Existing conceptual frameworks explaining social inequality in oral health emphasise the material and behavioural explanations advanced in the 1980 Black Report. Objectives: (1) To evaluate the contribution of psychosocial factors in explaining subjective oral health; and (2) to assess the explanatory potential of psychosocial factors among different income groups. Methods: Cross sectional study of dentate working adults (n=2,258) drawn from the 1999 National Dental Telephone Interview Survey (response = 56.6%) and follow-up mail survey (response = 64.6%, n=3,973). Subjective oral health was measured using the 14-item Oral Health Impact Profile (OHIP-14 \x96 Slade, 1997) that measures the adverse impact of oral conditions. Mean OHIP-14 scores were the dependent variable. Explanatory variables were entered into hierarchical regression models in five steps: socioedemographic factors; tooth loss; psychosocial factors; health beliefs; and dental behaviour. Results: In bivariate analysis (ANOVA), OHIP scores were positively associated with material disadvantage (education, eligibility for subsidised dental care), tooth loss, and psychosocial factors (perceived stress, work-home interference) and were negatively associated with health beliefs (dental satisfaction, health self-efficacy), and dental behaviour (self-care, visiting). In regression analysis, almost half the 22.0% of variance in OHIP scores explained by the model was accounted for by psychosocial factors. Psychosocial factors accounted for half of the 20.5% of the variance explained for individuals with income >$50,000 (n=1,243), and almost half of 43.5% of variance explained for those with income <$30,000 (n=350). For the small subset with income <$20,000 (n=147) psychosocial factors accounted for more than half of 62.5% of variance explained. Conclusion: Two psychosocial factors (stress, work-home interference) explained more variance in subjective oral health than did material or behavioural factors alone. The framework explained more variation in subjective oral health among low income adults than among those with higher income. This research was supported by an Australian Dental Research Foundation grant.
A Sanders*, AJ Spencer
Presented at the 81st General Session and Exhibition of the IADR, 25-28 June 2003, Goteborg, Sweden