Acculturation, Academic Stress, and Self-Care Disparities: A Cross-Sectional Evaluation of Oral Health Attitudes among International University Students in Iran

Background: Oral health disorders, including dental caries and periodontal disease, represent a substantial global disease burden, often exacerbated in mobile and migrant populations due to complex socioeconomic and structural barriers. International university students constitute a vulnerable demographic experiencing compounded challenges, including high academic load and acculturation stress, which can negatively impact oral health self-care attitudes (OHAs). Objectives: This study aimed to assess the mean OHA score among international university students residing in Iranian cities and to evaluate the influence of key demographic (gender, nationality) and academic discipline factors on these attitudes. Methods: A cross-sectional study was performed during 2023–2024, enrolling N=207 international students residing in dormitories across four major Iranian university cities (Isfahan, Tehran, Mashhad, Shiraz). Data were collected using a modified, validated 33-item questionnaire focusing on self-care attitudes (Cronbach’s alpha=0.78). Statistical analysis utilized non-parametric tests, including Mann-Whitney U and Kruskal-Wallis H tests, given the confirmed non-normal distribution of the OHA scores (p=0.019). Results: The mean overall OHA score for the cohort was 19.01 \pm 3.00 (out of 33), classifying the general attitude as moderate. No significant difference in OHA score was detected based on gender (Mann-Whitney U, p=0.961). However, a highly significant difference was observed when comparing academic disciplines (Kruskal-Wallis H, p < 0.001). Counterintuitively, students in Engineering (Mean Score: 20.09) and Basic Sciences disciplines demonstrated significantly higher positive OHA ranks compared to Medical students (Mean Score: 17.92). Significant variations were also identified based on nationality and city of study. Conclusions: The moderate overall OHA score and the unexpected deficit observed specifically among Medical students suggest that academic stress and associated self-care neglect may actively undermine knowledge and intent for preventive behaviors in high-pressure fields. ^{Targeted, culturally sensitive, and structural interventions addressing time poverty and mental health are essential to improve oral health outcomes for this vulnerable population of international students.}