Contextual and individual factors associated with oral health literacy in adolescents: A multilevel approach

Abstract

This study aimed to evaluate the association of contextual and individual factors with Oral Health literacy (OHL) in early adolescence. This is a population-based cross-sectional study carried out with 740 12-year-old adolescents randomly selected by a two-stage probabilistic cluster sampling process from schools in Campina Grande, Brazil. The guardians provided sociodemographic information. Adolescents answered the Brazilian version of the Family Adaptability and Cohesion Scales (FACES III) to measure family functioning, and the Brazilian Rapid Estimate of Literacy in Dentistry (BREALD-30) to measure OHL. Descriptive analysis was conducted, followed by robust Poisson's regression analysis for complex samples with a multilevel approach (p<0.05). Rate ratio (RR) and 95% confidence intervals (Cl) were calculated. The two levels of the analysis were students and schools. Adolescents enrolled at schools with higher grade-retention rate had slightly worse OHL scores (RR = 0.99; 95% Cl: 0.98 to 0.99). The following individual factors were associated with the level of OHL: The female sex (RR = 1.05; 95°/o Cl: 1.01 to 1.10), mother's schooling more than eight years (RR = 1.13; 95%Cl: 1.08 to 1.19), younger guardians (RR = 0.94; 95% Cl: 0.90 to 0.97) and a balanced family functioning (RR = 1.08; 95% Cl: 1.01 to 1.14). Individual and contextual factors were associated with OHL in earlv adolescence.