Socioeconomic status and self-reported oral health in Iranian adolescents: the role of selected oral health behaviours and psychological factors

Abstract

Health inequality according to socioeconomic status has been established. There is evidence for inequality for self-reported oral health outcomes. There has been interest in exploring the factors that explain general health inequality such as health behaviours and psychological factors. However, few studies have examined whether oral health behaviours and psychological factors explain oral health inequality among adults from industrialised countries. The aim of this thesis is to investigate whether oral health behaviours and psychological factors explain inequality in self-reported oral health among Iranian adolescents. This study tested four conditions according to the hypothesis of mediation; the final condition is that adjusting for the mediating factors attenuates the relationship between socioeconomic status and oral health. A questionnaire was used to collect data on four sets of variables from 639 males and females aged 15-17 studying at secondary schools in Sanandaj, Iran: socioeconomic status, oral health behaviours, psychological factors, and self-reported oral health outcomes. Indicators of socioeconomic status were subjective socioeconomic status, wealth index, mother‟s education and father‟s education. Oral health behaviours were toothbrushing, dental flossing, and visiting dentist. Psychological factors were selfesteem, depression, and anxiety. Self-reported oral health outcomes were single item self-rated oral health, and the experience of dental pain. Several regression models were conducted to examine the four conditions of the hypothesis of mediation. This study found a graded relationship between indicators of socioeconomic status and self-reported oral health outcomes, but no strong evidence to support the hypothesis that oral health behaviours and psychological factors mediate oral health inequality for self-reported oral health outcomes. Adjustment for oral health behaviours and psychological factors led to only small changes in the associations between socioeconomic status and self-reported oral health outcomes. In conclusion, oral health behaviours and psychological factors explained a little extent of oral health inequality for self-reported oral health outcomes.