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

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.