Effect of environmental and socioeconomic factors on the use of dental floss among children: a hierarchical approach

Abstract The aim of this study was to evaluate the association of environmental and socioeconomic characteristics with the use of dental floss in preschool children. This cross-sectional study was conducted with a sample of 402 preschool children aged 1–5 years, from Santa Cruz do Sul, a Southern city in Brazil. Mothers answered questions about environmental, demographic, and socioeconomic characteristics. Behavior variables as use of dental floss (study outcome) and dental attendance were also evaluated. Poisson regression analysis with robust variance through a hierarchical approach was used to investigate the association of explanatory variables for use of dental floss. Prevalence ratio (PR) and 95% confidence intervals (95%CI) were estimated. The mean sample age was 3.32 years (standard deviation [SD] 1.10). Of the included children, 291 (73.12%) did not use dental floss. The environmental model indicated that children who attended daycare (PR 2.53; 95%CI 1.39–4.60) and those whose parents were members of volunteer networks (RP 1.58; 95%CI 1.02–2.46) were more likely to use dental floss. Children from families with higher income (PR 1.55; 95%CI 1.07–2.24) and maternal schooling (PR 2.21; 95%CI 1.31–3.74) presented a higher prevalence of dental floss use. Older children and those who attended dental services were also related to higher dental floss use. Our findings suggest that children who live in a supporting environment and those with a higher socioeconomic status are more likely to use dental floss.摘要 本研究旨在探讨学龄前儿童牙线使用行为与环境及社会经济特征之间的关联。本横断面研究纳入巴西南部城市圣克鲁斯杜苏尔的402名1~5岁学龄前儿童作为研究样本。由儿童母亲填写关于环境、人口学及社会经济特征的调查问卷，同时评估了作为研究结局的牙线使用情况，以及牙科就诊行为等变量。本研究采用分层分析法结合稳健方差泊松回归（Poisson regression），探究牙线使用的影响因素，并估算了患病率比（prevalence ratio, PR）与95%置信区间（95% confidence intervals, 95%CI）。研究样本的平均年龄为3.32岁（标准差[SD, standard deviation] 1.10）。纳入的儿童中，291名（73.12%）未使用牙线。环境相关模型分析结果显示，入托儿童（PR 2.53；95%CI 1.39~4.60）以及父母参与志愿者网络的儿童（PR 1.58；95%CI 1.02~2.46）使用牙线的概率显著更高。家庭收入更高、母亲受教育程度更高的儿童，其牙线使用患病率也更高（PR分别为1.55、95%CI 1.07~2.24；2.21、95%CI 1.31~3.74）。年龄较大的儿童以及曾接受牙科服务的儿童，其牙线使用比例也相对更高。本研究结果表明，生活在支持性环境中且社会经济地位较高的学龄前儿童，更倾向于使用牙线。