The potential impact of neighborhood empowerment on dental caries among adolescents

Objective: Empowerment has been considered a dimension of social capital. It refers to social interaction processes that enable people to enhance their individual and collective skills and to exert greater control over their lives. This relationship has not been explored in relation to dental health. The objective of this study was to investigate the association between neighborhood empowerment and dental caries in adolescents. Methods: A multilevel study was designed to assess the individual and neighborhood effects on the oral health of adolescents. Four sources of data were used: (a) clinical examinations (WHO), (b) students' questionnaires, (c) parents' questionnaires and (d) census data. The study population was 1302, 14/15-year-old students from 39 public schools of two cities of the Distrito Federal (DF), Brazil. Data analysis used logistic multilevel modeling at two levels: students (sources a and b) and neighborhood as defined by catchment areas of schools (sources c and d). Results: High DMFT (DMFT > median, DMFT >= 3) rates were significantly lower in areas with higher levels of empowerment. This relationship was independent of socioeconomic variables at the individual and area levels and of all other individual risk factor variables such as sex, fluoride, sugar consumption, tooth brushing and dental attendance [OR for low compared with high empowerment was 1.54 (95% CI = 1.09-2.18), P = 0.014]. Conclusions: Neighborhood empowerment may play an important role in explaining inequalities in the levels of dental caries. New perspectives are needed so that more effective interventions can be implemented using area-based perspectives.