Trends in Oral Health Behaviors Among Korean Adolescents(2005?2024): A Joinpoint Regression Analysis = 조인포인트 회귀분석을 이용한 한국 청소년의 구강보건행태 추이(2005-2024)

다국어 초록 (Multilingual Abstract)

This study aimed to identify trends in South Korean adolescents’ oral health behavior over the past 20 years and analyze their relevance with major policies and social phenomena that affected these changes with a view to providing basic data for establishing future oral health policies for adolescents. In particular, attention was paid to the relevance with oral health, dietary life, smoking/drinking cessation, school health education policies, and the social phenomenon of coronavirus disease-19 (hereinafter referred to as COVID-19). The subjects of the study were adolescents aged 12 to 18 from the Korea Youth Health Behavior Survey (KYHBS) from 2005 to 2024 and the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2023. A total of 34 oral health indicators including 9 oral health indicators, 6 dietary life indicators, and 6 smoking and drinking indicators from the KYHBS, and 13 oral health indicators from the KNHANES were used in the analysis. Statistical analysis was performed using SAS (Version 9.4; SAS Institute Inc., Cary, NC, USA), Joinpoint Regression Program (Version 4.8.0.1), and R (Version 4.2.3). According to the results of this study, the proportions of annual tooth pain experience, annual gum bleeding experience, and annual bad breath experience decreased overall, but some indicators showed a tendency to increase again recently. The proportion of tooth brushing after lunch at school decreased sharply before and after the outbreak of COVID-19 and then recovered again, while the proportions of annual oral health education experience, annual dental scaling experience, and preventive dental care use continued to increase. The proportions of annual fluoride application experience and annual sealant experience repeatedly increased and decreased over time.
Regarding dietary behavior, the proportion of fruit consumption and vegetable consumption initially increased, but then decreased overall, and in particular, the proportion of vegetable consumption recently decreased sharply. The proportion of snack consumption decreased for some time, but has recently increased again, and the proportion of fast food consumption has shown a continuous increase. The proportions of sugar-sweetened beverages consumption and carbonated beverage consumption temporarily decreased and then increased again, indicating that adolescents’ sugar consumption behavior is worsening.
Regarding smoking and drinking behavior, the proportions of current regular cigarette smoking and current drinking have steadily decreased, while the proportions of current e-cigarette use and combined cigarette and e-cigarette use have recently increased again. The proportion of quitting attempts among current smokers remained stagnant, while the proportion of annual smoking prevention and cessation education experience continued to increase. The related proportions of experience significantly increased after the implementation of the fluoride application and sealant policy, and oral health education and the use of auxiliary oral hygiene products also improved overall.
According to the result of the analysis of oral health behaviors after policy implementation, the policies for healthy food stores in schools, banning the sale of high-calorie and low-nutrition foods, and restricting TV advertising had a positive effect on some dietary life behaviors, but the proportions of fast food consumption and carbonated beverage consumption increased on the contrary. In the case of the smoking cessation policy, cigarette price increase, the introduction of health warning graphics and texts on cigarette packs, and the No Tobacco campaign were effective in reducing the proportion of current regular cigarette smoking, but the proportion of current e-cigarette use increased on the contrary. The proportion of current drinking decreased after the restrictions on alcoholic beverage advertising broadcast time and the implementation of drinking prevention education.
After the outbreak of COVID-19, the proportions of tooth pain experience, gum bleeding experience, and tooth fracture due to exercise or accident decreased, while the proportions of annual dental scaling experience and dental clinic use increased. The proportions of fruit and vegetable consumption decreased, but the proportions of fast food, sugar-sweetened beverages, and carbonated beverage consumption increased significantly. The proportion of current regular cigarette smoking decreased, the proportions of current e-cigarette use and combined cigarette and e-cigarette use increased, while that of quitting attempts among current smokers decreased.
Therefore, in summary, South Korean adolescents’ oral health behavior has shown generally positive changes over the past 20 years. The proportions of annual major oral symptom experience, current regular cigarette smoking, and current drinking have steadily decreased, while the proportions of annual oral health education experience and preventive dental care use have steadily increased. However, since the outbreak of COVID-19, the proportions of fruit consumption, vegetable consumption, and tooth brushing after lunch at school have decreased, while the proportions of fast food consumption, sugar-sweetened beverages consumption, carbonated beverage consumption, and current e-cigarette use have increased, a worrisome result because some behaviors were worsened.
In terms of policies, cigarette price increase, the introduction of health warning graphics and texts on cigarette packs, and the No Tobacco campaign were effective in reducing the proportion of current regular cigarette smoking, while restrictions on alcoholic beverage advertising broadcasting time and drinking prevention education contributed to reducing the proportion of drinking among adolescents. In addition, putting sealants under health insurance coverage, fluoride application projects, oral health education and promotion projects, banning the sales of high-calorie and low-nutrition foods, restrictions on TV advertising, and school health education policies have had a positive effect on improving adolescents’ oral health behavior. However, the phenomenon that the proportions of fast food consumption and carbonated beverage consumption are increasing even after the implementation of some policies suggests that continuous inspection and intervention are necessary to secure the effectiveness of the policies and supplement the policies.

국문 초록 (Abstract)

본 연구는 우리나라 청소년의 구강보건행태에 대한 지난 20년간의 추이를 파악하고, 이러한 변화에 영향을 미친 주요 정책 및 사회적 현상과의 관련성을 분석하여 향후 청소년 구강보건정책 수립을 위한 기초자료를 제공하는 것을 목적으로 하였다. 특히 구강보건, 식생활, 금연·금주, 학교보건교육 정책 및 사회적 현상인 코로나바이러스감염증-19(이하 코로나19)와의 관련성에 주목하였다.
연구대상은 2005년부터 2024년까지 청소년건강행태조사(Korea Youth Health Behavior Survey, KYHBS)와, 2007년부터 2023년까지 국민건강영양조사(Korea National Health and Nutrition Examination Survey, KNHANES)의 만 12세에서 18세 청소년이었다.
분석에 활용된 구강건강지표는 총 34개로, 청소년건강행태조사에서는 구강건강 9개 지표, 식생활 6개 지표, 흡연 및 음주 6개 지표를 포함하였고, 국민건강영양조사에서는 구강건강 13개 지표를 활용하였다. 통계분석은 SAS(Version 9.4; SAS Institute Inc., Cary, NC, USA), Joinpoint Regression Program(Version 4.8.0.1), R(Version 4.2.3)을 이용하였다.
연구결과, 구강증상 경험의 치아통증, 잇몸출혈, 구취 경험률 등은 전반적으로 감소하였으나, 최근 들어 일부 지표는 다시 증가하는 경향을 보였다. 코로나19 발생 전후로 학교에서 점심식사 후 칫솔질 실천율은 급감한 후 다시 회복세를 보였고, 구강보건교육 및 스케일링, 예방치료 이용률은 지속적으로 증가하였다. 불소도포와 실란트 경험률은 시기에 따라 증감을 반복하였다.
식생활행태는 과일과 채소 섭취율이 초기에는 증가하였으나 이후 전반적으로 감소하였으며, 특히 최근 채소 섭취율은 급격히 하락하였다. 과자 섭취율은 한때 감소하였으나 최근 다시 증가하고 있으며, 패스트푸드 섭취율은 지속적인 증가 추세를 보였다. 단맛음료 및 탄산음료 섭취율은 일시적 감소 이후 재증가하면서 청소년의 당류 섭취행태는 악화되고 있다.
흡연 및 음주 행태에서는 일반담배 사용률과 현재 음주율이 꾸준히 감소한 반면, 전자담배와 복합 사용률(일반담배와 전자담배 동시사용)은 최근 다시 증가세를 보였다. 금연 시도율은 정체된 반면, 흡연예방 및 금연교육 경험률은 지속적으로 상승하였다. 불소도포 및 실란트 정책 시행 이후 관련 경험률은 유의하게 증가하였고, 구강보건교육과 보조구강위생용품 사용도 전반적으로 향상되었다.
정책 시행에 따른 분석 결과, 학교 내 건강식품 판매점(건강매점), 고열량·저영양 식품 판매금지, TV 광고제한 정책 등은 일부 식생활행태에 긍정적인 영향을 주었으나, 패스트푸드 및 탄산음료 섭취율은 오히려 증가하기도 하였다. 금연정책의 경우, 담배가격 인상, 담뱃갑 건강경고 그림·문구 도입, 노담(No 담배) 캠페인은 일반담배 흡연율 감소에 효과가 있었으나, 전자담배 사용률은 오히려 증가하였다. 현재 음주율은 주류광고 방송시간 제한 및 음주 예방교육 시행 이후 감소하였다.
코로나19 발생 이후에는 치아통증, 잇몸출혈, 치아파절 경험률이 감소하였고, 스케일링 및 치과 이용률은 증가하였다. 과일·채소 섭취율은 감소하였으나 패스트푸드와 단맛음료, 탄산음료 섭취율은 뚜렷하게 증가하였다. 일반담배 흡연율은 감소하였고, 전자담배와 복합 사용률(일반담배와 전자담배 동시사용)은 증가하였으며, 금연 시도율은 오히려 감소하였다.
따라서 본 연구 결과를 종합해 보면, 지난 20년간 우리나라 청소년의 구강보건행태는 전반적으로 긍정적인 변화 양상을 보였다. 주요 구강증상 경험률, 일반담배 흡연율, 현재 음주율은 꾸준히 감소하였으며, 구강보건교육 경험과 예방치료 이용률은 지속적으로 증가하였다. 그러나 코로나19 발생 이후 과일·채소 섭취율과 학교에서 점심식사 후 칫솔질 실천율은 감소하고, 패스트푸드·단맛음료·탄산음료 섭취율 및 전자담배 사용률은 증가하는 등 일부 행태의 악화는 우려되는 결과이다.
정책적 측면에서는 담배가격 인상, 담뱃갑 건강경고 그림·문구 도입, 노담(No 담배)캠페인이 일반담배 흡연율 감소에 효과적이었고, 주류광고 방송시간 제한과 음주예방교육이 청소년 음주율 저감에 기여하였다. 또한 실란트 건강보험 급여화, 불소도포사업, 구강보건교육 및 홍보사업, 고열량·저영양 식품 판매금지 및 TV 광고제한, 학교보건교육 정책 등은 청소년의 구강보건행태 개선에 긍정적인 영향을 미쳤다. 그러나 일부 정책 시행 이후에도 패스트푸드 및 탄산음료 섭취율이 증가하는 현상은 정책의 실효성 확보와 보완을 위한 지속적인 점검과 개입이 필요함을 시사한다.

목차 (Table of Contents)

• LIST OF FIGURES
• LIST OF TABLES
• ABSTRACT IN ENGLISH
• 1. INTRODUCTION
• 1.1 Research background
• 1.2 Purpose of the Study
• 1.3 Theoretical Background
• 1.3.1 Oral Health Projects in South Korea
• 1.3.2 South Korea's Dietary Life Policy
• 1.3.3 Antismoking Policies in South Korea
• 1.3.4 South Korea's Antidrinking Policy
• 1.3.5 School Health Education in South Korea
• 1.3.6 Coronavirus Disease (COVID-19) in South Korea
• 2. METHOD
• 2.1 Research Design
• 2.2 Research subjects
• 2.3 Definitions of terms and indicators
• 2.3.1 Definition of Adolescents
• 2.3.2 Definition of Oral Health Behavior
• 2.3.3 Definition of Oral Health Behavior Indicators
• 2.4 Analysis Variables
• 2.4.1 Independent Variables
• 2.4.2 Dependent variables
• 2.4.3 Control variables
• 2.5 Data Analysis
• 2.5.1 Tuning and Age-standardized rate
• 2.5.2 Weight analysis
• 2.5.3 Statistical analysis
• 3. RESULT
• 3.1 Trends of oral health behavior of South Korean adolescents
• 3.2 Trend of South Korean adolescents’ dietary life
• 3.3 Trend of South Korean adolescents’ smoking and drinking behavior
• 3.4 Changes in South Korean adolescents’ oral health behavior according to whether the oral health projects and policies are implemented or not
• 3.5 Changes in South Korean adolescents’ dietary life behavior according to whether the dietary life projects and policies are implemented or not
• 3.6 Changes in South Korean adolescents’ smoking behavior according to whether smoking cessation projects and policies are implemented or not
• 3.7 Changes in South Korean adolescents’ drinking behavior according to whether drinking cessation projects and policies are implemented or not
• 3.8 Changes in South Korean adolescents’ dietary life, smoking, and drinking behaviors according to whether school health education policies are implemented or not
• 3.9 Changes in South Korean adolescents’ oral health behaviors according to whether COVID-19 occurred or not
• 3.10 Changes in South Korean adolescents’ dietary life behavior according to whether COVID-19 occurred or not
• 3.11 Changes in South Korean adolescents’ smoking and drinking behaviors according to whether COVID-19 occurred or not
• 4. DISCUSSION
• 5. CONCLUSION
• REFERENCES
• APPENDICES1
• ABSTRACT IN KOREAN