Oral Health Behaviour and Social and Health Factors in University Students from 26 Low, Middle and High Income Countries
Identifieur interne : 002529 ( Pmc/Corpus ); précédent : 002528; suivant : 002530Oral Health Behaviour and Social and Health Factors in University Students from 26 Low, Middle and High Income Countries
Auteurs : Karl Peltzer ; Supa PengpidSource :
- International Journal of Environmental Research and Public Health [ 1661-7827 ] ; 2014.
Abstract
Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that 67.2% of students reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. In a multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, depression and PTSD symptoms, tobacco use and frequent gambling, low physical activity, and low daily meal and snacks frequency were associated with inadequate tooth brushing (
Url:
DOI: 10.3390/ijerph111212247
PubMed: 25431876
PubMed Central: 4276612
Links to Exploration step
PMC:4276612Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Oral Health Behaviour and Social and Health Factors in University Students from 26 Low, Middle and High Income Countries</title><author><name sortKey="Peltzer, Karl" sort="Peltzer, Karl" uniqKey="Peltzer K" first="Karl" last="Peltzer">Karl Peltzer</name><affiliation><nlm:aff id="af1-ijerph-11-12247">ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand; E-Mail:<email>supaprom@yahoo.com</email></nlm:aff></affiliation><affiliation><nlm:aff id="af2-ijerph-11-12247">Department of Psychology, University of Limpopo, Turfloop Campus, Sovenga 0727, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="af3-ijerph-11-12247">HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa</nlm:aff></affiliation></author><author><name sortKey="Pengpid, Supa" sort="Pengpid, Supa" uniqKey="Pengpid S" first="Supa" last="Pengpid">Supa Pengpid</name><affiliation><nlm:aff id="af1-ijerph-11-12247">ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand; E-Mail:<email>supaprom@yahoo.com</email></nlm:aff></affiliation><affiliation><nlm:aff id="af4-ijerph-11-12247">Department of Research & Innovation, University of Limpopo, Turfloop Campus, Sovenga 0727, South Africa</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25431876</idno><idno type="pmc">4276612</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276612</idno><idno type="RBID">PMC:4276612</idno><idno type="doi">10.3390/ijerph111212247</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002529</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002529</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Oral Health Behaviour and Social and Health Factors in University Students from 26 Low, Middle and High Income Countries</title><author><name sortKey="Peltzer, Karl" sort="Peltzer, Karl" uniqKey="Peltzer K" first="Karl" last="Peltzer">Karl Peltzer</name><affiliation><nlm:aff id="af1-ijerph-11-12247">ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand; E-Mail:<email>supaprom@yahoo.com</email></nlm:aff></affiliation><affiliation><nlm:aff id="af2-ijerph-11-12247">Department of Psychology, University of Limpopo, Turfloop Campus, Sovenga 0727, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="af3-ijerph-11-12247">HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa</nlm:aff></affiliation></author><author><name sortKey="Pengpid, Supa" sort="Pengpid, Supa" uniqKey="Pengpid S" first="Supa" last="Pengpid">Supa Pengpid</name><affiliation><nlm:aff id="af1-ijerph-11-12247">ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand; E-Mail:<email>supaprom@yahoo.com</email></nlm:aff></affiliation><affiliation><nlm:aff id="af4-ijerph-11-12247">Department of Research & Innovation, University of Limpopo, Turfloop Campus, Sovenga 0727, South Africa</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Environmental Research and Public Health</title><idno type="ISSN">1661-7827</idno><idno type="eISSN">1660-4601</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that 67.2% of students reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. In a multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, depression and PTSD symptoms, tobacco use and frequent gambling, low physical activity, and low daily meal and snacks frequency were associated with inadequate tooth brushing (</p> </div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Hassija, J" uniqKey="Hassija J">J. Hassija</name></author><author><name sortKey="Sridhar, N" uniqKey="Sridhar N">N. Sridhar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sharda, A J" uniqKey="Sharda A">A.J. Sharda</name></author><author><name sortKey="Shetty, S" uniqKey="Shetty S">S. Shetty</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kassak, K M" uniqKey="Kassak K">K.M. Kassak</name></author><author><name sortKey="Dagher, R" uniqKey="Dagher R">R. Dagher</name></author><author><name sortKey="Doughan, B" uniqKey="Doughan B">B. Doughan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kirtilo Lu, T" uniqKey="Kirtilo Lu T">T. Kirtiloğlu</name></author><author><name sortKey="Yavuz, U S" uniqKey="Yavuz U">U.S. Yavuz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Halboub, E" uniqKey="Halboub E">E. Halboub</name></author><author><name sortKey="Dhaifullah, E" uniqKey="Dhaifullah E">E. Dhaifullah</name></author><author><name sortKey="Yasin, R" uniqKey="Yasin R">R. Yasin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rimondini, L" uniqKey="Rimondini L">L. Rimondini</name></author><author><name sortKey="Zolfanelli, B" uniqKey="Zolfanelli B">B. Zolfanelli</name></author><author><name sortKey="Bernardi, F" uniqKey="Bernardi F">F. Bernardi</name></author><author><name sortKey="Bez, C" uniqKey="Bez C">C. Bez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Luebke, T E" uniqKey="Luebke T">T.E. Luebke</name></author><author><name sortKey="Driskell, J A" uniqKey="Driskell J">J.A. Driskell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chindia, M L" uniqKey="Chindia M">M.L. Chindia</name></author><author><name sortKey="Valderhaug, J" uniqKey="Valderhaug J">J. Valderhaug</name></author><author><name sortKey="Ng Ng, P M" uniqKey="Ng Ng P">P.M. Ng’ang’a</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bamise, C T" uniqKey="Bamise C">C.T. Bamise</name></author><author><name sortKey="Bada, T A" uniqKey="Bada T">T.A. Bada</name></author><author><name sortKey="Bamise, F O" uniqKey="Bamise F">F.O. Bamise</name></author><author><name sortKey="Ogunbodede, E O" uniqKey="Ogunbodede E">E.O. Ogunbodede</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Neamatollahi, H" uniqKey="Neamatollahi H">H. Neamatollahi</name></author><author><name sortKey="Ebrahimi, M" uniqKey="Ebrahimi M">M. Ebrahimi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vent, I" uniqKey="Vent I">I. Ventä</name></author><author><name sortKey="Murtomaa, H" uniqKey="Murtomaa H">H. Murtomaa</name></author><author><name sortKey="Meurman, J" uniqKey="Meurman J">J. Meurman</name></author><author><name sortKey="Turtola, L" uniqKey="Turtola L">L. Turtola</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey=" Str M, A N" uniqKey=" Str M A">A.N. Åstrøm</name></author><author><name sortKey="Masalu, J R" uniqKey="Masalu J">J.R. Masalu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Astr M, A N" uniqKey="Astr M A">A.N. Astrøm</name></author><author><name sortKey="Mbawalla, H" uniqKey="Mbawalla H">H. Mbawalla</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marulanda, A M" uniqKey="Marulanda A">A.M. Marulanda</name></author><author><name sortKey="Coral, D" uniqKey="Coral D">D. Coral</name></author><author><name sortKey="Sabogal, D" uniqKey="Sabogal D">D. Sabogal</name></author><author><name sortKey="Serrano, C" uniqKey="Serrano C">C. Serrano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tada, A" uniqKey="Tada A">A. Tada</name></author><author><name sortKey="Hanada, N" uniqKey="Hanada N">N. Hanada</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Ansari, J M" uniqKey="Al Ansari J">J.M. Al-Ansari</name></author><author><name sortKey="Honkala, S" uniqKey="Honkala S">S. Honkala</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Freddo, S L" uniqKey="Freddo S">S.L. Freddo</name></author><author><name sortKey="Aerts, D R" uniqKey="Aerts D">D.R. Aerts</name></author><author><name sortKey="Abegg, C" uniqKey="Abegg C">C. Abegg</name></author><author><name sortKey="Davoglio, R" uniqKey="Davoglio R">R. Davoglio</name></author><author><name sortKey="Vieira, P C" uniqKey="Vieira P">P.C. Vieira</name></author><author><name sortKey="Monteiro, L" uniqKey="Monteiro L">L. Monteiro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maes, L" uniqKey="Maes L">L. Maes</name></author><author><name sortKey="Vereecken, C" uniqKey="Vereecken C">C. Vereecken</name></author><author><name sortKey="Vanobbergen, J" uniqKey="Vanobbergen J">J. Vanobbergen</name></author><author><name sortKey="Honkala, S" uniqKey="Honkala S">S. Honkala</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nzioka, B M" uniqKey="Nzioka B">B.M. Nzioka</name></author><author><name sortKey="Nyaga, J K" uniqKey="Nyaga J">J.K. Nyaga</name></author><author><name sortKey="Wagaiyu, E G" uniqKey="Wagaiyu E">E.G. Wagaiyu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Siziya, S" uniqKey="Siziya S">S. Siziya</name></author><author><name sortKey="Muula, A S" uniqKey="Muula A">A.S. Muula</name></author><author><name sortKey="Rudatsikira, E" uniqKey="Rudatsikira E">E. Rudatsikira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pengpid, S" uniqKey="Pengpid S">S. Pengpid</name></author><author><name sortKey="Peltzer, K" uniqKey="Peltzer K">K. Peltzer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peltzer, K" uniqKey="Peltzer K">K. Peltzer</name></author><author><name sortKey="Pengpid, S" uniqKey="Pengpid S">S. Pengpid</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zaborski, A" uniqKey="Zaborski A">A. Zaborski</name></author><author><name sortKey="Milciuviene, S" uniqKey="Milciuviene S">S. Milciuviene</name></author><author><name sortKey="Bendoraitiene, E" uniqKey="Bendoraitiene E">E. Bendoraitiene</name></author><author><name sortKey="Zaborskyte, A" uniqKey="Zaborskyte A">A. Zaborskyte</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kateeb, E" uniqKey="Kateeb E">E. Kateeb</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khami, M R" uniqKey="Khami M">M.R. Khami</name></author><author><name sortKey="Virtanen, J I" uniqKey="Virtanen J">J.I. Virtanen</name></author><author><name sortKey="Jafarian, M" uniqKey="Jafarian M">M. Jafarian</name></author><author><name sortKey="Murtomaa, H" uniqKey="Murtomaa H">H. Murtomaa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lopez, R" uniqKey="Lopez R">R. Lopez</name></author><author><name sortKey="Baelum, V" uniqKey="Baelum V">V. Baelum</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ekanayake, L" uniqKey="Ekanayake L">L. Ekanayake</name></author><author><name sortKey="Ando, Y" uniqKey="Ando Y">Y. Ando</name></author><author><name sortKey="Miyazaki, H" uniqKey="Miyazaki H">H. Miyazaki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ola, D" uniqKey="Ola D">D. Ola</name></author><author><name sortKey="Gamboa, A B" uniqKey="Gamboa A">A.B. Gambôa</name></author><author><name sortKey="Folayan, M O" uniqKey="Folayan M">M.O. Folayan</name></author><author><name sortKey="Marcenes, W" uniqKey="Marcenes W">W. Marcenes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Attwood, D" uniqKey="Attwood D">D. Attwood</name></author><author><name sortKey="West, P" uniqKey="West P">P. West</name></author><author><name sortKey="Blinkhorn, A S" uniqKey="Blinkhorn A">A.S. Blinkhorn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wardle, J" uniqKey="Wardle J">J. Wardle</name></author><author><name sortKey="Steptoe, A" uniqKey="Steptoe A">A. Steptoe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Andresen, E M" uniqKey="Andresen E">E.M. Andresen</name></author><author><name sortKey="Malmgren, J A" uniqKey="Malmgren J">J.A. Malmgren</name></author><author><name sortKey="Carter, W B" uniqKey="Carter W">W.B. Carter</name></author><author><name sortKey="Patrick, D L" uniqKey="Patrick D">D.L. Patrick</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kilbourne, A M" uniqKey="Kilbourne A">A.M. Kilbourne</name></author><author><name sortKey="Justice, A C" uniqKey="Justice A">A.C. Justice</name></author><author><name sortKey="Rollman, B L" uniqKey="Rollman B">B.L. Rollman</name></author><author><name sortKey="Mcginnis, K A" uniqKey="Mcginnis K">K.A. McGinnis</name></author><author><name sortKey="Rabeneck, L" uniqKey="Rabeneck L">L. Rabeneck</name></author><author><name sortKey="Weissman, S" uniqKey="Weissman S">S. Weissman</name></author><author><name sortKey="Smola, S" uniqKey="Smola S">S. Smola</name></author><author><name sortKey="Schultz, R" uniqKey="Schultz R">R. Schultz</name></author><author><name sortKey="Whittle, J" uniqKey="Whittle J">J. Whittle</name></author><author><name sortKey="Rodriguez Barradas, M" uniqKey="Rodriguez Barradas M">M. Rodriguez-Barradas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kimerling, R" uniqKey="Kimerling R">R. Kimerling</name></author><author><name sortKey="Ouimette, P" uniqKey="Ouimette P">P. Ouimette</name></author><author><name sortKey="Prins, A" uniqKey="Prins A">A. Prins</name></author><author><name sortKey="Nisco, P" uniqKey="Nisco P">P. Nisco</name></author><author><name sortKey="Lawler, C" uniqKey="Lawler C">C. Lawler</name></author><author><name sortKey="Cronkite, R" uniqKey="Cronkite R">R. Cronkite</name></author><author><name sortKey="Moos, R H" uniqKey="Moos R">R.H. Moos</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Babor, T F" uniqKey="Babor T">T.F. Babor</name></author><author><name sortKey="Higgins Biddle, J C" uniqKey="Higgins Biddle J">J.C. Higgins-Biddle</name></author><author><name sortKey="Saunders, J B" uniqKey="Saunders J">J.B. Saunders</name></author><author><name sortKey="Monteiro, M" uniqKey="Monteiro M">M. Monteiro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lesieur, H R" uniqKey="Lesieur H">H.R. Lesieur</name></author><author><name sortKey="Blume, S B" uniqKey="Blume S">S.B. Blume</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Craig, C L" uniqKey="Craig C">C.L. Craig</name></author><author><name sortKey="Marshall, A L" uniqKey="Marshall A">A.L. Marshall</name></author><author><name sortKey="Sjostrom, M" uniqKey="Sjostrom M">M. Sjöström</name></author><author><name sortKey="Bauman, A E" uniqKey="Bauman A">A.E. Bauman</name></author><author><name sortKey="Booth, M L" uniqKey="Booth M">M.L. Booth</name></author><author><name sortKey="Ainsworth, B E" uniqKey="Ainsworth B">B.E. Ainsworth</name></author><author><name sortKey="Pratt, M" uniqKey="Pratt M">M. Pratt</name></author><author><name sortKey="Ekelund, U" uniqKey="Ekelund U">U. Ekelund</name></author><author><name sortKey="Yngve, A" uniqKey="Yngve A">A. Yngve</name></author><author><name sortKey="Sallis, J F" uniqKey="Sallis J">J.F. Sallis</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Hall, J N" uniqKey="Hall J">J.N. Hall</name></author><author><name sortKey="Moore, S" uniqKey="Moore S">S. Moore</name></author><author><name sortKey="Harper, S B" uniqKey="Harper S">S.B. Harper</name></author><author><name sortKey="Lynch, J W" uniqKey="Lynch J">J.W. Lynch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Steptoe, A" uniqKey="Steptoe A">A. Steptoe</name></author><author><name sortKey="Wardle, J" uniqKey="Wardle J">J. Wardle</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Peltzer, K" uniqKey="Peltzer K">K. Peltzer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nanakorn, S" uniqKey="Nanakorn S">S. Nanakorn</name></author><author><name sortKey="Osaka, R" uniqKey="Osaka R">R. Osaka</name></author><author><name sortKey="Chusilp, K" uniqKey="Chusilp K">K. Chusilp</name></author><author><name sortKey="Tsuda, A" uniqKey="Tsuda A">A. Tsuda</name></author><author><name sortKey="Maskasame, S" uniqKey="Maskasame S">S. Maskasame</name></author><author><name sortKey="Ratanasiri, A" uniqKey="Ratanasiri A">A. Ratanasiri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Polychronopoulou, A" uniqKey="Polychronopoulou A">A. Polychronopoulou</name></author><author><name sortKey="Kawamura, M" uniqKey="Kawamura M">M. Kawamura</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kawamura, M" uniqKey="Kawamura M">M. Kawamura</name></author><author><name sortKey="Honkala, E" uniqKey="Honkala E">E. Honkala</name></author><author><name sortKey="Widstrom, E" uniqKey="Widstrom E">E. Widström</name></author><author><name sortKey="Komabayashi, T" uniqKey="Komabayashi T">T. Komabayashi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Astr M, A N" uniqKey="Astr M A">A.N. Astrøm</name></author><author><name sortKey="Rise, J" uniqKey="Rise J">J. Rise</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gilbert, G H" uniqKey="Gilbert G">G.H. Gilbert</name></author><author><name sortKey="Rose, J S" uniqKey="Rose J">J.S. Rose</name></author><author><name sortKey="Shelton, B J" uniqKey="Shelton B">B.J. Shelton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Doshi, D" uniqKey="Doshi D">D. Doshi</name></author><author><name sortKey="Baldava, P" uniqKey="Baldava P">P. Baldava</name></author><author><name sortKey="Anup, N" uniqKey="Anup N">N. Anup</name></author><author><name sortKey="Sequeira, P S" uniqKey="Sequeira P">P.S. Sequeira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bou, C" uniqKey="Bou C">C. Bou</name></author><author><name sortKey="Miquel, J L" uniqKey="Miquel J">J.L. Miquel</name></author><author><name sortKey="Poisson, P" uniqKey="Poisson P">P. Poisson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Li, L Z" uniqKey="Li L">L.Z. Li</name></author><author><name sortKey="Zhang, H Y" uniqKey="Zhang H">H.Y. Zhang</name></author><author><name sortKey="Guan, X L" uniqKey="Guan X">X.L. Guan</name></author><author><name sortKey="Hao, N" uniqKey="Hao N">N. Hao</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Environ Res Public Health</journal-id><journal-id journal-id-type="iso-abbrev">Int J Environ Res Public Health</journal-id><journal-id journal-id-type="publisher-id">ijerph</journal-id><journal-title-group><journal-title>International Journal of Environmental Research and Public Health</journal-title></journal-title-group><issn pub-type="ppub">1661-7827</issn><issn pub-type="epub">1660-4601</issn><publisher><publisher-name>MDPI</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25431876</article-id><article-id pub-id-type="pmc">4276612</article-id><article-id pub-id-type="doi">10.3390/ijerph111212247</article-id><article-id pub-id-type="publisher-id">ijerph-11-12247</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Oral Health Behaviour and Social and Health Factors in University Students from 26 Low, Middle and High Income Countries</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Peltzer</surname><given-names>Karl</given-names></name><xref ref-type="aff" rid="af1-ijerph-11-12247">1</xref><xref ref-type="aff" rid="af2-ijerph-11-12247">2</xref><xref ref-type="aff" rid="af3-ijerph-11-12247">3</xref><xref rid="c1-ijerph-11-12247" ref-type="corresp">*</xref></contrib><contrib contrib-type="author"><name><surname>Pengpid</surname><given-names>Supa</given-names></name><xref ref-type="aff" rid="af1-ijerph-11-12247">1</xref><xref ref-type="aff" rid="af4-ijerph-11-12247">4</xref></contrib></contrib-group><contrib-group><contrib contrib-type="editor"><name><surname>de Abreu</surname><given-names>Mauro Henrique Nogueira Guimarães</given-names></name><role>External Editor</role></contrib></contrib-group><aff id="af1-ijerph-11-12247"><label>1</label>ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand; E-Mail:<email>supaprom@yahoo.com</email></aff><aff id="af2-ijerph-11-12247"><label>2</label>Department of Psychology, University of Limpopo, Turfloop Campus, Sovenga 0727, South Africa</aff><aff id="af3-ijerph-11-12247"><label>3</label>HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa</aff><aff id="af4-ijerph-11-12247"><label>4</label>Department of Research & Innovation, University of Limpopo, Turfloop Campus, Sovenga 0727, South Africa</aff><author-notes><corresp id="c1-ijerph-11-12247"><label>*</label>Author to whom correspondence should be addressed; E-Mail: <email>karl.pel@mahidol.ac.th</email>; Tel.: +27-12-302-2000; Fax: +27-12-302-2601.</corresp></author-notes><pub-date pub-type="epub"><day>26</day><month>11</month><year>2014</year></pub-date><pub-date pub-type="ppub"><month>12</month><year>2014</year></pub-date><volume>11</volume><issue>12</issue><fpage>12247</fpage><lpage>12260</lpage><history><date date-type="received"><day>22</day><month>9</month><year>2014</year></date><date date-type="rev-recd"><day>19</day><month>11</month><year>2014</year></date><date date-type="accepted"><day>20</day><month>11</month><year>2014</year></date></history><permissions><copyright-statement>© 2014 by the authors; licensee MDPI, Basel, Switzerland.</copyright-statement><copyright-year>2014</copyright-year><license><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>).</license-p></license></permissions><abstract><p>Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that 67.2% of students reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. In a multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, depression and PTSD symptoms, tobacco use and frequent gambling, low physical activity, and low daily meal and snacks frequency were associated with inadequate tooth brushing (</p> </abstract><kwd-group><kwd>ocial determinants</kwd><kwd>mental health</kwd><kwd>university students</kwd><kwd>26 countries</kwd></kwd-group></article-meta></front><body><sec><title>1. Introduction</title><p>Healthy habits and good oral hygiene, including twice daily tooth brushing, are critical in preventing gum disease and maintaining good oral health [<xref rid="B1-ijerph-11-12247" ref-type="bibr">1</xref>]. The prevalence of less than twice tooth brushing per day among university students seems to be higher in low and middle income than in high income countries, e.g., 52.2% in India [<xref rid="B2-ijerph-11-12247" ref-type="bibr">2</xref>], 35% in Lebanon [<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>], 32% in Turkey [<xref rid="B4-ijerph-11-12247" ref-type="bibr">4</xref>]; 24% not regularly in Yemen [<xref rid="B5-ijerph-11-12247" ref-type="bibr">5</xref>]) than in high income countries (7.9% in Italy [<xref rid="B6-ijerph-11-12247" ref-type="bibr">6</xref>], 25% in USA [<xref rid="B7-ijerph-11-12247" ref-type="bibr">7</xref>]). Similarly, the prevalence of less than an annual dental check-up among university students also seem to be higher in developing countries (84% in Kenya [<xref rid="B8-ijerph-11-12247" ref-type="bibr">8</xref>], 92.2% in Nigeria [<xref rid="B9-ijerph-11-12247" ref-type="bibr">9</xref>], 70% in Turkey [<xref rid="B4-ijerph-11-12247" ref-type="bibr">4</xref>]; 42.7% in India never had a dental visit [<xref rid="B2-ijerph-11-12247" ref-type="bibr">2</xref>] and 48.2% in Iran never visited the dentist [<xref rid="B10-ijerph-11-12247" ref-type="bibr">10</xref>]) than in industrial countries (41% in Finland [<xref rid="B11-ijerph-11-12247" ref-type="bibr">11</xref>] and 40.1% in Italy [<xref rid="B6-ijerph-11-12247" ref-type="bibr">6</xref>]).</p><p>Various factors have been found to be associated with suboptimal tooth brushing among young people, including sociodemographics such as men [<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>,<xref rid="B7-ijerph-11-12247" ref-type="bibr">7</xref>,<xref rid="B12-ijerph-11-12247" ref-type="bibr">12</xref>,<xref rid="B13-ijerph-11-12247" ref-type="bibr">13</xref>,<xref rid="B14-ijerph-11-12247" ref-type="bibr">14</xref>,<xref rid="B15-ijerph-11-12247" ref-type="bibr">15</xref>,<xref rid="B16-ijerph-11-12247" ref-type="bibr">16</xref>] and lower socioeconomic status [<xref rid="B17-ijerph-11-12247" ref-type="bibr">17</xref>,<xref rid="B18-ijerph-11-12247" ref-type="bibr">18</xref>,<xref rid="B19-ijerph-11-12247" ref-type="bibr">19</xref>]; poor oral health attitude [<xref rid="B2-ijerph-11-12247" ref-type="bibr">2</xref>]; addictive risk behaviour such as smoking [<xref rid="B5-ijerph-11-12247" ref-type="bibr">5</xref>,<xref rid="B13-ijerph-11-12247" ref-type="bibr">13</xref>] and alcohol and cannabisuse [<xref rid="B20-ijerph-11-12247" ref-type="bibr">20</xref>]; lack of exercises [<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>], dietary behaviour, including infrequent fruits and/or vegetables consumption [<xref rid="B21-ijerph-11-12247" ref-type="bibr">21</xref>,<xref rid="B22-ijerph-11-12247" ref-type="bibr">22</xref>,<xref rid="B23-ijerph-11-12247" ref-type="bibr">23</xref>], frequent servings of chocolate, candy or chips/day [<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>], and poor mental health or psychological distress [<xref rid="B21-ijerph-11-12247" ref-type="bibr">21</xref>]. Less than annual or no dental visits has been found to be associated with being male [<xref rid="B15-ijerph-11-12247" ref-type="bibr">15</xref>,<xref rid="B24-ijerph-11-12247" ref-type="bibr">24</xref>,<xref rid="B25-ijerph-11-12247" ref-type="bibr">25</xref>,<xref rid="B26-ijerph-11-12247" ref-type="bibr">26</xref>,<xref rid="B27-ijerph-11-12247" ref-type="bibr">27</xref>], lower socioeconomic status [<xref rid="B16-ijerph-11-12247" ref-type="bibr">16</xref>,<xref rid="B26-ijerph-11-12247" ref-type="bibr">26</xref>,<xref rid="B28-ijerph-11-12247" ref-type="bibr">28</xref>], younger age [<xref rid="B9-ijerph-11-12247" ref-type="bibr">9</xref>]; poor oral health attitudes [<xref rid="B25-ijerph-11-12247" ref-type="bibr">25</xref>]; health risk behaviour, including infrequent tooth brushing [<xref rid="B26-ijerph-11-12247" ref-type="bibr">26</xref>], smoking [<xref rid="B29-ijerph-11-12247" ref-type="bibr">29</xref>] and anticipation of painful treatment [<xref rid="B9-ijerph-11-12247" ref-type="bibr">9</xref>].</p><p>Few studies have been conducted on oral health in university students, in particular in low and middle income counries. Therefore, the aim of this study was to investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. The two hypotheses being that (1) male university students from lower socioeconomic backgrounds, having low physical activity, having more addictive risk behaviours, poorer dietary behaviour and poorer mental health are more likely to have poor tooth brushing behaviour, and (2) male university students from lower socioeconomic backgrounds and risk behaviours are more likely to have less than annual or no dental visits. This study adds to the existing research, in particular in the group of university students who are in a period of transition to take on personal responsibility for oral health behaviours and who will be future leaders and role models in their societies.</p></sec><sec><title>2. Methods</title><sec><title>2.1. Sample and Procedure</title><p>This cross-sectional study was carried out with a network of collaborators in participating countries (see Acknowledgments). The anonymous, self-administered questionnaire used for data collection was developed in English, then translated and back-translated into languages (Arabic, Bahasa, French, Lao, Russian, Spanish, Thai, Turkish) of the participating countries. The study was initiated through personal academic contacts of the principal investigators. These collaborators arranged for data to be collected from intended 400 male and 400 female undergraduate university students aged 16–30 years by trained research assistants in 2013 in one or two universities in their respective countries. The 27 universities involved were located in the capital cities or other major cities in the participating countries. Research assistants working in the participating universities asked classes of undergraduate students to complete the questionnaire at the end of a teaching class. Classes were selected through a stratified random sample procedure. The students who completed the survey varied in the number of years for which they had attended the university. A variety of majors were involved, including education, humanities and arts, social sciences, business and law, science, engineering, manufacturing and construction, agriculture, health and welfare and services. Informed consent was obtained from participating students, and the study was conducted in 2013. Participation rates were in most countries over 90%. Ethics approvals were obtained from institutional review boards from all participating institutions.</p></sec><sec><title>2.2. Measures</title><sec><title>2.2.1. Oral Health Behaviour</title><p>Oral health behaviour was assessed with two questions, (1) “Do you brush your teeth? … Twice or more a day, about once a day, less than once a day, and seldom or never” [<xref rid="B30-ijerph-11-12247" ref-type="bibr">30</xref>] and (2) “How frequently do you go for dental checkups?...Twice a year, once a year, rarely and never” [<xref rid="B12-ijerph-11-12247" ref-type="bibr">12</xref>].</p></sec><sec><title>2.2.2. Socio-Demographic</title><p>Socio-demographic questions included age, gender, and socioeconomic background were assessed by rating their family background as wealthy (within the highest 25% in “country”, in terms of wealth), quite well off (within the 50% to 75% range for their country), not very well off (within the 25% to 50% range from “country”), or quite poor (within the lowest 25% in their country, in terms of wealth) [<xref rid="B30-ijerph-11-12247" ref-type="bibr">30</xref>].</p></sec><sec><title>2.2.3. Health Beliefs</title><p>Health beliefs in the importance of brushing teeth regularly were assessed with one question. The response option ranged from 1 = of very low importance to 10 = of very high importance [<xref rid="B30-ijerph-11-12247" ref-type="bibr">30</xref>].</p></sec><sec><title>2.2.4. Mental Health</title><p><italic>Centres for Epidemiologic Studies Depression Scale (CES-D).</italic> We assessed depressive symptoms using the 10-item version of the CES-D [<xref rid="B31-ijerph-11-12247" ref-type="bibr">31</xref>]. Scoring is classified from 0 to 9 as having a mild level of depressive symptoms, 10 to 14 as moderate depressive symptoms, and 15 representing severe depressive symptoms [<xref rid="B32-ijerph-11-12247" ref-type="bibr">32</xref>]. The Cronbach alpha reliability coefficient of this 10-item scale was 0.74 in this study.</p><p><italic>Post traumatic stress disorder (PTSD).</italic> Breslau’s 7-item screener was used to identify PTSD symptoms in the past month [<xref rid="B33-ijerph-11-12247" ref-type="bibr">33</xref>]. Items asked included whether the respondent had experienced difficulties related to a traumatic experience (e.g., “Did you become jumpy or get easily startled by ordinary noises or movements?”). Consistent with epidemiological evidence, participants who answered affirmatively to at least four of the questions were considered to have a positive screen for PTSD [<xref rid="B33-ijerph-11-12247" ref-type="bibr">33</xref>]. The Cronbach alpha reliability coefficient of this 7-item scale was 0.75 in this study.</p></sec><sec><title>2.2.5. Addictive Risk Behaviour</title><p><italic>Tobacco use</italic> was assessed with the question: Do you currently use one or more of the following tobacco products (cigarettes, snuff, chewing tobacco, cigars, <italic>etc.</italic>)? Response options were “yes” or “no” [<xref rid="B34-ijerph-11-12247" ref-type="bibr">34</xref>].</p><p><italic>Binge drinking</italic> was assessed with one item, “How often do you have (for men) five or more and (for women) four or more drinks on one occasion?” Response options ranged from 1 = never to 5 = daily or almost daily [<xref rid="B35-ijerph-11-12247" ref-type="bibr">35</xref>].</p><p><italic>Illicit drug use</italic> was assessed with the question, “How often have you taken drugs in the past 12 months; other than prescribed by the health care provider.”</p><p>The <italic>South Oaks Gambling Screen</italic> (SOGS), a standardized measure of pathological gambling and gambling behaviours in their lifetime [<xref rid="B36-ijerph-11-12247" ref-type="bibr">36</xref>] was used to assess 9 different gambling behaviours, e.g., “Played cards for money.” Response options ranged from 1 = not at all to 3 = Once a week or more. Cronbach alpha for this 9 item scale was 0.91 in this sample.</p></sec><sec><title>2.2.6. Physical Activity</title><p><italic>Physical activity</italic> was assessed using the self-administered International Physical Activity Questionnaire (IPAQ) short version, for the last 7 days (IPAQ-S7S). We used the instructions given in the IPAQ manual for reliability and validity, which is detailed elsewhere [<xref rid="B37-ijerph-11-12247" ref-type="bibr">37</xref>]. We categorized physical activity (short form) according to the official IPAQ scoring protocol [<xref rid="B38-ijerph-11-12247" ref-type="bibr">38</xref>] as low, moderate and high.</p></sec><sec><title>2.2.7. Dietary Behaviour Variables</title><p>Fruit and vegetable (FV) consumption was assessed with two questions ‘‘How many servings of fruit do you eat on a typical day?’’and ‘‘How many servings of vegetables do you eat on a typical day?’’ using the 24-h dietary recall data as the gold standard [<xref rid="B39-ijerph-11-12247" ref-type="bibr">39</xref>]. Insufficient FV consumption was defined as less than 5 servings of fruits and/or vegetables a day [<xref rid="B39-ijerph-11-12247" ref-type="bibr">39</xref>]. Additional dietary variables included: (a) frequency of having breakfast; (b) frequency of between-meal snacks and (c) number of meals a day [<xref rid="B40-ijerph-11-12247" ref-type="bibr">40</xref>].</p></sec></sec><sec><title>2.3. Data Analysis</title><p>The data were analysed using STATA 11.00 (StatCorp LP, College Station, TX, USA). Descriptive statistics were used for reporting the proportion of oral health behaviour. We used univariate logistic regression, followed by multivariate unconditional logistic regression to obtain adjusted odds ratios (AOR) and associated 95% confidence intervals to assess the association between sociodemographic variables, health beliefs, addictive risk behaviour, low physical activity, poor mental health, dietary behaviour and oral health behaviour (<italic>p</italic> < 0.05 level in bivariate analyses were included in the multivariate model. <italic>p</italic> < 0.05 was considered significant. Variance inflation factor (VIF) and tolerance values for each model indicate multicollinearity was not a concern in any of the multivariate analyses. Since the study used a clustered design, country was included as a clustering variable in the regression models.</p></sec></sec><sec><title>3. Results and Discussion</title><sec><title>3.1. Sample Characteristics</title><p>In all, 21,639 university students were recruited, 20,222 agreed to participate and for 19,560 complete questionnaires of students in the age range of 16–30 years were available. The final sample included 19,560 university students (41.4% men and 58.6% women), with a mean age of 20.8 years (SD = 2.8). Overall, 67.2% reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. The overall prevalence of recommended tooth brushing frequency (twice or more a day) among university students differed by country, ranging from below 30% in Nigeria, India and Egypt, to about 90 or more percent in Thailand, Indonesia and Venezuela. Likewise, the dental check-up visit (at least once a year) differed by country, ranging from below 25% in Egypt, Ivory Coast, Nigeria, and South Africa to above 70% in Columbia, Venezuela, and Russia. The belief in the importance of tooth brushing was generally positively evaluated, with a mean of 8.7, on a scale from 1 to 10. However, university students from several countries had a weak belief in the importance of tooth brushing, e.g., Tunisia (5.7), Nigeria (6.5) and Egypt (7.2) (see <xref ref-type="table" rid="ijerph-11-12247-t001">Table 1</xref>).</p></sec><sec><title>3.2. Associations with Oral Health (Tooth Brushing and Dental Visit)</title><p>In multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, poor mental health (depression and PTSD symptoms), addictive risk behaviour (current tobacco use and frequent gambling), low physical activity, and dietary behaviour (low daily meal and snack frequency) were associated with inadequate tooth brushing (<xref ref-type="table" rid="ijerph-11-12247-t002">Table 2</xref>).</p><table-wrap id="ijerph-11-12247-t001" position="float"><object-id pub-id-type="pii">ijerph-11-12247-t001_Table 1</object-id><label>Table 1</label><caption><p>Oral health behaviour prevalence by country.</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="3" align="center" valign="middle" colspan="1">Study Country</th><th colspan="4" align="center" valign="middle" rowspan="1">Tooth Brushing</th><th colspan="5" align="center" valign="middle" rowspan="1">Dental Check-up</th><th rowspan="2" align="center" valign="middle" colspan="1">Belief of the Importance of Tooth Brushing</th></tr><tr style="border-top: solid thin"><th align="center" valign="middle" rowspan="1" colspan="1"></th><th align="center" valign="middle" rowspan="1" colspan="1">Twice or More per Day</th><th align="center" valign="middle" rowspan="1" colspan="1">About Once a Day</th><th align="center" valign="middle" rowspan="1" colspan="1">Less than Once a Day/Seldom or Never</th><th align="center" valign="middle" rowspan="1" colspan="1"></th><th align="center" valign="middle" rowspan="1" colspan="1">Twice a Year</th><th align="center" valign="middle" rowspan="1" colspan="1">Once a year</th><th align="center" valign="middle" rowspan="1" colspan="1">Rarely</th><th align="center" valign="middle" rowspan="1" colspan="1">Never</th></tr><tr style="border-top: solid thin"><th align="center" valign="middle" rowspan="1" colspan="1">N</th><th align="center" valign="middle" rowspan="1" colspan="1">%</th><th align="center" valign="middle" rowspan="1" colspan="1">%</th><th align="center" valign="middle" rowspan="1" colspan="1">%</th><th align="center" valign="middle" rowspan="1" colspan="1">N</th><th align="center" valign="middle" rowspan="1" colspan="1">%</th><th align="center" valign="middle" rowspan="1" colspan="1">%</th><th align="center" valign="middle" rowspan="1" colspan="1">%</th><th align="center" valign="middle" rowspan="1" colspan="1">%</th><th align="center" valign="middle" rowspan="1" colspan="1">M (SD)</th></tr></thead><tbody><tr><td align="center" valign="middle" rowspan="1" colspan="1">All</td><td align="center" valign="middle" rowspan="1" colspan="1">19,560</td><td align="center" valign="middle" rowspan="1" colspan="1">67.2</td><td align="center" valign="middle" rowspan="1" colspan="1">28.8</td><td align="center" valign="middle" rowspan="1" colspan="1">4.0</td><td align="center" valign="middle" rowspan="1" colspan="1">19,399</td><td align="center" valign="middle" rowspan="1" colspan="1">16.3</td><td align="center" valign="middle" rowspan="1" colspan="1">25.6</td><td align="center" valign="middle" rowspan="1" colspan="1">33.9</td><td align="center" valign="middle" rowspan="1" colspan="1">24.3</td><td align="center" valign="middle" rowspan="1" colspan="1">8.7 (2.3)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1">Caribbean and South America</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Barbados <sup>4</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">563</td><td align="center" valign="middle" rowspan="1" colspan="1">76.6</td><td align="center" valign="middle" rowspan="1" colspan="1">22.7</td><td align="center" valign="middle" rowspan="1" colspan="1">0.7</td><td align="center" valign="middle" rowspan="1" colspan="1">559</td><td align="center" valign="middle" rowspan="1" colspan="1">18.6</td><td align="center" valign="middle" rowspan="1" colspan="1">27.0</td><td align="center" valign="middle" rowspan="1" colspan="1">41.3</td><td align="center" valign="middle" rowspan="1" colspan="1">13.1</td><td align="center" valign="middle" rowspan="1" colspan="1">9.0 (1.5)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Grenada <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">430</td><td align="center" valign="middle" rowspan="1" colspan="1">85.1</td><td align="center" valign="middle" rowspan="1" colspan="1">14.2</td><td align="center" valign="middle" rowspan="1" colspan="1">0.7</td><td align="center" valign="middle" rowspan="1" colspan="1">431</td><td align="center" valign="middle" rowspan="1" colspan="1">21.8</td><td align="center" valign="middle" rowspan="1" colspan="1">32.9</td><td align="center" valign="middle" rowspan="1" colspan="1">34.1</td><td align="center" valign="middle" rowspan="1" colspan="1">11.1</td><td align="center" valign="middle" rowspan="1" colspan="1">9.2 (1.5</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Jamaica <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">757</td><td align="center" valign="middle" rowspan="1" colspan="1">76.8</td><td align="center" valign="middle" rowspan="1" colspan="1">22.1</td><td align="center" valign="middle" rowspan="1" colspan="1">1.2</td><td align="center" valign="middle" rowspan="1" colspan="1">757</td><td align="center" valign="middle" rowspan="1" colspan="1">16.8</td><td align="center" valign="middle" rowspan="1" colspan="1">34.6</td><td align="center" valign="middle" rowspan="1" colspan="1">40.0</td><td align="center" valign="middle" rowspan="1" colspan="1">8.6</td><td align="center" valign="middle" rowspan="1" colspan="1">9.3 (1.5)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Colombia <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">816</td><td align="center" valign="middle" rowspan="1" colspan="1">94.2</td><td align="center" valign="middle" rowspan="1" colspan="1">5.8</td><td align="center" valign="middle" rowspan="1" colspan="1">0.0</td><td align="center" valign="middle" rowspan="1" colspan="1">816</td><td align="center" valign="middle" rowspan="1" colspan="1">42.0</td><td align="center" valign="middle" rowspan="1" colspan="1">37.6</td><td align="center" valign="middle" rowspan="1" colspan="1">18.4</td><td align="center" valign="middle" rowspan="1" colspan="1">2.0</td><td align="center" valign="middle" rowspan="1" colspan="1">9.4 (1.3)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Venezuela <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">554</td><td align="center" valign="middle" rowspan="1" colspan="1">84.7</td><td align="center" valign="middle" rowspan="1" colspan="1">14.1</td><td align="center" valign="middle" rowspan="1" colspan="1">1.3</td><td align="center" valign="middle" rowspan="1" colspan="1">552</td><td align="center" valign="middle" rowspan="1" colspan="1">34.1</td><td align="center" valign="middle" rowspan="1" colspan="1">40.6</td><td align="center" valign="middle" rowspan="1" colspan="1">22.8</td><td align="center" valign="middle" rowspan="1" colspan="1">2.5</td><td align="center" valign="middle" rowspan="1" colspan="1">9.3 (1.4)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1">Sub-Saharan Africa</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Cameroon <sup>2</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">626</td><td align="center" valign="middle" rowspan="1" colspan="1">65.0</td><td align="center" valign="middle" rowspan="1" colspan="1">30.7</td><td align="center" valign="middle" rowspan="1" colspan="1">2.2</td><td align="center" valign="middle" rowspan="1" colspan="1">626</td><td align="center" valign="middle" rowspan="1" colspan="1">18.2</td><td align="center" valign="middle" rowspan="1" colspan="1">33.4</td><td align="center" valign="middle" rowspan="1" colspan="1">38.3</td><td align="center" valign="middle" rowspan="1" colspan="1">10.1</td><td align="center" valign="middle" rowspan="1" colspan="1">9.1 (1.8)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Ivory Coast <sup>2</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">806</td><td align="center" valign="middle" rowspan="1" colspan="1">68.1</td><td align="center" valign="middle" rowspan="1" colspan="1">27.4</td><td align="center" valign="middle" rowspan="1" colspan="1">4.5</td><td align="center" valign="middle" rowspan="1" colspan="1">786</td><td align="center" valign="middle" rowspan="1" colspan="1">3.8</td><td align="center" valign="middle" rowspan="1" colspan="1">7.3</td><td align="center" valign="middle" rowspan="1" colspan="1">21.6</td><td align="center" valign="middle" rowspan="1" colspan="1">67.3</td><td align="center" valign="middle" rowspan="1" colspan="1">9.6 (1.9)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Madagascar <sup>1</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">780</td><td align="center" valign="middle" rowspan="1" colspan="1">81.9</td><td align="center" valign="middle" rowspan="1" colspan="1">17.1</td><td align="center" valign="middle" rowspan="1" colspan="1">1.0</td><td align="center" valign="middle" rowspan="1" colspan="1">768</td><td align="center" valign="middle" rowspan="1" colspan="1">15.4</td><td align="center" valign="middle" rowspan="1" colspan="1">18.2</td><td align="center" valign="middle" rowspan="1" colspan="1">35.2</td><td align="center" valign="middle" rowspan="1" colspan="1">31.3</td><td align="center" valign="middle" rowspan="1" colspan="1">8.9 (2.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Mauritius <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">491</td><td align="center" valign="middle" rowspan="1" colspan="1">78.6</td><td align="center" valign="middle" rowspan="1" colspan="1">21.0</td><td align="center" valign="middle" rowspan="1" colspan="1">0.4</td><td align="center" valign="middle" rowspan="1" colspan="1">492</td><td align="center" valign="middle" rowspan="1" colspan="1">15.4</td><td align="center" valign="middle" rowspan="1" colspan="1">28.3</td><td align="center" valign="middle" rowspan="1" colspan="1">41.1</td><td align="center" valign="middle" rowspan="1" colspan="1">15.2</td><td align="center" valign="middle" rowspan="1" colspan="1">9.1 (1.7)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Namibia <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">494</td><td align="center" valign="middle" rowspan="1" colspan="1">59.7</td><td align="center" valign="middle" rowspan="1" colspan="1">39.5</td><td align="center" valign="middle" rowspan="1" colspan="1">0.8</td><td align="center" valign="middle" rowspan="1" colspan="1">486</td><td align="center" valign="middle" rowspan="1" colspan="1">11.3</td><td align="center" valign="middle" rowspan="1" colspan="1">21.8</td><td align="center" valign="middle" rowspan="1" colspan="1">24.9</td><td align="center" valign="middle" rowspan="1" colspan="1">42.0</td><td align="center" valign="middle" rowspan="1" colspan="1">9.3 (1.6)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Nigeria <sup>2</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">755</td><td align="center" valign="middle" rowspan="1" colspan="1">20.9</td><td align="center" valign="middle" rowspan="1" colspan="1">70.5</td><td align="center" valign="middle" rowspan="1" colspan="1">8.6</td><td align="center" valign="middle" rowspan="1" colspan="1">731</td><td align="center" valign="middle" rowspan="1" colspan="1">3.3</td><td align="center" valign="middle" rowspan="1" colspan="1">8.9</td><td align="center" valign="middle" rowspan="1" colspan="1">28.5</td><td align="center" valign="middle" rowspan="1" colspan="1">59.4</td><td align="center" valign="middle" rowspan="1" colspan="1">6.5 (3.9)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">South Africa <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">820</td><td align="center" valign="middle" rowspan="1" colspan="1">58.9</td><td align="center" valign="middle" rowspan="1" colspan="1">38.3</td><td align="center" valign="middle" rowspan="1" colspan="1">2.8</td><td align="center" valign="middle" rowspan="1" colspan="1">818</td><td align="center" valign="middle" rowspan="1" colspan="1">7.3</td><td align="center" valign="middle" rowspan="1" colspan="1">14.9</td><td align="center" valign="middle" rowspan="1" colspan="1">17.6</td><td align="center" valign="middle" rowspan="1" colspan="1">60.1</td><td align="center" valign="middle" rowspan="1" colspan="1">8.6 (2.4)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1">North Africa, Neareast and Central Asia</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Egypt <sup>2</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">804</td><td align="center" valign="middle" rowspan="1" colspan="1">26.1</td><td align="center" valign="middle" rowspan="1" colspan="1">49.4</td><td align="center" valign="middle" rowspan="1" colspan="1">24.5</td><td align="center" valign="middle" rowspan="1" colspan="1">798</td><td align="center" valign="middle" rowspan="1" colspan="1">13.7</td><td align="center" valign="middle" rowspan="1" colspan="1">9.8</td><td align="center" valign="middle" rowspan="1" colspan="1">43.5</td><td align="center" valign="middle" rowspan="1" colspan="1">33.1</td><td align="center" valign="middle" rowspan="1" colspan="1">7.2 (3.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Tunisia <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">883</td><td align="center" valign="middle" rowspan="1" colspan="1">57.6</td><td align="center" valign="middle" rowspan="1" colspan="1">32.6</td><td align="center" valign="middle" rowspan="1" colspan="1">9.7</td><td align="center" valign="middle" rowspan="1" colspan="1">875</td><td align="center" valign="middle" rowspan="1" colspan="1">20.1</td><td align="center" valign="middle" rowspan="1" colspan="1">18.9</td><td align="center" valign="middle" rowspan="1" colspan="1">31.4</td><td align="center" valign="middle" rowspan="1" colspan="1">29.6</td><td align="center" valign="middle" rowspan="1" colspan="1">5.7 (3.4)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Turkey <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">795</td><td align="center" valign="middle" rowspan="1" colspan="1">52.6</td><td align="center" valign="middle" rowspan="1" colspan="1">37.4</td><td align="center" valign="middle" rowspan="1" colspan="1">10.1</td><td align="center" valign="middle" rowspan="1" colspan="1">768</td><td align="center" valign="middle" rowspan="1" colspan="1">16.9</td><td align="center" valign="middle" rowspan="1" colspan="1">28.4</td><td align="center" valign="middle" rowspan="1" colspan="1">39.2</td><td align="center" valign="middle" rowspan="1" colspan="1">15.5</td><td align="center" valign="middle" rowspan="1" colspan="1">8.4 (2.3)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Kyrgyzstan <sup>1</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">836</td><td align="center" valign="middle" rowspan="1" colspan="1">64.1</td><td align="center" valign="middle" rowspan="1" colspan="1">33.5</td><td align="center" valign="middle" rowspan="1" colspan="1">2.4</td><td align="center" valign="middle" rowspan="1" colspan="1">836</td><td align="center" valign="middle" rowspan="1" colspan="1">18.9</td><td align="center" valign="middle" rowspan="1" colspan="1">32.5</td><td align="center" valign="middle" rowspan="1" colspan="1">38.0</td><td align="center" valign="middle" rowspan="1" colspan="1">10.5</td><td align="center" valign="middle" rowspan="1" colspan="1">9.0 (2.1)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Russia <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">784</td><td align="center" valign="middle" rowspan="1" colspan="1">71.7</td><td align="center" valign="middle" rowspan="1" colspan="1">25.4</td><td align="center" valign="middle" rowspan="1" colspan="1">2.9</td><td align="center" valign="middle" rowspan="1" colspan="1">883</td><td align="center" valign="middle" rowspan="1" colspan="1">29.5</td><td align="center" valign="middle" rowspan="1" colspan="1">42.0</td><td align="center" valign="middle" rowspan="1" colspan="1">24.9</td><td align="center" valign="middle" rowspan="1" colspan="1">3.6</td><td align="center" valign="middle" rowspan="1" colspan="1">8.9 (2.0)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1">South Asia and China</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Bangladesh <sup>1</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">790</td><td align="center" valign="middle" rowspan="1" colspan="1">53.0</td><td align="center" valign="middle" rowspan="1" colspan="1">42.4</td><td align="center" valign="middle" rowspan="1" colspan="1">4.6</td><td align="center" valign="middle" rowspan="1" colspan="1">792</td><td align="center" valign="middle" rowspan="1" colspan="1">10.9</td><td align="center" valign="middle" rowspan="1" colspan="1">15.7</td><td align="center" valign="middle" rowspan="1" colspan="1">37.9</td><td align="center" valign="middle" rowspan="1" colspan="1">35.6</td><td align="center" valign="middle" rowspan="1" colspan="1">8.7 (2.3)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">India <sup>2</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">787</td><td align="center" valign="middle" rowspan="1" colspan="1">29.1</td><td align="center" valign="middle" rowspan="1" colspan="1">62.3</td><td align="center" valign="middle" rowspan="1" colspan="1">8.6</td><td align="center" valign="middle" rowspan="1" colspan="1">746</td><td align="center" valign="middle" rowspan="1" colspan="1">8.7</td><td align="center" valign="middle" rowspan="1" colspan="1">18.9</td><td align="center" valign="middle" rowspan="1" colspan="1">40.1</td><td align="center" valign="middle" rowspan="1" colspan="1">32.3</td><td align="center" valign="middle" rowspan="1" colspan="1">9.2 (2.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Pakistan</td><td align="center" valign="middle" rowspan="1" colspan="1">813</td><td align="center" valign="middle" rowspan="1" colspan="1">49.9</td><td align="center" valign="middle" rowspan="1" colspan="1">46.4</td><td align="center" valign="middle" rowspan="1" colspan="1">3.7</td><td align="center" valign="middle" rowspan="1" colspan="1">812</td><td align="center" valign="middle" rowspan="1" colspan="1">8.3</td><td align="center" valign="middle" rowspan="1" colspan="1">24.8</td><td align="center" valign="middle" rowspan="1" colspan="1">35.0</td><td align="center" valign="middle" rowspan="1" colspan="1">32.0</td><td align="center" valign="middle" rowspan="1" colspan="1">9.7 (0.7)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">China <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">1102</td><td align="center" valign="middle" rowspan="1" colspan="1">79.3</td><td align="center" valign="middle" rowspan="1" colspan="1">19.6</td><td align="center" valign="middle" rowspan="1" colspan="1">1.1</td><td align="center" valign="middle" rowspan="1" colspan="1">1102</td><td align="center" valign="middle" rowspan="1" colspan="1">9.7</td><td align="center" valign="middle" rowspan="1" colspan="1">33.0</td><td align="center" valign="middle" rowspan="1" colspan="1">38.8</td><td align="center" valign="middle" rowspan="1" colspan="1">18.4</td><td align="center" valign="middle" rowspan="1" colspan="1">8.1 (1.7)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1">Southeast Asia</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Indonesia <sup>2</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">749</td><td align="center" valign="middle" rowspan="1" colspan="1">89.9</td><td align="center" valign="middle" rowspan="1" colspan="1">9.2</td><td align="center" valign="middle" rowspan="1" colspan="1">0.9</td><td align="center" valign="middle" rowspan="1" colspan="1">742</td><td align="center" valign="middle" rowspan="1" colspan="1">16.3</td><td align="center" valign="middle" rowspan="1" colspan="1">15.5</td><td align="center" valign="middle" rowspan="1" colspan="1">45.8</td><td align="center" valign="middle" rowspan="1" colspan="1">22.4</td><td align="center" valign="middle" rowspan="1" colspan="1">9.5 (1.5)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Laos <sup>2</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">806</td><td align="center" valign="middle" rowspan="1" colspan="1">77.0</td><td align="center" valign="middle" rowspan="1" colspan="1">21.1</td><td align="center" valign="middle" rowspan="1" colspan="1">1.9</td><td align="center" valign="middle" rowspan="1" colspan="1">806</td><td align="center" valign="middle" rowspan="1" colspan="1">11.9</td><td align="center" valign="middle" rowspan="1" colspan="1">20.3</td><td align="center" valign="middle" rowspan="1" colspan="1">30.9</td><td align="center" valign="middle" rowspan="1" colspan="1">36.8</td><td align="center" valign="middle" rowspan="1" colspan="1">8.8 (2.4)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Philippines <sup>2</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">780</td><td align="center" valign="middle" rowspan="1" colspan="1">90.9</td><td align="center" valign="middle" rowspan="1" colspan="1">8.8</td><td align="center" valign="middle" rowspan="1" colspan="1">0.3</td><td align="center" valign="middle" rowspan="1" colspan="1">781</td><td align="center" valign="middle" rowspan="1" colspan="1">18.2</td><td align="center" valign="middle" rowspan="1" colspan="1">38.3</td><td align="center" valign="middle" rowspan="1" colspan="1">38.2</td><td align="center" valign="middle" rowspan="1" colspan="1">5.4</td><td align="center" valign="middle" rowspan="1" colspan="1">9.3 (1.3)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Singapore <sup>4</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">885</td><td align="center" valign="middle" rowspan="1" colspan="1">77.6</td><td align="center" valign="middle" rowspan="1" colspan="1">20.8</td><td align="center" valign="middle" rowspan="1" colspan="1">1.6</td><td align="center" valign="middle" rowspan="1" colspan="1">887</td><td align="center" valign="middle" rowspan="1" colspan="1">17.6</td><td align="center" valign="middle" rowspan="1" colspan="1">31.1</td><td align="center" valign="middle" rowspan="1" colspan="1">38.7</td><td align="center" valign="middle" rowspan="1" colspan="1">12.6</td><td align="center" valign="middle" rowspan="1" colspan="1">8.2 (1.8)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Thailand <sup>3</sup></td><td align="center" valign="middle" rowspan="1" colspan="1">854</td><td align="center" valign="middle" rowspan="1" colspan="1">89.0</td><td align="center" valign="middle" rowspan="1" colspan="1">9.5</td><td align="center" valign="middle" rowspan="1" colspan="1">1.5</td><td align="center" valign="middle" rowspan="1" colspan="1">849</td><td align="center" valign="middle" rowspan="1" colspan="1">20.7</td><td align="center" valign="middle" rowspan="1" colspan="1">35.7</td><td align="center" valign="middle" rowspan="1" colspan="1">32.7</td><td align="center" valign="middle" rowspan="1" colspan="1">10.8</td><td align="center" valign="middle" rowspan="1" colspan="1">9.0 (1.7)</td></tr></tbody></table><table-wrap-foot><fn><p><bold><sup>1</sup></bold> Low income country; <bold><sup>2</sup></bold> Lower middle income country; <bold><sup>3</sup></bold> Upper middle income country; <bold><sup>4</sup></bold> High income country (Source: [<xref rid="B41-ijerph-11-12247" ref-type="bibr">41</xref>]).</p></fn></table-wrap-foot></table-wrap><table-wrap id="ijerph-11-12247-t002" position="float"><object-id pub-id-type="pii">ijerph-11-12247-t002_Table 2</object-id><label>Table 2</label><caption><p>Logistic regression analyses predicting oral health (tooth brushing and dental visit).</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2" align="left" valign="middle" colspan="1">Variables (N,% or M, SD)</th><th colspan="2" align="center" valign="middle" rowspan="1">Tooth Brushing < Twice Daily</th><th colspan="2" align="center" valign="middle" rowspan="1">Dental Visits < Yearly</th></tr><tr style="border-top: solid thin"><th align="center" rowspan="1" colspan="1">Crude OR (95% CI)</th><th align="center" rowspan="1" colspan="1">Adjusted OR (95% CI)</th><th align="center" rowspan="1" colspan="1">Crude OR (95% CI)</th><th align="center" rowspan="1" colspan="1">Adjusted OR (95% CI)</th></tr><tr style="border-top: solid thin"><th align="left" valign="middle" rowspan="1" colspan="1">Socio-Demographic Variables</th><th align="center" valign="middle" rowspan="1" colspan="1"></th><th align="center" valign="middle" rowspan="1" colspan="1"></th><th align="center" valign="middle" rowspan="1" colspan="1"></th><th align="center" valign="middle" rowspan="1" colspan="1"></th></tr></thead><tbody><tr style="border-top: solid thin"><td align="left" valign="middle" rowspan="1" colspan="1"><italic>Gender</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Female (58.3%)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Male (41.7%)</td><td align="center" valign="middle" rowspan="1" colspan="1">2.06 (1.94–2.19) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">2.12 (1.95–2.31) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.50 (1.41–1.59) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.53 (1.42–1.65) ***</td></tr><tr style="border-top: solid thin"><td align="left" valign="middle" rowspan="1" colspan="1"><italic>Age in years</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">16–19 (34.1%)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">20–21 (35.5%)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.06 (0.89–1.14)</td><td align="center" valign="middle" rowspan="1" colspan="1">---</td><td align="center" valign="middle" rowspan="1" colspan="1">1.13 (1.05–1.21) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.06 (0.97–1.15)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">22 or more (30.4%)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.09 (0.99–1.16)</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1">1.32 (1.22–1.42) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.14 (1.04–1.25) **</td></tr><tr style="border-top: solid thin"><td align="left" valign="middle" rowspan="1" colspan="1"><italic>Wealth</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Not well off/Poor (46.4%)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Wealthy/ Quite well off (53.6%)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.50 (1.41–1.59) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.43 (1.31–1.55) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.70 (0.66–0.74) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.66 (0.61–0.71) ***</td></tr><tr style="border-top: solid thin"><td align="left" valign="middle" rowspan="1" colspan="1"><italic>Country income</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Upper middle income/High income (49.8%)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Low income/Lower middle income (50.2%)</td><td align="center" valign="middle" rowspan="1" colspan="1">2.12 (1.99–2.26) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.65 (1.51–1.81) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">2.22 (2.09–2.36) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">2.15 (1.98–2.33) ***</td></tr><tr style="border-top: solid thin"><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Health Beliefs</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Weak beliefs in importance of regular tooth brushing (27.5%) (1–8 <italic>vs.</italic> 9–10) (base = 9–10)</td><td align="center" valign="middle" rowspan="1" colspan="1">2.24 (2.10–2.39) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.85 (1.69–2.43) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.34 (1.25–1.43) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.34 (1.23–1.47) ***</td></tr><tr style="border-top: solid thin"><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Poor Mental Health</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Depression symptoms (≥15; severe) (12.8%) (base ≤ 15)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.45 (1.34–1.58) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.34 (1.19–1.51) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.11 (1.02–1.21) *</td><td align="center" valign="middle" rowspan="1" colspan="1">1.03 (0.92–1.16)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">PTSD symptoms (≥4) (20.9%) (base ≤ 4)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.40 (1.30–1.51) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.22 (1.10–1.35) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.24 (1.15–1.34) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.19 (1.08–1.31) ***</td></tr><tr style="border-top: solid thin"><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Addictive Risk Behaviour</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Current tobacco use (12.1%) (base ≤ 4 weeks tobacco use)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.53 (1.41–1.67) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.17 (1.04–1.32) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.99 (0.91–1.08)</td><td align="center" valign="middle" rowspan="1" colspan="1">---</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Binge drinking (past month) (11.8%) (base ≤ past months)</td><td align="center" valign="middle" rowspan="1" colspan="1">0.78 (0.71–0.86) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.74 (0.64–0.84) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.64 (0.59–0.79) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.67 (0.60–0.75) ***</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Past year illicit drug use (17.4%) (base ≤ past year)</td><td align="center" valign="middle" rowspan="1" colspan="1">0.95 (0.89–1.03)</td><td align="center" valign="middle" rowspan="1" colspan="1">---</td><td align="center" valign="middle" rowspan="1" colspan="1">1.40 (1.30–1.50) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.23 (1.13–1.35) ***</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Gambling (>once a week) (8.2%) (base ≤ 1 week)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.30 (1.17–1.44) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.23 (1.06–1.43) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.02 (0.92–1.13)</td><td align="center" valign="middle" rowspan="1" colspan="1">---</td></tr><tr style="border-top: solid thin"><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Low Physical Activity</bold> (47.5%) (base = moderate or high physical activity)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.23 (1.16–1.30) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.15 (1.06–1.25) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.17 (1.10–1.24) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.09 (1.01–1.18) *</td></tr><tr style="border-top: solid thin"><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Dietary Behaviour</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Daily meal frequency [2.6 (0.7] (continuous variable)</td><td align="center" valign="middle" rowspan="1" colspan="1">0.77 (0.73–0.80) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.87 (0.82–0.93) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.81 (0.78–0.85) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.96 (0.91–1.01)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Daily snacks frequency [1.5 (0.9)] (continuous variable)</td><td align="center" valign="middle" rowspan="1" colspan="1">0.91 (0.88–0.94) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.92 (0.88–0.97) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.86 (0.83–0.89) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.88 (0.85–0.92) ***</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Skips breakfast (46.2%) (base = not skip breakfast)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.24 (1.17–1.32) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.07 (0.98–1.17)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.25 (1.18–1.33) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.09 (1.01–1.18) *</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Fruit and Vegetables (<5 servings/day) (82.8%) (base ≥ 5 servings/day)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.15 (1.05–1.25) **</td><td align="center" valign="middle" rowspan="1" colspan="1">1.05 (0.94–1.18)</td><td align="center" valign="middle" rowspan="1" colspan="1">1.15 (1.06–1.24) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.12 (1.01–1.24) *</td></tr></tbody></table><table-wrap-foot><fn><p>*** <italic>p</italic> < 0.001; ** <italic>p</italic> < 0.01; * <italic>p</italic> < 0.05.</p></fn></table-wrap-foot></table-wrap></sec><sec><title>3.3. Discussion</title><p>The study found, among a large sample of university students from 26 low, middle and high income countries across Asia, Africa and the Americas, a large group of 32.8% engaged in inadequate or no tooth brushing, and 58.2% rarely or never had gone for a dental check-up visit. These findings seem to confirm low rates of tooth brushing and dental attendance in developing economy countries [<xref rid="B2-ijerph-11-12247" ref-type="bibr">2</xref>,<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>,<xref rid="B4-ijerph-11-12247" ref-type="bibr">4</xref>,<xref rid="B5-ijerph-11-12247" ref-type="bibr">5</xref>,<xref rid="B8-ijerph-11-12247" ref-type="bibr">8</xref>,<xref rid="B9-ijerph-11-12247" ref-type="bibr">9</xref>,<xref rid="B10-ijerph-11-12247" ref-type="bibr">10</xref>] compared to high income countries [<xref rid="B6-ijerph-11-12247" ref-type="bibr">6</xref>,<xref rid="B7-ijerph-11-12247" ref-type="bibr">7</xref>,<xref rid="B11-ijerph-11-12247" ref-type="bibr">11</xref>].</p><p>However, the study found a large country variation in the overall prevalence of inadequate tooth brushing and less than annual dental visits, which in part confirms findings from previous studies of poor oral health practices in India, Nigeria, South Africa, and Turkey [<xref rid="B2-ijerph-11-12247" ref-type="bibr">2</xref>,<xref rid="B4-ijerph-11-12247" ref-type="bibr">4</xref>,<xref rid="B9-ijerph-11-12247" ref-type="bibr">9</xref>,<xref rid="B42-ijerph-11-12247" ref-type="bibr">42</xref>], and on the other hand countries with more optimal oral health practices such as Colombia [<xref rid="B14-ijerph-11-12247" ref-type="bibr">14</xref>] and Thailand [<xref rid="B43-ijerph-11-12247" ref-type="bibr">43</xref>]. Studies among dental students in different cultures showed that oral health behaviour can largely differ between countries, which could be explained by different cultural and health education systems [<xref rid="B4-ijerph-11-12247" ref-type="bibr">4</xref>,<xref rid="B44-ijerph-11-12247" ref-type="bibr">44</xref>,<xref rid="B45-ijerph-11-12247" ref-type="bibr">45</xref>]. For example, in some cultures the toothpick is commonly used as a dental cleaning device or different perceptions on putting off going to the dentist until having toothache [<xref rid="B4-ijerph-11-12247" ref-type="bibr">4</xref>,<xref rid="B44-ijerph-11-12247" ref-type="bibr">44</xref>]. It is further possible that in our study countries with poor oral health practices (India, Nigeria, South Africa, Turkey) oral hygiene education was not sufficiently integrated into the secondary school system.</p><p>In concordance with a number of other studies [<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>,<xref rid="B7-ijerph-11-12247" ref-type="bibr">7</xref>,<xref rid="B12-ijerph-11-12247" ref-type="bibr">12</xref>,<xref rid="B13-ijerph-11-12247" ref-type="bibr">13</xref>,<xref rid="B14-ijerph-11-12247" ref-type="bibr">14</xref>,<xref rid="B15-ijerph-11-12247" ref-type="bibr">15</xref>,<xref rid="B16-ijerph-11-12247" ref-type="bibr">16</xref>,<xref rid="B24-ijerph-11-12247" ref-type="bibr">24</xref>,<xref rid="B25-ijerph-11-12247" ref-type="bibr">25</xref>,<xref rid="B26-ijerph-11-12247" ref-type="bibr">26</xref>,<xref rid="B27-ijerph-11-12247" ref-type="bibr">27</xref>], the study found across the countries that men engaged more frequently in poor oral health behaviour (less frequent tooth brushing, less or never dental attendance). It is possible that women care more for body and appearance, and thus their oral health than men [<xref rid="B2-ijerph-11-12247" ref-type="bibr">2</xref>,<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>]. Lack of dental attendance was in agreement with another study [<xref rid="B9-ijerph-11-12247" ref-type="bibr">9</xref>] associated with younger age.</p><p>Further, the study found that living in a low income or lower middle income was associated with poor oral health behaviour (tooth brushing and dental attendance), the same was true regarding coming from a not well off or poor family background and poor dental attendance, while coming from a wealthy or quite well off family background was associated with poor tooth brushing behaviour. Previous studies have generally found that lower socioeconomic background was associated with a poorer oral health behaviour (tooth brushing and dental attendance) [<xref rid="B16-ijerph-11-12247" ref-type="bibr">16</xref>,<xref rid="B17-ijerph-11-12247" ref-type="bibr">17</xref>,<xref rid="B18-ijerph-11-12247" ref-type="bibr">18</xref>,<xref rid="B19-ijerph-11-12247" ref-type="bibr">19</xref>,<xref rid="B26-ijerph-11-12247" ref-type="bibr">26</xref>,<xref rid="B28-ijerph-11-12247" ref-type="bibr">28</xref>]. It is possible that university students with lower socioeconomic status were less likely to go for regular dental check-ups because they were not able to pay for the dental services.</p><p>Unexpectedly, students from more affluent economic backgrounds were less likely to brush their teeth twice of more a day. It is possible that in this group other factors such as lack of knowledge and cultural values about the importance of tooth brushing impact on poor oral health behaviour [<xref rid="B26-ijerph-11-12247" ref-type="bibr">26</xref>]. University students from lower economic backgrounds may be equally exposed to oral health information and communication than students from higher economic backgrounds, and engage in oral health behaviour (tooth brushing).</p><p>After adjusting for relevant socio-demographic variables, the current study findings indicate associations between poor oral health behaviour and weak beliefs in the importance of regular tooth brushing, poor mental health, and health risk behaviours, including addictive risk behaviours, low physical activity, inadequate dietary behaviours (skipping breakfast and insufficient fruit and vegetable consumption), which is largely consistent with findings of previous research [<xref rid="B2-ijerph-11-12247" ref-type="bibr">2</xref>,<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>,<xref rid="B5-ijerph-11-12247" ref-type="bibr">5</xref>,<xref rid="B13-ijerph-11-12247" ref-type="bibr">13</xref>,<xref rid="B20-ijerph-11-12247" ref-type="bibr">20</xref>,<xref rid="B21-ijerph-11-12247" ref-type="bibr">21</xref>,<xref rid="B22-ijerph-11-12247" ref-type="bibr">22</xref>,<xref rid="B23-ijerph-11-12247" ref-type="bibr">23</xref>,<xref rid="B25-ijerph-11-12247" ref-type="bibr">25</xref>,<xref rid="B29-ijerph-11-12247" ref-type="bibr">29</xref>]. Contrary to some previous findings [<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>,<xref rid="B20-ijerph-11-12247" ref-type="bibr">20</xref>], this study found that binge drinking and more frequent daily meals and snacks, was found to be protective of poor oral health behaviour. For some of these findings the reports in the literature has been conflicting and might also come from different measurement instruments [<xref rid="B3-ijerph-11-12247" ref-type="bibr">3</xref>]. The significant relationship of oral health behaviour with the attitudes of the students, indicates the importance of attitude and beliefs in influencing the behaviour, which should be utilized in planning preventive oral health promotion programmes. Present results seem to generally indicate an overlap between oral and general health behaviour, which could imply that oral and general health behaviour should be approached jointly in health promotion lifestyle programmes [<xref rid="B46-ijerph-11-12247" ref-type="bibr">46</xref>].</p><sec><title>Study Limitations</title><p>This study had several limitations. The study was cross-sectional, so causal conclusions cannot be drawn. The investigation was carried out with students from one or two universities in each country, and inclusion of other centres could have resulted in different results. University students are not representative of young adults in general, and the oral health behaviour levels, sociodemographic and health risk behaviour variables may be different in other sectors of the population. A further limitation of the study was that all information collected in the study was based on self-reporting. It is possible that rates of oral health behaviours were under or over reported. However, a previous study found that the self-reported dental care use was valid for some service types [<xref rid="B47-ijerph-11-12247" ref-type="bibr">47</xref>]. Further, the assessment of oral health behaviour was limited to tooth brushing and dental attendance, and other oral hygiene knowledge and behaviours such as knowledge of fluoridated toothpastes, frequency of brushing with fluoride toothpaste, frequency of toothbrush renewal, use of dental floss, and ‘sugar behaviour’ [<xref rid="B2-ijerph-11-12247" ref-type="bibr">2</xref>,<xref rid="B48-ijerph-11-12247" ref-type="bibr">48</xref>] and oral health status [<xref rid="B49-ijerph-11-12247" ref-type="bibr">49</xref>,<xref rid="B50-ijerph-11-12247" ref-type="bibr">50</xref>] should be assessed in future studies. Finally, no data of variety of social factors in the same country, and no link between the two poor oral health behaviours and oral diseases (periodontal diseases) were assessed and include an additional limitation of the study</p></sec></sec></sec><sec><title>4. Conclusions</title><p>This study confirms low rates of tooth brushing and dental attendance among university students in different cultures across Africa, Asia and the Americas. Various factors identified, such as socioeconomic status, weak beliefs in the importance of regular tooth brushing and co-occurrence of general health risk behaviour can be used to guide interventions to improve oral health behaviour among university students. Oral health promotion programmes targeting the young adult population could help to improve their attitude and oral health behaviour to achieve good oral health.</p></sec></body><back><ack><title>Acknowledgements</title><p>Partial funding for this study was provided by the South African Department of Higher Education. The following colleagues participated in this student health survey and contributed to data collection (locations of universities in parentheses) Bangladesh: Gias Uddin Ahsan (Dhaka); Barbados: T. Alafia Samuels (Bridgetown); Cameroon: Jacques Philippe Tsala Tsala (Yaounde); China: Tony Yung and Xiaoyan Xu (Hong Kong and Chengdu); Colombia: Carolina Mantilla (Pamplona); Egypt: Alaa Abou-Zeid (Cairo); Grenada: Omowale Amuleru-Marshall (St. George); India: Krishna Mohan (Visakhapatnam); Indonesia: Indri Hapsari Susilowati (Jakarta); Ivory Coast: Issaka Tiembre (Abidjan); Laos: Vanphanom Sychareun (Vientiane); Madagascar: Onya H Rahamefy (Antananarivo); Mauritius: Hemant Kumar Kassean (Réduit, Moka); Namibia: Pempelani Mufune (Windhoek); Nigeria: Solu Olowu (Ile-Ife); Philippines: Alice Ferrer (Miagao); Russia: Alexander Gasparishvili (Moscow); Singapore: Mee Lian Wong (Singapore); Thailand: Tawatchai Apidechkul (Chiang Rai); Tunisia: Hajer Aounallah-Skhiri (Tunis); Turkey: Neslihan Keser Özcan (Istanbul); Venezuela: Yajaira M Bastardo (Caracas).</p></ack><notes><title>Author Contributions</title><p>Karl Peltzer and Supa Pengpid designed the study, analysed the data and wrote the paper.</p></notes><notes><title>Conflicts of Interest</title><p>The authors declare no conflict of interest.</p></notes><ref-list><title>References</title><ref id="B1-ijerph-11-12247"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hassija</surname><given-names>J.</given-names></name><name><surname>Sridhar</surname><given-names>N.</given-names></name></person-group><article-title>Healthy Lifestyle for Healthy Gums</article-title><source>Dentistry</source><year>2014</year><volume>4</volume><pub-id pub-id-type="doi">10.4172/2161-1122.1000235</pub-id></element-citation></ref><ref id="B2-ijerph-11-12247"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sharda</surname><given-names>A.J.</given-names></name><name><surname>Shetty</surname><given-names>S.</given-names></name></person-group><article-title>A comparative study of oral health knowledge, attitude and behaviour of first and final year dental students of Udaipur city, Rajasthan, India</article-title><source>Int. J. Dent. Hyg.</source><year>2008</year><volume>6</volume><fpage>347</fpage><lpage>353</lpage><pub-id pub-id-type="doi">10.1111/j.1601-5037.2008.00308.x</pub-id><pub-id pub-id-type="pmid">19138186</pub-id></element-citation></ref><ref id="B3-ijerph-11-12247"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kassak</surname><given-names>K.M.</given-names></name><name><surname>Dagher</surname><given-names>R.</given-names></name><name><surname>Doughan</surname><given-names>B.</given-names></name></person-group><article-title>Oral hygiene and lifestyle correlates among new undergraduate university students in Lebanon</article-title><source>J. Am. Coll. Health</source><year>2001</year><volume>50</volume><fpage>15</fpage><lpage>20</lpage><pub-id pub-id-type="doi">10.1080/07448480109595706</pub-id><pub-id pub-id-type="pmid">11534746</pub-id></element-citation></ref><ref id="B4-ijerph-11-12247"><label>4.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kirtiloğlu</surname><given-names>T.</given-names></name><name><surname>Yavuz</surname><given-names>U.S.</given-names></name></person-group><article-title>An assessment of oral self-care in the student population of a Turkish university</article-title><source>Public Health</source><year>2006</year><volume>120</volume><fpage>953</fpage><lpage>957</lpage><pub-id pub-id-type="doi">10.1016/j.puhe.2006.05.006</pub-id><pub-id pub-id-type="pmid">16828129</pub-id></element-citation></ref><ref id="B5-ijerph-11-12247"><label>5.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Halboub</surname><given-names>E.</given-names></name><name><surname>Dhaifullah</surname><given-names>E.</given-names></name><name><surname>Yasin</surname><given-names>R.</given-names></name></person-group><article-title>Determinants of dental health status and dental health behavior among Sana’a University students, Yemen</article-title><source>J. Investig. Clin. Dent.</source><year>2013</year><volume>4</volume><fpage>257</fpage><lpage>264</lpage><pub-id pub-id-type="doi">10.1111/j.2041-1626.2012.00156.x</pub-id><pub-id pub-id-type="pmid">23371921</pub-id></element-citation></ref><ref id="B6-ijerph-11-12247"><label>6.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rimondini</surname><given-names>L.</given-names></name><name><surname>Zolfanelli</surname><given-names>B.</given-names></name><name><surname>Bernardi</surname><given-names>F.</given-names></name><name><surname>Bez</surname><given-names>C.</given-names></name></person-group><article-title>Self-preventive oral behavior in an Italian university student population</article-title><source>J. Clin. Periodontol.</source><year>2001</year><volume>28</volume><fpage>207</fpage><lpage>211</lpage><pub-id pub-id-type="doi">10.1034/j.1600-051x.2001.028003207.x</pub-id><pub-id pub-id-type="pmid">11284532</pub-id></element-citation></ref><ref id="B7-ijerph-11-12247"><label>7.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Luebke</surname><given-names>T.E.</given-names></name><name><surname>Driskell</surname><given-names>J.A.</given-names></name></person-group><article-title>A group of Midwestern university students needs to improve their oral hygiene and sugar/pop consumption habits</article-title><source>Nutr. Res.</source><year>2010</year><volume>30</volume><fpage>27</fpage><lpage>31</lpage><pub-id pub-id-type="doi">10.1016/j.nutres.2009.11.001</pub-id><pub-id pub-id-type="pmid">20116657</pub-id></element-citation></ref><ref id="B8-ijerph-11-12247"><label>8.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chindia</surname><given-names>M.L.</given-names></name><name><surname>Valderhaug</surname><given-names>J.</given-names></name><name><surname>Ng’ang’a</surname><given-names>P.M.</given-names></name></person-group><article-title>Oral health habits and periodontal health among a group of university students in Kenya</article-title><source>East Afr. Med. J.</source><year>1992</year><volume>69</volume><fpage>337</fpage><lpage>340</lpage><pub-id pub-id-type="pmid">1505422</pub-id></element-citation></ref><ref id="B9-ijerph-11-12247"><label>9.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bamise</surname><given-names>C.T.</given-names></name><name><surname>Bada</surname><given-names>T.A.</given-names></name><name><surname>Bamise</surname><given-names>F.O.</given-names></name><name><surname>Ogunbodede</surname><given-names>E.O.</given-names></name></person-group><article-title>Dental care utilization and satisfaction of residential university students</article-title><source>Libyan J. Med.</source><year>2008</year><volume>3</volume><fpage>20</fpage><lpage>25</lpage><pub-id pub-id-type="doi">10.4176/080601</pub-id><pub-id pub-id-type="pmid">21499477</pub-id></element-citation></ref><ref id="B10-ijerph-11-12247"><label>10.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Neamatollahi</surname><given-names>H.</given-names></name><name><surname>Ebrahimi</surname><given-names>M.</given-names></name></person-group><article-title>Oral health behavior and its determinants in a group of Iranian students</article-title><source>Indian J. Dent. Res.</source><year>2010</year><volume>21</volume><fpage>84</fpage><lpage>88</lpage><pub-id pub-id-type="doi">10.4103/0970-9290.62820</pub-id><pub-id pub-id-type="pmid">20427913</pub-id></element-citation></ref><ref id="B11-ijerph-11-12247"><label>11.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ventä</surname><given-names>I.</given-names></name><name><surname>Murtomaa</surname><given-names>H.</given-names></name><name><surname>Meurman</surname><given-names>J.</given-names></name><name><surname>Turtola</surname><given-names>L.</given-names></name></person-group><article-title>Use of dental services by students of Helsinki University during six years</article-title><source>Proc. Finn. Dent. Soc. Suom. Hammaslaakariseuran Toim.</source><year>1992</year><volume>88</volume><fpage>123</fpage><lpage>129</lpage></element-citation></ref><ref id="B12-ijerph-11-12247"><label>12.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Åstrøm</surname><given-names>A.N.</given-names></name><name><surname>Masalu</surname><given-names>J.R.</given-names></name></person-group><article-title>Oral health behavior patterns among Tanzanian university students: A repeat cross-sectional survey</article-title><source>BMC Oral Health</source><year>2001</year><volume>1</volume><pub-id pub-id-type="doi">10.1186/1472-6831-1-2</pub-id></element-citation></ref><ref id="B13-ijerph-11-12247"><label>13.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Astrøm</surname><given-names>A.N.</given-names></name><name><surname>Mbawalla</surname><given-names>H.</given-names></name></person-group><article-title>Factor structure of health and oral health-related behaviors among adolescents in Arusha, northern Tanzania</article-title><source>Acta. Odontol. Scand.</source><year>2011</year><volume>69</volume><fpage>299</fpage><lpage>309</lpage><pub-id pub-id-type="doi">10.3109/00016357.2011.568960</pub-id><pub-id pub-id-type="pmid">21449689</pub-id></element-citation></ref><ref id="B14-ijerph-11-12247"><label>14.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marulanda</surname><given-names>A.M.</given-names></name><name><surname>Coral</surname><given-names>D.</given-names></name><name><surname>Sabogal</surname><given-names>D.</given-names></name><name><surname>Serrano</surname><given-names>C.</given-names></name></person-group><article-title>Periodontal conditions of Colombian university students aged 16 to 35</article-title><source>Braz. Oral Res.</source><year>2014</year><volume>28</volume><fpage>1</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">25337936</pub-id></element-citation></ref><ref id="B15-ijerph-11-12247"><label>15.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tada</surname><given-names>A.</given-names></name><name><surname>Hanada</surname><given-names>N.</given-names></name></person-group><article-title>Sexual differences in oral health behaviour and factors associated with oral health behaviour in Japanese young adults</article-title><source>Public Health</source><year>2004</year><volume>118</volume><fpage>104</fpage><lpage>109</lpage><pub-id pub-id-type="doi">10.1016/j.puhe.2003.05.007</pub-id><pub-id pub-id-type="pmid">15037039</pub-id></element-citation></ref><ref id="B16-ijerph-11-12247"><label>16.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Al-Ansari</surname><given-names>J.M.</given-names></name><name><surname>Honkala</surname><given-names>S.</given-names></name></person-group><article-title>Gender differences in oral health knowledge and behavior of the health science college students in Kuwait</article-title><source>J. Allied Health</source><year>2007</year><volume>36</volume><fpage>41</fpage><lpage>46</lpage><pub-id pub-id-type="pmid">17425190</pub-id></element-citation></ref><ref id="B17-ijerph-11-12247"><label>17.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Freddo</surname><given-names>S.L.</given-names></name><name><surname>Aerts</surname><given-names>D.R.</given-names></name><name><surname>Abegg</surname><given-names>C.</given-names></name><name><surname>Davoglio</surname><given-names>R.</given-names></name><name><surname>Vieira</surname><given-names>P.C.</given-names></name><name><surname>Monteiro</surname><given-names>L.</given-names></name></person-group><article-title>Oral hygiene habits and use of dental services among teenage students in a city in southern Brazil</article-title><source>Cad. Saude Publica</source><year>2008</year><volume>24</volume><fpage>1991</fpage><lpage>2000</lpage><pub-id pub-id-type="doi">10.1590/S0102-311X2008000900005</pub-id><pub-id pub-id-type="pmid">18813675</pub-id></element-citation></ref><ref id="B18-ijerph-11-12247"><label>18.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Maes</surname><given-names>L.</given-names></name><name><surname>Vereecken</surname><given-names>C.</given-names></name><name><surname>Vanobbergen</surname><given-names>J.</given-names></name><name><surname>Honkala</surname><given-names>S.</given-names></name></person-group><article-title>Tooth brushing and social characteristics of families in 32 countries</article-title><source>Int. Dent. J.</source><year>2006</year><volume>56</volume><fpage>159</fpage><lpage>167</lpage><pub-id pub-id-type="pmid">16826883</pub-id></element-citation></ref><ref id="B19-ijerph-11-12247"><label>19.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nzioka</surname><given-names>B.M.</given-names></name><name><surname>Nyaga</surname><given-names>J.K.</given-names></name><name><surname>Wagaiyu</surname><given-names>E.G.</given-names></name></person-group><article-title>The relationship between tooth brushing frequency and personal hygiene habits in teenagers</article-title><source>East Afr. Med. J.</source><year>1993</year><volume>70</volume><fpage>445</fpage><lpage>448</lpage><pub-id pub-id-type="pmid">8293705</pub-id></element-citation></ref><ref id="B20-ijerph-11-12247"><label>20.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Siziya</surname><given-names>S.</given-names></name><name><surname>Muula</surname><given-names>A.S.</given-names></name><name><surname>Rudatsikira</surname><given-names>E.</given-names></name></person-group><article-title>Self-reported poor oral hygiene among in-school adolescents in Zambia</article-title><source>BMC Res. Notes</source><year>2011</year><volume>4</volume><pub-id pub-id-type="doi">10.1186/1756-0500-4-255</pub-id><pub-id pub-id-type="pmid">22082027</pub-id></element-citation></ref><ref id="B21-ijerph-11-12247"><label>21.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pengpid</surname><given-names>S.</given-names></name><name><surname>Peltzer</surname><given-names>K.</given-names></name></person-group><article-title>Hygiene behaviour and associated factors among in-school adolescents in nine African countries</article-title><source>Int. J. Behav. Med.</source><year>2011</year><volume>18</volume><fpage>150</fpage><lpage>159</lpage><pub-id pub-id-type="doi">10.1007/s12529-010-9109-6</pub-id><pub-id pub-id-type="pmid">20593258</pub-id></element-citation></ref><ref id="B22-ijerph-11-12247"><label>22.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Peltzer</surname><given-names>K.</given-names></name><name><surname>Pengpid</surname><given-names>S.</given-names></name></person-group><article-title>Oral and hand hygiene behaviour and risk factors among in-school adolescents in four Southeast Asian countries</article-title><source>Int. J. Environ. Res. Public Health.</source><year>2014</year><volume>11</volume><fpage>2780</fpage><lpage>2792</lpage><pub-id pub-id-type="doi">10.3390/ijerph110302780</pub-id><pub-id pub-id-type="pmid">24608901</pub-id></element-citation></ref><ref id="B23-ijerph-11-12247"><label>23.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zaborski</surname><given-names>A.</given-names></name><name><surname>Milciuviene</surname><given-names>S.</given-names></name><name><surname>Bendoraitiene</surname><given-names>E.</given-names></name><name><surname>Zaborskyte</surname><given-names>A.</given-names></name></person-group><article-title>Oral health behaviour of adolescents: A comparative study in 35 countries</article-title><source>Stomatologija</source><year>2004</year><volume>6</volume><fpage>44</fpage><lpage>50</lpage></element-citation></ref><ref id="B24-ijerph-11-12247"><label>24.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kateeb</surname><given-names>E.</given-names></name></person-group><article-title>Gender-specific oral health attitudes and behaviour among dental students in Palestine</article-title><source>East Mediterr. Health J.</source><year>2010</year><volume>16</volume><fpage>329</fpage><lpage>333</lpage><pub-id pub-id-type="pmid">20795450</pub-id></element-citation></ref><ref id="B25-ijerph-11-12247"><label>25.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Khami</surname><given-names>M.R.</given-names></name><name><surname>Virtanen</surname><given-names>J.I.</given-names></name><name><surname>Jafarian</surname><given-names>M.</given-names></name><name><surname>Murtomaa</surname><given-names>H.</given-names></name></person-group><article-title>Oral health behaviour and its determinants amongst Iranian dental students</article-title><source>Eur. J. Dent. Educ.</source><year>2007</year><volume>11</volume><fpage>42</fpage><lpage>47</lpage><pub-id pub-id-type="pmid">17227395</pub-id></element-citation></ref><ref id="B26-ijerph-11-12247"><label>26.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lopez</surname><given-names>R.</given-names></name><name><surname>Baelum</surname><given-names>V.</given-names></name></person-group><article-title>Factors associated with dental attendance among adolescents in Santiago, Chile</article-title><source>BMC Oral Health.</source><year>2007</year><volume>7</volume><pub-id pub-id-type="doi">10.1186/1472-6831-7-4</pub-id></element-citation></ref><ref id="B27-ijerph-11-12247"><label>27.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ekanayake</surname><given-names>L.</given-names></name><name><surname>Ando</surname><given-names>Y.</given-names></name><name><surname>Miyazaki</surname><given-names>H.</given-names></name></person-group><article-title>Patterns and factors affecting dental utilisation among adolescents in Sri Lanka</article-title><source>Int. Dent. J.</source><year>2001</year><volume>51</volume><fpage>353</fpage><lpage>358</lpage><pub-id pub-id-type="doi">10.1002/j.1875-595X.2001.tb00849.x</pub-id><pub-id pub-id-type="pmid">11697589</pub-id></element-citation></ref><ref id="B28-ijerph-11-12247"><label>28.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ola</surname><given-names>D.</given-names></name><name><surname>Gambôa</surname><given-names>A.B.</given-names></name><name><surname>Folayan</surname><given-names>M.O.</given-names></name><name><surname>Marcenes</surname><given-names>W.</given-names></name></person-group><article-title>Family structure, socioeconomic position and utilization of oral health services among Nigerian senior secondary school pupils</article-title><source>J. Public Health Dent.</source><year>2013</year><volume>73</volume><fpage>158</fpage><lpage>165</lpage><pub-id pub-id-type="doi">10.1111/j.1752-7325.2012.00362.x</pub-id><pub-id pub-id-type="pmid">22970821</pub-id></element-citation></ref><ref id="B29-ijerph-11-12247"><label>29.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Attwood</surname><given-names>D.</given-names></name><name><surname>West</surname><given-names>P.</given-names></name><name><surname>Blinkhorn</surname><given-names>A.S.</given-names></name></person-group><article-title>Factors associated with the dental visiting habits of adolescents in the west of Scotland</article-title><source>Community Dent. Health</source><year>1993</year><volume>10</volume><fpage>365</fpage><lpage>373</lpage><pub-id pub-id-type="pmid">8124624</pub-id></element-citation></ref><ref id="B30-ijerph-11-12247"><label>30.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wardle</surname><given-names>J.</given-names></name><name><surname>Steptoe</surname><given-names>A.</given-names></name></person-group><article-title>The European Health and Behaviour Survey: Rationale, methods and initial results from the United Kingdom</article-title><source>Soc. Sci. Med.</source><year>1991</year><volume>33</volume><fpage>925</fpage><lpage>936</lpage><pub-id pub-id-type="doi">10.1016/0277-9536(91)90263-C</pub-id><pub-id pub-id-type="pmid">1745917</pub-id></element-citation></ref><ref id="B31-ijerph-11-12247"><label>31.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Andresen</surname><given-names>E.M.</given-names></name><name><surname>Malmgren</surname><given-names>J.A.</given-names></name><name><surname>Carter</surname><given-names>W.B.</given-names></name><name><surname>Patrick</surname><given-names>D.L.</given-names></name></person-group><article-title>Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale)</article-title><source>Am. J. Prev. Med.</source><year>1994</year><volume>10</volume><fpage>77</fpage><lpage>84</lpage><pub-id pub-id-type="pmid">8037935</pub-id></element-citation></ref><ref id="B32-ijerph-11-12247"><label>32.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kilbourne</surname><given-names>A.M.</given-names></name><name><surname>Justice</surname><given-names>A.C.</given-names></name><name><surname>Rollman</surname><given-names>B.L.</given-names></name><name><surname>McGinnis</surname><given-names>K.A.</given-names></name><name><surname>Rabeneck</surname><given-names>L.</given-names></name><name><surname>Weissman</surname><given-names>S.</given-names></name><name><surname>Smola</surname><given-names>S.</given-names></name><name><surname>Schultz</surname><given-names>R.</given-names></name><name><surname>Whittle</surname><given-names>J.</given-names></name><name><surname>Rodriguez-Barradas</surname><given-names>M.</given-names></name></person-group><article-title>Clinical importance of HIV and depressive symptoms among veterans with HIV infection</article-title><source>J. Gen. Int. Med.</source><year>2002</year><volume>17</volume><fpage>512</fpage><lpage>520</lpage><pub-id pub-id-type="doi">10.1046/j.1525-1497.2002.10803.x</pub-id></element-citation></ref><ref id="B33-ijerph-11-12247"><label>33.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kimerling</surname><given-names>R.</given-names></name><name><surname>Ouimette</surname><given-names>P.</given-names></name><name><surname>Prins</surname><given-names>A.</given-names></name><name><surname>Nisco</surname><given-names>P.</given-names></name><name><surname>Lawler</surname><given-names>C.</given-names></name><name><surname>Cronkite</surname><given-names>R.</given-names></name><name><surname>Moos</surname><given-names>R.H.</given-names></name></person-group><article-title>Brief report: Utility of a short screening scale for DSM-IV PTSD in primary care</article-title><source>J. Gen. Int. Med.</source><year>2006</year><volume>21</volume><fpage>65</fpage><lpage>67</lpage><pub-id pub-id-type="doi">10.1111/j.1525-1497.2005.00292.x</pub-id></element-citation></ref><ref id="B34-ijerph-11-12247"><label>34.</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>World Health Organization (WHO)</collab></person-group><source>Guidelines for Controlling and Monitoring the Tobacco Epidemic</source><publisher-name>WHO</publisher-name><publisher-loc>Geneva, Switzerland</publisher-loc><year>1998</year></element-citation></ref><ref id="B35-ijerph-11-12247"><label>35.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Babor</surname><given-names>T.F.</given-names></name><name><surname>Higgins-Biddle</surname><given-names>J.C.</given-names></name><name><surname>Saunders</surname><given-names>J.B.</given-names></name><name><surname>Monteiro</surname><given-names>M.</given-names></name></person-group><source>AUDIT: The Alcohol Use Disorder Identification Test</source><publisher-name>World Health Organization</publisher-name><publisher-loc>Geneva, Switzerland</publisher-loc><year>2001</year></element-citation></ref><ref id="B36-ijerph-11-12247"><label>36.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lesieur</surname><given-names>H.R.</given-names></name><name><surname>Blume</surname><given-names>S.B.</given-names></name></person-group><article-title>The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers</article-title><source>Am. J. Psychiatry</source><year>1987</year><volume>144</volume><fpage>1184</fpage><lpage>1188</lpage><pub-id pub-id-type="pmid">3631315</pub-id></element-citation></ref><ref id="B37-ijerph-11-12247"><label>37.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Craig</surname><given-names>C.L.</given-names></name><name><surname>Marshall</surname><given-names>A.L.</given-names></name><name><surname>Sjöström</surname><given-names>M.</given-names></name><name><surname>Bauman</surname><given-names>A.E.</given-names></name><name><surname>Booth</surname><given-names>M.L.</given-names></name><name><surname>Ainsworth</surname><given-names>B.E.</given-names></name><name><surname>Pratt</surname><given-names>M.</given-names></name><name><surname>Ekelund</surname><given-names>U.</given-names></name><name><surname>Yngve</surname><given-names>A.</given-names></name><name><surname>Sallis</surname><given-names>J.F.</given-names></name><etal></etal></person-group><article-title>International physical activity questionnaire: 12-Country reliability and validity</article-title><source>Med. Sci. Sport. Exerc.</source><year>2003</year><volume>35</volume><fpage>1381</fpage><lpage>1395</lpage><pub-id pub-id-type="doi">10.1249/01.MSS.0000078924.61453.FB</pub-id></element-citation></ref><ref id="B38-ijerph-11-12247"><label>38.</label><element-citation publication-type="webpage"><person-group person-group-type="author"><collab>International Physical Activity Questionnaire (IPAQ)</collab></person-group><article-title>IPAQ Scoring Protocol</article-title><comment>Available online: <ext-link ext-link-type="uri" xlink:href="sites.google.com/site/theipaq/">sites.google.com/site/theipaq/</ext-link></comment><date-in-citation>(accessed on 5 April 2014)</date-in-citation></element-citation></ref><ref id="B39-ijerph-11-12247"><label>39.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hall</surname><given-names>J.N.</given-names></name><name><surname>Moore</surname><given-names>S.</given-names></name><name><surname>Harper</surname><given-names>S.B.</given-names></name><name><surname>Lynch</surname><given-names>J.W.</given-names></name></person-group><article-title>Global variability in fruit and vegetable consumption</article-title><source>Am. J. Prev. Med.</source><year>2009</year><volume>36</volume><fpage>402</fpage><lpage>409</lpage><pub-id pub-id-type="doi">10.1016/j.amepre.2009.01.029</pub-id><pub-id pub-id-type="pmid">19362694</pub-id></element-citation></ref><ref id="B40-ijerph-11-12247"><label>40.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Steptoe</surname><given-names>A.</given-names></name><name><surname>Wardle</surname><given-names>J.</given-names></name></person-group><article-title>Cognitive predictors of health behaviour in contrasting regions of Europe</article-title><source>Br. J. Clin. Psychol.</source><year>1992</year><volume>31</volume><fpage>485</fpage><lpage>502</lpage><pub-id pub-id-type="doi">10.1111/j.2044-8260.1992.tb01021.x</pub-id><pub-id pub-id-type="pmid">1483158</pub-id></element-citation></ref><ref id="B41-ijerph-11-12247"><label>41.</label><element-citation publication-type="webpage"><person-group person-group-type="author"><collab>World Bank</collab></person-group><article-title>New Country Classifications, 2013</article-title><comment>Available online: <ext-link ext-link-type="uri" xlink:href="data.worldbank.org/news/new-country-classifications">data.worldbank.org/news/new-country-classifications</ext-link></comment><date-in-citation>(accessed on 5 April 2014)</date-in-citation></element-citation></ref><ref id="B42-ijerph-11-12247"><label>42.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Peltzer</surname><given-names>K.</given-names></name></person-group><article-title>Psychosocial correlates of healthy lifestyles in Black South African university students</article-title><source>Health SA Gesondheid.</source><year>2001</year><volume>6</volume><fpage>68</fpage><lpage>74</lpage></element-citation></ref><ref id="B43-ijerph-11-12247"><label>43.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nanakorn</surname><given-names>S.</given-names></name><name><surname>Osaka</surname><given-names>R.</given-names></name><name><surname>Chusilp</surname><given-names>K.</given-names></name><name><surname>Tsuda</surname><given-names>A.</given-names></name><name><surname>Maskasame</surname><given-names>S.</given-names></name><name><surname>Ratanasiri</surname><given-names>A.</given-names></name></person-group><article-title>Gender differences in health-related practices among university students in Northeast Thailand</article-title><source>Asia Pac. J. Public Health</source><year>1999</year><volume>11</volume><fpage>10</fpage><lpage>15</lpage><pub-id pub-id-type="doi">10.1177/101053959901100103</pub-id><pub-id pub-id-type="pmid">10829821</pub-id></element-citation></ref><ref id="B44-ijerph-11-12247"><label>44.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Polychronopoulou</surname><given-names>A.</given-names></name><name><surname>Kawamura</surname><given-names>M.</given-names></name></person-group><article-title>Oral self-care behaviours: comparing Greek and Japanese dental students</article-title><source>Eur. J. Dent. Educ.</source><year>2005</year><volume>9</volume><fpage>164</fpage><lpage>170</lpage><pub-id pub-id-type="doi">10.1111/j.1600-0579.2005.00387.x</pub-id><pub-id pub-id-type="pmid">16194248</pub-id></element-citation></ref><ref id="B45-ijerph-11-12247"><label>45.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kawamura</surname><given-names>M.</given-names></name><name><surname>Honkala</surname><given-names>E.</given-names></name><name><surname>Widström</surname><given-names>E.</given-names></name><name><surname>Komabayashi</surname><given-names>T.</given-names></name></person-group><article-title>Cross-cultural differences of self-reported oral health behaviour in Japanese and Finnish dental students</article-title><source>Int. Dent. J.</source><year>2000</year><volume>50</volume><fpage>46</fpage><lpage>50</lpage><pub-id pub-id-type="doi">10.1111/j.1875-595X.2000.tb00546.x</pub-id><pub-id pub-id-type="pmid">10945180</pub-id></element-citation></ref><ref id="B46-ijerph-11-12247"><label>46.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Astrøm</surname><given-names>A.N.</given-names></name><name><surname>Rise</surname><given-names>J.</given-names></name></person-group><article-title>Socio-economic differences in patterns of health and oral health behaviour in 25 year old Norwegians</article-title><source>Clin. Oral Investig.</source><year>2001</year><volume>5</volume><fpage>122</fpage><lpage>128</lpage><pub-id pub-id-type="doi">10.1007/s007840000102</pub-id><pub-id pub-id-type="pmid">11480810</pub-id></element-citation></ref><ref id="B47-ijerph-11-12247"><label>47.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gilbert</surname><given-names>G.H.</given-names></name><name><surname>Rose</surname><given-names>J.S.</given-names></name><name><surname>Shelton</surname><given-names>B.J.</given-names></name></person-group><article-title>A prospective study of the validity of data on self-reported dental visits</article-title><source>Community Dent. Oral Epidemiol.</source><year>2002</year><volume>30</volume><fpage>352</fpage><lpage>362</lpage><pub-id pub-id-type="doi">10.1034/j.1600-0528.2002.00062.x</pub-id><pub-id pub-id-type="pmid">12236826</pub-id></element-citation></ref><ref id="B48-ijerph-11-12247"><label>48.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Doshi</surname><given-names>D.</given-names></name><name><surname>Baldava</surname><given-names>P.</given-names></name><name><surname>Anup</surname><given-names>N.</given-names></name><name><surname>Sequeira</surname><given-names>P.S.</given-names></name></person-group><article-title>A comparative evaluation of self-reported oral hygiene practices among medical and engineering university students with access to health-promotive dental care</article-title><source>J. Contemp. Dent. Pract.</source><year>2007</year><volume>8</volume><fpage>68</fpage><lpage>75</lpage><pub-id pub-id-type="pmid">17211507</pub-id></element-citation></ref><ref id="B49-ijerph-11-12247"><label>49.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bou</surname><given-names>C.</given-names></name><name><surname>Miquel</surname><given-names>J.L.</given-names></name><name><surname>Poisson</surname><given-names>P.</given-names></name></person-group><article-title>Oral health status of 1500 university students in Toulouse France</article-title><source>Odontostomatol. Trop.</source><year>2006</year><volume>29</volume><fpage>29</fpage><lpage>33</lpage><pub-id pub-id-type="pmid">16910115</pub-id></element-citation></ref><ref id="B50-ijerph-11-12247"><label>50.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Li</surname><given-names>L.Z.</given-names></name><name><surname>Zhang</surname><given-names>H.Y.</given-names></name><name><surname>Guan</surname><given-names>X.L.</given-names></name><name><surname>Hao</surname><given-names>N.</given-names></name></person-group><article-title>Investigation of oral health status in freshmen of university students</article-title><source>Hua Xi Kou Qiang Yi Xue Za Zhi</source><year>2009</year><volume>27</volume><fpage>294</fpage><lpage>296</lpage><pub-id pub-id-type="pmid">19637481</pub-id></element-citation></ref></ref-list></back>
