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Preventive Dental Behavior in Families: A National Survey
A R T IC L E S
Preventive dental behavior in families: a national survey Meei-Shia Chen, MPH, PhD Laurna Rubinson, PhD
B ecause dental disease is so p rev a len t among children and adults, a survey was done to ascertain the dental health p ractices o f A m erican fam ilies. A comparison is m a d e with results o f surveys done in 1966 and 1974.
D ental disease is a universal prob lem that affects nearly all people in all societies, races, and socioeconomic classes throughout the world. It has been estimated that dental caries affect 98% of the population in the United States and is the most prevalent physi cal problem among school age chil dren and young adults.1 In addition, 90% of American adults are afflicted with periodontal disease.2 Unfortunately, the magnitude of this problem and its prevalence through out the population have not alerted the public to the serious health hazards that it poses. Most people accept den tal disease as a fact of life and pay scant attention to it.3 Greenberg4 also points out that dental health is usually ig nored by the general population until treatment is necessary. The high prevalence of dental dis ease in contrast to the low level of pre ventive dental behavior has prompted health professionals to conduct re search to account for this highly dis appointing situation. On the basis of information obtained from the investi
gations, it will then be possible to search for the factors that encourage or discourage people from engaging in preventive dental behavior. To date, few systematic and nationwide studies have been conducted on dental health of the American public. The American Dental Association (ADA) conducted national surveys in 1966 and 1974 to determine trends in the dental practices of a representative sample of Am erican families. Re cently, the University of Illinois col laborated with the ADA to survey the current status of dental practice and to explore the dental problems of the American public. This article is the description and analysis of that sur vey.
Survey design A cross-sectional sam ple of 1,000 fam ilies w as selected by using a stratified quota sampling to conform to the latest available US Census Date (1970) for nine geographical divisions of the country. Each division within
the sample was representative with re spect to population density, age of homemaker, annual family income, and family size. Data were collected by a mail ques tionnaire that was answered by the homemaker during the months of Sep tember and October 1980. Free tooth brushes for each family member were sent with the questionnaire. A letter enclosed with the questionnaire in structed the homemaker to complete the questionnaire and return it in the envelope provided. Of the 1,000 families who received the questionnaire, 708 (70.8% ) re turned it. The response rates as well as the distribution of the sample popula tion are shown in Table 1.
Results and discussion The results of this study are based on the data collected from the sample of 685 white American families who re turned the questionnaire. The 23 non white families who also returned the questionnaire were excluded from the analysis because the number was too small to be representative.
Toothbrushing The Illustration shows the toothbrush ing schedule of the families surveyed. A majority of the family members fol lowed a strict toothbrushing schedule. JADA, Vol. 105, July 1982 ■ 43
A R T IC L E S
Table 1 ■ Comparison of number returned questionnaires with number mailed, by geographic division, population density, age of homemaker,* annual family income, family size, and race. Total sent Variable Geographic division Northeast South North central West Population density Rural and cities 2,500-49,999 M etropolitan areas 50,000-499,999 500,000-1,999,999 2,00 0 ,0 0 0 and over Age of homemaker Under 30 years 30-39 years 4 0-49 years 50-59 years 60 years and over Annual fam ily income U nder $ 1 0 ,000 $10,000-$14,999 $15,000-$19,999 $20,000-$24,999 $ 2 5 ,000 and over Fam ily size 2 3 to 5 More than 5 Race W hite Black Oriental M exican Other Total
No.
% of total
Total returned No.
% of total
228 331 267 174
22.8 33.1 26.7 17.4
164 216 200 128
23.2 30.5 28.2 18.1
278
27.8
188
26.6
194 271 257
19.4 27.1 25.7
144 197 179
20.3 27.8 25.3
222 238 187 179 174
22.2 23.8 18.7 17.9 17.4
147 185 132 127 117
20.8 26.1 18.6 17.9 16.5
218 148 154 162 318
21.8 14.8 15.4 16.2 31.8
137 106 114 118 233
19.4 15.0 16.1 16.7 32.9
382 556 62
38.2 55.6 6.2
263 405 40
37.1 57.2 5.6
951 28 3 8 10 1,000
95.1 2.8 .3 .8 1.0 100.0
685 15 2 3 3 708
96.8 2.1 .3 .4 .4 100.0
•Homemakers are the wives except in families with single male-parent.
However, wives reported following a stricter schedule than did the hus bands and children. The children’s toothbrushing schedule was the least strict. This pattern was similar to that found in the 1966 and 1974 surveys.5,6 With regard to brushing times (Table 2), bedtime was the most popular time of brushing. The second most common time of brushing was after breakfast or on arising. Again, this pattern of pre ferred brushing times is similar to that in the two previous surveys. Toothbrushing is a convenient, rela tiv ely in exp en siv e, and effective prophylactic process that has been ad vocated for years by health profes sionals. However, as shown in Figure 1, a disappointingly high percentage of family ‘m embers (34.3% of wives, 43.8% of husbands, and 51.9% of chil
dren) did not follow a strict tooth brushing schedule. Moreover, a rather large proportion of children, for whom the development of good health behav ior is important, do not brush their teeth according to strict schedules.
Flossing One of the findings disturbing to those fostering preventive dental health care is that daily flossing was practiced by a minority of family members (20.0% of wives, 11.5% of husbands, and 6.4% of children). The percentages of family members who flossed at least once a week were 51% of wives, 32.2% of husbands, and 25.5% of children. More than half of the wives and husbands used dental floss, regardless of the frequency of
flossing, whereas less than half of the sampled population in the 1974 sur vey did so. However, many family members (27.6% of wives, 45.3% of husbands, and 48.8% of children) did not use dental floss at all. This was probably because using dental floss was not widely recognized as an effec tive preventive measure by the sub jects in this study. To improve the den tal health of the American public, this area requires increased educational ef forts.
Dental visits More than half of the sample (66.1% of wives, 52.8% of husbands, and 69.5% of children) visited their dentists regu larly; 25.9% of wives, 32.3% of hus bands, and 16.9% of children visited their dentist occasionally. Husbands had dental checkups least regularly. A small percentage of the sample (7.4% o fw iv e s , 14.2% of husbands, and 12.1% of children) reported that they did not visit a dentist for regular checkups. Within the past six months, 58% of the wives, 46.9% of the husbands, and 61.2% of children had seen dentists for preventive examinations or cleanings. A rather high proportion of the sam ple (79.0% of wives, 70.8% of hus bands, and 78.1% of children) had vis ited their dentists for preventive ex aminations or cleanings within the year before this survey. Again, among family members, husbands seem to be the least likely to visit the dentists reg ularly. Furthermore, a rather high per centage (12.2%) of the children had never been to a dentist for dental exam inations and I or cleanings.
Comparison of preventive dental behavior To test the significance of the increase or decrease in the percentages of people engaging in preventive dental activities, the results of the survey were compared (by using Z-tests) with those of the national family dental sur veys conducted by the American Den tal Association in 1966 and 1974. The
More than h alf the sample visited their dentists regularly, but 12.2% of the children had never been to a dentist. 4 4 ■ JADA, Vol. 105, July 1982
A R T IC L E S
In comparing the percentages of those who had dental examinations or cleanings w ithin the previous six months in 1980 w ith those in 1974, significant increases occurred in a ll fam ily members.
7565.7
I
I W ives (644)
g g ) Husbands (591) ¥~di Children (857)
50S tu u hi o> PM
38.9
25-
15.1
12.1
7.1 .9
S t r ic t
L o o se
N one
,8
.9
N o an sw er
T o o th b r u s h in g s c h e d u le Toothbrushing schedule of w hite A m erican fam ilies.
samples of these earlier surveys are comparable with those of the 1980 sur vey because the same sampling tech niques and parameters were used: the stratified quota sampling with region, p o p u la tio n d e n s ity , ag e of homemaker, and annual family in come. Table 3 shows the comparison of the results of the three national family dental surveys. The results of Z-tests are insignificant (X2 = 1.15, P = 875)
for the toothbrushing schedule of all family members of the 1974 vs 1966 studies. Other dental activities did not have sufficient data for computing Z -te s ts . H o w ev er, m o st of them show ed little ch an ge during the 1966-1974 period. The only areas in which improvements were made were in regular dental check-ups for both wives and husbands. A decline in pre ventive behavior was observed for the dental examinations and I or cleanings
Table 2 ■ Toothbrushing times of white American families.__________ Wives (644)* Brushing tim est Seldom brushed On arising After breakfast After lunch After evening meal After snacks At bedtime Before going away A ll others No answer Total
Husbands (591)*
Children (857)*
No. of responses
%
No. of responses
%
No. of responses
%
18 299 331 118 157 27 486 14 3 2 1,455
1.2 20.6 22.7 8.1 10.8 1.9 33.4 1.0 .2 .1 100.0
51 288 224 61 94 12 344 8 2 5 1,089
4.7 26.4 20.6 5.6 8.6 1.1 31.6 .7 .2 .5 100.0
66 282 433 68 140 27 596 8 3 7 1,630
4.0 17.3 26.6 4.2 8.6 1.7 36.6 .5 .2 .4 100.1
‘ Number of subjects studied. tCategories are not mutually exclusive; that is, each subject may brush more than once a day.
within the previous six months for children (67.0% in 1966, 57.2% in 1974). Improvement in dental practices oc curred in 1980 as compared with 1974 and 1966. The overall percentage of family members who followed a strict toothbrushing schedule increased significantly (P < .0001) in 1980, al though this significant increase did not appear between 1974 and 1980 for husbands. The percentages of wives and husbands who had regular dental checkups increased significantly. In comparing the percentages of those who had dental examinations or clean ings within the previous six months in 1980 with those in 1974, significant increases occurred in all family mem bers. Although almost no improvement was made in preventive dental behav ior from 1966 to 1974, there was a sig nificant improvement since 1974. Be cause no investigation on the effects of p ercep tion s or sociod em ograp h ic variables on preventive dental behav-
Chen-R ubinson : PREVENTIVE DENTAL BEHAVIOR IN FA M ILIES ■ 45
A R T IC L E S
Table 3 ■ Comparison in frequency and percent of the results of national family dental surveys in 1966, 1974, and 1980.*
Year of survey 1966*
1974
1980
Frequency and percentage who followed strict toothbrushing schedule Fam ily members Wives Husbands Children Total Wives Husbands Children Total Wives Husbands Children Total
N o.f
%
Frequency and percentage who had dental checkups regularly No.
Frequency and percentage who had a dental exam ination or cleaning w ithin previous six months No.
% 50.3 39.0 68.0
1,493 392 325 387 1,104 423 332 412 1,167
(2,986) (669) (613) (999) (2,281) (644) (591) (857) (2,092)
50.0 59.2 53.0 38.7 48.4 65.7 56.2 48.1 55.8
376 274 680 1,330 426 312 596 1,334
(669) (613) (999) (2,281) (644) (591) (857) (2,092)
56.2 44.7 68.1 58.3 66.1 52.8 69.5 63.8
% 51.0 42.0 67.0
346 254 572 1,172 374 277 525 1,176
(669) (613) (999) (2,281) (644) (591) (857) (2,092)
51.6 4 1 .6§ 57.2§ 51.4 58.0 46.9 61.2 56.2
*Data on flossing a re not available for 1966 and 1974 surveys; therefore, these data are not compared. tN um ber in parentheses represents the total number of subjects studied. $Data for 1 9 6 6 are not complete. §The percentages under this category for 1974 were mistaken by Craig and Montague (1974) as half of the original values: 25.8% for wives, 20.8% for husbands, and 28.6% for children. The original report prepared by National Family Opinion indicates that the correct values are 51.6% , 41.6% , and 57.2% , respectively.
ior was done in the last two surveys, it is impossible to explore the reasons for the improvement. Despite an overall improvement, the percentage of husbands who followed a strict toothbrushing schedule and of children who have regular check-ups does not seem to be increasing. The percent of children who have regular check-ups may not be increasing be cause the parents had recognized the importance of a regular dental check up for their children. The children had already achieved a high percentage of regular check-ups by 1974, hence there was little room for improvement.
breakfast, and on arising. This pattern of preferred brushing times was simi lar to that in the 1966 and 1974 sur veys. Only a small percentage of the sam ple flossed daily. More than half of the sample visited their dentists regularly. More than 70% visited their dentists for preventive examinations or clean ings within the year before the survey was done. Compared with the results from the 1966 and 1974 surveys, the preventive dental behavior of the white American families has improved significantly since 1966. fT
Summary The results of the 1980 survey showed that a majority of white American fam ily members adhered to a strict toothbrushing schedule. The popular times of brushing were before bedtime, after
46 ■ JADA, Vol. 105, July 1982
This study was supported by the Am erican Dental Association through a grant for a national family dental survey. We thank the National Fam ily Opinion, Inc, who helped conduct the nationwide sampling.
Dr. Chen is assistant professor, department of physical and h ealth education, U niversity of Texas at Austin, and Dr. Rubinson is. associate professor, department of health and safety educa tion, University of Illinois at Champaign-Urbana, 1206 S Fourth St, Champaign, 61820. Address re quests for reprints to Dr. Rubinson. 1. Morris, A.L. Dentistry: retrospect and pros pect. JADA 8 7 :9 9 2 -9 9 7 ,1 9 7 3 . 2. Eisenberg, A., and Eisenberg, H. Alive and w ell: decisions in health. New York, McGraw-Hill Book Co, 1979, p 113. 3. Thornton, A.W. Mass com m unication and dental health behavior. Health Education Mono graphs 2 :2 0 1 -2 0 8 ,1 9 7 4 . 4. Greenberg, J.S. A study of behavior m odifi cation applied to dental health. I School Health 4 7 :5 9 4 -5 9 6 ,1 9 7 7 . 5. Bureau o f Dental Health Education, and Bureau of E con om ic Research and Statistics, Am erican Dental Association. Survey of family toothbrush ing p ractice. JADA 7 2 :1 4 8 9 -1 4 9 1 , 1966. 6. Craig, T .T ., and Montague, J.L. Fam ily oral health survey. JADA 9 2 :326-332,1976.
Preventive dental behavior in families: a national survey Meei-Shia Chen, MPH, PhD Laurna Rubinson, PhD
B ecause dental disease is so p rev a len t among children and adults, a survey was done to ascertain the dental health p ractices o f A m erican fam ilies. A comparison is m a d e with results o f surveys done in 1966 and 1974.
D ental disease is a universal prob lem that affects nearly all people in all societies, races, and socioeconomic classes throughout the world. It has been estimated that dental caries affect 98% of the population in the United States and is the most prevalent physi cal problem among school age chil dren and young adults.1 In addition, 90% of American adults are afflicted with periodontal disease.2 Unfortunately, the magnitude of this problem and its prevalence through out the population have not alerted the public to the serious health hazards that it poses. Most people accept den tal disease as a fact of life and pay scant attention to it.3 Greenberg4 also points out that dental health is usually ig nored by the general population until treatment is necessary. The high prevalence of dental dis ease in contrast to the low level of pre ventive dental behavior has prompted health professionals to conduct re search to account for this highly dis appointing situation. On the basis of information obtained from the investi
gations, it will then be possible to search for the factors that encourage or discourage people from engaging in preventive dental behavior. To date, few systematic and nationwide studies have been conducted on dental health of the American public. The American Dental Association (ADA) conducted national surveys in 1966 and 1974 to determine trends in the dental practices of a representative sample of Am erican families. Re cently, the University of Illinois col laborated with the ADA to survey the current status of dental practice and to explore the dental problems of the American public. This article is the description and analysis of that sur vey.
Survey design A cross-sectional sam ple of 1,000 fam ilies w as selected by using a stratified quota sampling to conform to the latest available US Census Date (1970) for nine geographical divisions of the country. Each division within
the sample was representative with re spect to population density, age of homemaker, annual family income, and family size. Data were collected by a mail ques tionnaire that was answered by the homemaker during the months of Sep tember and October 1980. Free tooth brushes for each family member were sent with the questionnaire. A letter enclosed with the questionnaire in structed the homemaker to complete the questionnaire and return it in the envelope provided. Of the 1,000 families who received the questionnaire, 708 (70.8% ) re turned it. The response rates as well as the distribution of the sample popula tion are shown in Table 1.
Results and discussion The results of this study are based on the data collected from the sample of 685 white American families who re turned the questionnaire. The 23 non white families who also returned the questionnaire were excluded from the analysis because the number was too small to be representative.
Toothbrushing The Illustration shows the toothbrush ing schedule of the families surveyed. A majority of the family members fol lowed a strict toothbrushing schedule. JADA, Vol. 105, July 1982 ■ 43
A R T IC L E S
Table 1 ■ Comparison of number returned questionnaires with number mailed, by geographic division, population density, age of homemaker,* annual family income, family size, and race. Total sent Variable Geographic division Northeast South North central West Population density Rural and cities 2,500-49,999 M etropolitan areas 50,000-499,999 500,000-1,999,999 2,00 0 ,0 0 0 and over Age of homemaker Under 30 years 30-39 years 4 0-49 years 50-59 years 60 years and over Annual fam ily income U nder $ 1 0 ,000 $10,000-$14,999 $15,000-$19,999 $20,000-$24,999 $ 2 5 ,000 and over Fam ily size 2 3 to 5 More than 5 Race W hite Black Oriental M exican Other Total
No.
% of total
Total returned No.
% of total
228 331 267 174
22.8 33.1 26.7 17.4
164 216 200 128
23.2 30.5 28.2 18.1
278
27.8
188
26.6
194 271 257
19.4 27.1 25.7
144 197 179
20.3 27.8 25.3
222 238 187 179 174
22.2 23.8 18.7 17.9 17.4
147 185 132 127 117
20.8 26.1 18.6 17.9 16.5
218 148 154 162 318
21.8 14.8 15.4 16.2 31.8
137 106 114 118 233
19.4 15.0 16.1 16.7 32.9
382 556 62
38.2 55.6 6.2
263 405 40
37.1 57.2 5.6
951 28 3 8 10 1,000
95.1 2.8 .3 .8 1.0 100.0
685 15 2 3 3 708
96.8 2.1 .3 .4 .4 100.0
•Homemakers are the wives except in families with single male-parent.
However, wives reported following a stricter schedule than did the hus bands and children. The children’s toothbrushing schedule was the least strict. This pattern was similar to that found in the 1966 and 1974 surveys.5,6 With regard to brushing times (Table 2), bedtime was the most popular time of brushing. The second most common time of brushing was after breakfast or on arising. Again, this pattern of pre ferred brushing times is similar to that in the two previous surveys. Toothbrushing is a convenient, rela tiv ely in exp en siv e, and effective prophylactic process that has been ad vocated for years by health profes sionals. However, as shown in Figure 1, a disappointingly high percentage of family ‘m embers (34.3% of wives, 43.8% of husbands, and 51.9% of chil
dren) did not follow a strict tooth brushing schedule. Moreover, a rather large proportion of children, for whom the development of good health behav ior is important, do not brush their teeth according to strict schedules.
Flossing One of the findings disturbing to those fostering preventive dental health care is that daily flossing was practiced by a minority of family members (20.0% of wives, 11.5% of husbands, and 6.4% of children). The percentages of family members who flossed at least once a week were 51% of wives, 32.2% of husbands, and 25.5% of children. More than half of the wives and husbands used dental floss, regardless of the frequency of
flossing, whereas less than half of the sampled population in the 1974 sur vey did so. However, many family members (27.6% of wives, 45.3% of husbands, and 48.8% of children) did not use dental floss at all. This was probably because using dental floss was not widely recognized as an effec tive preventive measure by the sub jects in this study. To improve the den tal health of the American public, this area requires increased educational ef forts.
Dental visits More than half of the sample (66.1% of wives, 52.8% of husbands, and 69.5% of children) visited their dentists regu larly; 25.9% of wives, 32.3% of hus bands, and 16.9% of children visited their dentist occasionally. Husbands had dental checkups least regularly. A small percentage of the sample (7.4% o fw iv e s , 14.2% of husbands, and 12.1% of children) reported that they did not visit a dentist for regular checkups. Within the past six months, 58% of the wives, 46.9% of the husbands, and 61.2% of children had seen dentists for preventive examinations or cleanings. A rather high proportion of the sam ple (79.0% of wives, 70.8% of hus bands, and 78.1% of children) had vis ited their dentists for preventive ex aminations or cleanings within the year before this survey. Again, among family members, husbands seem to be the least likely to visit the dentists reg ularly. Furthermore, a rather high per centage (12.2%) of the children had never been to a dentist for dental exam inations and I or cleanings.
Comparison of preventive dental behavior To test the significance of the increase or decrease in the percentages of people engaging in preventive dental activities, the results of the survey were compared (by using Z-tests) with those of the national family dental sur veys conducted by the American Den tal Association in 1966 and 1974. The
More than h alf the sample visited their dentists regularly, but 12.2% of the children had never been to a dentist. 4 4 ■ JADA, Vol. 105, July 1982
A R T IC L E S
In comparing the percentages of those who had dental examinations or cleanings w ithin the previous six months in 1980 w ith those in 1974, significant increases occurred in a ll fam ily members.
7565.7
I
I W ives (644)
g g ) Husbands (591) ¥~di Children (857)
50S tu u hi o> PM
38.9
25-
15.1
12.1
7.1 .9
S t r ic t
L o o se
N one
,8
.9
N o an sw er
T o o th b r u s h in g s c h e d u le Toothbrushing schedule of w hite A m erican fam ilies.
samples of these earlier surveys are comparable with those of the 1980 sur vey because the same sampling tech niques and parameters were used: the stratified quota sampling with region, p o p u la tio n d e n s ity , ag e of homemaker, and annual family in come. Table 3 shows the comparison of the results of the three national family dental surveys. The results of Z-tests are insignificant (X2 = 1.15, P = 875)
for the toothbrushing schedule of all family members of the 1974 vs 1966 studies. Other dental activities did not have sufficient data for computing Z -te s ts . H o w ev er, m o st of them show ed little ch an ge during the 1966-1974 period. The only areas in which improvements were made were in regular dental check-ups for both wives and husbands. A decline in pre ventive behavior was observed for the dental examinations and I or cleanings
Table 2 ■ Toothbrushing times of white American families.__________ Wives (644)* Brushing tim est Seldom brushed On arising After breakfast After lunch After evening meal After snacks At bedtime Before going away A ll others No answer Total
Husbands (591)*
Children (857)*
No. of responses
%
No. of responses
%
No. of responses
%
18 299 331 118 157 27 486 14 3 2 1,455
1.2 20.6 22.7 8.1 10.8 1.9 33.4 1.0 .2 .1 100.0
51 288 224 61 94 12 344 8 2 5 1,089
4.7 26.4 20.6 5.6 8.6 1.1 31.6 .7 .2 .5 100.0
66 282 433 68 140 27 596 8 3 7 1,630
4.0 17.3 26.6 4.2 8.6 1.7 36.6 .5 .2 .4 100.1
‘ Number of subjects studied. tCategories are not mutually exclusive; that is, each subject may brush more than once a day.
within the previous six months for children (67.0% in 1966, 57.2% in 1974). Improvement in dental practices oc curred in 1980 as compared with 1974 and 1966. The overall percentage of family members who followed a strict toothbrushing schedule increased significantly (P < .0001) in 1980, al though this significant increase did not appear between 1974 and 1980 for husbands. The percentages of wives and husbands who had regular dental checkups increased significantly. In comparing the percentages of those who had dental examinations or clean ings within the previous six months in 1980 with those in 1974, significant increases occurred in all family mem bers. Although almost no improvement was made in preventive dental behav ior from 1966 to 1974, there was a sig nificant improvement since 1974. Be cause no investigation on the effects of p ercep tion s or sociod em ograp h ic variables on preventive dental behav-
Chen-R ubinson : PREVENTIVE DENTAL BEHAVIOR IN FA M ILIES ■ 45
A R T IC L E S
Table 3 ■ Comparison in frequency and percent of the results of national family dental surveys in 1966, 1974, and 1980.*
Year of survey 1966*
1974
1980
Frequency and percentage who followed strict toothbrushing schedule Fam ily members Wives Husbands Children Total Wives Husbands Children Total Wives Husbands Children Total
N o.f
%
Frequency and percentage who had dental checkups regularly No.
Frequency and percentage who had a dental exam ination or cleaning w ithin previous six months No.
% 50.3 39.0 68.0
1,493 392 325 387 1,104 423 332 412 1,167
(2,986) (669) (613) (999) (2,281) (644) (591) (857) (2,092)
50.0 59.2 53.0 38.7 48.4 65.7 56.2 48.1 55.8
376 274 680 1,330 426 312 596 1,334
(669) (613) (999) (2,281) (644) (591) (857) (2,092)
56.2 44.7 68.1 58.3 66.1 52.8 69.5 63.8
% 51.0 42.0 67.0
346 254 572 1,172 374 277 525 1,176
(669) (613) (999) (2,281) (644) (591) (857) (2,092)
51.6 4 1 .6§ 57.2§ 51.4 58.0 46.9 61.2 56.2
*Data on flossing a re not available for 1966 and 1974 surveys; therefore, these data are not compared. tN um ber in parentheses represents the total number of subjects studied. $Data for 1 9 6 6 are not complete. §The percentages under this category for 1974 were mistaken by Craig and Montague (1974) as half of the original values: 25.8% for wives, 20.8% for husbands, and 28.6% for children. The original report prepared by National Family Opinion indicates that the correct values are 51.6% , 41.6% , and 57.2% , respectively.
ior was done in the last two surveys, it is impossible to explore the reasons for the improvement. Despite an overall improvement, the percentage of husbands who followed a strict toothbrushing schedule and of children who have regular check-ups does not seem to be increasing. The percent of children who have regular check-ups may not be increasing be cause the parents had recognized the importance of a regular dental check up for their children. The children had already achieved a high percentage of regular check-ups by 1974, hence there was little room for improvement.
breakfast, and on arising. This pattern of preferred brushing times was simi lar to that in the 1966 and 1974 sur veys. Only a small percentage of the sam ple flossed daily. More than half of the sample visited their dentists regularly. More than 70% visited their dentists for preventive examinations or clean ings within the year before the survey was done. Compared with the results from the 1966 and 1974 surveys, the preventive dental behavior of the white American families has improved significantly since 1966. fT
Summary The results of the 1980 survey showed that a majority of white American fam ily members adhered to a strict toothbrushing schedule. The popular times of brushing were before bedtime, after
46 ■ JADA, Vol. 105, July 1982
This study was supported by the Am erican Dental Association through a grant for a national family dental survey. We thank the National Fam ily Opinion, Inc, who helped conduct the nationwide sampling.
Dr. Chen is assistant professor, department of physical and h ealth education, U niversity of Texas at Austin, and Dr. Rubinson is. associate professor, department of health and safety educa tion, University of Illinois at Champaign-Urbana, 1206 S Fourth St, Champaign, 61820. Address re quests for reprints to Dr. Rubinson. 1. Morris, A.L. Dentistry: retrospect and pros pect. JADA 8 7 :9 9 2 -9 9 7 ,1 9 7 3 . 2. Eisenberg, A., and Eisenberg, H. Alive and w ell: decisions in health. New York, McGraw-Hill Book Co, 1979, p 113. 3. Thornton, A.W. Mass com m unication and dental health behavior. Health Education Mono graphs 2 :2 0 1 -2 0 8 ,1 9 7 4 . 4. Greenberg, J.S. A study of behavior m odifi cation applied to dental health. I School Health 4 7 :5 9 4 -5 9 6 ,1 9 7 7 . 5. Bureau o f Dental Health Education, and Bureau of E con om ic Research and Statistics, Am erican Dental Association. Survey of family toothbrush ing p ractice. JADA 7 2 :1 4 8 9 -1 4 9 1 , 1966. 6. Craig, T .T ., and Montague, J.L. Fam ily oral health survey. JADA 9 2 :326-332,1976.