title: Are school and home environmental characteristics associated with oral health-related quality of life in Brazilian adolescents and young adults?
abstract: The aim of this study was to test the association of contextual school and home environmental characteristics and individual factors with oral health-related quality of life (OHRQoL) in a representative sample of Brazilian adolescents and young adults.
  
  
  
  Individual-level data from 3854 fifteen- to nineteen-year-olds who participated in the Brazilian Oral Health Survey were pooled with contextual city-level data. The dependent variable was the frequency of impacts of oral disorders on daily performances (OIDP extent), as a measure of OHRQoL. Contextual school and home environmental characteristics were categorized into three equal groups according to tertiles of the contextual variable's scores (low, moderate and high). Individual demographic, socioeconomic and oral clinical measures were the covariates. The association between contextual and individual characteristics and OIDP extent was estimated using multilevel Poisson regression models.
  
  
  
  The mean of OIDP extent was 0.9 (standard error 0.1). Adolescents and young adults living in the cities with high levels of lack of security at school (RR 1.33; 95% CI=1.02-1.74), moderate levels of bullying at school (RR 1.56; 95% CI=1.20-2.03) and moderate levels of low maternal schooling (RR 1.43; 95% CI=1.06-1.92) had a higher mean OIDP extent. Male sex, higher age, skin colour, poor individual socioeconomic status and worse oral clinical measures were also associated with higher mean of OIDP extent.
  
  
  
  Poor school and home environmental characteristics were independently associated with poor OHRQoL in individuals aged between 15 and 19 years. Our findings suggest the place where they study and the maternal level of education are meaningful aspects for their oral health.
authors.affiliation: Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.|Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Maram Ali M
authors.initials: MAM
authors.lastname: Alwadi
authors.affiliation: Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
authors.forename: Mario Vianna
authors.identifier: 0000-0001-6299-4432
authors.initials: MV
authors.lastname: Vettore
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D058445:Bullying / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009059:Mouth Diseases / Q000453:epidemiology; D009909:Oral Health / Q000706:statistics & numerical data*; D011788:Quality of Life; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012574:Schools / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: health inequalities; multilevel analysis; oral health; quality of life; social determinants of health