The study targeted mothers with children under three years attending a primary healthcare centre in Kaunas, Lithuania. A self-administered anonymous questionnaire  assessed the mothers’ health behaviour and background information. The Bioethics Centre of the Lithuanian University of Health Sciences approved the study (No. BEC-OF-14).
The study population comprised mothers with children under three years attending the Department of Family Medicine at the LSMU Hospital, the mid-sized primary healthcare centre in Kaunas city providing free-of-charge services. With 300,000 inhabitants, Kaunas is the second largest town in central Lithuania. The most developed industries in Kaunas are the food and beverage industries, textile and light industries. The majority (93.6%) of citizens are Lithuanians.
The Department of Family Medicine at the LSMU Hospital invites all mothers with children between 1 and 36 months for health check-ups and vaccinations. About 200 mothers visit the centre annually. During routine visits for regular check-ups and vaccinations for the children, the mothers were invited to voluntarily complete a self-administered anonymous questionnaire distributed by the health nurses. To obtain a representative sample of (ca. 200) mothers from the health clinic, the estimated time needed to conduct the survey was one year. The survey was carried out from August 2016 to August 2017. During the mothers’ routine visits to the clinic, two health nurses distributed the questionnaires to all and collected them immediately after the mothers completed them. Of 176 mothers visiting the centre, 123 completed the questionnaires (response rate: 69.9%). About 15% of registered children live abroad and do not pay routine compulsory visits. Fathers and grandparents with children paid regular visits to the public health clinic; mothers who refused to complete the questionnaire were excluded.
The self-administered questionnaire enquired about the mothers’ background characteristics, perceived oral health status, smoking, attitudes toward oral health and behaviours regarding the potential transmission of oral bacteria to their children, the dietary habits of both the mothers and their children, such as the consumption of sugar-sweetened beverages (SSB) and sweets, and their own and their children’s tooth brushing .
The first part of the questionnaire enquired questions about the mothers’ oral health, tooth brushing habits, dental visits, smoking, and sweets consumption. The mothers’ behaviour and understanding of their own oral health may impact their children’s oral health behaviour .
The second part of the questionnaire enquired questions about the mothers’ knowledge of and attitude towards indicators of dental caries risk . The questions were: Gingivitis is caused by bacteria in the mouth; A sugary diet causes gingivitis; Frequent use of sugar increases dental decay; The use of fluoride prevents dental decay; Good oral hygiene inhibits tooth decay; Tooth decay is caused by too little use of fluoride toothpaste, frequent consumption of sugar, bacterial activity, characteristics of one’s teeth, and how often one brushes one’s teeth; Bacterial transfer from the mother’s mouth to the child’s mouth. Answer options used a Likert scale (totally agree, partially agree, don’t know, partially disagree and totally disagree). The question “Bacterial transfer from the mother’s mouth to the child’s mouth” had the following answer options: never, seldom, quite often, often, and always. The question “When should one start to brush one’s child’s teeth with fluoride toothpaste?” had several answer options: at eruption of the first tooth, when all primary teeth erupt, when permanent teeth start to erupt, and when child the learns how to brush its teeth. The last question “At what age would it be good/beneficial to stop using a pacifier?” had the following answer options: until 1 year old, until 2 years old, until 3 years old and as long as the child wants.
The third part of the questionnaire included questions about the mothers’ behaviour towards their children’s oral hygiene (1 question), sweets consumption (2 questions) and bacterial transmission from mother to child (4 questions) . Inadequate oral hygiene, frequent sweets and SSB consumption, and possible transmission of cariogenic bacteria from mother to child are risk indicators of early childhood caries.
The mothers’ background information included age in years (< 25, 25-29, 30-34, 35-39, 40+), later categorised into four by combining the two oldest age groups into one (35+). The mothers’ level of education was categorised as basic, secondary, college and university education, which was later combined into two groups: ≤ college and university. Each child was classified into one of three age groups: 1-11 months, 12-23 months and 24-36 months.
Questions about the mothers’ tooth brushing had four options: never, almost every day, once a day, and more than once a day. These options were later dichotomised into two groups: less than twice daily and twice daily. Questions about tooth brushing of the children’s teeth had the following options: not at all, seldom, once a week, every other day, once a day, more than once a day. These options were later combined into four groups: never, less than daily (seldom, once a week and every other day), once a day, and more than once a day .
Questions about smoking had four options: smoke daily, smoke occasionally, do not smoke, and have quitted. All options were later dichotomised into the following groups: smoke daily/occasionally (smoker) and do not smoke/have quitted (non-smoker).
Questions about the mothers’ frequency of sugar-sweetened products (SSP) consumption (coffee or tea with sugar; other sweet drinks; biscuit, raisins or chips; candies) had five options (corresponding scores appear in brackets): more than 3 times per day (2), 1-2 times per day (2), 2-5 times a week (1), less frequently (0), never (0). These scores were summed to describe the intensity of the mothers’ SSP consumption and ranged from 0 to 8. The higher the score, the more frequent their reported SSP consumption. The scores for the intensity of the mothers’ SSP consumption were categorised as low (scores 0-1), moderate (scores 2-6) and high (scores > 6).
Questions about the children’s consumption of SSB and sweets/candies had six answer options (the corresponding scores appear in brackets): not at all (0), seldom (1), once a week (2), every other day (3), once a day (4), and more than once a day (5). The frequency of the children’s SSB or sweets consumption was categorised as never, less than daily (seldom, once a week, every other day) and daily (once a day, more than once a day). For further analysis, the original scores for SSB and sweets consumption were combined to assess the intensity of the children’s SSP consumption. The scores for the intensity of the children’s SSP consumption ranged from 0 to 10. The higher the score, the more frequent their total reported SSP consumption . The scores for the intensity of the children’s SSP consumption were categorised as low (scores 0-1), moderate (scores 2-6), and high (scores > 6).
The Statistical Package for Social Sciences (SPSS version 22) served for the analysis. Chi-squared tests served to measure differences between the mothers’ background characteristics: smoking habits, their own health behaviour and their oral health behaviour towards their children. We then calculated the means and standard deviations (SD); a P-value ≤ 0.05 indicated statistically significant differences.
Univariate logistic regression analysis, including the odds ratio (OR) and its confidence interval (95% CI), served to calculate the probability of an event (mothers giving SSB or sweets/candies to their children, the frequency of their children’s tooth brushing, sharing a spoon or mug/plate with their children, cleaning their children’s pacifier in their own mouth) corresponding to a certain risk indicator (the mother’s education level, the frequency of the mother’s tooth brushing, and kissing the child on the lips).
Multivariate logistic regression models, including the odds ratio (OR) and its confidence interval (95% CI), served in the complex evaluation of the probability of an event (giving SSB to a child daily), in light of certain indicators (mother’s education level ≤ college and the mother’s tooth brushing less than twice daily).