Area-Level Determinants of Oral Health Behaviours Among Australian Adolescents

Oral health behaviours are key determinants of oral health. Studies show that area-level factors are closely associated with individual-level oral health behaviours and outcomes. However, different area-level factors can influence oral health behaviours differently. The aim of this study was to examine variations in the associations between geographic remoteness and area deprivation on oral health behaviours in Australian adolescents aged 12 and 13 years.

This cross-sectional study utilised data from the Longitudinal Study of Australian Children (LSAC; wave 7, 2015) which consists of a sample size of 3381 adolescents aged 12 and 13 years. The associations of the exposure variables (area-level social disadvantage and remoteness) on five outcomes (number of dental visits, tooth brushing frequency, fruit juice consumption, fast food consumption and consumption of sugar-sweetened beverages) were estimated by fitting multilevel logistic regression models.

Adolescents living in the most socioeconomically deprived areas exhibited substantially higher odds of unfavourable oral health behaviours and limited access to dental care services. They were more likely to not have visited a dentist within the past year (OR = 1.59, 95% CI: 1.25, 2.02), brush their teeth less than twice a day (OR = 1.43, 95% CI: 1.14, 1.78), consume fruit juice (OR = 1.31, 95% CI: 1.05, 1.63), fast food (OR = 1.65, 95% CI: 1.31, 2.08) and sugar-sweetened beverages (OR = 1.59, 95% CI: 1.27, 1.99) the previous day compared to those residing in the least deprived regions. Participants from outer regional and remote regions had higher odds of not visiting the dentist within a year (OR = 1.23, 95% CI: 0.95, 1.60), had lower odds of consuming fast food (OR = 0.92, 95% CI: 0.71, 1.19), but no differences were observed for suboptimal tooth brushing frequency (OR = 1.07, 95% CI: 0.83, 1.37), consuming fruit juice (OR = 0.95, 95% CI: 0.74, 1.22) or sugar-sweetened beverages (OR = 1.02, 95% CI: 0.79, 1.31) compared to those in major cities.

Geographic remoteness was associated with dental visits and fast-food consumption. Area deprivation was strongly associated with dental visits, tooth brushing, consumption of SSBs, fast food and fruit juices. Public health policymakers are encouraged to target oral health inequalities based on the socio-economic status of an area.