Determinantes sociais estruturais e intermediários da qualidade de vida relacionada à saúde bucal, cárie dentária não tratada e dieta em adolescentes

Abstract

The aim of this thesis was to assess the association between social, structural and intermediate determinants on oral health-related quality of life (OHRQoL), untreated caries and dietary pattern in an adolescent population. Three scientific articles will be presented: the first study assessed the association between contextual characteristics of the neighborhood and OHRQoL in adolescents from Santa Maria -RS; the second study assessed the status of untreated caries in adolescents living in the same neighborhood with different family socioeconomic condition; and the third assessed the pathways leading to a cariogenic diet influenced by demographic, socioeconomic and oral health predictors in adolescence. This cross-sectional study assessed 1,197 students aged 15 to 19 years old enrolled in public and private urban high schools in Santa Maria, a city in southern Brazil. Adolescents were clinically evaluated at the schools for dental caries and malocclusion. OHRQoL was measured using the OHIP-14 questionnaire. General health conditions and behavioral characteristics were assessed using a structured questionnaire answered by the students. Another questionnaire with demographic, socioeconominc and contextual data was answered by adolescents of legal age or sent to their parents/guardians. Data analysis for the first and the second study was performed using multilevel Poisson regression models and structural equation modeling was used in the third study. Contextual characteristics of the neighborhood related to the absence of paved streets (rate ratio[RR]=1.10; confidence interval 95%[CI95%]=1.05-1.16) and tap water (RR=1.11; CI95%=1.02-1.20), lack of covering by the Family Health Strategy (RR=1.13; CI95%=1.08-1.19) and availability of dental care (RR=1.08; CI95%=1.03-1.13) were associated with poor OHRQoL. This population presented a mean±standard deviation of 0.47±1.05 teeth with untreated caries (prevalence 26%). Adolescents from poor households living in poverty areas had the worse untreated caries scenario. Those with poor households conditions but residing in nonpoverty areas had a protection in relation to their untreated caries status (RR=0.60; CI95%=0.39-0.82). Adolescents living in families with higher income had lower mean of teeth with untreated caries, regardless of the neighborhood mean income. The cariogenic diet was directly influenced by the consumption of alcoholic beverage, smoking and low brushing frequency. Add to this, poor socioeconomic status indirectly influenced the diet. Thus, the findings of this thesis point out that adolescents living in non-supportive environments tend to report poor OHRQoL. Living in higher-income environments favors the oral health of lowincome adolescents. Furthermore, unhealthy behaviors and poor socioeconomic status have been shown to be negatively associated with the quality of the diet in adolescence. These results point to the need for public polices aimed at the main social determinants in adolescence.