The Effects of Socioeconomic Status on Dental Health Care Knowledge, Behavior, and Utilization among Shanghai Residents

Objectives: The purpose was to assess the current status of dental health knowledge (DHK), dental health behavior (DHB), and dental health utilization (DHU) of Shanghai residents with different exposure to dental public health initiatives (PH), and socioeconomic status (SES). Research on economic variables and dental health is almost non-existent in China and abroad. Methods: Volunteers (N=387) who were randomly recruited from government run hospitals and clinics throughout Shanghai, were asked to complete a 65-item, forced-choice questionnaire in Chinese. (A) DHK is defined by floss awareness, the benefits of fluoride, and sugar restriction. (B) DHB is defined by the frequency of brushing, use of toothpaste, floss, and fluoride products. (C) DHU is defined by the number of visits to the dentist, reasons for receiving dental care, and perceived importance of dental care. Data analysis consisted of univariate regression models for the variables. Multivariate linear regression models were then fit with the variables and a final model was determined by stepwise selection. Results: The results indicate that subjects who are more educated, have workplace insurance, and purchase more commercial products (variables of SES) are (A) more knowledgeable about how to brush, the use of floss, and the benefits of fluoride and sugar restriction (p<0.001, p<0.01, and p<0.03 respectively). Additionally, those of higher education and of greater dental health knowledge, whom have workplace dental insurance and who purchase more (B) tend to brush, use toothpaste, floss, and fluoride products more frequently (p<0.01, p<0.0001, p<0.02, p<0.04 respectively) and regard dental visits as more important (p<0.001). After controlling for SES, DHK, DHB, and PH continue to be positively associated with DHU (p<0.008). Conclusions: In conclusion, improved measures of DHK, DHB, and DHU appear among Shanghai residents of higher SES. DHU is dependent upon DHK, DHB, and PH regardless of SES.