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Parent's perspective on child rearing and corporal punishment

Abstracts

OBJECTIVE: To describe parents' current perception of corporal punishment associated to child rearing and its practices. METHODOLOGICAL PROCEDURES: There were studied 31 family members whose children were warded due to child abuse complaints (12) and not warded (19) at a health care unit and a local social service unit in the city of Belo Horizonte (Southeastern Brazil) in 2006. Data was collected through semi-structured interviews and speech analysis was performed grouped by subjects and categories. ANALYSIS OF DISCOURSE: There was limitation of the respondents' speeches based on their production means. There was a diversity of conceptions on child rearing and its practices and corporal punishment was reported by all parents, even among those who expressed strong disapproval of this practice. Speeches were characterized by heterogeneity and polyphony with emphasis on the tradition speech, the religious speech and the popular scientific speech. Respondents did not express concepts of legal interdiction of corporal punishment or its excesses. CONCLUSIONS: The culture of corporal punishment of children is changing; tradition approving it has weakened and prohibition has been slowly adopted. Reinforcing legal actions against this practice can contribute to speed up the process to end corporal punishment of children.

Child Rearing; Punishment; Parent-Child Relations; Domestic Violence; Qualitative Research


OBJETIVO: Descrever a percepção dos pais acerca do castigo físico, considerando-se o significado da educação e punição física, e formas de educar. PROCEDIMENTOS METODOLÓGICOS: Foram abordados 31 familiares, estando 12 sob tutela por denúncia de maus-tratos e 19 não tutelados em unidade básica de saúde e na secretaria de Assistência Social de Belo Horizonte (MG) em 2006. Procedeu-se à análise de discurso dos relatos obtidos por meio de entrevistas semi-estruturadas. Os dados foram organizados em temas e categorias. ANÁLISE DO DISCURSO: Os resultados apontaram a restrição dos discursos dos entrevistados em função das suas condições de produção. Houve diversidade de concepções sobre educação e formas de educar, tendo como pontos comuns o relato da prática da punição física por todos os pais, mesmo entre aqueles que a condenam. Os discursos foram marcados pela heterogeneidade e polifonia, sobressaindo-se o discurso da tradição, o discurso religioso e o discurso científico popularizado. Não foi observada expressão do conceito de interdição legal da prática ou dos seus excessos pelos participantes. CONCLUSÕES: A cultura do castigo físico encontra-se em transição, em que a tradição de permissão se enfraquece e a interdição se inicia lentamente. Reforço ações de repressão legal à prática poderia contribuir para acelerar o processo de interdição do castigo físico.

Educação Infantil; Punição; Relações Pais-Filho; Violência Doméstica; Pesquisa Qualitativa


OBJETIVO: Describir la percepción de los padres acerca del castigo físico, considerándose el significado de la educación y punición física, y formas de educar. PROCEDIMIENTOS METODOLÓGICOS: Fueron abordados 31 familiares, estando 12 bajo la tutela por denuncia de malos tratos y 19 no tutelados en unidad básica de salud y en la secretaria de Asistencia Social de Belo Horizonte (Sureste de Brasil) en 2006. Se procedió al análisis de discurso de los relatos obtenidos por medio de entrevistas semi-estructuradas. Los datos fueron organizados en temas y categorías. ANÁLISIS DEL DISCURSO: Los resultados señalaron la restricción de los discursos de los entrevistados en función de sus condiciones de producción. Hubo diversidad de concepciones sobre educación y formas de educar, teniendo como puntos comunes el relato de la práctica de la punición física por todos los padres, inclusive entre aquellos que la condenan. Los discursos fueron marcados por la heterogeneidad y polifonía, sobresaliéndose el discurso de la tradición, el discurso religioso y el discurso científico popularizado. No fue observada expresión de concepto de interdicción legal de la práctica o de sus excesos por los participantes. CONCLUSIONES: La cultura de castigo físico se encuentra en transición, en que la tradición de permisividad se debilita y la interdicción se inicia lentamente. Refuerzo de acciones de represión legal a la práctica podría contribuir para acelerar el proceso de interdicción del castigo físico.

Crianza del Niño; Castigo; Relaciones Padres-Hijo; Violencia Doméstica; Investigación Cualitativa


ORIGINAL ARTICLES

Parent's perspective on child rearing and corporal punishment

Paternidad: responsabilidad social del hombre en el papel de proveedor

Miguir Terezinha Vieccelli Donoso; Janete Ricas

Departamento de Enfermagem Básica. Escola de Enfermagem. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil

Correspondence Correspondence: Miguir Terezinha Vieccelli Donoso Escola de Enfermagem da UFMG R. Alfredo Balena, 190 - Campus da Saúde Santa Efigênia 30130-100, Belo Horizonte, MG, Brasil E-mail: miguir@enf.ufmg.br

ABSTRACT

OBJECTIVE: To describe parents' current perception of corporal punishment associated to child rearing and its practices.

METHODOLOGICAL PROCEDURES: There were studied 31 family members whose children were warded due to child abuse complaints (12) and not warded (19) at a health care unit and a local social service unit in the city of Belo Horizonte (Southeastern Brazil) in 2006. Data was collected through semi-structured interviews and speech analysis was performed grouped by subjects and categories.

ANALYSIS OF DISCOURSE: There was limitation of the respondents' speeches based on their production means. There was a diversity of conceptions on child rearing and its practices and corporal punishment was reported by all parents, even among those who expressed strong disapproval of this practice. Speeches were characterized by heterogeneity and polyphony with emphasis on the tradition speech, the religious speech and the popular scientific speech. Respondents did not express concepts of legal interdiction of corporal punishment or its excesses.

CONCLUSIONS: The culture of corporal punishment of children is changing; tradition approving it has weakened and prohibition has been slowly adopted. Reinforcing legal actions against this practice can contribute to speed up the process to end corporal punishment of children.

Descriptors: Child Rearing. Punishment. Parent-Child Relations. Domestic Violence. Qualitative Research.

RESUMEN

OBJETIVO: Analizar los significados atribuidos a la paternidad por hombres que son padres.

DELINEAMIENTO DEL ESTUDIO: Estudio realizado en Joao Pessoa (Noreste de Brasil), en 2003, desarrollado bajo el abordaje cualitativo y enfoque teórico del género. Los participantes del estudio fueron diez hombres, cuyos hijos eran atendidos en el ambulatorio de puericultura de un hospital escuela. Las informaciones analizadas fueron obtenidas por medio de entrevistas semi-estructuradas. Los relatos fueron analizados por la técnica de análisis crítica del discurso.

ANÁLISIS DE LOS DISCURSOS: Los sujetos de estudio concebían la paternidad como un nuevo encargo social, vinculándola más a la provisión material de la familia que al espacio de envolvimiento afectivo con él(la) hijo(a). Así mismo, los participantes experimentaban un proceso de transición en el cual el padre tradicional convivía entre aquellos cuya dimensión afectiva de la paternidad se presentaba como el eje central de preocupación del ser padre.

CONCLUSIONES: El significado y el ejercicio concreto de la paternidad se situaron en un campo de responsabilidades que predominantemente reproducen el padre tradicional pero también re-crean el papel de padre, con inclusión de la dimensión afectiva.

Descriptores: Paternidad; Relaciones Padre-Hijo; Identidad de Género; Responsabilidad Social; Investigación Cualitativa.

INTRODUCTION

From the point of view of science, and increasingly of the professionals who are involved with children, physical punishment is considered to be violence. It might not, however, be perceived as such by those who practice it, due to the spread and social acceptance of the practice. Even among intellectuals, the use of physical punishment is sometimes explained as being a routine and normal procedure. In popular communities it may even be a reason for boasting and is frequently demanded by society in those situations where children transgress and break the sociability norms adopted by the particular social group to which they belong. By incorporating cultural values, even the children who suffer punishment may not see punishment as violence,14 because they learn early on that it is "normal" or even desirable to be hit by ones parents.

The tendency to condemn physical punishment, by placing it in the category of violence, regardless of the form it takes or its intensity, is based on studies and observations that show the risks and consequences of this practice for the child.

The tolerated limits of intensity and the forms of "educational" physical punishment that are culturally accepted vary widely between social groups and families. A simple slap coexists alongside beatings and both are justified in the same way: the need to rear children.ª a Cardoso ACA. Maus tratos infantis: estudo clinico, social e psicológico de um grupo de crianças internadas no Instituto da Criança do Hospital das Clínicas da FMUSP [doctorate thesis]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2002.

Even when it has a child-rearing intention, the act of hitting easily exceeds the limits imposed by the child-rearer him/herself, because of the very characteristics of the act. According to Bessa et al,2 physical punishment is often used in an uncontrolled way, more as relief for the person who is hitting than as a means of imposing discipline.

The child-rearing justification frequently covers other intentions, whether conscious or not, which are motivated by the adult's feelings of rejection, anger, frustration, among others, against the child, or directed towards him/her.15

When the physical punishment fails to produce the results desired by the child-rearer, the tendency is to increase the intensity and frequency, leading to a vicious circle that may result in tragic situations. Zagury16 claims that in some situations, even when they are being hit and afraid, children identify this act as humiliating, thereby finding the strength to face up to their parents, when they say "It didn't hurt". This is a forum of defense that may result in more aggression, because of the possible loss of control of the parents. Therefore, what many parents agree to call "slaps" may result in a beating.

Studies have shown the harmful, sometimes catastrophic effects on the affective, social and cognitive development of the child that beatings cause and with serious repercussions in their adult life.15

The quality of life of the child is compromised. The right to respect, dignity and physical and moral integrity should not have to wait until they become adults.

Literature has shown how complex it is to determine violence against children and indicated the great number of variables that are interrelated in the causes of this phenomenon.16 Examples are: 1) historical questions related to the place, measured by child culture in society and the family;5 2) economic and social questions, like coming from underprivileged social segments and situations associated with illiteracy, delinquency and unemployment;b b Tourinho JOS. Tutela jurídico - penal da infância e da juventude: dos maus tratos [master's dissertation] Maringá: Universidade Estadual de Maringá; 2001 3) questions related to inequality, gender domination and power relations between generations;13 4) coming from normally conflict-ridden environments, where there are psychological problems, such as depression, alcoholism and other types of drug addiction;1,10,12 5) lack of social sensitivity, isolation and inadequate social support;17 6) type of family structure and tradition.1

Actions for reducing violence must take into consideration all the determinants, among which are cultural issues. Specifically, the question of social acceptance of punishment must be looked at in more depth. The objective must be to establish types of intervention aimed at the "deconstructing" physical punishment in order to give way to forms of rearing children that are less harmful to them.

The objective of this study was to describe the parents' perception of physical punishment, considering the meanings of child rearing, the association between rearing children and physical punishment and ways of rearing children.

METHODOLOGICAL PROCEDURES

Semi-structured interviews were conducted with two groups of parents. The first group comprised 19 mothers of preschool age children; no institutions had ever complained that these children were suffering from physical violence. The mothers were contacted and interviewed in the waiting room of a basic health unit in the city of Belo Horizonte, Southeastern Brazil, from March to May 2006. Those taking part were asked to talk about rearing children, the ways they use to rear them, the establishment of limits, situations that give rise to physical punishment and their experiences with rearing their children. The second group comprised nine mothers, a father and a grandmother, all of whom had already been formally denounced for ill-treatment of their children and who were under the custody of Children's Issues Public Prosecutor's Office. This stage was carried out with the support of a Welcoming Families Program (WFP), of the Assistant Municipal Secretary for Social Assistance of Belo Horizonte, which attends families with children from zero to 12 years old, who are the subject of protection orders issued by the competent bodies (Custodial Councils, the Dependency Court and the public prosecutor's office). The interviews were individually carried out in private rooms.

The final number of participants in each group was determined by the saturation criterion.7

Discourse analysis3 was used as a theoretical point of reference for analyzing the reports. The data were organized in themes and categories.

The research project was approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais (COEP-UFMG) and by the Research Ethics Committee of the City Health Department of of Belo Horizonte (CEP - SMSA/PBH).

DISCOURSE ANALYSIS

The analysis of the reports, based on the principles of discourse analysis, resulted in four situations to be considered.

Analysis situations

Influence of the physical conditions of the interview setting

In the first group, the limitations and informality of the waiting room restricted privacy and deflected attention, but at the same time, the fact of sitting alongside the interviewer and in the company of other people, who presumably share the same ideas, helped reduce discourse restrictions:

"That's it [...]. But, I didn't change my mind, because I think she deserved the beating with the stick at the time I gave it to her... she deserved it and she has to be punished when she deserves it." (Renata, G1)

In the second group, on the other hand, the use of a room with privacy may have increased attention and facilitated expressing details that were confidential. The formality of the situation, however, may have increased discourse restrictions:

"Oh, I don't know if the reply is the right one, but it's ... I no longer want to do to Chiquinho what they did to me...Today, I believe that bringing up a child is talking to them...." (Samira, G2)

Restrictions imposed by the type of discourse and institutional context

Even semi-structured interviews categorize what is said into a questions and answers, in accordance with a predetermined objective. The fact that they took place in a health center and in the custody institution instead of the household or on other more neutral ground was relevant, mainly for the second group, due to the legal relationship and the dependence of the participants on the institution.

Imaginary representations of the subjects about their own identity and that of others

Right at the outset, a hierarchical relationship was established in both groups, in which the researcher was seen as having more legitimate knowledge than the interviewee, in relation to whom the latter's own knowledge would be evaluated:

"So, we don't bring up children by slapping them, but if they stress you out a lot and make you so angry, before you know it you've hit them. Do you understand? You explain things, you talk to them, but it does no good. That's when you end up flying off the handle!" (Raissa, G1).

In the second group, two the mediation of the Custodial Institution led to the perception of the researcher as its representative, who had the power to judge, punish and remove benefits.

Intentions expressed by the interviewees

Although the interviewer had the declared intention of gathering information, in the first group, along with the information that was provided there was also a predominant attempt to show off; the mothers tried to show how fair their concepts and attitudes were:

"I've already given it to him (slaps); if it's necessary I really give it to him. I punish him and I, like, talk with him a lot. There are mothers who hit their kids, but don't explain why the child is being slapped. Every time I slap my son I always say to him afterwards: 'Son, do you know why Mummy slapped you? It was because of this. So, I ... I think that I provide the best upbringing I can." (Rosane, G1)

In the second group, the interviewees tried to show that their actions had determinants in addition to their own intentions and will:

"Look, before... long before, my life was like this, it was a very difficult life, so I had no other, like, way of bringing up my little boy..." (Sílvia, G2);

They also tried to show that their concepts and attitudes had undergone transformations, such as in the words of a mother who had been accused of causing a serious and disabling injury to her daughter:

"Thank God I get on well with her! With all my daughters. I only hit her once. Thank God nothing ever happened again...!" (Regina, G1)

Furthermore, the current social and economic situation of the families was considered as a determinant of their discourse and restricted it:

"Because my family believes in keeping things on the right track. It's just poor, but it doesn't have this bad habit (stealing), does it?" (Sibele, G2)

Poverty was predominant in the first group, while in the second group most lived below the poverty line and had great difficulty when it came to supplying even their basic needs. They had not completed four years of schooling.

Analysis of the reports

Analysis of the reports allowed them to be categorized into: 1) meanings attributed to rearing children, and 2) ways of rearing children. Analytical categories related to the following themes: scientific concepts about domestic violence; ways of rearing children as disclosed by the media and social assistance programs and from contact with health and education professionals; legislation about children's rights and the history of infancy in Brazil, particularly as far as concerns the naturalization of physical punishment.

Meanings attributed to rearing children and physical punishment

Categories that contained expressions about what it means to rear children were grouped under this theme:

Preparing them for life

Child rearing is seen as an instrument to be used for their social insertion, in the sense of conforming to the law or preparing them for survival.

"Well, for me, I think like this, don't I? It's the way I think. I think bringing up a child is something important that the parents have to do, right? So, like, it's preparing them for the world, isn't it, to get ahead, so they know what they shouldn't do, isn't it?" (Renata, G1)

In this preparation for the world, their words highlight prohibition. Possibilities are emphasized in the need for schooling:

"I always tell him to study, that I wasn't able to study, do you understand?" (Raquel, G1).

Mothers belonging to the group under custody pointed to studying as a substitute for violence when it came to bringing up their children:

"Ah, rearing them is giving them education, looking after them right, because today violence doesn't teach anyone" (Sibele, G2).

The second group was specially marked by the violence in their daily lives; they did not expect physical punishment to have such a connotation. The report on interviewee Sibele prepared by the Protection Council when it sent her to the WFP stated that she had violent attitudes and had beaten her daughter with a piece of burning wood. The mother said that study and maternal care were necessary for the child, instead of physical aggression. In these statements, one observed how the discourse transmitted by the professionals of the Custodial Council had been incorporated by the interviewee, which characterizes a situation of polyphony.

Transmission of culture

In this category, rearing children is seen as repetition and denial of what was experienced in their own childhoods:

"I no longer want to do to Chiquinho what they did to me, because I got hit a lot. I got hit by my mother, I got hit by my brothers. Today, I think that bringing up a child is conversing with them.... I think it's worth more than punishment, because the mark of a beating, a slap, a walloping, being hit with a slipper... that hurts a lot. I don't want him to go through what I had to, because it hurts a lot" (Samira, G2)

Literature points to the experience of ill-treatment in childhood as one of the determinants of aggressive behavior in adults. According to Lieder et al,8 condemnation of the aggressive act was attributed by some parents to this experience. In a study carried out in the United States, Renner & Slack11 concluded that there was little support for upholding the hypothesis of violence transmission. They showed that when these children become adults, they are more likely to be victimized than victimizers.

In this study all participants, even those who say they disagree with physical punishment, spontaneously reported having already beaten their children. This indicates a contradiction between former values and the adoption of new ones, which is shown by the polyphony in what is said, in which one perceives, above all, the implicit or explicit incorporation of the teaching and psychology discourse:

"But then, after I started treatment with the psychologist, he said that bringing up children is talking to them; hitting them doesn't solve anything. If hitting solved things, there'd be no criminals on the street. That I had to discuss things with him, talk to him more." (Simone, G2)

Even considering all the restrictions to discourse, there was little censure in the practice report, which reveals the still predominant traditional discourse, in which beating was recommended and the right of parents.4 In group 2 in particular, considering the fact that they were under custody, some of the comments show the strength of tradition in the conviction of the concepts expressed:

"I deal with them...when they deserve it, I hit them! Now, if they do nothing wrong I don't hit them. But if they do something wrong I hit them a lot!" (Sonia, G2)

The incoherence between cognitive condemnation of the practice revealed in the discourse and the practice itself may be an indication of a cultural change and perhaps a reduction in violence. The study by Duhamel6 in Canada, showed the relation between justifying violence and its use against children. Mothers who expressed greater tolerance to violence against children had a greater chance of using it against their own children.

Attention to vital needs: love, affection and attention

"Ah, it's because children, like, you've got to give them everything, like, they need, for example, don't you? Affection, isn't it? Don't let them stay out in the street, proper food, a school for studying, right?" (Roseli, G1)

The influence of the economic and social origin can be inferred in this concept. In fact, under conditions of deprivation or non-abundance, giving "everything the child needs" may imply significant sacrifices for the family, meaning the child is valued. In better-off classes "giving everything" may even be a sign of negligence.

"It's treating them with love and affection, isn't it? Understanding, being always aware of the things they're doing, isn't it? That's what it is for me. It's always observing them." (Rita, G1)

Awareness of the child's need for affection is relatively recent in history. It is possible that disclosure of scientific theories by the media has an important role to play in formulating this discourse. Even if affection arises naturally in relation to children, its social prescription may also be an indicator of changes in the value of the child for the family and for society.

Ways of rearing children

Talking to them

Some mothers, even though admitting the use of physical punishment, said they prefer to talk. This expression seems not to have, however, the connotation of dialogue but rather imposition:

"It's like I said, today I know how to talk to him without hitting him. Today, when he gets up to mischief, when he does something wrong, it's... I call him a little boy: that's right, my lad...are we going to talk or is it the blessed stick on top of the fridge for you? Are you going to do something wrong? Are we going to talk or am I going to have to use the stick?" (Samira, G2)

By means of non-physical punishment

In this situation, the mother who found herself under custody reported having used non-physical punishment. Previously, she had reported beating her daughter for the same reason. One infers the influence on the discourse of the location, the interview situation and the incorporation of the discourse of professionals from the Institution.

"Well then, like, my system of rearing my children is like this. Bring them up by teaching them that we can't take something that doesn't belong to us. I took her later with the money to give it back. She said she was sorry. She said she was sorry, do you understand? She was really embarrassed, she was annoyed." (Sheila, G2)

Establishing limits

In this category the establishment of rules, a routine and discipline was mentioned. The expression "saying no", was also used by parents.

"It's because... if he goes into the street you've got to have a time limit for him to come home. It's the same thing with food. You must have a limit to what you eat... [...] everything must have a limit with things, you know? It's what I say at home. But if you leave it to them, right? If children never have that limit of things.. That's what bringing up children is." (Roseli, G1)

Establishing discipline and clear rules, based on family and social values, and no ambiguity when applying what has been established, has been emphasized in scientific literature and science dissemination literature. Use of the pronoun "you" in the first example and the verb in the infinitive in the second may signify the belief of the mothers in the universal truth of their claims, inferring a deeper incorporation of the academic discourse.

Inflicting physical punishment

Some of those interviewed acknowledge that the practice of physical punishment as is legitimate, frequently adding that the child's behavior, circumstance, motivation or forms of applying it may justify its use.

There were reports of the unrestricted acceptance of physical punishment in two situations: because parents consider it their right and because they believe in the effectiveness of the act in rearing children:

"Ah, I think that this right... we have this right, don't we? That kids, our children, it's for bringing them up, isn't it? So, no, it's not just that I'm systematic, but we have this right." (Soraia, G2)

Physical punishment was also reported as acceptable with some restrictions: when the reason is explained, it depends on the way and the place on the body that's hit and the wrong that has been committed.

"Oh, I hit them, but it's on the legs, isn't it? On their legs and on their bottom. With rubber". (Sônia, G2)

"Without leaving a mark. I don't like to leave a mark..." (Severina, G2)

Martins9 points out that in the social imagination there is a clear difference between hitting children to hurt physically and hitting them in the interests of rearing them. According to the parents, the limit is in the strength used when hitting them. Previous comments also suggest that the limit between rearing children and violence, in the concept of the parents, may be associated more with intention than with form or intensity.

Literature has shown that the Church occupied a significant place in the Western European culture, and also in Brazil, of children and their upbringing, by justifying and even encouraging the use of physical punishment as beneficial for children.11 Some comments revealed the religious influence in rearing children, which may be associated with the belief that if the intention is to rear the child, then physical punishment is appropriate:

"Then, when I see that he's doing something wrong I say to him: 'That's right, my boy... are we going to talk or is it the blessed stick on top of the fridge for you?" (Samira, G2)

CONCLUSIONS

This study confirms that physical punishment still remains in the social imaginary as a permitted and suitable resource for rearing children, which we consider to be a serious public health problem. It also confirms the variation that exists in acceptance of the forms and intensity with which physical punishment is applied. However, in the heterogeneity and polyphony of the discourse of the parents, the study also shows the significant presence of other discourses in ways of rearing children.

In particular, the parents under the custody of the Dependency Court, although they were more explicit in revealing the cognitive assimilation of the discourse of the professionals who attended them, restated their conviction as to their sense of ownership of the child. One person said that they intended to keep on punishing the child physically, suggesting a continuation of violence in adult life, as a perpetrator. However, at no time did the parents express their perception of the legal prohibition of physical punishment, or even its excessiveness.

The culture of physical punishment is going through a transition, in which the tradition of permission is weakening and prohibition is slowly beginning. Reinforcing actions for legally repressing the practice may help accelerate the process of prohibiting physical punishment.

REFERENCES

Received: 5/5/2008

Approved: 8/28/2008

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  • 17. Zolotor AJ, Runyan DK. Social capital, family violence, and neglect. Pediatrics. 2006;117(6):e1124-31. DOI: 10.1542/peds.2005-1913
  • Correspondence:

    Miguir Terezinha Vieccelli Donoso
    Escola de Enfermagem da UFMG
    R. Alfredo Balena, 190 - Campus da Saúde Santa Efigênia
    30130-100, Belo Horizonte, MG, Brasil
    E-mail:
  • a
    Cardoso ACA. Maus tratos infantis: estudo clinico, social e psicológico de um grupo de crianças internadas no Instituto da Criança do Hospital das Clínicas da FMUSP [doctorate thesis]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2002.
  • b
    Tourinho JOS. Tutela jurídico - penal da infância e da juventude: dos maus tratos [master's dissertation] Maringá: Universidade Estadual de Maringá; 2001
  • Publication Dates

    • Publication in this collection
      06 Aug 2010
    • Date of issue
      Feb 2009

    History

    • Accepted
      28 Aug 2008
    • Received
      05 May 2008
    Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
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