Wang Jiangping, Zhang Lujin, Dai Jiadan, Sun Ruyu, Chen Xuepeng, Zhang Weifang
Department of Child Psychology, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Zhejiang University, Hangzhou, Zhejiang, China.
Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Zhejiang University, Hangzhou, Zhejiang, China.
BMJ Open. 2025 Aug 4;15(8):e098530. doi: 10.1136/bmjopen-2024-098530.
OBJECTIVES: To examine the relationship between uncertainty stress and oral health-related quality of life (OHRQoL) among junior high school students in Zhejiang Province, China, and to identify the sociodemographic factors that may influence this association. DESIGN: Cross-sectional survey using multistage cluster sampling. SETTING: Junior high schools in two cities (Ningbo and Jinhua) in Zhejiang Province, China, between April and July 2024. PARTICIPANTS: 1348 eighth-grade students aged 13-16 years were included. INCLUSION CRITERIA: voluntary participation with guardian consent, absence of mental illness or physical disabilities and adequate literacy to complete questionnaires. EXCLUSION CRITERIA: intellectual disability or incomplete responses. OUTCOME MEASURES: OHRQoL was dichotomised based on the Child Perceptions Questionnaire for 11- to 14-year-olds (CPQ11-14) median score (≤20=good OHRQoL and >20=poor OHRQoL). Uncertainty stress was measured via a validated 5-point Likert scale (≤12=low and ≥13=high). RESULTS: High uncertainty stress was significantly associated with poor OHRQoL (χ²=41.34, p<0.001). Multivariable logistic regression adjusting for gender and maternal education showed students with high uncertainty stress had 4.7-fold increased odds of poor OHRQoL (adjusted OR (aOR)=4.72, 95% CI: 2.81 to 7.93, p<0.001). Female gender was independently associated with poor OHRQoL (aOR=1.30, 95% CI: 1.05 to 1.62, p<0.05). Higher maternal education had a protective association with a maternal bachelor's degree associated with 57% reduced odds of poor OHRQoL (aOR=0.43, 95% CI: 0.25 to 0.75, p<0.01). CONCLUSIONS: Junior high school students experiencing high uncertainty stress have a significantly increased risk of poor OHRQoL. Female students and those with less educated mothers were particularly vulnerable. School-based interventions should integrate psychological support with oral health promotion. Future longitudinal studies are needed to establish causal relationships.
目的：探讨中国浙江省初中生不确定性压力与口腔健康相关生活质量（OHRQoL）之间的关系，并确定可能影响这种关联的社会人口学因素。 设计：采用多阶段整群抽样的横断面调查。 地点：2024年4月至7月期间，中国浙江省两个城市（宁波和金华）的初中。 参与者：纳入1348名年龄在13 - 16岁的八年级学生。 纳入标准：经监护人同意自愿参与，无精神疾病或身体残疾，具备足够的读写能力以完成问卷。 排除标准：智力残疾或回答不完整。 结果指标：基于11至14岁儿童感知问卷（CPQ11 - 14）的中位数得分将OHRQoL分为两类（≤20 = 良好的OHRQoL，>20 = 较差的OHRQoL）。通过经过验证的5点李克特量表测量不确定性压力（≤12 = 低，≥13 = 高）。 结果：高不确定性压力与较差的OHRQoL显著相关（χ² = 41.34，p < 0.001）。在对性别和母亲教育程度进行调整的多变量逻辑回归分析中，不确定性压力高的学生OHRQoL较差的几率增加了4.7倍（调整后的比值比（aOR）= 4.72，95%置信区间：2.81至7.93，p < 0.001）。女性性别与较差的OHRQoL独立相关（aOR = 1.30，95%置信区间：1.05至1.62，p < 0.05）。母亲教育程度较高具有保护作用，母亲拥有学士学位与OHRQoL较差的几率降低57%相关（aOR = 0.43，95%置信区间：0.25至0.75，p < 0.01）。 结论：经历高不确定性压力的初中生OHRQoL较差的风险显著增加。女生和母亲受教育程度较低的学生尤其脆弱。基于学校的干预措施应将心理支持与口腔健康促进相结合。未来需要进行纵向研究以建立因果关系。
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