title: Assessing individual and neighborhood social factors in child oral health-related quality of life: a multilevel analysis.
abstract: OBJECTIVE
  It has been suggested that subjective measures of oral health are influenced by both individual and contextual characteristics. This study assessed the relationship between neighborhood and individual social networks and child oral health-related quality of life (COHRQoL).
  
  
  METHODS
  This study followed a cross-sectional design using a multistage sample of 478 children aged 1-5 years old. Caregivers completed the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) and answered questions related to socioeconomic status and social network. The dental examination provided information on the prevalence of dental caries, dental trauma, and occlusion. Contextual social determinants included the presence of cultural community centers and of workers' association in the neighborhood. Data analysis considered the total ECOHIS scores as the outcome and neighborhood/individual social networks as the independent variables. A multilevel Poisson regression model was used to investigate the association among individual and contextual characteristics and COHRQoL.
  
  
  RESULTS
  Total ECOHIS scores ranged from 0 to 41 (possible range 0-52). The mean ECOHIS score was low (mean = 1.8, SD = 3.9), and the functional domain presented the highest mean impact on COHRQoL (mean = 0.5, SD = 1.4). Following adjusted analysis, low household income, visiting a neighbor less than once a month, the presence of anterior open bite, dental trauma, and dental caries were identified as individual determinants of negative impact on a child's quality of life. These variables remained associated with the outcome even after adding the contextual-level variables in the model. At the contextual level, the presence of community cultural centers was associated with overall mean ECOHIS score; higher impacts on COHRQoL were observed in those living in neighborhoods without cultural community centers.
  
  
  CONCLUSIONS
  There is a significant association between individual and contextual social determinants and COHRQoL; unfavorable social conditions and poor socioeconomic status have a negative impact on caregiver reports of children's oral health-related quality of life.
authors.affiliation: Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil.
authors.forename: Renata Saraiva
authors.initials: RS
authors.lastname: Guedes
authors.forename: Chaiana
authors.initials: C
authors.lastname: Piovesan
authors.forename: José Leopoldo Ferreira
authors.initials: JL
authors.lastname: Antunes
authors.forename: Fausto Medeiros
authors.initials: FM
authors.lastname: Mendes
authors.forename: Thiago Machado
authors.initials: TM
authors.lastname: Ardenghi
mesh_terms: D001938:Brazil; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003731:Dental Caries; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D008297:Male; D009909:Oral Health; D016012:Poisson Distribution; D011788:Quality of Life; D012111:Residence Characteristics; D012923:Social Class; D012944:Social Support; D011795:Surveys and Questionnaires
references.citation: Community Dent Oral Epidemiol. 2007 Jun;35(3):170-8
references.pmid: 17518963
references.citation: Community Dent Oral Epidemiol. 2013 Aug;41(4):336-44
references.pmid: 23253051
references.citation: Community Dent Oral Epidemiol. 2007 Jun;35(3):195-206
references.pmid: 17518966
references.citation: Community Dent Oral Epidemiol. 2007 Aug;35 Suppl 1:8-19
references.pmid: 17615046
references.citation: Community Dent Oral Epidemiol. 2009 Feb;37(1):19-26
references.pmid: 19046333
references.citation: Am J Public Health. 2006 Aug;96(8):1462-8
references.pmid: 16809595
references.citation: Qual Life Res. 2010 Nov;19(9):1359-66
references.pmid: 20571918
references.citation: Caries Res. 2012;46(2):102-6
references.pmid: 22398411
references.citation: Community Dent Oral Epidemiol. 2007 Apr;35(2):81-8
references.pmid: 17331149
references.citation: Community Dent Oral Epidemiol. 2006 Apr;34(2):146-52
references.pmid: 16515679
references.citation: Cad Saude Publica. 2008 Aug;24(8):1897-909
references.pmid: 18709230
references.citation: Braz Dent J. 2013 Nov-Dec;24(6):655-61
references.pmid: 24474365
references.citation: Community Dent Oral Epidemiol. 2011 Oct;39(5):449-57
references.pmid: 21504439
references.citation: Qual Life Res. 2011 Aug;20(6):951-9
references.pmid: 21181500
references.citation: JAMA. 1995 Jan 4;273(1):59-65
references.pmid: 7996652
references.citation: Bull World Health Organ. 2005 Sep;83(9):661-9
references.pmid: 16211157
references.citation: Community Dent Oral Epidemiol. 2008 Apr;36(2):149-56
references.pmid: 18333879
references.citation: Int J Behav Med. 2012 Mar;19(1):56-64
references.pmid: 21125364
references.citation: Rev Saude Publica. 2007 Oct;41(5):830-8
references.pmid: 17923905
references.citation: Res Nurs Health. 2005 Oct;28(5):408-18
references.pmid: 16163676
references.citation: Soc Sci Med. 2001 Oct;53(7):915-25
references.pmid: 11522137
references.citation: J Clin Periodontol. 2012 Jan;39(1):73-9
references.pmid: 22093022
references.citation: Community Dent Oral Epidemiol. 2011 Jun;39(3):239-49
references.pmid: 21091754
references.citation: BMC Oral Health. 2011 Jun 13;11:19
references.pmid: 21668959
references.citation: Health Qual Life Outcomes. 2011 Sep 24;9:78
references.pmid: 21943368
references.citation: Br Dent J. 2007 Jan 27;202(2):E2
references.pmid: 17260428
references.citation: Community Dent Oral Epidemiol. 2013 Aug;41(4):327-35
references.pmid: 23330729
references.citation: J Public Health Dent. 2012 Spring;72(2):156-63
references.pmid: 22372974
references.citation: Cad Saude Publica. 2007 Nov;23(11):2533-54
references.pmid: 17952247
references.citation: Eur J Oral Sci. 2008 Feb;116(1):37-43
references.pmid: 18186730
references.citation: Dent Traumatol. 2007 Apr;23(2):114-9
references.pmid: 17367459
references.citation: Health Qual Life Outcomes. 2007 Jan 30;5:6
references.pmid: 17263880
references.citation: Cad Saude Publica. 2012 Feb;28(2):367-74
references.pmid: 22331162
references.citation: Health Qual Life Outcomes. 2008 Jan 22;6:9
references.pmid: 18211711
references.citation: Community Dent Oral Epidemiol. 2011 Apr;39(2):105-14
references.pmid: 21029148
references.citation: Community Dent Oral Epidemiol. 2004 Apr;32(2):81-5
references.pmid: 15061856
references.citation: BMC Oral Health. 2010 Aug 13;10:20
references.pmid: 20707920
references.citation: Community Dent Oral Epidemiol. 2011 Dec;39(6):498-504
references.pmid: 21692751
references.citation: J Epidemiol Community Health. 2002 Aug;56(8):588-94
references.pmid: 12118049
references.citation: Int J Paediatr Dent. 2014 May;24(3):234-43
references.pmid: 24102653
references.citation: Caries Res. 2009;43(4):245-9
references.pmid: 19439944
references.citation: Qual Life Res. 2007 Sep;16(7):1097-105
references.pmid: 17530444
references.citation: Community Dent Health. 2004 Sep;21(3):193-8
references.pmid: 15470828
references.citation: Community Dent Oral Epidemiol. 2013 Jun;41(3):204-11
references.pmid: 23004568
references.citation: Science. 1997 Aug 15;277(5328):918-24
references.pmid: 9252316
references.citation: Int J Paediatr Dent. 2009 Nov;19(6):399-405
references.pmid: 19811551
references.citation: J Am Dent Assoc. 2003 Dec;134(12):1591-6
references.pmid: 14719755
references.citation: Community Dent Oral Epidemiol. 2002 Jun;30(3):193-8
references.pmid: 12000342
references.citation: Int J Paediatr Dent. 2002 May;12(3):183-8
references.pmid: 12028310
references.citation: Soc Sci Med. 2003 Sep;57(5):843-60
references.pmid: 12850110
references.citation: Annu Rev Public Health. 2000;21:171-92
references.pmid: 10884951
references.citation: Eur J Oral Sci. 2009 Oct;117(5):547-54
references.pmid: 19758251
references.citation: Community Dent Oral Epidemiol. 2010 Aug;38(4):287-98
references.pmid: 20370808
references.citation: Gac Sanit. 2011 Sep-Oct;25(5):391-6
references.pmid: 21703730
references.citation: Community Dent Oral Epidemiol. 1998 Feb;26(1):52-61
references.pmid: 9511843
references.citation: BMC Med Res Methodol. 2003 Oct 20;3:21
references.pmid: 14567763
references.citation: Community Dent Oral Epidemiol. 2006 Oct;34(5):344-50
references.pmid: 16948673
references.citation: BMC Oral Health. 2010 Apr 06;10:4
references.pmid: 20367888
references.citation: J Dent Res. 2002 Jul;81(7):459-63
references.pmid: 12161456
references.citation: Health Qual Life Outcomes. 2011 Dec 22;9:118
references.pmid: 22192577