Keywords
general health behaviors - oral health behaviors - adults - National Health and Nutrition
Examination Survey - risk behaviors
Introduction
General health is associated with the health of all organs of the body, one of which
is the mouth. The mouth and body are intertwined; diseases of the mouth can adversely
affect an individual’s overall health and quality of life.[1] Diseases of the cardiovascular system, immune system, diabetes, as well as neurological
and congenital disorders are linked to the health of the oral cavity.[2]
[3]
[4]
[5] Likewise, diseases of the mouth, such as dental infections and teeth loss, can adversely
affect chronic diseases such as diabetes, kidney disease, and cardiovascular disease.[4]
[6] The connection between the oral health and general health is believed to be due
to common risk factors and/or behaviors, for example, smoking, alcohol use, physical
activity, and maintaining proper weight.
Samnieng et al, in a geriatric population, found that general health practices were
associated with the clinical oral health status such as the number of teeth present,
decayed teeth, periodontal disease, oral malodor, and salivary flow rate.[7] Petersen et al found that adolescents with high levels of preventive oral health
practices also demonstrated general health-promoting behaviors.[8] This is supported by Tada and Maksukubo’s study that found tooth-brushing frequency
was the most predictive indicator of general health behavior.[9]
Since there are common risk factors that are directly or indirectly related to poor
oral health and poor general health,[7] it is crucial to examine these factors and the nature of their relationship with
each other. One of the benefits of understanding the relationship between general
and oral health behaviors is to manage poor behaviors to improve other behaviors related
to them, thereby reducing unfavorable general and oral health conditions.[7] Another benefit is cost-effectiveness. It is more cost-effective to integrate oral
health promotion into general health promotion than to target single oral health diseases.[8] Hence, if certain health behaviors are strongly correlated, it will be more efficient
to target all such behaviors in similar interventional or promotional programs, which
in turn can also result in positive outcomes for nontargeted behaviors. Similarly,
if associations between certain risk factors are weak, then changes in one behavior
is not expected to cause changes in all other behaviors.[8]
[10]
Therefore, this study aims to examine the relationship between general health behaviors
and oral health behaviors in adults who participated in the National Health and Nutrition
Examination Survey (NHANES) of 2015 to 2016.
Materials and Methods
This project used the 2015–2016 NHANES data set focusing on the findings of the 5,992
adults (≥18 years old) who participated in the home interview. NHANES is a cross-sectional
assessment of the health and nutrition status of US children and adults conducted
every 2 years. It uses stratified, multistage probability sampling, to produce a representative
sample of the civilian, noninstitutionalized US population.[11] There is an oversampling of low-income persons, African Americans, Mexican Americans,
adolescents aged 12 to 19 years, and persons 60 years and older.
The data are accessible to the public through the Centers for Disease Control and
Prevention NHANES data Web site.[12] This project was exempted from the institutional review board review because it
used anonymous secondary data set.
NHANES has a complex design that employed unequal chances of selection for the respondents
by race and Hispanic origin, income, age, and sex. Each respondent in the NHANES sample
is given a case weight, which estimated the number of people in the target population
that each person represents.
Variables describing oral health behavior were selected as dependent variables: time
of last visit to a dentist, the main reason for that visit, embarrassment of the mouth
condition in the previous year, and flossing frequency. Each of these variables was
rescaled in the multivariate regression analysis because there were many scales (i.e.,
many answer choices) in each of these variables that affected the analysis and the
interpretation of the results. Therefore, time to last visit to a dentist was rescaled
from 7 scales to 4, embarrassment of the mouth was rescaled from 5 scales to 3, and
flossing frequency, which was a continuous variable, was recategorized into a categorical
variable of 2 scales; flossing less than three times per week and flossing three or
more times per week.
Health care utilization (i.e., health facility used and mental therapy), physical
activity, sexual behavior, and tobacco use were selected as independent variables.
Six demographic variables were considered covariates: gender, age, race, citizenship
status, level of education, and ratio of family income. All demographic variables
were categorical except age, which is a continuous variable. Individuals 80 years
and older are top coded at 80 years of age. In the multivariate regression analysis,
age is categorized into four categories: adults < 30 years old, 30 to 44 years old,
45 to 64 years old, and ≥ 65 years old. NHANES uses the Department of Health and Human
Services poverty guidelines to calculate the ratio of family income to poverty[13] and scaled it 1 to 5. The ratio was calculated by dividing family (or individual)
income by the poverty guidelines specific to the survey year. Values at or above 5.00
were coded as 5.00.[14]
Logistic regression was used to examine the relationship of demographic data and the
dependent variables; statistically significant findings were controlled for in all
analyses to rule out the effect of demographics on oral health behaviors. The data
were weighted according to population distributions of different demographic groups
and complex sampling methods were used to adjust sampling biases.
Descriptive statistics were used to describe the sample. Chi-squared independent test
was used to assess the association of demographic data with oral health behaviors.
Binary logistics regression was used to examine the association of independent variables
with flossing frequency. Multinomial logistic regression was used to examine the associations
of independent variables with the categorical dependent variables (i.e., time to last
visit to a dentist, main reason for a visit, and previous embarrassment of the mouth).
SPSS Statistical Software Version 23 (IBM Corp., Armonk, N.Y., United States) was
used to perform the analysis. Bonferroni correction was used to determine adjusted
p-values for multiple hypothesis testing. A p-value of 0.05 or less was considered statistically significant.
Results
There were 5,992 adults, and approximately 83% of them were US citizens. There were
2,887 (48.2%) men and 3,105 (51.8%) women. Age of participants ranged from 18 to 80
(or older) years, with a mean age of 48.12 (±18.52) years. More than half of the sample
population consisted of non-Hispanic whites (1,914 or 31.9%) or non-Hispanic blacks
(1,265 or 21.1%). The remaining race/ethnicity distribution was Mexican Americans
(1,064 or 17.8%), other Hispanics (798 or 13.3%), non-Hispanic Asians (726 or 12.1%),
and other races (225 or 3.8%).
Less than half (43.4%) of the participants had a high school diploma or less, 28%
had some college, and 23% had college or graduate degrees. The mean ratio of family
income to poverty was 2.4 (±1.6). The association of demographic data with oral health
behavior is seen in [Table 1].
Table 1
The relationship of demographics with oral health behaviors in US adults aged 18 to
≥ 80 years (n = 5,992) (NHANES 2015–2016, weighted)
|
Gender (%)
|
Age (%)
|
Citizenship (%)
|
Educationa (%)
|
Raceb (%)
|
Family income ratio (%)
|
|
Abbreviations: chi-squared test of independence was used in the analysis; NA, not
available.
aEducation:1 is high school graduate or less, 2 is some college, and 3 is college graduate
or higher.
bRace: H is Hispanic, W is white, B is Black, A is Asian, and O is other.
|
|
Last visit to a dentist
|
M; F
|
p < 0.001
|
<30; 30–45; 45–65; >65
|
p < 0.001
|
Y, N
|
p < 0.001
|
1; 2; 3
|
p < 0.001
|
H; W; B; A; O
|
p < 0.001
|
<1; 1–2.5; 2.5–4; 4–5
|
p < 0.001
|
|
<1 y ago
|
45; 55
|
19.0; 23.6; 35.5; 21.8
|
92.8, 7.2
|
29; 30.8; 40.2
|
12; 67.9; 0.2; 6.4; 3.6
|
9.6; 23.4; 19.8; 47.2
|
|
1–3 y ago
|
50.4; 49.6
|
27.6; 27.0; 31.4; 14.0
|
88.4, 11.6
|
43.3; 35.3; 21.4
|
20.1; 56; 14.9; 5; 4
|
19.2; 32.6; 23.8; 24.4
|
|
≥3 y ago
|
53.7; 46.3
|
18.2; 26.8; 34.8; 20.2
|
88.4, 11.6
|
50.2; 32.8; 16.9
|
19; 61.1; 11.6; 4.4; 4
|
22; 40; 18.1; 19.9
|
|
Never been to a dentist
|
69.6; 30.4
|
33.9; 36.7; 19.9; 9.4
|
37, 63
|
76.2; 14.7; 9.1
|
53.7; 10.3; 19.9; 15.5; 0.6
|
50.2; 36.8; 6.4; 6.5
|
|
Main reason to visit
|
p = 0.634
|
|
p < 0.001
|
|
p < 0.001
|
|
p < 0.001
|
|
p < 0.001
|
|
p < 0.001
|
|
Went in on own for checkup
|
46.8; 53.2
|
22.5; 27.9; 32.3; 17.3
|
91.5, 8.5
|
28.5; 31.5; 40
|
13.5; 66.9; 10; 6.5; 3.2
|
9.8 23.9 19.7 46.6
|
|
Was called in for a checkup
|
48.8; 51.2
|
20.2; 23.5; 37.2; 19.0
|
96.1, 3.9
|
24.9; 31.7; 43.5
|
8.7; 69.8; 9.1; 5.6; 6.8
|
9.4; 18.2; 22.6; 49.8
|
|
Something was hurting
|
50; 50
|
17.6; 23.7; 37.7; 21.0
|
89.7, 10.3
|
51.5; 34; 14.5
|
17.7; 58.1; 15.2; 4.4; 4.6
|
22; 37.9; 19.3; 20.8
|
|
Treatment of a condition
|
48.5; 51.5
|
18.2; 16.9; 37.4; 27.4
|
88.2, 11.8
|
43.2; 32.2; 24.6
|
20.7; 61.2; 10.2; 4.9; 3
|
19.2; 37.0; 22.5; 21.3
|
|
Embarrassment of the mouth in the last year
|
p = 0.005
|
|
p = 0.054
|
|
p = 0.433
|
|
p < 0.001
|
|
p < 0.001
|
|
p < 0.001
|
|
Often
|
41.1; 48.9
|
NA; 27.6; 52.1; 20.3
|
89.5, 10.5
|
51.2; 36.3; 12.5
|
19.8; 58.9; 15.4; 1.6; 4.3
|
29.4 41.5 14.8 14.2
|
|
Occasionally
|
40.6; 59.4
|
NA; 32; 43.4; 24.6
|
91.9, 8.1
|
40.4; 39.9; 19.7
|
14.8; 67.2; 10.2; 3; 4.8
|
17.2; 33.6; 25.3; 23.9
|
|
Never/hardly
|
49.1; 50.9
|
NA; 32; 42.3; 25.6
|
90.8,,9.2
|
33.2; 29.9; 36.9
|
13.3; 66.6; 10.3; 6.4; 3.4
|
10.6; 25.3; 19.7; 44.4
|
|
Flossing times/wk
|
p < 0.001
|
|
p < 0.001
|
|
p < 0.001
|
|
p < 0.001
|
|
p = 0.095
|
|
p < 0.001
|
|
≥3 times
|
41.5; 58.5
|
NA; 27.4; 46.3; 26.3
|
92.5, 7.2
|
27.6; 32.8; 39.6
|
13.3; 66.9; 9.8; 6.3; 3.7
|
10.1 24.1 18.7 47.1
|
More than half of participants (52.5%) visited a doctor’s clinic or a health maintenance
organization of medical care, around one-quarter (24.2%) visited a clinic or a health
center, and the rest visited a hospital or another place. Less than 10% (8.8%) reported
receiving mental health therapy.
Just more than one-fifth (20.7%) of participants reported having vigorous work activity
with a mean of 4.03 days/week (±1.83), and 37.7% had moderate work activity with a
mean of 4.2 days/week (±1.80). Of those who exercised, 26% had vigorous recreational
activity with a mean of 3.3 days/week (±1.57), and ~41% had moderate recreational
activity with a mean of 3.5 days/week (±1.80). Twenty-three percent of participants
reported that they walk or use bicycle, with a mean of 4.6 days/week (±1.95).
Approximately 67% of participants spent 1 to 5 hours/day watching TV or playing video
games in the last 30 days, and 16.5% reported more than 5 hours/day. Forty- five percent
reported spending 1 to 5 hours/day using a computer in the last 30 days with around
35% never having used a computer in the last 30 days. Sixty percent did not respond
to the question regarding tobacco use. Of the 40% who answered, 34.4% reported smoking
daily, 18% used e-cigarettes, and 14% used smokeless tobacco, and ~55% reported never
smoking. Those who tried to quit smoking were ~55%.
Among those who shared information about their sexual behavior, 5% reported having
sex for the first time when they were younger than 12 years, and 52% between 12 and
18 years old. Those who reported using protection when performing oral sex were 8%,
and 82.4% reported that they never used protection. In addition, 18% reported having
a new sexual partner each year, and 45% reported that they never used condom when
having sex, and about one-quarter reported using condoms all the time when having
sex.
More than half of the study sample participants had seen a dentist in the previous
year (53.6%), and only 2.4% had never been to a dentist. Twenty-seven percent had
not seen a dentist for more than a year but less than 5 years, and approximately 16%
reported their last dental visit being more than 5 years ago. The most common reason
for the last visit to a dentist was going in for checkup, examination, or cleaning
(47.3%). More than one-quarter (28.7%) reported visiting a dentist because something
was hurting or bothering them. The majority of respondents (63.4%) reported being
hardly ever or never having been embarrassed by their mouth condition, less than 20%
were often or occasionally embarrassed, and 20.9% did not report anything. Approximately
44% reported flossing less than three times per week, 35% reported more than three
times a week, and 21% did not report anything.
Multivariate Analysis
Participants who reported having a new sexual partner each year were three times more
likely to visit a dentist compared with those who did not have new sexual partners
each year ([Table 2]). Having sex at an earlier age was significantly associated with having visited
a dentist because something was bothering or hurting.
Table 2
Relationship of sexual behavior with oral health behaviors
|
OR
|
p-Valuea
|
95% CI
|
|
Abbreviations: CI, confidence interval; OR, odds ratio.
Note: Only significant variables are included.
a”Never have been to a dentist’’ is the reference group for time since the last visit
to a dentist.
b”Went in on own for checkup, examination, or cleaning” is the reference group for
main reason of the last visit.
c”Hardly ever or never embarrassed of the mouth” is the reference group for embarrassment
of the mouth.
|
|
Time since last visit to a dentist
a
|
|
Less than a year ago
|
|
Have new partner each year
|
3.06
|
0.036
|
1.08–8.67
|
|
Didn’t have a new partner each year
|
1
|
|
|
|
More than a year but not more than 3 y ago
|
|
Have new partner each year
|
3.09
|
0.036
|
1.06–9.02
|
|
Didn’t have a new partner each year
|
1
|
|
|
|
More than 3 y ago
|
|
Have new partner each year
|
3.59
|
0.021
|
1.21–10.63
|
|
Didn’t have a new partner each year
|
1
|
|
|
|
Main reason of the last visit to a dentist
b
|
|
Something was wrong bothering or hurting
|
|
Had sex when was 12 y or younger
|
2.80
|
0.002
|
1.46–5.38
|
|
Had sex when was 12–18 y old
|
1.81
|
0.001
|
1.28–2.55
|
|
Had sex at 18 y or older
|
1
|
|
|
|
Went for treatment of a condition that dentist discovered earlier
|
|
Have new partner each year
|
0.462
|
0.028
|
0.232–0.921
|
|
Didn’t have a new partner each year
|
1
|
|
|
|
Embarrassment of the mouth
c
|
|
Often embarrassed
|
|
Had sex when was 12 y or younger
|
3.36
|
0.005
|
1.45–7.79
|
|
Had sex at 18 y or older
|
1
|
|
|
|
Occasionally embarrassed
|
|
Use condom half of the time
|
0.245
|
0.019
|
0.075–0.797
|
|
Use condoms more than half of the time
|
0.255
|
0.015
|
0.085–0.768
|
|
Use condoms always
|
1
|
|
|
Regarding the relationship of health care utilization with oral health behaviors,
two variables were used to predict oral health behaviors: the facility that was usually
used for health care and mental health counseling. None of the associations between
the health care facilities used and oral health behaviors were statistically significant.
Mental health counseling was significantly associated with timing of the last dental
visit. Those having had mental health counseling were more likely to have visited
a dentist within the previous year (odds ratio [OR]: 5.013; 95% confidence interval
[CI]: 1.006–24.971, p = 0.049) or have visited a dentist more than a year ago but less than 3 years ago
(OR: 6.984; 95% CI: 1.396–34.926, p = 0.018) compared with those who never visited a dentist. Furthermore, they were
more likely to visit a dentist for treatment of a condition that was discovered earlier
(OR: 1.78; 95% CI: 1.16–2.71, p = 0.008) and were more likely to be occasionally or often embarrassed than never
embarrassed (OR: 1.70; 95% CI: 1.0–2.90, p = 0.049) and (OR: 2.22; 95% CI: 1.44–3.43, p < 0.0001), respectively. Flossing frequency was not statistically significant.
As seen in [Table 3], computer use was statistically significant with the timing of the last dental visit,
being embarrassed of their mouth condition or flossing frequency. Other sedentary
physical activities (i.e., watching TV or playing video games) were not statistically
significant.
Table 3
Relationship of physical activity with oral health behaviors
|
OR
|
p-Valuea
|
95% CI
|
|
Abbreviations: CI, confidence interval; OR, odds ratio.
Note: Only significant variables are included.
a”Never been to a dentist” is the reference group for time since last visit to a dentist.
b”Went in on own for checkup, examination, or cleaning” is the reference group for
main reason of the last visit.
c”Hardly ever or never embarrassed of the mouth” is the reference group for embarrassment
of the mouth.
d”Flossing less than three times/week” is the reference group for flossing times.
|
|
Time since last visit to a dentist
a
|
|
Less than a year ago
|
|
Moderate recreational activity
|
1.62
|
0.042
|
1.02–2.57
|
|
No moderate recreational activity
|
1
|
0.009
|
1.23–4.40
|
|
Use computer 1 h or less
|
2.33
|
0.001
|
1.69–7.28
|
|
Use computer 2–4 h
|
3.05
|
|
|
|
Doesn’t use computers
|
1
|
|
|
|
More than a year but less than 3 y ago
|
|
Use computer 2–4 h
|
3.68
|
0.001
|
1.76–7.7
|
|
Doesn’t use computers
|
1
|
|
|
|
More than 3 y ago
|
|
Use computer 1 h or less
|
2.02
|
0.031
|
1.07–3.85
|
|
Use computer 2–4 h
|
2.92
|
0.005
|
1.39–6.07
|
|
Doesn’t use computers
|
1
|
|
|
|
Main reason of the last visit to a dentist
b
|
|
Something was wrong, bothering or hurting
|
|
Vigorous work activity
|
1.56
|
<0.0001
|
1.24–2.06
|
|
No vigorous work activity
|
1
|
|
Walk or bike
|
0.79
|
0.036
|
0.63–0.98
|
|
Doesn’t walk or bike
|
1
|
|
Moderate recreational activity
|
0.74
|
0.003
|
0.601–0.902
|
|
No moderate recreational activity
|
1
|
|
Embarrassment of the mouth in the last year
c
|
|
Often embarrassed
|
|
Moderate work activity
|
1.38
|
0.046
|
1.01–1.90
|
|
No moderate work activity
|
1
|
|
Vigorous recreational activity
|
0.63
|
0.049
|
0.40–0.99
|
|
No vigorous recreational activity
|
1
|
|
Use computer 5 h or more
|
1.93
|
0.026
|
1.08–3.43
|
|
Doesn’t use computers
|
1
|
|
Occasionally embarrassed
|
|
Moderate work activity
|
1.65
|
0.009
|
1.31–2.40
|
|
No moderate work activity
|
1
|
|
Use computer 2–4 h
|
1.7
|
0.015
|
1.11–2.60
|
|
Use computer 5 h or more
|
2.16
|
0.018
|
1.14–4.11
|
|
Doesn’t use computers
|
1
|
|
Flossing more than three times per week
d
|
|
Moderate recreational activity
|
1.36
|
0.003
|
1.11–1.66
|
|
No moderate recreational activity
|
1
|
|
Use computer 1 h or less
|
1.33
|
0.014
|
1.06–1.66
|
|
Doesn’t use computers
|
1
|
Those doing moderate-intensity sports, fitness, or recreational activities during
the week were more likely to have seen a dentist within the last year, were less likely
to have visited a dentist because something was bothering or hurting them, and were
more likely to floss their teeth more than three times per week. Moderate-intensity
activity at work was associated with being embarrassed by their mouth’s condition.
[Table 3] summarizes the significant associations.
Trying to quit smoking was the only significant predictor of the relationship between
tobacco use and oral health behaviors. Those who tried to quit smoking were less likely
to have visited a dentist because something was bothering or hurting them compared
with those who never tried to quit smoking (OR: 0.64; 95% CI: 0.42–0.96, p = 0.031). Moreover, they were more likely to be often embarrassed by the condition
of their mouth (OR: 1.64; 95% CI: 1.03–2.74, p = 0.042).
Discussion
NHANES data show that participants have generally healthy oral health practices, including
regular visits to the dentist for regular checkup, cleaning, or examination without
the need to be reminded by the dental office. This positive attitude of maintaining
regular dental checkups can be attributed to having health insurance or a higher socioeconomic
status. This finding is consistent with studies conducted outside the United States.[2]
[15]
[16]
[17] Unfortunately, NHANES data in this 2-year wave did not indicate if dental insurance
was included in the participants’ overall health insurance coverage. However, having
dental coverage does not necessary indicate receipt of dental care. The Medical Expenditure
Panel Survey, in 2004, revealed that only 57% of those having private dental coverage
had visited a dental clinic compared with 32% of those having public dental coverage
had visited a dental clinic, and only 27% of those with no dental coverage had visited
a dental clinic.[18] The fact that some study participants in this sample did not visit a dentist in
the last 5 years, some had never visited a dentist, and some visited a dentist only
when they had pain or discomfort, suggests that such participants might have difficulty
in accessing oral health care, had a negative attitude toward health, or both.
It is not easy to predict reasons of poor oral health behaviors. However, studies
in different populations, including Korean, Japanese, Brazilian, Thai, Chinese, Turkish,
and the US populations,[4]
[7]
[8]
[19]
[20]
[21]
[22] have shown that poor oral health behaviors are significantly associated with poor
general health behaviors. Although there are few resources to explain the connection
between the two, health theories were insightful. Hollister and Anema reviewed several
health theories and their possible application to oral health,[10] and Dumitrescu et al tested five social-cognitive models to explain predictors of
personal oral health behaviors and intentions to improve them.[23] Conclusions of these studies and others[24]
[25] showed that health beliefs significantly affect oral health behaviors.
The relationship between demographic data and oral health behaviors indicates that
an individual’s demographic background significantly affects their oral health behaviors,
which is consistent with many studies and national reports.[2]
[8]
[17]
[20]
[22]
[26]
[27] General health behaviors have also been shown to have significant relationships
with an individual’s demographics.[17]
[20]
[28] Therefore, controlling for demographic data in the analysis decreased the number
of significant associations between independent and dependent variables, yet some
associations were still statistically significant.
Results of the examined associations in this study were not always as expected when
compared with other studies. For example, the association of age at one’s first sexual
encounter with the main reason of visiting a dentist, the association of mental health
counseling with time since the last visit to a dentist and with embarrassment of mouth,
and the association of sedentary activities with being embarrassed by the condition
of mouth indicated that better or less risky health behaviors are associated with
better oral health behaviors and vice versa, which were consistent with findings in
other studies.[8]
[9]
[17]
[27] On the other hand, there are possible explanations for unexpected associations.
Those who have a new partner each year might be concerned about the medical consequences
of their continuous new relationships that can result in a disease transmission and,
therefore, seek medical care regularly, including oral health care.[29] Another explanation, at least among women, could be the perceived importance of
needing good oral health to attract a significant other. Studies have shown that women
were more interested in their physical appearance and the use of preventive and dental
care services than men.[27]
[30] Another unexpected finding was the association of computer use with positive oral
health behaviors. However, the extended use of computers in this adult population
may be related to employment opportunities in jobs associated with a higher socioeconomic
status; the latter may usually be associated with a healthier life style. Computer
and internet use influencing oral health behaviors and health status was reported
among Korean adolescents.[31]
[32]
Inconsistency is also found among studies. For example, Jiang et al found that physical
activity and sedentary activities (i.e., watching television, playing computer games)
were weakly associated with dental health status and needs in Chinese urban adolescents.[33] However, Coulter et al reported a strong association of oral health with mental
and physical health in a nationally representative sample of HIV-infected persons
receiving medical care,[34] which is in accordance with what Petersen et al reported that vigorous physical
activity was strongly associated with positive oral and general hygiene practices.[8] However, our findings indicate that moderate, not vigorous, recreational activities
were associated with positive oral health behaviors.
Overall, a positive oral health behavior does not necessitate positivism in all general
health behaviors as suggested by Tada et al, who found that some relationships of
oral health behaviors with general health behaviors were positive and some were not.[9]
Limitations
Although NHANES data are one of the most representative national data available, the
study design is limited by sampling only a civilian, noninstitutionalized US population.
Using a secondary data analysis design limited the number and types of variables available
to select from, resulting in difficulty to decide if the outcome variables (i.e.,
oral health behaviors) included in this study were the most suitable for examining
the association between general and oral health behaviors. In addition, it is inappropriate
to conclude a causal relationship between these variables because of cross-sectional
nature of the study design. There were a lot of missing values in some variables that
hindered the inclusion of answers of many individuals who could increase the credibility
of the results if their answers were available. Another challenge that compromises
the credibility of the results is the self-reported nature of the survey, which increased
the chance of recall bias, especially when questions ask about information of behaviors
that occurred years ago.
Public Health Implications
Results of this study found that an individual’s demographics has a major influence
on oral health behaviors as do some general health behaviors (i.e., age at one’s first
sexual encounter, having a new sexual partner, mental health counseling, moderate-intensity
sports, and computer use). Based on such findings, general and oral health promotion
efforts should target risk behaviors common to both oral and general health. However,
future research is recommended to examine more in depth the significant relationship
found between such general health behaviors and oral health behaviors, to emphasize
findings of this study and to help health promotion initiatives in designing effective
programs.
