The aim of this study was to make an environmental/behavioral assessment at the community level regarding causal relationships among health-related factors in order to make the job of the health professional easier. Guardians of 18-month-old children were asked to complete a questionnaire regarding 7 oral health compo-nents ('environment', 'reinforcing factors', 'enabling factors', 'predisposing factors', 'dental health behavior', 'oral health' and 'Quality of Life (QOL)') on the basis of the PRECEDE-PROCEED model. Figure 1 (causal chain) shows that 'QOL' consisting of 'oral quality of life' and 'physical and appearance conditioning behavior' would be improved by strengthening 'dental health behavior' and/or 'predisposing factors'. In this study, the X^2 test was used to clarify differences between two areas (A-area: 620 guardians, B-area: 218 guardians). Of great significance was a finding that 47% of guardians in B answered that they have never had instructions on tooth brushing by a dental professional, in contrast with 26% of guardians in A (p<0.01). Nearly one half of the guardians in A answered that public sectors were encouraging dental health education for everyone, while 27% of guardians in B answered this way. Significant differences between the two areas were found for all items of 'reinforcing factors', and in each case, more guardians in A reported 'reinforced' behavior than guardians in B. Only a minority reported use of dental floss (A-area; 19%, B-area; 13%, p<0.05). Differences between the two areas' assessment of other items were small or not significant except 'use of dental floss'. These findings suggest that the causal relationships studied are important considerations when planning dental health education or other interventions at the community level.
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