Search

BackgroundWhile inequalities in oral health are documented, little is known about the extent to which they are attributable to potentially modifiable factors. We examined the role of behavioural and dental attendance pathways in explaining oral health inequalities among adults in England, Wales and Northern Ireland.MethodsUsing nationally representative data, we analysed inequalities in self-rated oral health and number of natural teeth. Highest educational attainment, equivalised household income and occupational social class were used to derive a latent socioeconomic position (SEP) variable. Pathways were dental attendance and behaviours (smoking and oral hygiene). We used structural equation modelling to test the hypothesis that SEP influences oral health directly and also indirectly via dental attendance and behavioural pathways.ResultsLower SEP was directly associated with fewer natural teeth and worse self-rated oral health (standardised path coefficients, −0.21 (SE=0.01) and −0.10 (SE=0.01), respectively). We also found significant indirect effects via behavioural factors for both outcomes and via dental attendance primarily for self-rated oral health. While the standardised parameters of total effects were similar between the two outcomes, for number of teeth, the estimated effect of SEP was mostly direct while for self-rated oral health, it was almost equally split between direct and indirect effects.ConclusionReducing inequalities in dental attendance and health behaviours is necessary but not sufficient to tackle socioeconomic inequalities in oral health.

Background Socioeconomic position (SEP) influences adult health. People who experienced material disadvantages in childhood or adulthood tend to have higher adult disease levels than their peers from more advantaged backgrounds. Even so, life is a dynamic process and contains a series of transitions that could lead people through different socioeconomic paths. Research on social mobility takes this into account by adopting a trajectory approach, thereby providing a long-term view of the effect of SEP on health. The aim of this research is examine the effects of intergenerational social mobility on adult general health, oral health and functioning in a population aged 50 and over in England. Methods This study is based on the secondary analysis of data from the English Longitudinal Study of Ageing (ELSA). Using cross-sectional data, nine social trajectories were created based on parental and adult occupational socio-economic position. Regression models were used to estimate the associations between social trajectories and the following outcomes: adult self-rated health, self-rated oral health, oral health related quality of life, total tooth loss and grip strength; while controlling for socio-economic background and health related behaviours. Results Associations with adult SEP were generally stronger than with childhood SEP, suggesting a stronger influence of proximal rather than distal SEP on health and oral health. Compared to the stable high group, being in the low SEP groups in childhood and adulthood was associated with poorer health and oral health for all examined outcome measures. For adult self-rated health and edentulousness, graded associations with social mobility trajectories were observed. Conclusion Intergenerational social mobility was associated with self-rated health and total tooth loss. Compared to only those who remained in a low SEP group over time reported worse self-rated oral health and oral health related quality of life, and had lower grip strength measurements. Potential limitations in relation to data quality will be discussed.

Introduction: Alcohol misuse is a significant public health problem with major health, social and economic consequences. Systematic reviews have reported that brief advice interventions delivered in various health service settings can reduce harmful drinking. Although the links between alcohol and oral health are well established and dentists come into contact with large numbers of otherwise healthy patients regularly, no studies have been conducted in the UK to test the feasibility of delivering brief advice about alcohol in general dental settings. Methods and analysis: The Dental Alcohol Reduction Trial (DART) aims to assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice in patients attending National Health Service (NHS) general dental practices in North London. DART is a cluster randomised control feasibility trial and uses a mixed methods approach throughout the development, design, delivery and evaluation of the intervention. It will be conducted in 12 NHS general dental practices across North London and will include dental patients who drink above the recommended guidance, as measured by the Alcohol Use Disorders Identification Test (AUDIT-C) screening tool. The intervention involves 5 min of tailored brief advice delivered by dental practitioners during the patient’s appointment. Feasibility and acceptability measures as well as suitability of proposed primary outcomes of alcohol consumption will be assessed. Initial economic evaluation will be undertaken. Recruitment and retention rates as well as acceptability of the study procedures from screening to follow-up will be measured. Ethics and dissemination: Ethical approval was obtained from the Camden and Islington Research Ethics Committee. Study outputs will be disseminated via scientific publications, newsletters, reports and conference presentations to a range of professional and patient groups and stakeholders. Based on the results of the trial, recommendations will be made on the conduct of a definitive randomised controlled trial. Trial registration number: ISRCTN81193263.

Background The relevance of neighbourhoods for children’s cognitive development, while receiving increasing attention, is still subject to debate. One mechanism that has been proposed is via institutional resources such as schools. Another hypothesis is that neighbourhood aspects influence maternal psychological well-being and parenting practices. However, the contribution of schools to the neighbourhood effect is understudied, and findings regarding the role of maternal mental health and parenting have so far been inconsistent. The aim of this research was twofold: first, to partition the variability in children’s cognitive test performance between neighbourhoods, schools and families, and second, to examine whether maternal psychological distress and parenting practices were on the pathway between neighbourhood characteristics and these outcomes. Methods We analysed data from the UK Millennium Cohort Study. Outcome measures were cognitive test performance at age 7 in reading, maths and a pattern construction test. Data were analysed for 9,412 children who had not changed school and lived in the same neighbourhood since age 5, and for whom information was complete. Neighbourhoods were defined as Lower Layer Super Output Areas. Cross-classified multilevel models were used to simultaneously estimate the variability in cognitive test outcomes between neighbourhoods and schools before and after adjusting for family-level covariates; and to examine the contribution of maternal psychological distress and parenting practices. Results At age 7, the percentage of the unadjusted variance in cognitive test performance between neighbourhoods was about 5% for reading, 9% for maths and 7% for pattern construction. The unadjusted variance between schools was about 10% for reading, 12% for maths, and 6% for pattern construction. After allowing for a range of family background characteristics, the neighbourhood variance for reading was no longer statistically significant, while a school effect of about 7% remained. For maths, the remaining variance attributable to neighbourhoods and schools was 7% and 10% respectively, while for pattern construction, this was about 3% at both levels. Reading and math test performance were independently associated with neighbourhood median household income, and pattern construction scores with the IMD education domain in the expected direction. Our data did not support the hypothesis of a mediating effect via maternal psychological distress and parenting practices. Conclusion Our findings highlight the importance of including both neighbourhoods and schools when aiming to determine the contribution of contextual factors to children’s cognitive test performance. Differences between neighbourhoods and schools appear to contribute to inequalities in children’s cognitive development already at this early age.