title: Longitudinal association of adolescents' sense of coherence with tooth-brushing using an integrated behaviour change model.
abstract: OBJECTIVE
  To determine the association between adolescents' sense of coherence (SOC) and their tooth-brushing behaviour.
  
  
  METHODS
  This 18-month longitudinal study involved a representative sample of 8th-graders (n = 1025) from 11 randomly selected public high schools in the Limpopo Province, South Africa. Data collected by means of a self-administered questionnaire included respondents' socio-demographic profiles, vulnerability to depression, smoking status, dental treatment attendance pattern, frequency of and motivation for tooth-brushing. Based on the responses to the question on readiness to change brushing behaviour and in line with the integrated change model, respondents were also categorized as being in the pre-contemplation, contemplation or preparation/action stages. Respondents' SOC was measured using a six-item adapted Antonovsky SOC scale. Data analysis included chi-squared analysis, t-tests and step-wise multiple logistic regression.
  
  
  RESULTS
  At baseline, 72.6% (n = 744) of the respondents reported that they were not consistently brushing twice daily. Of those who did not brush twice daily and were followed up on (n = 578), those living with their mother at baseline not only presented with a greater increase in their SOC over time (follow-up minus baseline), but they were also more likely to be brushing twice daily at the time of the follow-up (15.4% versus 10.6%; P = 0.04). Adding baseline intention state to a multivariate model attenuated the influence of baseline SOC to a statistically insignificant level. However, increasing within-subject SOC changes (beta = 0.16; P < 0.01), living with the mother (beta = 0.11; P < 0.05), smoking (beta = -0.14; P < 0.05), being depression vulnerable (beta = -0.23; P < 0.01) and in the preparation/action stage (beta = 0.13; P < 0.05) remained associated with the transition to twice-daily tooth-brushing.
  
  
  CONCLUSIONS
  In planning oral health promotion interventions, it should be considered that children's psychological predisposition and family environment might significantly influence their tooth-brushing behaviour.
authors.affiliation: Department of Community Dentistry, School of Dentistry, Oral and Dental Hospital, University of Pretoria, Pretoria, South Africa. lekan.ayoyusuf@up.ac.za
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Ayo-Yusuf
authors.forename: Priscilla S
authors.initials: PS
authors.lastname: Reddy
authors.forename: Bart W
authors.initials: BW
authors.lastname: van den Borne
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior; D001294:Attitude to Health; D001364:Awareness; D002648:Child; D003729:Dental Care; D003863:Depression / Q000523:psychology; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006798:Housing; D006801:Humans; D033182:Intention; D008137:Longitudinal Studies; D008297:Male; D009034:Mother-Child Relations; D009042:Motivation; D011446:Prospective Studies; D012649:Self Concept; D012907:Smoking / Q000523:psychology; D012959:Socioeconomic Factors; D013019:South Africa; D014099:Toothbrushing / Q000523:psychology*; D055815:Young Adult