UNIFESP Violence and child rights: an educational-scientific cooperation between Norway and Brazil

Isabel A. Bordina, John A. Rønningb, Wagner Ribeiroa, Andre Souranderc, Cristiane S. Duarted

a Universidade Federal de São Paulo, Brazil; b University of Tromsø, Norway; c Turku University, Finland; Columbia University, USA

Acknowledgments: This collaborative initiative is sponsored by the University of Tromsø with funds received from the Research Council of Norway (Project # 201470/S50)Correspondence: BRAZIL - Isabel A. Bordin, MD, PhD – iasbordin@gmail.com; NORWAY - John A. Rønning, PhD – john.ronning@uit.no

Background

The University of Tromsø (Norway) and the Universidade Federal de São Paulo (Brazil) have recently established a long-term educational-scientific cooperation including a collaborative longitudinal project (VIOLENCE AND CHILD RIGHTS IN BRAZIL: CAN THE CYCLE OF VIOLENCE BE BROKEN?), and the promotion of scientific exchange among researchers from the two countries.

Violence against children and adolescents is extremely common in Latin America1. However, with a few exceptionse.g., 2, most studies on the topic have been conducted in high income countries3. Norway, for example, has developed the most widespread school antiviolence programs4. In the proposed study, a team of Norwegian and Brazilian researchers will examine the impact of different types of violence on the lives of Brazilian children and adolescents. The Brazilian research team will benefit from the expertise of Norwegian investigators on school violence, service use and the long tradition of using Rights based approach. For the Norwegian team this is a unique opportunity to learn about the existing child-related resources in Brazil and to support the expansion of care for those exposed to violence within an existing Right-based framework and service system.

Objectives

In a probability sample of children and adolescents (6-16 years) (N=1,400) living in Itaboraí City, Rio de Janeiro, the study main goals are: (1) To examine the impact of child exposure to violence in their homes, schools and/or communities on child well-being (including violent behaviors, mental health problems, general health, school performance, social and family interpersonal relationships, and expectations about the future); (2) To describe the services received by children/adolescents who have been exposed to violence (service type, frequency, adherence, duration, satisfaction) and the potential benefits of received services on child well-being; (3) To examine the role of different types of services in reducing the negative impact of exposure to violence on child well-being; and (4) To expand understanding about services for children who are victims of violence by collecting information from community members and professionals working in key services using semi-structured interviews (qualitative research).

Method

The project will be carried out in Itaboraí, which is a municipality located about 60 km far from Rio de Janeiro, the second largest Brazilian city. According to the last Brazilian census (2010) the population of Itaboraí is of about 218,000 inhabitants5 – 32.0% of them under 20 years of age6.

The choice of Itaboraí city as our research site is based on three facts: (1) poverty – in 2000, 20.2% of inhabitants were living in households without a toilet and without running water7, and in 2007, 35.2% of the city population were considered poor compared to 18.8% in the State of Rio de Janeiro8; (2) violence - in 2006, the city registered a high homicide rate among adolescents (six deaths per thousand in the age range 12-18 years) 9; and (3) psychosocial stress - in a city with high rates of unemployment, an unskilled work force is facing the challenges of a recent massive investment from Petrobrás (governmental Brazilian oil company)10 that will generate more than 200 thousand jobs for trained professionals, attracting new inhabitants to the city, increasing rental prices, and favoring alcohol/drug consumption, urban violence and adolescent prostitution.

The project includes two modules: (1) a longitudinal study that will follow-up a representative sample of 1,440 children and adolescents (6-16 years) from 2011-2012 to 2012/2013 (nine month interval between wave 1 and wave 2); and (2) a qualitative study (2012) that will obtain information on mental health problems, violence exposure and service use from mothers, adolescents and professionals (focus groups and in-depth interviews).

In the epidemiological study, census information will be used to select a probabilistic sample of the city population of children and adolescents (6-16 years) (N=1,440). Mothers or main caregivers and adolescents (11-16 years) will be individually interviewed at home by previously trained interviewers. Information on the same set of variables (table 1, table 2) will be obtained at wave 1 and wave 2. Standardized instruments will be applied such as the Strength and Difficulties Questionnaire (SDQ), the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR) for mental health assessment of children/adolescents, the Self-Report Questionnaire (SRQ) for mental health assessment of mothers/caregivers, the WorldSAFE Core Questionnaire for the identification of domestic violence against children/adolescents and marital violence, and the Service Assessment for Children and Adolescents (SACA) for examining service use.

In the qualitative study, focus groups will be carried out with parents/caregivers and with 11-16 year olds. In-depth interviews will be conducted with community health workers, nurses, pediatricians and/other primary-care health professionals, guardianship councilors, and school representatives. The objective of the qualitative module is to examine ideas about the meaning of and resource to deal with violence (domestic, school and community) from the perspective of parents, youth and care providers, and to identify which factors, according to their perspectives, can either facilitate or impeach the seeking for help.

Conclusion

This experience will highlight in which ways the mental health of children and adolescents in Brazil is related to a reality of poverty, violence, difficulties, distress and deprivation.

We expect that our research efforts will bring positive outcomes for the population of Itaboraí city, making the collaboration a learning experience useful for Brazil and Norway.

References1) Weaver K, Maddaleno M. Youth violence in Latin America: current situation and violence prevention

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2) Bordin IA, Duarte CS, Peres CA, Nascimento R, Curto BM, Paula CS. Severe physical punishment: risk of mental health problems for poor urban children in Brazil. Bull World Health Organ 2009; 87(5):336-344.

3) WHO. World Report on Violence and Health. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. 92 4 154561 5. 2002. Geneva, WHO.

4) Olweus D. Bully/victim problems among schoolchildren: Basic facts and effects of a school based intervention program. In: Pepler DJ, Rubin KH, editors. The Development and Treatment of Childhood Aggression. Hillsdale, N.J.: Lawrence Erlbaum, 1991: 411-448.

5) Instituto Brasileiro de Geografia e Estatística (IBGE). Sinopse do censo demográfico 2010 por estado e município – população residente. Available from: http://www.censo2010.ibge.gov.br/sinopse/index.php?uf=33&dados=1

6) IBGE. Sinopse do censo demográfico 2010 por estado e município – população por grupo de idade. Available from: http://www.censo2010.ibge.gov.br/sinopse/index.php?uf=33&dados=26

7) Ferreira PCG. Um diagnóstico das condições habitacionais da região metropolitana do Rio de Janeiro (relatório de pesquisa). 2004. Available from: http://www.iets.org.br/biblioteca/Um_diagnostico_das_condicoes_habitacionais_da_RM_do_RJ.pdf

8) Programa das Nações Unidas para os Assentamentos Humanos (UN-Habitat). Objetivos de desenvolvimento do Milênio – Itaboraí – 2007 (relatório de acompanhamento). ODM 1 - Erradicar a extrema pobreza e a fome. Available from: http://webcache.googleusercontent.com/search?q=cache:VvNALbLl-a8J:www.unhabitat.org/pmss/getElectronicVersion.asp%3Fnr%3D2772%26alt%3D1+pobreza+Itabora%C3%AD&cd=15&hl=pt-BR&ct=clnk&gl=br&source=www.google.com.br

9) Secretaria Especial dos Direitos Humanos da Presidência da República (SPDCA/SEDH), Fundo das Nações Unidas para a Infância (UNICEF), Observatório de Favelas (OF), Laboratório de Análise da Violência (LAV/UERJ). Índice de homicídios na adolescência (IHA): análise preliminar dos homicídios em 267 municípios brasileiros com mais de 100 mil habitantes. 2009. Available from: http://www.observatoriodefavelas.org.br/observatoriodefavelas/includes/publicacoes/471da5ee11f02534b6022e2a2d6a40dc.pdf

10)Prefeitura de Itaboraí. COMPERJ - Complexo Petroquímico do Estado do Rio de Janeiro. Available from: http://www.itaborai.rj.gov.br/cidade/comperj.php

TABLE 1 - PARENTS’ INTERVIEW VARIABLES

• Demographics• Child’s exposure to community violence• Child’s exposure to domestic violence• Child’s exposure to school violence (bullying)• Child’s mental health problems• Child’s impairment related to mental health problems• Child’s use of alcohol and drugs• Child’s school performance• Parents’ perception on child’s attitudes towards violence• Parents’ attitudes towards violence• Parents' use of alcohol and drugs• Use of services• Mother’s mental health status

TABLE 2 - ADOLESCENTS’ INTERVIEW VARIABLES

• Demographics• Exposure to community violence• Exposure to domestic violence• Exposure to school violence (bullying)• Attitudes towards violence• Use of alcohol and drugs• Mental health problems• Impairment related to mental health problems• Performance at school• Pro-social activities (participation in sport, leisure etc.)• Resilience