those who studied in public schools and only 11.9% among those of private schools.

In the 2012 edition, PeNSE included an item about the habit of having breakfast (61.9% of the 9th graders used to do that five or more days a week).  Besides, 64.0% of them used to eat while watching television or studying.

There was also an investigation about the existence of cafeterias and alternative spots for selling snacks in schools, and about the products sold in them. Whereas baked pastry was available for 39.2% of the students, fresh fruit or fruit salad was available for only 10.8%. In alternative selling spots there was a predominance of delicacies (candies, confections, chocolate, ice-cream and the like), available to 33.4% of the students, whereas fresh fruit were available to only 3.5% of them.

Besides the practice of physical activity, PeNSE also investigated accumulated physical activity and  showed that most teenagers, 45.1%, were classified as insufficiently active. About 38.6% of the teenagers interviewed reported having had one or more physical education classes in the week preceding the survey. Although the Law of Directives and Bases of National Education 96/1996 established the compulsory practice of physical education in schools, the proportion of teenagers by level of attendance to this class in the week preceding the survey ranged between 18.3% (those who did not attend any class) to 38.6% (thos who did on two or more days).

 

TV

The habit of watching two or more hours of television on a weekday was reported by 78% of the 9th graders in primary school. The Southeast Region presented the highest occurrence of two or more hours of television watching. The WHO recommends that children should not spend more than two hours watching TV or a playing videogames.

 

Mental Health 

The specific section on Mental Health has the objective of identifying cases of subjective distress, such as a feeling of solitude and  difficulty to get to sleep due to preoccupation. It also approaches one's having or not having close friends, which is an important aspect in the evaluation of teenagers' social interaction capacity. A total 16.4% of 9th graders in primary school in Brazil reported having felt alone in the 12 months preceding the survey. Whereas 21.7% of the female students declared to have felt this way, only 10.7% of male students reported the same. In Campo Grande, Palmas and Curitiba, about one fourth (25%, the highest occurrences) of the girls declared to have felt alone in the 12 preceding months. The highest percentage of boys feeling the same was found in Belém (14.5%).  PeNSE  also investigated the themes Difficulty to sleep and Existence of friends.

 

 

Asthma and Use of Health Services

Asthma is the most prevalent chronic disease in childhood and teenage years, which causes high costs for the health system, interferes with quality of life and in generates school absenteeism.  Besides, it can be fatal if not controlled.  Results show that 23.2% of the students sufferend from wheezing in the period.  Wheezing was most frequent among girls (24.9%) than among boys (21.4%). The Southeast Region (24.9%) had the highest percentage of students suffering from wheezing, and the Northeast, the lowest (19.8%).  Students suffering from asthma amounted to 12.4% in the country, ranging from 18.4% in the North to 11.4% in the Southeast.  Data show that 48.2% of the students searched for some kind of service or professional for health-related problems, in the last twelve months, being the majority female (49.1%) and not male ones (47.2%).

 

Hygiene Habits 

PeNSE also investigated hygiene habits  such as washing one's hand before eating ad after using the restroom and one's use of soap to wash their hands. About 15% seldom washed their hands before eating. Almost all the students interviewed (91.8%) reported washing their hands after using the restroom.  However, 9.1% of the 9th graders never or very seldom used a soap in the same situations.

 

Oral Health

The proportion of 9th graders of primary school who reported brushing their teeth three or more times a day was 68.4%; it was higher among girls (72.1%) than boys (64.3%). A total 19% of the students interviewed said they felt pain and 36.4% of them declared not to have been to the dentist once in the previous year.

Parental schooling

The percentage of students whose mothers did not have any level of schooling or had only incomplete primary school was 34.5%, and the proportion of students whose mothers had complete high school was only 8.9%. The percentage of students whose fathers did not have any level of schooling or had only incomplete primary school was 35.7%

Work among students

The theme Work among students was included in the 2012 edition of PeNSE. Data show that 86.9% of the students declared not to have any job; 11.9% said they work and earn money for their activities and 1.2% reported performing unpaid activities. The survey data also show that the highest percentage of students who worked and were paid for that live in the South of the country (15.1%).  

Possession of goods and existence of services

The data of 2012 show that 95.5% of the students of private schools, versus 59.8% of students of public schools, declared to have some kind of computer (desktop, netbook, laptop).

With reference to Internet access, 93.5% of the students of private schools and 53.5% of students of public schools in the country said they access the Internet from home. 

When asked if someone who lived in the same housing unit as themselves had a car, 80.3% of the students of private schools and 44% of the students of public schools in the country answered positively.

Considering the service of paid domestic workers, 27.3% of the students of private schools and only 6.5% of those of public schools said they had this service in their homes five or more days a week.

Knowledge of students' parents or caregivers about their free time 

PeNSE 2012 showed that 62% of the students lived in homes with a father and a mother; 28.5% reported living with their mother only and 4%, with the father, only.  The ones who declared not to live with either a father or a mother amounted to 5.4%. 

A total 58.5% of the students declared that their parents or caregivers knew about what they did in their free time, in the 30 days preceding the survey, and  25.8% had missed classes, in the 30 days preceding the survey, without permission of parents or caregivers.  

The survey also investigated the presence of parents or caregivers at meal time, the supervision of homework, and the level of parental understanding regarding the students's concerns.  In this case, among the students interviewed, 45.8% said their parents were able to understand their problems and concerns.  Male students (47.2%) received more attention from parents or caregivers than female ones (44.6%).

PeNSE also brings information on the existence of libraries in schools (a resource available for 86.7% of the 9th graders), Internet access in the school (accessible to 84.2% of the students), access to computers in the classroom (possible for 21.3% of the students), structure for physical activities (patio, courts, changing room, running track and swimming pools).  In spite of its smaller structure for physical activity, the public school is the one which most often offers free sports practice to students, out of the regular class shifts.  Among public school students, 61.5% had this service, versus 38.3% in private schools.

 

 

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¹ Consumption of food in school was considered as the ingestion of snacks/luch at least three days a week.