Social gradient in intermediary determinants of oral health at school level in Finland.

OBJECTIVE: An adapted framework for oral health inequalities suggests that structural determinants cause oral health inequalities through socio-economic position (SEP) and intermediary determinants. We applied this framework to examine whether there is a social gradient in the intermediary determinants at the school level, even when adjusted for school size, geographical location and teaching language. BASIC RESEARCH DESIGN: Cross-sectional survey. METHODS: This study combined data from two independent studies focusing on Finnish upper comprehensive schools (N=970): the School Health Promotion study (SHPS) and the School Sweet Selling survey (SSSS). All schools that took part in the SSSS and whose pupils answered the SHPS were included in the analysis (n=360, response rate=37%). From the questions of the SHPS and the SSSS suitable for the theoretical framework, attitudes and access to intoxicants, school health services, school environment, home environment, the school's oral health-related actions and the pupil's own behaviour were selected as the intermediary determinants and as the factors determining the school-level SEP. The social gradient in the intermediary determinants of oral health was investigated with Pearson's and Spearman's correlation coefficients between those and the school-level SEP. In the multivariable analysis, the General Linear Model with manual backward elimination was used. RESULTS: A social gradient was observed in the intermediary determinants 'home environment' and 'the pupils' tooth brushing frequency' and an inverse social gradient in 'attitudes and access to intoxicants' and 'school health services'. CONCLUSIONS: Social gradient between schools could increase Finnish adolescents' oral health inequalities.

Associations between schools' guidelines and pupils' smoking and sweet consumption.

OBJECTIVE: The aims were to find out if schools' sweet-selling was associated with pupils' sweet consumption, and whether the school's guideline about leaving the school area was associated with pupils' tobacco and sweet consumption. METHODS: Two independently collected datasets from all Finnish upper secondary schools (N = 988) were linked together. The first dataset on schools' sweet-selling (yes/no) and guideline about leaving school area (yes/no) was collected via school principals in 2007 using an Internet questionnaire with a response rate of 49%, n = 480. The second dataset on pupils' self-reported: weekly school-time (0, never; 1, less than once; 2, 1-2 times; 3, 3-5 times), overall sweet consumption frequencies (1, never; 2, 1-2 times; 3, 3-5 times; 4, 6-7 times) and smoking and snuff-using frequencies (1, never; 2, every now and then; 3 = every day) was collected in 2006-2007 in the School Health Promotion Study from pupils. An average was calculated for the school-level with a response rate 80%, n = 790. The total response rate of the linked final data was 42%, n = 414. Mean values of self-reported sweet and tobacco consumption frequencies between sweet-selling and non-sweet-selling schools and between schools with different guidelines were compared using Mann-Whitney test. RESULTS: Pupils in sweet-selling schools and in schools without a guideline about leaving the school area, more frequently used sweet products and tobacco products than their peers in other schools. CONCLUSIONS: Schools may need help in building permanent guidelines to stop sweet-selling in school and to prevent leaving the school area to decrease pupils' sweet consumption and smoking.

Evaluating the provision of oral health education material in Schools in Finland.

INTERVENTIONS: The Finnish Dental Association donated new oral health education material (OHEM) to all upper comprehensive schools in 2008. OBJECTIVE: The aim of this study was to determine whether that OHEM was noticed, received and used in schools, and whether oral health teaching and teachers' attitudes towards oral health changed after distribution of the OHEM. METHODS: Surveys were conducted using online questionnaires for all health education teachers in upper comprehensive schools in Finland. Schools response rates were 39% in 2008, and 40% in 2009. Statistical significances between the teachers and between the schools according to background variables were analysed using a Pearson's Chi-square test for nominal data and Mantel-Haenszel Chi-square test for ordinal data. Changes between 2008 and 2009 were evaluated using percentage change and confidence intervals. RESULTS: Of the responding teachers, 46% reported that they had received the OHEM and 33% had used it in their teaching. The number of teachers teaching oral health did not change after the OHEM, but teachers who taught oral health reported teaching all oral-health-related topics more frequently than they did before. Female teachers more often reported having received the OHEM (48% vs 32%, p=0.011) and having used it (36% vs 22%, p=0.017) than did male teachers. CONCLUSIONS: The OHEM may not lead more teachers to teach oral health, but it provides them with the resources to teach the subject more comprehensively. The OHEM must be planned in close co-operation between schools and local dental health care professionals, to make it better known and accepted among teachers, especially male teachers.

Effect of national recommendations on the sale of sweet products in the upper level of Finnish comprehensive schools.

INTERVENTIONS: In 2007, the Finnish National Board of Education (FNBE) and the National Public Health Institute (KTL) recommended to schools that they quit regular selling of candies and soft drinks. OBJECTIVE: The aim of this study was to determine how and why such selling changed from 2007 to 2008 after the national recommendation. METHODS: Surveys were conducted using online questionnaires to all upper comprehensive schools in Finland. In 2007, 480 (49%) and in 2008, 507 (51%) schools answered the questionnaire; 319 (32%) schools participated in both studies. Schools were asked whether they sold candies, soft drinks or other sweet products and, if theyhad changed the selling of these products, why. The changes in selling were analyzed by using McNemar's test. RESULTS: Of the responding schools, 56% (n=267) and 46% (n=233) sold sweet products in 2007 and 2008, respectively. Of the schools responding both years, 56% reported selling sweet products in 2007 and 50% in 2008. Selling had decreased by 11% among the schools that took part in both studies. The main reasons stated for quitting selling these products were concern about pupils' health (40%) and the recommendation of the FNBE and KTL (38%). CONCLUSIONS: The national recommendation was followed by some decrease in sale of sweet products. For further progress, new actions, both policy measures and broader public involvement, may be needed.