3.1 Aims and Objectives
Aim 1: The first aim is to investigate the relationship between obesity and oral
health in adolescents aged 11-17 years old attending Public and Private Schools in Sharjah City, United Arab Emirates.
Objectives were:
1. To assess socio-demographic characteristics of adolescents aged 11-17
years in Sharjah City.
2. To assess health behaviour and lifestyle including dietary habits, physical
activity and oral hygiene habits amongst adolescents aged 11-17 years in Sharjah City.
3. To determine the prevalence and severity of dental caries in 11-17 years
old adolescents in Sharjah City.
4. To determine the prevalence of obesity and being over-weight of 11-17
years old adolescents in Sharjah City.
5. To investigate the relation between socio-demographic factors and the
development of obesity and oral health in adolescents aged 11-17 years of Sharjah City.
6. To investigate the effect of health behaviour and lifestyle choices including
dietary habits, physical activity and oral hygiene habits on the development of obesity and poor oral health in adolescents aged 11-17 years in Sharjah City.
7. To investigate association between dental caries and oral hygiene
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Aim 2: The second aim is to explore the psychological consequences (self-
esteem) of poor oral health and obesity of 11-17 year old adolescents.
Objectives were:
1. To investigate the relationship between socio-demographic characteristics
and psychological status (self-esteem) in adolescents aged 11-17.
2. To investigate psychological status (self-esteem) in relation to obesity and
poor oral health in a 11-17 year old adolescent population.
The Null Hypotheses:
1. There is no difference between oral status (DMFT and oral cleanliness) of
obese and non obese adolescents.
2. There is no difference in level of self-esteem in relation to obesity.
3. There is no difference in level of self-esteem in relation to poor oral health.
3.2 Theortical framework
In order to achieve the aims and objectives of our study, the general hypothesis of this study proposed an association between socio-demographic, health behaviour and health outcomes. The theoretical foundation of the study was based on two well-established models of health (Saarloos et al., 2009), shown in Figure 2-1 and the Petersen, et al. (2005) models.
These models were selected because they take a broader view the role of individual and interpersonal characteristics, and take into account the multilayer network of interactions that can affect individual health behaviour and subsequent health outcome (Saarloos et al., 2009). According to Peterson and co-workers (2005), disease has its roots in a complex combination of environmental,
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behavioural and socio-economic factors. They say “proximal factors act directly or
almost directly on an adverse health outcome, while distal factors are further back in the causal chain and act via a number of intermediate causes” (Petersen, et al.,
2005)
Therefore, this research examines the relation between distal explanatory variables (socio-demographic characteristics), an intermediate explanatory variable (health behaviour) and adolescents’ health outcomes (oral health status,
BMI and their self-esteem) as demonstrated in Figure 3-1.
The socio-demographic characteristics chosen in the present study were age, gender, socio-economic status and ethnicity. This model considers that the person’s socio-demographic background can influence their lifestyle and health
behaviour. For example, the lower social class is less physically active, has worse oral hygiene and dietary habits. Lifestyle and health behaviour tend to be different between males and females, different age groups and ethnicity (Jebb et al., 2004, Baltrus et al., 2005, Ahn et al., 2008). In addition it has previously shown that those from lower socio-economic status have a lower self-esteem (Macgregor et al, 1997), and evidence suggests that those from a lower socio-economic group experience more psychological impact (Locker, 2009). Self-esteem tends to change with age according to Macgregor (1997) there is a general improvement of self-esteem from adolescents through early adulthood. Therefore, socio- demographic characteristics are an important distal predictor that could affect adolescent’s health outcome.
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The health behaviours considered and selected as intermediate predictors in the model were dietary habits, physical activity and oral hygiene habits. This model hypothesized that health behaviour factors namely dietary habits, physical activity and oral hygiene habits can affect the adolescent’s health outcomes, such as oral
health status (Rugg-Gunn and Nunn, 1999, Moynihan, 2003, Dye et al., 2004), BMI (Gillis and Bar-Or, 2003, Adair and Popkin, 2005, Cho et al., 2003, Vanelli et al., 2005, Rashidi et al, 2007, Croezen et al., 2009). Several studies have demonstrated a strong correlation between obesity and self-esteem where obese children had low self-esteem (French et al., 1995, Strauss 2000, Franklin et al., 2006, Stern et al., 2007, Kristjansson et al, 2008). With regard to aesthetic problems such as abnormalities of shape, size, color and structure of the teeth this has been shown to affect the psychosocial health among children and adolescents (Bryan and Welbury, 2003, Bryan and Welbury, 2006) socialization and self-image is also affected by tooth loss, discoloration and appearance on psychological factors particularly on socialization and self-image (Teo, 1989, Welbury and Shaw, 1990). This therefore underlines the importance of oral health status on self- esteem.
Therefore, this study has been designed to test the interaction between socio- demographic characteristics, the health behaviour or lifestyle of individual and health outcome (obesity, dental caries and self-esteem). The study was also designed to test the interaction and relationship between each of three health outcomes namely obesity, oral health status and self-esteem, by exploring the association between obesity and oral health and also the relationship between obesity and poor oral health on the self-esteem of this particular population.
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