Violence in schools and the voice of teachers

Purpose: To correlate self-reporting of voice disorders with habits that impact voice production and situations of violence experienced by teachers. Methods: The study involved 41 elementary-school teachers of rural and urban areas. Two instruments were used for data collection: The Vocal Production Condition Teacher (CPV-P) questionnaire and the Screening Index for Voice Disorders ITDV. The chi-square test was used to verify association among variables with a significance level of 5%. Results: The sample consisted of 8 men and 33 women aged 25-66 years with a median of 39 years. Regarding vocal habits, 33 people (80.5%) mentioned the screaming as usual practice, 40 people (97.5%) declared they talk a lot. As for voice care, 31 people (73.1%) reported drinking water while using their voice. As for the ITDV total score, 30 teachers (73.1%) were above the score threshold set for predisposition to vocal disorders. Statistical analysis revealed a significant association between female participants and complaint of graffiti writings as a type of violence. No significant correlation between the ITDV results with gender and the ITDV with forms of violence evaluated in the study was indicated. Conclusion: Self-reporting of voice disorders showed no significant relationship with acts of violence. However, analysis of the context of violence in schools and vocal problems are issues worthy of attention, particularly the observed naturalization of gender inssues, which is seldom problematized.


INTRODUCTION
Our voice accrues from the association of biological, psychic, and social aspects, arising from each individual's subjective and unique experiences (1) .Therefore, it is important to investigate the relationship between the conditions of vocal production with regard to factors that may influence this process, for instance, violence in schools.
Social violence falls upon not only private spaces, but also those in the public domain, and its effects impact how institutional contexts work, among them, schools (2) .The school may be understood as an environment for the development of individuals in the social perspective.However, concepts, preconceptions, and values of a dominant culture are also reproduced in this space (3) .Thus, cases of violence inside or around the school are generated in this course, which is a common reality in the different Brazilian regions, widely publicized by the media over the last years.
In this context, the faculty of elementary and high-school education, without exception, have at some point been involved in an episode of violence, either as direct victims, hearers, or witnesses of events experienced by others (4) .
Thus, teachers, directly or indirectly, have become the target of various forms of violence.A study (5) has found an association between violence situations and vocal disorder in elementary and high-school teachers.
Vocal changes deriving from different factors, such as prolonged use of voice and negative and violent experiences can entail difficulties in performing their role and achieving the objectives proposed for the adequate training of students.Consequently, it compromises their role as educators.Teachers also report that aphonia has a negative impact on their family relationships, expression of emotions, and leisure activities (6) .
In this context, this paper proposes to reflect on the connections between the different forms of violence in the school context and teachers' vocal health.Thus, it aims to relate self-reporting of vocal disorder with habits that influence voice production and the main situations of violence experienced by teachers.As inclusion criteria, all primary school teachers from public municipal schools without vocal complaint or diagnosis of laryngeal alterations were invited to participate.Teachers on leave, retired, or readapted did not take part in the study.

This
Two instruments were used for data collection: The Vocal Production Condition -Teacher (CPV-P) questionnaire, aiming to analyze the voice conditions of teachers in their work activity, and the Screening Index for Voice Disorder (ITDV), seeking to understand the main vocal complaints of teachers, according to their own perception.
CVP-P (7) presents 84 questions, whereas most are answered with "always", "sometimes", "hardly ever", never", or "I don't know", organized around the following variables: identification of the school, functional situation, school environment, organization of work, vocal aspects, and lifestyle.This research considered answers directed to the identification of teachers, workload with students, the items under the topic "organization of work" that are related to situations of violence, and two questions on the topic "vocal aspects", "habits and lifestyle", which are related to vocal habits.
The ITDV (8) , validated for screening, presents 12 questions related to vocal quality, whose answer options are "never", "hardly ever", "sometimes", and "always".For analysis, the answers "sometimes" and "always" add one point each.Individuals with scores equal to, or higher than, five are prone to vocal disorders (8) .
The data were organized on a spreadsheet in software Excel 2013, tabulated and submitted to statistical analysis with software SPSS ® 16.0.To verify association among variables, the Chi-square test was used with a level of significance of 5%.

RESULTS
The sample was composed by 8 men and 33 women ages between 25 and 66 years, with a median of 39 years old.With regard to vocal habits, 33 people (80.5%) reported the habit of screaming, of which 26 (63.4%) presented a score above five on ITDV, 40 people (97.5%) reported speaking a lot, of which 30 (73.2%) presented a score above five on ITDV.As to voice care, 31 people (73.1%) reported they drink water while speaking, and 25 (61%) presented a total score above five on ITDV.
With regard to workload in direct contact with students, 16 teachers (39%) are with students for over 20 hours a week, and 25 (61%) are in direct contact with students for less than 20 hours a week.
Table 1 illustrated the answers regarding violence in the classroom and other violent events that have been reported.As to total score on ITDV, 30 teachers (73.1%) were positioned above the score proposed as indicating predisposition to vocal disorder.
The statistical analysis has shown a significant association between the female gender and complaints about violence related to graffiti writings (p<0.01).However, significant associations between the other forms of violence inquired and gender were not evident.
No significant correlation between the ITDV score and gender were found (p<0.05), as well as between the ITDV and the forms of violence assessed in the study (p<0.05).An association was found between the ITDV scores and workload (p<0.05).

DISCUSSION
The composition of the group of teachers in this study is similar to that of other research studies developed in the field: the majority is of the female gender (9,10) .In Brazil, there is little research that considers gender as a category of analysis, which can be justified by some naturalized ideas such as teaching being understood as a female profession (11) .
In general, the social and family context of women who, for the most part, has a triple working day, due to the need for more than one job, is added to their protagonist role in caring for the family and the home (12) , which impacts the increase in vocal demand and may be the cause of vocal symptoms and organic lesions on the larynx (13) .
In the female teacher population of this study, a high index of self-report of vocal disorders was found.According to studies, the glottic proportion, around 1.0, causes an increase in the angle of opening of the anterior commissure of vocal cords, favoring greater impact among them, thus justifying vocal discomfort (14) .
The occurrence of dysphonia may be related to the habit of speaking a lot or screaming, as well as the presence of allergy or pharyngolaryngeal reflux.Such aspects may be related to environmental factors of the school which interfere with healthy voice production (15) .
Some studies indicate an association between the school environment and the occurrence of voice disorders in teachers, especially those who work in primary and elementary education.Elements such as excessive noise, unsatisfactory cleaning, lighting, and inappropriate room size are some of the aspects associated with voice disorders in teachers (16) .
Teachers in general use the screaming as a strategy in the classroom.Studies point out that vocal disorders affect women the most, and in some specific cases, those working in early grades, where classroom noise is higher.Thus, the strategy used is to raise the frequency and produce a strong intensity (17) .
Regarding ingestion of water, teachers reported drinking water while using their voice.This finding corroborates a survey that evaluated 80 teachers, where 54 of them (67.5%)often drink water as they use their voice (18) .Results suggest that teachers are aware of the habits that interfere with vocal well-being.However, they do not put them into practice for several factors.Among them, lack of knowledge about the benefit of hydration (19) .Some other factors alter the voice of teachers.Among them, aspects originated in the organization of work, commonly related to didactic-pedagogical content, division of labor, and interpersonal relationships in the professional environment.
Among the external elements, i.e. those that are not directly related to the teaching role, violence is one of the aspects that must be considered in the exercise of teaching.
Violence in schools is an aspect that calls for the attention of the public authorities as, despite the plans and measures put in place, the violence phenomenon seems to be increasing (20) .
The activities of the educational institution may be related to violence in cases such as the occurrence of fire caused by students, aggression and insults to teachers, among others (20) .
The most commonly seen types of violence, according to the teachers taking part in this research, are fights between students and theft of personal objects.Results of other studies have shown that teachers have emphasized in their reports that violence, especially disrespect, is a constant in the school environment.They indicate that violence in public schools is trivialized, which means that violent acts are not perceived as such (21) .This would justify the presence of an association only between graffiti and the female gender, and the fact that other violent realities were not even mentioned by the teachers of the present study.
Added to this context, there is still a close relationship between violence and gender, which finds in schools a privileged space for the creation and strengthening of gender stereotypes (22) .This affirmation contributes to the evidence that the female teachers in this study perceive violence more evidently, when it comes to graffiti, compared to male teachers.Furthermore, school graffiti are more sensitive to the female audience, as often drawings of male genitalia are imposed, and phrases that objectify women are commonly used as a sort of male domination and naturalization of sexism.Most certainly, violence is a type of behavior acquired in the processes of socialization as a cultural construction, and it has the power to provoke several consequences, which deeply affect learning in everyday school life and the health of everyone that is part of the institution (23) .

CONCLUSION
Self-reporting on voice disorders did not indicate a significant relation to the situations of violence presented to the teachers.However, analysis of the context of violence in schools and vocal problems in teachers are worthy of attention, particularly the issue of gender that is naturalized and seldom problematized when it comes to women and work.In this way, the present article can contribute with specific actions in health care for the vulnerable population and provide guidance to the creation of public policies capable of minimizing vocal disorders in these professionals, thus reflecting on mechanisms that prevent or diminish the situations of violence in schools.

Table 1 .
Absolute and relative frequency of violence acts reported by the teachers taking part in the research and self-reports of vocal changes