Abstract
OBJECTIVES: To examine the relationship between uncertainty stress and oral health-related quality of life (OHRQoL) among junior high school students in Zhejiang Province, China, and to identify the sociodemographic factors that may influence this association. DESIGN: Cross-sectional survey using multistage cluster sampling. SETTING: Junior high schools in two cities (Ningbo and Jinhua) in Zhejiang Province, China, between April and July 2024. PARTICIPANTS: 1348 eighth-grade students aged 13-16 years were included. INCLUSION CRITERIA: voluntary participation with guardian consent, absence of mental illness or physical disabilities and adequate literacy to complete questionnaires. EXCLUSION CRITERIA: intellectual disability or incomplete responses. OUTCOME MEASURES: OHRQoL was dichotomised based on the Child Perceptions Questionnaire for 11- to 14-year-olds (CPQ11-14) median score (≤20=good OHRQoL and >20=poor OHRQoL). Uncertainty stress was measured via a validated 5-point Likert scale (≤12=low and ≥13=high). RESULTS: High uncertainty stress was significantly associated with poor OHRQoL (χ²=41.34, p<0.001). Multivariable logistic regression adjusting for gender and maternal education showed students with high uncertainty stress had 4.7-fold increased odds of poor OHRQoL (adjusted OR (aOR)=4.72, 95% CI: 2.81 to 7.93, p<0.001). Female gender was independently associated with poor OHRQoL (aOR=1.30, 95% CI: 1.05 to 1.62, p<0.05). Higher maternal education had a protective association with a maternal bachelor's degree associated with 57% reduced odds of poor OHRQoL (aOR=0.43, 95% CI: 0.25 to 0.75, p<0.01). CONCLUSIONS: Junior high school students experiencing high uncertainty stress have a significantly increased risk of poor OHRQoL. Female students and those with less educated mothers were particularly vulnerable. School-based interventions should integrate psychological support with oral health promotion. Future longitudinal studies are needed to establish causal relationships.