Abstract:
Background : Studies of self-rated oral health are always done at either the individual level or the aggregate level. Partitioning individual and neighbourhood sources of variation also enables explorations of the influences of people’s social context on their self-rated oral health. Objective : The main objective of the study was to examine the influence of the social context in which people live on their self-rating of their oral health, independent of individual indicators of good oral health. Method : This study used a secondary analysis of data on a nationally representative sample of 2 907 South African adults (aged ≥ 16 years) who had participated in the 2007 annual South African Social Attitude Survey (SASAS). The 2007 SASAS used a multi-stage probability sampling strategy, with census enumeration areas as the primary sampling unit. Using an interviewer-administered questionnaire, the information obtained included socio-demographic data, the respondents’ level of trust in people (a proxy measure for social capital), oral health behaviours and self-rated oral health. Using the 2005 General Household Survey (GHS) (persons’ n=107 987; households’ n=28 129), the living environment characteristics of participants of the SASAS were obtained, including sources of water and energy supply and household cell phone ownership as a proxy measure for social networking. A mixed-effects model was then constructed to determine factors associated with a self-rating of oral health as ‘very good/good’. Results : Of the respondents, 51.7% were female. Among the respondents, 76.3% self-rated their oral health as good. There was a significant gender modifying effect, thus analyses was stratified by gender. The odds of self-rating oral health as good was significantly higher only among females living in areas with higher household cell phone ownership density, even after controlling for potential confounders. At the individual level, trust was positively associated with good self-rated oral health only among males, and higher social ranking in the society was positively associated with good self-rated oral health only among females. Overall, 55% of the total variance in self-rated oral health was explained by factors operating at the individual level, whereas 18% of the total variance was explained by factors operating at the community level. Self-report of recent oral health problems such as toothache and oral malodour were significantly associated with lower odds of self-rating their oral health as good, as was with reporting less frequent brushing. Conclusion : Good self-rated oral health may be positively associated with indicators of higher levels of social capital both at the level of the individual and the community and with less physical impairments of oral functioning. Furthermore, the findings indicate that unlike men’s oral health ratings, women’s oral health ratings are more likely to be influenced by women’s social relationships with others in the society. Copyright
