Abstract
Aim: The aim of this study was to examine the interrelationships of family functioning, parental socioeconomic position and child oral health.Methods: Cross-sectional data of 733 parent-child (3-4-year-olds) dyads who participated in the East London Oral Health Inequalities (ELOHI) study were analysed. Parents reported their demographic characteristics, socioeconomic position (SEP), family functioning, and their child’s demographic factors, dental behaviours (sugars intake, dental attendance pattern and toothbrushing frequency) and quality of life. Family functioning was assessed with the Family Assessment Device (60-item) that yielded a general functioning score and six domain scores (roles, communication, problem solving, affective involvement, affective responsiveness, and behaviour control). Dental caries was assessed clinically, from which the dmft, dt and mft scores were derived. Oral health-related quality of life was assessed with the Early Childhood Oral Health Impact Scale (ECOHIS) that measures the impacts of children’s oral conditions on the child (child impact section, CIS) and family (family impact section, FIS). The independent, mediating and moderating role of family functioning in the association between family SEP and child oral health outcomes were explored in adjusted regression models.
Results: Unhealthy general family functioning was associated with high child sugars intake, greater dmft and dt scores and higher FIS, after adjustment for confounders. In analysis by domains, unhealthy functioning in roles was associated with high sugars intake, lower mft score and higher FIS whereas unhealthy behaviour control was associated with high sugars intake and lower mft score. There was also some evidence that general family functioning may partially mediate the associations of parental SEP with high sugars intake, and dmft and dt scores. Roles and behaviour control showed the strongest evidence of mediation, particularly for the association of low parental SEP with high sugars intake and lower mft score. Finally, unhealthy general family functioning worsened the association of low parental SEP with higher dt score. By domains, unhealthy behaviour control intensified the association of low parental SEP with higher dt score.
Conclusions: This study showed that family functioning was associated with multiple child dental behaviours, dental caries and oral health-related quality of life, over and above well-known determinants of child oral health. Evidence on the mediating and moderating role of family functioning in the association between family SEP and child oral health was weaker and somewhat inconsistent. Effective assignment and fulfilment of roles as well as setting and control over daily routines might be relevant to improving child dental behaviours, and subsequently, child oral health.
| Date of Award | 1 Apr 2023 |
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| Original language | English |
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| Supervisor | Sasha Scambler (Supervisor) & Eduardo Bernabe (Supervisor) |