Determinants factors in the recognition of a usual source of care by Brazilian adolescents

Martins, Maísa Mônica Flores; Prado, Nília Maria de Brito Lima; Vilasbôas, Ana Luiza Queiroz; Aquino, Rosana

doi:10.1590/1413-81232024295.04772023EN

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THEMATIC ARTICLE • Ciênc. saúde coletiva 29 (5) • May 2024 • https://doi.org/10.1590/1413-81232024295.04772023EN copy

Determinants factors in the recognition of a usual source of care by Brazilian adolescents

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The present study aimed to analyze the demographic, socioeconomic, and health factors and risk behaviors associated with the recognition of a Usual Source of Care (USC), according to gender. This work was a cross-sectional study, based on the National Survey of School Health (2015), conducted with 100,464 Brazilian adolescents. Descriptive analyses were performed based on Pearson’s χ2, and the prevalence ratio (PR) through logistic regression models in Stata 14 for each type of USC (Primary Health Care (PHC), Private Practice, Hospital, and Emergency), stratified by sex. Recognition of a USC was reported by 55.5% of the adolescents, 58.6% of whom were female. In the multivariate analysis, the variables that present social, economic, and risk behavior inequalities showed positive associations for USC PHC for both genders. For the other types of USC, the demographic and socioeconomic characteristics showed negative associations. The results of this study showed that PHC is the service with the highest recognition among adolescents in conditions of social vulnerability. This reinforces the need to consolidate the PHC in order to favor the health care of adolescents, establishing bonds and improving access to health actions.

Key words:
Quality Indicators; Health Care; Adolescent; Primary Health Care

Variables		Sample					Usual Source of Care (USC)
		N	%	N	Yes (%)	P value	Male		Female
		N	%	N	Yes (%)	P value	Yes (%)	P value	Yes (%)	P value
Sex					0,00
	Male	48,232	48.0	48,232	51.4
	Female	52,232	52.0	52,232	58.6
Age range					0.00		0.00		0.01	0,01
	11 to 14 years of age	67,937	67.6	67,937	56.5		53.3		59.2
	15 to 19 years of age	32,527	32.4	32,527	51.9		47.9		57.0
Race/color					0.00		0.00		0.00	0,00
	Black/Brown/Yellow/Indigenous	67,099	66.8	67,099	53.6		50.0		56.9
	White	33,272	33.2	33,272	57.8		53.6		62.0
Paid work					0.91		0.08		0.66	0,66
	No	87,842	87.5	87,842	55.1		51.0		58.5
	Yes	12,565	12.5	12,407	55.0		52.9		59.1
School lag					0.00		0.00		0.29	0,29
	No	88,150	87.8	88,150	55.4		51.9		58.5
	Yes	12,296	12.2	12,296	52.9		47.8		59.8
Mother’s educational level					0.00		0.00		0.00	0,00
	Even incomplete high school	35,516	47.0	35,516	53.5		49.7		56.7
	From high school to higher education	40,138	53.0	40,138	62.1		58.1		66.0
Administrative dependency of the school					0.00		0.00		0.00	0,00
	Private	20,722	20.6	20,722	67.7		64.7		70.6
	Public	79,742	79.4	79,742	53.0		49.1		56.6
Smoking in the last 30 days					0.31		0.67		0.28	0,28
	No	95,137	94.7	95,137	55.2		51.4		58.7
	Yes	5,282	5.3	5,282	53.6		50.5		56.7
Drug use in the last 30 days					0.29		0.12		0.99	0,99
	No	96,603	96.2	96,603	55.0		51.2		58.6
	Yes	3,835	3.8	3,835	56.7		55.1		58.6
Alcohol use in the last 30 days					0.00		0.00		0.10	0,10
	No	78,140	77.8	78,140	54.4		50.5		58.2
	Yes	22,249	22.2	22,249	57.3		54.3		59.8
Sexual intercourse					0.68		0.89		0.01	0,01
	No	72,232	72.0	72,232	55.2		51.4		58.1
	Yes	28,040	28.0	28,040	54.9		51.5		60.8
Last unprotected sex					0.00		0.00		0.00	0,00
	No	91,051	91.6	81,719	54.6		50.4		58.0
	Yes	8,330	8.4	18,627	57.6		54.5		62.9
Suffered physical violence in the last 12 months					0.00		0.00		0.00	0,00
	No	82,220	82.0	82,220	53.8		49.5		57.7
	Yes	17,996	18.0	17,996	61.2		59.6		63.0
Suffered sexual violence in the last 12 months					0.00		0.00		0.14	0,14
	No	96,248	96.0	96,248	54.8		50.8		58.5
	Yes	4,055	4.0	4,055	63.4		66.2		61.2
Consider health status					0.90		0.88		0.13	0,13
	Fair to very bad	71,744	71.5	28,625	55.2		51.3		57.8
	Good very good	28,625	28.5	71,744	55.1		51.4		59.0
Body image satisfaction					0.00		0.00		0.34	0,34
	Indifferent to Very dissatisfied	17,846	19.9	17,846	57.7		54.6		59.1
	Satisfied	71,676	80.1	71,676	54.0		50.2		58.2

Variables		Type of USC
		PHC		Private Medical Office		Hospital		Emergency
		RP	IC(95%)	RP	IC(95%)	RP	IC(95%)	RP	IC(95%)
Age range
	15 to 19 years of age	1.01	(0.96-1.06)	0.91*	(0.85-0.98)	0.85*	(0.75-0.97)	1.02	(0.83-1.27)
Race/color
	Black/Brown/Yellow/ Indigenous	1.13*	(1.08-1.18)	0.85*	(0.81-0.90)	0.94	(0.86-1.04)	1.01	(0.85-1.21)
Paid work
	Yes	1.04	(0.99-1.09)	0.98	(0.91-1.05)	1.00	(0.88-1.14)	1.11	(0.89-1.39)
School lag
	Yes	1.04	(0.98-1.11)	0.96	(0.86-1.06)	1.11	(0.94-1.31)	0.89	(0.66-1.19)
Mother's educational level
	Up to incomplete high school	1.26*	(1.21-1.32)	0.63*	(0.59-0.67)	0.75*	(0.67-0.83)	0.85	(0.70-1.01)
Administrative dependency of the school
	Public	2.67*	(2.46-2.89)	0.37*	(0.35-0.39)	0.66*	(0.60-0.74)	1.12	(0.90-1.39)
Smoking in the last 30 days
	Yes	0.99	(0.90-1.09)	0.97	(0.84-1.12)	0.99	(0.78-1.27)	0.74	(0.49-1.13)
Drug use in the last 30 days
	Yes	0.92	(0.82-1.03)	1.05	(0.91-1.22)	0.66*	(0.49-0.90)	1.98*	(1.35-2.91)
Alcohol use in the last 30 days
	Yes	0.96	(0.90-1.01)	1.03	(0.96-1.11)	1.10	(0.98-1.24)	1.11	(0.89-1.39)
Sexual intercourse
	Yes	0.95	(0.89-1.01)	0.94	(0.85-1.03)	0.78*	(0.66-0.92)	0.63*	(0.46-0.87)
Last unprotected sex
	Yes	1.20*	(1.12-1.28)	1.24*	(1.13-1.37)	1.18	(0.99-1.40)	1.35	(0.98-1.86)
Suffered physical violence in the last 12 months
	Yes	1.06*	(1.01-1.12)	1.10*	(1.03-1.17)	1.41*	(1.27-1.58)	1.48*	(1.21-1.81)
Suffered sexual violence in the last 12 months
	Yes	1.19*	(1.08-1.31)	1.21*	(1.05-1.39)	0.79	(0.59-1.06)	0.82	(0.51-1.33)
Consider health status
	Fair to very bad	0.92*	(0.88-0.97)	0.89*	(0.84-0.96)	1.10	(0.98-1.22)	1.28*	(1.06-1.55)
Body image satisfaction
	Indifferent to Very dissatisfied	0.88*	(0.82-0.94)	1.05	(0.97-1.13)	0.90	(0.78-1.02)	1.13	(0.89-1.42)

Variables		Type of USC
		PHC		Private Medical Office		Hospital		Emergency
		RP	IC(95%)	RP	IC(95%)	RP	IC(95%)	RP	IC(95%)
Age range
	15 to 19 years of age	1.05*	(1.00-1.10)	0.93*	(0.87-0.99)	0.94	(0.84-1.06)	1.07	(0.89-1.29)
Race/color
	Black/Brown/Yellow/Indigenous	1.14*	(1.09-1.19)	0.85*	(0.81-0.89)	0.97	(0.88-1.06)	0.94	(0.81-1.08)
Paid work
	Yes	1.08*	(1.02-1.15)	1.01	(0.93-1.10)	1.14	(0.99-1.31)	0.71*	(0.54-0.94)
School lag
	Yes	1.09*	(1.02-1.16)	1.03	(0.93-1.14)	1.03	(0.87-1.22)	0.79	(0.59-1.06)
Mother's educational level
	Up to incomplete high school	1.34*	(1.28-1.39)	0.58*	(0.55-0.61)	0.88*	(0.81-0.97)	0.72*	(0.62-0.84)
Administrative dependency of the school
	Public	2.88*	(2.66-3.11)	0.38*	(0.37-0.41)	0.82*	(0.74-0.91)	1.17	(0.97-1.40)
Smoking in the last 30 days
	Yes	0.85*	(0.77-0.94)	0.93	(0.81-1.06)	1.02	(0.82-1.27)	0.91	(0.64-1.29)
Drug use in the last 30 days
	Yes	0.93	(0.83-1.05)	1.07	(0.93-1.23)	0.81	(0.62-1.07)	1.29	(0.89-1.86)
Alcohol use in the last 30 days
	Yes	0.97	(0.93-1.02)	1.16*	(1.10-1.23)	1.12*	(1.01-1.24)	1.07	(0.90-1.27)
Sexual intercourse
	Yes	1.05	(0.98-1.13)	0.96	(0.87-1.07)	0.86	(0.71-1.04)	1.17	(0.89-1.54)
Last unprotected sex
	Yes	1.11*	(1.03-1.20)	1.08	(0.96-1.21)	1.27*	(1.04-1.55)	0.98	(0.73-1.32)
Suffered physical violence in the last 12 months
	Yes	1.03	(0.98-1.08)	0.96	(0.90-1.02)	1.10	(0.99-1.23)	1.62*	(1.38-1.90)
Suffered sexual violence in the last 12 months
	Yes	1.07	(0.98-1.16)	0.87*	(0.76-0.99)	1.24*	(1.03-1.50)	0.90	(0.65-1.26)
Consider health status
	Fair to very bad	0.95*	(0.91-0.99)	1.00	(0.95-1.05)	1.20*	(1.10-1.31)	1.53*	(1.33-1.77)
Body image satisfaction
	Indifferent to Very dissatisfied	0.87	(0.83-0.91)	0.96	(0.92-1.01)	0.98	(0.89-1.07)	1.03	(0.88-1.20)

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