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Hand and Oral Hygiene Practices Among Adolescents In International Journal of Environmental Research and Public Health Brief Report Hand and Oral Hygiene Practices among Adolescents in Dominican Republic, Suriname and Trinidad and Tobago: Prevalence, Health, Risk Behavior, Mental Health and Protective Factors Supa Pengpid 1,2 and Karl Peltzer 3,* 1 ASEAN Institute for Health Development, Mahidol University, Salaya 73170, Thailand; [email protected] 2 Department of Research Administration and Development, University of Limpopo, Sovenga 0727, South Africa 3 Department of Psychology, University of the Free State, Bloemfontein 9300, South Africa * Correspondence: [email protected] Received: 28 September 2020; Accepted: 24 October 2020; Published: 27 October 2020 Abstract: Objective: The study aimed to estimate the prevalence and correlates of oral hygiene (OH) and hand hygiene (HH) behavior among school adolescents in three Caribbean countries. Method: In all, 7476 school adolescents (median age 14 years) from the Dominican Republic, Suriname, and Trinidad and Tobago responded to the cross-sectional Global School-Based Student Health Survey (GSHS) in 2016–2017. Results: The prevalence of poor OH (tooth brushing < 2 times/day) was 16.9%, poor HH (not always before meals) was 68.2%, poor HH (not always after toilet) was 28.4%, and poor HH (not always with soap) was 52.7%. In the adjusted logistic regression analysis, current cannabis use, inadequate fruit and vegetable intake, poor mental health, and low parental support increased the odds for poor OH. Rarely or sometimes experiencing hunger, trouble from alcohol use, inadequate fruit and vegetable intake, poor mental health, and low parental support were associated with poor HH (before meals and/or after the toilet, and/or with soap). Conclusion: The survey showed poor OH and HH behavior practices. Several sociodemographic factors, health risk behaviors, poor mental health, and low parental support were associated with poor OH and/or HH behavior that can assist with tailoring OH and HH health promotion. Keywords: oral hygiene; hand hygiene; school adolescents; correlates; Caribbean 1. Introduction Oral hygiene (OH) (“tooth brushing 2/day”) is a major tool to prevent and control periodontal ≥ diseases and dental caries [1]. Good hand hygiene (HH) using soap can “avert 0.5–1.4 million deaths every year” [2]. Despite the potential positive impact of good OH and HH, the prevalence of good OH and HH practices among adolescents is low [3–8]. There is a lack of recent national information on OH and HH among adolescents in Caribbean countries, such as the Dominican Republic, Suriname, and Trinidad and Tobago [4]. Among school adolescents in 15 Latin American and Caribbean countries from 2006–2011, 2–9% reported infrequent (<one time/day) tooth brushing and 2–7% infrequent (never or rarely) HH after toilet use [4]. In the Dominican Republic, “risk factors for diarrhea and cholera transmission include poor adherence to water, sanitation, and hygiene (WASH) practices such as consistent hand washing” [9–11]. In Suriname, the prevalence of caries in schoolchildren was moderate to high (using WHO criteria), and the majority of children had dental caries [12]. The prevalence of tooth-cleaning ( 2 times/day) among adults in the Dominican Republic was 94.2% [13]. ≥ Int. J. Environ. Res. Public Health 2020, 17, 7860; doi:10.3390/ijerph17217860 www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2020, 17, 7860 2 of 8 In a multi-country investigation among school adolescents, most of the respondents (80%) reported daily tooth brushing, and more than one in 20 students brushed their teeth “less than once a day or never” in half of the countries [5], including 10.0% in Zambia [14]. In a study among school-going adolescents in nine African countries, the results showed that 22.7% had poor OH (tooth brushing < 2/day), 62.2% had poor HH (not always before meals), 58.4% had poor HH (not always after toilet), and 35.0% had poor HH (not always with soap) [15], whereas in six Southeast Asian countries, 17.1% had poor OH, 44.8% had poor HH (before meals), 31.9% had poor HH (after toilet), and 55.8% had poor HH (with soap) [3]. As reviewed earlier [3], “factors associated with poor OH among adolescents include sociodemographic variables (early adolescence, male sex, and lower wealth status), health risk behaviours (insufficient fruit and vegetable consumption, physical inactivity, and tobacco use), poor mental health and lack of parental support”. Factors associated with poor HH among adolescents [3], include “male sex, lower wealth status, health risk behaviours (low fruit and vegetable consumption, sedentary behaviour and physical inactivity, and substance use), poor mental health, and lack of parental support”. Recent national data on the prevalence and correlates of OH and HH among adolescents are lacking in the Caribbean region. Therefore, the aim of this study was to assess the prevalence of OH and HH in three Caribbean countries. We looked at sociodemographic factors, health risk behaviors, and protective factors of poor OH and HH among adolescents in the Dominican Republic, Suriname, and Trinidad and Tobago in 2016–2017. 2. Methods 2.1. Sample and Procedures Cross-sectional nationally representative survey data from the 2016 Dominican Republic, 2016 Suriname, and 2017 Trinidad and Tobago Global School-Based Student Health Survey (GSHS) were analyzed [16]. The sampling approach included a two-stage sampling design, including schools and classes. All school students present in a selected classroom were eligible to participate by filling in a self-administered anonymous questionnaire [16]. Information that was more detailed can be publically accessed [16]; the overall response rate was 63% in the Dominican Republic, 83% in Suriname, and 89% in Trinidad and Tobago [16]. Ethical approval was obtained from the ethics committees in each study country, and participants gave written consent [16]. 2.2. Measures The GSHS questions used [16] are described in Supplementary Table S1. Oral hygiene was sourced from the question, “During the past 30 days, how many times per day did you usually clean or brush your teeth?” Responses ranged from “1 = I did not clean or brush my teeth during the past 30 days to 4 = 6 or more times per day (coded 1–3 = 1 and 4–6 = 0)”. Hand hygiene was sourced from three items. “During the past 30 days, how often did you wash your hands before eating/after using the toilet or latrine/use soap?” Response options ranged from “1 = never to 5 = always (coded 1–4 = 1 and 5 = 0)”. Sociodemographic information included country, sex, age, and experiences of hunger (as a proxy for economic status). Health risk behaviors assessed included current tobacco use, trouble from alcohol use, current cannabis use, fruit and vegetable consumption, leisure-time sedentary behavior, physical activity, and attendance of physical education classes. Poor mental health was defined as “0 = 0 low, 1 = 1 medium, and 2–5 = 2 high based on positive responses to the items no close friends, loneliness, anxiety, suicidal ideation and suicide attempt” [3]. Protective factors included school attendance, peer, and parental support. “The four items on parental Int. J. Environ. Res. Public Health 2020, 17, 7860 3 of 8 or guardian support were summed and classified into three groups, 0–1 low, 2 medium, and 3–4 high support” [3]. 2.3. Data Analysis Statistical analyses were conducted with STATA software version 15 (Stata Corporation, College Station, TX, USA), taking into account the sampling weights and multistage sampling design. Multivariable logistic regression analyses were used to predict the covariates of poor OH (tooth brushing <2/day), poor HH (not always before meals), poor HH (not always after toilet), and poor HH (not always with soap). Missing variable information was excluded from the analysis and p-values < 0.05 indicated statistical significance. 3. Results 3.1. Sample Characteristics and Hygiene Behavior The study sample comprised 7476 school adolescents (14 years median age; interquartile range = 13–16) from the Dominican Republic, Suriname and Trinidad and Tobago. In all three countries, the prevalence of poor OH (<twice a day tooth brushing) was 16.9%, poor HH (not always before meals) was 68.2%, poor HH (not always after toilet) was 28.4%, and poor HH (not always with soap) was 52.7% (see Table1). Table 1. Characteristics of the sample and hygiene behavior in the Dominican Republic, Suriname, and Trinidad and Tobago, 2016–2017. Variable Sample Not Always Hand Hygiene Oral Hygiene Before After With Tooth Brushing < 2/day Meals Toilet Soap N (%) % % % % All 7476 68.2 28.4 52.7 16.9 Sociodemographic variables Country Dominican Republic 1481 (19.8) 69.9 30.7 51.2 16.2 Suriname 2126 (28.4) 46.0 14.1 56.2 14.3 Trinidad and Tobago 3869 (51.8) 66.6 19.8 60.3 22.1 Gender Female 3916 (50.6) 68.1 28.0 52.2 14.0 Male 3466 (49.4) 67.5 26.3 51.7 16.8 Age in years 13 2210 (29.7) 56.9 22.8 50.1 17.0 ≤ 14–15 3148 (42.3) 67.5 26.1 47.4 14.9 16 2083 (28.0) 71.8 31.4 57.3 17.8 ≥ Went hungry Never 4011 (62.2) 64.4 23.6 48.4 15.2 Rarely/sometimes 2802 (33.9) 75.2 35.9 60.0 17.9 Mostly/always 589 (3.9) 67.2 31.6 53.5 26.0 Health risk behavior Current tobacco use 910 (12.1) 73.9 44.3 59.4 31.2 Trouble from alcohol use 661 (12.1) 71.8 41.5 69.0 25.1 Current cannabis use 365 (4.4) 67.5 42.6 62.1 32.1 Fruit/Vegetables (<5 servings/day) 5756 (82.4) 70.5 28.2 54.5 17.6 Sedentary behavior 3354 (47.4) 71.3 27.8 55.4 18.5 Physical inactivity 5920 (86.6) 68.3 28.5 53.1 17.5 No physical education 2117 (27.3) 72.7 33.4 58.2 21.5 Poor mental health Low 4200 (64.4) 64.7 23.1 50.3 12.9 Moderate 1440 (18.4) 71.1 32.1 55.0 20.2 High 1309 (17.3) 74.1 37.3 55.8 19.7 Int.
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