ABSTRACT:

Introduction:

Violence experienced in adolescence results in serious damage and suffering to society. This study aims to characterize the profile of violence victims and likely perpetrators of violence against adolescents, as well as to describe the percentage of notifying municipalities according to the federation unit.

Methods:

Cross-sectional study conducted with data on notification of violence against adolescents from the Information System for Notifiable Diseases, from 2011 to 2017. The chi-square test was used to assess the statistical significance of the differences between the proportions in the comparison between genders. Proportion ratios for the most frequent types of violence were estimated according to selected variables.

Results:

The notifications came from 75.4% of all the Brazilian municipalities. Physical violence predominated among males, aged 15-19 years. Psychological violence was predominant among females, between 10 and 14 years old, when perpetrated repeatedly at home by family aggressors. Sexual violence prevailed among females, aged 10 to 14 years old, in the indigenous, black and yellow races/colors, when perpetrated repeatedly at home. Negligence was more common among males, between 10 and 14 years old, when perpetrated repeatedly by family aggressors.

Conclusions:

Sexual violence occurred predominantly against females and generated significant negative impacts on mental, physical, sexual and reproductive health. Community violence, perpetrated with sharp objects and firearms, were prominent among males and are important risk factors for male over-mortality. Because the problems are complex, addressing them requires intersectoral actions.

Keywords:
Violence; Adolescent health; Aggression; Violence against women; Mandatory reporting

INTRODUCTION

Adolescence is a unique formative stage of human development that requires special attention in national development policies, programs and plans¹1. World Health Organization (WHO). Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation [Internet]. Genebra: WHO; 2017 [acessado em 02 jan. 2019]. Disponível em: Disponível em: https://www.who.int/maternal_child_adolescent/topics/adolescence/framework-accelerated-action/en/
https://www.who.int/maternal_child_adole... . During this period, individuals have new experiences, and many protective or risky behaviors begin or consolidate, with more exposure to accidents and violence¹1. World Health Organization (WHO). Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation [Internet]. Genebra: WHO; 2017 [acessado em 02 jan. 2019]. Disponível em: Disponível em: https://www.who.int/maternal_child_adolescent/topics/adolescence/framework-accelerated-action/en/
https://www.who.int/maternal_child_adole... ^,22. Andrade SSC de A, Yokota RT de C, Sá NNB de, Silva MMA da, Araújo WN de, Mascarenhas MDM, et al. Relação entre violência física, consumo de álcool e outras drogas e bullying entre adolescentes escolares brasileiros. Cad Saúde Pública [Internet]. 2012 [acessado em 26 ago. 2019];28(9):1725-36. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2012000900011&lng=pt&tlng=pt https://doi.org/10.1590/S0102-311X2012000900011
http://www.scielo.br/scielo.php?script=s... ^,33. World Health Organization (WHO) . Coming of age: Adolescent health [Internet]. Health topics: adolescent health. Genebra: WHO ; 2019 [acessado em 1º ago. 2019]. Disponível em: Disponível em: http://www.who.int/topics/adolescent_health/en/
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The violence experienced in adolescence can result in serious physical and psychosocial consequences for individuals and directly affect quality of life⁶6. Malta DC, Bernal RTI, Pugedo FSF, Lima CM, Mascarenhas MDM, Jorge A de O, et al. Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência. Ciên Saúde Colet [Internet]. 2017 [acessado em 22 jan. 2019]; 22(9): 2899-908. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902899&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.14212017
http://www.scielo.br/scielo.php?script=s... , with disabilities, psychological disorders⁷7. World Health Organization (WHO). Child and adolescent injury prevention: a global call to action. Genebra: WHO ; 2005. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/43279/9241593415_eng.pdf?sequence=1&isAllowed=y
https://apps.who.int/iris/bitstream/hand... ^,88. Dunn EC, Gilman SE, Willett JB, Slopen NB, Molnar BE. The impact of exposure to interpersonal violence on gender differences in adolescent-onset major depression: results from the National Comorbidity Survey Replication (NCS-R). Depress Anxiety [Internet]. 2012 [acessado em 23 mar. 2012]; 29(5): 392-9. Disponível em: Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/22447513 https://doi.org/10.1002/da.21916
https://www.ncbi.nlm.nih.gov/pubmed/2244... and suffering for both families and the society⁶6. Malta DC, Bernal RTI, Pugedo FSF, Lima CM, Mascarenhas MDM, Jorge A de O, et al. Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência. Ciên Saúde Colet [Internet]. 2017 [acessado em 22 jan. 2019]; 22(9): 2899-908. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902899&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.14212017
http://www.scielo.br/scielo.php?script=s... ^,99. Mejia A, Emsley R, Fichera E, Maalouf W, Segrott J, Calam R. Protecting Adolescents in Low- And Middle-Income Countries from Interpersonal Violence (PRO YOUTH TRIAL): Study Protocol for a Cluster Randomized Controlled Trial of the Strengthening Families Programme 10-14 (“Familias Fuertes”) in Panama. Trials [Internet]. 2018 [acessado em 04 mar. 2019]; 19(1): 320. Disponível em: Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/29907128 https://doi.org/10.1186/s13063-018-2698-0
https://www.ncbi.nlm.nih.gov/pubmed/2990... . Interpersonal violence that occurs in this phase is associated with risky sexual behaviors, poor school performance and alcohol and other drugs abuse, which in turn are risk factors for several health problems throughout life⁶6. Malta DC, Bernal RTI, Pugedo FSF, Lima CM, Mascarenhas MDM, Jorge A de O, et al. Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência. Ciên Saúde Colet [Internet]. 2017 [acessado em 22 jan. 2019]; 22(9): 2899-908. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902899&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.14212017
http://www.scielo.br/scielo.php?script=s... ^,99. Mejia A, Emsley R, Fichera E, Maalouf W, Segrott J, Calam R. Protecting Adolescents in Low- And Middle-Income Countries from Interpersonal Violence (PRO YOUTH TRIAL): Study Protocol for a Cluster Randomized Controlled Trial of the Strengthening Families Programme 10-14 (“Familias Fuertes”) in Panama. Trials [Internet]. 2018 [acessado em 04 mar. 2019]; 19(1): 320. Disponível em: Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/29907128 https://doi.org/10.1186/s13063-018-2698-0
https://www.ncbi.nlm.nih.gov/pubmed/2990... ^,1010. Ward E, Ashley D. The new imperative: reducing adolescent-related violence by building resilient adolescents. J Adolesc Health [Internet]. 2013 [acessado em 16 dez. 2019]; 52(2 Supl. 2): S43-5. Disponível em: Disponível em: https://www.jahonline.org/article/S1054-139X(12)00230-3/fulltext https://doi.org/10.1016/j.jadohealth.2012.06.009
https://www.jahonline.org/article/S1054-... ^,1111. Costa MCO, Carvalho RC de, Santa Bárbara J de FR, Santos CAST, Gomes W de A, Sousa HL de. O perfil da violência contra crianças e adolescentes, segundo registros de Conselhos Tutelares: vítimas, agressores e manifestações de violência. Ciên Saúde Colet [Internet]. 2007 [acessado em 26 jun. 2019]; 12(5): 1129-41. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000500010&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232007000500010
http://www.scielo.br/scielo.php?script=s... . The earlier the exposure to violence and the more intense it is, the greater the problems arising from it and the greater the probability of the victim’s involvement in future violent behaviors¹⁰10. Ward E, Ashley D. The new imperative: reducing adolescent-related violence by building resilient adolescents. J Adolesc Health [Internet]. 2013 [acessado em 16 dez. 2019]; 52(2 Supl. 2): S43-5. Disponível em: Disponível em: https://www.jahonline.org/article/S1054-139X(12)00230-3/fulltext https://doi.org/10.1016/j.jadohealth.2012.06.009
https://www.jahonline.org/article/S1054-... . It is noteworthy that violence is associated with an increased risk of depression from adolescence, especially among women, considering that in their case, some types of violence, including sexual victimization, increase markedly in early adolescence⁸8. Dunn EC, Gilman SE, Willett JB, Slopen NB, Molnar BE. The impact of exposure to interpersonal violence on gender differences in adolescent-onset major depression: results from the National Comorbidity Survey Replication (NCS-R). Depress Anxiety [Internet]. 2012 [acessado em 23 mar. 2012]; 29(5): 392-9. Disponível em: Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/22447513 https://doi.org/10.1002/da.21916
https://www.ncbi.nlm.nih.gov/pubmed/2244... .

Interpersonal violence is the third leading cause of death among adolescents worldwide, although its prominence varies by region of the world. This violence causes almost a third of all male adolescent deaths in low- and middle-income countries in the Americas¹1. World Health Organization (WHO). Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation [Internet]. Genebra: WHO; 2017 [acessado em 02 jan. 2019]. Disponível em: Disponível em: https://www.who.int/maternal_child_adolescent/topics/adolescence/framework-accelerated-action/en/
https://www.who.int/maternal_child_adole... ^,1212. World Health Organization (WHO) . Adolescents: health risks and solutions [Internet]. Fact sheets. 2018 [acessado em 04 mar. 2019]. Disponível em: Disponível em: https://www.who.int/en/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions
https://www.who.int/en/news-room/fact-sh... . In Brazil, homicide is the main cause of death of adolescents and young people between 15 and 24 years of age and affects mainly black youth living in the peripheries and metropolitan areas of urban centers⁵5. Monteiro EMLM, Brandão Neto W, de Lima LS, de Aquino JM, Gontijo DT, Pereira BO. Culture Circles in adolescent empowerment for the prevention of violence. Int J Adolesc Youth [Internet]. 2015; 20(2): 167-84. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391289/ https://dx.doi.org/10.1080%2F02673843.2014.992028
https://www.ncbi.nlm.nih.gov/pmc/article... ^,1313. Instituto de Pesquisa Econômica Aplicada. Atlas da violência 2019 [Internet]. Brasília: Instituto de Pesquisa Econômica Aplicada; 2019 [acessado em 19 set. 2019]. Disponível em: Disponível em: http://www.ipea.gov.br/portal/images/stories/PDFs/relatorio_institucional/190605_atlas_da_violencia_2019.pdf
http://www.ipea.gov.br/portal/images/sto... . Overall, it is estimated that one in three female adolescents aged 15 to 19 years old has suffered emotional, physical, psychological and/or sexual violence by their husband or partner¹²12. World Health Organization (WHO) . Adolescents: health risks and solutions [Internet]. Fact sheets. 2018 [acessado em 04 mar. 2019]. Disponível em: Disponível em: https://www.who.int/en/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions
https://www.who.int/en/news-room/fact-sh... . The Sustainable Development Goals contain the goals of global action by 2030, including indicators to tackling violence¹⁴14. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Objetivos de Desenvolvimento Sustentável [Internet]. 2018 [acessado em 14 ago. 2019]. Disponível em: Disponível em: https://ods.ibge.gov.br/
https://ods.ibge.gov.br/... .

In Brazil, the reporting of violence against adolescents was established as mandatory through the Child and Adolescent Statute (ECA, in the Portuguese acronym)¹⁵15. Brasil. Lei nº 8.069, de 13 de julho de 1990. Dispõe sobre o Estatuto da Criança e do Adolescente e dá outras providências. Diário Oficial da União [Internet]. 1990 [acessado em 29 ago. 2019]. Disponível em: Disponível em: http://www.planalto.gov.br/ccivil_03/leis/l8069.htm
http://www.planalto.gov.br/ccivil_03/lei... , in 1990. Within the health sector, from 2011 onwards, notification of violence became part of the national list of compulsory notification, universalizing notification to all health services in the country¹⁶16. Brasil. Viva: instrutivo notificação de violência interpessoal e autoprovocada [Internet]. Brasília: Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde; 2016 [acessado em 15 jan. 2019]. 92p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/viva_instrutivo_violencia_interpessoal_autoprovocada_2ed.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ^,1717. Rates SMM, Melo EM de, Mascarenhas MDM, Malta DC, Rates SMM, Melo EM de, et al. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Ciên Saúde Colet [Internet]. 2015 [acessado em 30 jan. 2019]; 20(3): 655-65. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232015000300655&lng=en&tlng=em https://doi.org/10.1590/1413-81232015203.15242014
http://www.scielo.br/scielo.php?script=s... ^,1818. Santos M de J, Mascarenhas MDM, Rodrigues MTP, Monteiro RA. Caracterização da violência sexual contra crianças e adolescentes na escola - Brasil, 2010-2014. Epidemiol Serv Saúde [Internet]. 2018 [acessado em 28 jan. 2019]; 27(2). Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2237-96222018000200305&lng=pt&nrm=iso&tlng=pt https://doi.org/10.5123/s1679-49742018000200010
http://www.scielo.br/scielo.php?script=s... . In this context, notification is an important protection instrument and one of the dimensions of the line of care for adolescents in situations of violence, which also provides for reception, care and follow-up in the care and social protection network¹⁹19. Brasil. Ministério da Saúde. Linha de cuidado para a atenção integral à saúde de crianças, adolescentes e suas famílias em situação de violências: orientação para gestores e profissionais de saúde [Internet]. Brasília: Ministério da Saúde; 2010 [acessado em 06 out. 2019]. 104 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/linha_cuidado_criancas_familias_violencias.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... .

In view of the social and epidemiological severity of violence against adolescents, studies on aggressions notified to the Notifiable Diseases Information System (Sinan, in the Portuguese acronym) may contribute to broaden the knowledge about violence practiced against this group and guide the creation of public policies for its prevention.

The objective of this study was to characterize the violence, the victims and the probable perpetrators notified to Sinan, in the period from 2011 to 2017, as well as to describe the percentage of municipalities notifying violence by Federation unit.

METHODS

STUDY DESIGN AND POPULATION

Cross-sectional study, conducted with data from notifications of violence against adolescents in the period from 2011 to 2017, in Brazil. Adolescents were defined as individuals aged between 10 and 19 years old, according to the convention prepared by the World Health Organization³3. World Health Organization (WHO) . Coming of age: Adolescent health [Internet]. Health topics: adolescent health. Genebra: WHO ; 2019 [acessado em 1º ago. 2019]. Disponível em: Disponível em: http://www.who.int/topics/adolescent_health/en/
http://www.who.int/topics/adolescent_hea... and adopted by the Brazilian Ministry of Health²⁰20. Brasil. Diretrizes nacionais para a atenção integral à saúde de adolescentes e jovens na promoção, proteção e recuperação da saúde [Internet]. Brasília; 2010 [acessado em 27 jan. 2019]. 132 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_nacionais_atencao_saude_adolescentes_jovens_promocao_saude.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... .

SOURCE OF DATA

The data used were extracted from Sinan, which is fed by the Individual Notification Form of Interpersonal/Self-harm.

The notification of violence against adolescents is mandatory for both sexes and for all public and private health establishments in the country since 2011¹⁶16. Brasil. Viva: instrutivo notificação de violência interpessoal e autoprovocada [Internet]. Brasília: Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde; 2016 [acessado em 15 jan. 2019]. 92p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/viva_instrutivo_violencia_interpessoal_autoprovocada_2ed.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... . It is noteworthy that in situations of suspicion or identification of violence against adolescents, health professionals must report the case and communicate the competent bodies, supported by ECA¹⁶16. Brasil. Viva: instrutivo notificação de violência interpessoal e autoprovocada [Internet]. Brasília: Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde; 2016 [acessado em 15 jan. 2019]. 92p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/viva_instrutivo_violencia_interpessoal_autoprovocada_2ed.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ^,1919. Brasil. Ministério da Saúde. Linha de cuidado para a atenção integral à saúde de crianças, adolescentes e suas famílias em situação de violências: orientação para gestores e profissionais de saúde [Internet]. Brasília: Ministério da Saúde; 2010 [acessado em 06 out. 2019]. 104 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/linha_cuidado_criancas_familias_violencias.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... , regardless of the acceptance of family members¹⁹19. Brasil. Ministério da Saúde. Linha de cuidado para a atenção integral à saúde de crianças, adolescentes e suas famílias em situação de violências: orientação para gestores e profissionais de saúde [Internet]. Brasília: Ministério da Saúde; 2010 [acessado em 06 out. 2019]. 104 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/linha_cuidado_criancas_familias_violencias.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... .

STUDY VARIABLES

Cases of violence were described according to the victims’ sociodemographic characteristics: sex (female, male), age group (10 to 14 and 15 to 19 years old), ethnicity/skin color (white, black [black + brown], yellow, indigenous), education (0 to 8 years of study, 9 or more years of study), presence of disability/disorder (yes, no). Physical, intellectual, visual and hearing disabilities, mental disorders, behavioral disorders, as well as other disabilities and other disorders were considered. Characteristics of violence: history of recurrent violence (yes, no), place where the violence occurred (home, street, school, other places), self-harm (yes, no), type of violence (physical, sexual, psychological, negligence, others), means of aggression (corporal force/beating, threat, poisoning/intoxication, sharp objects, firearm, blunt object, hanging, hot object/substance, other means). Characteristics of the likely perpetrator of violence: number of people involved (one, two or more), sex (female, male), bond with the victim (family, friend/acquaintance, stranger, intimate partner, other bonds), suspected alcohol abuse by the aggressor (yes, no). The variables “type of violence” and “bond with the victim” allowed multiple responses.

DATA ANALYSIS

The chi-square test was used to assess the statistical significance of the differences between the proportions in the comparison between genders, with significance level of 5%. Proportion ratios (PR) and respective 95% confidence intervals (95%CI) were estimated for the most frequent types of violence according to selected variables. The percentage of municipalities notifying violence per federation unit in 2011 through 2017 was also calculated.

ETHICAL ASPECTS

The national database that supported this study was accessed through the portal of the Unified Health System’s Informatics Department²¹21. Brasil. Ministério da Saúde. Departamento de Informática do SUS. Transferência/Download de Arquivos [Internet]. [acessado em 1º jul. 2019]. Disponível em: Disponível em: http://www2.datasus.gov.br/DATASUS/index.php?area=0901&item=1&acao=41
http://www2.datasus.gov.br/DATASUS/index... . The definitive data corresponding to each Brazilian federation unit from 2011 to 2017 were accessed. As this is a study with secondary data without identification, the research project was exempted from any considerations by the Research Ethics Committee, in accordance with guidelines of the National Health Council Resolution nº 510 of 2016.

RESULTS

From 2011 to 2017, 1,429,931 cases of interpersonal or self-violence were reported. Of this total, 374,673 (26.2%) corresponded to notifications of violence against adolescents.

In 2011, 28,792 cases of violence against adolescents were reported and, in 2017, 79,914 cases, which represents an increase of 177.6% in the number of notifications. These came from 4,202 notifying municipalities, equivalent to 75.4% of Brazilian municipalities.

In 2011, only two federal units (Rio de Janeiro and Mato Grosso do Sul) had a more than 50% notifying municipalities, that is, municipalities that had at least one notification of violence against adolescents in the year. In 2017, 17 federation units had more than 50% notifying municipalities, and among these, Roraima, Acre, Minas Gerais, Amazonas and Rio de Janeiro had a percentage greater than 80%. Among the 10 federation units with notifying municipalities below 50% 2017, eight of them (Paraíba, Sergipe, Piauí, Rio Grande do Norte, Maranhão, Bahia, Alagoas, Ceará) are located in the Northeast Region.

The sociodemographic characteristics of adolescents in situations of violence are detailed in Table 1. Of the total of notified cases, 65.2% involved females. The average age was 15.2 years. Most victims (60.3%) were between 15 and 19 years old, 54.9% were black, 68.6% had completed up to eight years of study and 7.9% had some disability or disorder.

We could see that 39.9% of the events had the characteristic of being repetitive and 56.9% occurred at the victims’ household. Females were victims of repetitive violence and violence at home in a greater proportion than males. Self-inflicted injuries accounted for 18.5% of notifications and occurred in a greater proportion among females. The most reported types of violence were: physical (64.7%), sexual (24.7%), psychological (24.5%) and negligence/abandonment (12.2%). Sexual and psychological violence were more frequent among females, while physical violence and negligence/abandonment were more frequent among males (Table 2). The most used means of violence were body force (45.4%) and threat (15.5%), with a higher proportional distribution among females. Sharp objects (10.3%), firearms (9.0%) were also reported as means of aggression, with higher frequency among males, and poisoning, more frequent among females (results not shown in table).

The evaluation of the characteristics of the probable author of violence showed that in 73.1% of the notifications there was involvement of an author and that, among females, the proportion of these aggressions perpetrated by only one aggressor was higher. In 66.5% of the cases, the aggressor was a male and, as to the bond with the victim, they were family members (28.7%), friends/acquaintances (23.9%), a stranger (19.4%), intimate partners (16.4%). There was a difference in the distribution of aggressors according to the victim’s sex: females were more frequently raped by intimate partners than males, who in turn were victims of family members, friends/acquaintances and strangers in greater proportion than females. The suspicion that the abuser had consumed alcohol was mentioned by 28.5% of the victims (Table 3).

Table 4 shows the proportion and PR of the types of violence mostly reported according to selected characteristics. Physical violence was significantly higher among indigenous people (PR = 1.15), black (PR = 1.03) and yellow people (PR = 1.03), and when the aggressor was suspected of abusing alcohol (PR = 1.21). It was significantly lower among females (PR = 0.75), at the age of 10 to 14 years (PR = 0.65), with the characteristic of being repetitive (PR = 0.83), when occurring at home (PR = 0.73), and when practiced by family members (PR = 0.70).

Psychological violence was significantly higher among females (PR = 1.73) in the group aged 10 to 14 years (PR = 1.19), being repetitive (PR = 1.68), at home (PR = 1.40), by family members (PR = 1.16), and with suspected alcohol abuse by the aggressor (PR = 1.33). It was significantly lower in the black-skin people group (PR = 0.96) compared to the white-skin people group.

Sexual violence was six times more frequent for females (PR = 6.20), three times higher in the group aged 10 to 14 years (PR = 3.11), more common among indigenous people (PR = 1 , 40), black people (PR = 1.38) and yellow people (PR = 1.28), perpetrated repeatedly (PR = 1.39), at home (PR = 1.34) and in suspicion of alcohol abuse by the aggressor (PR = 1.08). It was perpetrated by family members in a significantly lower proportion compared to non-family members (PR = 0.63).

Negligence was predominant in the age group from 10 to 14 years (PR = 2.23), perpetrated repeatedly (PR = 1.47), at home (PR = 1.12), by family members (PR = 14.48). It was significantly lower among females (PR = 0.58), in the black-skin group (PR = 0.84), yellow-skin group (PR = 0.78), indigenous group (PR = 0.36), and when there was suspicion of use of alcohol by the aggressor (PR = 0.89).

DISCUSSION

Notifications of violence in the health sector contribute to the epidemiological analysis of cases and provide support for the organization of services and the creation of public health policies. Furthermore, communicating cases to the Guardianship Councils serves the purpose of activating the social protection network for adolescents¹⁶16. Brasil. Viva: instrutivo notificação de violência interpessoal e autoprovocada [Internet]. Brasília: Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde; 2016 [acessado em 15 jan. 2019]. 92p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/viva_instrutivo_violencia_interpessoal_autoprovocada_2ed.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ^,2222. Lima J de S, Deslandes SF. A notificação compulsória do abuso sexual contra crianças e adolescentes: uma comparação entre os dispositivos americanos e brasileiros. Interface [Internet]. 2011 [acessado em 18 mar. 2019]; 15(38): 819-32. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-32832011000300016&lng=pt&tlng=pt https://doi.org/10.1590/S1414-32832011005000040
http://www.scielo.br/scielo.php?script=s... . In this context, the increase in the number of notifications and the number of notifying municipalities in the period from 2011 to 2017 is in line with the strategies to fight violence against adolescents in Brazil.

Despite the increase in the number of notifying municipalities, the increase was uneven between federation units and regions. This indicates the need to design public policies and specific strategies to expand the coverage of notifications in different Brazilian territories, in view of the different regional realities.

In this context, underreporting in health services is a limitation of this study. Notifications cannot be considered as the set of violence perpetrated against adolescents, but rather an approach to the problem or a diagnosis based on the cases of people in situations of violence who sought the health service and had access to it, and whose cases were notified by professionals working in the notifying services¹⁷17. Rates SMM, Melo EM de, Mascarenhas MDM, Malta DC, Rates SMM, Melo EM de, et al. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Ciên Saúde Colet [Internet]. 2015 [acessado em 30 jan. 2019]; 20(3): 655-65. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232015000300655&lng=en&tlng=em https://doi.org/10.1590/1413-81232015203.15242014
http://www.scielo.br/scielo.php?script=s... . It is known that these professionals find it difficult to register notifications due to the difficulty of diagnosing situations of violence in diffuse complaints, the refusal to deal with violence as a health problem, the accumulation of activities and lack of time in the work process, embarrassment that can be caused by the approach to these cases, due to fear of retaliation and exposure of professional performance, and lack of training²³23. Kind L, Orsini M de LP, Nepomuceno V, Gonçalves L, Souza GA de, Ferreira MFF. Subnotificação e (in)visibilidade da violência contra mulheres na atenção primária à saúde. Cad Saúde Pública [Internet]. 2013 [acessado em 3 out. 2018]; 29(9): 1805-15. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2013000900020&lng=pt&nrm=iso&tlng=em https://doi.org/10.1590/0102-311X00096312
http://www.scielo.br/scielo.php?script=s... ^,2424. Souza EG de, Tavares R, Lopes JG, Magalhães MAN, Melo EM de. Atitudes e opiniões de profissionais envolvidos na atenção à mulher em situação de violência em 10 municípios brasileiros. Saúde Debate [Internet]. 2018 [acessado em 9 out. 2019]; 42( Esp. 4): 13-29. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042018000800013&lng=pt&tlng=pt https://doi.org/10.1590/0103-11042018s401
http://www.scielo.br/scielo.php?script=s... . It should be noted that not every case of violence results in injuries that can be cared for in health services²⁵25. Ester Lopes da Silva L, Liz Cunha de Oliveira M. Características epidemiológicas da violência contra a mulher no Distrito Federal, 2009 a 2012. Epidemiol Serv Saúde [Internet]. 2016 [acessado em 28 jan. 2019]; 25(2): 331-42. Disponível em: https://doi.org/10.5123/s1679-49742016000200012
https://doi.org/https://doi.org/10.5123/... . In addition, different federation units and municipalities may have different levels of coverage of the violence surveillance system, resulting in differences in the capacity to register violence¹⁷17. Rates SMM, Melo EM de, Mascarenhas MDM, Malta DC, Rates SMM, Melo EM de, et al. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Ciên Saúde Colet [Internet]. 2015 [acessado em 30 jan. 2019]; 20(3): 655-65. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232015000300655&lng=en&tlng=em https://doi.org/10.1590/1413-81232015203.15242014
http://www.scielo.br/scielo.php?script=s... .

The larger number of reports of violence among females, in addition to the more frequent victimization of women, especially when it comes to sexual violence²⁶26. Delziovo CR, Bolsoni CC, Nazário NO, Coelho EBS. Características dos casos de violência sexual contra mulheres adolescentes e adultas notificados pelos serviços públicos de saúde em Santa Catarina, Brasil. Cad Saúde Pública [Internet]. 2017 [acessado em 31 jul. 2019]; 33(6). Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2017000605011&lng=pt&tlng=pt https://doi.org/10.1590/0102-311x00002716
http://www.scielo.br/scielo.php?script=s... ^,2727. Justino LCL, Ferreira SRP, Nunes CB, Barbosa MAM, Gerk MA de S, Freitas SLF de. Violência sexual contra adolescentes: notificações nos conselhos tutelares, Campo Grande, Mato Grosso do Sul, Brasil. Rev Gaúcha Enferm [Internet]. 2011 [acessado em 16 jul. 2019]; 32(4): 781-7. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472011000400020&lng=pt&tlng=pt https://doi.org/10.1590/S1983-14472011000400020
http://www.scielo.br/scielo.php?script=s... ^,2828. Sena CA de, Silva MA da, Falbo Neto GH. Incidência de violência sexual em crianças e adolescentes em Recife/Pernambuco no biênio 2012-2013. Ciên Saúde Colet [Internet]. 2018 [acessado em 24 mar. 2019]; 23(5): 1591-9. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232018000501591&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232018235.18662016
http://www.scielo.br/scielo.php?script=s... , psychological and perpetrated by intimate partners in home environment⁶6. Malta DC, Bernal RTI, Pugedo FSF, Lima CM, Mascarenhas MDM, Jorge A de O, et al. Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência. Ciên Saúde Colet [Internet]. 2017 [acessado em 22 jan. 2019]; 22(9): 2899-908. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902899&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.14212017
http://www.scielo.br/scielo.php?script=s... ^,2929. Schraiber LB, D’Oliveira AFPL, Couto MT. Violência e saúde: estudos científicos recentes. Rev Saúde Pública [Internet]. 2006 [acessado em 13 ago. 2019]; 40(N. Esp.): 112-20. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102006000400016&lng=pt&tlng=pt https://doi.org/10.1590/S0034-89102006000400016
http://www.scielo.br/scielo.php?script=s... , may be related to factors such as greater search for health care by females than by men³⁰30. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa nacional de saúde: 2013: acesso e utilização dos serviços de saúde, acidentes e violências: Brasil, grandes regiões e unidades da federação [Internet]. Rio de Janeiro: IBGE; 2015 [acessado em 16 ago. 2019]. 100 p. Disponível em: Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv94074.pdf
https://biblioteca.ibge.gov.br/visualiza... and, consequently, more acknowledgment of violence among them.

Regarding the higher proportion of victims in the black skin group, it is relevant to highlight that black adolescents and young people are more subjected to social inequalities and situations of insecurity, as well as more exposed to violence compared to white people⁵5. Monteiro EMLM, Brandão Neto W, de Lima LS, de Aquino JM, Gontijo DT, Pereira BO. Culture Circles in adolescent empowerment for the prevention of violence. Int J Adolesc Youth [Internet]. 2015; 20(2): 167-84. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391289/ https://dx.doi.org/10.1080%2F02673843.2014.992028
https://www.ncbi.nlm.nih.gov/pmc/article... ^,1313. Instituto de Pesquisa Econômica Aplicada. Atlas da violência 2019 [Internet]. Brasília: Instituto de Pesquisa Econômica Aplicada; 2019 [acessado em 19 set. 2019]. Disponível em: Disponível em: http://www.ipea.gov.br/portal/images/stories/PDFs/relatorio_institucional/190605_atlas_da_violencia_2019.pdf
http://www.ipea.gov.br/portal/images/sto... ^,3131. Malta DC, Mascarenhas MDM, Bernal RTI, Andrade SSC de A, Neves ACM das, Melo EM de, et al. Causas externas em adolescentes: atendimentos em serviços sentinelas de urgência e emergência nas Capitais Brasileiras - 2009. Ciên Saúde Colet [Internet]. 2012 [acessado em 27 jan. 2019]; 17(9): 2291-304. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232012000900011&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232012000900011
http://www.scielo.br/scielo.php?script=s... ^,3232. Araújo EM de, Costa M da CN, Hogan VK, Mota ELA, Araújo TM de, Oliveira NF de. Diferenciais de raça/cor da pele em anos potenciais de vida perdidos por causas externas. Rev Saúde Pública [Internet]. 2009 [acessado em 16 ago. 2019]; 43(3): 405-12. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102009000300003&lng=pt&nrm=iso&tlng=em https://doi.org/10.1590/S0034-89102009005000021
http://www.scielo.br/scielo.php?script=s... ^,3333. Brasil. Painél de Idicadores do SUS Temático Saúde da População Negra [Internet]. Brasília; 2016 [acessado em 04 fev. 2019]. 82 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/tematico_saude_populacao_negra_v._7.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... .

Females were victims of repetitive violence in greater proportion than males. Studies describe that episodes of violence against women are chronic and tend to become progressively more serious³⁴34. Barufaldi LA, Souto RMCV, Correia RS de B, Montenegro M de MS, Pinto IV, Silva MMA da, et al. Violência de gênero: comparação da mortalidade por agressão em mulheres com e sem notificação prévia de violência. Ciên Saúde Colet [Internet]. 2017 [acessado em 14 set. 2018]; 22(9): 2929-38. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902929&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.12712017
http://www.scielo.br/scielo.php?script=s... . This repetitive violence has significant repercussions on women’s health or mental suffering and contributes to a greater demand for health services compared to men³⁴34. Barufaldi LA, Souto RMCV, Correia RS de B, Montenegro M de MS, Pinto IV, Silva MMA da, et al. Violência de gênero: comparação da mortalidade por agressão em mulheres com e sem notificação prévia de violência. Ciên Saúde Colet [Internet]. 2017 [acessado em 14 set. 2018]; 22(9): 2929-38. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902929&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.12712017
http://www.scielo.br/scielo.php?script=s... ^,3535. Moreira S da NT, Galvão LLLF, Melo COM, Azevedo GD de. Violência física contra a mulher na perspectiva de profissionais de saúde. Rev Saúde Pública [Internet]. 2008 [acessado em 10 jul. 2019]; 42(6): 1053-9. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102008000600011&lng=pt&nrm=iso&tlng=en
http://www.scielo.br/scielo.php?script=s... .

The household and the public road stood out as places where violence occurs, as observed in other studies⁶6. Malta DC, Bernal RTI, Pugedo FSF, Lima CM, Mascarenhas MDM, Jorge A de O, et al. Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência. Ciên Saúde Colet [Internet]. 2017 [acessado em 22 jan. 2019]; 22(9): 2899-908. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902899&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.14212017
http://www.scielo.br/scielo.php?script=s... ^,1111. Costa MCO, Carvalho RC de, Santa Bárbara J de FR, Santos CAST, Gomes W de A, Sousa HL de. O perfil da violência contra crianças e adolescentes, segundo registros de Conselhos Tutelares: vítimas, agressores e manifestações de violência. Ciên Saúde Colet [Internet]. 2007 [acessado em 26 jun. 2019]; 12(5): 1129-41. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000500010&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232007000500010
http://www.scielo.br/scielo.php?script=s... ^,3131. Malta DC, Mascarenhas MDM, Bernal RTI, Andrade SSC de A, Neves ACM das, Melo EM de, et al. Causas externas em adolescentes: atendimentos em serviços sentinelas de urgência e emergência nas Capitais Brasileiras - 2009. Ciên Saúde Colet [Internet]. 2012 [acessado em 27 jan. 2019]; 17(9): 2291-304. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232012000900011&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232012000900011
http://www.scielo.br/scielo.php?script=s... ^,3636. Garbin CAS, Gomes AM de P, Gatto RCJ, Garbin AJI. Um Estudo Transversal Sobre Cinco Anos de Denúncia Sobre Violência Contra Crianças e Adolescentes em Araçatuba - São Paulo. J Health Sci [Internet]. 2016 [acessado em 26 jun. 2019]; 18(4): 273-7. Disponível em: Disponível em: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3293/3403
http://www.pgsskroton.com.br/seer/index.... ^,3737. Souto DF, Zanin L, Ambrosano GMB, Flório FM. Violence against children and adolescents: profile and tendencies resulting from Law 13.010. Rev Bras Enferm[Internet]. 2018 [acessado em 30 jan. 2019]; 71(Supl. 3): 1237-46. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000901237&lng=en&tlng=en https://doi.org/10.1590/0034-7167-2017-0048
http://www.scielo.br/scielo.php?script=s... . The violence practiced in the victims’ homes reveals that the aggressors are family members or have free access to the household¹¹11. Costa MCO, Carvalho RC de, Santa Bárbara J de FR, Santos CAST, Gomes W de A, Sousa HL de. O perfil da violência contra crianças e adolescentes, segundo registros de Conselhos Tutelares: vítimas, agressores e manifestações de violência. Ciên Saúde Colet [Internet]. 2007 [acessado em 26 jun. 2019]; 12(5): 1129-41. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000500010&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232007000500010
http://www.scielo.br/scielo.php?script=s... ^,2929. Schraiber LB, D’Oliveira AFPL, Couto MT. Violência e saúde: estudos científicos recentes. Rev Saúde Pública [Internet]. 2006 [acessado em 13 ago. 2019]; 40(N. Esp.): 112-20. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102006000400016&lng=pt&tlng=pt https://doi.org/10.1590/S0034-89102006000400016
http://www.scielo.br/scielo.php?script=s... ^,3737. Souto DF, Zanin L, Ambrosano GMB, Flório FM. Violence against children and adolescents: profile and tendencies resulting from Law 13.010. Rev Bras Enferm[Internet]. 2018 [acessado em 30 jan. 2019]; 71(Supl. 3): 1237-46. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000901237&lng=en&tlng=en https://doi.org/10.1590/0034-7167-2017-0048
http://www.scielo.br/scielo.php?script=s... . This situation is opposed to the concept of home as a safe place, the source of development for children and adolescents³⁷37. Souto DF, Zanin L, Ambrosano GMB, Flório FM. Violence against children and adolescents: profile and tendencies resulting from Law 13.010. Rev Bras Enferm[Internet]. 2018 [acessado em 30 jan. 2019]; 71(Supl. 3): 1237-46. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000901237&lng=en&tlng=en https://doi.org/10.1590/0034-7167-2017-0048
http://www.scielo.br/scielo.php?script=s... .

Females were victims of violence at home in a greater proportion than males. The violence they suffer has their parents, boyfriend or mothers’ partner as main authors⁶6. Malta DC, Bernal RTI, Pugedo FSF, Lima CM, Mascarenhas MDM, Jorge A de O, et al. Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência. Ciên Saúde Colet [Internet]. 2017 [acessado em 22 jan. 2019]; 22(9): 2899-908. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902899&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.14212017
http://www.scielo.br/scielo.php?script=s... ^,2929. Schraiber LB, D’Oliveira AFPL, Couto MT. Violência e saúde: estudos científicos recentes. Rev Saúde Pública [Internet]. 2006 [acessado em 13 ago. 2019]; 40(N. Esp.): 112-20. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102006000400016&lng=pt&tlng=pt https://doi.org/10.1590/S0034-89102006000400016
http://www.scielo.br/scielo.php?script=s... , and commonly in the domestic environment. Among males, violence on public roads occurred in practically the same proportion as domestic violence. The high proportion of violence among males on the public road by strangers is related to greater exposure to risks in public spaces than women⁶6. Malta DC, Bernal RTI, Pugedo FSF, Lima CM, Mascarenhas MDM, Jorge A de O, et al. Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência. Ciên Saúde Colet [Internet]. 2017 [acessado em 22 jan. 2019]; 22(9): 2899-908. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902899&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.14212017
http://www.scielo.br/scielo.php?script=s... ^,3838. Reichenheim ME, Souza ER, Moraes CL, Jorge MHLPM, Silva CMFPF, Minayo MCS. Violência e lesões no Brasil: efeitos, avanços alcançados e desafios futuros. Lancet [Internet]. 2011 [acessado em 13 ago. 2019]; 75-89. Disponível em: Disponível em: http://download.thelancet.com/flatcontentassets/pdfs/brazil/brazilpor5.pdf
http://download.thelancet.com/flatconten... .

Self-inflicted injuries accounted for 18.5% of notifications and occurred in a greater proportion among females. This result is in line with a study carried out in urgency and emergency sentinel services in Brazilian capitals, which showed a greater chance of assisting females for this cause³⁹39. Bahia CA, Avanci JQ, Pinto LW, Minayo MC de S. Lesão autoprovocada em todos os ciclos da vida: perfil das vítimas em serviços de urgência e emergência de capitais do Brasil. Ciên Saúde Colet[Internet]. 2017 [acessado em 2 set. 2019]; 22(9): 2841-50. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902841&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.12242017
http://www.scielo.br/scielo.php?script=s... . The vulnerability of Brazilian adolescents and young people to suicide occurs in an increasing, sustained and high-impact manner, a fact that requires new public policies and strategies aimed at facing the problem in this population group⁴⁰40. Ribeiro JM, Moreira MR, Ribeiro JM, Moreira MR. Uma abordagem sobre o suicídio de adolescentes e jovens no Brasil. Ciên Saúde Colet[Internet]. 2018 [acessado em 19 ago. 2019]; 23(9): 2821-34. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232018000902821&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232018239.17192018
http://www.scielo.br/scielo.php?script=s... .

Physical violence was predominant among males, in the group aged 15 to 19 years, when perpetrated outside the home and when the aggressors were not family members, results that are in line with the findings of a survey carried out in emergency services in Brazilian capitals⁶6. Malta DC, Bernal RTI, Pugedo FSF, Lima CM, Mascarenhas MDM, Jorge A de O, et al. Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência. Ciên Saúde Colet [Internet]. 2017 [acessado em 22 jan. 2019]; 22(9): 2899-908. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902899&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.14212017
http://www.scielo.br/scielo.php?script=s... . Injuries resulting from community violence, an important public health problem, especially among adolescents and young male adults, are identified in the literature as risk factors for male over-mortality⁶6. Malta DC, Bernal RTI, Pugedo FSF, Lima CM, Mascarenhas MDM, Jorge A de O, et al. Violências contra adolescentes nas capitais brasileiras, segundo inquérito em serviços de urgência. Ciên Saúde Colet [Internet]. 2017 [acessado em 22 jan. 2019]; 22(9): 2899-908. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902899&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.14212017
http://www.scielo.br/scielo.php?script=s... ^,3838. Reichenheim ME, Souza ER, Moraes CL, Jorge MHLPM, Silva CMFPF, Minayo MCS. Violência e lesões no Brasil: efeitos, avanços alcançados e desafios futuros. Lancet [Internet]. 2011 [acessado em 13 ago. 2019]; 75-89. Disponível em: Disponível em: http://download.thelancet.com/flatcontentassets/pdfs/brazil/brazilpor5.pdf
http://download.thelancet.com/flatconten... ^,4141. Pinheiro R, Peres AMAM, Velloso G, Caldas M de S. Apoio regional no estado do Rio de Janeiro, Brasil: um relato de experiência. Interface [Internet]. 2014 [acessado em 31 jul. 2018]; 18(Supl. 1): 1125-33. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-32832014000501125&lng=pt&tlng=pt https://doi.org/10.1590/1807-57622013.0375
http://www.scielo.br/scielo.php?script=s... ^,4242. Andrade-Barbosa TL de, Xavier-Gomes LM, Barbosa V de A, Caldeira AP. Mortalidade masculina por causas externas em Minas Gerais, Brasil. Ciên Saúde Colet [Internet]. 2013 [acessado em 28 jan. 2019]; 18(3): 711-9. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232013000300017&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232013000300017
http://www.scielo.br/scielo.php?script=s... .

The high level of notifications of physical violence observed in this and other studies can be justified by the presence of visible bruises or marks that facilitate identification, which may not occur in other forms of violence, thus requiring more detailed investigation for identification¹1. World Health Organization (WHO). Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation [Internet]. Genebra: WHO; 2017 [acessado em 02 jan. 2019]. Disponível em: Disponível em: https://www.who.int/maternal_child_adolescent/topics/adolescence/framework-accelerated-action/en/
https://www.who.int/maternal_child_adole... ^,1111. Costa MCO, Carvalho RC de, Santa Bárbara J de FR, Santos CAST, Gomes W de A, Sousa HL de. O perfil da violência contra crianças e adolescentes, segundo registros de Conselhos Tutelares: vítimas, agressores e manifestações de violência. Ciên Saúde Colet [Internet]. 2007 [acessado em 26 jun. 2019]; 12(5): 1129-41. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000500010&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232007000500010
http://www.scielo.br/scielo.php?script=s... ^,4343. Souza C dos S, Costa MCO, Assis SG de, Musse J de O, Nascimento Sobrinho C, Amaral MTR. Sistema de Vigilância de Violências e Acidentes/VIVA e a notificação da violência infanto-juvenil, no Sistema Único de Saúde/SUS de Feira de Santana-Bahia, Brasil. Ciên Saúde Colet [Internet]. 2014 [acessado em 20 nov. 2018]; 19(3): 773-84. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232014000300773&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232014193.18432013
http://www.scielo.br/scielo.php?script=s... .

Sexual violence was more frequent among females and in the group aged 10 to 14 years, which is in accordance with the literature²⁶26. Delziovo CR, Bolsoni CC, Nazário NO, Coelho EBS. Características dos casos de violência sexual contra mulheres adolescentes e adultas notificados pelos serviços públicos de saúde em Santa Catarina, Brasil. Cad Saúde Pública [Internet]. 2017 [acessado em 31 jul. 2019]; 33(6). Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2017000605011&lng=pt&tlng=pt https://doi.org/10.1590/0102-311x00002716
http://www.scielo.br/scielo.php?script=s... ^,2727. Justino LCL, Ferreira SRP, Nunes CB, Barbosa MAM, Gerk MA de S, Freitas SLF de. Violência sexual contra adolescentes: notificações nos conselhos tutelares, Campo Grande, Mato Grosso do Sul, Brasil. Rev Gaúcha Enferm [Internet]. 2011 [acessado em 16 jul. 2019]; 32(4): 781-7. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472011000400020&lng=pt&tlng=pt https://doi.org/10.1590/S1983-14472011000400020
http://www.scielo.br/scielo.php?script=s... ^,2828. Sena CA de, Silva MA da, Falbo Neto GH. Incidência de violência sexual em crianças e adolescentes em Recife/Pernambuco no biênio 2012-2013. Ciên Saúde Colet [Internet]. 2018 [acessado em 24 mar. 2019]; 23(5): 1591-9. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232018000501591&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232018235.18662016
http://www.scielo.br/scielo.php?script=s... . The greater victimization among women reinforces the evidence of inequalities expressed in the gender relations of a sexist society, which legitimizes the preservation of a supposed male supremacy and places women at risk for victimization by violence²⁷27. Justino LCL, Ferreira SRP, Nunes CB, Barbosa MAM, Gerk MA de S, Freitas SLF de. Violência sexual contra adolescentes: notificações nos conselhos tutelares, Campo Grande, Mato Grosso do Sul, Brasil. Rev Gaúcha Enferm [Internet]. 2011 [acessado em 16 jul. 2019]; 32(4): 781-7. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472011000400020&lng=pt&tlng=pt https://doi.org/10.1590/S1983-14472011000400020
http://www.scielo.br/scielo.php?script=s... ^,2828. Sena CA de, Silva MA da, Falbo Neto GH. Incidência de violência sexual em crianças e adolescentes em Recife/Pernambuco no biênio 2012-2013. Ciên Saúde Colet [Internet]. 2018 [acessado em 24 mar. 2019]; 23(5): 1591-9. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232018000501591&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232018235.18662016
http://www.scielo.br/scielo.php?script=s... ^,4444. Meneghel SN, Portella AP. Feminicídios: conceitos, tipos e cenários. Ciên Saúde Colet [Internet]. 2017 [acessado em 9 jul. 2018]; 22(9): 3077-86. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002903077&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.11412017
http://www.scielo.br/scielo.php?script=s... . In addition, it is worth noting that the younger the victim, the greater the consequences of this type of violence, which causes considerable psychological and physical damage that will accompany them throughout life²⁷27. Justino LCL, Ferreira SRP, Nunes CB, Barbosa MAM, Gerk MA de S, Freitas SLF de. Violência sexual contra adolescentes: notificações nos conselhos tutelares, Campo Grande, Mato Grosso do Sul, Brasil. Rev Gaúcha Enferm [Internet]. 2011 [acessado em 16 jul. 2019]; 32(4): 781-7. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472011000400020&lng=pt&tlng=pt https://doi.org/10.1590/S1983-14472011000400020
http://www.scielo.br/scielo.php?script=s... ^,2828. Sena CA de, Silva MA da, Falbo Neto GH. Incidência de violência sexual em crianças e adolescentes em Recife/Pernambuco no biênio 2012-2013. Ciên Saúde Colet [Internet]. 2018 [acessado em 24 mar. 2019]; 23(5): 1591-9. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232018000501591&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232018235.18662016
http://www.scielo.br/scielo.php?script=s... ^,4545. Souto RMCV, Porto DL, Pinto IV, Vidotti CCF, Barufaldi LA, Freitas MG de, et al. Estupro e gravidez de meninas de até 13 anos no Brasil: características e implicações na saúde gestacional, parto e nascimento. Ciên Saúde Colet [Internet]. 2017 [acessado em 9 jul. 2018]; 22(9): 2909-18. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902909&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.13312017
http://www.scielo.br/scielo.php?script=s... .

Furthermore, it is known that the real prevalence of sexual abuse is little known and it is believed that the underreporting rate is very high¹¹11. Costa MCO, Carvalho RC de, Santa Bárbara J de FR, Santos CAST, Gomes W de A, Sousa HL de. O perfil da violência contra crianças e adolescentes, segundo registros de Conselhos Tutelares: vítimas, agressores e manifestações de violência. Ciên Saúde Colet [Internet]. 2007 [acessado em 26 jun. 2019]; 12(5): 1129-41. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000500010&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232007000500010
http://www.scielo.br/scielo.php?script=s... ^,4646. Justino LCL, Nunes CB, Gerk MA de S, Fonseca SSO, Ribeiro AA, Paranhos Filho AC, et al. Violência sexual contra adolescentes em Campo Grande, Mato Grosso do Sul. Rev Gaúcha Enferm [Internet]. 2015 [acessado em 16 jul. 2019]; 36(N. Esp.): 239-46. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472015000500239&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... due to factors such as the victim’s embarrassment, fear of humiliation and of lack of understanding by family members, friends and authorities¹¹11. Costa MCO, Carvalho RC de, Santa Bárbara J de FR, Santos CAST, Gomes W de A, Sousa HL de. O perfil da violência contra crianças e adolescentes, segundo registros de Conselhos Tutelares: vítimas, agressores e manifestações de violência. Ciên Saúde Colet [Internet]. 2007 [acessado em 26 jun. 2019]; 12(5): 1129-41. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000500010&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232007000500010
http://www.scielo.br/scielo.php?script=s... .

Psychological violence was more frequent among women and when perpetrated in a chronic way. Due to its subjectivity and different expressions, this type of violence is difficult to register. In general, it is part of the context of other forms of violence, it is inflicted in a chronic way, and can lead to serious damages to the cognitive and psychosocial development of children and adolescents, compromising emotional health¹¹11. Costa MCO, Carvalho RC de, Santa Bárbara J de FR, Santos CAST, Gomes W de A, Sousa HL de. O perfil da violência contra crianças e adolescentes, segundo registros de Conselhos Tutelares: vítimas, agressores e manifestações de violência. Ciên Saúde Colet [Internet]. 2007 [acessado em 26 jun. 2019]; 12(5): 1129-41. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000500010&lng=pt&tlng=pt https://doi.org/10.1590/S1413-81232007000500010
http://www.scielo.br/scielo.php?script=s... ^,4343. Souza C dos S, Costa MCO, Assis SG de, Musse J de O, Nascimento Sobrinho C, Amaral MTR. Sistema de Vigilância de Violências e Acidentes/VIVA e a notificação da violência infanto-juvenil, no Sistema Único de Saúde/SUS de Feira de Santana-Bahia, Brasil. Ciên Saúde Colet [Internet]. 2014 [acessado em 20 nov. 2018]; 19(3): 773-84. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232014000300773&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232014193.18432013
http://www.scielo.br/scielo.php?script=s... ^,4747. Assis SG de, Avanci JQ. Abuso Psicológico e Desenvolvimento Infantil. In: Ministério da Saúde, editor. Violência Faz Mal à Saúde [Internet]. Brasília: Ministério da Saúde ; 2006 [acessado em 02 ago. 2019]. p. 59-67. Disponível em: Disponível em: http://bibliotecadigital.puc-campinas.edu.br/services/e-books-MS/06_0315_M.pdf
http://bibliotecadigital.puc-campinas.ed... .

Negligence and abandonment were more frequent when practiced in a chronic way, in the home environment and when the aggressors were family members, which is in accordance with a work published with data from the Violence and Accident Surveillance System with the child and adolescent population⁴³43. Souza C dos S, Costa MCO, Assis SG de, Musse J de O, Nascimento Sobrinho C, Amaral MTR. Sistema de Vigilância de Violências e Acidentes/VIVA e a notificação da violência infanto-juvenil, no Sistema Único de Saúde/SUS de Feira de Santana-Bahia, Brasil. Ciên Saúde Colet [Internet]. 2014 [acessado em 20 nov. 2018]; 19(3): 773-84. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232014000300773&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232014193.18432013
http://www.scielo.br/scielo.php?script=s... , and the highest proportion was observed among males⁴³43. Souza C dos S, Costa MCO, Assis SG de, Musse J de O, Nascimento Sobrinho C, Amaral MTR. Sistema de Vigilância de Violências e Acidentes/VIVA e a notificação da violência infanto-juvenil, no Sistema Único de Saúde/SUS de Feira de Santana-Bahia, Brasil. Ciên Saúde Colet [Internet]. 2014 [acessado em 20 nov. 2018]; 19(3): 773-84. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232014000300773&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232014193.18432013
http://www.scielo.br/scielo.php?script=s... ^,4848. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde. Viva: Vigilância de Violências e Acidentes : 2013 e 2014 [Internet]. Brasília; 2017 [acessado em 02 ago. 2019]. 218 p. Disponível em: Disponível em: http://portalarquivos2.saude.gov.br/images/pdf/2017/janeiro/12/viva_vigilancia_violencia_acidentes_2013_2014.pdf
http://portalarquivos2.saude.gov.br/imag... . This type of violence is difficult to define and needs fundamental elements for identification, such as the contexts of poverty, isolation, social deprivation and other deficiencies present in the life history of parents and victims³⁷37. Souto DF, Zanin L, Ambrosano GMB, Flório FM. Violence against children and adolescents: profile and tendencies resulting from Law 13.010. Rev Bras Enferm[Internet]. 2018 [acessado em 30 jan. 2019]; 71(Supl. 3): 1237-46. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000901237&lng=en&tlng=en https://doi.org/10.1590/0034-7167-2017-0048
http://www.scielo.br/scielo.php?script=s... ^,4343. Souza C dos S, Costa MCO, Assis SG de, Musse J de O, Nascimento Sobrinho C, Amaral MTR. Sistema de Vigilância de Violências e Acidentes/VIVA e a notificação da violência infanto-juvenil, no Sistema Único de Saúde/SUS de Feira de Santana-Bahia, Brasil. Ciên Saúde Colet [Internet]. 2014 [acessado em 20 nov. 2018]; 19(3): 773-84. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232014000300773&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232014193.18432013
http://www.scielo.br/scielo.php?script=s... . These factors, related to structural violence perpetrated historically against millions of Brazilian families, make it more difficult to judge more precisely between abusive practice and impossibility of providing what it takes to the development of children and adolescents⁴⁹49. Sanchez RN, Minayo MC de S. Violência Contra Crianças e Adolescentes: Questão Histórica, Social e de Saúde. In: Ministério da Saúde, editor. Violência faz mal à saúde [Internet]. Brasil: Ministério da Saúde; 2006 [acessado em 13 ago. 2019]. p. 29-38. Disponível em: Disponível em: http://bibliotecadigital.puc-campinas.edu.br/services/e-books-MS/06_0315_M.pdf
http://bibliotecadigital.puc-campinas.ed... .

The higher proportion of poisoning observed among adolescents may be related to the fact that among women, especially adolescents and young adults⁵⁰50. Gondim APS, Nogueira RR, Lima JGB, Lima RAC, Albuquerque PLMM, Veras M do SB, et al. Tentativas de suicídio por exposição a agentes tóxicos registradas em um Centro de Informação e Assistência Toxicológica em Fortaleza, Ceará, 2013. Epidemiol Serv Saúde [Internet]. 2017 [acessado em 17 jul. 2019]; 26(1): 109-19. Disponível em: Disponível em: http://revista.iec.gov.br/template_doi_ess.php?doi=10.5123/S1679-49742017000100109&scielo=S2237-96222017000100109 https://doi.org/10.5123/s1679-49742017000100012
http://revista.iec.gov.br/template_doi_e... , suicide attempts are carried out using the most easily accessible method, such as toxic agents³⁹39. Bahia CA, Avanci JQ, Pinto LW, Minayo MC de S. Lesão autoprovocada em todos os ciclos da vida: perfil das vítimas em serviços de urgência e emergência de capitais do Brasil. Ciên Saúde Colet[Internet]. 2017 [acessado em 2 set. 2019]; 22(9): 2841-50. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902841&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.12242017
http://www.scielo.br/scielo.php?script=s... ^,5050. Gondim APS, Nogueira RR, Lima JGB, Lima RAC, Albuquerque PLMM, Veras M do SB, et al. Tentativas de suicídio por exposição a agentes tóxicos registradas em um Centro de Informação e Assistência Toxicológica em Fortaleza, Ceará, 2013. Epidemiol Serv Saúde [Internet]. 2017 [acessado em 17 jul. 2019]; 26(1): 109-19. Disponível em: Disponível em: http://revista.iec.gov.br/template_doi_ess.php?doi=10.5123/S1679-49742017000100109&scielo=S2237-96222017000100109 https://doi.org/10.5123/s1679-49742017000100012
http://revista.iec.gov.br/template_doi_e... .

Firearms and sharp objects were the most used means of aggression against male adolescents and corroborate the national literature⁵¹51. Souza ER de. Masculinidade e violência no Brasil: contribuições para a reflexão no campo da saúde. Ciên Saúde Colet [Internet]. 2005 [acessado em 17 jul. 2019]; 10(1): 59-70. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232005000100012&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... ^,5252. Ribeiro AP, Souza ER de, Sousa CAM de. Lesões provocadas por armas de fogo atendidas em serviços de urgência e emergência brasileiros. Ciên Saúde Colet [Internet]. 2017 [acessado em 17 jul. 2019]; 22(9): 2851-60. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002902851&lng=pt&tlng=pt https://doi.org/10.1590/1413-81232017229.16492017
http://www.scielo.br/scielo.php?script=s... ^,5353. Gaspar VLV, Lamounier JA, Cunha FM, Gaspar JC. Fatores relacionados a hospitalizações por injúrias em crianças e adolescentes. J Pediatr (Rio J) [Internet]. 2004 [acessado em 17 jul. 2019]; 80(6): 447-52. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572004000800005&lng=pt&nrm=iso&tlng=pt https://doi.org/10.1590/S0021-75572004000800005
http://www.scielo.br/scielo.php?script=s... ^,5454. Pinto IV, Barufaldi LA, Campos MO, Malta DC, Souto RMCV, Freitas MG de, et al. Tendências de situações de violência vivenciadas por adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar 2009, 2012 e 2015. Rev Bras Epidemiol [Internet]. 2018 [acessado em 22 ago. 2019]; 21(Supl. 1). Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2018000200416&tlng=pt
http://www.scielo.br/scielo.php?script=s... , which points out the predominance of these aggressions in young adults and adolescents. It is important to highlight that, globally, 48% of homicides are committed with firearms and 27% with sharp objects, such as knives. In low- and middle-income countries in the Americas region, firearm deaths account for 75% of all homicides, while cases perpetrated by sharp objects account for 16%⁵⁵55. Organização Mundial da Saúde. Relatório Mundial sobre a Prevenção da Violência 2014 [Internet]. São Paulo: OMS; 2015 [acessado em 14 ago. 2019]. Disponível em: Disponível em: https://www.who.int/violence_injury_prevention/violence/status_report/2014/report/report/en/
https://www.who.int/violence_injury_prev... . Absence of firearms in the household and community environments is the most reliable and effective measure to prevent suicide, homicide and unintentional injuries by firearms in children and adolescents¹²12. World Health Organization (WHO) . Adolescents: health risks and solutions [Internet]. Fact sheets. 2018 [acessado em 04 mar. 2019]. Disponível em: Disponível em: https://www.who.int/en/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions
https://www.who.int/en/news-room/fact-sh... ^,5656. Firearm-Related Injuries Affecting the Pediatric Population. Pediatrics [Internet]. 2012 [acessado em 09 jul. 2019]; 130(5): e1416-e1423. Disponível em: Disponível em: http://pediatrics.aappublications.org/content/130/5/e1416.abstract https://doi.org/10.1542/peds.2012-2481
http://pediatrics.aappublications.org/co... .

Most cases of violence had males as aggressors. It is important to highlight that the constitution of male identity, which is hegemonically characterized by strength, competition and sexism, enhances the association between “masculine” and “violence”⁵¹51. Souza ER de. Masculinidade e violência no Brasil: contribuições para a reflexão no campo da saúde. Ciên Saúde Colet [Internet]. 2005 [acessado em 17 jul. 2019]; 10(1): 59-70. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232005000100012&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... ^,5757. Alves RA, Pinto LMN, Silveira AM, Oliveira GL, Melo EM de. Homens, vítimas e autores de violência: a corrosão do espaço público e a perda da condição humana. Interface [Internet]. 2012 [acessado em 21 ago. 2019]; 16(43): 871-83. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-32832012000400002&lng=pt&tlng=pt https://doi.org/10.1590/S1414-32832012005000049
http://www.scielo.br/scielo.php?script=s... and imprisons men as victims and perpetrators⁵⁷57. Alves RA, Pinto LMN, Silveira AM, Oliveira GL, Melo EM de. Homens, vítimas e autores de violência: a corrosão do espaço público e a perda da condição humana. Interface [Internet]. 2012 [acessado em 21 ago. 2019]; 16(43): 871-83. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-32832012000400002&lng=pt&tlng=pt https://doi.org/10.1590/S1414-32832012005000049
http://www.scielo.br/scielo.php?script=s... . Overcoming this problem requires the implementation and strengthening of initiatives that promote deep reflection on values, forms of socialization and the construction of male and female identities in current societies, based on the establishment of more equitable relations among men, with their peers and with the opposite sex⁵¹51. Souza ER de. Masculinidade e violência no Brasil: contribuições para a reflexão no campo da saúde. Ciên Saúde Colet [Internet]. 2005 [acessado em 17 jul. 2019]; 10(1): 59-70. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232005000100012&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... .

Regarding the use of alcohol by the aggressor, it is necessary to highlight that, in Brazil, part of the violence has been associated, in addition to social and cultural determinants, to alcohol abuse, use of illicit drugs and the vast availability of firearms³⁸38. Reichenheim ME, Souza ER, Moraes CL, Jorge MHLPM, Silva CMFPF, Minayo MCS. Violência e lesões no Brasil: efeitos, avanços alcançados e desafios futuros. Lancet [Internet]. 2011 [acessado em 13 ago. 2019]; 75-89. Disponível em: Disponível em: http://download.thelancet.com/flatcontentassets/pdfs/brazil/brazilpor5.pdf
http://download.thelancet.com/flatconten... . Alcohol consumption is a significant promoter of violent situations¹²12. World Health Organization (WHO) . Adolescents: health risks and solutions [Internet]. Fact sheets. 2018 [acessado em 04 mar. 2019]. Disponível em: Disponível em: https://www.who.int/en/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions
https://www.who.int/en/news-room/fact-sh... ^,5858. Carvalho AP de, Silva TC da, Valença PA de M, Ferreira Santos C da FB, Colares V, Menezes VA de. Consumo de álcool e violência física entre adolescentes: quem é o preditor? Ciên Saúde Colet [Internet]. 2017 [acessado em 21 ago. 2019]; 22(12): 4013-20. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017021204013&lng=pt&tlng=pt https://doi.org/10.1590/1413-812320172212.06172016
http://www.scielo.br/scielo.php?script=s... ^,5959. Malta DC, Machado ÍE, Felisbino-Mendes MS, Prado RR do, Pinto AMS, Oliveira-Campos M, et al. Uso de substâncias psicoativas em adolescentes brasileiros e fatores associados: Pesquisa Nacional de Saúde dos Escolares, 2015. Rev Bras Epidemiol [Internet]. 2018 [acessado em 22 ago. 2019];21(Supl. 1). Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2018000200400&tlng=pt https://doi.org/10.1590/1980-549720180004.supl.1
http://www.scielo.br/scielo.php?script=s... , from the point of view of both the aggressor and the victim⁵⁸58. Carvalho AP de, Silva TC da, Valença PA de M, Ferreira Santos C da FB, Colares V, Menezes VA de. Consumo de álcool e violência física entre adolescentes: quem é o preditor? Ciên Saúde Colet [Internet]. 2017 [acessado em 21 ago. 2019]; 22(12): 4013-20. Disponível em: Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017021204013&lng=pt&tlng=pt https://doi.org/10.1590/1413-812320172212.06172016
http://www.scielo.br/scielo.php?script=s... .

The findings of this study point out the predominance of intrafamily and community violence in the reports of violence against adolescents, with a strong chronic, repetitive character. As the problem is complex and requires several sectors to face it, the health field needs to act in a network, in an articulated way, so that effective intra and intersectoral referrals are offered.

It is concerning that sexual violence is the second most prevalent type in notifications among female adolescents. Due to its negative impacts on mental, physical, sexual and reproductive health, special attention should be offered to professionals and services qualified for this assistance, as to guarantee humanized and comprehensive care.

Furthermore, a support and protection structure for professionals who report violence is relevant, as well as continuous training on the topic. Finally, the viability of tools that facilitate and qualify the notification process, such as an online system, can be relevant to improve notification as an important dimension of the line of care.

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