Peer-reviewed article

Role of family factors in adolescents' oral health: An associational variable analysis.

Isabella Lili He, Pei Liu, Samantha Kai Yan Li, May Chun Mei Wong, Chun Hung Chu et al. · 27 Jul 2026

Abstract

OBJECTIVES: This study aimed to investigate the associations linking family-level psychosocial factors to adolescents' toothbrushing behaviors and subsequent clinical oral health status. METHODS: A cross-sectional survey of 1156 parent-adolescent dyads in Hong Kong collected data on socio-demographics, parental oral health literacy (OHL), family cohesion, adolescent's oral health beliefs, and toothbrushing frequency. Clinical examinations assessed plaque (Visible Plaque Index, VPI), gingival inflammation (Bleeding on Probing, BOP), and caries experience (DMFT). Directed Acyclic Graphs (DAGs) were utilized to pre-specify a confounder adjustment strategy. Bivariate analyses and associational variable analyses (PROCESS Macro) were then utilized to evaluate direct and indirect associations. RESULTS: Among the participants (mean age 14.4 ± 0.8 years; 55% female), 70% reported brushing twice or more daily. Associational variable analysis indicated that parental OHL was indirectly associated with adolescents' toothbrushing via parental toothbrushing behavior (indirect association = 0.03, 95% CI [0.01, 0.05]) and adolescents' oral health beliefs (indirect association = 0.02, 95% CI [0.01, 0.04]). Similarly, family cohesion was indirectly associated with adolescents' toothbrushing via parental toothbrushing behavior (indirect association = 0.03, 95% CI [0.01, 0.05]) and adolescents' oral health beliefs (indirect association = 0.03, 95% CI [0.02, 0.05]). Furthermore, adolescents' optimal toothbrushing was concurrently associated with lower VPI, BOP, and DMFT scores. CONCLUSION: Family cohesion and parental OHL are robustly associated with adolescents' oral hygiene practices through the dual pathways of parental behavioral modeling and adolescents' health beliefs. Additionally, adolescents' toothbrushing frequency was concurrently associated with more favorable clinical outcomes. CLINICAL SIGNIFICANCE: These findings support extending adolescent oral health promotion from a person-centered approach to a family-centered model. Clinical interventions might be enhanced by integrating parental modeling, the broader family environment, and adolescents' oral health beliefs, rather than relying solely on delivering knowledge to adolescents.