Prevalence and correlates of physical fighting among school-going adolescents in Santiago, Chile Prevalencia e correlaciones de la lucha física entre adolescentes escolares en Santiago de Chile, Chile

Objective: There is a growing interest in injury as a public health issue across the world. There is paucity of data on the prevalence and social correlates of non-fatal interpersonal violence in lowand middle-income income nations. The objective of this study was to estimate the prevalence of, and associated factors for physical fighting among school-going adolescents in Santiago, Chile. Method: We conducted a secondary analysis of the Chilean Global School-Based Health Survey conducted in 2004 in Santiago. We aimed to assess the prevalence and social correlates of having been involved in a physical fight in the prior 12 months. Results: Of the 2111 respondents, 40.7% (54.3% males and 26.6% females) reported having been in a physical fight in the prior 12 months. Males were more likely to have been in a physical fight than females [OR = 3.89, 95% CI (3.11, 4.85)]. Substance use (cigarette smoking, drinking alcohol, and using drugs) and bullying victimization were positively associated with fighting [OR = 3.05, 95% CI (2.40, 3.87) for substance use, and OR = 1.65, 95% CI (1.32, 2.05) for bullying]. Parental supervision was negatively associated with physical fighting [OR = 0.62, 95% CI (0.50, 0.78)]. Conclusion: We have estimated the prevalence of having engaged in a physical fight among inschool adolescents in Santiago, Chile. We have found that the prevalence is similar to what has been reported in diverse settings in Africa, Europe and North America. Descriptors: Chile; Adolescent behavior; Mental health; Violence; School health Resumen Objetivo: Existe un creciente interés en el daño como un asunto de salud pública a través del mundo. Hay escasez de datos en la prevalencia y correlaciones sociales de violencia interpersonal no fatal, en naciones con bajos y medianos ingresos. El objetivo de este estudio fue estimar la prevalencia y el factor asociado a lucha física entre estudiantes adolescentes en Santiago, Chile. Método: Hemos conducido un análisis secundario de la Encuesta Global Chilena de Salud Basada en Escuelas, realizada en el 2004 en Santiago. Nuestro objetivo fue determinar la prevalencia y correlaciones sociales de haber estado involucrado en agresión física en los pasados 12 meses. Resultados: De los 2111 respondedores, 40.7% (54.3% masculinos y 26.6% femeninos) reportaron haber estado en una agresión física en los pasados 12 meses. Los varones tuvieron más probabilidad de haber estado en una agresión física que las mujeres [OR = 3.89, 95% CI (3.11, 4.85)]. El uso de substancias (fumar cigarros, beber alcohol y usar drogas) e intimidaciones violentas estuvieron positivamente asociados con agresión [OR = 3.05, 95% CI (2.40, 3.87)] La supervisión parental estuvo asociada negativamente con agresión física [OR = 0.62, 95% CI (0.50, 0.78)]. Conclusión: Hemos estimado la prevalencia de haber estado involucrado en una agresión física entre adolescentes escolares en Santiago, Chile. Encontramos que la prevalencia es similar a la que ha sido reportada en diversos lugares en Africa, Europa y Norteamérica. Descriptores: Chile; Conducta del adolescente; Salud mental; Violencia; Salud escolar 1 Department of Global Health, Loma Linda University, School of Public Health, Loma Linda, California, USA 2 Department of Biostatistics and Epidemiology, Loma Linda University, School of Public Health, Loma, Linda, California, USA 3 Department of Community Health, University of Malawi, College of Medicine, Blantyre, Malawi 4 Department of Community Medicine, University of Zambia Medical School, Lusaka, Zambia Emmanuel Rudatsikira,1,2 Adamson S Muula,3 Seter Siziya4 Correspondence Adamson S. Muula Department of Community Health University of Malawi-College of Medicine Private Bag 360, Chichiri, Blantyre 3, Malawi Phone: 265-1-671 911 Fax: 265-1-674 700 Email: [email protected] Submitted: October 15, 2007 Accpeted: April 5, 2008 Rev Bras Psiquiatr. 2008;30(3):197-202 ORIGINAL ARTICLE 197 Physical fighting among adolescents Rev Bras Psiquiatr. 2008;30(3):197-202 198 Introduction Interpersonal violence is an important global public health problem. In the United States, interpersonal violence against adolescents has been a leading cause of death and emergency hospital attendance among this age group.1,2 Violence-related injuries are defined as those that result from the intentional use of physical force or power against oneself, another person, or a group or community.3 Rachuba et al. and Zohoori et al. have reported that in Kingston, Jamaica, violence-related injuries were responsible for 11.5% of all recorded hospital visits in the public health system.4,5 Data from the Scottish Information and Statistics Division, Common Services Agency of the Scottish Health Service published by MacCallum et al.6 report that assault was the commonest cause of head injury among hospitalized male patients in Scotland. Assault was the leading cause of head injury among females aged 20 years or more. Much of the research and reports on violence in Chile have been directed towards intimate partner violence against women.7-9 This is clearly an important public health issue in the country as some 41% of women reported having been physically abused by intimate partner in the prior 12 months.7,8 While the concern on adolescent physical fighting largely concern physical injury and deaths, physical fighting in itself is also a marker of other unhealthy lifestyles. Kuzman10 have reported that early sexual experience among Croatian adolescents was associated with history of physical fighting. Valois et al.11 have also reported that adolescents who had experienced physical fighting were also likely to have engaged in sexual intercourse. This association may not result from cause-effect relationship, but rather a clustering of unhealthy lifestyles in adolescents i.e. an adolescent who is exposed to one unhealthy lifestyle is more likely to be also exposed to other behaviors. However, there has been limited research interest in middleand low-income countries. In order to contribute to the literature on interpersonal violence in lowand middle income settings, we carried out a secondary analysis of the Chilean Metropolitan Region (Santiago) Global School-Based Health Survey (GSHS) conducted in 2004 to estimate the prevalence of physical fighting and identify its social correlates. Method 1. The Global School Based Health Survey The standard methodology of the Global School-Based Health Survey has been described elsewhere.12 The present study is based on a secondary analysis of the Chilean Global School-Based Health Survey (GSHS) conducted in 2004 in Santiago. A comprehensive description of the GSHS, with regard to its purpose, sampling strategy, study participant selection has been reported elsewhere.13 In brief, however, the GSHS is a cross sectional survey which uses a two-stage sampling technique. The survey has three main aims which are 1) to assist countries develop priorities, establish programmes, and advocate for resources for school health and youth health programmes and policies; 2) to allow various agencies, countries, and others stakeholders make comparisons across countries regarding the prevalence of health-related behaviours; and 3) to establish trends in the prevalence of behaviors that are relevant to health and associated that may be used in the evaluation of interventions to promote school and youth health. 2. Sampling of study participants The aim of the GSHS is to collect data from 13-to-15 year olds in-school adolescents. In the case of Chile, age range was covered by grades 7 and 8 of primary school as well as first grade of secondary school. The survey used a cross-sectional two-stage survey sampling design. Eligible public and state-sponsored private schools comprised the sampling frame in the first stage of sampling. The probability of a school being selected was proportional to the enrolment size of the school in the selected grades. In the second stage of sampling, classrooms within the selected schools were randomly selected. All students present in the classrooms that had been selected were eligible to participate in the survey regardless of their actual ages. Only public schools and state-sponsored private schools were eligible for participation. All schools that were eligible participated, while 85% of the eligible students participated in the study. The Ministry of Health was in charge of the survey in Chile, with the technical assistance of CDC (Atlanta, Georgia, United States). 3. Ethical considerations and questionnaire administration Survey questionnaires were anonymously completed by all students who volunteered to be included in the survey. A selfcompleted, computer scannable questionnaire was used for data collection. We mean a questionnaire was self completed by the students and the questionnaire had already been prepared that it could be scanned thereafter. 4. Questionnaire administration Students were asked many questions but for the purposes of the current study, the following variables were of interest: whether they had engaged in a physical fight in the prior 12 months; how many times in the prior 30 days they had been bullied; alcohol, cigarette and illicit drug use; and other sociodemographic variables. 5. Choice of variables We were interested in the prevalence and social correlates of having engaged in physical fighting in the prior 12 months. The Chilean GSHS also collected data from other areas but the data from those areas were not the focus in the current study. Identification of the relevant explanatory variables was largely based on review of the literature which showed that the following variables had been identified to be associated with physical fighting or other unhealthy behaviors: cigarette smoking;12,14 male gender;15,16 alcohol use;12,17,18 bullying victimization19 and illicit drugs.20,21 Parental supervision and support of the adolescent have been reported as protective22,23 Previous research has suggested that traditional masculine gender socialization and social norms models seem to encourage men to engage in behaviours that put their health at risk.10,24 Males may be more likely to engage in fighting because society may be more likely to be tolerant towards male fighting than fighting in which females are involved. Individuals who use substances such as alcohol or illicit drugs may be involved in fights due to several reasons. Some substances such as alcohol may have a disinhibiting effect when used. Previous research has reported that the disinhibiting effect of alcohol may be associated with violence, unsafe sexual practices and unsafe driving.25-29 Furthermore, individuals who engage in alcohol use and illicit drugs may also be exposed to environments where anti-social behaviours such as fighting are likely to occur. Individuals who are victimized through bullying may be more likely to be engaged in physical fighting should they attempt to defend themselves.30 Previous researches from the United States have