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

Abstract

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. How to cite this article: Nery NG, Antunes JLF, Jordão LMR, Freire MDCM. Can the school environment influence oral health-related behaviours? A multilevel analysis of the

Socioeconomic Inequalities and Toothbrushing Frequency among Schoolchildren Aged 6 to 12 Years in a Multi-Site Study of Mexican Cities: A Cross-Sectional Study

“…Studies in Mexico have reported prevalence ranging from 49.8% in Campeche [ 29 ], 56.3% in Sinaloa [ 40 ], to 81.7% also in Campeche [ 15 ]. In other countries, very low percentages of toothbrushing in schoolchildren have been reported, such as in Iran (18.0%) [ 26 ], Palestine (19.7%) [ 41 ], or China (26.3%) [ 42 ], to prevalence numbers higher than 80%, such as in Norway [ 27 ], Indonesia [ 43 , 44 ], and Brazil [ 23 ]. Differences may be due to different circumstances such as the specific age of the children and adolescents in the studies, and even the economic development of the communities or countries where research was conducted.…”

“…In Australia [ 21 ], children who had private health insurance exhibited higher frequency of toothbrushing. Paradoxically, in Brazil [ 23 ] low frequency of daily toothbrushing was associated with higher level of education of the mother. There is no “ideal indicator” related to SEP for all purposes and applicable to all life stages and in all settings.…”

“…Scientific evidence suggests that there is a very strong and consistent association between socioeconomic position (SEP) and the prevalence and severity of oral diseases, a phenomenon called "social gradient in health" [20]. This observation has been replicated around the world for toothbrushing frequency, because individuals of lower socioeconomic status practice less frequent toothbrushing [21][22][23][24][25][26][27]. In addition to SEP, other variables have been observed to be associated with toothbrushing frequency, such as sociodemographic and behavioral variables [15,24,[28][29][30][31].…”

Implementação do Programa Saúde na Escola: relação com aspectos da saúde bucal dos estudantes

“…Chama a atenção a ausência de associação entre o PSE e os comportamentos em saúde mais diretamente relacionados com a saúde bucal dos estudantes: frequência diária de escovação e frequência anual de visita ao dentista. Em estudo anterior utilizando dados da PeNSE 2015, somente nas capitais, esses comportamentos foram associados ao indicador de potencial de suporte à promoção da saúde bucal da escola, que incluiu a implementação do PSE e outros fatores das escolas 10 . A relação entre ações de educação em saúde bucal na escola e maior frequência de escovação tem sido demonstrada em outros contextos 20 .…”

“…Nesse sentido, destacam-se as práticas de gestão escolar relacionadas com a saúde, que apontam para um potente processo de promoção de qualidade de vida dos estudantes, como os comitês de saúde na escola; ações em conjunto com as Unidades Básicas de Saúde (UBS) de referência do território da escola; e o Programa Mais Educação Estudos anteriores 9,10 , utilizando os dados da PeNSE 2015, mostraram que o potencial de promoção da saúde bucal de escolas das capitais brasileiras foi associado a fatores contextuais das escolas, das capitais e das regiões brasileiras 9 . Escolas com maior potencial de contribuir para a saúde bucal dos escolares apresentaram maior prevalência de comportamentos mais favoráveis -visita anual ao dentista, consumo semanal de refrigerantes e guloseimas com açúcar, frequência diária de escovação e experimentação de cigarro 10 . Contudo, o efeito da implementação do PSE não foi analisado isoladamente, mas como um componente do 'ambiente escolar promotor de saúde bucal' proposto nesses estudos.…”