Preadolescents and Their Mothers as Oral Health-Promoting Actors : Non-biologic Determinants of Oral Health among Turkish and Finnish Preadolescents

Is oral health becoming a part of the global health culture? Oral health seems to turn out to be part of the global health culture, according to the findings of a thesis-research, Institute of Dentistry, University of Helsinki. The thesis is entitled as “Preadolescents and Their Mothers as Oral Health-Promoting Actors: Non-biologic Determinants of Oral Health among Turkish and Finnish Preadolescents.” The research was supervised by Prof.Murtomaa and led by Dr.A.Basak Cinar. It was conducted as a cross-sectional study of 611 Turkish and 223 Finnish school preadolescents in Istanbul and Helsinki, from the fourth, fifth, and sixth grades, aged 10 to 12, based on self-administered and pre-tested health behavior questionnaires for them and their mothers as well as the youth’s oral health records. Clinically assessed dental status (DMFT) and self-reported oral health of Turkish preadolescents was significantly poorer than the Finns`. A similar association occurred for well-being measures (height and weight, self-esteem), but not for school performance. Turkish preadolescents were more dentally anxious and reported lower mean values of toothbrushing self-efficacy and dietary self-efficacy than did Finns. The Turks less frequently reported recommended oral health behaviors (twice daily or more toothbrushing, sweet consumption on 2 days or less/week, decreased between-meal sweet consumption) than did the Finns. Turkish mothers reported less frequently dental health as being above average and recommended oral health behaviors as well as regular dental visits. Their mean values for dental anxiety was higher and self-efficacy on implementation of twice-daily toothbrushing were lower than those of the Finnish. Despite these differences between the Turks and Finns, the associations found in common for all preadolescents, regardless of cultural differences and different oral health care systems, assessed for the first time in a holistic framework, were as follows: There seems to be interrelation between oral health and general-well being (body height-weight measures, school performance, and self-esteem) among preadolescents: • The body height was an explanatory factor for dental health, underlining the possible common life-course factors for dental health and general well-being. • Better school performance, high levels of self-esteem and self-efficacy were interrelated and they contributed to good oral health. • Good school performance was a common predictor for twice-daily toothbrushing. Self-efficacy and maternal modelling have significant role for maintenance and improvement of both oral- and general health- related behaviors. In addition, there is need for integration of self-efficacy based approaches to promote better oral health. • All preadolescents with high levels of self-efficacy were more likely to report more frequent twice-daily toothbrushing and less frequent sweet consumption. • All preadolescents were likely to imitate toothbrushing and sweet consumption behaviors of their mothers. • High levels of self-efficacy contributed to low dental anxiety in various patterns in both groups. As a conclusion: • Many health-detrimental behaviors arise from the school age years and are unlikely to change later. Schools have powerful influences on children’s development and well-being. Therefore, oral health promotion in schools should be integrated into general health promotion, school curricula, and other activities. • Health promotion messages should be reinforced in schools, enabling children and their families to develop lifelong sustainable positive health-related skills (self-esteem, self-efficacy) and behaviors. • Placing more emphasis on behavioral sciences, preventive approaches, and community-based education during undergraduate studies should encourage social responsibility and health-promoting roles among dentists. Attempts to increase general well-being and to reduce oral health inequalities among preadolescents will remain unsuccessful if the individual factors, as well as maternal and societal influences, are not considered by psycho-social holistic approaches.

Perhetaustan ja sukupuolen yhteys koulunkäyntiin

Finnish education policy has aimed at providing equal educational pathways that level educational opportunities and aims at the equity of participation. Combined with the Finnish welfare state it has succeeded in sustaining social mobility. Yet the adolescents do not necessarily have equal possibilities to achieve these educational positions. Socio-economic differences in Finland are persistent and both education and poverty are still partly inherited. This thesis concentrated on prevailing socio-economic differences on school attendance and on studying the associations between family backgrounds, gender and school attendance. The key question for this thesis was formulated as: What kind of differences in school attendance there can be found among 9th graders from Helsinki according to their family background and their gender? The core data was a school-based survey carried on in Helsinki in 2004. There were two thirds of the schools of Helsinki and 2381 respondents. The questionnaire included questions on young people s school-related experiences, school attendance, school performance and their family. The analysis had three steps: after describing the respondents the associations between school attendance and family background were analyzed using MCA (Multiple Classification Analysis). Finally the associations between school attendance, family and school environment were studied using logistic regression analysis. The results showed that schooling (school attendance) was a variety of attitudes and experiences. The analysis showed also that all the family background factors had an effect on school attendance. From the family background measurements, it seems that the perceived parental support varied most with school attendance. Apart from the school environment factors, each family-related factor is statistically significantly related to two or more school attendance factors, even when adjusted with the school environment factors. There was also a gender-related difference in school attendance. Girls seem to like school attendance more than boys; they do better at school, but are also more worried about school work. Especially the expected associations with the parental educational level, but also with perceived parental support, gender and school attendance, are important results. When they are combined with the support pupils get from firm family structure and employment status it is possible to point out some factors that are relevant when discussing the ways educational achievements are moved to next generations in good and worse.

Mielikuvat transformatiivisen oppimisen välineenä : Tutkimus mielikuvaoppimisesta luontevan esiintymistavan löytämiseksi

The research focus of this study is imagery-based learning aimed at discovering an authentic way of public speaking in the context of transformative learning. The experiences of the participants in this learning process were also a subject of study. This learning process consisted of both guided and independent imagery-based training techniques. Critical reflection plays an important role in transformative learning. Actions, and interpretations and assumptions guiding them, are recognised and subjected to critical reflection. The goal of the learning process is an authentic and wide meaning perspective. Imagery-based training benefits from the gap between the new and the old experience of public speaking, and this is utilised as an activating factor for learning. The study is qualitative, looking at the imagery learning process and its outcomes from the subjective viewpoint of the participants personal experience. The imagery training acted as an intervention in the process of learning authentic public performance. The number of participants in this study was ten, five men and five women from four different working backgrounds. There were 80 individual training sessions, each attended by one person. The author conducted the imagery-based training. For each participant the learning process took roughly nine months. The research data consisted in the answers to questions in writing, diary entries, interviews and researcher notes. The data gathered by these methods was compiled into a personal report for each participant. The learners perceived authentic public speaking performance at the end of the learning process as wider, more flexible and more genuine than at the start of the training. Authenticity was defined through an internal process of becoming aware instead of some external characteristics. The learners understood the process of imagery learning as training for public performance and as an opportunity to become familiar with one s own personal way of acting and with one s own attitudes. They also perceived it as a tool that enabled the observation of personal experiences from different points of view. The learners reflected on ways of acting related to public speaking as well as on contributing factors to performance anxiety during the imagery learning process. Towards the end of the learning process, even critical reflection took place. The learners were categorized into three groups according to differences in their learning processes: the participants, the actors and the critical reflectors. This grouping reflected the relative amount of transformation in their learning processes. The participants became aware of their actions and assumptions. They took part in guided training sessions only. Worries in private life also had some consequences to their training in imagery learning. Apart from than becoming more conscious, the learning process did not yield much difference to the public speaking experiences of the participants. The actors attended both guided imagery training sessions and did individual training on their own. They became aware of their assumptions and their ways of acting. The encounter of the new and the old way of acting stimulated their learning. The actors advanced towards their own goals or even achieved them. The critical reflectors recognised their own assumptions and ways of acting and started to reflect critically on their own attitudes, as well as external attitudes and interpretations. Their assumptions, interpretations and experiences of public performance started to change in a positive direction. The learning process of the critical reflectors was functioning as a transformative process. This learning process revealed old assumptions hindering learning and old ways of acting resulting from these assumptions, thus opening up an opportunity for critical reflection and transformation. Avainsanat Nyckelord imagery learning, imagery-based training, transformative learning, reflection, critical reflection, public speaking anxiety, authentic public performance

Koulukasvatusta teknologisoituvaan yhteiskuntaan : Kansakoulun opetussuunnitelman rakentuminen, 1945-1952

Education for a Technological Society. Public School Curriculum Construction, 1945-1952. The subject of my research is the significance of technology in the construction process of the public school curriculum during the years 1945-1952. During the period the war reparation and rebuilding placed demands and actions to rationalise and dramatise industry and agriculture. Thereby the ambitions of building a technological country and the reformation of curriculum took place simultaneously. Fordistian terms of reference, of which the principles were mass production, rationalisation and standardisation, a hierarchical division of labour and partition of assignments, provided a model for the developing curriculum. In the research the curriculum is examined as an artefact, which shapes socio-technically under the influence of social and technical factors. In the perspective of socio-technical construction the artefact is represented by the viewpoints of members of relevant social groups. The groups give meaning to the curriculum artefact, which determines the components of the curriculum. The weakness of the curriculum was its ineffectiveness, which was due to three critical problems. Firstly, the curriculum was to be based on scientific work, which meant the development of schools through experiments and scientific research. Secondly, the civilised conseption in the curriculum was to be composed of theoretical knowledge, as well as practical skills. Practical education was useful for both the individual and society. Thirdly, the curriculum was to be reformed in a way that the individuality of the pupil would be taken into account. It was useful for the society that talents and natural abilities of every pupil were observed and used to direct the pupil to the proper place in the social division of labour, according to the "right man in a right place" principle. The solutions to critical problems formed the instructions of the public school curriculum, which described the nature and content of education. Technology and its development were on essential part of the whole school curriculum process. The quality words connected to the development of technology - progress, rationality and effectiveness - were also suitable qualifiers and reasons for the reform of the curriculum. On the other hand, technology set a point of comparison and demand for the development of all phases of education. The view of technology was not clearly deterministic - it was also possible to shape technological society with the help of education. The public school curriculum process indicates how originally the principles of technological systems were shaped to the language of education and accepted in educational content.

Onko oppimistulokset valettu betoniin? : Tutkimus Helsingin kaupunkirakenteen ja peruskoulujen oppimistulosten välisestä yhteydestä ja kouluvalintojen vaikutuksista

The aim of this study is to find out how urban segregation is connected to the differentiation in educational outcomes in public schools. The connection between urban structure and educational outcomes is studied on both the primary and secondary school level. The secondary purpose of this study is to find out whether the free school choice policy introduced in the mid-1990´s has an effect on the educational outcomes in secondary schools or on the observed relationship between the urban structure and educational outcomes. The study is quantitative in nature, and the most important method used is statistical regression analysis. The educational outcome data ranging the years from 1999 to 2002 has been provided by the Finnish National Board of Education, and the data containing variables describing the social and physical structure of Helsinki has been provided by Statistics Finland and City of Helsinki Urban Facts. The central observation is that there is a clear connection between urban segregation and differences in educational outcomes in public schools. With variables describing urban structure, it is possible to statistically explain up to 70 % of the variation in educational outcomes in the primary schools and 60 % of the variation in educational oucomes in the secondary schools. The most significant variables in relation to low educational outcomes in Helsinki are abundance of public housing, low educational status of the adult population and high numbers of immigrants in the school's catchment area. The regression model has been constructed using these variables. The lower coefficient of determination in the educational outcomes of secondary schools is mostly due to the effects of secondary school choice. Studying the public school market revealed that students selecting a secondary school outside their local catchment area cause an increase in the variation of the educational outcomes between secondary schools. When the number of students selecting a school outside their local catchment area is taken into account in the regressional model, it is possible to explain up to 80 % of the variation in educational outcomes in the secondary schools in Helsinki.