School academic climate and oral health (tooth loss) in adolescents

poor, the scarcity hypothesis adds an alternative explanation, viz., the poor do not benefit from the same aspirational climate as the better off. According to Mullainathan & Shafir [12], pov- erty is a condition associated with uncertainty, e.g. uncertainty about the future. In that con- text, individuals can become more focused on the present, and fail to invest for the future. Oral health maintenance behavior is a fitting example of future orientation. An individual must engage in daily routines (brushing/flossing, avoiding sweets and cigarettes) in order to avoid dental caries and tooth loss in the future. A corollary is that an individual who does not perceive improving prospects would have scant motivation to invest in the future self. Brumley et al. [40] suggest that adolescents with pessimistic expectations about their college are more likely to engage in higher rates of violence. In line with this, our findings showed that oral Table 1. Sample characteristics. Variables N (%) School climate Mean (SD) Tooth loss High/medium educational aspiration Low educational aspiration Age (n = 1,237) (n = 700) (n = 537) 16–19 yrs 882 (71.30) 461 (52.27)��� 421 (47.73) 0.28 (0.65)� 14-15yrs 355 (28.70) 239 (67.32) 116 (32.68) 0.19 (0.54) Gender (n = 1,237) (n = 700) (n = 537) Female 730 (59.01) 427 (58.49) 303 (41.51) 0.26 (0.64) Male 507 (40.99) 273 (53.85) 234 (46.15) 0.24 (0.60) Mother’s level of schooling (n = 1,237) (n = 700) (n = 537) < 9 years of study 449 (36.30) 193 (42.98)��� 256 (57.02) 0.36(0.74)���

� 9 years 788 (63.70) 507 (64.34) 281 (35.66) 0.19(0.54) Family allowance (n = 1,237) (n = 700) (n = 537) Yes 570 (46.08) 301 (52.81)� 269 (47.19) 0.35(0.73)��� No 667 (53.92) 399 (59.82) 268 (40.18) 0.17(0.51) Dental anxiety (n = 1,237) (n = 700) (n = 537) Yes,I‘ve fear/Yes,I‘ve a lot of fear 88 (7.11) 50 (56.82) 38 (43.18) 0.41(0.87)�� No/Yes, a little bit 1,149 (92.89) 650 (56.57) 499 (43.43) 0.24(0.60) Self-perception of oral health (n = 1,237) (n = 700) (n = 537) Fair/poor 573 (46.32) 293 (51.13)��� 280 (48.87) 0.36(0.73)��� Excellent/very good/good 664 (53.68) 407 (61.30) 257 (38.70) 0.16(0.50) Periodontitis (n = 1,237) (n = 700) (n = 537) None tooth 1,182 (95.55) 672 (56.85) 510 (43.15) 0.25(0.62) 1or+ 55 (4.45) 28 (50.91) 27 (49.09) 0.27(0.62) Decayed tooth (n = 1,237) (n = 700) (n = 537) None tooth 921 (74.45) 549 (59.61)��� 372 (40.39) 0.18(0.55)��� 1or+ teeth 316 (25.55) 151 (47.78) 165 (52.22) 0.45(0.77) Type of school (26 schools) (n = 1,237) (n = 700) (n = 537) Regular (17 schools) 519 (41.96) 132 (25.43)��� 387 (74.57) 0.32(0.70)�� Full-time/partial time school (9 schools) 718 (58.04) 568 (79.11) 150 (20.89) 0.20(0.56) Social Vulnerability Index (22 neighborhoods) (n = 1,237) (n = 700) (n = 537) High/very high (6 schools) 240 (19.40) 166 (69.17)��� 74 (30.83) 0.28 (0.67) Medium/low/very low (20 schools) 997 (80.60) 534 (53.56) 463 (46.44) 0.25 (0.61) P values calculated from a T-tests for numerical variables or a Pearson’s chi-squared test for categorical variables. � p < 0.05

�� p < 0.01 ��� p < 0.001 https://doi.org/10.1371/journal.pone.0233505.t001 PLOS ONE School academic climate and tooth loss in adolescents PLOS ONE | https://doi.org/10.1371/journal.pone.0233505 May 21, 2020 6 / 11