School academic climate and oral health (tooth loss) in adolescents.

Carolina Da Franca Bandeira Ferreira Santos,Patrícia Maria Zarzar,Valdenice Aparecida Menezes,Viviane Colares,Raquel Conceição Ferreira,Ichiro Kawachi,Fabiana Godoy

doi:10.1371/journal.pone.0233505

Carolina Da Franca Bandeira Ferreira Santos, Patrícia Maria Zarzar + Show 5 more

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https://doi.org/10.1371/journal.pone.0233505

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Abstract

BackgroundPreventing tooth loss depends on oral health maintenance behaviors. This study hypothesized that adolescents with educational aspirations have greater motivation to invest in the future, including maintenance of oral health status.AimTo analyze the association between a school academic climate of educational aspirations and tooth loss (first permanent molars) among adolescents.MethodsA cross-sectional study was designed to include 2,500 adolescents (aged 14–19 years) enrolled in public high schools of Olinda located in Northeast Brazil. Multilevel Poisson regression random intercept models were conducted with tooth loss (first permanent molars) as the outcome. The primary cohort of interest was school academic climate, as measured by the proportion of students taking the national high school exams.ResultsTooth loss of the first permanent molars (assessed by clinical exam) was more prevalent in adolescents from more disadvantaged backgrounds (receiving family allowance, low maternal education). However, after controlling for a wide range of individual characteristics, adolescents enrolled in schools with lower academic climate had a higher prevalence of tooth loss (PR 1.42, 95%CI: 1.09,1.85).ConclusionThe school academic climate is associated with tooth loss, suggesting that educational aspirations are linked to adolescent oral health maintenance behaviors.

Highlights

Prevalence of tooth loss increases gradually with age [1] and in adolescents is associated with a number of deleterious outcomes including poor self-esteem [2], low quality of life [3], impact on daily performance [4], as well as impacts on social relations, and labor market outcomes [5]
After controlling for a wide range of individual characteristics, adolescents enrolled in schools with lower academic climate had a higher prevalence of tooth loss (PR 1.42, 95%CI: 1.09,1.85)
The school academic climate is associated with tooth loss, suggesting that educational aspirations are linked to adolescent oral health maintenance behaviors

Summary

Introduction

Prevalence of tooth loss increases gradually with age [1] and in adolescents is associated with a number of deleterious outcomes including poor self-esteem [2], low quality of life [3], impact on daily performance [4], as well as impacts on social relations, and labor market outcomes (employability) [5]. Socioeconomic inequalities in the practice of oral health maintenance behaviors can be explained by different behavioral theories which focus on disparities in health literacy, time & resource scarcity, differences in norms & attitudes, and self-efficacy [13] Behavioral theories such as the Theory of Planned Behavior and the Health Belief Model tend to emphasize factors operating at the level of individual decision-making, such as self-control beliefs, attitudes toward the behavior, as well as perceived social norms surrounding the behavior [14, 15]. An exclusively individual focus on health behavior provides an incomplete picture of the social contextual factors which may motivate (or demotivate) the adoption of preventive practices To address this gap, the “scarcity hypothesis” from the field of behavioral economics suggests that socioeconomic disadvantage is characterized by uncertainty about the future, and that this can help to explain the lack of future orientation among youth raised in poverty [12]. This study hypothesized that adolescents with educational aspirations have greater motivation to invest in the future, including maintenance of oral health status

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Conclusion