title: Oral Health Inequalities: Relationships between Environmental and Individual Factors.
abstract: Recent research has emphasized the relationships between environmental and individual factors that may influence population oral health and lead to health inequalities. However, little is known about the effect of interactions between environmental and individual factors on inequalities in clinical (e.g., decayed teeth) and subjective oral health outcomes (e.g., oral health-related quality of life [OHQoL]). This cohort study aimed to explore the direct and mediated longitudinal interrelationships between key environmental and individual factors on clinical and subjective oral health outcomes in adults. Self-reported measures of OHQoL and individual (sense of coherence [SOC], social support, stress, oral health beliefs, dental behaviors, and subjective socioeconomic status [SES]) and environmental factors (SES and social network) were collected at baseline and 3-mo follow-up, together with a baseline clinical examination of 495 adult employees of an automobile parts manufacturer in India. Lagged structural equation modeling was guided by the adapted Wilson and Cleary/Brunner and Marmot model linking clinical, individual, and environmental variables to quality of life. The study provides tentative evidence that SES may influence levels of resources such as social support and SOC, which mediate stress and in turn may influence subjective oral health outcomes. Accordingly, the present findings and the adapted Wilson and Cleary/Brunner and Marmot model on which they are predicted provide support for the psychosocial pathway being key in the SES-oral health relationship. The pathways through which environmental factors interact with individual factors to impact subjective oral health outcomes identified here may bring opportunities for more targeted oral health promotion strategies.
authors.affiliation: School of Clinical Dentistry, University of Sheffield, Sheffield, UK e.gupta@sheffield.ac.uk.
authors.forename: E
authors.initials: E
authors.lastname: Gupta
authors.affiliation: School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
authors.forename: P G
authors.initials: PG
authors.lastname: Robinson
authors.affiliation: Sudha Rastogi Dental College, Faridabad, India.
authors.forename: C M
authors.initials: CM
authors.lastname: Marya
authors.affiliation: School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009909:Oral Health / Q000706:statistics & numerical data*; D009910:Oral Hygiene / Q000706:statistics & numerical data; D011584:Psychology; D011788:Quality of Life; D060685:Sense of Coherence; D012944:Social Support; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Wilson and Cleary model; adults; health disparities; oral health quality of life; psychosocial determinants; salutogenesis