title: Stages and transitions in the development of tooth brushing skills in children of Mexican immigrant families: a qualitative study.
abstract: OBJECTIVE
  Compared with white children, the oral health of Latino children in the United States is much worse. One factor contributing to oral health is tooth brushing. Few studies have addressed the formation of the tooth brushing habit in children, and only one of them studied a Latino population. The purpose of this study is to explore the development of the tooth brushing habit in children of Mexican immigrant families and develop hypothesis based on its results.
  
  
  METHODS
  This is an exploratory qualitative study, with a case study design based on 20 in-depth interviews. Participants were Mexican immigrant mothers living in Pittsburgh and Philadelphia, PA. Participants had at least one child six-years-old or younger. Interviews were recorded, transcribed verbatim, and analyzed using qualitative analysis procedures.
  
  
  RESULTS
  Four stages were identified in the tooth brushing learning process: initiation and entirely dependent tooth brushing, assisted tooth brushing, road to tooth brushing independence, and independent tooth brushing. Two factors influenced parents' teaching approaches: parents' perceptions of their child's achievement of physical, cognitive, and motor developmental milestones and parents' knowledge about oral hygiene.
  
  
  CONCLUSIONS
  We identified four distinct stages and found evidence to hypothesize that transitions from one stage to the next are triggered not by the age of the child but by parents' knowledge about oral hygiene and their perceptions of their child's achievement of physical, cognitive, and motor developmental milestones. Future quantitative research studies should be conducted to test this hypothesis in larger groups of Latinos as well as other ethnic groups.
authors.affiliation: School of Public Health, Universidad Mayor, Santiago, Region Metropolitana, Chile.|Community Oral Health, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Dafna
authors.initials: D
authors.lastname: Benadof
authors.affiliation: Dental Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Polk
authors.affiliation: Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Documet
mesh_terms: D002648:Child; D004641:Emigration and Immigration; D006801:Humans; D008800:Mexico / Q000208:ethnology; D036301:Qualitative Research; D020377:Self Efficacy; D014099:Toothbrushing; D014481:United States
keywords: health behavior; oral hygiene; qualitative research; tooth brushing