Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017

Original Article Imprimir 

Páginas 133 a 142

Perception of Brazilian teenager's health: an intergenerational approach based on the Brazilian Health Survey

Percepción de salud del adolescente brasileño: un abordaje intergeneracional basadoen la Pesquisa Nacional de Salud

Percepção de saúde do adolescente brasileiro: uma abordagem intergeracional baseada na Pesquisa Nacional de Saúde

Autores: Rebeca Carmo de Souza Cruz1; Luiz Alexandre Rodrigues da Paixão2; Marília Miranda Forte Gomes3; Leides Barroso Azevedo de Moura4

1. Director in Development, Society and International Cooperation at the University of Brasília (UnB). Brasília, DF, Brazil. Master of International Development from the University of Glasgow. Glasgow, Scotland. Manager of Studies and Analysis of Social Promotion of the Direction of Studies and Social Policies of the Company of Planning of the Federal District ( Codeplan ). Brasília, DF, Brazil
2. Master in Development, Society and International Cooperation by the Postgraduate Program in Development, Society and International Cooperation of the Center for Advanced and Multidisciplinary Studies. Graduation in Statistics from the University of Brasília (UnB). Brasília, DF, Brazil. Consultant to the United Nations Educational, Scientific and Cultural Organization. Brasília, DF, Brazil
3. Doctorate in Demography by the University of Minas Gerais (UFMG). Belo Horizonte, MG, Brazil. Professor of Post-Graduation in Development, Society and International Cooperation and of the Department of Biomedical Engineering of Campi Gama, University of Brasília (UnB). Brasília, DF, Brazil
4. Post-Doctorate from University College London (UCL). London, England. Professor of the Faculty of Health Sciences and the Postgraduate Program in Development, Society and International Cooperation of the University of Brasília (UnB). Brasília, DF, Brazil

Rebeca Carmo de Souza Cruz
SMPW, Quadra 14, conjunto 3, lote 3, casa B.
Brasília, DF, Brasil.
CEP: 71741-403.

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How to cite this article

Keywords: Adolescent, adolescent health, equity, health equity.
Palabra Clave: Adolescente, salud del adolescente, equidad, equidad ensalud.
Descritores: Adolescente, saúde do adolescente, equidade, equidade em saúde.

OBJECTIVE: Analyze the weight of intergenerational factor on the potential health status of Brazilian adolescents. Our study was based on the variable of reported health status in the National Health Survey (PNS) conducted in 2013. The article innovates by inserting an intergenerational transmission of health using PNS.
METHODS: It is a cross-sectional study to predict the perception of health status in Brazil using PNS database. It was proposed a logistic model in which reported health status of teenagers is predictby reported health condition of theirparents, including controlling variables of schooling and sociodemographic characteristics.
RESULTS: Parents reporting poor health status have 8.2 times more chances of having their children with same health status. Female adolescents are more likely to have negative health statusthan their male counterparts. Adolescents living in the South of Brazil are less likely to present negative health status when compared to adolescents in other Brazilian regions. Parents' health perception was shown to be significantly associated with the adolescents' perception, especially when considering teenagers racial origin.
CONCLUSION: Poor perception of the health status of Brazilian adolescents was associated with intergenerational factors, especially the ones associated tosocial determinants of health. It is recommended specific health promotion actions related to the transmission of intergenerational health potential.

OBJETIVO: Analizar el peso de la intergeneracionalidad sobre el potencial de salud de los adolescentes brasileños, basado en la percepción del estado de salud de acuerdo conla Pesquisa Nacional de Salud (PNS) realizada en 2013. El artículo innova al insertarla intergeneracionalidad en lasaludcon informaciones de la PNS en la perspectiva del curso de vida en la etapa de adolescencia.
MÉTODOS: Se trata de estudio transversal para identificar la asociaciónla intergeneracionalidad de la percepción del estado de saluden Brasil conel uso de datos de la PNS. Fue propuesto un modelo logístico en que el estado de salud del adolescente es previsto por la condición de salud de los padres, con variables explicativas basadas en características sociodemográficas.
RESULTADOS: Los responsablescon percepción negativa de la salud tienen 8,2 veces másposibilidades de tener unhijo adolescente conla misma percepción de salud. Adolescentes del sexo femenino tienen másposibilidades que sus pares del sexo masculino presentar percepción negativa desalud, y aquellos que residenen la región Sur tienen menores posibilidades de tener su estado de salud reportado negativamente en relación a los adolescentes de las demás regiones brasileñas. La percepción de salud de los responsables se mostró significativamente asociada conla percepción de los adolescentes, principalmente la variables raza/color del adolescente.
CONCLUSIÓN: La percepción negativa del estado de salud de los adolescentes brasileños fue asociada a factores intergeneracionales, destacándosea las determinantes sociales desalud. Se recomiendan acciones específicas de promoción de salud relacionadas conla transmisión de potencial de saludla intergeneracional.

OBJETIVO: Analisar o peso da intergeracionalidade sobre o potencial de saúde dos adolescentes brasileiros, baseado na percepção do estado de saúde de acordo com a Pesquisa Nacional de Saúde (PNS) realizada em 2013. O artigo inova ao inserir a intergeracionalidade na saúde com informações da PNS na perspectiva do curso de vida na etapa da adolescência.
MÉTODOS: Trata-se de estudo transversal para identificar a associação intergeracional da percepção de estado de saúde no Brasil com o uso dos dados da PNS. Foi proposto um modelo logístico em que o estado de saúde do adolescente é previsto pela condição de saúde dos pais, com variáveis explicativas baseadas em características sóciodemográficas.
RESULTADOS: Os responsáveis com percepção negativa da saúde tem 8,2 vezes mais chances de ter um filho adolescente com a mesmo percepção de saúde. Adolescentes do sexo feminino têm mais chance que seus pares do sexo masculino apresentaram percepção negativa da saúde, e aqueles que residem na região Sul têm menores chances de terem seu estado de saúde reportado negativamente em relação aos adolescentes das demais regiões brasileiras. A percepção de saúde dos responsáveis se mostrou significativamente associada com a percepção dos adolescentes, principalmente a variável raça/cor do adolescente.
CONCLUSÃO: A percepção negativa do estado de saúde dos adolescentes brasileiros foi associada a fatores intergeracionais, com destaque para os determinantes sociais da saúde. Recomenda-se ações específicas de promoção de saúde relacionadas com a transmissão de potencial de saúde intergeracional.


About 17% of the Brazilian population is between 10 and 19 years old, belonging to the age group identified as adolescence according to the classification of international organisms1,2. This is a period marked by intense biological, emotional, social, cognitive and cultural changes that precede adult life3, being, for many, associated with physical vigor1, representing the need for continuous reflection on the care of this population segment4.

Adolescents in countries with high inequality in wealth distribution are more vulnerable to unfavorable health outcomes, regardless of their level of income5. Thus, in an unequal society such as Brazil, the intergenerational transmission of health potential reflects the social gradient produced by the social determinants of health, leaving millions of adolescents with no access to a healthy and productive life. In this context, the study of the intergenerational health potential is crucial to propose public policies that prioritize equity in the health of the population.

Research that addresses intergenerational health influences is increasingly frequent in academic journals6,7,8. The increase in the production of evidence on the transmission of health potential between the generations is due to the fact that health also has a socioeconomic factor associated with income and education6.

There are several approaches used to explore the effect of intergenerationality on health, and interdisciplinarity is a necessity in the analysis of these data. Previous studies have focused on the relationship between the height of the mother and the probability of infant mortality7, on the chances of the children presenting the same health problem of the parents6, as well as on the correlation between the mother's health and the health perception indicators of her children8.

In the specific case of adolescence, intergenerational transmission of health is evaluated in relation to health risk behaviors, such as the use of tobacco, illicit substances, alcohol consumption, inadequate diet and sedentary lifestyle9,10,11.Studies focused on this stage of life usually did not present an intergenerational perspective on health perception12,13.

In Brazil, intergenerational health studies are still scarce, especially when it involves adolescence. The published articles focus on the study of obesity14, on the relationship between health and social mobility of the family15, on the intergenerational transmission of violence16, on the intergenerational transmission of income 17 and on the intergenerational evolution of height18.

The objective of the research is to analyze the intergenerationality of the Brazilian health potential of adolescents, based on the declaration of the perception of health status according to the National Health Survey (PNS) conducted in 2013. The article innovates by inserting intergenerationality in health with the information of the PNS in the perspective of the course of life, in adolescence.


This is a cross-sectional study with a quantitative approach and use of PNS data. The PNS is a nationally representative household survey conducted by the Ministry of Health in partnership with the Brazilian Institute of Geography and Statistics (IBGE), whose general objective was to produce data on the health status and lifestyles of the population Brazilian

According to the recommendations of the World Health Organization (WHO)2, this study considers as adolescents individuals between 10 and 19 years of age. The children of the head of household and / or their spouse were included in the survey, and the information reported when one of them resides with the child at home, including reports of two-parent and single-parent households, was considered. The domicile with the father and the mother, or one of the parents with his / her spouse, was considered to be biparental.

The indicator of health perception was constructed based on the answers of those responsible for the following question: "In general, what is the health status of (name of the individual)?". Responses were classified into five categories in which respondents rated their health or someone's home as "very poor", "poor", "fair", "good" and "very good." For the purposes of this study, the positive perception of health was given to those who used the "good" and "very good" categories, while the negative perception was given to those who reported health status as "regular", "bad", and "too bad".

Based on previous work on intergenerationality in health14, a binary logistic regression model was proposed in which health perception for adolescents was categorized as negative ("regular, poor or very bad") and positive ("very good or "good"). The logistic model allows a prediction of a categorical binary variable, in this case negative or positive health perception, based on a series of explanatory variables. The explanatory variables were those that provide information related to the characteristics of adolescents, parents and the region of residence. Thus, the dependent variable is the adolescents' perception of health that was reported by their parents/guardians.

The variables related to the characteristics of the adolescents were sex, race / color and age / series distortion. For sex, the categories were female and male. For the race / color, the categories included white, black, brown, yellow and indigenous. For the age-series distortion variable, the following categories were considered: (i) uninstructed or out of school, (ii) compatible age-series when the age-series mismatch is less than two years, (iii) age-series not compatible with the expected, when there is age-series lag equal to or greater than two years.

As for the variables of the parents responsible for the household, variables related to the home arrangement, the educational level and the health perception were used. The household arrangement variable was divided if the household was biparental or single parent. The level of education was divided into four categories: (i) incomplete elementary education, (ii) incomplete and incomplete secondary education, (iii) incomplete secondary and tertiary education, and (iv) superior complete education. The perception of health was classified as positive and negative, as I defined previously. As for the region of the interviewed households, the categories corresponded to the five major Brazilian regions: North, Northeast, Midwest, South and Southeast.

In the multivariate analysis, four logistic models were elaborated and the variables were inserted according to the group to which they belong, in order to evaluate their influence on adolescents' health perception: (i) Model 1: variables related to adolescents / color and age / series distortion); (ii) Model 2: variables related to the region of residence and the household arrangement; (iii) Model 3: variable of schooling relative to parents 'level of education, and (iv) Model 4: variable of parents' health perception. Each group of variables was inserted separately to see if it would have any effect on the dependent variable. The SPSS (Statistical Package for the Social Sciences) software version 17.0 was used for the analyzes.


According to PNS, there were 27.7 million adolescents in 2013 in Brazil. The majority of these were men (51.4%), with race / color declared as black or brown (57.4%). In addition, most of the adolescents did not show age / school grade distortion (68.5%); however, 15.2% had no education or were out of school. Among those who did not attend school, 84.2% were between 17 and 19 years of age. Regarding the region of residence, the majority of adolescents resided in the Southeast (40.4%) and Northeast (29.2%). In addition, it was also observed that the Southeast was the region of residence of the majority of adolescents between 15 years and 19 years of age (51.1%).

Table 1 shows the distribution of parents' or guardians' perceptions regarding adolescents' health according to their socio-demographic characteristics and those of their parents. From it, it was noticed that the perception of health of the adolescents is, in the great majority, positive (88.5%). For the negative perception cases reported for adolescents, the frequency of negative vision of health among the male adolescents (10.7%) was lower than among the female adolescents (12.3%). Regarding race / color, the proportion of white adolescents with a negative health perception (8.1%) was lower than that of adolescents declared as black and brown (13.8%).

Concerning the age-grade distortion, the frequency of negative perception of health was higher for those who were not educated or who were out of school (15.0%), followed by those who were in the wrong age and schooling (15.5% ). In addition, the North and Northeast were the regions with the highest negative perceptions of adolescents' health, with 18.2% and 16.5%, respectively, of responses such as "regular", "bad" and "very poor". Finally, 77% of the analyzed cases were adolescents residing in two-parent households. Of these, 10.9% had negative health evaluations compared to 13.6% from single-parent households, who also reported a negative perception.

Table 2 presents the results of the four models proposed by the study through the odds ratios of adolescents' negative health perception. In the case of logistic regression, the results should be interpreted in relation to the reference variables that, in the present study, are indicated in the table below.

Model 1 considered the variables gender, race / color and age / school grade distortion. It was observed that there are 24% more chances of negative health reports in female adolescents than in their male counterparts. Adolescents declared of black/brown race were 73% more likely to receive a negative health perception than those declared as white. Considering the age-series distortion of the adolescent, it was observed that uneducated or out-of-school adolescents and adolescents with age-grade mismatch, both are about 60% more likely to present negative perceptions of health in relation to adolescents attending the series according to their age.

Model 2 added information about the Brazilian region of residence and household arrangement to the variables of Model 1. It was observed that the adolescents living in the North and Northeast regions presented 2.33 and 2.11 times more chances of receiving perception of health, when compared with those living in the Southeast. The home arrangement proved to be a protective factor for adolescents in the issue of health perception, since adolescents in biparental homes were 19% less likely to present negative health perception than those who were in single-parent households. The inclusion of these two variables also decreased the negative perception of health among all race / color categories declared for adolescents. Similarly, there was a reduction in the odds of negative health perception of uninstructed or out-of-school adolescents relative to those with adequate grade-age.

The variable of the level of education of the heads of households was introduced in Model 3. Adolescents with parents who had the level of education corresponding to incomplete and incomplete elementary school were less likely to have a negative health perception in comparison with adolescents with those responsible who had incomplete elementary education. It was observed that the higher the level of education of those responsible, the lower the chances of the adolescents to present a negative perception of health. For example, seniors with full college education were 53 percent less likely to report negative health perceptions to their adolescent children.

In addition, the gender inequality in health perception decreased with the inclusion of the variable on the level of education of those responsible. Adolescents of black / brown or race had a 7% reduction in the odds of presenting negative perceptions of health compared to white adolescents. The level of education of those responsible was a determinant of the health perception for the adolescents residing in the Northeast, since there was a reduction of 5.5% in the adolescents' chances of presenting a negative perception of health.

Finally, the health perception of the heads of the household was included in Model 4. The results showed that adolescents with those with a negative perception of health are eight times more likely to also present negative health perception, compared to adolescents with positive health perception. However, the inclusion of the variable of health perception of the person responsible changed the odds ratio of adolescents' health perception, in relation to gender and household arrangement. In this model, female adolescents presented a 26% higher chance of perceived negative health in relation to male adolescents. In addition, adolescents in biparental homes showed a lower probability (16%) of negative health perception compared to adolescents from single-parent households.

When the other variables were aggregated, the health perception of those responsible was significantly associated with the adolescents' perception of health in the race / color variable. In this case, adolescents declared as black or brown had a 6% reduction in their chances of presenting negative health perception. On the other hand, although the odds of adolescents presenting negative health perceptions remained lower when those responsible had a high level of education, these chances decreased when the household health variable was aggregated.


Previous studies have already described differences in adolescents' perceptions of health according to gender and level of schooling. Female adolescents presented higher chances of negative self-perception of health in relation to their peers, according to a survey carried out in the cities of Santa Maria12 and Florianópolis19. In another study conducted in Pelotas, it was identified that age-series distortion was inversely associated with negative self-perception of health13. Identifying that a considerable portion of Brazilian adolescents consider their own health in a negative way requires an interdisciplinary approach in the interpretation of this data and adoption of intersectoral health promotion interventions in a period of human development marked by multidimensional vulnerabilities, but also by potentials for change protagonism. It is important to analyze the life context of adolescents who perceive their health in a negative way and investigate the behaviors of the family as a whole as well as health risk behaviors. Beyond family behaviors, it is necessary to consider structuring poverty in the different Brazilian regions and the impact of public policies21.

Although there is a shortage of studies with the same intergenerational approach adopted in this article, other studies have also demonstrated the intergenerational effect of parents on adolescents' health, focusing on the reproduction of health risk behaviors, such as smoking, alcohol consumption, inadequate feeding9,10. The correlation of the health potential between parents and children would be explained by the Cognitive Social Theory that relies on the modeling of behaviors by the family. In this theoretical perspective, it is assumed that children tend to reproduce behaviors and habits learned from parents, including those harmful to health20. People learn through observation that occurs to the detriment of coexistence and they are influenced by the relational environment and examples, although they retain their capacity to act to elaborate new behaviors.

It should be noted, however, some factors that limit the results presented. Firstly, adolescents' health perception indicators were used, and these were constructed based on the answers obtained by the head of the household and not by the adolescent himself. Thus, it is difficult to understand how these responses actually reflect the health status of the target population of the study, since this phase of life is marked by increased autonomy and independence, and parents and caregivers may not know the real condition of their teenage children. In addition, we highlight the fact that the intergenerational correlation of health potential was studied, indicating that there is an association between the health of parents and their children, but not a causal relationship.


The present study had as objective to study the intergenerational correlation of health potential between parents and adolescent children, based on information from the PNS. The results showed that the health status of adolescents in Brazil has intergenerational correlation, and the children of parents with negative health perception were more likely to have their health presented negatively.

In addition, among the determinants of the negative perception of the health status of adolescents, they were identified as being female, living in the North and Northeast of Brazil, declaring black or brown, living in a single parent household, having no education and having parents or guardians with incomplete elementary education as a level of education. This demonstrates the importance of social determinants in health.

Despite the existence of social policies aimed at inclusion of the most vulnerable groups in health services, specific actions should be taken in order to produce a virtuous cycle of health promotion potential transmission over generations. In addition, new studies that consider other databases are necessary in order to strengthen the area of evidence-based health with regard to the intergenerational transmission of health potential, in the logic of social determinants and geographic territories and territorialities.


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