The relationship between neighborhood empowerment and
               dental caries experience: a multilevel study in adolescents and
               adults

Santiago, Bianca Marques; Valença, Ana Maria Gondim; Vettore, Mario Vianna

doi:10.1590/1809-4503201400060002

Brasil

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Original Articles • Rev. bras. epidemiol. 17 (Suppl 2) • 2014 • https://doi.org/10.1590/1809-4503201400060002 linkcopy

The relationship between neighborhood empowerment and dental caries experience: a multilevel study in adolescents and adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE: To investigate the relationship of contextual social capital (neighborhood empowerment) and individual social capital (social support and social network) with dental caries experience in adolescents and adults.

METHODS: A population-based multilevel study was conducted involving 573 subjects, 15-19 and 35-44 years of age, from 30 census tracts in three cities of Paraíba, Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. Caries experience was assessed using the DMFT index (decayed, missing and filled teeth) and participants were divided into two groups according to the median of the DMFT index in low and high caries experience. Demographic, socioeconomic, behaviors, use of dental services and social capital measures were collected through interviews. Neighborhood empowerment was obtained from the mean scores of the residents in each census tract. Multilevel multivariate logistic regression was used to test the relationship between neighborhood empowerment and caries experience.

RESULTS: High caries experience was inversely associated with neighborhood empowerment (OR = 0.58; 95%CI 0.33 - 0.99). Individual social capital was not associated with caries experience. Other associated factors with caries experience were age (OR = 1.15; 95%CI 1.12 - 1.18) and being a female (OR = 1.72; 95%CI 1.08 - 2.73).

CONCLUSION: The association between neighborhood empowerment and caries experience suggests that the perception of features of the place of residence should be taken into account in actions of oral health promotion.

Dental caries; Oral health; Social inequity; Social capital; Socioeconomic factors; Multilevel analysis

	High n = 271 n (%)	Low n = 302 n (%)	OR	95%CI	p-value
	Dental caries experience				p-value
Sociodemographic characteristics
Age^&	31.3 ± 11.1	18.2 ± 6.1	1.14	1.12 – 1.17	< 0.001
Gender
Male	75 (27.7)	136 (45.0)	1
Female	196 (72.3)	166 (55.0)	2.14	1.51 – 3.04	< 0.001
Ethnicity
White	64 (23.6)	72 (23.8)	1
Mulatto	188 (69.4)	210 (69.5)	1.01	0.68 – 1.49	0.971
Black	19 (7.0)	20 (6.6)	1.07	0.52 – 2.18	0.855
Years of education^&	6.6 ± 3.4	7.9 ± 2.4	0.86	0.81 – 0.92	< 0.001
Family income^*
≤ R$250	15 (10.3)	23 (9.2)	1
R$251 – 500	70 (28.9)	68 (27.2)	0.95	0.49 – 1.83	0.871
R$501 – 1.500	128 (52.9)	120 (48.0)	0.98	0.53 – 1.82	0.952
> R$1.500	19 (7.9)	39 (15.6)	0.45	0.20 – 0.99	0.046
Sanitary conditions of household**
Piped water inside the house	240 (88.6)	277 (92.0)	1
No piped water/outside of the house	31 (11.4)	24 (8.0)	1.49	0.85 – 2.61	0.162
Behaviors related to oral health
Frequency of intake of sweets
≤ 3 times a week	188 (69.4)	163 (54.0)	1
≥ 4 times a week	83 (30.6)	139 (46.0)	0.52	0.37 – 0.73	< 0.001
Frequency of tooth brushing**
≥ 3 times a day	162 (60.0)	197 (65.2)	1
2 times a day	89 (33.0)	95 (31.5)	2.31	1.04 – 5.11	0.039
1 time a day	19 (7.0)	10 (3.3)	1.14	0.80 – 1.63	0.473
Use of dental services
Had at least 1 dental appointment
No	2 (0.7)	17 (5.6)	1
Yes	269 (99.3)	285 (94.4)	8.02	1.84 – 35.05	0.006
Time since last appointment
Never had an appointment	3 (1.1)	17 (5.6)	1
Less than one year	161 (59.4)	168 (55.6)	5.43	1.56 – 18.88	0.008
One year or more	107 (39.5)	117 (38.7)	5.18	1.48 – 18.18	0.010

	High n = 271 n (%)	Low n = 302 n (%)	OR	95%CI	p-value
	Dental caries experience				p-value
Census tract empowerment
Low	83 (30.6)	87 (28.8)	1
Intermediate	77 (28.4)	109 (36.1)	0.74	0.48 – 1.13		0.157
High	111 (41.0)	106 (35.1)	1.10	0.73 – 1.65		0.644
Social support*^&
Affective support	92.7 ± 13.5	92.4 ± 13.6	1.02	0.91 – 1.15		0.786
Emotional support	85.0 ± 19.2	82.6 ± 20.1	1.06	0.98 – 1.15		0.148
Informational support	86.7 ± 18.1	86.3 ± 17.4	1.01	0.92 – 1.11		0.805
Positive interaction	87.6 ± 17.4	87.7 ± 16.3	1.00	0.91 – 1.10		0.939
Material support	88.4 ± 16.3	88.7 ± 14.8	0.99	0.90 – 1.09		0.811
Social network
Sports and artistic activities in the last year
≥ 1	106 (39.1)	175 (57.9)	1
0	165 (60.9)	127 (42.1)	2.14	1.54 – 3.00		<0.001
Meetings/gatherings in the last year
≥ 1	40 (14.8)	32 (10.6)	1
0	231 (85.2)	270 (89.4)	0.68	0.42 – 1.12		0.135
Volunteer work in the last year^**
≥ 1	52 (19.2)	66 (22.0)	1
0	219 (80.8)	234 (78.0)	1.19	0.79 – 1.78		0.408
Relatives^***
≥ 1	245 (90.7)	275 (91.1)	1
0	25 (9.3)	27 (8.9)	1.04	0.59 – 1.84		0.895
Friends^**
≥ 1	184 (68.1)	214 (71.1)	1
0	86 (31.9)	87 (28.9)	1.15	0.80 – 1.64		0.444

Independent variables	Model 1^a	Model 2^b	Model 3^c	Model 4^d
Independent variables	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)
Individual level variables
Age			1.15 (1.12 – 1.18)	1.15 (1.12 – 1.18)
Gender
Male			1	1
Female			1.63(1.02 – 2.61)	1.62 (1.01 – 2.58)
Frequency of intake of sweets
≤ 3 times a week				1
≥ 4 times a week				0.93 (0.60 – 1.46)
Individual social capital
Social network/Sports and artistic activities
≥ 1		1	1	1
No		2.27 (1.59 – 3.12)	1.45 (0.89 – 2.36)	1.42 (0.87 – 2.31)
Area level variables Empowerment
Low	1	1	1	1
Intermediate	0.73 (0.48 – 1.13)	0.68 (0.44 – 1.05)	0.60 (0.34 – 1.04)	0.57 (0.33 – 0.99)
High	1.10 (0.73-1.65)	1.05 (0.69-1.59)	1.05 (0.63-1.76)	1.02 (0.60-1.71)

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[t01TFN01] ^*
n = 492

[t01TFN02] ^**
n = 572

[t01TFN03] &mean±standard deviation. Exchange rate of 1 real = 1.70 American dollars at the time of the study.