{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:46:13Z","timestamp":1787028373880,"version":"build-2736575974"},"reference-count":31,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health","award":["4UH3DE029213-02"],"award-info":[{"award-number":["4UH3DE029213-02"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Improving children\u2019s oral health is a national priority. Parental knowledge and self-efficacy influence children\u2019s health behaviors; however, the relationship between parental oral health-related knowledge, self-efficacy, child oral health-related quality of life (OHQoL), and dental caries remains unclear, especially among low-income, ethnically diverse U.S. families. This study assesses the relationship between parental oral health-related knowledge, self-efficacy, child dental caries, and OHQoL. This cross-sectional seco ndary analysis uses baseline data from a school-based cluster-randomized controlled trial among children (kindergarten\u2013second grade). Dental assessments were conducted using the International Caries Detection and Assessment System (ICDAS) on site in schools at baseline (n = 34 schools, n = 1084 consenting parent\u2013child dyads). Child OHQoL, parental knowledge, and self-efficacy were measured using validated self-report surveys. Associations between exposures and outcomes (child dental caries prevalence, child OHQoL) were evaluated by univariate and multivariable logistic and linear regressions, respectively. After adjusting for covariates, higher parental self-efficacy was associated with lower child OHQoL (lower score indicates higher quality of life) [beta = \u22120.16, 95% CI: \u22120.24, \u22120.09, p &lt; 0.01] and lower odds of active dental caries [Adj OR: 0.95, 95% CI: 0.9, 0.99, p = 0.02]. No significant associations were noted for parental knowledge. These findings can inform future research, understanding how parental psychosocial factors influence dental caries prevention behaviors and risk, and inform interventions for children.<\/jats:p>","DOI":"10.3390\/ijerph22040513","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T06:06:35Z","timestamp":1743141995000},"page":"513","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Association of Parental Oral Health Knowledge and Self-Efficacy with Early Childhood Caries and Oral Health Quality of Life in Texas Schoolchildren"],"prefix":"10.3390","volume":"22","author":[{"given":"Shreela V.","family":"Sharma","sequence":"first","affiliation":[{"name":"Center for Health Equity, Department of Epidemiology, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette E.","family":"Deason","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8528-5951","authenticated-orcid":false,"given":"Mengxi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3530-8713","authenticated-orcid":false,"given":"Alejandra","family":"Garcia-Quintana","sequence":"additional","affiliation":[{"name":"Center for Health Equity, Department of Epidemiology, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru-Jye","family":"Chuang","sequence":"additional","affiliation":[{"name":"Center for Health Equity, Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kila","family":"Johnson","sequence":"additional","affiliation":[{"name":"Community Health and Wellness Division, Dental Health and Prevention, Harris County Public Health, Houston, TX 77027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3707-3104","authenticated-orcid":false,"given":"Shalisa","family":"Garner","sequence":"additional","affiliation":[{"name":"Community Health and Wellness Division, Dental Health and Prevention, Harris County Public Health, Houston, TX 77027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Kelder","sequence":"additional","affiliation":[{"name":"Department of Health Promotion & Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Austin (UTHealth Houston) School of Public Health, Houston, TX 78701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2505-0090","authenticated-orcid":false,"given":"Jose-Miguel","family":"Yamal","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2025, January 30). Oral Conditions\u2013Healthy People 2030, Available online: https:\/\/odphp.health.gov\/healthypeople\/objectives-and-data\/browse-objectives\/oral-conditions."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.adaj.2024.05.006","article-title":"Global trends in incidence of caries in permanent teeth of children aged 5 through 14 years, 1990 through 2019","volume":"155","author":"Huang","year":"2024","journal-title":"J. Am Dent. Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1038\/s41415-021-3775-4","article-title":"Understanding Dental Caries as a Non-Communicable Disease","volume":"231","author":"Pitts","year":"2021","journal-title":"Br. Dent. J."},{"key":"ref_4","unstructured":"US. Department of Health and Human Services (2025, January 30). Oral Health in America: A Report of the Surgeon General, Available online: https:\/\/www.nidcr.nih.gov\/sites\/default\/files\/2017-10\/hck1ocv.%40www.surgeon.fullrpt.pdf."},{"key":"ref_5","unstructured":"Fleming, E., and Afful, J. (2025, January 29). Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015\u20132016, Available online: https:\/\/www.cdc.gov\/nchs\/products\/databriefs\/db307.htm."},{"key":"ref_6","unstructured":"Texas Department of State Health Services (2025, January 29). Dental Health Data and Reporting. Texas DSHS, Available online: https:\/\/www.dshs.texas.gov\/dental-health\/dental-health-data-reporting."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/j.1752-7325.2007.00036.x","article-title":"Oral Health-Related Quality of Life of Children by Dental Caries and Fluorosis Experience","volume":"67","author":"Do","year":"2007","journal-title":"J. Public Health Dent."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1159\/000330231","article-title":"Oral Health-Related Quality of Life in Hong Kong Preschool Children","volume":"45","author":"Wong","year":"2011","journal-title":"Caries Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/cdoe.12035","article-title":"Exploring the Impact of Oral Diseases and Disorders on Quality of Life of Preschool Children","volume":"41","author":"Kramer","year":"2013","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/cdoe.12092","article-title":"Associations Between Perceived Needs for Dental Treatment, Oral Health-Related Quality of Life, and Oral Diseases in School-Aged Thai Children","volume":"42","author":"Krisdapong","year":"2014","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1111\/eos.12166","article-title":"Impact of Dental Caries on Quality of Life Among Preschool Children: Emphasis on the Type of Tooth and Stages of Progression","volume":"123","author":"Alencar","year":"2015","journal-title":"Eur. J. Oral Sci."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fleming, P. (2015). Timetable for Oral Prevention in Childhood\u2014A Current Opinion. Prog. Orthod., 16.","DOI":"10.1186\/s40510-015-0098-5"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/idj.12074","article-title":"The Primary and Mixed Dentition, Post-Eruptive Enamel Maturation, and Dental Caries: A Review","volume":"63","author":"Lynch","year":"2013","journal-title":"Int. Dent. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s40368-013-0046-3","article-title":"Evaluation of the Tooth Brushing Skills in Children Aged 6\u201312 Years","volume":"14","author":"Pujar","year":"2013","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Krol, D.M., Whelan, K., and The Section on Oral Health (2023). Maintaining and Improving the Oral Health of Young Children. Pediatrics, 151.","DOI":"10.1542\/peds.2022-060417"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Chuang, R.J., Byrd-Williams, C., Yamal, J.M., Johnson, K., Kelder, S., Nelson, S., Mofleh, D., and Sharma, S.V. (2022). Design for a Cluster Randomized Controlled Trial to Evaluate the Effects of the CATCH Healthy Smiles School-Based Oral Health Promotion Intervention Among Elementary School Children. Contemp. Clin. Trials Commun., 30.","DOI":"10.1016\/j.conctc.2022.101033"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/josh.13100","article-title":"Development and Feasibility Testing of CATCH Healthy Smiles, an Oral Health Promotion Intervention for Prevention of Dental Caries Among Elementary School Children","volume":"92","author":"Sharma","year":"2022","journal-title":"J. Sch. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1159\/000486429","article-title":"The International Caries Detection and Assessment System\u2013ICDAS: A Systematic Review","volume":"52","author":"Ekstrand","year":"2018","journal-title":"Caries Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Pahel, B.T., Rozier, R.G., and Slade, G.D. (2007). Parental Perceptions of Children\u2019s Oral Health: The Early Childhood Oral Health Impact Scale (ECOHIS). Health Qual. Life Outcomes, 5.","DOI":"10.1186\/1477-7525-5-6"},{"key":"ref_20","unstructured":"Centers for Disease Control and Prevention (2025, January 30). Child and Teen BMI Categories. BMI, Available online: https:\/\/www.cdc.gov\/bmi\/child-teen-calculator\/bmi-categories.html."},{"key":"ref_21","first-page":"422","article-title":"Reliability and Validity of Brief Measures of Oral Health-Related Knowledge, Fatalism, and Self-Efficacy in Mothers of African American Children","volume":"27","author":"Finlayson","year":"2005","journal-title":"Pediatr. Dent."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/cdoe.12019","article-title":"Parental Self-Efficacy and Oral Health-Related Knowledge Are Associated with Parent and Child Oral Health Behaviors and Self-Reported Oral Health Status","volume":"41","author":"Ashbolt","year":"2013","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_23","unstructured":"Centers for Disease Control and Prevention (2025, January 30). FastStats\u2013Oral and Dental Health, Available online: https:\/\/www.cdc.gov\/nchs\/fastats\/dental.htm."},{"key":"ref_24","unstructured":"Bandura, A. (2010). Social-Cognitive Theory, Psychology Press. [7th ed.]."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.jdent.2012.07.013","article-title":"Parental Influence and the Development of Dental Caries in Children Aged 0\u20136 Years: A Systematic Review of the literature","volume":"40","author":"Hooley","year":"2012","journal-title":"J. Dent."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Smith, S.R., Kroon, J., Schwarzer, R., and Hamilton, K. (2020). Parental Social-Cognitive Correlates of Preschoolers\u2019 Oral Hygiene Behavior: A Systematic Review and Meta-Analysis. Soc. Sci. Med., 264.","DOI":"10.1016\/j.socscimed.2020.113322"},{"key":"ref_27","first-page":"735","article-title":"The Differential Predictive Utility of Two Caregiver-Targeted Self-Efficacy Measures to Promote Oral Health of Underserved Children","volume":"42","author":"Hevel","year":"2023","journal-title":"Health Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wilson, A.R., Mulvahill, M.J., and Tiwari, T. (2017). The Impact of Maternal Self-Efficacy and Oral Health Beliefs on Early Childhood Caries in Latino Children. Front Public Health., 5.","DOI":"10.3389\/fpubh.2017.00228"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Zhao, J., Shi, H., Wang, J., Huang, R., Liu, Y., Zhang, Y., Jiang, N., Wang, T., Wang, J., and Xu, X. (2022). Association of oral health knowledge, self-efficacy and behaviours with oral health-related quality of life in Chinese primary school children: A cross-sectional study. BMJ Open., 12.","DOI":"10.1136\/bmjopen-2022-062170"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1207\/S15327027HC1203_01","article-title":"Closing the Knowledge-Behavior Gap in Health Promotion: The Mediating Role of Self-Efficacy","volume":"12","author":"Rimal","year":"2000","journal-title":"Health Commun."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/jphd.12648","article-title":"Training Protocol and Calibration of the International Caries Detection and Assessment System in a School-Based Clinical Trial of Elementary School-Age Children","volume":"85","author":"Yamal","year":"2024","journal-title":"J. Public Health Dent."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/513\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:03:43Z","timestamp":1760029423000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/513"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["ijerph22040513"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22040513","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]}}}