摘要：Objectives. Evidence suggests that communities with higher levels of social capital have better health, but this association has not been explored specifically in relation to dental injury. We investigated the association between social capital and dental injury. Methods. We conducted a multilevel study assessed individual and neighborhood effects on dental injury of 1302 14- to 15-year-old adolescents in 39 schools of Distrito Federal, Brazil. Children underwent a dental examination and, with their parents, answered a questionnaire about their local environments. Our data analysis used logistic multilevel modeling of students and neighborhood (the latter defined by catchment areas of schools). Results. The prevalence of dental injury was significantly lower in neighborhoods with higher levels of social capital, especially among boys. After control for individual and neighborhood variables, the adjusted odds ratio for a 1-unit increase in the standardized social capital index was 0.55 (95% confidence interval=0.37, 0.81; P =.002) among boys. Conclusions. Social capital may explain inequalities in rates of dental injury, especially among boys. Despite methodological inconsistencies, recent evidence suggests that social capital, the norms and networks that enable people to act collectively, may have an important influence on health. People in societies with higher levels of social capital live longer, have lower premature mortality rates, are less violent, and have lower levels of self-perception of poor health. 1 However, there are very few studies of the effects of social capital on injury. One study investigating accidental injury and several other causes of mortality in 39 US states found that mortality rates from injury were higher in states with higher mistrust, lack of fairness, and low perceived helpfulness between community members. 2 However, the estimated regression coefficients for social capital were substantially attenuated and became nonsignificant after the introduction of an area-level poverty variable to the statistical model. Using dental injury as a measure for general injury, Moyses 3 reported that a 3-item social cohesion index, as measured by a community’s participation in health and social care conferences, the community’s associations with other communities, and the presence of local health committees, was not significantly associated with dental injury, but an index of supportive policies, policies that support implementation of public day care centers, healthy food projects in schools, and adequate community dwellings, was. Others have assessed the relations between the prevalence of dental injury and supportive health-promoting school environments that may be an indirect measure of area-level social capital. 4 , 5 After adjusting for gender, time at school, and household income, Moyses et al. 4 predicted that a 5% decrease in the percentage of children with dental injury would be expected in supportive compared with nonsupportive schools. Similarly, Malikaew et al. 5 found significantly lower rates of dental injury in supportive compared with nonsupportive schools in Thailand after taking into account a contextual variable of physical environment and some individual-level variables (odds ratio=0.68; 95% confidence interval [CI]=0.49, 0.93). Very little is known about area-level determinants of dental injury, and the current literature is only indirectly related to social capital theory. Therefore, we investigated the influence of contextual and individual risk factors associated with dental injury. We hypothesized that the prevalence of dental injury was lower in neighborhoods with higher social capital levels. Dental injuries have long-lasting impacts on oral health–related quality of life and are seldom treated in most countries, making the presence of these types of injuries a good measure for dental health. Further, dental health and general health share many of the same determinants, so the same forces that normally cause body injuries also cause dental injuries. Neighborhoods with higher levels of social capital will have better social networks and environments that produce less dental injury because the conditions that would produce the trauma are not or are less present. Several factors justify this study: it introduces a social perspective to explain dental injury, a subject mostly investigated in terms of individual risk factors such as gender, age, tooth overjet, lip coverage, and obesity 6 ; the use of neighborhood factors is a subject that has not been fully explored in other studies. The association between social capital and dental injury also has been chosen because of the potential benefit of social capital in improving these injury rates. Furthermore, if disparities in dental injury can be explained by disparities in social capital, then injury reductions might be achieved by changes in policy.
