Behavioral Pathway between Social Support and Network, and Edentulism

The aims of this study were to evaluate how behaviors cluster together and to investigate the relationship among cluster of behaviors, social support and network, socioeconomic factors, and edentulism in older English adults. Data on social factors (Wave 3, 2006/07), behaviors (Wave 5, 2010/11), and edentulism (Wave 7, 2014/15) were extracted from the English Longitudinal Study of Ageing (ELSA). Baseline demographic factors (gender, ethnicity, and age) were included. Latent class analysis (LCA) was conducted on 4 behaviors (smoking, alcohol intake, fruit and vegetable consumption, physical activity). Confirmatory factor analysis (CFA) was used to create 2 latent variables, social support and network (positive support, negative support, network), and socioeconomic factors (education, wealth, self-rated social status). Two models of structural equation modeling (SEM) were constructed to assess the direct and indirect effect of latent variables on edentulism. A total of 3,087 participants were included. In the LCA, a 2-class model was chosen: class 1 (risky) and class 2 (healthy). The first SEM model showed that social support and network was not linked directly to edentulism, but higher levels of social support and network predicted being dentate indirectly through cluster of behaviors. The second model additionally accounting for socioeconomic position showed that social support and network was not associated with edentulism directly or indirectly, but higher socioeconomic position predicted directly and indirectly being dentate. In both models, cluster of behaviors was associated with edentulism. The result of this study clearly shows that cluster of behaviors mediate the relationship between each of social support and socioeconomic position and edentulism. Actions to improve socioeconomic conditions might have strong effects on changing behaviors and improved oral health.