The protective role of sense of community and access to resources on college student stress and COVID‐19‐related daily life disruptions

Abstract The aim of our study was to understand more about how college students have been impacted by the pandemic and how their universities can better support them by emphasizing protective factors that build resilience. The protective factors we explored were sense of community, perceived adequacy of resources, and perceived social support.We conducted an online survey, which was administered to 296 (70.4% female and Mage = 20.34) students from a private Northeastern University in the United States. There were gender and class year differences found after analysis. In addition, sense of community and perceived adequacy were found to be statistically significant. There were gender and class year differences found after analysis. In addition, sense of community and perceived adequacy were found to be statistically significant. Overall, our findings highlight the importance of sense of community and access to resources as protective factors in mitigating stress and coronavirus disease 2019‐related disruptions to daily life among college students, particularly for female students who report more adverse outcomes.

by Charles et al. (2021), evaluated the effects of COVID-19 disruptions on college students. Participants were divided into two groups and were compared on their stress and anxiety levels pre-COVID-19 and during the current pandemic. Measures assessing perceived stress, coping, and psychological symptoms were collected from a group of 240 students in Fall 2019 before the COVID-19 pandemic as a part of a more extensive study on health risks.
A second group of 148 students also completed the same measures in the Spring and Fall of 2020 after the pandemic had begun. Participants who completed the measures during the pandemic reported higher levels of perceived stress, mood disorder symptoms, and alcohol use compared to students who completed the measures before the start of the COVID-19 pandemic. The research seems to suggest that the COVID-19 pandemic has intensified the stress levels of college students and therefore poses a threat to their physical and mental well-being, as well as their education (Khan et al., 2020;Son et al., 2020).
Despite all these disruptions and outcomes, there are certain protective factors that can serve as buffers against the negative consequences of the COVID-19 pandemic. Protective factors are positive variables that negate the effects of risk factors and thus safeguard against negative outcomes (Loukas et al., 2006). Protective factors are referred to as protective because they abate the harmful effects of risks that predict behavioral health outcomes (Zimmerman, 2013). Protective factors are advantageous in that they could prevent the impact of adverse behavioral outcomes that result due to being exposed to risk factors, giving opportunity for the individual's personal development (Mosavel et al., 2015). Protective factors can be found in parental support, peer support, social connectedness, one's belief, and faith, along with so many other variables (S. Sharma et al., 2019;Zimmerman, 2013). For some students, engaging with peers in school was a protective factor against negative outcomes (V. Sharma et al., 2020); however, due to the pandemic, this was disrupted, leaving students with one less factor to mitigate against the negative consequences of COVID-19. This study examined three positive variables that have been shown to be effective protective factors: sense of community (SOC), access to resources, and social support.

| Sense of community
SOC is as: a feeling that members have of belonging, a feeling that members matter to one another and to the group, and a shared faith that member needs will be met by their commitment to be together. (McMillan & Chavis, 1986, p. 9) McMillan and Chavis (1986) proposed four elements to support this definition: Membership, influence, integration and fulfillment of needs, and shared emotional connection. Membership refers to the feeling of having invested oneself in a group as a member and therefore having a sense of belongingness. Influence denotes a sense of mattering, of being able to impact a group and the group likewise shaping its members. The third element, integration and fulfillment of needs, is the feeling that the members' needs would be met through or by the group.
Lastly, shared emotional connections refer to the shared history, shared traditions, and shared experiences that members have or will have (McMillan & Chavis, 1986). Hobfoll et al. (2002, as cited in Greenfield & Marks, 2010 proposed that having a strong SOC might protect against some of the long-term consequences of adverse childhood experiences. Individuals who build strong bonds with their community might develop a sense of empowerment and resilience as they view themselves as part of an interconnected social network. A strong SOC has been found to promote positive mental health in adults regardless of whether they have experienced negative events or not (Greenfield & Marks, 2010). Studies have shown that SOC aids in building resilience among individuals who have experienced childhood trauma (Banyard & Williams, 2007;Thomas & Hall, 2008;Valentine & Feinauer, 1993). This variable has also been found to build resilience in military veterans who have returned from combat zones and have difficulties adjusting to their new environments (Thomas & Bowie, 2016;Wombacher et al., 2010). SOC has likewise been found to improve the health of individuals in the workplace as it reduces stress due to work demands and strengthens the workers coping ability (Klein & D'Aunno, 1986).
Among college students, SOC has been shown to be a positive predictor of student persistence (Jacobs & Archie, 2008). In their study on the psychological SOC and college student burnout, McCarthy et al. (1990) found that SOC was significantly and negatively related to psychological symptoms resulting from burnout. McNally et al.
(2021) studied college students' grief, and found that SOC, especially the dimensions of integration and fulfillment of needs and shared emotional connection, served as a protective factor in helping the students deal positively with their grief and the negative outcomes associated with grief. The present study explores if SOC might also be a protective factor for college students during the pandemic.

| Access to resources
One of the many things the COVID-19 pandemic has affected is resources and the ability to access them (Núñez et al., 2021). There is limited access to healthcare, inadequate financial resources, and a strain on social and community resources. The availability of resources is significant as it promotes positive outcomes (CDC, 2018).
Access to resources has been shown to promote positive adaptation and diminish negative mental health outcomes among individuals and communities who have experienced disasters, whether man-made or natural (Zakour, 2019).
Individuals and communities who had access to resources were less anxious and more prepared for a disaster, thereby reducing the negative consequences of such events (Abramson et al., 2014;Mishra & Suar, 2011). This variable has been found to also be effective among Latino day laborers who experienced psychological distress due to racial discrimination. Workers who had access to cultural and community resources were less stressed, as having those resources mitigated the effects of discrimination (Organista & Ngo, 2019).
Perceived adequacy of resources has also been significantly related to individual well-being (Dunst et al., 1988).
In particular, access to mental health and community resources is essential in reducing the risks of mental health problems and promoting overall well-being in vulnerable populations (Williams & Rheingold, 2014). College students are considered a vulnerable population as they are at risk for poor outcomes and negative health consequences due to their developmental stage, sociocultural status, and other factors (Balon et al., 2015;Ponsford, 2016). Therefore, the ability to access resources that would help them negate the effects of the current pandemic is imperative. For example, students with adequate financial resources are more resilient and more likely to develop positive personal qualities such as hope and positive affect than students with inadequate financial resources (Karairmak & Sivis, 2011). The present study will explore if perceived access to resources impacts students' stress and daily life disruptions and if access to certain types of resources have more of an impact than access to others.

| Social support
Social support is essential in preserving physical and mental health; research has shown that in high quantities, this factor protects against stress and enhances well-being (Ozbay et al., 2007). Social support can be classified into perceived or received types. Perceived support refers to an individual's potential access to social support, whereas received social support refers to the actual receipt of support (Samuel & Burger, 2020). This study focuses on the former variable and only investigates for perceived support. A study of Chinese adolescents on the effect of social support on mental health during the COVID-19 pandemic revealed that adolescents with high levels of social support reported fewer depressive and anxiety symptoms (Qi et al., 2020). In addition, Asians and Asian Americans who faced discrimination due to the COVID-19 outbreak and its alleged origin reported that social support served BENSON AND WHITSON | 2749 as a buffer that helped mitigate the negative effects of racial discrimination (Lee & Waters, 2020). Another study (Yu et al., 2020) found that increased social support significantly correlated with a reduction in psychological distress during the pandemic, thereby highlighting the relevance of social support during times such as these. For college students, previous research has found that having high levels of social support has a positive effect on their well-being and predicts academic success (Tinajero et al., 2019). The present study explored if these protective effects of perceived social support were apparent for a sample of college students during the pandemic.

| PRESENT STUDY
Based on the above research, the present study explored if these protective factors-SOC, access to resources, and social support-impact COVID-19-related disruptions to daily life and perceived stress among college students. We were also interested in examining the potential moderating role of gender, ethnicity, class year, and student status (residential or commuter) variables. There is evidence that the COVID-19 pandemic has disproportionately affected some racial and minority groups. Social inequities such as poverty, lack of access to healthcare, and discrimination affect these groups, thereby predisposing them to risks and negative health outcomes (CDC, 2020). The study explored if these differences were relevant to the COVID-19-related-stress and disruptions to daily life in college students at a private Northeastern university in the United States. The findings of this study can help identify protective factors for coping with the COVID-19 pandemic, which would be used to inform intervention strategies and programs aimed at college students during this pandemic, as well as larger university policies and procedures.
We expected that SOC, access to resources, and social support would serve as a buffer to COVID-19-relatedstress and disruptions to the daily lives of college students. The following hypotheses were explored: 1. Greater perceived access to resources will be negatively correlated with perceived stress levels and COVID-19related daily life disruptions.

2.
A stronger SOC to the university will be negatively related to perceived stress and COVID-19-related disruptions to daily life.
3. Increased level of perceived social support will be negatively related to perceived stress and COVID-19-related disruptions to daily life.
4. Demographic variables such as gender, ethnicity, class year, and residential status would also have an influence on college students' perceived stress and COVID-19-related daily life disruptions, even when the predictor variables are included in the models.

| Participants
The target population for this study was college students in a small private school in the Northeastern United States. Participants were recruited through school emails and the Intro to Psychology participant pool. The survey was created through Qualtrics, and a link for the survey was generated and emailed to students through Graduate Students Services, Recognized Student Organizations, and the Psychology Department. As an incentive to participate in the study, participants were given the opportunity to provide their email addresses to be entered into a drawing for a chance to win a $100 gift card of their choice. First-year students taking the PSYC 1111/1112 course were offered course credit for participating in the study. The final sample of the study included 296 college students. Participants ranged from 18 to 53 years of age (M = 20.34; SD = 4.01). First-year students comprised 49.5% of the participants, 12.3% were sophomores, 7.9% were juniors, 12.6% were seniors, and 17.7% were graduate students. Of the participants, 57.4% were residential students, and 42.6% were commuters. Regarding gender, 70.4% of the participants were female, 27.8% were male, 7% were transgender, and 1.1% chose the option "Other." Of those who reported their race or ethnicity, 61.5% identified as White, 10.5% Black or African American, 2.2% Asian or Pacific Islander, 12.7% Hispanic or Latinx, 2.9% Indian or Southeast Asian, and 8.7% identified as Biracial or Bicultural. Therefore, the participants were mainly white students (62.4%, n = 169) compared to students of color (37.6%, n = 102).

| Measures
This was a cross-sectional survey study with three independent variables: SOC, perceived adequacy of resources, and perceived social support. The two dependent variables included perceived stress and disruption to daily life as a result of the COVID-19 pandemic. SOC was measured using the Brief Sense of Community Scale (BSCS), which has been found to have a strong internal consistency (α ≥ 0.92) and test-retest reliability (Peterson et al., 2008). This scale comprises eight items designed to measure SOC across four dimensions: group membership, influence, needs fulfillment, and emotional connection. The scale used a 5-point, Likert-type response option format ranging from Strongly Disagree to Strongly Agree. Responses can range from 8 to 40, with higher scores indicating a higher SOC. In addition, the BSCS has sample items such as "I feel connected to the school community." Perceived adequacy of resources was measured using the Perceived Adequacy of Resources Scale (PARS). The scale has been found to have a strong internal consistency (α ≥ 0.89) and high internal reliability of 0.87 (Rowland et al., 1985). This questionnaire is made up of 28 items that are designed to measure perceived adequacy of resources that contribute to the quality of life of an individual or family. A perception of inadequate resources indicates a lack of access to resources (Hannan et al., 2016). The scale assesses seven distinct resources: physical environment, health/physical energy, time, financial, interpersonal, knowledge/skills, and community resources.
Each subscale consists of four items with the response option format ranging from Strongly Disagree (1) to Strongly Agree (7). The possible range of scores is from 28 to 196, with high scores indicating higher perceived adequacy of resources. The PARS had sample items such as "Government programs in my community are available to help me." Perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS).
The scale's internal consistency ranges from 0.85 to 0.91, with test-retest reliability values ranging from 0.72 to 0.85 (Zimet et al., 1988). This tool is used to measure the perceptions of the adequacy of support from three sources: family, friends, and significant others. It consists of 12 items with 4 items in each subscale. The scale used a 7-point, Likert-type response option format ranging from Very Strongly Disagree to Very Strongly Agree. The possible total score ranges 12-84, with high scores indicating high perceived social support. In addition, the MSPSS has sample items such as "I get the emotional help & support I need from my family." Stress was measured using the Perceived Stress Scale (PSS), which is the most widely used psychological instrument to measure the perception of stress. It has a strong internal consistency of 0.87 (Cohen et al., 1983). This scale consists of 10 items and is designed to measure global perceived stress within the last month on a 5-point Likert type scale ranging from Never (0) to Very Often (4). Four out of 10 items were worded and scored in the reverse direction. Individual scores on the PSS can range from 0 to 40, with higher scores indicating higher perceived stress. The PSS-10 had sample items such as "In the last month, how often have you been upset because of something that happened unexpectedly?" Disruption to daily life as a result of COVID-19 was measured using the RAND (American Life Panel Survey: Carman & Nataraj, 2020). No reliability information is provided yet for this measure. The subscale on disruption to routine behaviors was selected to assess how much the COVID-19 pandemic has affected routine activities and behavior since its start. This subscale was adapted from Parks et al. (2017). The 10 items on the scale vary across behaviors such as sleeping, eating, exercise, and daily interactions. The response option ranges from Not at All (1)  Totally (5). Responses can range from 10 to 50, with higher scores indicating a higher disruption to routine behaviors. The RAND had sample items such as "Since the coronavirus (COVID-19) outbreak first started, how much has it prevented you from taking care of your usual daily chores?" In the demographic part of the survey, participants were asked their age, gender identity, ethnicity, class year, student status (as of Fall 2020), and socioeconomic status. These demographics were used to explore potential moderating variables.

| Procedure
The participants completed a secure and confidential Qualtrics survey using a link sent in an email that informed them of the study and requested their participation or through a separate system for students taking an Intro to Psychology course. Upon clicking the link, the informed consent was presented, and the participants were asked to provide or decline consent to proceed with the survey. Upon choosing to participate, participants were directed to the sense of community scale (BSCS), followed by social support (MSPSS), adequacy of resources (PARS), stress (PSS), the RAND, and finally, the demographics section. At the end of the survey, participants had the opportunity to enter their email for a chance to win a $100 gift card of their choice. The participants were not obliged to enter their email, and their email addresses were not linked to their responses on the survey. The email addresses were deleted right after the drawing was carried out, and a winner was chosen. There was a minimal risk for participants completing the survey; nonetheless, stress management resources were provided at the end of the survey. Participants were encouraged to make use of the resources.

| Preliminary analysis
The participants in the study consisted mainly of first-year students (n = 137) with a higher number of female students in comparison to male students with a ratio of 70.4% (n = 195) to 27.8% (n = 77). The study participants consisted mainly of white students 62.4% (n = 169) while students of color were 37.6% (n = 102).
Of those who participated in the study, 99.6% (n = 276) reported that the COVID-19 outbreak had disrupted their lives to varying degrees. The participants' feelings of stress within the past month were assessed using the PSS-10. A mean score of 31.56 (SD = 7.46) was generated, suggesting that stress levels were relatively high when the possible range was considered. The mean SOC score was 29.02 (SD = 6.30). The mean score for social support was 61.44 (SD = 12.21), indicating that the participants in the study experienced relatively high levels of support when the possible range was considered. Finally, the PARS had a mean score of 135.73 (SD = 26.64).
To investigate if the variables being explored were correlated to each other, bivariate correlations were conducted. The results showed that all the variables were correlated to each other, with perceived stress being significantly negatively correlated with SOC (r = −0.371, p < 0.05), perceived social support (r = −0.322, p < 0.05), and perceived adequacy of resources (r = −0.611, p < 0.05), indicating that as these latter variables increased, perceived stress scores decreased. However, perceived stress was positively correlated with disruptions to daily life as a result of the COVID-19 pandemic (r = 0.444, p < 0.05), suggesting that as disruption to routine behaviors as a result of the COVID-19 pandemic increased, perceived stress scores also increased.
Potential moderating variables were examined, and as a result, several independent t-tests were conducted.
First for gender, the results showed that female students had significantly higher stress level scores (M = 32.93; SD = 7.33) in comparison to male students (M = 27.62; SD = 6.69; t (270) = 5.30, p = 0.00). The independent t-test also showed that female students had lower scores in perceived adequacy of resources (M = 130.54; SD = 26.35), compared to male students (M = 150.14; SD = 22.60; t (270) = −19.60, p = 0.00). In addition, female students had significantly higher scores in disruption to routine behaviors as a result of the pandemic (M = 31.28; SD = 8.59) compared to male students (M = 26.89; SD = 8.93; t (270) = 2.61, p < 0.05). There was no significant difference between female students and male students when it came to SOC and perceived social support. However, these results should be interpreted with caution due to the uneven distribution of the groups as there were more female participants than male participants.
Class year was also explored using independent samples t-tests to examine potential differences between underclass students (first-year students and sophomores) and upper-class students (juniors and seniors). There was a statistically significant difference found between the perceived stress scores of underclass students (M = 31.05; SD = 7.73) and upper-class students (M = 33.60; SD = 6.63; t (226) = −2.54, p < 0.05), suggesting that upper-class students perceived higher levels of stress compared to underclass students. There was also a significant difference between the perceived adequacy of resources scores of underclass students (M = 139.80; SD = 26.29) and upper-class students (M = 127.91; SD = 27.76; t (226) = 11.89, p > 0.05), suggesting that upper-class students perceive that they have lower adequacy of resources. Likewise, there was a statistically significant difference between the disruption to routine behavior scores of the participants, with upper-class students having higher scores (M = 33.93; SD = 8.64) than underclass students (M = 29.77; SD = 8.34; t (226) = −4.16, p < 0.05), indicating that upper-class students experienced more disruption to routine behaviors as a result of the COVID-19 pandemic compared to underclass students. Similarly, these results should be interpreted with caution due to the uneven distribution between both groups as underclass students were a significantly larger portion of our participants.
Independent t-tests that examined the differences based on residential status showed that there was a significant statistical difference between the SOC of residential students (M = 29.80; SD = 6.06) and that of commuter students (M = 28.01; SD = 6.53; t (275) = 1.79, p < 0.05). This suggested that residential students reported experiencing a higher SOC compared to students who commute. There were no significant differences between residential groups on perceived stress, perceived social support, perceived adequacy of resources, or disruption to routine behaviors.
Finally, differences based on participants' ethnicity were examined. Because the majority of participants were White, for these analyses they were classified into two groups: White students and students of color. An independent t-test was conducted to examine the differences between the groups. The results showed that there was no statistical difference between White students and students of color on any of the variables.

| Multiple regression
Two multiple regressions analyses were conducted to examine the relationship between the predictor variables-SOC, perceived social support, and the perceived adequacy of resources-with each of the dependent variables: perceived stress and disruption to routine behavior as a result of the COVID-19 pandemic.
Tables 1 and 2 summarize the descriptive statistics and analysis results. The multiple regression model with all three predictors for perceived stress was significant overall (R² = 0.389, F(3, 274) = 58.19, p < 0.01), indicating that the three predictors account for 39% of the variance in perceived stress: SOC, perceived social support, and the perceived adequacy of resources. SOC and the perceived adequacy of resources had significant negative regression weights. Perceived adequacy of resources played a more significant role in predicting perceived stress (β = −.543, p = 0.00) than SOC (β = −0.133, p = 0.01). The results indicate that students with higher scores on these scales were expected to experience lower levels of perceived stress BENSON AND WHITSON | 2753 (suppressor effect) after controlling for other variables in the model. Perceived social support did not contribute to this multiple regression model (see Table 1). The multiple regression model with all three predictors for the disruption to routine behavior as a result of the COVID-19 pandemic was also significant overall (R² = 0.167, F(3, 273) = 18.19 p < 0.01), indicating that 16.7% of the variance in disruption to routine behaviors as a result of the COVID-19 pandemic can be accounted for by the three predictors. Perceived adequacy of resources had a significant regression weight (β = −0.428, p = 0.00), suggesting that students with higher scores on the PARS were less likely to experience disruption to routine behaviors as a result of the COVID-19 pandemic after controlling for other variables in the model. SOC and perceived social support did not contribute to this regression model (see Table 2).
T A B L E 1 Summary of multiple regression analyses for variables predicting perceived stress in college students

| Hierarchical regression analyses
To examine the unique contribution of gender (female vs. male) and class year (underclassmen vs. upperclassmen) on students perceived stress and the disruptions to their routine behaviors as a result of the COVID-19 pandemic, these two demographic variables were added into the above regression models, creating two hierarchical multiple regression analyses. For the first analysis, perceived stress was the dependent variable. In Step 1, gender and class year were entered as predictor variables. In Step 2, SOC and perceived adequacy of resources were added as predictor variables. The results of Step 1 indicated that the variance for (R²) with the first two independent variables was 0.143 (adjusted R² = 0.135), which was significantly different from zero (F(2, 222) = 18.46, p < 0.05). Gender was the only statistically significant independent variable, (β = −0.355, p < 0.05). In Step 2, the change in variance accounted for (ΔR²) was equal to 0.442, which was significantly different from zero (F(4, 220) = 43.51, p < 0.05).
The second hierarchical regression analysis examined disruptions to routine behaviors as a result of the COVID-19 pandemic as the dependent variable. In Step 1, gender and class year were again the predictor variables. In Step 2, SOC and perceived adequacy of resources were added as predictor variables. The results of Step 1 indicated that the variance for (R²) with the first two independent variables equaled 0.053 (adjusted R² = 0.045), which was significantly different from zero (F(2, 222) = 6.25, p < 0.05). Class year was the only statistically significant independent variable, (β = 0.168, p < 0.05). In Step 2, SOC and perceived adequacy of resources were entered into the regression equation, increasing the number of independent variables to four. The change in variance accounted for (ΔR²) was equal to 0.166, which was significantly different from zero (F(4, 220) = 10.97, p < 0.05). The perceived adequacy of resources was the only statistically significant independent variable (β = −0.369, p < 0.05). As can be seen from the results, class year loses its predictive effect when the other variables are included, leaving perceived adequacy of resources as the only significant predictor in Step 2 (see Table 4).
Because perceived adequacy of resources was the strongest predictor for both dependent variables, we explored these relationships more deeply by examining if specific subscales of the PARS accounted for the relationships. Specifically, we conducted two regression analyses again (one for each dependent variable), with each T A B L E 3 Summary of hierarchical multiple regression analyses for variables predicting perceived stress in college students Step 1   In the second regression analysis, results revealed that disruptions to daily life due to COVID were predicted by two subscales: health/physical energy resources (M = 20.34; SD = 5.05; p < 0.01) and the financial resources (M = 16.38; SD = 5.79; p < 0.01). Financial resources refer to money, including credit (Rowland et al., 1985); this subscale consists of items such as "I have enough financial resources to meet unexpected expenses."

| DISCUSSION
The present study examined the protective role of SOC, perceived access to resources, and perceived social support on perceived stress and COVID-19-related disruption to daily life. The roles of potential moderating variables such as gender and class year were also explored. The data analysis supported the hypothesis that students with a stronger SOC to the university would experience lower levels of perceived stress. However, SOC was not correlated to COVID-19-related disruptions to daily life. The hypothesis was also supported that greater perceived access to resources would negatively correlate with perceived stress levels and COVID-19-related disruptions to daily life. Our third hypothesis stated that increased levels of perceived social support would be negatively related to perceived stress and COVID-19-related disruption to daily life; the data analysis did not support this hypothesis. We found that perceived social support was not significantly related to perceived stress or COVID-19-related disruptions to daily life amongst our participants.
Our final hypothesis stated that demographic variables such as gender, ethnicity, class year, and residential status would also have an influence on college students' perceived stress and COVID-19-related daily life disruptions, even when our predictor variables (the independent variables) were included in the models.
Preliminary analysis showed that only gender and class year were significantly related to perceived stress and T A B L E 4 Summary of hierarchical multiple regression analyses for variables predicting disruption to routine behaviors as a result of the COVID-19 pandemic among college students Step 1  COVID-19-related disruptions to the daily life of college students. After a series of hierarchical regression analyses, we found that gender and class year had a significant predictive effect on perceived stress; however, only gender retained its significant predictive effect when the predictor variables were added to the analysis. For COVID-19related disruptions to daily life, only class year had a significant predictive effect; however, it lost its significant predictive effect when the predictor variables were added to the analysis.
Overall, the findings from the study highlight the importance of SOC and access to resources in mitigating stress and COVID-19-related disruptions to daily life among college students.

| Sense of community
Previous research has rarely examined how SOC safeguards against stress among college students; however, its significance as a protective factor has been emphasized. For example, studies have found that SOC effectively builds resilience and promotes positive well-being (Greenfield & Marks, 2010;Thomas & Bowie, 2016;Wombacher et al., 2010). Previous literature has also shown that SOC is significant in reducing stress and enhancing coping abilities (Klein & D'Aunno, 1986). In our study, students reported feeling an average to high SOC to the university.
Findings showed that the higher the SOC college students felt, the less they reported feeling stressed. Although the relationship was weak, as SOC increased, disruptions to the daily life of college students also appeared to be reduced. This suggests that SOC could be an important protective factor that may have the potential to boost college students' ability to cope with the COVID-19 pandemic.

| Access to resources
There has been limited research on the adequacy of resources as a protective factor against stress and other negative psychological outcomes. Previous research has mainly focused on the importance of access to resources in social institutions, food security, and the global society, to name a few. Research has also centered on how perceptions of adequacy and access to resources influence judgments, decisions, actions, and interactions (Berry, 1989;Elenbaas, 2019;Henderson & Loreau, 2020;Payne-Sturges et al., 2017). Although these aspects are relevant, the significance of access to resources as a protective factor against stress and overall psychological wellbeing has been overlooked. Access to resources is especially relevant during the current global pandemic as many people struggle to access needed resources (McMahon et al., 2020;Solomon et al., 2020;WHO, 2020). The findings from our study showed that most of the participants perceived that the resources they had were adequate.
Students who reported high perceived adequacy of resources also reported lower stress levels and fewer disruptions to their daily life. Furthermore, findings suggest that specific resources were more influential than others: health/physical energy resources, time resources, knowledge and skill resources, and financial resources. Rowland et al. (1985) referred to the first three resources as human resources. Human resources were classified as qualities and skills found within the individual. Furthermore, these resources had to be present for other resources to be efficiently utilized. In particular, health/physical energy resources were considered significant by college students across both dependent variables. This could be due to the importance of physical health in carrying out daily activities, especially during a pandemic and in dealing with stressful situations. Not only does the COVID-19 virus affects physical health, thereby limiting the activities that one can perform, but research has also shown that maintaining positive physical health is crucial in stressful situations, as it could serve as a buffer against stress and its negative adverse effects (Flueckiger et al., 2016;Perchtold-Stefan et al., 2020). Previous literature shows that having access to needed resources mitigates stress and promotes overall psychological well-being (Marshall et al., 2020;Organista & Ngo, 2019). Consistent with this previous research, our findings suggest that access to resources is an important protective factor that should be emphasized in every community. Access to BENSON AND WHITSON | 2757 resources helps vulnerable populations like college students combat the adverse effects of crisis events such as the COVID-19 pandemic.

| Gender
Female students reported having higher levels of stress and less perceived adequacy of resources than male students. Previous research has found that among undergraduate students, female students generally tended to report experiencing more stress in their daily lives than their male counterparts. In addition, female students also reported experiencing more stress in relation to the pandemic (Prowse et al., 2021). In a study by Soffer (2010), the role of stress was examined among young adults who were primarily undergraduate students. The results showed that female participants reported experiencing higher levels of stress (job/studies) compared to male participants.
Additionally, a Hungarian study on attitudes towards COVID-19 and stress levels revealed that women were more worried about the virus and reported higher levels of stress as a result of the pandemic (Szabo et al., 2020).
Furthermore, studies have shown that due to gender differences, women have historically and continue to have less access or control over resources (Mayoux, 1995;Paul & Rani, 2017;Ravindran, 2002;Solano & Rooks, 2018;Tesch-Römer et al., 2007). Therefore, it could be that in our study, female students' lower perceived adequacy of resources contributed to their higher levels of stress. These results emphasize the need to increase access to resources for female students, as it could be a protective factor relevant to this marginalized population. College students are a vulnerable population; however, female college students are even more vulnerable and susceptible to inequities and the negative social impact of events such as the COVID-19 pandemic. Therefore, protective factors such as having equal access to resources could help reduce the impact of the COVID-19 pandemic and boost their coping ability, thereby improving their well-being.

| Class year
Our findings indicated that upperclassmen (juniors and seniors) reported experiencing more stress and COVID-19related daily life disruptions than underclassmen (first-year students and sophomores). The reason for these differences is unclear. It could be that upperclassmen may be struggling with an exacerbation of typical uncertainties in response to graduation, future employment, to name a few. It may also be that underclassmen, particularly firstyear students, do not have a college routine yet as they are just beginning, so there is less to disrupt. Most research exploring stress in college focuses on the effect of stress on academic performance and overall well-being of college students (Baghurst & Kelley, 2013;Brougham et al., 2009;Chambel & Curral, 2005;Struthers et al., 2000;Zajacova et al., 2005). Therefore, more research will need to be conducted to see if these differences continue and to understand more about what might be driving them.

| Limitations
One of the study's main limitations was that the sample only consisted of students from a private Northeastern University in the United States. This could have confounded the data and limited its generalizability to all college students. A second limitation is the uneven distribution of gender, ethnicity, and class year of the participants in the study. A majority of the students in the sample identified as female, underclassmen (primarily first-year students), and White/Caucasian. Similarly, this uneven distribution limits generalizability to a more diverse population of college students. This uneven distribution could be attributed to the convenience sampling method that was utilized to collect data. A final limitation is that we cannot draw conclusions from the results due to the study's methodology. It is not clear if the COVID-19 pandemic is directly causing stress or disruptions to the daily life of these students (although the disruption to daily life measure explicitly focused on pandemic-related disruptions).
Therefore, caution should be taken when interpreting the results until more studies can be conducted.

| Implications
Keeping the study's limitations in mind, the results suggest that SOC and perceived access to resources could play a protective role for college students in dealing with stress and COVID-19-related disruptions to daily life due to the pandemic. Therefore, these factors should be emphasized more often in college communities to enhance psychological well-being and improve human functioning. In the case of SOC, college communities should make the environment more inclusive and welcoming to the students to foster or increase their sense of belongingness. To achieve this, universities could focus on organizing events and functions that would create shared experiences, having school rituals that connect people emotionally and coordinating projects that would involve diverse students working together, and building strong bonds that will last even after they leave the community. It is also crucial that the college community emphasizes how much they value its members. Students' opinions and complaints should always be taken seriously, and committees can be formed that would involve students in the decision-making processes in the school, especially the decisions that directly affect them. These committees should be diverse and inclusive, and truly representative of the college community. This would strengthen the SOC among the students and therefore serve as a protective factor against negative psychological factors during crises such as the COVID-19 pandemic.
Having access to needed resources is a fundamental right for every human being, but regrettably, inequalities exist, and the allocation of resources is not always fair. Unfortunately, the COVID-19 pandemic has not only limited access to resources but has also exacerbated the inequities that already exist, thereby exposing individuals and communities to more negative consequences. Our findings suggest that increased access to resources could be a critical factor in alleviating the adverse effects of the pandemic for college students, particularly female students who report more stress and lower perceived adequacy of resources. In addition, college communities can support their members by providing some of the resources. At the moment, many individuals lack financial resources, and school communities can help address this need by providing food and grocery gift cards, need-based assistance that could cover a month's rent, food pantries, data services, and other aids. College communities could also connect students to the resources in the community by forming partnerships with community agencies and organizations that would provide the needed resources to students in alliance with the school. This could include free COVID-19 testing, discounted health services, access to telehealth services, food pantries, and other forms of assistance. In addition, regular emails could be sent out to students informing them of available resources that they can easily access within the community. The mere act of providing them with helpful information is a resource that would be beneficial in getting through the pandemic. The benefits of having one's needed resources cannot be overemphasized, especially during pandemics and other crises.

| Future directions
Although many of the hypotheses were supported, there is still a need for future research. SOC and access to resources were negatively related to stress and COVID-19-related disruptions to daily life, suggesting that they could serve as protective factors for college students during this pandemic. Future studies should examine more diverse samples to have greater representation and generalizability. It would also be interesting to explore if demographic characteristics such as ethnicity, gender, and age would serve as moderators with larger and more diverse samples. Additionally, as previously mentioned, limited research has been done on access to resources as a protective factor and its importance to psychological well-being. Therefore, future research should consider focusing more on this aspect so as to provide more insight into its protective role and suggest additional ways we can use it to improve psychological well-being and functioning. There is also a need for more measures to be developed that assess the availability and adequacy of different kinds of resources ranging from human resources to social resources to psychological resources.
Furthermore, while the COVID-19 pandemic is still novel and we are still learning about it, we believe there is a need for more standardized COVID-19 measures that would assist future researchers in adequately exploring the pandemic and its effects on different populations. Finally, although the pandemic might end, the psychological impact of it will be with us for many years. Therefore, we can learn how best to support our college students and others through the aftermath and be more prepared to respond to any similar traumatic experiences in the future.

| Conclusion
This study found that SOC and perceived access to resources could be critical protective factors to help college students cope with stress and COVID-19-related disruptions to daily life. In particular, increased access to resources may be particularly helpful to female students who report more stress and disruptions. These protective factors should be emphasized in college communities and society as a whole, as they could protect against the negative psychological and social impacts of the ongoing COVID-19 pandemic. There is still an evident need to discover and enhance more protective factors to safeguard vulnerable populations against the negative consequences of pandemics and improve psychological well-being. This study takes a step in the right direction as it highlights the potential benefits of protective factors-SOC and access to resources-in building resilience and coping abilities amongst college students during the COVID-19 era. This study can serve as a basis for other studies and as a resource for informing policies that impact college students.

DATA AVAILABILITY STATEMENT
The data for this manuscript can be provided upon request.

PEER REVIEW
The peer review history for this article is available at https://publons.com/publon/10.1002/jcop.22817


s2fieldsofstudy:
Education
Political Science

text:
Socioeconomic and Demographic Contexts of Brazilian and International University Students Regarding the Use of Dental Services

This article characterizes the different socioeconomic and demographic contexts regarding the use and access to dental services by Brazilian and African students at a Brazilian university of international nature. This is a cross-sectional, analytical, observational study with a quantitative approach, with data produced by 350 students from a public university in the state of Ceará. Sociodemographic and economic factors, participation in educational activities, self-perception of oral health, and use of dental services by academics were analyzed. The results obtained indicated that of the university students participating in the study, 74.0% had already used dental services, of which 57.43% were Brazilian and 42.57% international. There was a significant association between being a Brazilian academic and having already used dental services, having an income less than or equal to the minimum wage, and having used the public dental service. The determination of the prevalence of use of dental services and the different contexts of university students can assist in planning future actions in oral health that prioritize groups of university students with greater difficulties in the use and access of these services.

Introduction
Despite the advances made in the oral health care process and its public policies, there are still social inequalities in the use of dental services. In this context, the reduced access and use of oral health services raise the need for effective public policies that provide greater assistance in oral health, focusing on the promotion, recovery, and prevention of pathologies. Such policies can act by implementing educational programs and expanding access and regular use of dental services by the population [1].
In the context of the use of oral health services, it is important to assess, among other factors, those related to the socioeconomic and demographic aspects of the populations. In fact, less economically favored individuals have greater limitations on access and use of dental services. From this perspective, evaluating the use of these services and their main limiting factors is extremely necessary to effectively know the challenge of universal access to health proposed by the unified health system (SUS) [2].
In Brazil, for decades, the use of dental services has focused on children and, subsequently, it has focused on private practice and workers with a formal contract. However, in the 2000s, there was an expansion in access to these services through the implementation of the oral health team (ESB) in the family health strategy (ESF). is strategy aimed, in particular, to guarantee access, overcome social inequalities and meet repressed demand [3].
In this context, despite the need to assess the population's access to dental services and their efficiency, especially after the creation of the ESB, several epidemiological studies follow methodologies recommended by the World Health Organization (WHO) that do not include the ages of 19 to 35 years, an age group that includes most university students [4]. us, data related to the use of dental services by university students is still scarce.
In several African countries, access to dental services is limited, and diseases of the oral cavity are often left untreated. e existence of caries disease among populations results not only from biological factors, but mainly from the social inequality into which these individuals are inserted [5,6]. Despite the relevance of care for oral diseases such as caries and periodontal disease worldwide, mainly because it is a challenge to global public health, oral health in some developing countries is still precarious [7].
Specifically, attention to oral health policies for college students becomes crucial when considering the involvement of this population in oral diseases such as dental caries and periodontal diseases. ese oral diseases may affect academic performance, damage family and social relationships, generate unnecessary spending on public services and promote systemic, psychological and social complications [8][9][10].
Dental caries is one of the main reasons for seeking dental services, in addition to being a serious public health problem in several countries, including Africa. Although the indexes show high tooth loss due to caries, this disease can be easily prevented with health education practices and changes in oral hygiene habits [11].
us, knowledge about access to oral health services for university students, as well as the factors that determine this use, is relevant to the formulation of health care policies aimed at reducing the impact of oral health on the quality of life of these students, whether Brazilian or international.
Based on the above, the present study aimed to characterize different socioeconomic and demographic contexts regarding the use and access of dental services by Brazilian and African students at a Brazilian university of international nature.

Materials and Methods
is is a cross-sectional analytical observational study with a quantitative approach, conducted at the University of International Integration of Afro-Brazilian Lusophony (UNILAB), at the Redenção campus and at the Academic Unit of Acarape, Ceará, Brazil. With 3,995 students enrolled in 2019, UNILAB's specific institutional mission is to train human resources to contribute to the integration between Brazil and the member countries of the Community of Portuguese-Speaking Countries (CPLP), especially African countries. In addition to promoting regional development and cultural, scientific, and educational exchange in the region of the state of Ceará [12].
Redenção is a city located in Maciço de Baturité, 61 km away from the capital of the state of Ceará, Fortaleza, and constituting one of the municipalities of the Serra de Guaramiranga Pole. In 2018, the estimated population was 27,633 inhabitants. Its economy is based on agriculture, with the cultivation of bananas, sugar cane, corn, and beans, as well as cattle, swine, and poultry [13,14]. e municipality of Acarape is 56 km from Fortaleza, located in the microregion of Baturité, a mesoregion of northern Ceará and comprising the Serra de Guaramiranga Pole. In 2018, its estimated population was 15,399 inhabitants. In the municipality, there are mainly activities focused on livestock, agriculture (cultivation of sugar cane, beans, and others), and the exploration of limestone [13,15].
e research was carried out from January to July 2019 by a team of three interviewers. Data collection was carried out in the morning and afternoon shifts during working days, at preestablished times. e interviews were conducted individually and in a reserved area on the university campus.
ey were invited to participate in the academic study of UNILAB, of different nationalities (Angola, Brazil, Cape Verde, Guinea-Bissau, Mozambique, São Tomé and Príncipe, and East Timor), of the bachelor's courses (Public Administration, Agronomy, Bachelor of Humanities-BHU, Natural Sciences and Mathematics, Social Sciences, Nursing, Computer Engineering, and Energy Engineering) and undergraduate courses (Biological Sciences, Letters-Portuguese Language, Mathematics, Pedagogy, and Chemistry). For the inclusion of participants, the following criteria were instituted: to be properly enrolled in a face-to-face undergraduate course; to be attending any semester. Academics absent from UNILAB on the days of questionnaires and oral exams were excluded from the study. e sample size was calculated in order to meet both the prevalence and association studies between the independent and dependent variables. e sample size was calculated at 350 students, with a response rate of 100%. For this, the sample size calculation was performed based on finite populations, assuming a 95% confidence level, 5% error, and 50% proportion [16].
Data collection started with the explanation of the project and the application of the free and informed consent term (ICF). After that, a validated questionnaire was applied [11] and adapted by the authors, containing objective questions related to sociodemographic and economic aspects, participation in oral health educational actions, selfperception of oral health, access and types of dental services used.
In the first block, for those scholars who made use of dental services, the variables were described as follows: nationality (Brazilian and international); sex (female and male); age in years (≤25 and >25); place of residence (urban and rural areas); color/race, the race/color white, black, and because they are small groups and not liable to form a specific category, individuals of yellow and indigenous skin color were incorporated to those of brown color, configuring the category "brown, yellow and indigenous" [17]; family income (≤1 minimum wage and >1 minimum wage); participation in educational oral health actions (yes and no); types of dental services used (public and private); last visit to the dentist (<1 year and ≥1 year), and perception of oral health (excellent/good, regular, and bad/very bad).
In the second block, the independent variables were represented by: nationality (Brazilian and international); sex (female and male); age in years (≤25 and >25); place of residence (urban and rural areas); family income (≤1 minimum wage and >1 minimum wage); participation in educational oral health actions (yes and no); and excellent/good self-perception of oral health (yes and no). e dependent variables were represented by: participation in educational oral health actions (yes and no); "excellent/ good" self-perception of oral health (yes and no); use of dental services (yes and no); types of dental services used (public and private); and last visit to the dentist (<1 year and ≥1 year).
In the third block, the independent variables were: use of dental services (yes and no) and types of dental services used (public and private). e following were considered as dependent variables: participation in educational oral health actions (yes and no); "excellent/good" self-perception of oral health (yes and no); and last visit to the dentist (<1 year and ≥1 year). e statistical analysis included the calculation of the measures of absolute and relative frequency. Pearson's chisquare and Fisher's exact tests were used to analyze the association between categorical variables. A significance level of 0.05 was adopted. e analysis was performed using the statistical program Epi InfoTM for Windows, version 7.2, available free of charge from the center of disease control and prevention (CDC).
Data collection was conducted according to the ethical principles contained in Resolution no. 466/12 of the National Health Council [18]. e project was approved by the Ethics Committee of the University Center Faculty of Medicine of ABC (FMABC) according to CAAE: 87168218.3.0000.0082 and opinion no. 2,647,693.

Results
Of the 350 academics who participated in the study, 74.00% used dental services, 57.43% were Brazilian and 42.57% were international academics, 53.30% were male and 73.04% were 25 years old or less. Of this total, 68.88% of the students lived in an urban area, 53.31% declared themselves to be black, 63.42% had an income less than or equal to 1 minimum wage, and 57.20% had already participated in educational oral health actions. Still, 63.81% of these students used the public service, 63.04% had done it less than 1 year ago, and 47.78% had a "great/good" perception of oral health (see Table 1).
When analyzing the association between nationality and participation in educational oral health actions, there was a significant relationship between being an international academic and not having participated in educational activities in oral health (p � 0.001). For the relationship between nationality, the use of dental services, and the time of the last visit to the dentist, a significant association was observed between being a Brazilian academic and having used dental services (p � 0.001) and having sought this type of care for less than 1 year (p � 0.002) (see Table 2).
Source: authors, 2019. As for the association between sex and participation in educational oral health actions, there was a significant relationship between being a male academic and not having participated in this type of activity (p � 0.046). Regarding the relationship between sex, perceived "good/good" oral health, and the use of dental services, there was a significant association between being a male academic and not having "great/good" perceived oral health (p � 0.023) and being a female academic and having used dental services (p � 0.009).
Regarding the association between age and perceived "great/good" oral health, there was a significant relationship between being an academic over the age of 25 and having "great/good" perceived oral health (p � 0.012). Regarding age and the use of dental services, there was a significant relationship between being academic aged 25 years or less and having used these services (p � 0.004).
Regarding the relationship between family income, the use of dental services, and the types of dental services used, there was a significant association between being an academic with an income higher than the minimum wage and not using these services (p � 0.001) and having an income less than or equal to the minimum wage and having used the public dental service (p � 0.003). For the place of residence, there was a significant relationship between being an academic who lives in a rural area and have used the public dental service (p � 0.034) and being an academic who lives  in an urban area and have sought this type of care for less than 1 year (p � 0.034).
As for the association between educational oral health actions and perceived "great/good" oral health, there was a significant relationship between not having participated in these actions and not having "great/good" perceived oral health (p � 0.003). Regarding participation in these actions, the use of dental services and their types, apprehending a significant relationship between the participants in these actions and the use of dental services, public or private (p � 0.001), and use of public service (p � 0.007).
Regarding the relationship between perceived "great/ good" oral health and participation in educational oral health actions, there was a significant association between not having a "great/good" perception of oral health and not having participated in this type of activity (p � 0.005). For the relationship between this perception and the time of the last visit to the dentist, a significant association was observed between having a "great/good" perception of oral health and having sought this type of care for 1 year or more (p � 0.008).
With regard to the association between the use of dental services and participation in oral health educational actions, there was a significant relationship between not using these services and having participated in oral health educational actions (p � 0.001). As for the relationship between the types of public and private dental services and this participation, a significant association was found between having used the public service and having participated in educational oral health actions (p � 0.007) (see Table 3).

Discussion
is study was one of the first to characterize and associate sociodemographic and economic aspects, perception and participation in oral health educational actions, and use of dental services by Brazilian and African students at a Brazilian university of international nature. Its conduction showed, among other results, that a considerable number of participants had used the public service and had a "great/ good" perception of oral health. Between the different associations, the research revealed a significant relationship between being an international academic and not having participated in educational oral health actions, as well as being a Brazilian academic and having used dental services and having sought this type of care for less than one year.
Specifically, the characterization and association between the variables mentioned above enabled a more excellent knowledge of the population of students of different nationalities, semesters, and courses at UNILAB, which may better direct the institution of strategies focused on oral health, including the search and use of dental services, with personal, academic, and professional repercussions.
When evaluating the nationality of the participants, the greater participation of international academics was unexpected since UNILAB, although it is an institution of higher education with an international character, has and receives a greater number of Brazilian students in relation to other nationalities. Similar to this result, the greater number of male academics in the present study was surprising since, according to UNILAB data, there is a predominance of female students, especially those aged 25 years or less. With regard to the predominance of participants aged 25 years or less, this finding corroborates the fact that, at the university, more than 50% of students, of both sexes, are in this age group. Regarding the largest number of academics who declared themselves black, although this race is the second most abundant among university graduates, this finding may be a reflection of the significant presence of Africans at UNILAB, as well as result from one of its selection processes, which specifically includes quilombola students [19].
As for household income, the highest number of academics with an income less than or equal to the minimum wage may result from the law's implementation at 12,711/ 2012, which determined that 50% of places at universities and federal institutions would be for students in full arising public high schools, with a gross family income of 1.5 minimum wages or less [20]. For the largest number of participants living in the urban area, this data can be justified based on the fact that living in the countryside, by significantly increasing the likelihood of an individual being relatively low income [21], can contribute to a lower level of education and more difficult access to university.
According to Neves et al. [22], socioeconomic inequalities directly affect health. Specifically, for the use of dental services, socioeconomic and demographic factors can interfere with usage patterns. In fact, individuals with better socioeconomic conditions may have easier access to health International Journal of Dentistry 5 care than people with low incomes. is social inequality in access tends to be greater in countries with a private health system, where the population has to pay for health care, either through plans and insurance or direct payment to the provider, than in countries with a universal system [23]. In this study, the economic factor did not seem to influence the use of dental services by academics, since many of those who had used this type of service had a low income. In particular, the use of this service by Brazilian academics, especially for less than 1 year, may be linked to greater awareness of the importance of oral health and/or the presence of a carious process since, according to the Oral Health Project 2010 [24], the number of cariesfree individuals decreases with increasing age. e project, by mentioning an average of decayed teeth among Brazilian adolescents of 4.25 teeth and a DMFT index of 16.75 among adults aged 35 to 44 years, reinforces the probability of an increase in carious lesions with age, which can support the search for dental care by academics aged 25 years or less, participating in this research. Other studies have also shown a higher frequency of demand for dental services among younger students [25,26].
In this context, it is worth mentioning that oral health care is relevant in the lives of young people. is care can have a direct influence on the self-esteem and socialization of these individuals. In particular, for teenagers, youth people, and adults. Among the oral problems that can interfere with your quality of life, we highlight untreated caries, severe malocclusions, pain, tooth loss, and gum bleeding [1,27,28].
In line with the findings observed here, there was a higher prevalence of the use of dental services in the population of Brazilian students in relation to international students [11,29]. Considering these results, it is possible that the scarcity of oral health professionals, inadequate infrastructure, and the lack of access to dental services in the country of origin, as well as the nonparticipation in educational health actions, may justify the lower use by international scholars of Brazilian dental services [30]. Notably, the noninvolvement in educational activities related to oral health by the international student was evidenced here by the association between being an international academic and not having participated in educational activities in oral health.
With regard to the use of dental services, according to sex, although the greatest amount of use of these services was found among male academics, which may result from their greater number among the participants in this study, the significant difference between these variables only occurred when it involved the female gender. is result, in addition to meeting many published studies [1,[31][32][33], can be understandable, considering that men have more difficulty in adopting healthy behaviors in relation to women [34]. It is also possible that this phenomenon occurred due to the nonparticipation of the male sex in oral health educational actions, which contributed to the association, observed here, between being a male academic and not having participated in this type of activity.
When assessing the place of residence among those who had done the most or made the most use of dental services, the greater use by those who lived in urban areas, especially less than 1 year ago, was not surprising. Indeed, the literature reports that, in general, there is less use of all types of health services in the rural area when compared to the urban area, as a consequence of the disparities in the offer of these services between these areas [35]. As for use in a period of less than 1 year, both by residents in urban areas and by participants in general, it can be justified based on the recommendations of the American Dental Association. According to her, generally, adults should make an annual visit to the dentist [36].
Also, considering the home location, the relationship observed between being an academic resident in a rural area and having used the public dental service highlights the remarkable dependence of the rural Brazilian population on public health services and reduced adherence to health plans [37]. is use may have been corroborated by the increase in the supply of health services by SUS [38]. Despite the increase in the services offered, access is still limited to the inhabitants of the rural areas due to their geographic conditions, uneven distribution of professionals, and deficiencies in the network of health units. In addition to these factors, they also contribute to the difficulty of accessing the preferred location of the reference network in the urban area [37].
As for the greater use of dental services by academics who declared it to be black, it can be assumed that this phenomenon occurred because they make up most of the sample of this research. It is possible that this increased use derives from an inadequate oral health condition. In fact, the literature mentions a relationship between the highest prevalence and risk of caries, the worst socioeconomic conditions, and the greatest need for dental treatment in the black population [10]. In this context, race/color is considered one of the limiting factors in the use and access of dental services [39]. e greater use of dental services by students with an income equal to or less than the minimum wage, similar to race/color, in this data may result from the greater number of these students among the participants. It is also possible that these academics, having already participated in educational oral health actions, were aware of the importance of periodic visits to the dental surgeon. is possibility is reinforced by the fact that countless students have already participated in oral health education activities and have already used the public dental service [40,41].
is assumption is also corroborated by the association observed here: academics participating in oral health education actions using dental services, particularly the public, as well as the relationship between being an academic and having used public service and having participated in actions on oral health education. e purpose of health education includes, in addition to knowledge and understanding of oral health conditions, the influence on oral hygiene habits and, consequently, the search for dental services [42]. However, it is possible that the individual did not seek dental care but participated in educational activities on oral health [43], a phenomenon that occurred in the present study. In fact, educational health actions can take place in different 6 International Journal of Dentistry spaces, including the school and home environment, without being restricted to basic health units [44][45][46]. As for the use of public service, it may be a reflection of the participants' low family income [47]. Considering family income, the relationship between income greater than the minimum wage and the nonuse of dental services was unexpected. It is possible that this event results from lower awareness of these students about the importance of oral health, which can be emphasized by the considerable number of academics who had not participated in educational activities on oral health. It can also be assumed that this higher income arises from paid work activities that, associated with academic life, restrict the student's dedication to health care and, consequently, provide fewer opportunities for searching for and using dental services. However, this result needs to be further investigated.
When evaluating perceived oral health, considered an important health indicator, which summarizes the objective and subjective health situation, values, and cultural expectations, the study showed a reasonable number of academics who considered it to be "great/good," in addition to the significant association between being an academic who had this perception and having not sought dental care for more than a year. is result is different from the literature, which reports that there is a relationship between the perception of oral health and the visit to the dentist [1,48,49].
Still in this context, the study showed an association between being a male academic and not having "great/good" perception of oral health. is data may be a reflection of the lesser care given to males to their health, which can be evidenced by the fact that men have greater difficulty in adhering to healthy behaviors and seeking prevention services [33]. For the relationship between being an academic over the age of 25 and having "great/good" perception of oral health, this association can be justified if considered that, in general, greater maturity implies greater responsibility of the individual in different aspects of including systemic and oral health.
In this sense, in addition to the factors age, sex, income, and education, the contribution of the social environment plays an important role in the perception of oral health. Indeed, the social environment, by involving living and working conditions, qualifies, in a different way, the way in which people think, feel, and act, regarding their individual health [15].
In addition to sex and age, a significant relationship was observed between being an academic and not having participated in educational health actions and not having a "great/good" perception of oral health. Specifically, for this finding, its justification may be based on the fact that participation in health education actions, in addition to increasing the chances of using dental services, as already reported, may imply more knowledge, awareness of the conditions of oral health and a better perception of this condition. is assumption can also support the association between being an academic and not having a "great/good" perception of oral health and not having participated in educational activities related to oral health.
As limitations of the study, it can be mentioned that the reduced access to students of UNILAB's evening courses was mentioned since the collection was carried out in the morning and afternoon periods, as well as the impossibility of carrying out the dental evaluation due to the lack of structure and the high number of students.
Despite the limitations, the research revealed the need to conduct educational activities, mainly aimed at the African public residing in the vicinity of the university, seeking, among other aspects, to encourage the search for dental care and the improvement of oral health. It is also necessary to improve public dental services due to the role they provide to the study population and, possibly, to other community members, in addition to offering structure and qualified professionals to carry out educational activities. It is also recommended to conduct research aimed at the dental evaluation of participants to associate it with the services used by the public and their oral and systemic repercussions.

Conclusion
From the results obtained, it can be concluded that, despite the low family income, the students used dental services, participated in educational activities on oral health, used public service, and had a great/good perception of oral health. Specifically, international students did not seem to participate in oral health educational activities, and Brazilians sought dental care within a reasonable time.

Data Availability
e data used to support the findings of this study are available from the corresponding author upon request.

Conflicts of Interest
e authors declare that they have no conflicts of interest.