Abstract(resumo):

School violence can affect all people present in the institution environment and generate fear in students who suffer aggression. Verbal bullying has an impact on who experiences it and can be one of the doors to reach physical violence. The sample consisted of 23,977 adolescents from seven Amazônia states in Brazil. Multinomial regression was performed to verify the association of variables with categories of verbal bullying. The level of statistical significance of 5% was adopted. The prevalence among adolescents in the Amazon in Brazil who were victims of verbal bullying at school was 4.3% (CI 95% 3.86–4.72); among those who practiced bullying, denominated as perpetrators, 15.9% (CI 95% 15.02–16.87); and among those who were victims and perpetrators of bullying, 2.0% (CI 95% 1.70–2.23). The school context of adolescents in the Brazilian Amazon continues to be a space for the reproduction of violence and that the school is not solely responsible for the production of violence, because it is a complex, dynamic, multifaceted and multicausal phenomenon, with roots also in macrosocial, economic and sociocultural issues.

Keywords(palavra-chave):

Adolescent; Violence; Academic Institutions; Health risk behavior; Bullying

Content(conteúdo):

INTRODUCTION

Violence among adolescents is a public health issue that manifests in various social spaces,
notably the school. The school-violence relationship encompasses both explicit aggression
and symbolic forms, rooted in cultural norms and social inequality. 1
Within the school environment, adolescents form affective bonds outside the family context,
and interpersonal relationships -between teachers and students, and among peers—are pivotal
for learning and value development. 2,3 These dynamics can foster positive experiences or lead

to conflict, including bullying. 3 Bullying refers to repeated intentional aggression rooted in
power imbalance, manifesting verbally, physically, relationally, or online. 4,5 Its consequences
span short to long-term impacts and can trigger health-risk behaviors. 4,6
The school mirrors broader societal relationships and plays a crucial role in shaping
adolescent experiences, citizenship, and social integration. 5,7,8 In Brazil, school violence
gained attention from the 1980s, initially linked to vandalism and theft. From the 1990s
onwards, the focus shifted to interpersonal conflicts and behavioral issues, including
bullying. 9,10 Such violence can affect the entire school community, compromising students'
well-being and academic performance. 11-13
Verbal violence, though frequent, remains underestimated despite its potential to escalate into
physical aggression. 12 Fights among students are common, as shown in international studies,
with significant prevalence among adolescents.¹¹?¹??¹? Brazilian surveys corroborate these
findings, highlighting disparities linked to race, socioeconomic status, and type of school. 18-20
Understanding the specificities of school violence is essential for developing effective
strategies. Awareness of risk factors supports the creation of healthier educational
environments. 7,21,22
This study analyzes factors associated with verbal bullying among adolescents in the Amazon,
based on data from the 2015 National School Health Survey (PeNSE).

METHODS
This is a cross-sectional study using data from the 2015 edition of the National School Health
Survey (PeNSE), conducted by the Brazilian Institute of Geography and Statistics (IBGE) in
partnership with the Ministry of Health and Ministry of Education. Only data from students in
the 9th grade of elementary school from the Northern region of Brazil (Amazon states) were
analyzed.

PeNSE uses a complex, multi-stage, stratified sampling design to represent Brazilian students
enrolled in public and private schools. For this study, 23,977 adolescents from 714 schools in
the Northern region were included. Students attending evening classes and those from other
regions of Brazil were excluded.

Instrumentation
Data were collected through self-administered structured questionnaires on smartphones. The
instrument covered thematic modules, including socioeconomic factors, family context,
bullying, eating habits, physical activity, violence, and safety. The 2015 database is publicly
available.²³
Study Variables
The outcome variable was verbal bullying, categorized as follows:
? Neither suffers nor practices: students who responded “no” to both victim and
perpetrator questions;
? Victim: those who reported having been verbally offended or humiliated by
classmates;
? Perpetrator: those who reported offending or humiliating classmates;
? Victim/Perpetrator: those who reported both suffering and practicing verbal bullying.
Independent variables included sociodemographic data (sex, age, skin color/race, type of
school, mother’s education), mental health indicators (loneliness, insomnia, presence of
friends), body image (perception and satisfaction) and family context (supervision, emotional
understanding, intrusion).
Data Processing and Analysis
Data were cleaned and processed in Stata version 14.0, using the svyset command to account
for sample weights and complex design. Pearson’s chi-square test was applied to assess

associations (significance level: 5%). Multinomial logistic regression was used to examine
associations between bullying categories and the independent variables, with "neither suffers
nor practices" as the reference. Models were adjusted for sociodemographic factors, including
sex, age, skin color/race, and type of school.

RESULTS
The final sample included 23,977 adolescents from seven states in the Brazilian Amazon
region, selected through a complex sampling process as described in the Methods section. The
sample selection process is detailed in Figure 1.
Figure 1 - Flowchart of the sample selection process – PeNSE 2015, Northern Brazil.

Among the participants, 51.4% were female, and 64.7% were aged between 11 and 14 years.
Most adolescents (89.2%) attended public schools and self-identified as having brown skin
color/race (56.4%).
Table 1 presents the distribution of adolescents by sociodemographic and mental health
characteristics. All sociodemographic variables showed statistically significant associations
with bullying categories. A higher prevalence of perpetrators was observed among males
(19.2%) compared to females (12.9%). Victimization was more prevalent among adolescents
who identified as having yellow skin color/race (7.4%), while brown, white, and Indigenous
students had rates close to 4%.
Regarding verbal bullying, the prevalence of victims was 4.3% (IC95%: 3.86–4.72),
perpetrators 15.9% (IC95%: 15.02–16.87), and victims/perpetrators 2.0% (IC95%:
1.70–2.23).
Mental health aspects such as feeling alone, insomnia, and lack of friendships were more
frequently reported among perpetrators (Table 1).

Table 1. Characterization of the sociodemographic and mental health aspects of adolescents in
the Northern Region of Brazil, according to the categories of bullying, 2015.

Table 2 shows that adolescents who considered their body image unimportant, or reported
feeling indifferent or dissatisfied with their body, had higher prevalence of victimization.
Those who considered themselves "too fat" also showed higher rates among victims and
victims/perpetrators. Among perpetrators, the distribution remained more stable across
categories.
Table 2. Characterization of aspects related to body image, family context and verbal bullying
categories – PeNSE 2015, Northern Brazil, 2015.

Regarding family context, 21.4% of adolescents reported skipping school without their
parents' knowledge, and only 32.9% reported parental supervision of homework. In contrast,
60.7% had supervision during free time. While 41.1% felt understood by their families, 11.8%
reported that their parents intruded on their personal belongings.
Victims of bullying were the ones who most reported experiencing parental intrusion and
sexual violence. Among perpetrators and victim/perpetrators, the prevalence of sexual
violence was also notably high. Adolescents who missed school three or more times per week
showed higher prevalence of bullying behavior compared to those who never missed school
(26.0% vs. 14.3% among perpetrators; 5.2% vs. 1.6% among victims/perpetrators).
Among the 12 variables analyzed, only "having family members who understand their
problems" acted as a protective factor for all bullying categories. Other variables, such as
skipping school, parental intrusion, and negative body feelings, were consistently associated
with all categories (Table 3).

Table 3. Association between mental health, body image and family context among
adolescents in the North of Brazil according to the categories of bullying, 2015.

Feeling alone was strongly associated with victimization (OR: 4.37; IC95%: 3.30–5.80) and
both roles (OR: 2.72; IC95%: 1.92–3.85), compared to perpetration (OR: 1.44; IC95%:
1.17–1.77). Insomnia showed a similar pattern, with stronger associations for victims (OR:
4.03; IC95%: 3.00–5.45) and victims/perpetrators (OR: 2.81; IC95%: 1.96–4.03) than for
perpetrators (OR: 1.70; IC95%: 1.43–2.03). Having friends was inversely associated only
with victimization.
Regarding body perception, categories such as "very skinny" and "fat" were associated with
all bullying groups, while "very fat" was not linked to perpetration but showed strong
associations with victimization (OR: 6.08; IC95%: 3.79–9.77) and victim/perpetration (OR:
6.26; IC95%: 3.05–12.85).
Considering body image as "unimportant" was associated with victimization (OR: 2.87;
IC95%: 2.00–4.11) and both roles (OR: 2.58; IC95%: 1.49–4.49), but not with perpetration.
Parental supervision of homework appeared as a protective factor among perpetrators and was
positively associated with victimization. Supervision during free time was associated only
with perpetration. Experiencing sexual violence was most strongly associated with the
victim/perpetrator group (OR: 6.18; IC95%: 3.66–10.44), compared to victimization (OR:
2.22; IC95%: 1.43–3.42) and perpetration (OR: 2.34; IC95%: 1.79–3.06).

DISCUSSION
This study revealed that among adolescent students from the Brazilian Amazon, verbal
bullying is a relevant issue, with higher prevalence of perpetration among male adolescents.

Additionally, factors related to mental health (such as loneliness and insomnia), body image
dissatisfaction, family context (lack of understanding, weak supervision, and intrusion), and
experiences of sexual violence were significantly associated with bullying - either as victim,
perpetrator, or both.
Consistent with prior literature, male adolescents showed greater prevalence of bullying
perpetration. 24-27 Boys often display more physically aggressive or explosive behaviors, which
may account for the gender difference. Among mental health indicators, feeling alone and
having insomnia were strongly associated with victimization, while having friends was
protective against being a victim of bullying. 28-31 These results reinforce the psychosocial
vulnerabilities experienced by bullied adolescents, often leading to emotional suffering,
impaired learning, and potential long-term consequences like antisocial behavior. 29,30
Other studies corroborate the association between bullying and sleep disorders, depressive
symptoms, and suicidal ideation. 16,32-36 Regarding body image, self-perception of being “very
fat” was strongly associated with victimization and dual-role bullying. Dissatisfaction and
perceived deviance from body ideals - often influenced by media - contribute to stigma and
social exclusion among adolescents. 37-40
School absenteeism without parental awareness has also been linked to bullying, particularly
among those are victims or occupy dual roles as both perpetrators and targets. 41-45 For
perpetrators, school absence may reflect engagement in risky behaviors such as alcohol use. 24
While this variable was statistically significant, its directionality remains uncertain.
Parental supervision has demonstrated a protective effect, especially concerning bullying
perpetration. Adolescents who received support, guidance, and feel understood by family
members are less likely do engage in bullying behaviors. 16,24,50–52 Conversely, limited parental
involvement and family instability are recognized as significant risk factors for bullying. 32,53,54

Experiencing sexual violence was most strongly associated with dual-role adolescents.
Literature supports the link between early sexual trauma and involvement in bullying - both as
victim and perpetrator. 32,47,55-63 The findings reinforce the notion that adolescents who
experience sexual violence may internalize or reproduce this trauma through bullying,
sometimes fueled by substance use or emotional distress. 64,65
This study has limitations, such as the reliance on self-reported data, which may be subject to
recall bias or social desirability. Additionally, skin color/race was self-declared, a variable
influenced by sociocultural context and perception, which may affect classification and
interpretation of findings. Also, the cross-sectional nature of the study precludes causal
inference between associated variables.
On the other hand, the study’s strengths include the use of a large, representative sample of
adolescents from the Amazon region, and the analysis of a wide range of variables -
sociodemographic, mental health, body image, and family context. Moreover, distinguishing
between victims, perpetrators, and dual-role adolescents enabled a more nuanced
understanding of the complexity of bullying.

Limitations
This study has limitations inherent to its cross-sectional design, which precludes the
establishment of causal relationships between the variables analyzed. Although associations
were observed, it is not possible to determine the temporality or direction of the effects.
Additionally, because the data were collected through self-administered questionnaires, there
may have been memory bias or social desirability bias, especially in sensitive topics such as
violence and family context.
Another important limitation concerns the use of self-reported skin color/race, which is a
subjective and context-dependent classification. In Brazil, the perception and declaration of

race or skin color can be influenced by regional, socioeconomic, and cultural factors,
potentially introducing classification bias and affecting the interpretation of differences
among population subgroups.
Conclusion
The school context of adolescents in the Brazilian Amazon continues to be a space for the
reproduction of violence and that the school is not solely responsible for the production of
violence, because it is a complex, dynamic, multifaceted and multicausal phenomenon, with
roots also in macrosocial, economic and sociocultural issues.

IMPLICATIONS FOR SCHOOL HEALTH
The indicators of violence evidenced in this study can guide and sustain the need for
intervention projects and public policies at school, with a view to strengthening respect for
differences. It is estimated that violence is one of the leading causes of death of adolescents
worldwide, and this is one of the factors that sustains it as a public health problem.
In Brazil, violence and its effects have not been seen as effective public policies in the school
field. In the last ten years, school education has been an arena between more conservative
versus progressive institutions, and in the last five years, there has been policies with more
contentious perspectives. These disputes and perspectives make education that promotes
citizenship, inclusion and prevention of violence impossible.
In the Brazilian Amazon, cultural aspects intertwined with native and colonialist practices
may favor even more disputes between victims and perpetrators. Adolescence is a stage of the
life cycle in which the experiences of violence are present, social relations extend beyond the
family axis and training begins for the autonomy of their choices. In the face of these aspects,
several contributions are proposed:

• Initial and continued training of teachers about adolescence as a life project, and not as a
problematic stage. This formation can be conducted under the socioconstructivist perspective
of human development, which considers the social and cultural dimensions of adolescents, in
addition to a reductionist, biological and psychological view.
• Projects involving the school community and the integration of sectors of society: family,
school, health network and social assistance. Improve the monitoring mechanisms of
adolescents, expanding alternatives for the construction of a new life project based on values
such as citizenship, ethics, respect for differences and solidarity.
• Activities at school, such as cultural events, conversation wheels and contextualized
articulation of the contents of the disciplines, such as mobilizers of dialogues and
protagonism, which aim to mobilize adolescents to build exits from the reality of violence in
which they are involved. With this, the school can become more attractive, and establish itself
as a potential space for welcoming and promoting the mental health of adolescents.

Human Subjects Approval Statement
National School Health Survey, 2015 approved by the National Research Ethics Commission
(CONEP) of the Ministry of Health, under the Certificate of Presentation for Ethical
Appreciation (CAAE) n° 38990714.6.0000.0008, Opinion n° 1,006,467, of March 30, 2015.

Conflict of Interest
The authors report that there are no conflicts of interest.

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