title: Social position, social ties and adult's oral health: 13 year cohort study.
abstract: OBJECTIVE
  This study explored different pathways by which social position and social ties influence adult's oral health over a 13-year period.
  
  
  METHODS
  A cohort investigation (Pro-Saúde Study) was conducted of non-faculty civil servants at a university in Rio de Janeiro, Brazil (N=1613). Baseline data collected in 1999 included age, social position, social ties, and access to dental care. Psychological factors and smoking were assessed in 2001, whereas tooth loss and self-rated oral health (SROH) were collected in 2012. A hypothesised model exploring different direct and indirect pathways was developed and tested using structural equation modelling.
  
  
  RESULTS
  The model was a good fit to the data and accounted for 40% and 27% of the variance in tooth loss and SROH, respectively. A greater social position was linked to more social ties (β=0.31), health insurance (β=0.48), low psychological distress (β=0.07), less smoking (β=-0.21), more regular dental visiting (β=0.30), less tooth loss (β=-0.44) and better SROH (β=-0.25) over time. Social position (β=0.0005) and social ties (β=-0.0015) were linked indirectly with psychological distress, smoking and tooth loss. Social position was linked indirectly with social ties, psychological distress and SROH (β=-0.0071).
  
  
  CONCLUSIONS
  Poor social position and weak social ties were important predictors for tooth loss and poor SROH in adults over the 13-year period. Direct and indirect pathways via psychological factors and smoking on the aforementioned relationships were identified, suggesting different areas of intervention to promote adults' oral health.
  
  
  CONCLUSIONS
  Adult's oral health is influenced by social conditions through direct and indirect pathways, including via psychological factors and smoking.
authors.affiliation: Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield S10 2TA, United Kingdom. Electronic address: m.vettore@sheffield.ac.uk.
authors.forename: Mario Vianna
authors.initials: MV
authors.lastname: Vettore
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Pavilhão João Lyra Filho, 7° andar blocos D e E, e 6° andar bloco E., Rua São Francisco Xavier, 524-Maracanã, Rio de Janeiro CEP 20550-013, Brazil. Electronic address: efaerstein@gmail.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Faerstein
authors.affiliation: Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield S10 2TA, United Kingdom. Electronic address: s.r.baker@sheffield.ac.uk.
authors.forename: Sarah Ruth
authors.initials: SR
authors.lastname: Baker
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009909:Oral Health / Q000706:statistics & numerical data*; D012924:Social Conditions; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Longitudinal studies; Social determinants of health; Social networks; Social support; Structural equation modelling; Tooth loss