Maus-tratos infantis, comportamento sexual de risco e capital humano no início da vida adulta

Abstract

Physical, sexual and emotional abuse, as well as neglect perpetrated against children and adolescents before the age of 18, are considered child abuse and can affect health and well-being not only when they occur, but also throughout the life cycle. Child maltreatment has been associated with the adoption of risky behaviors to children's health, development of mental disorders and lower education. In this thesis, composed of three articles, in addition to the research project, the objective was to evaluate the relationship between child maltreatment occurring up to 15 years of age and risky sexual behavior and human capital in early adulthood (18 and 22 years old). In the first article, the literature on child maltreatment and risky sexual behaviors in adulthood was systematically reviewed and it was found that child maltreatment negatively influences sexual risky behavior in adulthood. Most of the studies found were carried out in highincome countries and most assessed child abuse in isolation, without evaluating the co-occurrence of different maltreatments, or included only sexual abuse as exposure. In addition to the review, two original articles were written with data from the 1993 Pelotas Birth Cohort and evaluated: a) Article 2 - the association between child maltreatment (up to 15-years of age) and risky sexual behaviors (early sexual initiation, unprotected sexual intercourse and multiple sexual partners) in early adulthood (22 years) also investigating possible mechanisms involved in this relationship; and b) Article 3 - the association between child maltreatment (up to 15-years old) and human capital (intelligence quotient at 18-years old and schooling at 22-years old). In both articles, abuse (physical and emotional) and physical neglect were assessed as child maltreatment and the analyzes were stratified by sex. In article 2, sexual abuse was also evaluated as exposure, and a longitudinal analysis was performed with data from follow-ups performed at 15-, 18- and 22-years of age, with a sample of 2,674 individuals. It was observed that exposure to childhood maltreatment, especially sexual and emotional abuse, in isolation or co-occurring simultaneously with other forms of abuse, was associated with early sexual debut only for women. Among males, no effect was found for any outcome studied. The lack of effect can be explained by the high mediation burden of school dropout (53%) between physical neglect and multiple sexual partners and harmful use of alcohol (39.1%) on the effect of physical abuse on having multiple sexual partners. The third article also used data from perinatal, 15-, 18- , and 22-years old follow-ups, with a final sample of 3,736 and 3,413 participants, according to available data for exposures and outcomes. The main finding showed that women who suffered physical neglect in childhood had a lower IQ at 18-years of age (β: -4.17 95%CI -6.99; -1.35). In addition, women who experienced physical neglect before age 15 years had, on average, one less year of schooling by age 22. Lower schooling was also observed in women exposed to two or more types of child maltreatment simultaneously (-0.56 years of schooling, on average). Interventions and efforts to reduce the occurrence of risky sexual behavior and improve the human capital accumulation in early adulthood must include strategies to prevent child maltreatment in all its forms.