Association between health behaviors and socio-demographic variables
An initial set of statistical tests examined the associations between all study health behaviors variables, with age and parent’s education. As all variables are categorized, the analyses were performed using the Chi-square test. Table2 shows that the health behavior variables that were significantly associated with both parents’ education and age are dental visits, washing hands after toilet visits, using seat belts, and consuming soft drinks.
There is a strong association between washing hands after visiting the toilet and the father’s education (P<0.001). This is also associated with the mother’s education with a p-value=0.03. Additionally, there is an association between using seat belts and mother education (p<0.001), father’s education (p=0.03), and age (p=0.003). Consuming soft drinks on the other hand was strongly associated with the mother’s education (p<0.001). Regarding smoking, the results show an association with fathers’ education (p<0.03).
Association between health behaviors and socioeconomic status variables
After running unvaried analysis for all variables, a significant association was found between visiting a dentist and mother education P=0.001 for (OR=2.9; 95% CI=1.60-5.31). Students who reported that their mothers have had higher education were more likely to visit a dentist regularly. The results again indicate an association between travailing abroad and visiting dentists regularly. Teenagers who travelled outside Saudi Arabia are more likely to visit dentists regularly compared to those who do not with an OR=2.59 (p=0.002). Doing physical activity more than five times per week had a weak association with students who reported having their bedroom (P=0.02 OR=0.39; 95% CI=0.18-0.85).
In addition, using seat belts is strongly associated with the mother’s level of education, having her bedroom, and traveling with a p-value <0.001. A strong association has been established between the frequency of consuming fast food and having own bedroom with p<0.001 (OR=3.4; 95%CI=1.89-6.27). Teenagers who have their bedroom are less likely to consume fast food with p<0.001.
Another strong association was found between consuming soft drinks and the mother’s level of education (P =0.002). Those who have a mother with higher education consume less soft drink P=0.001(OR=0.43; 95%CI=0.25-0.71). Regarding the frequency of taking showers, the results show that those who have their bedrooms are 2.7 more likely to take showers twice a day (p=0.008).
Multivariate analysis was carried out to assess the effect of potential confounders on the association between the exposure and outcome (health behaviors). After adjustment for age and all socio-economic variables, the effect of our exposure of interest was substantially reduced but remains significant in some variables (p<0.05). An example of this is the association between using a seat belt and mother education or having own bedroom and traveling abroad.
A student who has her bedroom is more likely to wear a seat belt. Moreover, the mother’s level of education is strongly associated with taking soft drinks after age adjustments and all other socioeconomic variables. Having an own bedroom, frequency of eating fast foods, and consuming soft drinks remain significant after age adjustment and other SES variables. The results after adjustment reveal that students who have their bedrooms are three times more likely to wear seat belts than those who don’t have. On the other hand, those who traveled abroad or their mothers have had higher education were less likely to wear seat belts.
The association between mothers’ education and consumption of soft drinks is significantly associated even after the adjustment of all variables (p=0.003). The frequency of taking a shower has been found strongly associated with having an own bedroom (p=0.007) and travailing abroad (p=0.01) was not altered after the adjustment for all socioeconomic status and age. The relationship between having an own bedroom and physical activity was confounded by age, parent’s education, and traveling abroad.
Regarding the association between peer social networks and health behaviors, we did not find any significant relationship like other previous studies.
Discussion
A few studies are available on the general and dental health behaviors of female teenagers in Riyadh. These studies included different questions on health behaviors and cut-offs focused on different age groups and a variety of populations. Hence, it is difficult to compare the results with these studies. The present study provides such information as regards intermediate and secondary schools. The present findings show that 89.75% of all the respondents cleaned their teeth at least once a day.
The findings in another study were 65% in Riyadh and 61% in ALMadianh (AL-Sadhan, 2003; ALTamimi &Petersen, 1998). However, it is far less than the 92-100% finding reported in some developed countries (Russel et al, 1989; Walsh, 1985). As the child grew older, they brushed their teeth more frequently which agrees with other findings of several studies (Rise et al, 1991; Honkala et al, 2002). Mother’s level of education was significantly associated with visiting a dentist regularly and drinking fewer soft drinks confirming results from previous studies (Honkala et al, 1997; Lopez et al, 2006; AL-Sadhan,2003).
However, students who reported having a mother with a high level of education are less likely to use seat belts. Students whose fathers had diplomas or university degrees were significantly associated with washing hands after using the toilet. This is similar to a previous study conducted in China (Petersen et al, 2008). Family affluence indicators such as having an own bedroom were strongly associated with most of the health behaviors (consumption of vegetables, sweets, and fast foods, using seat belts, and doing exercises).
In this study, there was no significant association between health behaviors and peer social networks. Using composite measures of health behaviors in this study does not provide the best approach to investigate the socioeconomic differences in health behaviors. These findings contradict the findings in the study. The study itself has some strengths and limitations. It was not based on the involvement of all areas in Riyadh and the sample size was very small (245). The data is therefore not representative of the country in purely statistical terms. However, the response rate was very high with very little missing data in the present study. The assessment of the health behaviors was also based on self-report.
Despite the potentiality for bias, previous studies indicated that health behaviors reported by adolescents have adequate validity (Honkala, 1990; Brener, 2003). A few questions especially those in general health behaviors such as smoking, were sensitive, particularly for girls in Saudi Arabia society. These could cause underreporting. Confidentiality and anonymity on the other hand were maintained, with students asked not to write their names on the questionnaires.
In this study, parents’ education was used as the only measure of SES. Traditional SES indicators, such as parental occupation, education, or income were not used. However, most of the study shows that the indicators are vulnerable to inaccurate reporting with missing data (Torsheim et al, 2004; Jung et al, 2010). Therefore we use FA factors as supplementary indicators of family SES. Lastly, the cut-off point for all oral health behaviors may have influenced the findings. Further studies are needed to understand better the association between the SES and the oral health behaviors of adolescents in Saudi Arabia.