School environment and oral health promotion: the National Survey of School Health (PeNSE)

Nery, Newillames Gonçalves; Jordão, Lidia Moraes Ribeiro; Freire, Maria do Carmo Matias

doi:10.11606/s1518-8787.2019053001376

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Original Article • Rev. Saúde Pública 53 • 2019 • https://doi.org/10.11606/s1518-8787.2019053001376 copy

School environment and oral health promotion: the National Survey of School Health (PeNSE)

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Adolescent Health; School Dentistry Services; School Health Services; Health Disparities Oral Health; Health Promotion; Epidemiological Surveys

Geographic location	n	%
Regions and capital cities (States)

North region	303	22.6
Porto Velho (RO)	46	3.4
Rio Branco (AC)	41	3.1
Manaus (AM)	35	2.6
Boa Vista (RR)	44	3.3
Belém (PA)	46	3.4
Macapá (AP)	51	3.8
Palmas (TO)	40	3.0
Northeast region	480	35.9
São Luís (MA)	54	4.0
Teresina (PI)	58	4.3
Fortaleza (CE)	46	3.4
Natal (RN)	59	4.4
João Pessoa (PB)	68	5.1
Recife (PE)	56	4.2
Maceió (AL)	41	3.1
Aracaju (SE)	54	4.0
Salvador (BA)	44	3.3
Southeast region	218	16.3
Belo Horizonte (MG)	62	4.6
Vitória (ES)	62	4.6
Rio de Janeiro (RJ)	51	3.8
São Paulo (SP)	43	3.2
South region	139	10.4
Curitiba (PR)	42	3.1
Florianópolis (SC)	51	3.8
Porto Alegre (RS)	46	3.4
Midwest region	199	14.9
Campo Grande (MS)	44	3.3
Cuiabá (MT)	39	2.9
Goiânia (GO)	68	5.1
Federal District (FD)	48	3.6

Total	1,339	100.0

Organizational characteristics

Location in the municipality
Rural	48	3.6
Urban	1,291	96.4
Total	1,339	100.0
Administrative dependence
Public	940	70.2
Private	399	29.8
Total	1,339	100.0
Full-time school
Yes	275	20.5
No	1,063	79.4

Total	1,338	100.0

Variables		Sale of soft drinks in the canteen	Sale of other beverages with added sugar in the canteen	Sale of sweets and other delicacies in the canteen	Sale of soft drinks at alternative points	Sale of other beverages with added sugar at alternative points	Sale of sweets and other delicacies at alternative points	School develops actions of the PSE	School develops actions along with the PHU	School prohibits tobacco consumption	School prohibits alcohol consumption
Sale of soft drinks in the canteen	Pearson Correlation	1
	p
	n	1,304
Sale of other beverages with added sugar in the canteen	Pearson Correlation	0.50	1
	p	< 0.001
	n	1,304	1,304
Sale of sweets and other delicacies in the canteen	Pearson Correlation	0.60	0.47
	p	< 0.001	< 0.001
	n	1,304	1,304	1,304
Sale of soft drinks at alternative points	Pearson Correlation	-0.02	0.02	-0.01	1
	p	0.433	0.509	0.778
	n	1,300	1,300	1,300	1,332
Sale of other beverages with added sugar at alternative points	Pearson Correlation	-0.00	0.08	0.06	0.63	1
	p	0.857	0.005	0.023	< 0.001
	n	1,300	1,300	1,300	1,332	1,332
Sale of sweets and other delicacies at alternative points	Pearson Correlation	0.00	0.04	0.11	0.53	0.46	1
	p	0.926	0.121	< 0.001	< 0.001	< 0.001
	n	1,300	1,300	1,300	1,332	1,332	1,332
School develops actions of the PSE	Pearson Correlation	0.27	0.23	0.22	0.03	0.07	0.03	1
	p	< 0.001	< 0.001	< 0.001	0.298	0.013	0.271
	n	1,303	1,303	1,303	1,331	1,331	1,331	1,336
School develops actions along with the PHU	Pearson Correlation	0.25	0.22	0.18	0.004	0.035	-0.026	0.40	1
	p	< 0.001	< 0.001	< 0.001	0.873	0.200	0.350	< 0.001
	n	1,303	1,303	1,303	1,331	1,331	1,331	1,335	1,336
School prohibits tobacco consumption	Pearson Correlation	0.02	-0.01	0.01	-0.01	-0.05	-0.03	0.05	0.07	1
	p	0.563	0.617	0.632	0.623	0.050	0.303	0.047	0.013
	n	1,303	1,303	1,303	1,331	1,331	1,331	1,335	1,335	1,336
School prohibits alcohol consumption	Pearson Correlation	0.01	-0.04	-0.01	-0.04	-0.06	-0.07	0.032	0.032	0.60	1
	p	0.684	0.149	0.755	0.141	0.023	0.017	0.240	0.238	0.000
	n	1,303	1,303	1,303	1,331	1,331	1,331	1,335	1,335	1,336	1,336

Resulting variables and dimensions	n	%	CATPCA

			Calculated variance	Factor loadings	Eigenvalue	Percentage of variance explanation	Cronbach’s Alpha
Dimension 1 – Within-school aspects

Canteen: soft drinks			0.566	0.752	2.419	24.2%	0.652
Yes	404	30.2
No	900	67.2
Canteen: sweets or delicacies			0.546	0.739
Yes	324	24.2
No	980	73.2
Canteen: beverages with added sugar			0.499	0.706
Yes	284	30.02
No	1,020	76.2
School: PSE actions			0.302	0.549
No	796	59.4
Yes	540	40.3
School: actions with PHU			0.250	0.500
No	840	62.7
Yes	496	37.0

Dimension 2 – Aspects of the area around the school

Alternative sale point: soft drinks			0.656	0.810	2.099	21.0%	0.582
Yes	276	20.6
No	1,056	78.9
Alternative sale point: other beverages with added sugar			0.595	0.771
Yes	162	12.1
No	1,170	87.4
Alternate sale point: sweets or delicacies			0.517	0.719
Yes	244	18.2
No	1,088	81.3

Dimension 3 – Prohibitive policies

School: prohibits tobacco consumption			0.744	0.863	1.602	16.0%	0.417
No	1,214	90.7
Yes	111	8.3
School: prohibits alcohol consumption			0.720	0.849
No	1,225	91.5
Yes	111	8.3

Total			-	-	6.120	61.2%	0.930

Level	Schools with lower AEPSB (n = 654)			Schools with higher AEPSB (n = 685)			p*

Variables

Categories	n	%	95%CI	n	%	95%CI
School
School location
Rural	22	45.8	32.4–59.9	26	54.2	40.1–67.6	0.671
Urban	632	48.9	46.2–51.7	659	51.1	48.3–53.8
Administrative dependence
Public	394	41.9	38.8–45.1	546	58.1	54.9–61.2	< 0.001
Private	260	65.2	60.4–69.7	139	34.8	30.3–39.7
Full-time
No	525	49.4	46.4–52.4	538	50.6	47.6–53.6	0.401
Yes	128	46.5	40.7–52.5	147	53.5	47.5–59.3
Capital
Human development index
Low	246	54.4	49.8–59.0	206	45.6	41.0–50.2
Medium	270	50.7	46.4–54.9	263	49.3	45.1–53.6	< 0.001
High	138	39.0	34.0–44.1	216	61.0	55.8–66.0
Gini Index
High	201	54.0	48.9–59.0	171	46.0	41.0–51.0
Medium	237	49.4	44.9–53.9	243	50.6	46.2–55.1	0.018
Low	216	44.4	40.0–48.8	271	55.7	51.2–60.0
Region
Human development index
Low	417	53.3	49.7–56.7	366	46.7	43.3–50.3	< 0.001
High	237	42.6	38.6–46.8	319	57.4	53.2–61.4
Gini Index
High	165	54.5	48.8–60.0	138	45.5	40.0–51.2	0.026
Low	489	47.2	44.2–50.3	547	52.8	49.8–55.8

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[1] Correspondence: Newillames Gonçalves Nery Rua Salvador Qd. 123 Lt. 14 Ed. Plaza de España, Apto. 1102 A Pq. Amazônia 74.843-050 Goiânia, GO, Brasil E-mail: psfnery@globomail.com