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CLUSTERING OF HEALTH AND ORAL-HEALTH COMPROMISING BEHAVIOURS AMONG
ADOLESCENTS IN KEDAH
NMRR-17-3419-38899

Nurul Izzah A, Norintan AM, Marhazlinda J

Introduction: Health behaviours tend to cluster together among individual. Research has
shown that health-compromising behaviours, for example smoking and high sugar
consumption; and oral health-compromising behaviours, such as poor tooth brushing
frequency and irregular dental attendance, tend to cluster together in specific patterns.
Co-occurrence of multiple health and oral health-compromising behaviours increases the
risk of mortality and morbidity. Studies also reported that those behaviours commonly
start during adolescence and can extend into adulthood. Objective: To determine the
prevalence, the clustering pattern of health and oral health-compromising behaviours
amongst selected adolescents in Kedah, and its determining factors. Materials and
Methods: A cross-sectional study that employed a stratified cluster random sampling
method was conducted among selected adolescents aged 13 and 16 years old, who
attended public and private schools in four districts in Kedah. Validated self-administered
questionnaires were distributed to assess multiple health and oral health-compromising
behaviours namely dietary intake, physical activity and sedentary behaviour, smoking
status, alcohol consumption, drug use, physical fighting, bullying, use of electronic media
communication, frequency of tooth brushing, use of fluoridated toothpaste, and flossing
behaviour. Using the statistical program for social sciences version 23, the descriptive
statistics, phi pairwise correlations, Hierarchical Agglomerative Cluster Analysis (HACA),
and Poisson Regression analysis were performed. Results: A total of 2983 respondents
completed this survey, which comprised of females (54.1%), Malays (86.9%), and those
who studied in the public schools (67.2%) and resided in urban areas (53.8%). Most of the
respondents had low milk/milk products intake (89%), were physically inactive (81%), had
poor oral health behaviours (79.9%), ate inadequate vegetables (72%) and fruits (53.1%)
intake, had high sugar intake (58.7%) and sedentary behaviours (57.1%). Two broad
clusters of health-compromising behaviours were identified. The first cluster named as
high-risk behaviours, consists of respondents with high acidic food intake, low intake of
plain water, high social media addiction, smokers, alcohol and drug users, and had been
involved in bullying and physical fighting. The second cluster named as poor adherence to
preventive behaviours, included respondents with high sugar intake, low intake of
vegetables, fruits and milk/milk products, poor oral health behaviours, had sedentary
behaviours, were physically inactive and were breakfast skippers. In term of clustering
count, almost one-fifth of respondents had seven (22%), six (21.3%) and eight (16.8%)
health and oral health-compromising behaviours. Mean clustering count of health and
oral health-compromising behaviours was significantly differed by gender (p=<0.001) and
parental educational levels (p=<0.001), and was significantly associated with life
satisfaction (p=<0.001) and self-confidence (p=<0.001) of the respondents.

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