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

Abstract

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. 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 51192 students from 1339 public and private schools in the 27 Brazilian State Capitals, aged 11-19years 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. 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. 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.