O capital social e a qualidade de vida relacionada à saúde bucal de adolescentes

Abstract

Social capital has been investigated as one of the determining factors of the health disease process. However, few studies have addressed the association of social capital and oral healthrelated quality of life (OHRQoL) in adolescents. In addition, there is no evidence about the factors related to social capital throughout adolescence. The study of these factors in this age group is extremely important, once individuals are in a biopsychosocial process with many changes, which may influence their entire life course. This thesis consists of two articles. The first one evaluates the relationship between social capital and OHRQoL of adolescents in the municipality of Santa Maria, through a cross-sectional study nested in a cohort. The second article longitudinally assesses the ways in which contextual, socioeconomic, demographic, and clinical factors in early adolescence affect social capital levels over time. This 6-year cohort study is composed of a randomized sample of 1,134 12-year-old schoolchildren evaluated in 2012 (T1) in the city of Santa Maria, southern Brazil. After 6 years, the subjects underwent a second evaluation (T2). Oral health-related quality of life was assessed using the reduced version of the Child Perception Questionnaire for 11- to14- Years- Old- Children (CPQ11-14). Social capital was measured using a questionnaire consisting of five questions regarding five dimensions: social trust, social control, empowerment, neighborhood security and political effectiveness. Demographic, socioeconomic, behavioral and clinical characteristics (such as tooth decay and gingivitis) were also evaluated. Multilevel Poisson Regression analysis was performed to verify the association between social capital (T2) and OHRQoL (T2). The second objective of this study was answered using Structural Equation Models, where the paths between the relation of demographic, socioeconomic and clinical (T1) characteristics and social capital (T2) were tested. From the 1,134 adolescents evaluated at T1, about 769 were reevaluated at T2 (response rate of 67.9%). In the first study, our findings showed that low social capital was associated with greater impacts on OHRQoL (T2). In addition, female adolescents with low socioeconomic status and untreated dental caries had also worse OHRQoL. Considering the results of the second article, caries experience and low socioeconomic status at T1 were directly associated with low social capital at T2. In addition, low maternal education, lower family income and greater crowding were associated with the experience of dental caries and toothache (T1). Our findings demonstrate that social capital influences on adolescent´s quality of life and that contextual, social and clinical factors in early adolescence influence on social capital. These findings are useful to encourage actions in order to reduce the impacts caused by health inequities.