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Oral Health Knowledge, Attitudes and Behaviour of Children and Adolescents in China

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Oral Health Knowledge, Attitudes and Behaviour of Children and Adolescents in China International Dental Journal (2003) 53, 289–298 Oral health knowledge, attitudes and behaviour of children and adolescents in China Ling Zhu Beijing, China Poul Erik Petersen Geneva, Switzerland Hong-Ying Wang, Jin-You Bian and Bo-Xue Zhang Beijing, China Objectives: A national representative study to describe oral health During the past two decades, many behaviour, illness behaviour, oral health knowledge and attitudes among industrialised countries have expe- 12-year-old and 18-year-old Chinese, to analyse the oral health behaviour rienced a dramatic decline in dental profile of the two age groups in relation to province and urbanisation, and to caries prevalence of children and assess the relative effect of socio-behavioural risk factors on dental caries adolescents14. The reasons for the experience. Methods: The total number of 4,400 of each age group were improved oral health are complex selected and data were collected by clinical examinations (WHO criteria) but may involve a more sensible and self-administered structured questionnaires. Results: 44.4% of the approach to sugar consumption, respondents brushed their teeth at least twice a day but only 17% used improved oral hygiene practices, fluoridated toothpaste. Subjects who saw a dentist during the previous 12 fluorides in toothpaste, topical fluo- months or two years were 31.3% and 35.3% for 12-year-olds and 22.5% ride application, effective use of and 20.2% for 18-year-olds, respectively. Nearly one third (29%) of 12 year- oral health services and establish- olds and 40.5% of 18-year-olds would visit a dentist in case of signs of ment of school-based preventive caries but only when in pain. Nearly half of the participants (47.2%) had programmes510. In parallel with the never received any oral health care instruction. Significant variations in oral changing oral disease patterns there health practices were found according to province and regular dental care have been significant improvements habits were more frequent in urban than in rural areas. The risk of dental in oral health awareness, dental caries was high in the case of frequent consumption of sweets and dental knowledge and attitudes of chil- caries risk was low for participants with use of fluoridated toothpaste. 1113 Conclusion: Systematic community-oriented oral health promotion dren and parents . Conversely, programmes are needed to target lifestyles and the needs of children, increasing levels of dental caries particularly for those living in rural areas. A prevention-oriented oral health have been observed in several care policy would seem more advantageous than the present curative developing countries, especially for approach. those countries where preventive programmes have not been imple- Key words: Epidemiology, oral health knowledge, oral health behaviour, oral mented1416. health habits In China, surveys of oral health status have been conducted in different provinces or local communities. Some variation in the occurrence of oral disease is found, for example in recent studies the mean dental caries experience of 12-year-olds was reported at 0.4 Correspondence to: Dr. Poul Erik Petersen, World Health Organization, Non-Communica- 1722 ble Disease Prevention and Health Promotion, Oral Health Programme, 20 Avenue Appia, 1.9 DMFT . The analysis of oral CH-1211 Geneva 27, Switzerland. Email: [email protected] health habits, knowledge and atti- © 2003 FDI/World Dental Press 0020-6539/03/05289-10 290 tudes of children was initiated in stratified cluster random sampling then transferred to the National the late 1980s and these studies were involving 11 provinces and within Committee for Oral Health in carried out in some provinces each province the total number of Beijing for central data analysis. The among urban children19,22. How- 400 subjects of the WHO standard national data file was constructed ever, such oral health behaviour ages was identified from randomly by the Department for Epidemi- data of children are scarce for rural selected schools. The schools were ology, Peking University, Faculty population groups. Since the intro- chosen from at least three loca- of Medical Science, Beijing. The duction of the national Love Teeth tions in each province and district data were finally converted for Day campaigns in 1988, a number and in urban and rural areas, analysis by means of the Statistical of health education projects have respectively. For the present study, Package for the Social Sciences been implemented at province and the survey comprised 8,800 partici- (SPSS 10.0) in the WHO Collabo- community-levels throughout the pants, i.e. 4,400 in each age group rating Centre for Community Oral country. and the final sample was balanced Health Programmes and Research, National oral health behaviour by gender and urbanisation. University of Copenhagen. Bivariate data are needed for national plan- Oral epidemiological data were and multivariate analyses of the data ning and evaluation of health collected by clinical examinations on oral health knowledge, attitudes promotion programmes and system- according to WHO methodology and behaviour were based on atic analysis of oral health behaviour and criteria and all examiners were frequency distributions. The Chi- may help the specification of oral trained and calibrated to accept- square test was used in the statistical health messages as well as devel- able standard17,24. Examinations evaluation of the bivariate frequency opment of behaviour modification were carried out in daylight. In distributions. For the assessment of strategies relevant to China. There- addition, structured questionnaires the relative effect of behavioural fore, the second national oral health were used for self-administration factors on dental caries experience, survey was designed in order to whereby the participants were multiple dummy regression analy- provide nation-wide information asked about demographic back- sis and logistic regression analysis for the analysis of both oral health ground, oral health knowledge and were performed. Dental caries status and oral health knowledge, attitudes, self-care practices, and experience index (DMFT) was the attitudes and behaviour of the utilisation of dental services. The dependent variable in the dummy Chinese population of ages 12, 18, questionnaires were filled out by regression analyses. In the logistic 3544, and 6574 years. The the respondents themselves in the regression model the dependent results from the clinical investiga- classroom and the data collection variable was represented by the tion of oral health conditions have was supervised by survey staff dichotomous presence or absence been described separately17,23. The specially trained for this activity. of caries (i.e. DMFT=1 or more, purpose of this report is to The supervisors had at least tertiary or DMFT=0); thereby the regres- describe the pattern of oral health education level and they were care- sion coefficient indicates the Odds behaviour, illness behaviour, oral fully instructed in the rationality and Ratio (OR=P/1-P) of caries. For health knowledge and attitudes meaning of questions. Prior to the the statistical evaluation of the among 12-year-old and 18-year- data collection the questions were regression coefficients, the t-test was old Chinese at the national level; to pre-tested among comparable used in the dummy regression analyse the oral health behaviour groups of children in order to whereas the Wald-test was chosen profile of the two age groups in assess reliability and validity. In each in the logistic regression. relation to province and urbanisa- province one dentist was in charge tion, and to assess the relative of the organisation of clinical Results effect of socio-behavioural risk examinations as well as administra- factors on caries experience. tion of questionnaires. Oral hygiene habits Processing of data was performed Tables 12 summarise the findings by use of EPI-INFO v5.0 (Chinese concerning tooth brushing habits Study population and version) whereby data were checked of 12- and 18-year-olds. No signifi- methods for logical errors. The data entry cant differences in tooth brushing The present study is part of the took place in every province and behaviour were found according 2nd comprehensive national oral the staff members were carefully to gender. In all, nearly half of the health survey, which was completed trained on how to use the data respondents claimed to brush their in China in 199617. The study popu- input program. Double data entry teeth at least twice a day and such lation and principles of sampling was carried out. All questionnaires practice was reported more often have been detailed in previous were collected from each prov- in urban than in rural areas. The reports17,24. The participants of this ince, checked for logical errors by majority of children and adoles- survey were chosen by multistage use of EPI-INFO and the files were cents brushed their teeth in the International Dental Journal (2003) Vol. 53/No.5 291 Table 1 The percentages of 12- and 18- year-old Chinese according to frequency of tooth brushing, occasion of brushing, use of toothpaste and age of starting brushing in relation to urbanisation 12 years 18 years Urban Rural Total Urban Rural Total (n=2200) (n=2200) (n=4400) (n=2200) (n=2200) (n=4400) Frequency of tooth brushing seldom or no brushing 7.2 26.3 16.8 2.0 9.5 5.8 brushing once a day 33.7 42.8 38.2 45.8 54.9 50.3 brushing at least twice a day 59.1*** 31.0 45.0 52.1*** 35.6 43.9 Occasion of tooth
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