Spatial analysis of COVID-19 spread in Iran: Insights into geographical and structural transmission determinants at a province level

The Islamic Republic of Iran reported its first COVID-19 cases by 19^th February 2020, since then it has become one of the most affected countries, with more than 73,000 cases and 4,585 deaths to this date. Spatial modeling could be used to approach an understanding of structural and sociodemographic factors that have impacted COVID-19 spread at a province-level in Iran. Therefore, in the present paper, we developed a spatial statistical approach to describe how COVID-19 cases are spatially distributed and to identify significant spatial clusters of cases and how socioeconomic and climatic features of Iranian provinces might predict the number of cases. The analyses are applied to cumulative cases of the disease from February 19^th to March 18^th. They correspond to obtaining maps associated with quartiles for rates of COVID-19 cases smoothed through a Bayesian technique and relative risks, the calculation of global (Moran’s I) and local indicators of spatial autocorrelation (LISA), both univariate and bivariate, to derive significant clustering, and the fit of a multivariate spatial lag model considering a set of variables potentially affecting the presence of the disease. We identified a cluster of provinces with significantly higher rates of COVID-19 cases around Tehran (p-value< 0.05), indicating that the COVID-19 spread within Iran was spatially correlated. Urbanized, highly connected provinces with older population structures and higher average temperatures were the most susceptible to present a higher number of COVID-19 cases (p-value < 0.05). Interestingly, literacy is a factor that is associated with a decrease in the number of cases (p-value < 0.05), which might be directly related to health literacy and compliance with public health measures. These features indicate that social distancing, protecting older adults, and vulnerable populations, as well as promoting health literacy, might be useful to reduce SARS-CoV-2 spread in Iran. One limitation of our analysis is that the most updated information we found concerning socioeconomic and climatic features is not for 2020, or even for a same year, so that the obtained associations should be interpreted with caution. Our approach could be applied to model COVID-19 outbreaks in other countries with similar characteristics or in case of an upturn in COVID-19 within Iran.     

Challenges and Opportunities: What Can We Learn from Patients Living with Chronic Musculoskeletal Conditions,Health Professionals and Carers about the Concept of Health Literacy Using Qualitative Methods of Inquiry?

The field of health literacy continues to evolve and concern public health researchers and yet remains a largely overlooked concept elsewhere in the healthcare system. We conducted focus group discussions in England UK, about the concept of health literacy with older patients with chronic musculoskeletal conditions (mean age  = 73.4 years), carers and health professionals. Our research posed methodological, intellectual and practical challenges. Gaps in conceptualisation and expectations were revealed, reiterating deficiencies in predominant models for understanding health literacy and methodological shortcomings of using focus groups in qualitative research for this topic. Building on this unique insight into what the concept of health literacy meant to participants, we present analysis of our findings on factors perceived to foster and inhibit health literacy and on the issue of responsibility in health literacy. Patients saw health literacy as a result of an inconsistent interactive process and the implications as wide ranging; healthcare professionals had more heterogeneous views. All focus group discussants agreed that health literacy most benefited from good inter-personal communication and partnership. By proposing a needs-based approach to health literacy we offer an alternative way of conceptualising health literacy to help improve the health of older people with chronic conditions.     

Readability of the written study information in pediatric research in France

Background

The aim was to evaluate the readability of research information leaflets (RIL) for minors asked to participate in biomedical research studies and to assess the factors influencing this readability.

Methods and Findings

All the pediatric protocols from three French pediatric clinical research units were included (N = 104). Three criteria were used to evaluate readability: length of the text, Flesch''s readability score and presence of illustrations. We compared the readability of RIL to texts specifically written for children (school textbooks, school exams or extracts from literary works). We assessed the effect of protocol characteristics on readability. The RIL had a median length of 608 words [350 words, 25^th percentile; 1005 words, 75^th percentile], corresponding to two pages. The readability of the RIL, with a median Flesch score of 40 [30; 47], was much poorer than that of pediatric reference texts, with a Flesch score of 67 [60; 73]. A small proportion of RIL (13/91; 14%) were illustrated. The RIL were longer (p<0.001), more readable (p<0.001) and more likely to be illustrated (p<0.009) for industrial than for institutional sponsors.

Conclusion

Researchers should routinely compute the reading ease of study information sheets and make greater efforts to improve the readability of written documents for potential participants.     

Prevalence of Dental Caries and Fissure Sealants in a Portuguese Sample of Adolescents

Introduction

The aims of this study were to assess the prevalence of dental caries and the DMFT index, as well as the distribution pattern of pit and fissure sealants on permanent teeth in a Portuguese sample of adolescents, and to assess whether the existing usage of sealants and socio-demographic factors are correlated to caries prevalence on the examined sample.

Materials and Methods

A cross-sectional study was designed with a sample of 447 adolescents aged 12 to 18 years old, attending a public school in Sátão, Portugal. A self-administered questionnaire with questions about oral health behaviours and socio-economic status was answered by adolescents in the classroom. Clinical examination of oral health status and assessment of fissure sealants were accomplished by only one trained member of the research team.

Results

We obtained a DMFT index of 3.32 (2.92), which indicates a moderate level of prevalence of dental caries. When considering a DMFT = 0, we found significant statistical differences between the parents´ level of education (≤ 4^th grade = 26.3 vs 5^th–12^th grade = 18.8 vs <12^th grade = 43.3, p = 0.001), gender (male = 27.3 vs female = 19.6, p = 0.04), age (≤15 years = 27.1 vs <15 years = 18.5, p = 0.02), presence of fissure sealants (yes = 30.6 vs no = 13.5, p = 0.001) and experience of dental pain (no = 25.4 vs yes = 16.8, p = 0.02). When analyzing the prevalence of fissure sealants, we verified that 58.8% of adolescents had at least one fissure sealant applied. Significant statistical differences were found when analyzing the presence of fissure sealants related with parents´educational level (<9^th grade, OR = 1.56 CI95% = 1.05–2.54), gender (female, OR = 1.86 CI95% = 1.19–2.98), experience of dental pain (yes, OR = 0.62 CI95% = 0.39–0.97) and presence of dental caries (yes, OR = 0.35 CI95% = 0.19–0.65).

Conclusions

The moderate level of caries prevalence reveals the need of improvement of primary prevention interventions among Portuguese adolescents. The establishment of a more targeted preventive program with better and more effective oral health education is essential, having into account socio-demographic aspects.     

Modeling the Cost-Effectiveness of the Integrated Disease Surveillance and Response (IDSR) System: Meningitis in Burkina Faso

Background

Effective surveillance for infectious diseases is an essential component of public health. There are few studies estimating the cost-effectiveness of starting or improving disease surveillance. We present a cost-effectiveness analysis the Integrated Disease Surveillance and Response (IDSR) strategy in Africa.

Methodology/Principal Findings

To assess the impact of the IDSR in Africa, we used pre- and post- IDSR meningococcal meningitis surveillance data from Burkina Faso (1996–2002 and 2003–2007). IDSR implementation was correlated with a median reduction of 2 weeks to peak of outbreaks (25^th percentile 1 week; 75^th percentile 4 weeks). IDSR was also correlated with a reduction of 43 meningitis cases per 100,000 (25^th–40: 75^th-129). Assuming the correlations between reductions in time to peak of outbreaks and cases are related, the cost-effectiveness of IDSR was $23 per case averted (25^th-$30; 75^th - cost saving), and $98 per meningitis-related death averted (25^th-$140: 75^th – cost saving).

Conclusions/Significance

We cannot absolutely claim that the measured differences were due to IDSR. We believe, however, that it is reasonable to claim that IDSR can improve the cost-effectiveness of public health surveillance.     

Exploring Health Literacy in Medical University Students of Chongqing,China: A Cross-Sectional Study

Health literacy is important in public health and healthcare, particularly in effective communication between patients and health professionals. Although most medical students will eventually work as health professionals after graduation, research on health literacy of medical students is scarce. This study aimed to assess the health literacy level of medical students in Chongqing, China, and its influencing factors. A cross-sectional study was conducted and 1,275 participants (250 males and 1,022 females) who majored in five different disciplines were involved. The Health Literacy Questionnaire was used as the survey tool. The junior students obtained the highest scores, whereas the freshman students had the lowest scores on each scale. The average score of males was higher than that of females except in “feeling understood and supported by healthcare providers,” and the average score of students who reside in urban areas was higher than that of students in rural areas. Moreover, the average score of engineering students was higher than that of medical or health sciences students. Multiple linear regression models (R_adj² = 0.435, P = 0.000) showed that the grade, socioeconomic status, and parent’s highest level of education were positively correlated with health literacy. In conclusion, the health literacy levels of the medical students are insufficient and need improvement.     

Morbidity Patterns and Health Care Seeking Behavior among Older Widows in India

In the process of health transition, India is facing rapid pace of demographic aging. Rapid increase in older adult population posed serious concerns regarding health and health care utilization for them. However, very limited research documented resultant implications of demographic aging for health and health care use in the nexus of marital status and gender. With this perspective, the present study examined patterns in morbidity prevalence and health seeking behaviour among older widows in India. Multivariate logistic regression models were estimated to examine the effects of socio-demographic conditions on morbidity prevalence among older widows and their health care seeking behavior. Data from the latest 60^th round of National Sample Survey (NSS), 2004 was used. Overall, morbidity prevalence was 13% greater among older widows compared to older widowers. Adjusted prevalence of communicable and non-communicable diseases was found 74 and 192 per 1000 older widows respectively. At the same time, likelihood of seeking health care services for reported morbidities was substantially lower among older widows. The findings of this study are important to support policy makers and health care providers in identifying individuals ‘at risk’ and could be integrated into the current programs of social, economic and health security for the older persons.     

Language Lateralization in Children Aged 10 to 11 Years: A Combined fMRI and Dichotic Listening Study

Objective

The aims of this study were to develop and assess a method to map language networks in children with two auditory fMRI protocols in combination with a dichotic listening task (DL). The method is intended for pediatric patients prior to epilepsy surgery. To evaluate the potential clinical usefulness of the method we first wanted to assess data from a group of healthy children.

Methods

In a first step language test materials were developed, intended for subsequent implementation in fMRI protocols. An evaluation of this material was done in 30 children with typical development, 10 from the 1^st, 4^th and the 7^th grade, respectively. The language test material was then adapted and implemented in two fMRI protocols intended to target frontal and posterior language networks. In a second step language lateralization was assessed in 17 typical 10–11 year olds with fMRI and DL. To reach a conclusion about language lateralization, firstly, quantitative analyses of the index data from the two fMRI tasks and the index data from the DL task were done separately. In a second step a set of criteria were applied to these results to reach a conclusion about language lateralization. The steps of these analyses are described in detail.

Results

The behavioral assessment of the language test material showed that it was well suited for typical children. The results of the language lateralization assessments, based on fMRI data and DL data, showed that for 15 of the 17 subjects (88%) a conclusion could be reached about hemispheric language dominance. In 2 cases (12%) DL provided critical data.

Conclusions

The employment of DL combined with language mapping using fMRI for assessing hemispheric language dominance is novel and it was deemed valuable since it provided additional information compared to the results gained from each method individually.     

An Australian Based Study on the Readability of HIV/AIDS and Type 2 Diabetes Clinical Trial Informed Consent Documents

The aims of this study were to measure the readability of Australian based informed consent documents and determine whether informed consent readability guidelines have been established by Australian human research ethics committees (HRECs). A total of 20 informed consent documents, 10 HIV/AIDS and 10 type 2 diabetes, were measured for readability using the Simple Measure of Gobbledygook (SMOG) and Gunning Fog Index (Fog). Published guidelines and policy statements of the two local HREC who approved the 20 clinical trials under study where examined to identify whether they had any formal policies/guidelines on the readability of informed consent documents. The two HRECs were contacted via e-mail to also determine whether they utilised any informal readability standards or “rules of thumb” that may not have been mentioned in the published documents. The HIV/AIDS and type 2 diabetes informed consent documents were, on average, written at a grade 13 reading level. Formal readability standards had not been established by the two local HRECs, however, they did verify the use of informal rules for assessing readability of informed consent documents. Based on Australian literacy data, the majority of informed consent documents were written well beyond the reading ability of many Australians. Unreadable informed consent documents may result in patients rejecting trial participation altogether or conversely may result in their participating in a trial with inadequate consent. Therefore, a step toward reducing the complexity of informed consent documents may be to implement objective readability assessments into the human research ethics application and review process.     

The Characteristics of Chinese Orthographic Neighborhood Size Effect for Developing Readers

Orthographic neighborhood size (N size) effect in Chinese character naming has been studied in adults. In the present study, we aimed to explore the developmental characteristics of Chinese N size effect. One hundred and seventeen students (40 from the 3^rd grade with mean age of 9 years; 40 from the 5^th grade with mean age of 11 years; 37 from the 7^th grade with mean age of 13 years) were recruited in the study. A naming task of Chinese characters was adopted to elucidate N-size- effect development. Reaction times and error rates were recorded. Results showed that children in the 3^rd grade named characters from large neighborhoods faster than named those from small neighborhoods, revealing a facilitatory N size effect; the 5^th graders showed null N size effect; while the 7^th graders showed an inhibitory N size effect, with longer reaction times for the characters from large neighborhoods than for those from small neighborhoods. The change from facilitation to inhibition of neighborhood size effect across grades suggested the transition from broadly tuned to finely tuned lexical representation in reading development, and the possible inhibition from higher frequency neighbors for higher graders.     

Natives and Newcomers: Gaining Access to Literacy in a Classroom for Deaf Children

This article describes a residential school classroom for deaf third-graders. A critical school skill, the ability to engage in literacy activities, grows from the ability to exploit American Sign Language-based (ASL) literacy practices. These practices are indigenous to the culture of signing Deaf people and are critical for literacy learning when ASL is the medium of instruction.     

Irregular Bedtime and Nocturnal Cellular Phone Usage as Risk Factors for Being Involved in Bullying: A Cross-Sectional Survey of Japanese Adolescents

Purpose

A number of studies have tried to identify risk factors for being involved in bullying in order to help developing preventive measures; however, to our knowledge, no study has investigated the effect of nocturnal lifestyle behavior such as sleep pattern or cellular phone usage. In the present study, we aimed to investigate the relationship between school bullying and sleep pattern or nocturnal cellular phone usage in adolescents. The effect of school size on school bullying was also examined.

Methods

Data from the cross-sectional survey of psychopathologies conducted for 19,436 Japanese students from 45 public junior high schools (7^th–9^th grade) and 28 senior high schools (10^th–12^th grade) were analyzed.

Results

Bullying status was significantly associated with irregular bedtime (OR = 1.23 and 1.41 for pure bullies and bully-victims, respectively) and e-mail exchange or calling after lights-out (OR = 1.53 and 1.31 for pure bullies and bully-victims, respectively) after controlling domestic violence and substance usage. In addition, school size was significantly associated with the increased risk of bullying in junior high school students (OR = 1.13 for bully-victims).

Conclusions

The present results suggested that sleep pattern and nocturnal cellular phone usage might be risk factors for being involved in school bullying in adolescents. Although further accumulation of data is needed, progressive trend towards nocturnal lifestyle and increasing usage of cellular phone might impair the well-being of adolescents. School-based interventions for lifestyle including sleep pattern and cellular phone usage may be encouraged to reduce school bullying.     

Changes in Activities of Antioxidant Enzymes in Sunflower Leaves of Different Ages

Role of superoxide dismutase isozymes and other antioxidant enzymes was studied in relation to leaf age in sunflower (Helianthus annuus L. cv. ACC 1508) at pre-flowering and grain filling stages. Relative water content (RWC) did not change much in leaves of different age and at the two stages. Protein content declined continuously from the youngest to the oldest leaf, while chlorophyll (Chl) and carotenoids (Car) contents increased down to 7^th/9^th leaf and declined in subsequent older leaves. Protein, Chl and Car contents were higher at pre-flowering than at seed filling stage. Superoxide dismutase (SOD), its isozymes, and ascorbate peroxidase (APO) and catalase (CAT) activities were highest in the 9^th leaf and declined in subsequent older leaves. SOD and APO activities were higher at seed filling, except in oldest senescent (13^th, 15^th) leaves. Among SOD isozymes, Cu/Zn-SOD and Mn-SOD activities accounted for most of the total SOD, and only marginal activity was observed for Fe-SOD. Peroxidase activity increased from youngest to the oldest leaf at pre-flowering stage and down to 13^th leaf at seed filling stage. This revised version was published online in July 2006 with corrections to the Cover Date.     

Focus: Preventive Medicine: Leveraging Organizational Health Literacy to Enhance Health Promotion and Risk Prevention: A Narrative and Interpretive Literature Review

Organizational health literacy involves the health care organizations’ ability to establish an empowering and co-creating relationship with patients, engaging them in the design and delivery of health services in collaboration with health professionals. Although scholars agree that organizational health literacy contributes to health promotion and risk prevention via patient empowerment, literature is not consistent in depicting the interplay between organizational health literacy and preventive medicine. The article intends to shed light into this issue, summarizing current knowledge about this topic and advancing avenues for further development. A narrative literature review was performed through a systematic search on PubMed^®, Scopus^®, and Web of Science^™. The review focused on 50 relevant contributions. Organizational health literacy triggers the transition towards a patient-centered approach to care. It complements individual health literacy, enabling patients to actively participate in health promotion and risk prevention as co-producers of health services and co-creators of value. However, many obstacles – including lack of time and limited resources available – prevent the transition towards health literate health care organizations. Two initiatives are required to overcome extant barriers. On the one hand, a health literate workforce should be prepared to increase the institutional ability of health care organizations to empower and engage patients in health co-creation. On the other hand, increased efforts should be made to assess organizational health literacy and to make its contribution to preventive medicine explicit.     

Safety and risk assessment for the human superorganism

This editorial on safety evaluation and risk assessment for the human superorganism introduces a series of papers arguing for a fundamental shift in how we approach human health risk assessment. In this series emphasis is placed on the risk of infectious disease. Our 21^stst century understanding of human biology is that, as holobionts, we possess a majority of microbial cells and genes. In fact, our microbes fundamentally affect our interactions with the external environment, metabolism, physiology, and risk of both pathology and disease. As holobionts, we require our microbial partners for us to be both complete and healthy. Using the 20^th century understanding of human biology, we failed to capture the effects of the microbiome in evaluating health risks. But 21^st century risk assessments such as those associated with exposure to specific microbial pathogens need to include the human microbiome. Microbiome status will be central in determining the health risks for both individuals and populations.     

Gene Transfer into Older Chicken Embryos by ex ovo Electroporation

The chicken embryo provides an excellent model system for studying gene function and regulation during embryonic development. In ovo electroporation is a powerful method to over-express exogenous genes or down-regulate endogenous genes in vivo in chicken embryos¹. Different structures such as DNA plasmids encoding genes^2-4, small interfering RNA (siRNA) plasmids⁵, small synthetic RNA oligos⁶, and morpholino antisense oligonucleotides⁷ can be easily transfected into chicken embryos by electroporation. However, the application of in ovo electroporation is limited to embryos at early incubation stages (younger than stage HH20 - according to Hamburg and Hamilton)⁸ and there are some disadvantages for its application in embryos at later stages (older than stage HH22 - approximately 3.5 days of development). For example, the vitelline membrane at later stages is usually stuck to the shall membrane and opening a window in the shell causes rupture of the vessels, resulting in death of the embryos; older embryos are covered by vitelline and allantoic vessels, where it is difficult to access and manipulate the embryos; older embryos move vigorously and is difficult to control the orientation through a relatively small window in the shell.In this protocol we demonstrate an ex ovo electroporation method for gene transfer into chicken embryos at late stages (older than stage HH22). For ex ovo electroporation, embryos are cultured in Petri dishes⁹ and the vitelline and allantoic vessels are widely spread. Under these conditions, the older chicken embryos are easily accessed and manipulated. Therefore, this method overcomes the disadvantages of in ovo electroporation applied to the older chicken embryos. Using this method, plasmids can be easily transfected into different parts of the older chicken embryos^10-12.     

Promoting life skills and preventing tobacco use among low-income Mumbai youth: effects of Salaam Bombay Foundation intervention

Background

In response to India''s growing tobacco epidemic, strategies are needed to decrease tobacco use among Indian youth, particularly among those who are economically disadvantaged. The objective of this study was to assess the effectiveness of a school-based life-skills tobacco control program for youth of low socio-economic status in Mumbai and the surrounding state of Maharashtra. We hypothesized that compared to youth in control schools, youth exposed to the program would have greater knowledge of effects of tobacco use; be more likely to take action to prevent others from using tobacco; demonstrate more positive life skills and attitudes; and be less likely to report tobacco use.

Methods/Findings

Using a quasi-experimental design, we assessed program effectiveness by comparing 8^th and 9^th grade students in intervention schools to 8^th grade students in comparable schools that did not receive the program. Across all schools, 1851 students completed a survey that assessed core program components in early 2010. The program consisted of activities focused on building awareness about the hazards of tobacco, developing life skills, and advocacy development. The primary outcome measure was self-reported tobacco use in the last 30 days.Findings indicate that 4.1% of 8^th grade intervention students (OR = 0.51) and 3.6% of 9^th grade intervention students (OR = 0.33) reported using tobacco at least once in the last 30 days, compared to 8.7% of students in the control schools. Intervention group students were also significantly more knowledgeable about tobacco and related legislation, reported more efforts to prevent tobacco use among others, and reported stronger life skills and self-efficacy than students in control schools. Limitations to the study include schools not being randomly assigned to condition and tobacco use being measured by self-report.

Conclusions

This program represents an effective model of school-based tobacco use prevention that low-income schools in India and other low- and middle-income countries can replicate.     

Community-based knowledge transfer and exchange: Helping community-based organizations link research to action

Background

Community-based organizations (CBOs) are important stakeholders in health systems and are increasingly called upon to use research evidence to inform their advocacy, program planning, and service delivery efforts. CBOs increasingly turn to community-based research (CBR) given its participatory focus and emphasis on linking research to action. In order to further facilitate the use of research evidence by CBOs, we have developed a strategy for community-based knowledge transfer and exchange (KTE) that helps CBOs more effectively link research evidence to action. We developed the strategy by: outlining the primary characteristics of CBOs and why they are important stakeholders in health systems; describing the concepts and methods for CBR and for KTE; comparing the efforts of CBR to link research evidence to action to those discussed in the KTE literature; and using the comparison to develop a framework for community-based KTE that builds on both the strengths of CBR and existing KTE frameworks.

Discussion

We find that CBR is particularly effective at fostering a climate for using research evidence and producing research evidence relevant to CBOs through community participation. However, CBOs are not always as engaged in activities to link research evidence to action on a larger scale or to evaluate these efforts. Therefore, our strategy for community-based KTE focuses on: an expanded model of 'linkage and exchange' (i.e., producers and users of researchers engaging in a process of asking and answering questions together); a greater emphasis on both producing and disseminating systematic reviews that address topics of interest to CBOs; developing a large-scale evidence service consisting of both 'push' efforts and efforts to facilitate 'pull' that highlight actionable messages from community relevant systematic reviews in a user-friendly way; and rigorous evaluations of efforts for linking research evidence to action.

Summary

Through this type of strategy, use of research evidence for CBO advocacy, program planning, and service delivery efforts can be better facilitated and continually refined through ongoing evaluations of its impact.

     

Intersecting Cultures in Deaf Mental Health: An Ethnographic Study of NHS Professionals Diagnosing Autism in D/deaf Children

Autism assessments for children who are deaf are particularly complex for a number of reasons, including overlapping cultural and clinical factors. We capture this in an ethnographic study of National Health Service child and adolescent mental health services in the United Kingdom, drawing on theoretical perspectives from transcultural psychiatry, which help to understand these services as a cultural system. Our objective was to analyse how mental health services interact with Deaf culture, as a source of cultural-linguistic identity. We ground the study in the practices and perceptions of 16 professionals, who have conducted autism assessments for deaf children aged 0–18. We adopt a framework of intersectionality to capture the multiple, mutually enforcing factors involved in this diagnostic process. We observed that professionals working in specialist Deaf services, or with experience working with the Deaf community, had intersectional understandings of assessments: the ways in which cultural, linguistic, sensory, and social factors work together to produce diagnoses. Working with a diagnostic system that focuses heavily on ‘norms’ based on populations from a hearing culture was a key source of frustration for professionals. We conclude that recognising the intersectionality of mental health and Deaf culture helps professionals provide sensitive diagnoses that acknowledge the multiplicity of D/deaf experiences.     

Is Social Capital a Determinant of Oral Health among Older Adults? Findings from the English Longitudinal Study of Ageing

There are a number of studies linking social capital to oral health among older adults, although the evidence base mainly relies on cross-sectional study designs. The possibility of reverse causality is seldom discussed, even though oral health problems could potentially lead to lower social participation. Furthermore, few studies clearly distinguish between the effects of different dimensions of social capital on oral health. The objective of the study was to examine the longitudinal associations between individual social capital and oral health among older adults. We analyzed longitudinal data from the 3^rd and 5^th waves of the English Longitudinal Study of Ageing (ELSA). Structural social capital was operationalized using measures of social participation, and volunteering. Number of close ties and perceived emotional support comprised the functional dimension of social capital. Oral health measures were having no natural teeth (edentate vs. dentate), self-rated oral health and oral health-related quality of life. Time-lag and autoregressive models were used to explore the longitudinal associations between social capital and oral health. We imputed all missing data, using multivariate imputation by chained equations. We found evidence of bi-directional longitudinal associations between self-rated oral health, volunteering and functional social capital. Functional social capital was a strong predictor of change in oral health-related quality of life – the adjusted odds ratio of reporting poor oral health-related quality of life was 1.75 (1.33–2.30) for older adults with low vs. high social support. However in the reverse direction, poor oral health-related quality of life was not associated with changes in social capital. This suggests that oral health may not be a determinant of social capital. In conclusion, social capital may be a determinant of subjective oral health among older adults rather than edentulousness, despite many cross-sectional studies on the latter.