The poor response rate in this survey dictates the need for caution in interpretation of the results. However, they suggest that the health of students is poor relative to that of their peers, and that their emotional health is more of a problem than their physical health. Public health practitioners might want to pay more attention to the health of this important and relatively neglected group. Worries about studies and money appear to be affecting students' academic work, and this should be of concern to higher education establishments.

The purpose of this investigation was to examine the relation between some dental health behaviours and 2 measures of self-concept in adolescents. Data from a survey of 41142, 12-16-year-old children from 244 secondary schools throughout England were analysed to obtain information about their frequencies of toothbrushing, use of dental floss and dental attendance, and whether they recalled advice about toothbrushing, in relation to self-esteem and health locus of control (HLOC). Subjects completed a questionnaire, anonymously, in school class. The results showed a significant positive correlation (Spearman) between the frequencies of flossing and toothbrushing, in both sexes, and between social group and toothbrushing frequency, where brushing frequency increased as socio-economic status improved. Some association between use of floss and social group emerged, but this was smaller and less consistent than that observed with toothbrushing brushing frequency. Self-esteem was positively correlated with toothbrushing frequency at ages 12-15 years, while HLOC showed correlations at some ages but not others. Use of dental floss showed no relation to self-concept. Subjects with more favourable self-concept were more likely to make more frequent dental visits than those with a poorer self-view. There was a strong and consistent correlation between recalled advice about toothbrushing and lower self- esteem and external locus of control. The results are in agreement with our earlier reports and suggest that self-concept may play a significant role in mediating changes in dental health behaviour.

A survey of 7770 schoolchildren, aged 14-15 years, from 131 secondary schools in England, was made in 1990 to obtain information about toothbrushing frequency, motivation for mouth care, frequency of dental visits, self-esteem and health locus of control (HLOC). The aim of the study was to compare self-esteem and HLOC as predictors of dental health behaviour. Subjects completed a questionnaire, anonymously, in class during normal school hours. The results showed significant associations (chi 2 test) between the 3 dental variables and self-esteem, in both sexes. Toothbrushing frequency and the proportions of subjects brushing to make their teeth feel clean increased with increasing self-esteem; recent and distant visits to the dentist were associated with low self-esteem. Only toothbrushing frequency showed any significant variation with HLOC. In males, this association showed more frequent toothbrushing with more internal HLOC, but in females, no consistent pattern emerged. HLOC scores showed markedly less correlation (Spearman) with frequencies of toothbrushing and dental visits compared with self-esteem scores. Significant positive correlations were observed between toothbrushing frequency and self-esteem in both sexes, and frequency of dental visits in males, but not in females. HLOC showed a significant positive correlation only with toothbrushing frequency in males. The correlation between toothbrushing frequency and self-esteem was significantly greater than that between brushing frequency and HLOC, in both sexes. The results suggest that self-esteem, which is a general construct, may have more potential for predicting dental health behaviour than the more specific health-related measure HLOC.

The aim of this study was to investigate the relation between flossing behaviour and other health, cleanliness and social behaviours in adolescents. Data from a survey of 41142, 12-16-year-old children from 244 secondary schools throughout England were analysed to obtain information about flossing frequency, dental attendance and recalled advice about flossing, and some general cleanliness and social behaviours. Subjects completed a questionnaire, anonymously, in class during normal school hours. Flossing frequency was found to change with age, its use becoming less frequent from age 12 through age 16 years. There was a significant relationship between flossing frequency and the time since the last dental attendance, the more recent attenders flossing more frequently. 6% of subjects recalled receiving advice about flossing at their last dental attendance and higher proportions of those who used floss recalled such advice, compared with non-flossers. Flossing frequency was also found to correlate positively with frequencies of washing hands after visiting the lavatory and bathing, and having a current friend of the opposite gender. There was only a small association between smoking habit and flossing, and only in school years 8 and 10: subjects most committed to smoking used floss slightly more frequently than those who did not smoke. Factor analysis showed evidence of gender differences in perceptions of flossing. Males equated use of floss with health-related behaviours while females associated flossing more with cleanliness behaviours. This finding is consistent with gender differences in toothbrushing behaviour reported in previous studies. The present study provides further insights into the history of dental flossing.

The aim of this study was to investigate the relation between some 'lifestyle' factors and motivation for toothbrushing in young people. Data from a questionnaire survey of 7770 children aged 14-15 years were analysed to obtain information about their main reason for toothbrushing, their toothbrushing frequency, smoking behaviour and social efficacy. In those who brushed their teeth less frequently, toothbrushing was performed more for cosmetic reasons, that is, having teeth that look and feel good and breath that smells fresh, in contrast to the avoidance of toothache and false teeth, which are health reasons. The more socially advantaged individuals were more inclined to brush their teeth to avoid toothache, and less for the sake of good appearance, compared with the more disadvantaged. Motivation for toothbrushing varied significantly with smoking behaviour, committed smokers were more inclined to brush for cosmetic reasons whereas those who had never smoked were more concerned to avoid dental problems. Similarly, those who had a current friend of opposite sex, and in males, those expressing confidence when meeting members of the opposite sex, brushed more for cosmetic reasons. In conclusion, different people perform their dental hygiene for quite different reasons. These findings need to be taken into account when instructing patients in personal dental care and formulating dental health messages.