Oral Hygiene Behavior among Adolescents in Mongolia: Results from the Global School-based Health Survey 2019

Oral Hygiene Behavior among Adolescents in Mongolia: Results from the Global School-based Health Survey 2019 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Oral Hygiene Behavior among Adolescents in Mongolia: Results from the Global School-based Health Survey 2019 Javzan Badarch, Delgertstetseg Jargaltsogt, Bilguun Enkhtaivan, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3899097/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Tooth brushing at least twice a day is a crucial role for the prevention and control of dental caries and periodontal diseases. The aim of the current study was to examine the prevalence of poor oral hygiene (tooth brushing less than two times per day) and to identify the associated factors among adolescents in Mongolia. We analyzed data from the 2019 Mongolian Global School-based Health Survey (GSHS) conducted nationwide among 10–18-year-old students. Univariable and multivariable analyses were performed to assess the correlates of poor oral hygiene. Overall, 35.6% of the adolescents reported to have poor oral hygiene in 2019. Multivariable analysis showed a significant association in the total sample of poor oral hygiene with male gender, poor hand hygiene behaviors including did not wash hand before eating, did not wash hand after toilet and handwashing without soap, being bullied, lack of close friends, smoking, exposure to second-hand smoke, physical inactivity and sedentary behavior. Several factors, including hand hygiene behaviors, mental distress, substance use, and health risk behaviors were found to be associated, which can aid in designing school-based dental health education intervention strategies to help students to develop habits that improve their health. Introduction The According to the World Health Organization (WHO) definition, “Oral Health” is the state of the mouth, teeth, and orofacial structures that enables people to perform significant roles, such as eating, breathing, and speaking, and includes psychosocial dimensions, and live without discomfort [ 1 ]. There are more than 300 diseases and conditions that affect human beings as a consequence of oral diseases including dental caries and periodontal diseases [ 2 ]. The WHO’s Global Oral Health Status Report (GOHSR) estimated that oral diseases affect nearly 3.5 billion people worldwide, and 2 billion adults and 514 million children suffer from dental caries [ 3 ]. In 2019, oral diseases affected an estimated 800 million people, including tooth decay, periodontal diseases, and tooth loss in the Western Pacific Region (WPR) [ 4 ]. Among school adolescents in WPR such as Philippines in 2011 and Malaysia in 2012 reported infrequent tooth brushing were 12.2%-12.9% [ 5 , 6 ]. In six Southeast Asian countries, the results showed that 17.1% had poor oral hygiene (brushing teeth less than twice a day) [ 7 ], whereas in Indonesia 10.8% had poor oral hygiene according to the GSHS (Global School-based Health Survey) in 2014–2015 [ 8 ]. Poor oral hygiene among adolescents has been associated with being male [ 9 ], older age or grade [ 10 ], hand hygiene behaviors [ 11 ], mental distress including being bullied and lonely [ 12 ], smoking and alcohol consumption [ 13 ], and health risk behaviors such as inadequate exercise and sedentary leisure time behavior [ 7 ]. The Fourth Mongolian STEPS Survey on the Prevalence of Non-Communicable Disease (NCD) and Injury Risk Factors showed that the prevalence of tooth brushing two or more times a day was 57% in people aged 15−69 years [ 14 ]. According to the Mongolian GSHS factsheets, brushing their teeth “less than once a day or never” were 8.2% and 5.1% among school-going students in 2010 and 2013 [ 15 , 16 ]. There is a lack of recent national information on oral hygiene behavior among adolescents in Mongolia. Therefore, the aim of the present paper is to update a previous GSHS study conducted in 2013, to assess the prevalence, and risk factors of poor oral hygiene practice, among adolescents in Mongolia. Results Sample characteristics of adolescents included in the study by sex. The Mongolian GSHS 2019 was conducted with a total sample size of 7149 students. The characteristics of the sample are shown in Table 1 . More than one-third (35.6%) of adolescents reported to have had poor oral hygiene in the past 30 days of the survey. (see Table 1 ) Table 1 Sample characteristics of adolescents included in the study by sex Total Male Female N % N % N % Oral Hygiene Good 4598 64.4 1846 56.8 2734 70.8 Poor 2542 35.6 14 43.2 11 29.2 Demographic Factors Grade 5th grade 1459 20.5 757 23.3 696 18.1 6th grade 1054 14.8 488 15.0 556 14.4 7th grade 676 9.5 310 9.5 265 9.5 8th grade 823 11.6 353 10.9 470 12.2 9th grade 721 10.1 360 11.1 361 9.4 10th grade 882 12.4 356 11.0 524 13.6 11th grade 982 13.8 403 12.4 576 15.0 12th grade 523 7.3 219 6.7 303 7.9 Hand Hygiene Behaviors Handwashing before eating Good 2911 41.0 1232 38.0 1679 43.6 Poor 4188 59.0 2014 62.0 2174 56.4 Handwashing after toilet Good 2709 38.2 1089 33.6 1620 42.1 Poor 4381 61.8 2150 66.4 2231 57.9 Handwashing with soap Good 4283 60.4 1888 58.2 2395 62.2 Poor 2807 39.6 1354 41.8 1453 37.8 Mental Distress Being bullied Yes 2478 34.9 1273 39.2 1205 31.3 No 4619 65.1 1971 60.8 2648 68.7 Had no close friend Yes 416 5.9 173 5.4 243 6.3 No 6643 94.1 3052 94.6 3591 93.7 Substance Use Cigarette smoking Yes 1401 19.7 739 22.8 662 17.2 No 5693 80.3 2502 77.2 3191 82.8 Exposed to second-hand smoke Yes 4229 59.9 2044 63.2 2185 57.0 No 2836 40.1 1190 36.8 1646 43.0 Alcohol drinking Yes 1316 18.5 656 20.2 660 17.1 No 5780 81.5 2586 79.8 3194 82.9 Health Risk Behaviors Physical activity Active 5768 81.5 2573 79.5 3195 83.1 Inactive 1312 18.5 662 20.5 650 16.9 Sedentary behavior Yes 2801 39.8 1194 37.1 1607 42.0 No 4240 60.2 2025 62.9 2215 58.0 Table 2. Results of univariable logistic regression analysis for oral hygiene behavior UAOR 95 % CI for p Value Lower Upper Demographic Factors Gender Male 1.85 1.67 2.04 <0.001 Female 1.00 Grade* /Increase of one grade/ 0.86 0.75 0.98 0.032 Hand Hygiene Behaviors Handwashing before eating Poor 1.97 1.78 2.18 <0.001 Good 1.00 Handwashing after toilet Poor 2.05 1.84 2.27 <0.001 Good 1.00 Handwashing with soap Poor 1.60 1.45 1.77 <0.001 Good 1.00 Mental Distress Being bullied Yes 1.29 1.17 1.43 <0.001 No 1.00 Had no close friend Yes 1.38 1.13 1.68 0.002 No 1.00 Substance Use Cigarette smoking Yes 1.24 1.10 1.40 <0.001 No 1.00 Exposed to second-hand smoke Yes 1.26 1.14 1.39 <0.001 No 1.00 Alcohol drinking Yes 1.18 1.04 1.33 0.009 No 1.00 Health Risk Behaviors Physical activity Inactive 1.42 1.26 1.61 <0.001 Active 1.00 Sedentary behavior Yes 1.15 1.04 1.27 0.004 No 1.00 * Grade: continuous variable. UAOR: UnAdjusted Odds Ratio. 95% CI: 95% confidence interval Table 3. Results of multivariable logistic regression analysis for poor oral hygiene behavior AOR 95% CI for Lower Upper p Value Demographic Factors Male Gender 1.73 1.56 1.92 <0.001 Grade /Increase of one grade/ 0.94 0.87 1.00 0.072 Hand Hygiene Behaviors Poor handwashing before eating 1.54 1.37 1.73 <0.001 Poor handwashing after toilet 1.56 1.39 1.75 <0.001 Poor handwashing with soap 1.31 1.18 1.46 <0.001 Mental Distress Being bullied 1.16 1.02 1.33 0.021 Had no close friend 1.37 1.10 1.69 0.004 Substance Uses Currently cigarette smoking 1.29 1.00 1.55 0.048 Exposed to second-hand smoke 1.15 1.03 1.30 0.011 Currently alcohol drinking 0.79 0.60 1.05 0.109 Health Risk Behaviors Physically inactive 1.35 1.18 1.53 <0.001 Sedentary behavior 1.16 1.05 1.29 0.004 Reference categories: female gender, good handwashing before eating, good handwashing after toilet, handwashing with soap, did not report being bullied, had close friends, no cigarette smoking, no exposure to second-hand smoke, no alcohol drinking, physically active, and did not report sedentary behavior. *AOR: Adjusted Odds Ratio Results of univariable logistic regression analysis for oral hygiene behavior. According to the univariable analysis (Table 2 ), students who reported poor oral hygiene were more likely to be male and be in grade older than elementary grade. They had poor handwashing practices including did not wash hand before eating, did not wash hand after toilet, and handwashing without soap; had no close friends, reported being bullied; smoked cigarettes, were exposed to second-hand smoke at home, and drank alcohol. Students who reported being physically inactive and spent more than 3 hours per day sitting were more likely to have insufficient tooth brushing. All the independent variables were a significant relationship with poor oral hygiene among school-aged adolescents in Mongolia. (see Table 2 ) Results of multivariable logistic regression analysis for poor oral hygiene behavior . The multivariable logistic regression model is shown in Table 3 . Compared with the results of univariable analyses, the multiple model showed small differences in the predictors of oral hygiene in the total samples. Male students were 1.73 times (Adjusted Odds Ratio; (AOR) = 1.73; 95% Confidence Interval (CI) [1.56-–1.92]) more likely to have poor oral hygiene compared to the females. Concerning hand hygiene behaviors, students who had poor handwashing before eating were 1.54 times (AOR = 1.54; 95% CI [1.37–1.73]), poor handwashing after toilet were 1.56 times (AOR = 1.56; 95% CI [1.39–1.75]) and handwashing without soap were 1.31 times (AOR = 1.31; 95% CI [1.18–1.46]) more likely to be associated with poor oral hygiene. Moreover, students who reported being bullied were 1.16 times (AOR = 1.16; 95% CI [1.02–1.33]) and had no close friend were 1.37 times (AOR = 1.37; 95% CI [1.10–1.69]) more likely to have poor oral health than students who reported did not being bullied and had a close friend. As to smoking behaviors, students who reported cigarette smoking past 30 days of the survey were 1.29 times (AOR = 1.29; 95% CI [1.00–1.55]), and those being exposed to second-hand smoke were 1.15 times (AOR = 1.15; 95% CI [1.03–1.30]) more likely to report poor oral hygiene. Regarding health risk behaviors, students who were physically inactive were 1.35 times (AOR = 1.35; 95% CI [1.18–1.53]) and students who spent sitting more than 3 hours per day were 1.16 times (AOR = 1.16; 95% CI [1.05–1.29)]) as likely as to have poor oral hygiene compared to the counterparts. (see Table 3 ) Discussion This was a cross-sectional study among adolescents based on the GSHS 2019. Nearly 36% of Mongolian school-aged adolescents had poor oral hygiene seemed almost the same as the previous study [ 18 ]. In addition, this result was also higher than Indonesia in 2015 (10.8%) [ 19 ], Suriname in 2016 (14.3%), and Trinidad and Tobago in 2017 (22.1%) [ 20 ], but lower than Ghana in 2012 (37.4%) [ 12 ]. Our study investigated associations between demographic factors, hand hygiene behaviors, mental distress, substance use, health risk behaviors, and oral hygiene practice among adolescents in Mongolia. Our observation that males tended to have poorer oral hygiene practices than females was similar to findings from other studies [ 21 , 22 ]. This tendency might be because female students were more concerned about dental aesthetics and more aware of dental problems than male students. The findings that hand hygiene practices were associated with oral hygiene practice are in line with prior studies [ 11 ]. It is possible that good hand hygiene practices, which are known to have positive effects on well-being, act as a mediator in the context of poor oral hygiene. Our study confirmed previous findings showing an association between substance use, including current smoking and exposure to second-hand smoke, and poor oral hygiene in the adolescent population [ 23 ]. The adolescents with good oral hygiene practices were more likely to avoid smoking, and reducing their second-hand smoke exposure. An association between substance use and poor dental hygiene behavior may refer to a clustering of risky behaviors. The results of the present study showed a positive association between unhealthy risk behaviors such as being physically inactive and leisure time sedentary behavior and infrequent tooth brushing were consistent with evidence from the previous research [ 24 , 25 ]. Physical activity could indicate a disposition towards a healthy lifestyle and the capacity to keep general and oral health [ 26 ]. Children's sedentary behavior, such as the use of electronic media or screen-based activities suggested that excessive game players had less free time for tooth brushing as they chose to take part in screen-based activity [ 27 ]. Strengths and Limitations GSHS was a large, nationally representative survey, the data of which were collected by the WHO and the Centers for Disease Control and Prevention (CDC). GSHS is globally recognized and implemented providing highly generalizable data and findings. Schools and students were randomly selected from both urban and rural areas. The findings of this investigation must be viewed in light of its limitations. Firstly, the data were cross-sectional, so did not prove causation, but they did provide information on correlations. Secondly, a self-reported questionnaire was applied, so it might be possible that the children provided invalid answers. Thirdly, this study focused on only school-aged adolescents meaning that the findings are not generalizable to all adolescents in the country. Lastly, the involvement of parents/guardians may protect young people from risk factors, and the GSHS in Mongolia does not assess parental engagement. Conclusions The prevalence of poor oral hygiene (tooth brushing less than twice a day) was almost the same as the previous GHSH 2013 in Mongolia. Adolescents need to be encouraged to take responsibility for their oral hygiene. Several factors, including poor hand hygiene behaviors, mental distress, substance use, and other health risk behaviors were found to be associated, which can aid in designing school-based dental health education intervention strategies for that target adolescents and may help students to develop habits that improve their oral health. Methods Participants and Procedures. This study was a secondary data analysis of the 2019 Mongolian GSHS data. The GSHS 10 core questionnaire modules address the leading causes/risk factors of morbidity and mortality among children: tobacco, alcohol, and other drug use; dietary behaviors; hygiene; mental health; physical activity; sexual behaviors that contribute to HIV infection, other sexually transmitted infections, and unintended pregnancy; unintentional injuries and violence; and respondent demographics. Students were asked to participate voluntarily in the survey, and written informed consent was obtained from each student and parents/guardians. The GSHS used a two-stage cluster sampling design where participants were given a self-reported questionnaire. The first stage, the probability of schools being selected was proportional to the number of students enrolled. The second stage, involved classes being randomly selected and all students in the selected classes were eligible to participate [ 17 ]. The Mongolian GSHS protocol was approved by Resolution No. 88 of the Ethical Committee of the National Center for Public Health in November 2018. Altogether 7149 students participated in the 2019 Mongolian GSHS survey. Measures. With the exception of grade, all variables were dichotomized as yes or no/good or poor answers. Oral hygiene as the dependent variable is based on the following question: “During the past 30 days, how many times per day did you usually clean or brush your teeth?” (Response options were 1 = Did not brush my teeth during the past 30 days, 2 = less than 1 time per day, 3 = 1 time per day, 4 = 2 times a day, 5 = 3 times a day and 6 = 4 or more times per day; coded 1–3 = poor oral hygiene was defined as brushing teeth less than two times per day and 4–6 = good oral hygiene when brushing 2 or more times per day). The independent variables were demographic factors, hand hygiene behaviors, mental distress, substance uses, and health risk behaviors. Demographic factors: Gender “What is your sex?” (Response options were 1 = male and 2 = female; coded 0 = male and 1 = female). Grade “Which grade are you study?” (Response options were 1 = 5th grade, 2 = 6th grade, 3 = 7th grade, 4 = 8th grade, 5 = 9th grade, 6 = 10th grade, 7 = 11th grade and 8 = 12th grade). Hand Hygiene behaviors: Handwashing before eating “How often did you wash your hand before eating?” (Response options were 1 = never, 2 = rarely, 3 = sometimes, 4 = most of the time and 5 = always; coded 1–4 = no and 5 = yes). Handwashing after toilet “How often did you wash your hands after using the toilet or latrine?” (Response options were 1 = never, 2 = rarely, 3 = sometimes, 4 = most of the time and 5 = always; coded 1–4 = no and 5 = yes). Handwashing with soap “How often did you use soap when washing your hands?” (Response options were from “1 = never, 2 = rarely, 3 = sometimes, 4 = most of the time and 5 = always; coded 1–4 = no and 5 = yes). Mental Distress: Being bullied : “During the past 30 days, on how many days have you been bullied?” (Response options were 1 = 0 day, 2 = 1 or 2 days, 3 = 3 to 5 days, 4 = 6 to 9 days, 5 = 10 to 19 days, 6 = 20 to 29 days and 7 = All 30 days; coded 1 = no and 2–7 = yes). [Description provided in the questionnaire: Bullying occurs when one or more students or someone else about your age teases, threatens, ignores, spreads rumors about, hits, shoves, or hurts another person over and over again]. Close friend “How many close friends do you have?” (Response options were 1 = 0 friend, 2 = 1 friend, 3 = 2 friends and 4 = 3 or more; coded 1 = no and 2–4 = yes). Substance use: Cigarette smoking “During the past 30 days, how many days have you smoked cigarettes?” (Response options were 1 = 0 day, 2 = 1 or 2 days, 3 = 3 to 5 days, 4 = 6 to 9 days, 5 = 10 to 19 days, 6 = 20 to 29 days and 7 = All 30 days; coded 1 = no and 2–7 = yes). Exposed to second-hand smoke “During the past 7 days, on how many days did people smoke in your presence?” (Response options were 1 = 0 day, 2 = 1 or 2 days, 3 = 3 or 4 days, 4 = 5 or 6 days and 5 = all 7 days; coded 2–5 = yes and 1 = no) Alcohol drinking “During the past 30 days, on how many days have you had at least one drink containing alcohol?” (Response options were 1 = 0 day, 2 = 1 or 2 days, 3 = 3 to 5 days, 4 = 6 to 9 days, 5 = 10 to 19 days, 6 = 20 to 29 days and 7 = All 30 days; coded 1 = no and 2–7 = yes). Health risk behaviors: Physical activity: “ During the past 7 days, on how many days were you physically active for a total of at least 60 min per day?” (Response options were 1 = 0 day, 2 = 1 day, 3 = 2 days, 4 = 3 days, 5 = 4 days, 6 = 5 days, 7 = 6 days and 8 = 7 days; coded 1 = physically inactive and 2–8 = physically active) Sedentary behavior “How much time do you spend during a typical or usual day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities?” (Response options were 1 = Less than 1 hour per day, 2 = 1 to 2 hours per day, 3 = 3 to 4 hours per day, 4 = 5 to 6 hours per day, 5 = 7 to 8 hours per day and 6 = more than 8 hours per day; coded 3–6 = yes and 1–2 = no). Data Analysis . Data analysis was carried out with IBM SPSS (Statistical Package for the Social Sciences) version 28 (SPSS Inc., Chicago, IL, USA). Descriptive statistic was done to describe the study sample; distributions were calculated according to the number of current answerers. Univariable logistic regression analyses were conducted to examine unadjusted associations between oral hygiene and independent variables. Multivariable logistic regression analysis was used to assess the independent contribution of demographic factors, hand hygiene behaviors, mental distress, substance uses, and health risk behaviors to poor oral hygiene. The independent variables involved in the regression analysis were student gender, grade, and hand hygiene behaviors including handwashing before eating, handwashing after toilet and handwashing with soap, being bullied, having no close friends, cigarette smoking, exposure to second-hand smoke, alcohol drinking, being physically inactive, and sedentary behavior. The student’s grade was considered as a continuous variable in the model. Odds ratio (OR) and 95% CI of OR were used to indicate the association between the oral hygiene and the selected independent variables. Statistical significance was defined at p < 0.05. Declarations Acknowledgments This research uses data from the Global School-Based Student Health Survey (GSHS). The authors would like to thank GSHS country coordinators and other staff members as well as adolescent participants in Mongolia. Author contributions Conceptualization, J.B., D.J., B.E., N.B., B.C. and E.P.; methodology, J.B. and B.C.; formal analysis, J.B. and B.C.; investigation, J.B., B.B., D.J., B.E.; writing—original draft preparation, J.B., B.B., N.B. and B.C.; writing—review and editing, B.B., S.B. and E.P. All authors have read and agreed to the published version of the manuscript. Competing Interests The authors declare no conflict of interest. Funding This research did not receive any funds from public or private funding agencies. Institutional Review Board Statement The Ethical Committee (resolution No.88) of the National Center approved the Mongolia GSHS protocol for Public Health, Mongolia in November 2018. Informed Consent Statement Written informed consent was obtained from each student who asked, voluntarily, to participate in the survey and from his or her parents/guardians. Data Availability Statement Datasets generated during the study can be obtained directly from the fourth author at [email protected] . References World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030: regional summary of the Southeast Asia Region. Geneva; 2023 Apr. Available from: https://www.who.int/publications/i/item/9789240070844 Accessed on 04 Jan 2024. World Health Organization. Regional Office for Europe. Global Oral Health Status report: towards universal health coverage for oral health by 2030: Summary of the WHO European Region. 2023 . 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Physical activity, BMI and oral health behavior among adolescents: Finnish School Health Promotion Study. Eur J Public Health. 2019 Apr 1; 29 (2):296–302. Binu Santha HSVSMJ and VT. The Impact of Body Mass Index on Oral Hygiene Practices of Adolescents in Bhopal City, India. Journal of the College of Physicians and Surgeons Pakistan . 2016; 26 (2):125–9. Granich J, Rosenberg M, Knuiman M, Timperio A. Understanding children’s sedentary behavior: A qualitative study of the family home environment. Health Educ Res . 2010 Apr; 25 (2):199–210 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3899097","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":271202006,"identity":"4ba297a0-faaf-4d40-8392-6f930c9e7839","order_by":0,"name":"Javzan Badarch","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBACxgYwZQPjMxOtJY0ELVBwmAQtzO1njD/83HE+2lwiO/kDQ4V1YoPY2QP4HdaTY2DYe+Z27s4ZudskGM6kJzZI5yXg19KQlpDA23Y7d8ON3G0MjG2HgVpyDPBr6X+WcPBv2zmQls0fGP8Ro2VG8sFm3rYDIC0bJBgbiNLy+DCzbFty7oYzb7dJJBxLN24jpMWwP7H549s2u9wNx4EO+1BjLdtPUEsDMi8BiNnwqgcCeUIKRsEoGAWjYBQwAAD0lUvfW2cy/wAAAABJRU5ErkJggg==","orcid":"","institution":"Mongolian National University of Medical Science, School of Dentistry, Department of Dental Technology and Oral Hygiene","correspondingAuthor":true,"prefix":"","firstName":"Javzan","middleName":"","lastName":"Badarch","suffix":""},{"id":271202007,"identity":"d232e86d-a2df-4871-9755-91001ae468e5","order_by":1,"name":"Delgertstetseg Jargaltsogt","email":"","orcid":"","institution":"Mongolian National University of Medical Science, School of Dentistry, Department of Dental Technology and Oral Hygiene","correspondingAuthor":false,"prefix":"","firstName":"Delgertstetseg","middleName":"","lastName":"Jargaltsogt","suffix":""},{"id":271202008,"identity":"7f87999f-8917-4402-b8cc-ca93e94c6a66","order_by":2,"name":"Bilguun Enkhtaivan","email":"","orcid":"","institution":"Mongolian National University of Medical Science, School of Dentistry, Department of Dental Technology and Oral Hygiene","correspondingAuthor":false,"prefix":"","firstName":"Bilguun","middleName":"","lastName":"Enkhtaivan","suffix":""},{"id":271202009,"identity":"2b13b2de-3b74-4718-997a-00e0c244c0d4","order_by":3,"name":"Nyamdelger Bat-Orshikh","email":"","orcid":"","institution":"Mongolian National University of Medical Science, School of Dentistry, Department of Dental Technology and Oral Hygiene","correspondingAuthor":false,"prefix":"","firstName":"Nyamdelger","middleName":"","lastName":"Bat-Orshikh","suffix":""},{"id":271202010,"identity":"bb36cace-fcc6-4b06-b6da-add8f99f9482","order_by":4,"name":"Bayar Chuluunbaatar","email":"","orcid":"","institution":"Medicine and Medical Devices Regulatory Agency","correspondingAuthor":false,"prefix":"","firstName":"Bayar","middleName":"","lastName":"Chuluunbaatar","suffix":""},{"id":271202011,"identity":"001383bd-9795-4c20-a107-191e99af9016","order_by":5,"name":"Suvd Batbaatar","email":"","orcid":"","institution":"National Center for Public Health, Department of Environmental Health","correspondingAuthor":false,"prefix":"","firstName":"Suvd","middleName":"","lastName":"Batbaatar","suffix":""},{"id":271202012,"identity":"c988f9c9-a5a6-45dd-8495-8be157d8970f","order_by":6,"name":"Edit Paulik","email":"","orcid":"","institution":"University of Szeged, Albert Szent-Györgyi Medical School, Department of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Edit","middleName":"","lastName":"Paulik","suffix":""},{"id":271202013,"identity":"d30db1f6-62bb-4a6c-a95d-e5d36705127b","order_by":7,"name":"Batbayar Badral","email":"","orcid":"","institution":"Mongolian National University of Medical Science, School of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Batbayar","middleName":"","lastName":"Badral","suffix":""}],"badges":[],"createdAt":"2024-01-26 05:44:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3899097/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3899097/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65240242,"identity":"9fcc5fd1-a736-400f-9350-2cfceb917f0b","added_by":"auto","created_at":"2024-09-25 06:32:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1063369,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3899097/v1/c6d01a65-774a-4994-98d5-a368308136a8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Oral Hygiene Behavior among Adolescents in Mongolia: Results from the Global School-based Health Survey 2019","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe According to the World Health Organization (WHO) definition, \u0026ldquo;Oral Health\u0026rdquo; is the state of the mouth, teeth, and orofacial structures that enables people to perform significant roles, such as eating, breathing, and speaking, and includes psychosocial dimensions, and live without discomfort [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. There are more than 300 diseases and conditions that affect human beings as a consequence of oral diseases including dental caries and periodontal diseases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The WHO\u0026rsquo;s Global Oral Health Status Report (GOHSR) estimated that oral diseases affect nearly 3.5\u0026nbsp;billion people worldwide, and 2\u0026nbsp;billion adults and 514\u0026nbsp;million children suffer from dental caries [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In 2019, oral diseases affected an estimated 800\u0026nbsp;million people, including tooth decay, periodontal diseases, and tooth loss in the Western Pacific Region (WPR) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Among school adolescents in WPR such as Philippines in 2011 and Malaysia in 2012 reported infrequent tooth brushing were 12.2%-12.9% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn six Southeast Asian countries, the results showed that 17.1% had poor oral hygiene (brushing teeth less than twice a day) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], whereas in Indonesia 10.8% had poor oral hygiene according to the GSHS (Global School-based Health Survey) in 2014\u0026ndash;2015 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Poor oral hygiene among adolescents has been associated with being male [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], older age or grade [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], hand hygiene behaviors [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], mental distress including being bullied and lonely [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], smoking and alcohol consumption [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and health risk behaviors such as inadequate exercise and sedentary leisure time behavior [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Fourth Mongolian STEPS Survey on the Prevalence of Non-Communicable Disease (NCD) and Injury Risk Factors showed that the prevalence of tooth brushing two or more times a day was 57% in people aged 15\u0026minus;69 years [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. According to the Mongolian GSHS factsheets, brushing their teeth \u0026ldquo;less than once a day or never\u0026rdquo; were 8.2% and 5.1% among school-going students in 2010 and 2013 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere is a lack of recent national information on oral hygiene behavior among adolescents in Mongolia. Therefore, the aim of the present paper is to update a previous GSHS study conducted in 2013, to assess the prevalence, and risk factors of poor oral hygiene practice, among adolescents in Mongolia.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv\u003e\n \u003cp\u003e\u003cstrong\u003eSample characteristics of adolescents included in the study by sex.\u003c/strong\u003e The Mongolian GSHS 2019 was conducted with a total sample size of 7149 students. The characteristics of the sample are shown in Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e. More than one-third (35.6%) of adolescents reported to have had poor oral hygiene in the past 30 days of the survey. (see Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSample characteristics of adolescents included in the study by sex\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOral Hygiene\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic Factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5th grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6th grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7th grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8th grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9th grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10th grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11th grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e982\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12th grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHand Hygiene Behaviors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandwashing before eating\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandwashing after toilet\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandwashing with soap\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental Distress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeing bullied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHad no close friend\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubstance Use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCigarette smoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposed to second-hand smoke\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol drinking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Risk Behaviors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSedentary behavior\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Results of univariable logistic regression analysis for oral hygiene behavior\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"676\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eUAOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.17751479289941%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e95 % CI for\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.17391304347826%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.391304347826086%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.956521739130434%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.4782608695652173%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographic Factors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade* /Increase of one grade/\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHand Hygiene Behaviors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandwashing before eating\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandwashing after toilet\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandwashing with soap\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMental Distress\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeing bullied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHad no close friend\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubstance Use\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCigarette smoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.59171597633136%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposed to second-hand smoke\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol drinking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHealth Risk Behaviors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eInactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSedentary behavior\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.50295857988166%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.088757396449704%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.63905325443787%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86390532544379%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.366863905325444%\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cdiv align=\"char\"\u003e* Grade: continuous variable. UAOR: UnAdjusted Odds Ratio. 95% CI: 95% confidence interval\u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Results of multivariable logistic regression analysis for poor oral hygiene behavior\u003c/p\u003e\n\u003c/div\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.815709969788518%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;95% CI for\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.656716417910445%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.552238805970148%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.507462686567163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.28358208955224%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographic Factors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003eMale Gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003eGrade /Increase of one grade/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHand Hygiene Behaviors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003ePoor handwashing before eating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003ePoor handwashing after toilet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003ePoor handwashing with soap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMental Distress\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003eBeing bullied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003eHad no close friend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubstance Uses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003eCurrently cigarette smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003eExposed to second-hand smoke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003eCurrently alcohol drinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHealth Risk Behaviors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003ePhysically inactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.34743202416919%\" valign=\"bottom\"\u003e\n \u003cp\u003eSedentary behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.782477341389727%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.033232628398792%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.803625377643504%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eReference categories: female gender, good handwashing before eating, good handwashing after toilet, handwashing with soap, did not report being bullied, had close friends, no cigarette smoking, no exposure to second-hand smoke, no alcohol drinking, physically active, and did not report sedentary behavior.\u003c/p\u003e\n\u003cp\u003e*AOR: Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Results of univariable logistic regression analysis for oral hygiene behavior.\u003c/strong\u003e According to the univariable analysis (Table\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e), students who reported poor oral hygiene were more likely to be male and be in grade older than elementary grade. They had poor handwashing practices including did not wash hand before eating, did not wash hand after toilet, and handwashing without soap; had no close friends, reported being bullied; smoked cigarettes, were exposed to second-hand smoke at home, and drank alcohol. Students who reported being physically inactive and spent more than 3 hours per day sitting were more likely to have insufficient tooth brushing. All the independent variables were a significant relationship with poor oral hygiene among school-aged adolescents in Mongolia. (see Table\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eResults of multivariable logistic regression analysis for poor oral hygiene behavior\u003c/strong\u003e. The multivariable logistic regression model is shown in \u003cstrong\u003eTable\u0026nbsp;3\u003c/strong\u003e. Compared with the results of univariable analyses, the multiple model showed small differences in the predictors of oral hygiene in the total samples. Male students were 1.73 times (Adjusted Odds Ratio; (AOR)\u0026thinsp;=\u0026thinsp;1.73; 95% Confidence Interval (CI) [1.56-\u0026ndash;1.92]) more likely to have poor oral hygiene compared to the females. Concerning hand hygiene behaviors, students who had poor handwashing before eating were 1.54 times (AOR\u0026thinsp;=\u0026thinsp;1.54; 95% CI [1.37\u0026ndash;1.73]), poor handwashing after toilet were 1.56 times (AOR\u0026thinsp;=\u0026thinsp;1.56; 95% CI [1.39\u0026ndash;1.75]) and handwashing without soap were 1.31 times (AOR\u0026thinsp;=\u0026thinsp;1.31; 95% CI [1.18\u0026ndash;1.46]) more likely to be associated with poor oral hygiene. Moreover, students who reported being bullied were 1.16 times (AOR\u0026thinsp;=\u0026thinsp;1.16; 95% CI [1.02\u0026ndash;1.33]) and had no close friend were 1.37 times (AOR\u0026thinsp;=\u0026thinsp;1.37; 95% CI [1.10\u0026ndash;1.69]) more likely to have poor oral health than students who reported did not being bullied and had a close friend. As to smoking behaviors, students who reported cigarette smoking past 30 days of the survey were 1.29 times (AOR\u0026thinsp;=\u0026thinsp;1.29; 95% CI [1.00\u0026ndash;1.55]), and those being exposed to second-hand smoke were 1.15 times (AOR\u0026thinsp;=\u0026thinsp;1.15; 95% CI [1.03\u0026ndash;1.30]) more likely to report poor oral hygiene. Regarding health risk behaviors, students who were physically inactive were 1.35 times (AOR\u0026thinsp;=\u0026thinsp;1.35; 95% CI [1.18\u0026ndash;1.53]) and students who spent sitting more than 3 hours per day were 1.16 times (AOR\u0026thinsp;=\u0026thinsp;1.16; 95% CI [1.05\u0026ndash;1.29)]) as likely as to have poor oral hygiene compared to the counterparts. (see \u003cstrong\u003eTable\u0026nbsp;3\u003c/strong\u003e)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis was a cross-sectional study among adolescents based on the GSHS 2019. Nearly 36% of Mongolian school-aged adolescents had poor oral hygiene seemed almost the same as the previous study [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In addition, this result was also higher than Indonesia in 2015 (10.8%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Suriname in 2016 (14.3%), and Trinidad and Tobago in 2017 (22.1%) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], but lower than Ghana in 2012 (37.4%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study investigated associations between demographic factors, hand hygiene behaviors, mental distress, substance use, health risk behaviors, and oral hygiene practice among adolescents in Mongolia.\u003c/p\u003e\u003cp\u003eOur observation that males tended to have poorer oral hygiene practices than females was similar to findings from other studies [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This tendency might be because female students were more concerned about dental aesthetics and more aware of dental problems than male students.\u003c/p\u003e\u003cp\u003eThe findings that hand hygiene practices were associated with oral hygiene practice are in line with prior studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It is possible that good hand hygiene practices, which are known to have positive effects on well-being, act as a mediator in the context of poor oral hygiene.\u003c/p\u003e\u003cp\u003eOur study confirmed previous findings showing an association between substance use, including current smoking and exposure to second-hand smoke, and poor oral hygiene in the adolescent population [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The adolescents with good oral hygiene practices were more likely to avoid smoking, and reducing their second-hand smoke exposure. An association between substance use and poor dental hygiene behavior may refer to a clustering of risky behaviors.\u003c/p\u003e\u003cp\u003eThe results of the present study showed a positive association between unhealthy risk behaviors such as being physically inactive and leisure time sedentary behavior and infrequent tooth brushing were consistent with evidence from the previous research [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Physical activity could indicate a disposition towards a healthy lifestyle and the capacity to keep general and oral health [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Children's sedentary behavior, such as the use of electronic media or screen-based activities suggested that excessive game players had less free time for tooth brushing as they chose to take part in screen-based activity [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Strengths and Limitations","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eGSHS was a large, nationally representative survey, the data of which were collected by the WHO and the Centers for Disease Control and Prevention (CDC). GSHS is globally recognized and implemented providing highly generalizable data and findings. Schools and students were randomly selected from both urban and rural areas. The findings of this investigation must be viewed in light of its limitations. Firstly, the data were cross-sectional, so did not prove causation, but they did provide information on correlations. Secondly, a self-reported questionnaire was applied, so it might be possible that the children provided invalid answers. Thirdly, this study focused on only school-aged adolescents meaning that the findings are not generalizable to all adolescents in the country. Lastly, the involvement of parents/guardians may protect young people from risk factors, and the GSHS in Mongolia does not assess parental engagement.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe prevalence of poor oral hygiene (tooth brushing less than twice a day) was almost the same as the previous GHSH 2013 in Mongolia. Adolescents need to be encouraged to take responsibility for their oral hygiene. Several factors, including poor hand hygiene behaviors, mental distress, substance use, and other health risk behaviors were found to be associated, which can aid in designing school-based dental health education intervention strategies for that target adolescents and may help students to develop habits that improve their oral health.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eParticipants and Procedures.\u003c/b\u003e This study was a secondary data analysis of the 2019 Mongolian GSHS data. The GSHS 10 core questionnaire modules address the leading causes/risk factors of morbidity and mortality among children: tobacco, alcohol, and other drug use; dietary behaviors; hygiene; mental health; physical activity; sexual behaviors that contribute to HIV infection, other sexually transmitted infections, and unintended pregnancy; unintentional injuries and violence; and respondent demographics. Students were asked to participate voluntarily in the survey, and written informed consent was obtained from each student and parents/guardians. The GSHS used a two-stage cluster sampling design where participants were given a self-reported questionnaire. The first stage, the probability of schools being selected was proportional to the number of students enrolled. The second stage, involved classes being randomly selected and all students in the selected classes were eligible to participate [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The Mongolian GSHS protocol was approved by Resolution No. 88 of the Ethical Committee of the National Center for Public Health in November 2018. Altogether 7149 students participated in the 2019 Mongolian GSHS survey.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures.\u003c/b\u003e With the exception of grade, all variables were dichotomized as yes or no/good or poor answers.\u003c/p\u003e\u003cp\u003e\u003cem\u003eOral hygiene\u003c/em\u003e as the dependent variable is based on the following question: \u0026ldquo;During the past 30 days, how many times per day did you usually clean or brush your teeth?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;Did not brush my teeth during the past 30 days, 2\u0026thinsp;=\u0026thinsp;less than 1 time per day, 3\u0026thinsp;=\u0026thinsp;1 time per day, 4\u0026thinsp;=\u0026thinsp;2 times a day, 5\u0026thinsp;=\u0026thinsp;3 times a day and 6\u0026thinsp;=\u0026thinsp;4 or more times per day; coded 1\u0026ndash;3\u0026thinsp;=\u0026thinsp;poor oral hygiene was defined as brushing teeth less than two times per day and 4\u0026ndash;6\u0026thinsp;=\u0026thinsp;good oral hygiene when brushing 2 or more times per day).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe independent variables were demographic factors, hand hygiene behaviors, mental distress, substance uses, and health risk behaviors.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDemographic factors:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eGender\u003c/strong\u003e \u003cp\u003e\u0026ldquo;What is your sex?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;male and 2\u0026thinsp;=\u0026thinsp;female; coded 0\u0026thinsp;=\u0026thinsp;male and 1\u0026thinsp;=\u0026thinsp;female).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGrade\u003c/strong\u003e \u003cp\u003e\u0026ldquo;Which grade are you study?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;5th grade, 2\u0026thinsp;=\u0026thinsp;6th grade, 3\u0026thinsp;=\u0026thinsp;7th grade, 4\u0026thinsp;=\u0026thinsp;8th grade, 5\u0026thinsp;=\u0026thinsp;9th grade, 6\u0026thinsp;=\u0026thinsp;10th grade, 7\u0026thinsp;=\u0026thinsp;11th grade and 8\u0026thinsp;=\u0026thinsp;12th grade).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eHand Hygiene behaviors:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eHandwashing before eating\u003c/strong\u003e \u003cp\u003e\u0026ldquo;How often did you wash your hand before eating?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;never, 2\u0026thinsp;=\u0026thinsp;rarely, 3\u0026thinsp;=\u0026thinsp;sometimes, 4\u0026thinsp;=\u0026thinsp;most of the time and 5\u0026thinsp;=\u0026thinsp;always; coded 1\u0026ndash;4\u0026thinsp;=\u0026thinsp;no and 5\u0026thinsp;=\u0026thinsp;yes).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHandwashing after toilet\u003c/strong\u003e \u003cp\u003e\u0026ldquo;How often did you wash your hands after using the toilet or latrine?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;never, 2\u0026thinsp;=\u0026thinsp;rarely, 3\u0026thinsp;=\u0026thinsp;sometimes, 4\u0026thinsp;=\u0026thinsp;most of the time and 5\u0026thinsp;=\u0026thinsp;always; coded 1\u0026ndash;4\u0026thinsp;=\u0026thinsp;no and 5\u0026thinsp;=\u0026thinsp;yes).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHandwashing with soap\u003c/strong\u003e \u003cp\u003e\u0026ldquo;How often did you use soap when washing your hands?\u0026rdquo; (Response options were from \u0026ldquo;1\u0026thinsp;=\u0026thinsp;never, 2\u0026thinsp;=\u0026thinsp;rarely, 3\u0026thinsp;=\u0026thinsp;sometimes, 4\u0026thinsp;=\u0026thinsp;most of the time and 5\u0026thinsp;=\u0026thinsp;always; coded 1\u0026ndash;4\u0026thinsp;=\u0026thinsp;no and 5\u0026thinsp;=\u0026thinsp;yes).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eMental Distress:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eBeing bullied\u003c/em\u003e: \u0026ldquo;During the past 30 days, on how many days have you been bullied?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;0 day, 2\u0026thinsp;=\u0026thinsp;1 or 2 days, 3\u0026thinsp;=\u0026thinsp;3 to 5 days, 4\u0026thinsp;=\u0026thinsp;6 to 9 days, 5\u0026thinsp;=\u0026thinsp;10 to 19 days, 6\u0026thinsp;=\u0026thinsp;20 to 29 days and 7\u0026thinsp;=\u0026thinsp;All 30 days; coded 1\u0026thinsp;=\u0026thinsp;no and 2\u0026ndash;7\u0026thinsp;=\u0026thinsp;yes). [Description provided in the questionnaire: Bullying occurs when one or more students or someone else about your age teases, threatens, ignores, spreads rumors about, hits, shoves, or hurts another person over and over again].\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClose friend\u003c/strong\u003e \u003cp\u003e\u0026ldquo;How many close friends do you have?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;0 friend, 2\u0026thinsp;=\u0026thinsp;1 friend, 3\u0026thinsp;=\u0026thinsp;2 friends and 4\u0026thinsp;=\u0026thinsp;3 or more; coded 1\u0026thinsp;=\u0026thinsp;no and 2\u0026ndash;4\u0026thinsp;=\u0026thinsp;yes).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSubstance use:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eCigarette smoking\u003c/strong\u003e \u003cp\u003e\u0026ldquo;During the past 30 days, how many days have you smoked cigarettes?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;0 day, 2\u0026thinsp;=\u0026thinsp;1 or 2 days, 3\u0026thinsp;=\u0026thinsp;3 to 5 days, 4\u0026thinsp;=\u0026thinsp;6 to 9 days, 5\u0026thinsp;=\u0026thinsp;10 to 19 days, 6\u0026thinsp;=\u0026thinsp;20 to 29 days and 7\u0026thinsp;=\u0026thinsp;All 30 days; coded 1\u0026thinsp;=\u0026thinsp;no and 2\u0026ndash;7\u0026thinsp;=\u0026thinsp;yes).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExposed to second-hand smoke\u003c/strong\u003e \u003cp\u003e\u0026ldquo;During the past 7 days, on how many days did people smoke in your presence?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;0 day, 2\u0026thinsp;=\u0026thinsp;1 or 2 days, 3\u0026thinsp;=\u0026thinsp;3 or 4 days, 4\u0026thinsp;=\u0026thinsp;5 or 6 days and 5\u0026thinsp;=\u0026thinsp;all 7 days; coded 2\u0026ndash;5\u0026thinsp;=\u0026thinsp;yes and 1\u0026thinsp;=\u0026thinsp;no)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAlcohol drinking\u003c/strong\u003e \u003cp\u003e\u0026ldquo;During the past 30 days, on how many days have you had at least one drink containing alcohol?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;0 day, 2\u0026thinsp;=\u0026thinsp;1 or 2 days, 3\u0026thinsp;=\u0026thinsp;3 to 5 days, 4\u0026thinsp;=\u0026thinsp;6 to 9 days, 5\u0026thinsp;=\u0026thinsp;10 to 19 days, 6\u0026thinsp;=\u0026thinsp;20 to 29 days and 7\u0026thinsp;=\u0026thinsp;All 30 days; coded 1\u0026thinsp;=\u0026thinsp;no and 2\u0026ndash;7\u0026thinsp;=\u0026thinsp;yes).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eHealth risk behaviors:\u003c/h2\u003e \u003cp\u003e \u003cem\u003ePhysical activity: \u0026ldquo;\u003c/em\u003eDuring the past 7 days, on how many days were you physically active for a total of at least 60 min per day?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;0 day, 2\u0026thinsp;=\u0026thinsp;1 day, 3\u0026thinsp;=\u0026thinsp;2 days, 4\u0026thinsp;=\u0026thinsp;3 days, 5\u0026thinsp;=\u0026thinsp;4 days, 6\u0026thinsp;=\u0026thinsp;5 days, 7\u0026thinsp;=\u0026thinsp;6 days and 8\u0026thinsp;=\u0026thinsp;7 days; coded 1\u0026thinsp;=\u0026thinsp;physically inactive and 2\u0026ndash;8\u0026thinsp;=\u0026thinsp;physically active)\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSedentary behavior\u003c/strong\u003e \u003cp\u003e\u0026ldquo;How much time do you spend during a typical or usual day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities?\u0026rdquo; (Response options were 1\u0026thinsp;=\u0026thinsp;Less than 1 hour per day, 2\u0026thinsp;=\u0026thinsp;1 to 2 hours per day, 3\u0026thinsp;=\u0026thinsp;3 to 4 hours per day, 4\u0026thinsp;=\u0026thinsp;5 to 6 hours per day, 5\u0026thinsp;=\u0026thinsp;7 to 8 hours per day and 6\u0026thinsp;=\u0026thinsp;more than 8 hours per day; coded 3\u0026ndash;6\u0026thinsp;=\u0026thinsp;yes and 1\u0026ndash;2\u0026thinsp;=\u0026thinsp;no).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eData Analysis\u003c/b\u003e. Data analysis was carried out with IBM SPSS (Statistical Package for the Social Sciences) version 28 (SPSS Inc., Chicago, IL, USA). Descriptive statistic was done to describe the study sample; distributions were calculated according to the number of current answerers. Univariable logistic regression analyses were conducted to examine unadjusted associations between oral hygiene and independent variables. Multivariable logistic regression analysis was used to assess the independent contribution of demographic factors, hand hygiene behaviors, mental distress, substance uses, and health risk behaviors to poor oral hygiene. The independent variables involved in the regression analysis were student gender, grade, and hand hygiene behaviors including handwashing before eating, handwashing after toilet and handwashing with soap, being bullied, having no close friends, cigarette smoking, exposure to second-hand smoke, alcohol drinking, being physically inactive, and sedentary behavior. The student\u0026rsquo;s grade was considered as a continuous variable in the model. Odds ratio (OR) and 95% CI of OR were used to indicate the association between the oral hygiene and the selected independent variables. Statistical significance was defined at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research uses data from the Global School-Based Student Health Survey (GSHS). The authors would like to thank GSHS country coordinators and other staff members as well as adolescent participants in Mongolia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConceptualization, J.B., D.J., B.E., N.B., B.C. and E.P.; methodology, J.B. and B.C.; formal analysis, J.B. and B.C.; investigation, J.B., B.B., D.J., B.E.; writing\u0026mdash;original draft preparation, J.B., B.B., N.B. and B.C.; writing\u0026mdash;review and editing, B.B., S.B. and E.P. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research did not receive any funds from public or private funding agencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethical Committee (resolution No.88) of the National Center approved the Mongolia GSHS protocol for Public Health, Mongolia in November 2018.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from each student who asked, voluntarily, to participate in the survey and from his or her parents/guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDatasets generated during the study can be obtained directly from the fourth author at [email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030: regional summary of the Southeast Asia Region. Geneva; \u003cstrong\u003e2023\u003c/strong\u003e Apr. Available from: https://www.who.int/publications/i/item/9789240070844 Accessed on 04 Jan 2024.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Regional Office for Europe. Global Oral Health Status report: towards universal health coverage for oral health by 2030: Summary of the WHO European Region. \u003cstrong\u003e2023\u003c/strong\u003e. Available from: https://policycommons.net/artifacts/3681553/global-oral-health-status-report/4487454/fragments/ Accessed on 04 Jan 2024.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global oral health status report Towards universal health coverage for oral health by 2030. Geneva; \u003cstrong\u003e2022\u003c/strong\u003e Nov. Available from: http://apps.who.int/bookorders. 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Prevalence and Factors Associated With Oral and Hand Hygiene Practices Among Adolescents in Malaysia: Findings From the National Health and Morbidity Survey 2017. \u003cem\u003eAsia Pac J Public Health\u003c/em\u003e. 2019 Nov 1;\u003cstrong\u003e31\u003c/strong\u003e(8_suppl):97S-104S. \u003c/li\u003e\n\u003cli\u003ePengpid S, Peltzer K. Prevalence and associated factors of oral and hand hygiene behavior among adolescents in six Southeast Asian countries. \u003cem\u003eInt J Adolesc Med Health\u003c/em\u003e. 2021 Dec 1;\u003cstrong\u003e33\u003c/strong\u003e(6):421\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eSantoso CMA, Bramantoro T, Nguyen MC, Nagy A. Lifestyle and psychosocial correlates of oral hygiene practice among Indonesian adolescents. \u003cem\u003eEur J Oral Sci\u003c/em\u003e. 2021 Feb 1;\u003cstrong\u003e129\u003c/strong\u003e(1). \u003c/li\u003e\n\u003cli\u003ePeltzer K, Pengpid S. 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Understanding children\u0026rsquo;s sedentary behavior: A qualitative study of the family home environment. \u003cem\u003eHealth Educ Res\u003c/em\u003e. 2010 Apr;\u003cstrong\u003e25\u003c/strong\u003e(2):199\u0026ndash;210\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3899097/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3899097/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTooth brushing at least twice a day is a crucial role for the prevention and control of dental caries and periodontal diseases. The aim of the current study was to examine the prevalence of poor oral hygiene (tooth brushing less than two times per day) and to identify the associated factors among adolescents in Mongolia. We analyzed data from the 2019 Mongolian Global School-based Health Survey (GSHS) conducted nationwide among 10\u0026ndash;18-year-old students. Univariable and multivariable analyses were performed to assess the correlates of poor oral hygiene. Overall, 35.6% of the adolescents reported to have poor oral hygiene in 2019. Multivariable analysis showed a significant association in the total sample of poor oral hygiene with male gender, poor hand hygiene behaviors including did not wash hand before eating, did not wash hand after toilet and handwashing without soap, being bullied, lack of close friends, smoking, exposure to second-hand smoke, physical inactivity and sedentary behavior. Several factors, including hand hygiene behaviors, mental distress, substance use, and health risk behaviors were found to be associated, which can aid in designing school-based dental health education intervention strategies to help students to develop habits that improve their health.\u003c/p\u003e","manuscriptTitle":"Oral Hygiene Behavior among Adolescents in Mongolia: Results from the Global School-based Health Survey 2019","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-07 10:16:48","doi":"10.21203/rs.3.rs-3899097/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6265854b-9b2d-4f11-995f-dbf19a90d1e2","owner":[],"postedDate":"February 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-25T06:24:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-07 10:16:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3899097","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3899097","identity":"rs-3899097","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}