Factors related to the use Abstract of dental services among Introduction: Access to health services, including those for oral health, depends adolescents from Gravataí, RS, upon socioeconomic, environmental and individual factors. Moreover, cultural and Brazil, in 2005 lifestyle differences also influence the de- gree to which services are sought. Objective: This study aimed to assess factors associa- Fatores associados ao uso de ted with the use of dental services among adolescents in the 7th grade of public pri- serviços odontológicos entre mary schools from the city of Gravataí, RS, Brazil, in 2005. Methods: A cross-sectional adolescentes de Gravataí, RS, em survey was carried out. Data were collec- 2005 ted in schools through self-administered questionnaires evaluating demographic, socioeconomic and psychosocial factors, lifestyle, oral health habits and behaviors of 1,170 adolescents, using the Global School- Based Student Health Survey, International Physical Activity Questionnaire and Body Shape Questionnaire. Data analysis was carried out by means of Cox regression modified for cross-sectional studies, using the STATA 6.0 software. Univariate and multivariate analyses were performed from a hierarchical conceptual model supported by the literature on hierarchical models. Results: The use of dental services was less frequent among those who reported con- cern with body image and involvement in fights; those whose parents did not know where they were in their leisure time, those who brushed their teeth less than twice a day, those who did not use dental floss daily, those who reported seeking dental services for curative treatment and those with a lower socioeconomic status. Conclusions: The results suggest that the use of dental services by adolescents depends upon the Rosane Silvia DavoglioI interaction of psychosocial and individual II Claídes Abegg factors as well as the family context. Denise Rangel Ganzo de Castro AertsIII I Postgraduate Program in Health and Biological Sciences of the Federal Keywords: Use of dental services. Dental University of Vale do São Francisco, Petrolina, PE, Brazil. care. Adolescents. Oral health. Global II Postgraduate Program in Dentistry of the Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. School-Based Student Health Survey. III Postgraduate Program in Collective Health of the Lutheran University of Brazil, Canoas, RS, Brazil. Corresponding author: Rosane Silvia Davoglio. Av. José de Sá Maniçoba, S/N – Centro, 56304-917 Petrolina, PE, Brazil. E-mail: [email protected] Rev Bras Epidemiol 546 2013; 16(2): 546-54 Resumo Introduction Introdução: O acesso a serviços, incluindo Access to health services, including os serviços odontológicos, depende de fato- those for oral health, depends upon so- res socioeconômicos, ambientais e indivi- cioeconomic, cultural, environmental and duais. Por outro lado, as diferenças, culturais individual factors1,2. Moreover, cultural and e estilo de vida também influenciam o grau lifestyle differences also influence the de- em que os serviços são utilizados. Objetivo: gree to which services are sought. According O objetivo deste estudo foi avaliar os fatores to Freeman3, oral health behaviors are also associados ao uso de serviços odontológicos influenced by adolescents’ social contacts, entre adolescentes da 7ª série de escolas tending to adopt behavior similar to their públicas do município de Gravataí, RS, peers. Among adolescents, it has been sho- no ano de 2005. Métodos: Foi realizado wn that low socioeconomic status and poor um estudo analítico transversal. Os dados mental health can increase the risk of adop- foram coletados nas escolas, por meio de ting health risk behaviors4. Additionally, questionários autoaplicados, investigando unhealthy habits such as smoking, eating fatores sociodemográficos, psicossociais, sweets and physical inactivity are associa- estilo de vida, hábitos e comportamentos ted with fewer visits to dentists and greater de saúde bucal em uma amostra de 1.170 curative needs5. The age group of adoles- adolescentes, usando o Global School-Based cents has drawn the attention of the World Student Health Survey, o Questionário Health Organization, because adolescence Internacional de Atividade Física e o Body is a period marked by considerable physical, Shape Questionnaire. A análise dos dados sexual, cognitive and emotional changes6. It foi executada no software STATA 6.0, por is a period when habits and behavior chan- meio de regressão de Cox modificada para ge, remaining in the future and influencing estudos transversais, tendo sido realizadas both their general and oral health. This is análises univariada e multivariada a par- why adolescence represents an essential tir de um modelo conceitual hierárquico time for health promotion2. In Brazil, a suportado pela literatura sobre modelos large section of the population has very hierárquicos. Resultados: O uso de servi- poor access to dental and health services. ços odontológicos foi menor para aqueles As an example, a national study performed que relataram preocupação com a imagem in 2003 showed that 22% of Brazilians, aged corporal e envolvimento em brigas, aqueles from 15 to 74 years, had never been to a cujos pais não sabiam onde os filhos esta- dentist7. This percentage was 14% among vam em seu tempo livre, que escovavam os adolescents, increasing to 22% in more dentes menos duas vezes ao dia, aqueles impoverished areas. Among all adolescents que não usavam fio dental diariamente, studied, 30% reported toothaches as the que relataram procurar os serviços odonto- reason for seeking dentists and only 34% lógicos para tratamento curativo, e aqueles made a dental appointment for routine/ com piores condições socioeconômicas. maintenance purposes7. Based on the WHO Conclusões: Os resultados sugerem que recommendations, Brazil has introduced o uso de serviços odontológicos por ado- health investigation strategies into the scho- lescentes depende da interação de fatores ols, prioritizing the 7th grade of primary edu- psicossociais e individuais, bem como do cation. Because of this new initiative and the contexto familiar. lack of information about factors affecting dental care among Brazilian adolescents, Palavras-chave: Uso de serviços odonto- the present study was conducted, aiming to lógicos. Adolescentes. Saúde bucal. Global investigate factors associated with the use School-Based Student Health Survey. of dental services among adolescents in the 7th grade of primary schools included in the Factors related to the use of dental services among adolescents from Gravataí, RS, Brazil, in 2005 547 Rev Bras Epidemiol Davoglio, R.S. et al. 2013; 16(2): 546-54 public school network of a city of the Greater conditions; physical activity, classified ac- Porto Alegre area, the capital of the state of cording to the International Physical Activity Rio Grande do Sul, in Southern Brazil. Questionnaire – IPAQ8; tobacco, alcohol and other drug use in life; experiences at home Methods and at school; feelings of depression; oral health, based upon the Global School-Based Sample Student Health Survey – GSHS6; and percep- tion of body image, using the Body Shape This is a school-based cross-sectional Questionnaire – BSQ, validated in Brazil by study. Participants were selected by clus- Cordás and Castilhos9. According to Cooper ter sampling. The city was divided into 15 et al.10, the BSQ score is classified into four administrative areas and all were included groups: 1) not concerned about body image in the study. Firstly, schools were randomly (<81 points), 2) slightly concerned (from 81 selected, followed by classes. All students to 110 points), 3) moderately concerned from the selected classes participated in (from 111 to 140 points), and 4) extremely the study. The sample calculation was ba- concerned (>140 points). For the purposes sed on a target population of 2,282 school of this study, adolescents were grouped into adolescents from Gravataí, a city of the “not concerned about body image” (up to Greater Porto Alegre area, in Southern 110 points) and “concerned about body Brazil. Considering that the study is part image” (above 110 points). of a larger research project with other ob- Explanatory variables were divided jectives, the larger estimate of prevalence into socio-demographic, psychosocial and for multiple outcomes (50%), a confidence lifestyle-related. Socio-demographic factors interval of 95% and maximum error of ± include sex, ethnicity (white, non-white) 3% were taken into consideration as refe- and economic status (B, C, D+E). The clas- rence, so that a sample of 728 subjects was sification criterion of the ABEP (Brazilian obtained. Applying a design effect of 1.5 Association of Market Research Companies) and adding 20% to compensate for losses, was used to define the economic status, the sample size increased to 1,312 adoles- considering the following five categories: cents. This number represented about half A, B, C, D, and E11. This classification takes of the schoolchildren enrolled. Because of into consideration household goods such this, it was decided that half plus one of as cars, televisions and washing machines. the groups would be randomly selected Category A is the highest and it was excluded from each of the 15 administrative regions as there were no schoolchildren classified in of Gravataí, observing the proportionality this category. Additionally, adolescents clas- of students per group. The sample totaled sified in categories D and E