Simultaneous oral health risk behaviors among adolescents: evidence from the National School-based Student Health Survey

ABSTRACT: Objective: To investigate the prevalence of simultaneous oral health risk behaviors and associated factors among Brazilian adolescents. Methods: The study comprised data of 109,104 adolescents participating in the Brazilian National School-based Student Health Survey. The simultaneous presence of less frequent toothbrushing (E), current smoking (C), no visits to the dentist (D), low fruit intake (F), and high sugar intake (A) was assessed by comparison of observed/expected prevalence (OP/EP). Logistic regression was used to assess sociodemographic and family factors associated with the clustering patterns of oral health risk behaviors. Results: The simultaneous occurrence of two or more oral health risk behaviors was of 60.40%. The highest prevalence values were found for the following patterns with OP/EP over 1.20: EDF, CFA, and EDFA. The odds for two or more combined oral health risk behaviors were higher for adolescents whose parents did not participate in homework, from public schools, males, and of Asian or Indigenous ethnicity (OR > 1.00; p < 0.05). Low family affluence level (FAL) acted as a risk factor for the pattern ECDFA (OR = 2.58; p = 0.009), while low and mean FAL functioned as protection factors for the pattern CFA (OR = 0.71; p < 0.001, and OR = 0.76; p = 0.011). Conclusion: The prevalence of simultaneous oral health risk behaviors was low and negatively associated with sociodemographic and family factors. Interventions aiming at reducing these behavior patterns should prioritize the groups that have been identified as being at most risk.

摘要：
研究目的：探究巴西青少年同时存在的口腔健康危险行为流行现状及其相关影响因素。
研究方法：本研究纳入参与巴西全国学校学生健康调查的109104名青少年数据。通过观测患病率与预期患病率的比值（observed/expected prevalence, OP/EP），评估以下五种行为的共现情况：刷牙频率过低（less frequent toothbrushing, E）、当前吸烟（current smoking, C）、未就诊牙医（no visits to the dentist, D）、水果摄入不足（low fruit intake, F）以及高糖摄入（high sugar intake, A）。采用逻辑回归（Logistic regression）分析与口腔健康危险行为聚集模式相关的社会人口学及家庭因素。
研究结果：同时存在两种及以上口腔健康危险行为的青少年占比为60.40%。观测患病率与预期患病率比值超过1.20的行为模式患病率最高，分别为EDF、CFA及EDFA。父母未参与子女家庭作业辅导、就读公立学校、男性以及亚裔或原住民族裔的青少年，其同时存在两种及以上口腔健康危险行为的比值比（Odds Ratio, OR）均大于1.00，且差异具有统计学意义（p < 0.05）。低家庭富裕程度水平（family affluence level, FAL）是ECDFA行为模式的危险因素（OR=2.58；p=0.009）；而低及中等家庭富裕程度水平则对CFA行为模式具有保护作用（OR=0.71；p < 0.001；OR=0.76；p=0.011）。
研究结论：本研究发现，青少年同时存在口腔健康危险行为的流行率较低，且该情况与社会人口学及家庭因素呈负相关。针对此类行为聚集模式的干预措施，应优先针对已识别出的高风险群体开展。