Comportamento sexual de risco e fatores associados entre adolescentes brasileiros: avaliação de efeitos secundários de uma intervenção
Data
2021-03-31
Orientadores
Sanchez, Zila van der Meer 
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Comportamentos sexuais de risco entre adolescentes são considerados
um problema de saúde pública mundial, pois desencadeiam uma série de problemas
relacionados à saúde e à esfera social. Considerando que os comportamentos de
risco tendem a ocorrer juntos, os comportamentos sexuais de risco estão intimamente
relacionados ao uso de álcool, tabaco e outras drogas ilícitas, bem como aos estilos
parentais. Devido à necessidade de proteger os adolescentes das consequências
negativas da iniciação sexual precoce e do sexo desprotegido, esta tese teve como
objetivo investigar os fatores de risco para comportamentos sexuais de risco, bem
como verificar o efeito de um programa de prevenção do uso de drogas sobre tais
comportamentos. Metodologia: Foram utilizados os dados de um ensaio controlado
randomizado por cluster, realizado nos anos de 2014/2015, com 6.391 estudantes,
com idades entre 11 e 15 anos, de 72 escolas públicas, em 6 cidades brasileiras, para
avaliar os efeitos do programa escolar governamental de prevenção ao uso de drogas
#Tamojunto (Unplugged). As turmas do grupo intervenção receberam as 12 aulas do
#Tamojunto, aplicadas por professores da própria escola, sob supervisão da equipe
do Ministério da Saúde. O grupo controle não recebeu nenhum programa de
prevenção do uso de álcool e outras drogas neste período. Os dados foram coletados
através de questionário anônimo de autopreenchimento, em 3 momentos: antes da
intervenção, 9 meses e 21 meses depois. A análise dos dados foi realizada por meio
de modelos de regressão logística ponderada. Também foram realizadas análises
considerando a estrutura multinível dos dados. Intentiontotreat
foi usada para avaliaras mudanças na prevalência de comportamentos sexuais de risco ao longo do tempo e entre os grupos. Ademais, uma revisão sistemática foi realizada para identificar os
fatores de risco para a iniciação sexual precoce. Foram acessadas três bases de
dados eletrônicas, PubMed, Embase e LILACS, buscando estudos de coorte
publicados de 1999 a dezembro de 2020. Resultados: Os resultados sugerem que
aqueles que fumavam tabaco e bebiam em excesso aumentaram significativamente a
probabilidade de praticar sexo sem proteção. Estilos parentais permissivos e
negligentes foram associados a maiores chances de atividade sexual. Adolescentes
que fizeram uso de substâncias e relataram estilos parentais empobrecidos tiveram
oito vezes mais probabilidade de fazer sexo sem proteção em comparação com
adolescentes que não relataram uso de substâncias e que eram de famílias com
estilos parentais autoritativos. O recebimento de #Tamojunto foi associado a um maior
risco para sexo na vida aos 21 meses de acompanhamento. Entre meninas, aos 9
meses de acompanhamento, o programa foi associado a uma maior probabilidade de
ter praticado sexo no último mês. Aos 21 meses de acompanhamento, meninas que
receberam o programa foram mais propensas a relatar relações sexuais sem
preservativo no último mês. Fatores de risco com associações mais fortes para
iniciação sexual precoce foram: uso de substâncias por adolescentes e pais,
problemas de conduta, vínculo familiar e acadêmico, não morar com os pais biológicos
e baixa escolaridade materna. Conclusões: O #Tamojunto pode ser ineficaz e
possivelmente prejudicial para a prevenção de comportamentos sexuais de risco,
especialmente entre meninas. As intervenções preventivas no campo do
comportamento sexual devem vincular os pais a programas de habilidades parentais.
Finalmente, os programas de prevenção devem olhar com cuidado para a vinculação
dos adolescentes com a escola e tentar aumentálo.
Introduction: Sexual risk behaviors among adolescents are considered a worldwide public health problem, as it triggers series of problems related to health and social sphere. Considering that risk behaviors tend to occur together, sexual risk behaviors are closely related to the use of alcohol, tobacco and other illicit drugs as well as parenting styles. In order to protect adolescents from negative consequences of early sexual intercourse and unprotected sex, this thesis aimed to investigate risk factors for sexual risk behaviors, as well as verified the effect of a drug use prevention program on these risky behaviors. Methodology: Data from a cluster randomized controlled trial of 6,391 students, aged 11 to 15 years, from 72 public schools in 6 Brazilian cities were used to assess the effects of the government's drug prevention program #Tamojunto (Unplugged ). Those in the intervention group received the 12 #Tamojunto lessons applied by trained teachers, under the supervision of the Brazilian Ministry of Health. The control group did not receive any drug prevention program during this period. Data were collected through an anonymous selfadministered questionnaire, in 3 moments of time: before the intervention, 9 months and 21 months later. Data analyzes were performed using weighted logistic regression models. Additionally, analyses were performed considering the multilevel structure of the data. Intentiontotreat was used to evaluate changes in the prevalence of sexual risk behaviors over time and between groups. Furthermore, a systematic review was conducted to identified risk factors for early sexual intercourse. Three electronic databases were accessed, PubMed, Embase and LILACS, searching cohort studies released from 1999 through December 2020. Results: The results showed that Those who engaged in smoking tobacco and binge drinking had significantly increased likelihood of unsafe sex. Permissive and negligent parenting styles were associated with higher odds of adolescent sexual activity. Moreover, adolescents who engaged in substance use and who reported poor parenting styles were eight times more likely to have unsafe sex compared to adolescents who did not reported substance use and who were from families with authoritative parenting styles. Among all participants, receipt of #Tamojunto was associated with higher risk of lifetime sex at 21 months followup. Among girls, at 9 months followup, the program was associated with higher likelihood of having engaged in sex in the last month. At 21 months followup, girls receiving the program were more likely to report engaging in condomless sex in the last month. Risk factors with stronger associations for ESI were: adolescents’ and parents’ substance use, conduct problems, family and academic attachment, not living with both biological parents, and low maternal education. Conclusions: #Tamojunto may be ineffective and possibly harmful for preventing sexual risk behaviors, especially among girls. Prevention interventions in the field of sex behavior should link parents to parenting skills programs. Finally, prevention programs should look more carefully for adolescent’s school attachment and try to raise it.
Introduction: Sexual risk behaviors among adolescents are considered a worldwide public health problem, as it triggers series of problems related to health and social sphere. Considering that risk behaviors tend to occur together, sexual risk behaviors are closely related to the use of alcohol, tobacco and other illicit drugs as well as parenting styles. In order to protect adolescents from negative consequences of early sexual intercourse and unprotected sex, this thesis aimed to investigate risk factors for sexual risk behaviors, as well as verified the effect of a drug use prevention program on these risky behaviors. Methodology: Data from a cluster randomized controlled trial of 6,391 students, aged 11 to 15 years, from 72 public schools in 6 Brazilian cities were used to assess the effects of the government's drug prevention program #Tamojunto (Unplugged ). Those in the intervention group received the 12 #Tamojunto lessons applied by trained teachers, under the supervision of the Brazilian Ministry of Health. The control group did not receive any drug prevention program during this period. Data were collected through an anonymous selfadministered questionnaire, in 3 moments of time: before the intervention, 9 months and 21 months later. Data analyzes were performed using weighted logistic regression models. Additionally, analyses were performed considering the multilevel structure of the data. Intentiontotreat was used to evaluate changes in the prevalence of sexual risk behaviors over time and between groups. Furthermore, a systematic review was conducted to identified risk factors for early sexual intercourse. Three electronic databases were accessed, PubMed, Embase and LILACS, searching cohort studies released from 1999 through December 2020. Results: The results showed that Those who engaged in smoking tobacco and binge drinking had significantly increased likelihood of unsafe sex. Permissive and negligent parenting styles were associated with higher odds of adolescent sexual activity. Moreover, adolescents who engaged in substance use and who reported poor parenting styles were eight times more likely to have unsafe sex compared to adolescents who did not reported substance use and who were from families with authoritative parenting styles. Among all participants, receipt of #Tamojunto was associated with higher risk of lifetime sex at 21 months followup. Among girls, at 9 months followup, the program was associated with higher likelihood of having engaged in sex in the last month. At 21 months followup, girls receiving the program were more likely to report engaging in condomless sex in the last month. Risk factors with stronger associations for ESI were: adolescents’ and parents’ substance use, conduct problems, family and academic attachment, not living with both biological parents, and low maternal education. Conclusions: #Tamojunto may be ineffective and possibly harmful for preventing sexual risk behaviors, especially among girls. Prevention interventions in the field of sex behavior should link parents to parenting skills programs. Finally, prevention programs should look more carefully for adolescent’s school attachment and try to raise it.
Descrição
Citação
Reis, L. F. Comportamento sexual de risco e fatores associados entre adolescentes brasileiros: avaliação de efeitos secundários de uma intervenção. São Paulo, 2021. 173 p. Tese (Doutorado em Saúde Coletiva) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2021