Saúde escolar e comportamento de risco para violência entre escolares em Fortaleza: análise longitudinal PeNSE e relatórios do Plano Plurianual de governo (2009-2019)

Abstract

This study evaluates the evolution of health indicators and risk behaviors associated with sexual health and violence among school adolescents in Fortaleza, focusing on the impact of public policies such as the School Health Program (PSE) and data from the National Survey of School Health (PeNSE). The context reveals challenges related to early sexual initiation, teenage pregnancy, violence, and mental health, in a scenario marked by socioeconomic inequalities and vulnerabilities. Specifically, the study aimed to compare regional and national indicators, analyze temporal trends, investigate thematic correlations, and assess the effects of PSE actions documented in Multi-Year Plans (PPAs). This is a documentary and qualitative-quantitative research conducted between 2009 and 2019. The methodology involved three stages: (1) data collection from PPA reports (2014–2025) and editions of PeNSE (2009, 2012, 2015, 2019); (2) descriptive and comparative analysis of health indicators, with an emphasis on temporal trends and thematic correlations; and (3) cross-referencing PPA and PeNSE data to evaluate the impact of planned actions. The sample consisted of data from 9th-grade students in public and private schools in Fortaleza, organized longitudinally. Analyses were performed using statistical tools, such as logistic regression, and qualitative methods, including thematic content analysis. Ethical aspects adhered to CNS Resolution No. 510/2016, ensuring anonymity and the use of public data. The results indicated progress in some indicators, such as the reduction in early sexual initiation, which declined from 33.1% (2009) to 27.9% (2019), and physical fights, which decreased from 23.8% (2015) to 12.7% (2019). The teenage pregnancy rate stabilized at around 7.4% (2019), while condom use showed a concerning decline, from 66.1% (2009) to 59.7% (2019). An increase was noted in the use of emergency contraception, from 25.4% (2012) to 45.5% (2019). However, sexual violence indicators showed stabilization at worrying levels, with 14.6% reporting sexual harassment in 2019 and 6.3% reporting exposure to forced sexual relations. The analysis of the Multi-Year Plans (PPAs) revealed challenges in the implementation of the PSE, such as a lack of resources in highly vulnerable areas, insufficient integration of education and health actions, and cultural resistance to sexual education. Reports indicated increased adherence to the PSE, with 97.3% of Brazilian municipalities participating, but highlighted significant gaps, such as 14 million students still outside the program in 2022. Despite progress, goals for reducing early pregnancy and increasing condom use were not fully achieved. It is concluded that public policies, such as the PSE, have promoted significant advancements in adolescent health in Fortaleza, particularly in reducing violent behaviors and early sexual initiation. However, the overall objective has been partially achieved, as challenges persist regarding consistent condom use, sexual violence, and the integrated and regionalized implementation of PSE actions. Strategies more adapted to local realities and greater intersectoral coordination are essential to consolidate the positive impacts of these policies.