Anttila J, Tolvanen M, Kankaanpää R, Lahti S
Department of Community Dentistry, University of Turku, Turku, Finland.
Community Dent Health. 2018 May 30;35(2):75-80. doi: 10.1922/CDH_4127Anttila07.
An adapted framework for oral health inequalities suggests that structural determinants cause oral health inequalities through socio-economic position (SEP) and intermediary determinants. We applied this framework to examine whether there is a social gradient in the intermediary determinants at the school level, even when adjusted for school size, geographical location and teaching language.
Cross-sectional survey.
This study combined data from two independent studies focusing on Finnish upper comprehensive schools (N=970): the School Health Promotion study (SHPS) and the School Sweet Selling survey (SSSS). All schools that took part in the SSSS and whose pupils answered the SHPS were included in the analysis (n=360, response rate=37%). From the questions of the SHPS and the SSSS suitable for the theoretical framework, attitudes and access to intoxicants, school health services, school environment, home environment, the school's oral health-related actions and the pupil's own behaviour were selected as the intermediary determinants and as the factors determining the school-level SEP. The social gradient in the intermediary determinants of oral health was investigated with Pearson's and Spearman's correlation coefficients between those and the school-level SEP. In the multivariable analysis, the General Linear Model with manual backward elimination was used.
A social gradient was observed in the intermediary determinants 'home environment' and 'the pupils' tooth brushing frequency' and an inverse social gradient in 'attitudes and access to intoxicants' and 'school health services'.
Social gradient between schools could increase Finnish adolescents' oral health inequalities.
一个适用于口腔健康不平等问题的框架表明，结构性决定因素通过社会经济地位（SEP）和中介性决定因素导致口腔健康不平等。我们应用这个框架来研究，即使在校规模、地理位置和教学语言得到调整的情况下，学校层面的中介性决定因素中是否存在社会梯度。
横断面调查。
本研究合并了两项针对芬兰高中综合学校（N = 970）的独立研究的数据：学校健康促进研究（SHPS）和学校糖果销售调查（SSSS）。所有参与SSSS且学生回答了SHPS的学校都纳入分析（n = 360，回复率 = 37%）。从SHPS和SSSS中适合该理论框架的问题里，将对致瘾物的态度和获取情况、学校卫生服务、学校环境、家庭环境、学校与口腔健康相关的行动以及学生自身行为选为中介性决定因素，以及作为决定学校层面SEP的因素。通过中介性决定因素与学校层面SEP之间的Pearson和Spearman相关系数，研究口腔健康中介性决定因素中的社会梯度。在多变量分析中，则使用了带有手动向后排除法的一般线性模型。
在中介性决定因素“家庭环境”和“学生刷牙频率”中观察到社会梯度，在“对致瘾物的态度和获取情况”以及“学校卫生服务”中观察到反向社会梯度。
学校之间的社会梯度可能会加剧芬兰青少年的口腔健康不平等。
