Stress and Oral Health-Related Risk Behaviours among South African Adolescents

Objective: To investigate the relationship between ability to cope with stress and oral health-related risk behaviours. Methods: A baseline cross-sectional study involving all 8th Graders from a representative sample of 21 randomly selected schools in rural Limpopo province of South Africa (N=2119). Ability to cope with stress was measured using the Antonovsky's 13-item sense of coherence (SOC) scale (Cronbach's alpha=0.69) on a self-administered questionnaire. Oral health-related risk behaviours recorded included past-month use of tobacco and alcohol, frequency of tooth-brushing and daily sugar intake, frequency of self-reported gum bleeding and intention to brush twice daily in future. Previous exposure to teaching of effect of tobacco in the mouth and attitudes to oral care were also documented. Chi-square and logistic regression was used in the data analysis. Results: The mean age of the learners was 14.6(±1.6) years. Prevalence of smoking, oral snuff and alcohol use was 9.7% (95%Confidence Interval [CI]; 7.2-13), 6% (CI; 3.3-10.4) and 13.7% (CI; 10.3-17.8) respectively. Of the learners, 38.8% had a strong SOC, 17.7% reported not brushing daily and 38.7% reported brushing twice daily. Those with strong SOC were less likely to report symptoms of depression (23.9% vs 42.4%; p<0.01), frequent bleeding gums (29.2% vs 43.6%; p<0.001) and less likely to be current tobacco and alcohol users (p<0.01). Those brushing twice daily were less likely to report bleeding gums (27.3% vs 37.4%; p<0.01) and were more likely to have had a lesson on effects of tobacco on the teeth (53.5% vs 49.2%; p=0.07). Intention to brush twice daily in future was significantly associated with strong SOC level (OR=1.35; 1.09-1.66), regular dental check-ups (OR=1.76; 1.49-2.09) and frequently attending religious activities (OR=1.57; 1.26-1.95). Conclusions: The study findings support the use of universal prevention approach, such as life-skills training, in promoting oral health in the studied population. Funding: MRC, South Africa.