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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 3  |  Page : 220-224

Influence of socioeconomic status and home environmental factors on oral health-related quality of life among school children in north Bengaluru, India: A cross-sectional study


1 Department of Public Health Dentistry, Vaidik Dental College and Research Centre, Daman, Daman and Diu, India
2 Department of Health Care Management, Prin. L. N. Welingkar Institute of Management Development and Research, Mumbai, Maharashtra, India

Date of Web Publication18-Sep-2017

Correspondence Address:
Nikhil Ahuja
C/602, Avon Plaza, Thakur Complex, Kandivali (East), Mumbai - 400 101, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_57_17

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  Abstract 

Introduction: There is an increasing recognition that children's oral health-related quality of life (OHRQoL) is affected by social and environmental factors. Aim: To assess the influence of socioeconomic status and home environment factors on OHRQoL among 13–14-year-old schoolchildren in North Bengaluru. Materials and Methods: This cross-sectional study was conducted among 800 children aged 13–14 years from government and private schools in North Bengaluru. OHRQoL was assessed using a shorter version of Child Perceptions Questionnaire (CPQ11-14). Socioeconomic status of children was measured using Kuppuswamy's scale. Children were also asked to provide information on home environmental factors. Descriptive, Chi-square, and Mann–Whitney U-tests were used to analyze data. Results: In both government and private schools, mean CPQ11-14 scores were highest for children belonging to upper lower class followed by the lower middle, upper middle, and upper class of socioeconomic status, showing statistically significant differences (P < 0.05). In government schools, children living with single parent/guardian, having two or more siblings, one or two rooms, staying with more than one person per room, family using alcohol/tobacco reported higher mean CPQ11-14 scores as compared to private schools. (P < 0.05). Conclusion: It is important to shift focus from the current biomedical and restricted paradigm on oral health and develop oral health policies and programs considering the socioeconomic status and home environmental factors in improving child OHRQoL outcomes.

Keywords: Children, environment, oral health, quality of life, socioeconomic status


How to cite this article:
Ahuja N, Ahuja N. Influence of socioeconomic status and home environmental factors on oral health-related quality of life among school children in north Bengaluru, India: A cross-sectional study. J Indian Assoc Public Health Dent 2017;15:220-4

How to cite this URL:
Ahuja N, Ahuja N. Influence of socioeconomic status and home environmental factors on oral health-related quality of life among school children in north Bengaluru, India: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2019 Mar 21];15:220-4. Available from: http://www.jiaphd.org/text.asp?2017/15/3/220/215065


  Introduction Top


Oral health-related quality of life (OHRQoL) is seen as a significant component of oral health and needs. It is defined as “the absence of negative impacts of oral diseases on physical, social, and psychological wellbeing and a positive sense of dentofacial self-confidence.”[1] Oral health problems are considered important factors causing a negative impact on daily performance and QoL because it influences how individuals grow, enjoy life, speak, chew, taste food, and socialize.[2],[3],[4]

Children's health-related QoL was earlier assessed using parents as informants. This was based on the fact that children's reports of their health and QoL would not meet accepted psychometric standards, due to limitations in their cognitive capacities and communication skills. Nowadays, there are several instruments available to measure OHRQoL in children.[5],[6] In this study, a shorter version of Child Perceptions Questionnaire (CPQ11-14), was used to assess OHRQoL; which evaluated aspects such as oral symptoms (OS), functional limitations (FL), emotional well-being (EWB), and social well-being (SWB).[7],[8],[9],[10]

There is an increasing recognition that children's OHRQoL is affected by personal, social, and environmental factors. It is reported that family environment and its socioeconomic conditions are important mediators of health and disease in school children. Furthermore, children going to a government or private school is an indication of its socioeconomic condition and consequently determines the type of environment where the child lives in.[11],[12] In addition, individuals living in poor socioeconomic conditions suffer from psychological and social problems, which directly influence the way parents care for their children.[13],[14],[15]

In recent times, family structures have changed globally and have shown an impact on the oral health status, OHRQoL, and self-perceived oral health of children, considering that family and its surrounding environment play a central role in promoting their oral health.[12] It is observed that underprivileged children living with both biological parents have the better supportive environment and require fewer dental treatment needs.[13] In addition, underprivileged families have less access to oral health information and fewer favorable conditions and resources to make healthier choices, including the use of oral hygiene aids, dietary choices, and access to dental care.[16]

Despite the association of socioeconomic status and home environment factors with OHRQoL, this aspect has not yet been sufficiently investigated and remains unclear among school children. Thus, the aim of this study was to assess the influence of socioeconomic status and home environment factors on OHRQoL among school children in North Bengaluru.


  Materials and Methods Top


This cross-sectional study was conducted among 13–14-year-old schoolchildren of government and private schools from November 2013 to April 2014 in North Bengaluru, India. The study protocol was submitted to the Institutional Ethical Committee (M R Ambedkar Dental College and Hospital, Bengaluru with reference number MRADC and H/ECIRB/1090/2012-13), and ethical clearance was obtained. Permission was obtained from the Deputy Director of Public Instructions (DDPI) and head of schools after explaining the purpose and procedure of the study. The study participants were clearly informed about the study and ensured that their participation was purely voluntary, following which, written informed consent was obtained from the parents.

A list of government and private schools was obtained from the DDPI. For this study, three government and three private schools were selected using convenience sampling. The sample size was calculated based on children's OHRQoL mean scores (18.3) and standard deviation (13.9) obtained from the pilot study. With 95% confidence interval level and 80% power, our expected sample size was 742. Considering the dropouts, convenient samples of 800 children were approached to participate in this study, of which 400 children were included from government schools and 400 from private schools. Schoolchildren diagnosed with fever and other systemic illnesses on the day of examination were excluded from the study.

This study used a structured pro forma for data collection consisting of three parts. Part one consisted of sociodemographic information such as age, gender, and type of school. The assessment of socioeconomic status was done using Kuppuswamy's scale updated for 2013.[17] Part two comprised questionnaire on OHRQoL. A shorter version of CPQ11-14 developed by Jokovic et al. was used in this study. The validity and reliability of this measure have been established in various studies.[18] The CPQ11-14 instrument was a self-administered questionnaire including 16 items grouped into 4 domains; OS, FL, EWB, and SWB. Each item inquired about the frequency of events, as applied to the teeth/mouth, in the previous 3 months. All the responses were scored using a four-point Likert scale with 0 = never, 1 = once or twice, 2 = sometimes, 3 = often, and 4 = everyday/almost every day. Additive scale scores for the CPQ11-14 were calculated by summing the item response codes, and the overall score was generated. Higher scores signify worse OHRQoL. In part three, participants were asked to answer questions regarding home environment which included; the structure of the family, the number of siblings, number of rooms per household, household overcrowding, and alcohol/tobacco habits in the family.

The questionnaire was translated from English to Kannada (local language) for the convenience and feasibility of the study and then translated back to English by bilingual experts to ensure that the meaning of the questions remains the same. The questionnaire was tested for its reliability by Cronbach's alpha which came out as α =0.71, suggesting an acceptable reliability. A pilot study was undertaken on 80 school children to identify any organizational and technical problems and to check the feasibility and relevance of the questionnaire. These school children were excluded from the main study.

Data analysis was performed using the Statistical Package for Social Science version 22.0 (SPSS, Inc., Chicago, IL, USA). Descriptive statistics were obtained, and means, standard deviation, and frequency distribution were calculated. Frequency tables were processed and analyzed using Chi-square test. Mann–Whitney U-test was used to analyze the association between socioeconomic status and home environmental factors with OHRQoL. The statistical significance was based on P < 0.05.


  Results Top


A total of 800 children participated in the study, of which 400 were selected from government schools and 400 from private schools. More number of males was reported in government schools (50.5%), whereas in private schools, females were predominant (52.7%). The majority of children in government schools belonged to lower middle class (47.7%) and upper lower class (47.3%), whereas in private schools, there were more number of children from lower middle class (52.3%) and upper middle class (22.5%) of socioeconomic status. There were no children from the lower class of socioeconomic status in both government and private schools [Table 1].
Table 1: Distribution of government and private school children based on gender and socioeconomic status

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The majority of children lived both with father and mother in government (81.5%) and private (83.7%) schools. Most of the children had one sibling in both the schools. One or two rooms per household were reported more in government schools (79.3%), whereas more than two rooms per household were found to be more in private school children (33.8%). In government schools, 72% children reported to have more than one person living per room as compared to 65.7% in private schools. Family members of the government school children (53.5%) consumed more alcohol or used tobacco as compared to private schools (35%) [Table 2].
Table 2: Distribution of government and private school children based on home environmental factors

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In both government and private schools, the mean CPQ11-14 scores were highest for children belonging to upper lower class followed by lower middle, upper middle, and upper class of socioeconomic status, showing statistically significant differences (P < 0.05) [Table 3]. In government schools, children living with single parent/guardian, having two or more siblings, one or two rooms, staying with more than one person per room, family using alcohol/tobacco reported higher mean CPQ11-14 scores as compared to private schools (P < 0.05) [Table 4].
Table 3: Association between socioeconomic status and oral health-related quality of life among school children

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Table 4: Association between home environmental factors and oral health-related quality of life among school children

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  Discussion Top


In recent times, evaluation of health programs is usually based on an assessment of outcomes of QoL.[19],[20] This study has used the CPQ11-14 to provide data on OHRQoL because children aged 12 years and above are capable of cognitive thinking and have better understanding and reasoning about their good or bad oral health experiences. To have representation from all social, economic, and cultural backgrounds, the children were selected from both government and private schools.[2],[19],[20],[21],[22]

Our study has shown significant differences between government and private school children with respect to socioeconomic status. The children from government schools reported poor OHRQoL as compared to private school children, where the QoL kept on decreasing as they moved down the scale of socioeconomic status. Similar findings have been reported in the earlier studies.[2],[5],[10],[14],[19],[23],[24],[25] This indicates that children at the top of the social ladder enjoy better OHRQoL outcomes as compared to those immediately below them. Oral diseases disproportionally affect lower segments of society placing an additional disease burden on such groups.[24] In addition, children who occupy socioeconomically lower positions are more likely to engage in unhealthy oral health behaviors including dietary choices and access to dental care. Furthermore, due to poverty, they lack the necessary economic or educational resources to health promotion initiatives and suffer from psychological and social problems. It is therefore important to understand the existence of this social gradient and take effective action to tackle this oral health inequalities.[23]

In the present study, children living with both parents reported better OHRQoL as compared to single parent or guardian. These findings are consistent with the earlier studies.[4],[5],[12],[24],[26],[27],[28],[29] This may suggest that children living with both biological parents are more likely to have a supportive economic and psychological environment for performing oral health behaviors than the environment provided by single parent or guardian. In addition, single-parent lacks financial stability to sustain their children, resulting in negligent attitudes towards oral health for both themselves and their children.[12]

In this study, the number of siblings was associated with greater negative impact on OHRQoL, and this may be because; financial resources and attention from parents are shared among the siblings as more number of children is born into the family. Household overcrowding showed a significant impact on OHRQoL, indicating that overcrowding can directly or indirectly affect the oral health of the families. Tobacco/alcohol habits in the family showed a strong influence on children's OHRQoL. This indicates that parents and other family members can act as facilitators of certain health-related behaviors. In addition, unhealthy behaviors such as smoking, alcohol use, and poor oral hygiene are more directly associated with a parenting style among children. Similar findings have been reported in the earlier studies.[4],[5],[12],[24],[26],[27],[28] It would thus seem reasonable to include family environmental factors in the promotion of children's oral health behavior.

As self-administered questionnaire was used in our study, the answers may have been subject to information bias. It is not possible to extrapolate the findings as samples were selected conveniently. Therefore, longitudinal studies are needed in future to clarify the relationship of causality. The study, however, highlighted that it is important to begin to think about the validity of contemporary conceptual models of disease and its consequences and develop oral health policies and programs considering social and home environmental factors in reducing inequalities.


  Conclusion Top


Socioeconomic status and home environmental factors exerted a negative impact on OHRQoL of children. Therefore, it is important to shift focus from current biomedical and restricted paradigm on oral health and emphasize the importance of social and home environmental factors in improving child OHRQoL outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McGrath C, Broder H, Wilson-Genderson M. Assessing the impact of oral health on the life quality of children: Implications for research and practice. Community Dent Oral Epidemiol 2004;32:81-5.  Back to cited text no. 1
[PUBMED]    
2.
Feu D, de Oliveira BH, de Oliveira Almeida MA, Kiyak HA, Miguel JA. Oral health-related quality of life and orthodontic treatment seeking. Am J Orthod Dentofacial Orthop 2010;138:152-9.  Back to cited text no. 2
[PUBMED]    
3.
Locker D, Jokovic A, Tompson B. Health-related quality of life of children aged 11 to 14 years with orofacial conditions. Cleft Palate Craniofac J 2005;42:260-6.  Back to cited text no. 3
[PUBMED]    
4.
Gomes MC, Pinto-Sarmento TC, Costa EM, Martins CC, Granville-Garcia AF, Paiva SM. Impact of oral health conditions on the quality of life of preschool children and their families: A cross-sectional study. Health Qual Life Outcomes 2014;12:55.  Back to cited text no. 4
[PUBMED]    
5.
Paula de JS, Gonçalves LI, Almeida de AB, Ambrosano GM, Mialhe FL. The impact of socio environmental characteristics on domains of oral health-related quality of life in Brazilian schoolchildren. BMC Oral Health 2013;13:10.  Back to cited text no. 5
    
6.
Traebert J, Lacerda JT, Foster Page LA, Thomson WM, Bortoluzzi MC. Impact of traumatic dental injuries on the quality of life of schoolchildren. Dent Traumatol 2012;28:423-8.  Back to cited text no. 6
[PUBMED]    
7.
Barbosa TS, Gavião MB. Oral health-related quality of life in children: Part II. Effects of clinical oral health status. A systematic review. Int J Dent Hyg 2008;6:100-7.  Back to cited text no. 7
    
8.
Bendo CB, Paiva SM, Varni JW, Vale MP. Oral health-related quality of life and traumatic dental injuries in Brazilian adolescents. Community Dent Oral Epidemiol 2014;42:216-23.  Back to cited text no. 8
[PUBMED]    
9.
Agou S, Locker D, Streiner DL, Tompson B. Impact of self-esteem on the oral-health-related quality of life of children with malocclusion. Am J Orthod Dentofacial Orthop 2008;134:484-9.  Back to cited text no. 9
[PUBMED]    
10.
Scapini A, Feldens CA, Ardenghi TM, Kramer PF. Malocclusion impacts adolescents' oral health-related quality of life. Angle Orthod 2013;83:512-8.  Back to cited text no. 10
[PUBMED]    
11.
Glendor U. Epidemiology of traumatic dental injuries – A 12 year review of the literature. Dent Traumatol 2008;24:603-11.  Back to cited text no. 11
[PUBMED]    
12.
Paula JS, Leite IC, Almeida AB, Ambrosano GM, Pereira AC, Mialhe FL. The influence of oral health conditions, socioeconomic status and home environment factors on schoolchildren's self-perception of quality of life. Health Qual Life Outcomes 2012;10:6.  Back to cited text no. 12
[PUBMED]    
13.
Balan A, Pasareanu M, Savin C, Balcos C, Zetu I. Socio-economic status and oral health behaviour – Possible dental caries risk factors in school communities. IJMD 2013;3:32-7.  Back to cited text no. 13
    
14.
Von Rueden U, Gosch A, Rajmil L, Bisegger C, Ravens-Sieberer U. Socioeconomic determinants of health related quality of life in childhood and adolescence: Results from a European study. J Epidemiol Community Health 2006;60:130-5.  Back to cited text no. 14
[PUBMED]    
15.
Piovesan C, Antunes JL, Mendes FM, Guedes RS, Ardenghi TM. Influence of children's oral health-related quality of life on school performance and school absenteeism. J Public Health Dent 2012;72:156-63.  Back to cited text no. 15
[PUBMED]    
16.
Pau A, Baxevanos KG, Croucher R. Family structure is associated with oral pain in 12-year-old Greek schoolchildren. Int J Paediatr Dent 2007;17:345-51.  Back to cited text no. 16
[PUBMED]    
17.
Vijaya K, Ravikiran E. Kuppuswamy's Socio-economic status scale-updating income ranges for the year 2013. Natl J Res Community Med 2013;2:79-82.  Back to cited text no. 17
    
18.
Jokovic A, Locker D, Stephens M, Kenny D, Tompson B, Guyatt G. Validity and reliability of a questionnaire for measuring child oral-health-related quality of life. J Dent Res 2002;81:459-63.  Back to cited text no. 18
[PUBMED]    
19.
Nurelhuda NM, Ahmed MF, Trovik TA, Åstrøm AN. Evaluation of oral health-related quality of life among Sudanese schoolchildren using child-OIDP inventory. Health Qual Life Outcomes 2010;8:152.  Back to cited text no. 19
    
20.
Bendo CB, Paiva SM, Torres CS, Oliveira AC, Goursand D, Pordeus IA, et al. Association between treated/untreated traumatic dental injuries and impact on quality of life of Brazilian schoolchildren. Health Qual Life Outcomes 2010;8:114.  Back to cited text no. 20
[PUBMED]    
21.
Shailee F, Sogi GM, Sharma KR, Nidhi P. Dental caries prevalence and treatment needs among 12- and 15- Year old schoolchildren in Shimla city, Himachal Pradesh, India. Indian J Dent Res 2012;23:579-84.  Back to cited text no. 21
[PUBMED]  [Full text]  
22.
Mouradian WE, Huebner CE, Ramos-Gomez F, Slavkin HC. Beyond access: The role of family and community in children's oral health. J Dent Educ 2007;71:619-31.  Back to cited text no. 22
[PUBMED]    
23.
Locker D. Disparities in oral health-related quality of life in a population of Canadian children. Community Dent Oral Epidemiol 2007;35:348-56.  Back to cited text no. 23
[PUBMED]    
24.
Lisboa CM, de Paula JS, Ambrosano GM, Pereira AC, Meneghim Mde C, Cortellazzi KL, et al. Socioeconomic and family influences on dental treatment needs among Brazilian underprivileged schoolchildren participating in a dental health program. BMC Oral Health 2013;13:56.  Back to cited text no. 24
[PUBMED]    
25.
Xavier A, de Carvalho FS, da Silva Bastos R, de Lourdes Caldana M, de Magalhaes Bastos JR. Dental caries-related quality of life and socioeconomic status of preschool children, Bauru, SP. Braz J Oral Sci 2012;11:463-8.  Back to cited text no. 25
    
26.
Levin KA, Currie C. Adolescent toothbrushing and the home environment: Sociodemographic factors, family relationships and mealtime routines and disorganisation. Community Dent Oral Epidemiol 2010;38:10-8.  Back to cited text no. 26
[PUBMED]    
27.
Aleksejuniene J, Brukiene V. Parenting style, locus of control, and oral hygiene in adolescents. Medicina (Kaunas) 2012;48:102-8.  Back to cited text no. 27
    
28.
Poutanen R, Lahti S, Tolvanen M, Hausen H. Parental influence on children's oral health-related behavior. Acta Odontol Scand 2006;64:286-92.  Back to cited text no. 28
[PUBMED]    
29.
Listl S. Family composition and children's dental health behavior: Evidence from Germany. J Public Health Dent 2011;71:91-101.  Back to cited text no. 29
[PUBMED]    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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