Associations between school deprivation indices and oral health status

Association of Paternal Individual Deprivation Measure with General Anthropometric Data and Dental Caries among 12 to 15 year old school going children, in Tiruvallur District - A cross sectional study

AIM

To determine General anthropometric data and dental caries and their association of paternal Individual Deprivation Measure among 12- to 15-year-old school going children in Tiruvallur District.

METHODS AND MATERIAL

The Anthropometric data such as Body mass index, Skin fold thickness and mid arm circumference was assessed. The study was also conducted to assess children's paternal deprivation using individual deprivation index (IDM). Paternal deprivation was calculated using Individual deprivation index which comprises of 15 dimensions. Pilot study was done to calculate sample size which is found to be 800.

RESULTS

Dimension of paternal individual deprivation measure in parent Education, Housing, toileting, family planning, problem in visiting doctor between Government and Private School children was significant with P value of 0.0005. Interpretation of Paternal individual deprivation measure was found to be significant among Government and private school children. There was no association of individual deprivation measure with dental caries, but there was an association of Individual paternal deprivation measure with one of the anthropometric measure was mid arm circumference. In paternal deprivation index 21.8% of the children's parent were not deprived, 45.8% were somewhat deprived, 22.6% were deprived, 7.3% were very deprived, 2.6 were extremely deprived among school children.

Can the school environment influence oral health-related behaviours? A multilevel analysis of the Brazilian National Adolescent School-Based Health Survey 2015

OBJECTIVE

To investigate the association between the potential support of schools for oral health promotion and a set of oral health-related behaviours among adolescent students in Brazilian state capitals.

METHODS

A cross-sectional study using individual and school environment data from the 2015 Brazilian National Adolescent School-Based Health Survey (PeNSE) was conducted. The sample consisted of 51 192 students from 1339 public and private schools in the 27 Brazilian State Capitals, aged 11-19 years old. The outcomes were six oral health-related behaviours: dental visits; toothbrushing frequency; soft drink and sweets consumption; smoking and alcohol consumption. The explanatory variable was the Oral Health Promotion School Environment index (OHPSE). Covariates were the adolescents' sociodemographic characteristics and organizational aspects of the schools. A two-level multilevel mixed-effects Poisson regression analysis with fixed slopes and random intercepts was performed, considering the complex sample design.

RESULTS

The prevalence of risk behaviours was 28.0% for 'low frequency of annual dental visits', 6.9% for 'low daily toothbrushing frequency', 28.8% for 'high weekly soft drink consumption', 41.7% for 'high weekly sweet consumption', 18.9% for 'cigarette experimentation' and 52.6% for 'alcoholic beverage experimentation'. The schools were classified as low (36.3%), intermediate (30.4%) and high (33.3%) OHPSE. In the adjusted model, schools with 'high OHPSE' had lower prevalence of 'low frequency of annual dental visits' (PR = 0.94 [95% CI 0.90; 0.99]), 'high weekly frequency of soft drink consumption' (PR = 0.94 [95% CI 0.89; 0.99]) and 'sweet consumption' (PR = 0.96 [95% CI 0.93; 1.00]) than those with 'low OHPSE'. In addition, schools with 'intermediate OHPSE' had higher prevalence's of 'low daily toothbrushing frequency' (PR = 1.12 [95% CI 1.03; 1.23]) and 'cigarette experimentation' (PR = 1.08 [95% CI 1.01; 1.16]) than those with 'low OHPSE'. 'Alcoholic beverage experimentation' was not associated with OHPSE.

CONCLUSIONS

The potential support of schools for oral health promotion was associated with most of the oral health-related behaviours among adolescent students. Those attending schools with higher OHPSE scores reported a higher annual frequency of dental visits and a lower weekly frequency of soft drink and sweet consumption, while those in schools with intermediate OHPSE had a lower daily toothbrushing frequency and a higher rate of cigarette experimentation.

The impact of a school-based tooth-brushing program on dental caries: a cross-sectional study

Background

Promotion of oral health in children is recognized as one of the components of health-promoting schools (HPSs). However, few studies have addressed supportive school environments for children’s oral health. This study aimed to evaluate the status of dental caries in school children at HPSs, with the objective of examining the impact of a supportive school environment for oral health, considering the lifestyles of individual children and the socioeconomic characteristics of their communities.

Methods

Data of 2043 5th-grade students in 21 elementary schools in Ichikawa city between 2008 and 2013 were analyzed. Children’s oral health status was evaluated using the decayed, missing, and filled permanent teeth (DMFT) index. A self-reported lifestyle questionnaire, a survey of the school environment promoting tooth-brushing, and community socioeconomic characteristics derived from the National Census data were included in the analyses. Bivariate analyses were conducted to evaluate the children’s DMFT status, and zero-inflated negative binominal (ZINB) regression was used to assess the relationships between DMFT and other variables.

Results

Prevalence of dental caries in the permanent teeth of 5th-grade children (aged 10–11 years) was 33.3%, with a mean DMFT score (± SD) of 0.83 ± 1.50. According to multilevel ZINB regression analysis, children from schools with after-lunch tooth-brushing time showed a higher odds ratio (OR) for excess zero DMFT (OR = 1.47, 95% CI = 1.00–2.15, P = 0.049) as compared to those from schools without it. Neither bivariate analysis nor ZINB model analysis revealed any significant influence of children’s gender or use of a toothpaste with fluoride.

Conclusions

The school-based environment supportive of oral health was significantly associated with a zero DMFT status in children. School-based efforts considering the socioeconomic characteristics of the area warrant attention even with declining prevalence of dental caries.

School environment and oral health promotion: the National Survey of School Health (PeNSE)

OBJECTIVE

To evaluate the potential support of schools for oral health promotion and associated factors in Brazilian capitals.

METHODS

Data from 1,339 public and private schools of the 27 Brazilian capitals were obtained from the National Survey of School Health (PeNSE) 2015. Data from the capitals were obtained from the United Nations Development Program and the Department of Informatics of the Brazilian Unified Health System (Datasus). The indicator “ ambiente escolar promotor de saúde bucal ” (AEPSB – oral health promoting school environment) was designed from 21 variables of the school environment with possible influence on students’ oral health employing the categorical principal components analysis (CATPCA). Associations between the AEPSB and characteristics of schools, capitals and regions were tested (bivariate analysis).

RESULTS

Ten variables comprised CAPTCA, after excluding those with low correlation or high multicollinearity. The analysis resulted in a model with three dimensions: D1. Within-school aspects (sales of food with added sugar in the canteen and health promotion actions), D2. Aspects of the area around the school (sales of food with added sugar in alternative points) and D3. prohibitive policies at school (prohibition of alcohol and tobacco consumption). The sum of the scores of the dimensions generated the AEPSB indicator, dichotomized by the median. From the total of schools studied, 51.2% (95%CI 48.5–53.8) presented a more favorable environment for oral health (higher AEPSB). In the capitals, this percentage ranged from 36.6% (95%CI 23.4–52.2) in Rio Branco to 80.4% (95%CI 67.2–89.1) in Florianópolis. Among the Brazilian regions, it ranged from 45.5% (95%CI 40.0–51.2) in the North to 67.6% (95%CI 59.4–74.9) in the South. Higher percentages of schools with higher AEPSB were found in public schools [58.1% (95%CI 54.9–61.2)] and in capitals and regions with higher Human Development Index [61.0% (95%IC 55.8–66.0) and 57.4% (95%CI 53.2–61.4), respectively] and lower Gini index [55.7% (95%CI 51.2–60.0) and 52.8 (95%CI 49.8–55.8), respectively].

CONCLUSIONS

The potential to support oral health promotion in schools in Brazilian capitals, assessed by the AEPSB indicator, was associated with contextual factors of schools, capitals and Brazilian regions.

Oral Health Disparities in Children: A Canary in the Coalmine?

Despite being largely preventable, oral diseases are still a major public health problem in child populations in many parts of the world. Increasingly, however, oral diseases disproportionately affect socially disadvantaged groups in society. It is unjust and unfair that children and families from disadvantaged backgrounds experience high levels of oral diseases. This article analyzes oral diseases through a health disparities lens. Action to combat oral health disparities requires a radical multifaceted strategy that addresses the shared underlying root causes of oral diseases, the social determinants of health inequality.

Oral Health-Related Quality of Life and Associated Factors in Brazilian Adolescents

This study aimed to assess the impact of oral health on the quality of life of adolescents. A cross-sectional study was performed with students from public and private schools from Passo Fundo, Brazil. All students were aged between 15 and 19 years old. The proportional random sample consisted of 736 adolescents from 20 schools. A structured questionnaire was applied, and an oral examination was performed, counting the number of teeth. Oral health-related quality of life was assessed by OHIP-14. Associations between quality of life and associated factors were analyzed. The mean OHIP-14 score was 7.25. Age, ethnicity and studying in a public school were associated to the OHIP-14 score. Tooth loss (p=0.79) was not associated with quality of life. Additionally, questions related to appearance, such as whether teeth appearance bothers the adolescent (p=0.68) were not associated with quality of life. Attending a public school (OR=1.63; CI95%: 0.98-2.70) and self-reported halitosis (OR=1.48; CI95%: 1.01-2.16) were strongly associated to higher impact on quality of life. It was concluded that socioeconomic conditions and halitosis were associated to higher impact on quality of life of adolescents.

Multiple Socioeconomic Factors and Dental Caries in Swedish Children and Adolescents

The study aimed to explore associations between multiple socioeconomic factors and dental caries experience in Swedish children and adolescents (3-19 years old). Electronic dental records from 300,988, in a Swedish region (97.3% coverage) were collected using the DMFT indices (decayed, missing, filled teeth: dependent variables). Socioeconomic status (SES) data (ethnicity, wealth, parental education, and employment) for individuals, parents, and families were obtained from official registers. Principal component analysis was used to explore SES data. Scores based on the first factor were used as an independent aggregated socioeconomic variable in logistic regression analyses. Dental caries experience was low in the participants: 16% in 3- to 6-year-olds (deft index: decayed, extracted, filled teeth) and 47% in 7- to 19-year-olds (DFT index). Both separate and aggregated socioeconomic variables were consistently associated with the dental caries experience irrespective of the caries index used: the crude odds ratio (OR) for having at least 1 caries lesion in 3- to 6-year-olds (deft index) in the lowest SES quintile was 3.26 (95% confidence interval [CI] 3.09-3.43) and in ≥7-year-olds (DFT index) OR 1.80 (95% CI 1.75-1.84) compared with children in the 4 higher SES quintiles. Overall, associations were stronger in the primary dentition than in the permanent dentition. Large SES models contributed more to explaining the caries experience than slim models including fewer SES indicators. In conclusion, socioeconomic factors were consistently associated with dental caries experience in the children and adolescents both as single factors and as multiple factors combined in an index. Socioeconomic inequalities had stronger associations to caries experience in young children than in older children and adolescents.

Oral Health-Promoting School Environments and Dental Caries in Québec Children

INTRODUCTION

Dental caries are highly prevalent among children and have negative health consequences. Their occurrence may depend in part on school-based environmental or policy-related factors, but few researchers have explored this subject. This study aimed to identify oral health promoting school environment types and estimate their relation with 2-year dental caries incidence among Québec children aged 8-10 years.

METHODS

This study used data from two visits (completed in 2008 and 2011) of the QUALITY (Québec Adipose Lifestyle Investigation in Youth) cohort, which recruited white children at risk of obesity and their families from Greater Montreal schools. Measures included school and neighborhood characteristics, and Decayed, Missing, Filled-Surfaces index scores. Principal component and cluster analyses, and generalized estimating equations were conducted.

RESULTS

Data were available for 330 children attending 200 schools. Based on a series of statistical analyses conducted in 2016, the authors identified three distinct school environment types. Type 1 and 2 schools had strong healthy eating programs, whereas Type 3 had weak programs. Type 1 schools had favorable neighborhood food environments, whereas Type 2 and 3 had unfavorable ones. Adjusting for potential confounders, children attending Type 1 and 2 schools had 21% (incidence rate ratio=0.79, 95% CI=0.68, 0.90) and 6% (incidence rate ratio=0.94, 95% CI=0.83, 1.07) lower 2-year incidence of dental caries, respectively, compared with Type 3 schools.

CONCLUSIONS

School-based oral health promotion programs combined with a favorable neighborhood can lower dental caries incidence in school children.

Global burden of dental condition among children in nine countries participating in an international oral health promotion programme, 2012-2013

The Live.Learn.Laugh. phase 2 programme is a unique global partnership between FDI World Dental Federation and Unilever Oral Care which aims to provide measurable improvement of oral health on a global scale through encouraging twice-daily brushing with a fluoride toothpaste. It was based on international recommendations using the principles of health promotion within school for the implementation of preventive health strategies. This paper is an overview of the dental caries condition of children from 2012 to 2013 in nine countries included in four World Health Organisation (WHO) regions. A cross-sectional study was conducted in each country before the implementation of health-promotion measures focused on twice-daily toothbrushing with fluoride toothpaste. The sample was based on stratified sampling according to the WHO pathfinder recommendations. From a total of 7,949 children examined, there were 517 children (1-2 years of age), 1,667 preschool children (3-5 years of age) and 5,789 schoolchildren (6-13 years of age). The prevalence and severity of primary dental caries, early childhood caries and temporary dental caries were described using decayed, filled teeth (dft), permanent decayed, missing, filled teeth (DMFT) indices and the significant caries index (SCI). The major findings were a high prevalence of caries, identification of high-risk groups and inequality in the distribution of the severity of dental conditions. Aggregated data from this overview should provide justification for implementing an oral health programme. The main point is the need to retain and expand the community fluoridation programme as an effective preventive measure. At the individual level, the aggregated data identify the need for more targeted efforts to reach children early - especially among specific high-risk groups.

Gender differences in risk factors for cigarette smoking initiation in childhood

INTRODUCTION

We investigated whether established risk factors for initiating cigarette smoking during adolescence (parents, siblings, friends smoke; home smoking rules, smokers at home, exposure to smoking in cars, academic performance, susceptibility to smoking, depressive symptoms, self-esteem, school connectedness, use of other tobacco products) are associated with initiation in preadolescents, and whether the effects of these factors differ by gender.

METHODS

In spring 2005, baseline data were collected in self-report questionnaires from 1801 5th grade students including 1553 never-smokers (mean age=10.7years), in the longitudinal AdoQuest I Study in Montréal, Canada. Follow-up data were collected in the fall and spring of 6th grade (2005-2006). Poisson regression analyses with robust variance estimated the effects of each risk factor on initiation and additive interactions with gender were computed to assess the excess risk of each risk factor in girls compared to boys.

RESULTS

101 of 1399 participants in the analytic sample (6.7% of boys; 7.7% of girls) initiated smoking during follow-up. After adjustment for age, gender and maternal education, all risk factors except academic performance and school connectedness were statistically significantly associated with initiation. Paternal and sibling smoking were associated with initiation in girls only, and girls with lower self-esteem had a significant excess risk of initiating smoking in 6th grade.

CONCLUSIONS

Risk factors for smoking initiation in preadolescents mirror those in adolescents; their effects do not differ markedly by gender. Preventive programs targeting children should focus on reducing smoking in the social environment and the dangers of poly-tobacco use.

Predictors of Cigarette Smoking Initiation in Early, Middle, and Late Adolescence

PURPOSE

Little is known about age-related differences in risk factors for cigarette smoking initiation. We identified predictors of initiation in early, middle, and late adolescence from among sociodemographic factors, indicators of smoking in the social environment, psychological characteristics, lifestyle indicators, and perceived need for cigarettes.

METHODS

Data were drawn from a longitudinal study of 1,801 children recruited at age 10-11 years from 29 elementary schools in Montreal, Canada. Multivariable logistic regression within a generalized estimating equations framework was used to identify predictors among never smokers across three 2-year windows: age 11-13 years (n = 1,221); age 13-15 years (n = 737); and age 15-17 years (n = 690).

RESULTS

Among the 18 risk factors investigated, two differed across age. Friends' smoking, a strong risk factor in early adolescence (odds ratio [95% confidence interval] = 5.78 [3.90-8.58]), lost potency in late adolescence (1.83 [1.31-2.57]). Depressive symptoms, a risk factor in early and middle adolescence (1.60 [1.26-2.02] and 1.92 [1.45-2.54], respectively), were inversely associated in late adolescence (.76 [.58-1.00]). Sex, TV viewing, and weight-related goals were not associated with initiation at any age. All other factors were significant in two or three age groups.

CONCLUSIONS

Most risk factors for smoking initiation were stable across age. Tobacco control interventions may be robust for risk factors across age groups and may not need adjustment. At all ages, interventions should focus on eliminating smoking in the social environment and on reducing the availability of tobacco products.

As desigualdades sociais e a saúde bucal nas capitais brasileiras

ResumoApesar da melhoria das condições de vida dos brasileiros, ainda persiste um panorama de iniquidades em saúde bucal. Este estudo ecológico avaliou a relação das condições socioeconômicas e de política de saúde pública com as de saúde bucal nas capitais brasileiras. Foi realizada análise fatorial com os indicadores de condições socioeconômicas, revelando dois fatores comuns: deprivação econômica e condição sociossanitária. Em seguida, executou-se análise de regressão linear múltipla para os indicadores de saúde bucal (média CPO-D 12 anos, média de dentes perdidos e taxa de população livre de cárie) com os dois fatores em comum e a fluoretação da água de abastecimento. A análise de regressão linear múltipla para o CPO-D das capitais foi estimado pelas condições sociossanitárias e fluoretação, ajustado pela deprivação econômica; enquanto que o modelo para a média de dentes perdidos foi estimado apenas pela fluoretação e deprivação econômica, e, por fim, o modelo para a taxa da população livre de cárie nas capitais brasileiras foi estimado pela condição econômica e sociossanitária ajustadas pelo abastecimento de água fluoretada. Portanto, os resultados apontam a necessidade de ações sociais que impactem nas condições de vida da população para redução da cárie dentária.

Home smoking bans may increase the risk of smoking onset in children when both parents smoke

INTRODUCTION

Our objective was to determine if there is effect modification by home smoking bans in the association between parental smoking and cigarette smoking onset in children.

METHODS

Data on smoking onset, number of parents who smoke, and home smoking rules were collected from children who had never smoked in self-report questionnaires in grades 5, 7, 9, and 11. The association between number of parents who smoke and smoking onset in children was tested in pooled logistic regression in 2 groups defined by the presence or absence of a complete home smoking ban.

RESULTS

In homes without a complete ban and relative to participants with no parents who smoke, the odds ratio (95% confidence interval [OR (95% CI]) for smoking onset was 1.5 (1.1-1.9) when one parent smoked and 1.4 (1.0-2.1) when both parents smoked. In homes with a complete ban, the OR (95% CI) was 1.6 (1.1-2.3) if one parent smoked, but 4.9 (2.4-9.9) if both parents smoked.

CONCLUSION

The association between number of parents who smoke and smoking onset in children was modified by the presence of a complete home smoking ban. In homes with a complete smoking ban in which both parents smoke, it may be prudent those parents communicate clearly with their children about their reasons for implementing the ban as well as about their reasons for continuing to smoke.

Socioeconomic and family influences on dental treatment needs among Brazilian underprivileged schoolchildren participating in a dental health program

BACKGROUND

The objective of this study was to compare the socioeconomic and family characteristics of underprivileged schoolchildren with and without curative dental needs participating in a dental health program.

METHODS

A random sample of 1411 of 8-to-10 year-old Brazilian schoolchildren was examined and two sample groups were included in the cross-sectional study: 544 presented curative dental needs and the other 867 schoolchildren were without curative dental needs. The schoolchildren were examined for the presence of caries lesions using the DMFT index and their parents were asked to answer questions about socioenvironmental characteristics of their families. Logistic regression models were adjusted estimating the Odds Ratios (OR), their 95% confidence intervals (CI), and significance levels.

RESULTS

After adjusting for potential confounders, it was found that families earning more than one Brazilian minimum wage, having fewer than four residents in the house, families living in homes owned by them, and children living with both biological parents were protective factors for the presence of dental caries, and consequently, curative dental needs.

CONCLUSIONS

Socioeconomic status and family structure influences the curative dental needs of children from underprivileged communities. In this sense, dental health programs should plan and implement strategic efforts to reduce inequities in oral health status and access to oral health services of vulnerable schoolchildren and their families.

[Social inequalities in health in 4 year-old children in the Hauts-de-Seine (France)]

The social effects on health described in France on newborn and 5- to 6-year-old children suggest the existence of a social gradient among the youngest children. The favoured, though unequal, social situation of the department of the Hauts-de-Seine (France), makes it particularly adapted to this study. A survey, conducted in 2010 by the departmental service of maternal and infantile protection (PMI) on a representative sample of 1227 children, who received check-ups in their first or second year of nursery school, reveals a significant increase of overweight (from 4.6 to 16.5%), of language disorders (from 8.3 to 25.3%), of the orientations to specialized consultations (from 20.6 to 36.6%), according to the socioprofessional category of the father or the social affiliation of the children in the following subgroups: children speaking or understanding a foreign language (36.6% of the sample), children schooled in priority educational zones (equivalent to education achievement zones in UK, 13.6%), children with limited social health coverage (13.4%). In contrast, the BCG and hepatitis B vaccinal coverage is systematically higher in these various groups. The multivariate analysis investigates for each health problem its links with these various subgroups, and with previous child care experiences, and PMI medical consultations. This study suggests therefore further prospects for different actions according to health problems or regarding vaccinal strategy. The development of such routine indicators of disadvantage should allow territorial health services to target their actions towards the decrease of social disparities in health and to check a posteriori the efficiency of the public systems, which have been implemented.

Social vulnerability and traumatic dental injury among Brazilian schoolchildren: a population-based study

The aim of the present study was to test the association between social vulnerability and the prevalence of traumatic dental injury (TDI). A population-based cross-sectional study was carried out with 1,556 schoolchildren aged 11 to 14 years in the city of Belo Horizonte, Brazil. The participants were examined for TDI using Andreasen's criteria and those diagnosed with TDI were interviewed to determine the history of the injury. The Social Vulnerability Index (SVI) was used for socioeconomic classification, which addresses environmental, cultural, economic, legal and security/survival dimensions. The Poisson regression model was used for the multivariate analysis, with the significance level set at 5%. The prevalence of TDI was 14.1%; 59.3% of the participants with TDI did not seek a dentist after the incident. Poorer environmental, economic and legal conditions were statistically associated with the occurrence of untreated TDI (p < 0.05) and all the five SVI dimensions were associated with seeking a dentist due to TDI (p < 0.006). The prevalence of untreated TDI was higher among boys (PR: 1.42; 95%CI: 1.11-1.81) and those in situations of greater social vulnerability (PR: 2.27; 95%CI: 1.11-4.61). In conclusion, the male gender and high social vulnerability proved to be associated with the occurrence of TDI.