Associations between adolescents' oral health and health literacy, gender and family affluence: perspective of the Health Behaviour in School-aged Children study data from Slovakia and Poland

Karolina Kamila Glińska¹Peter Kizek¹Andrea Madarasova Geckova²Zuzana Boberova³Anna Maria Dzielska⁴Dorota Kleszczewska⁵Erik Sigmund⁶Veronika Jurkova⁷Jaroslava Kopcakova^8,9*

• ¹Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, P. J. Safarik University in Kosice, Rastislavova 43, 041 90 Kosice, Slovakia, Kosice, Slovakia
• ²Department of Health Psychology and Research Methodology, Faculty of Medicine, University of Pavol Jozef Šafárik, Kosice, Slovakia
• ³Institute of Biology and Ecology, Faculty of Science, P. J. Safarik University in Kosice, Manesova 23, Kosice, 040 01, Slovakia, Kosice, Slovakia
• ⁴Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland, Warsaw, Poland
• ⁵Institute of Mother and Child, Foundation, Warsaw, Poland, Warsaw, Poland
• ⁶Faculty of Physical Culture, Institute of Active Lifestyle, Palacký University Olomouc, Olomouc, Czechia, Olomouc, Czechia
• ⁷Lifelong Learning Centre and Projects Support, P. J. Safarik University in Kosice, Srobarova 2, 041 80 Kosice, Slovakia, Kosice, Slovakia
• ⁸Medical Education Centre, Faculty of Medicine, P. J. Safarik University in Kosice, Trieda SNP 1, 04011 Kosice, Slovakia, Kosice, Slovakia
• ⁹Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czechia, Olomouc, Czechia

Objectives: The aim of this study was to examine the association between oral health and health literacy, gender, age, family affluence and country of origin among adolescents from Slovakia and Poland, using data from the Health Behaviour in School-aged Children study. Methods: We analysed data from the cross-sectional Health Behaviour in School-aged Children study conducted in 2022 on a representative sample of 6,289 Slovak and Polish 13-and 15-year old adolescents (mean age 14.48; SD=1.01; 50.5% boys). Data was collected through self-administered online questionnaires completed by respondents in schools during classes. Binomial logistic regression models were used to assess associations between oral health and health literacy, gender, age, family affluence and country of origin among adolescents from Slovakia and Poland. Results: The results indicate that boys (odds ratio/95% confidence interval OR/95% CI 0.431/0.381–0.489) are substantially less likely to engage in regular toothbrushing compared to girls, highlighting a persistent gender disparity in oral hygiene behaviour. Additionally, lower socioeconomic status, as measured by family affluence, is associated with a decreased likelihood of frequent toothbrushing (OR/95% CI 0.486/0.399–0.592 for low family affluence; OR/95% CI 0.761/0.647–0.895 for medium family affluence). Similarly, health literacy emerges as a key determinant, with adolescents exhibiting lower health literacy levels demonstrating significantly reduced engagement in regular toothbrushing (OR/95% CI 0.475 /0.384–0.587 for low health literacy; OR/95% CI 0.666/0.550–0.808 for medium health literacy). Conclusion: This study highlights the significant impact of gender, family affluence and health literacy on toothbrushing frequency among adolescents in Poland and Slovakia. The findings underscore the need for targeted oral health promotion strategies that consider gender differences, socioeconomic inequalities and the importance of health literacy in improving oral hygiene practices among adolescents.