INTRAFAMILY VIOLENCE WITNESSED AND EXPERIENCED BY SCHOOL ADOLESCENTS

Objective: to identify the forms, expressions, and the practitioners of intrafamily violence witnessed and/or experienced by adolescent students. Method: cross-sectional, descriptive study conducted in a public school in Salvador, Bahia - Brazil, with 230 adolescent students in November 2018. The database was archived using the Microsoft Excel program


INTRODUCTION
All over the world, children and adolescents are victims of intra-family violence, understood as any action or omission towards members of the same family or people who have a relational bond that results in damage to their integrity or well-being, which may take the form of physical, psychological, sexual, abandonment, neglect, or exploitation.Such grievance witnessed and/or experienced, compromises the potential for human development, which requires interventions to ensure that this audience has a family environment free of violence.
In Australia, a 2016 research study showed that one in 20 children reported witnessing violence against their mother and father respectively1.According to global violence data, since 2015, 1.3 billion children have suffered corporal punishment in the family environment, and more than half of all children and adolescents aged two to 17 have suffered emotional, sexual, and physical violence2.Therefore, the reality of children and adolescents who witness and/or suffer violence in the domestic environment is a warning.
Regardless of witnessing or experiencing this grievance, living in a violent home witnessing the aggression, and being victims of it, many children and adolescents may present compromises.Corroborating this, a study conducted in New Orleans with children and adolescents from five to 15 years old showed that witnessing physical aggression or suffering violence indirectly was related to externalizing behaviors, such as violent behavior, lack of emotional control, and relationship difficulties 3 .A national study with women and their daughters evidenced repercussions for children and adolescents in the psychological realm, such as decreased self-esteem, depression, and decreased school performance 4 .These repercussions impact all spheres of the lives of children and adolescents, compromising their full development.
Considering the experience of violence, as well as its repercussions on the lives of the victims, actions are needed directed to interventions in family relationships for the purpose of identifying violence, as well as its prevention and confrontation.To this end, professionals who work in the school environment and in Primary Health Care are in a prominent position due to their greater proximity (and bond) with this public and their families, being able to promote the care of children and adolescents, a group considerably vulnerable to the issue of witnessing and experiencing family abuse from an early age.In view of the above, the present study aims at identifying the forms, expressions and the (the) practitioners of the intrafamily violence witnessed and/or experienced by school adolescents.

METHOD
A cross-sectional descriptive study was carried out in a medium-sized public school located in Salvador, Bahia, Brazil.The choice of the place was justified by a previous partnership between the school and a public university, which has already been developing research, extension, and social-educational practices with the students.The study was written based on the criteria of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).
The study population consisted of 230 students aged between 10 and 19 years, this age group being understood as adolescence by the World Health Organization (WHO).The inclusion criterion was school attendance, and students who abstained from meetings were excluded from the study, even after three attempts at contact, on alternate days by the research team.
Intrafamily violence witnessed and experienced by school adolescents Lima CCO de J, Martins RD, Gomes NP, Cruz MA da, Gomes NR.Silva KKA da, et al.
As to the forms of violence experienced by the adolescents in the family environment (Table 1), 95 (41.3%) reported having experienced and 134 (58.3%) witnessed psychological violence, expressed by cursing and humiliation, with 76 (33%) reporting that, besides witnessing, they also experienced this form of aggression.Regarding physical violence: 122 (53%) reported having experienced it; 95 (41.3%) had witnessed it; and 69 (30%) had experienced both types, with the most cited expressions being pinching and slapping 114 (77%), followed by kicking and punching.The findings showed that sexual violence with a predominance of the expression related to "touching the body (breasts or genitals)" was experienced by 12 (5.2%) of the adolescents, witnessed by five (2.2%), and in one (0.43%), its intersection.Data collection occurred in November 2018 using a semi-structured form.The instrument adopted contained questions about sociodemographic data and regarding the forms (psychological, physical, and sexual) of intrafamily violence witnessed and experienced by schoolchildren, preceded by the questions: "Have you ever witnessed any of these things among your family members?" or "Has anyone in your family ever done any of these things to you?".For both modalities (witnessed and experienced), the following expressions were considered: cursing/humiliation (psychological violence); pinching/ tapping, kicking/punching, stabbing, shooting, burning (physical); and touching the body (breasts or genitalia), unwanted sex (sexual).The response options were dichotomized (yes/no).
For questions referring to the perpetrators of violence, the answer options were dichotomized (yes/no), with open answers for details: "Who witnessed the violence?"(father/ mother, stepfather/ stepmother, other relatives, and no answer) and "Who perpetrated the violence?It should be noted that the number of populations in the variables oscillated due to the multiple possibilities of responses.
The database was filed through the Microsoft Excel program and the frequencies were measured using the DataAnalysisandStatistical Software (STATA SE12).The data were analyzed descriptively, referred to as absolute and relative frequencies, and the analyses were measured according to the following modalities: witnessed (witnessed someone suffering), experienced (suffered), witnessed and experienced (witnessed and/or suffered, not necessarily concomitantly) some of the forms of intrafamily violence.
The study complied with ethical principles, and was approved by the Research Ethics Committee, under opinion number 384,208.Regarding the individuals indicated by the adolescents as perpetrators of the forms of intrafamily violence witnessed or experienced (Table 2), the study reveals that in the three forms (psychological, physical, and sexual) the fathers, mothers and other relatives were most mentioned.Sexual violence was the form with the greatest discrepancy between the percentages of practitioners father/mother and other relatives, unlike the psychological and physical forms whose percentages are equal.The incidence of stepfather/ stepmother as aggressor was less expressive in all forms, regardless of witnessing or experiencing the grievance.
Intrafamily violence witnessed and experienced by school adolescents Lima CCO de J, Martins RD, Gomes NP, Cruz MA da, Gomes NR.Silva KKA da, et al.

DISCUSSION
The study elucidates that most of the adolescents investigated have experienced intrafamily violence 180 (78.3%), signaling the expressive susceptibility to intrafamily violence in children and teenagers.In this sense, national research with 426 schoolchildren, aged 12 to 18 years, aiming to analyze data on intra-family and extra-family violence revealed even higher rates with adolescents witnessing (97%) and suffering (65.0%) injuries 5 .Although it does not distinguish between face-to-face and experienced violence, a situation that reinforces the lack of studies with this proposal, the high prevalence of domestic violence is also found in the international scenario, such as research that pointed to the exposure of 82.8% of children and adolescents to this grievance 6 .
One of the forms of intrafamily violence most frequently reported by the adolescents was psychological, totaling 99.6% among the modalities, a situation that may be related to the naturalization of this behavior in social relations.The use of derogatory or even aggressive words in daily family life can be used without the adolescents realizing that such actions constitute violence, nor do they know the effects of these behaviors, a circumstance that causes psychological violence to be perpetuated for long years throughout the lives of individuals, especially children and adolescents.A study of 1,429,931 cases of interpersonal violence reported in Brazil found that psychological violence (24.5%) was the type of violence most often reported by adolescents, occurring in their homes and with a history of repeated aggression 7 .
Psychological violence was expressed by more than a third of the adolescents by means of cursing and humiliation, which may be linked to the prerogative of the existence of few measures for punishment, even when it is violence.However, such violations are Intrafamily violence witnessed and experienced by school adolescents Lima CCO de J, Martins RD, Gomes NP, Cruz MA da, Gomes NR.Silva KKA da, et al.
recognized by the Statute of the Child and Adolescent (ECA) and are foreseen in its article 148, paragraph 6, which establishes the application of administrative penalties for cases of infractions against the rule that protects children or adolescents.
Despite the possibility of this form of expression being committed by anyone, in this study, psychological violence was presented with higher rates for other relatives, followed by parents, which denotes a family nucleus permeated with psychological aggression.In Brazil, a survey of 218 students found a predominance of psychological violence (94.5%), with the mother and father as the main perpetrators 8 .This naturalization of violence prevents the father/mother and other relatives from realizing that this attitude can generate, in children and adolescents, repressed feelings or, later, become a reproducer of the aggressions they have witnessed and/or experienced.
Socially justified as an educational measure, the naturalization of violence has also permeated physical violence, experienced by a significant number of adolescents (53.0%), a percentage like that found in a study conducted in Malawi with 561 adolescents, which showed a prevalence of 58.0% of adolescents being victims of this type of aggression 9 .In the cities of Kabul, Torkham and Jalalabad in Afghanistan, a study with parents and their children showed that physical violence was mostly justified to discipline their children 10 , corroborating research in Israel, which also showed the use of physical punishment as a method of discipline by ultra-Orthodox parents 11 .
In a similar way, the children themselves perceive that the aggressions come from educational measures, as described in a study with a children's drawing that shows the association of hitting with disobedience situations 12 .These findings show that the practice of physical aggression committed against children and adolescents is present in the family context, and it can be legitimized as a corrective method for bad behavior.Also, regarding physical violence, the most prevalent expressions were pinching and slapping.In the international context, the study carried out in Indonesia, with 1,313 schoolchildren who had experienced parental physical violence, revealed that 72.7% of the children said their parents like to hit them with their hands and 50.8% reported that their parents pinch them when they are trick-or-treating 13 .The greater constancy of slapping and pinching suggests that these are the mildest forms of physical reprimand and, therefore, perceived as acceptable ways to discipline their daughters and sons.
On the other hand, other expressions with more serious impacts were also experienced by the adolescents, such as kicking and punching, stabbing, burning, and shooting, a situation that shows the intensification of aggressions over time, often justified as correction and education of the children's behavior.Corroborating this, a study carried out in North Carolina, with 14,024 adults who suffered violence in childhood reveals as an expression of aggression, the kicking, punching, and hitting each other and directly hitting them 14 .Due to the nature of this type of aggression, it is important to consider the chances of more severe physical trauma, as revealed in a study carried out in an Emergency Room Hospital in Porto Alegre, RS, which indicated gun wounds, burns and several traumas as the main reasons for children being admitted to the intensive care unit 15 .
It is noteworthy that these more serious expressions escape the socially accepted and go through the reproduction of behaviors experienced in the childhood of mothers/ fathers, or even the scenario of marital violence experienced in relationships.In this regard, research with men who are perpetrators of violence reveals the reproduction of violent behavior experienced in childhood in the process of raising children, similarly to what was found in a case study with a couple with a history of violence that pointed to violence in conjugality being mirrored in the way they relate to and educate their offspring 16 .
In an organic way, in society, physical punishment is seen as a synonym for educating, and this practice has crossed several barriers, including that of life itself, where we can highlight the murder of Bernardo Boldrini in April 2014, who, when he was only 11 years old, had his life taken with a mixture of sedatives, administered by his father and stepmother.This act of extreme violence was responsible for naming the bill 7672/2010 as the Menino Bernardo Law, which was later nicknamed the "Lei da Palmada" (The spanking law) by the press, with the intention of prohibiting physical punishment, degrading and cruel treatment in the upbringing process of children and adolescents.
It is worth noting that although the law has the term "spanking" in its name, the body of the text does not include this denomination, which makes many of its points subjective, since there is no objectification of what physical suffering would be to substantiate legal consequences.The Menino Bernardo Law is an important step to abhor the use of any physical punishment and break the culture of violence committed by parents in the domestic sphere, with the caveat that educating is something normal and acceptable.
Just like the case of the Bernardo boy and even before the promulgation of the law, we still see cases in Brazil where children die because of mistreatment.An example of this is the situation of Henry Borel, who died on March 8, 2021.The report of the Medico-Legal Institute indicated as the cause of death internal bleeding and liver damage caused by blunt action, a situation that rules out the possibility of a domestic accident and indicates violence.This reality is added to the fragility of the laws, requiring the government to seek legal mechanisms, increasingly protective to this vulnerable public, raising awareness about the seriousness of the problem and informing those cases of aggression, even in autonomous units should be reported by all.
In agreement with the cases, our findings showed that the physical violence had, in its majority, as aggressors the father/mother (55.7%), the main responsible for taking care of the children and adolescents, reinforcing that the experience is occurring during the process of raising the daughters/daughters.This reality was also evidenced in a study carried out in Yemen, with 598 children, which pointed out the parents as the main perpetrators of physical violence 17 .
In this context, the home and the caretakers who should protect children and adolescents become a space or instrument for the violation of rights, contrary to the ECA (1990), which addresses respect for the inviolability of physical, psychological, and moral integrity; the responsibility of the family, community, and society to guarantee the dignity of the individual, and prohibits parents, extended family members, guardians, public agents carrying out socio-educational measures, or any person responsible for the care of children and adolescents from using physical punishment, cruel or degrading treatment, or any form of pretext.
It is hoped, therefore, to provoke reflection about the imposing, repressive and punitive practices as a form of "educating", which only demonstrate the unequal relationship of power and strength between adults, who are stronger, and their children, who are considered more vulnerable.From this perspective, we seek to stimulate the creation of more dialogical strategies to deal with children/adolescents as subjects of rights, conduct that is essential for them to learn peaceful and respectful ways of relating to and facing conflicts throughout their lives.
Unlike physical and psychological violence, which are often socially naturalized as an educational method, sexual abuse has a worldwide consensus as a crime against the human rights of children and adolescents.In this study, the experience was reported by 5.2% of the adolescents, making us worry about the suffering of this public subjected to the satisfaction of another's sexual desire.In this context, the child and/or adolescent becomes an object of desire within a fanciful and sick realm, in which the perpetrators seek to involve them through sexual stimulation or use them as a tool to obtain sexual satisfaction 18 .This reality is in line with another cross-sectional study in which, using data from the medical records of a psychiatric clinic that attended children and adolescents who were victims of sexual violence, aged between 10 and 18 years, the researchers revealed that 94% of the victims were sexually abused, with penetration, and 24% of the recorded cases were related to incest 19 .
It is important to emphasize the under-enumeration of these records, linked to the silence that permeates abusive relationships, especially with children and adolescents due to fear, as pointed out by a study conducted in Fortaleza-CE, which, analyzing secondary data on cases of sexual violence against adolescent women, warned about the use of threats against the victims by the aggressors 20 .The fear that victims have of exposing or denouncing the aggressor contributes to adolescents keeping the violence suffered to themselves, especially when the aggressor is part of their family circle, which facilitates the maintenance of blackmail and threats.
Regarding the expressions of aggression, in the experienced modality of sexual violence, the one that stood out the most was the act of touching the body (75.0%), considered to be molding that, in some situations, are not perceived by the children due to their innocence and naivety.This situation was also found in a study carried out in India, with boys who were sexually abused, revealing that the children did not realize they were being violated, as reported by one of the participants who had been molested by his uncle, when he was only three years old 21 .
The high prevalence of bullying can be explained by the ease of access of the aggressors to children/adolescents, precisely because of the relationship of trust established between them and the victim or those responsible for them.Corroborating these results, a study conducted in Ethiopia, with 462 university students between the ages of 18 and 26, revealed that the adolescents suffered sexual abuse when young, with the perpetrators being members of the victim's family, such as family members/relatives (25.2%)22.In Brazil, research conducted in Florianópolis, state of Santa Catarina, based on 489 notifications through the Sistema de Informação de Agravos de Notificação -SINAN (Brazilian System for Information on Notifiable Diseases), indicated that in all suspected or confirmed cases of child sexual abuse, there was a predominance of female victims, occurring in residences, and in more than half of the cases, the perpetrator was a man known to the victim 23 .
In view of the findings discussed, it is pointed out that adolescents are immersed in a family environment permeated by psychological and physical violence, arising from a behavior that naturalizes punitive measures as a means of education, and by sexual violence, permeated by silence, fear of reporting and feelings of guilt.In India, a study conducted with young students also found the same forms of violence (psychological, physical, and sexual) and revealed that fear, shame, and lack of understanding about the fact that it was violence were among the main reasons for not reporting the aggression. 24Therefore, it is necessary that all individuals are encouraged/ taught in childhood and adolescence to seek out people they trust to report situations of violence they have witnessed and experienced.
The encouragement of these people can occur through operative groups, allowing the approach of information about the forms of violence, complications arising from these and main ways of prevention, the exchange and learning of content, in addition to the perception of the facts experienced.A study carried out in units that develop activities to prevent violence against children has identified that, through campaigns with distribution of pamphlets, lectures with parents and families addressing types of violence, rights guaranteed by the statute of the child and adolescent, and the main bodies that support protection, it is possible to empower families and society, in addition to contributing to the strengthening of ties in order to establish better care and protection for children and adolescents 25 .
Thus, fathers, mothers, and/or family members should be agents that promote care and safeguard children and adolescents from all forms of disrespect, as well as participate in interrupting the cycle of violence that they have witnessed and/or experienced, considering that this is a right guaranteed by the Statute of the Child and Adolescent (ECA).
According to this statute, the duty to protect minors extends to all of society, including families and schools, which are institutions that are closest to this public.For education professionals, who are usually the first social group outside the family environment to develop more frequent contact with children and adolescents, interventions should be Intrafamily violence witnessed and experienced by school adolescents Lima CCO de J, Martins RD, Gomes NP, Cruz MA da, Gomes NR.Silva KKA da, et al.
directed to sensitize them to a broader listening and looking at situations that indicate violence within the homes, such as: aggressive behavior, difficulty in learning, recurrent absences from classes, among others.
In this context, a cross-sectional study conducted in the Philippines with 237 public school teachers analyzed the implementation of a training course for educators addressing cases of violence and noticed an improvement in the ability to identify the signs and symptoms of violence and in the intervention actions 26 .
If it weren't for the social distance proven by the COVID-19 pandemic, perhaps the school could have intervened in Henri's story, since due to the bonding relationship, the teachers could have suspected and sought actions to protect the child.It is inferred, therefore, that the non-action on the part of close people, as well as the inexistence of mechanisms that protect children, allows the perpetuation of cases of violence, and it is important to consider that omission also constitutes a practice of violence.
Other players who can contribute to the prevention and confrontation of violence against children and adolescents are health professionals during childcare appointments or when minors enter the health services.In this sense, a study conducted in Europe has highlighted the importance of the clinical judgment of nurses in identifying violence, as well as the use of instruments in their practice 27 .Confirming this, a study conducted in Cyprus, Greece, and Spain, with 50 health professionals, indicated that professionals in this area are essential to identify situations of violence against children and adolescents, and that the use of a tool can help this process 28 .
However, if health professionals neglect the signs and symptoms of violence, this can reverberate into various comorbidities for children and adolescents, and even death, like what happened in the case of Henry.This child, before the fatal outcome, had already been seen at the hospital because of injuries caused by abuse, however, the physical issue was resolved, but there was no suspicion of violence, nor report of the grievance, which resulted in the return of the child to a hostile scenario: death.Thus, it reiterates the role and importance that health professionals must identify the cases, interrupt the cycle of violence, and save lives.
Given the susceptibility of children and adolescents to abuse, it is essential that society acts as a watchdog to ensure a life free of violence.In this sense, to curb cases of violence, in Bahia, Law 14,278 was enacted requiring residential condominiums to report cases of domestic and family violence against women, children, adolescents, or the elderly.This law was enacted during the Covid-19 pandemic, social isolation due to the increase in the number of cases of domestic violence and the difficulty in accessing protection services.It is noteworthy that this mechanism, of local scope, can be expanded to sensitize the population to be alert to situations of violence and become agents of protection for the vulnerable.
It is believed that the study's limitation is the low adherence of adolescents and guardians to allow the research to be conducted, which could be assured with a larger sample.
The study shows that the adolescents experience intra-familiar violence, witnessing it and/or experiencing it in psychological, physical, and sexual forms with greater expression through cursing, humiliations, slaps, pinching, and body touching.It calls attention to the naturalization of psychological and physical violence rooted in the social belief of an educational measure and mostly practiced by mothers and fathers, responsible for

FINAL CONSIDERATIONS
perpetuating the abuse of minors masquerading as an educational method.On the other hand, sexual violence, more often committed by other relatives, is linked to fear and/or the difficulty of talking about what happened.These findings contribute to give visibility to the forms of expression of intra-family violence experienced and witnessed by children and adolescents, offering subsidies for adolescents to recognize themselves in a situation of violence, as well as for family members, education and health professionals, and society in general to identify victimized children and adolescents.

Table 2 -
Indicative of the practitioners of intrafamily violence witnessed and experienced by adolescent students.Salvador, Bahia, Brazil, 2020 Source: Authors (2020).