Sociodemographics and School Environment Correlates of Clustered Oral and General Health Related Behaviours in Tanzanian Adolescents


  • Febronia Kokulengya Kahabuka Department of Orthodontics, Paedodontics and Community Dentistry, School of Dentistry, Muhimbili University of Health and Allied Sciences, P.O. Box 65014, Dar es Salaam
  • Hawa Shariff Mbawalla Department of Orthodontics, Paedodontics and Community Dentistry, School of Dentistry, Muhimbili University of Health and Allied Sciences, P.O. Box 65014, Dar es Salaam
  • Elifuraha Godson Mumghamba Department of Restorative Dentistry, School of Dentistry, Muhimbili University of Health and Allied Sciences, P.O. Box 65014, Dar es Salaam
  • Poul Erik Petersen World Health Organization Collaborating Centre for Community Oral Health Programmes and Research, Department for Global Oral Health and Community Dentistry, Institute for Odontology, Centre for Health and Society, University of Copenhagen, Oester Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen



Health behaviours, Clustering, Adolescents, School relationship, Sociodemographic factors.


Objectives: To identify underlying clusters of general and oral health behaviours and acertain possible factors influencing the existence of the behaviours.

Materials and Methods: A cross sectional study was conducted among 4,847 school adolescents aged 11 to 17 years. Data were collected using a structured questionnaire in Kiswahili inquiring about general and oral health related behaviours, socio-demographics and adolescents’ school relationship. Principal component analysis was employed to identify clusters of health behaviour. Frequency distribution for proportions, cross tabulations with chi-square and a two stage binary logistic regression were done.

Results: Principal component analysis identified four clusters from twelve health behaviours; hygiene practices, dietary behaviours, cigarette smoking & alcohol consumption and sedentary related behaviours. Girls, OR 0.8 (95% CI 0.7, 0.9); secondary school attendees, OR 0.5 (95% CI 0.4, 0.7) and adolescents with good school relationship OR 0.7 (95% CI 0.6, 0.8) were less likely to smoke or use alcohol. Urban residents were less likely OR 0.8, (95% CI 0.7, 0.9) to report acceptable dietary behaviours. Adolescents whose fathers had secondary education or higher, were in secondary schools and had good school relationship were most likely to have acceptable hygiene behaviours, OR 1.4 (95% CI 1.2, 1.6), 1.6 (95% CI 1.1, 2.2) and 1.4 (95% CI 1.3, 1.7), respectively.

Conclusion: Oral and general health behaviours of Tanzanian adolescents factored into four clusters with hygiene behaviours being most practiced and physical exercise the least. The clustered behaviours were influenced by socio-demographics and school environment.


[1] Parry CD, Patra J, Rehm J. Alcohol consumption and non?communicable diseases: epidemiology and policy implications. Addiction 2011; 106: 1718-24.
[2] Currie C, Zanotti C, Morgan A, et al. Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: International report from the 2009/2010 survey. World Health Organization, Regional Office for Europe 2012.
[3] Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol: Commentary 2000; 28: 399-406.
[4] Short SE, Mollborn S. Social determinants and health behaviors: Conceptual frames and empirical advances. Curr Opin Psychol 2015; 5: 78-84.
[5] Niaz K, Maqbool F, Khan F, Bahadar H, Hassan FI, Abdollahi M. Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer. Epidemiol Health 2017; 39.
[6] Elamin A, Garemo M, Gardner A. Dental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates—the NOPLAS project. BMC Oral Health 2018; 18(1): 104.
[7] Hashim D, Sartori S, Brennan P, et al. The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium. Ann Oncol 2016; 27: 1619-25.
[8] Viner RM, Ozer EM, Denny S, et al. Adolescence and the social determinants of health. Lancet 2012; 379: 1641-52.
[9] Casey BJ, Jones RM. Neurobiology of the adolescent brain and behavior: implications for substance use disorders. J Am Acad Child Adolesc Psychiatry 2010; 49: 1189-201.
[10] Jordão LM, Malta DC, Freire MD. Clustering patterns of oral and general health?risk behaviours in Brazilian adolescents: Findings from a national survey. Community Dent Oral Epidemiol 2018; 46: 194-202.
[11] Ottevaere C, Huybrechts I, Benser J, et al. Clustering patterns of physical activity, sedentary and dietary behavior among European adolescents: The HELENA study. BMC Public Health 2011; 11: 328.
[12] Petersen PE, Jiang H, Peng B, Tai BJ, Bian Z. Oral and general health behaviours among Chinese urban adolescents. Community Dent Oral Epidemiol 2008; 36: 76-84.
[13] Alzahrani SG, Watt RG, Sheiham A, Aresu M, Tsakos G. Patterns of clustering of six health-compromising behaviours in Saudi adolescents. BMC Public Health 2014; 14(1): 1215.
[14] Åstrøm AN, Mbawalla H. Factor structure of health and oral health-related behaviors among adolescents in Arusha, northern Tanzania. Acta Odontol Scand 2011; 69: 299-309.
[15] Peltzer K. Leisure time physical activity and sedentary behavior and substance use among in-school adolescents in eight African countries. Int J Behav Med 2010; 17: 271-8.
[16] Brindova D, Pavelka J, Šev?ikova A, et al. How parents can affect excessive spending of time on screen-based activities. BMC Public Health 2014; 14(1): 1261.
[17] Kim Y, Barreira TV, Kang M. Concurrent associations of physical activity and screen-based sedentary behavior on

obesity among US adolescents: a latent class analysis. J Epidemiol 2016; 26: 137-44.
[18] Idowu A, Fatusi AO, Olajide FO. Clustering of behavioural risk factors for non-communicable diseases (NCDs) among rural-based adolescents in south-west Nigeria. Int J Adolesc Med Health 2016; 30(1).
[19] Ndagire CT, Muyonga JH, Nakimbugwe D. Fruit and vegetable consumption, leisure?time physical activity, and sedentary behavior among children and adolescent students in Uganda. Food Sci Nutr 2019; 7: 599-607.
[20] Ssewanyana D, Mwangala PN, Marsh V, et al. Socio-ecological determinants of alcohol, tobacco, and drug use behavior of adolescents in Kilifi County at the Kenyan coast. J Health Psychol 2018: 1359105318782594.
[21] Siziya S, Muula AS, Rudatsikira E. Prevalence and correlates of truancy among adolescents in Swaziland: findings from the Global School-Based Health Survey. Child Adolesc Psychiatry Ment Health 2007; 1(1): 15.
[22] Olawole-Isaac A, Ogundipe O, Amoo EO, Adeloye D. Substance use among adolescents in sub-Saharan Africa: A systematic review and meta-analysis. S Afr J Child Health 2018; 12(SPE): s79-84.
[23] Mbatia J, Jenkins R, Singleton N, White B. Prevalence of alcohol consumption and hazardous drinking, tobacco and drug use in urban Tanzania, and their associated risk factors. Int J Environ Res Public Health 2009; 6: 1991-2006.
[24] Paavola M, Vartiainen E, Haukkala A. Smoking, alcohol use, and physical activity: a 13-year longitudinal study ranging from adolescence into adulthood. J Adolesc Health 2004; 35: 238-44.
[25] Wallace Jr JM, Bachman JG, O'malley PM, Johnston LD, Schulenberg JE, Cooper SM. Tobacco, alcohol, and illicit drug use: racial and ethnic differences among US high school seniors, 1976-2000. Public Health Rep 2002; 117(Suppl 1): S67.
[26] Boyle MH, Offord DR. Smoking, drinking and use of illicit drugs among adolescents in Ontario: prevalence, patterns of use and sociodemographic correlates. Can Med Assoc J 1986; 135(10): 1113.
[27] Doku D, Koivusilta L, Raisamo S, Rimpelä A. Socio-economic differences in adolescents’ breakfast eating, fruit and vegetable consumption and physical activity in Ghana. Public Health Nutr 2013; 16: 864-72.
[28] Abdel-Hady D, El-Gilany AH, Sarraf B. Dietary habits of adolescent students in Mansoura, Egypt. Int J Collab Res Intern Med Public Health 2014; 6(6): 132.
[29] Kahabuka FK, Petersen PE, Mbawalla HS, Mumghamba EG. Adolescents’ health behaviours in relation to dental and medical consultation in Tanzania. Int J Health Sci Res 2018; 8: 73-82.
[30] Varenne B, Petersen PE, Ouattara S. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J 2006; 56: 61-70.
[31] Mashoto KO, Astrom AN, Skeie MS, Masalu JR. Socio-demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa district, Tanzania. BMC Oral Health 2010; 10(1): 7.
[32] Tran D, Phongsavan P, Bauman AE, Havea D, Galea G. Hygiene behaviour of adolescents in the Pacific: associations with socio-demographic, health behaviour and school environment. Asia Pac J Public Health 2006; 18: 3-11.
[33] Pengpid S, Peltzer K. Hygiene behaviour and associated factors among in-school adolescents in nine African countries. Int J Behav Med 2011; 18: 150-9.
[34] Peltzer K, Pengpid S. Oral and hand hygiene behaviour and risk factors among in-school adolescents in four Southeast Asian countries. Int J Environ Res Public Health 2014; 11: 2780-92.
[35] Park YD, Patton LL, Kim HY. Clustering of oral and general health risk behaviors in Korean adolescents: a national representative sample. J Adolesc Health 2010; 47: 277-81.
[36] Brodersen NH, Steptoe A, Williamson S, Wardle J. Sociodemographic, developmental, environmental, and psychological correlates of physical activity and sedentary behavior at age 11 to 12. Ann Behav Med 2005; 29: 2-11.
[37] van Stralen MM, Y?ld?r?m M, Wulp A, et al. Measured sedentary time and physical activity during the school day of European 10-to 12-year-old children: the ENERGY project. J Sci Med Sport 2014; 17: 201-6.
[38] Cerin E, Sit CH, Wong SH, Huang YJ, Gao GY, Lai PC, Macfarlane DJ, Barnett A. Relative contribution and interactive effects of psychological, social, and environmental correlates of physical activity, sedentary behaviour, and dietary behaviours in Hong Kong adolescents. Hong Kong Med J 2019; 25.
[39] Morojele NK, Brook JS, Brook DW. Tobacco and alcohol use among adolescents in South Africa: shared and unshared risks. J Child Adolesc Ment Health 2016; 28: 139-52.
[40] Wickholm S, Galanti MR, Söder B, Gilljam H. Cigarette smoking, snuff use and alcohol drinking: coexisting risk behaviours for oral health in young males. Community Dent Oral Epidemiol 2003; 31: 269-74.
[41] Busch V, Ananda Manders L, Rob Josephus de Leeuw J. Screen time associated with health behaviors and outcomes in adolescents. Am J Health Behav 2013; 37: 819-30.
[42] del Mar Bibiloni M, Pich J, Córdova A, Pons A, Tur JA. Association between sedentary behaviour and socioeconomic factors, diet and lifestyle among the Balearic Islands adolescents. BMC Public Health 2012; 12(1): 718.
[43] Míguez MC, Becoña E. Do cigarette smoking and alcohol consumption associate with cannabis use and problem gambling among Spanish adolescents?. Adicciones 2015; 27(1).
[44] Mbawalla HS, Ally K. Dietary Habits and Related Socio-demographics among secondary school adolescents of Zanzibar, Tanzania. Int J Med Health Res 2018 .






General Articles