Structural equation model for parental influence on children’s oral health practice and status

BACKGROUND: Children’s oral health status (OHS) can be influenced by their oral health practices and many parental factors. This study aimed to investigate pathways from parental factors to oral health practices and status of children in Hong Kong. METHODS: Using a combination of random and purposive sampling of Hong Kong households, 432 families with children aged 5–7 participated in a cross-sectional survey. Data on socioeconomic status, smoking, and oral health knowledge, attitudes, and practices, as well as OHS of parents and parents’ knowledge of and attitudes towards their children’s oral health, were collected through a questionnaire. Tooth status, periodontal status, and oral hygiene data were also collected through clinical examination. Correlations of oral health behaviors (OHB) and OHS within families were assessed by confirmatory factor analysis. A conceptual model of the parental influences on children’s oral health practices and status was tested by a structural equation model (SEM). Chi-square test, chi-square/df, nonnormed fit index, comparative fit index, and root mean square error of approximation were used to assess the model fit. RESULTS: Fit indexes for confirmatory factor analysis and SEM showed good fit. Positive correlations of OHB and OHS were found within the families that ranged from 0.74 to 0.98 for OHB and 0.30 to 0.43 for OHS. SEM showed better socioeconomic status of mothers led to better oral health knowledge and attitude (γ = 0.75, P < 0.001) and also towards their children’s better oral health knowledge and attitude (γ = 0.44, P < 0.01). Parents’ attitudes towards their children’s oral health (β = 0.40, P = 0.04) and mothers’ OHB (β = 0.60, P < 0.001) were positively associated with OHB of children. Positive OHB of children (β = − 0.48, P < 0.01) in turn led to better oral health. CONCLUSIONS: Correlations of OHB and OHS between mothers and children were stronger than those of fathers. Children’s OHS was directly affected by their mothers’ OHB, which in turn were affected by parents’ oral health knowledge, attitudes, and practices.