Dental care use by U.S. veterans eligible for VA care

Choosing a health behaviour theory or model for related research projects: a narrative review

Background

Theories are integral to a research project, providing the logic underlying what, how, and/or why a particular phenomenon happens. Alternatively, models are used to guide a research project by representing theories and visualising the structural framework of causal pathways by showing the different levels of analysis. With the rise in chronic and behaviour-related diseases, health behaviour theories and models have a particular importance in designing appropriate and research led behavioural intervention strategies. However, there is a dearth of papers that explain the role of behavioural theories and models in research projects.

Aims

The aim of this paper is to synthesise existing evidence on the relevance of health behaviour theories and models in research projects.

Methods

This paper reviews health behaviour theories and models commonly underpinning research projects in public health and clinical practices. The electronic databases, such as MEDLINE, CINAHL, and Scopus, as well as the search engines Google and Google Scholar were searched to identify health behaviour theories and models.

Results

Theories and models are essential in a research project. Theories provide the underlying reason for the occurrence of a phenomenon by explaining what the key drivers and outcomes of the target phenomenon are and why, and what underlying processes are responsible for causing that phenomenon. Models on the other hand provide guidance to a research project and assist in visualising the structural framework of causal pathways by showing the different levels of analysis. Health behaviour theories and models in particular offer valuable insights for designing effective and sustainable research projects for improved public health practice.

Conclusions

By employing appropriate health behaviour theory and/or model as a research framework, researchers will be able to identify relevant variables and translate these into clinical and public health practices.

Veterans' Reliance on VA Care by Type of Service and Distance to VA for Nonelderly VA-Medicaid Dual Enrollees

BACKGROUND

Not much is known about nonelderly veterans and their reliance on care from the Veterans Affairs (VA) health care system when they have access to non-VA care.

OBJECTIVES

To estimate VA reliance for nonelderly veterans enrolled in VA and Medicaid.

RESEARCH DESIGN

Retrospective, longitudinal analysis of Medicaid claims data and VA administrative data to compare patients' utilization of VA and Medicaid services 12 months before and for up to 12 months after Medicaid enrollment began.

SUBJECTS

Nonelderly veterans (below 65 y) receiving VA care and newly enrolled in Medicaid, calendar years 2006-2010 (N=19,890).

MEASURES

VA reliance (proportion of care received in VA) for major categories of outpatient and inpatient care.

RESULTS

Patients used VA outpatient care at similar levels after enrolling in Medicaid with the exceptions of emergency department (ED) and obstetrics/gynecology care, which decreased. VA inpatient utilization was similar after Medicaid enrollment for most types of care. VA-adjusted outpatient reliance was highest for mental health care (0.99) and lowest for ED care (0.02). VA-adjusted inpatient reliance was highest for respiratory (0.80) and cancer stays (0.80) and lowest for musculoskeletal stays (0.20). Associations between VA reliance and distance to VA providers varied by type of care.

CONCLUSIONS

Veterans dually enrolled in Medicaid received most of their outpatient care from the VA except ED, obstetrics/gynecology, and dental care. Patients received most of their inpatient care from Medicaid except mental health, respiratory, and cancer care. Sensitivity to travel distance to VA providers explained some of these differences.

Fatores associados à autopercepção da necessidade de tratamento odontológico e de prótese em idosos brasileiros

Resumo Este estudo teve como objetivo identificar fatores individuais e contextuais associados à autopercepção da necessidade de tratamento odontológico e de prótese em idosos brasileiros. Foram utilizados dados secundários de 7.619 indivíduos idosos do levantamento epidemiológico SB Brasil 2010. As associações entre as variáveis dependentes e os fatores individuais e contextuais foram estimadas através da razão de chances (odds ratio – OR) e intervalo de confiança de 95%, obtidas por regressão logística multinível. Dos idosos avaliados pelo SB Brasil 2010, 3.848 (50,5%) afirmaram necessitar de tratamento odontológico e 4.236 (55,6%) acreditavam necessitar de prótese. Os resultados da regressão logística multinível mostraram que sexo, cor da pele autorreferida, renda e cobertura pelas equipes de saúde bucal na Estratégia de Saúde da Família estiveram associados à autopercepção. O presente trabalho evidenciou maior influência de fatores individuais na autopercepção da necessidade de tratamento odontológico e de prótese entre idosos brasileiros. Essas informações podem auxiliar na identificação de desigualdades que afetam essa parcela da população e na definição de prioridades para o planejamento dos serviços de saúde.

[Comparison of access to Oral Health Services between areas covered and not covered by the Family Health Program in Campina Grande, Paraíba State, Brazil]

Although there are various studies on access to health studies, few have dealt specifically with access to oral health services. The aim of the current study was to evaluate factors associated with access to oral health services in Campina Grande, Paraíba State, Brazil, comparing the areas covered versus not covered by the Family Health Program (FHP). This was a cross-sectional, population-based study with a sample consisting of individuals over 18 years of age (n = 827) from urban census tracts that included health units of the Unified National Health System (SUS), stratified in areas covered versus not covered by the FHP. The statistical analysis used Pearson's chi-square and logistic regression. Individuals living in areas not covered by the FHP had 1.5 times greater odds of having access to oral health services (OR = 1.5; 95%CI: 1.1-1.9; p = 0.004) when compared to those living in areas covered by the FHP. However, this probability decreased, losing its significance (OR = 1.1; 95%CI: 0.8-1.6; p = 0.337), after adjusting for gender, age, individual income, schooling, and self-perceived health. Thus, no association was proven between coverage versus non-coverage by the FHP and access to oral health services.

Fatores relacionados à autopercepção da necessidade de tratamento odontológico entre idosos

OBJETIVO: Analisar fatores associados à autopercepção da necessidade de tratamento odontológico entre idosos. MÉTODOS: Foram pesquisados 5.326 indivíduos incluídos em amostra dos idosos (65-74 anos) brasileiros do inquérito domiciliar de saúde bucal realizado em 2002/2003 pelo Ministério da Saúde. A análise foi baseada no modelo de Gift, Atchison & Drury e foi utilizada a regressão de Poisson para análise de inquéritos com amostras complexas. RESULTADOS: Do total da amostra, 2.928 (55%) idosos relataram necessitar tratamento odontológico. A autopercepção dessa necessidade foi menor entre aqueles com 70 anos ou mais (RP=0,94; IC 95%: 0,89;0,99), que não receberam informações sobre como evitar problemas bucais (RP=0,89; IC 95%: 0,83;0,95) e que eram edentados (RP=0,68; IC 95%: 0,62;0,74). Foi maior entre aqueles que autoperceberam: saúde bucal regular (RP=1,31; IC 95%: 1,21;1,41) ou ruim/péssima (RP=1,29; IC 95%: 1,19;1,41); aparência como regular (RP=1,23; IC 95%: 1,15;1,32) ou ruim/péssima (RP=1,28; IC 95%:1,18;1,39); mastigação como regular (RP=1,08; IC 95%: 1,01;1,15) ou ruim péssima (RP=1,13; IC 95%:1,05;1,21); os que relataram dor nos dentes ou gengivas nos seis meses anteriores ao inquérito (RP=1,27; IC 95%: 1,18;1,36); os que necessitavam de prótese em uma arcada (RP=1,29; IC 95%: 1,19-1,39) ou em ambas (RP=1,27; IC 95%: 1,16;1,40). CONCLUSÕES: Informação, condições de saúde bucal e questões subjetivas estiveram associadas à autopercepção da necessidade de tratamento odontológico. Os resultados reforçam a necessidade de capacitar os indivíduos para realizarem o auto-exame bucal e identificar precocemente os sinais e sintomas não dolorosos das lesões da mucosa, da cárie e da doença periodontal.

Acculturation and orofacial pain among Hispanic adults

This study examined the associations between acculturation and orofacial pain and healthcare among Hispanic adults. Understanding the effects of acculturation on Hispanic oral health may improve understanding of oral health disparities in the United States. Data were collected from 911 Hispanic adults reporting tooth pain and painful oral sores who were part of a larger study of South Florida residents conducted using random-digit dialing methodology. The survey was conducted in Spanish or English by bilingual interviewers per the choice of each respondent. Greater use of the Spanish language was associated with disparities in healthcare visits for orofacial pain, not having a usual dentist, having greater pain, increased difficulty eating and sleeping, and more depression. Respondents' and their parents' nativity (families that had been in the United States longer) and those identifying more closely to Hispanic culture were also predictive of several of the outcomes. Gender, financial status, and age, independent of acculturation, were also associated with orofacial pain, accessing health care, and pain-related loss of functioning among Hispanics. The data support the hypothesis that Hispanics with less acculturation are less able to access needed oral health care. This study highlights the need for outreach programs targeting recent Hispanic immigrants focusing on oral health care.

PERSPECTIVE

This study found that lower levels of acculturation, particularly less frequent use of English, were associated with greater oral pain and depression for Hispanics adults. This emphasizes the need to provide Hispanic patients with information in Spanish and the importance of having bilingual materials and staff in dental clinics.

Acesso a e utilização de serviços odontológicos no Estado do Rio de Janeiro, Brasil, em 1998: um estudo exploratório a partir da Pesquisa Nacional por Amostra de Domicílios

O objetivo deste estudo foi analisar o acesso a e a utilização de serviços odontológicos no Estado do Rio de Janeiro, Brasil, em 1998, a partir da Pesquisa Nacional por Amostra de Domicílios (PNAD 1998). A população de estudo foi composta por 7.756 indivíduos subdivididos em três estratos etários (15 a 19, 35 a 44 e 65 a 74 anos). A avaliação do acesso baseou-se na pergunta sobre a última vez que o entrevistado foi ao dentista. O fato de um indivíduo nunca ter ido ao dentista na vida foi considerado como indicativo de restrição de acesso, analisado segundo variáveis demográficas, sócio-econômicas e epidemiológicas. As proporções de indivíduos que nunca consultaram dentista foram 7,6%, 1,8% e 2,6% respectivamente, entre os jovens, adultos e idosos. Os resultados sugerem que indivíduos menos favorecidos em termos sócio-econômicos apresentavam maior limitação de acesso, ou seja, os menos escolarizados (jovens e adultos), com menor renda per capita (jovens e idosos) e com menor posse de eletrodomésticos (adultos). Entre os jovens e os adultos, a posse de plano de saúde mostrou-se inversamente associada à restrição de acesso.

Características associadas ao uso de serviços odontológicos entre idosos dentados e edentados no Sudeste do Brasil: Projeto SB Brasil

Investigou-se o uso de serviços odontológicos entre idosos dentados e edentados residentes na Região Sudeste do Brasil, participantes do inquérito saúde bucal realizado pelo Ministério da Saúde em 2002/2003. Os idosos que usaram serviço há menos de um ano foram comparados aos que usaram há mais de um ano. Do total, 345 eram dentados e 669 edentados, sendo a prevalência de uso, 32% e 11%, respectivamente. Na regressão logística multivariada entre dentados, o uso foi maior entre idosos que percebiam a fala influenciada pela saúde bucal e menor entre residentes rurais; com menor renda; que usaram por problema bucal; que tinham sextante excluído; que necessitavam de prótese e que percebiam a aparência como péssima. Entre edentados, o uso foi maior entre idosos com 5-8 anos de escolaridade; que relatavam sensibilidade dolorosa; que percebiam a aparência como péssima; e menor entre idosos que usaram por problema bucal e que percebiam o relacionamento afetado pela condição bucal. A análise mostrou diferenças entre dentados e edentados. O menor uso entre idosos que mais necessitam sugere iniqüidade no acesso aos serviços odontológicos.

Is trust a predictor of having a dental home?

BACKGROUND

Developing a better understanding of sociodemographic variables that predict having a dental home may aid in reducing the disparities in oral health among minorities in the United States.

METHODS

The authors used data from a telephone survey of 1,005 randomly selected low-income residents (403 men, 602 women) aged 18 or older in two Florida counties--Miami-Dade and Duval--to examine the sociodemographic characteristics of people who reported having a regular dentist.

RESULTS

Bivariate analyses showed that respondents' levels of trust in physicians and dentists were strongly associated with having a dental home. After adjusting for other variables in a multiple logistic regression model, the authors found that respondents with a moderate level of trust in physicians and dentists were 52 percent less likely (odds ratio, or OR, = 0.48; 95 percent confidence interval, or CI, 0.26 to 0.89) and those with low trust were 54 percent less likely (OR = 0.46; 95 percent CI, 0.28 to 0.75) than those with high trust to have a regular dentist. Race/ethnicity, sex, age, education level and employment status remained significant correlates of having a regular dentist in the multivariate model.

CONCLUSIONS

The results of this study suggest that efforts to reduce disparities in access to dental care and establish dental homes should include programs to increase patients' trust in dental professionals.

CLINICAL IMPLICATIONS

While policy-makers consider ways to improve access to dental care, dental professionals should work at the community level to increase the level of trust of the community in the dental health provider.

Gender and use of health care among older adults in Egypt and Tunisia

In Western industrialized countries, women report using health services more often than do men. We explore the applicability of existing theory to explain gender differences in use of health care among older adults in Egypt and Tunisia, where females have received less health care than males in early life. Findings show that women report visiting providers and using medications more often than do men; however, adjusted odds of visiting doctors are comparable for women and men in Tunisia and lower for women than men in Egypt. Odds of using health care are higher for women than men among those reporting no morbidity or functional impairment, but these relative odds diminish or reverse among those reporting multiple morbidities or severe impairments. The contributions of subjective and objective illness, quality of social support, and availability of services on gender differences in care in later life should be assessed in these and other settings where girls' excess mortality persists.

The impact of stigma on maternal attitudes toward placement of children with disabilities in residential care facilities

This study examines willingness to consider placement of children with disabilities in residential care facilities among 81 mothers of children with disabilities. Perceived stigma is added to the Andersen and Newman model of health service utilization in order to evaluate its impact on placement attitudes controlling for predisposing, enabling and need characteristics and health beliefs. Findings of regression analyses suggest that older, single mothers of more severely disabled children are more likely than other mothers to consider residential placement and that adequate finances and residential stability may reduce this willingness. When these variables are controlled, the expectation that people with disabilities will be stigmatized by others in the community increases willingness to consider placement and does so by increasing the degree of caregiver burden experienced. Results also suggest, however, that among mothers of young children, specific aspects of perceived stigma have direct affects on willingness to consider placement even when perceived burden is controlled.

Racial Variations in Dental Procedures

BACKGROUND

Racial disparities have been widely documented in medical care, but variations in dental care have not been well examined.

OBJECTIVES

To determine if there is racial variation in use of root canal therapy versus tooth extraction across different levels of dental insurance coverage and adjusting for other factors known to influence treatment decisions.

METHODS

Within 3 different categories of insurance coverage, we examined whether there were racial differences in the provision of the tooth-sparing treatment of root canal therapy (vs. tooth extraction) among 54,423 users of outpatient Veterans Affairs dental care in 1998. Regression analyses adjusted for the severity of tooth- and gum-related disease, age, sex, medical and psychiatric comorbidities, prior use of preventive dental services, tooth extraction and root canal therapy, and clustering by geographic region.

RESULTS

In the adjusted regression models, black patients and those with unknown race were less likely overall to receive root canal therapy than whites, whereas Asians were more likely. Among patients with eligibility for continuing and comprehensive dental care, blacks were less likely and Asians more likely to receive root canals than whites. For patients covered only for emergency dental care, Hispanics had a higher likelihood of receiving root canal therapy. Among all other types of coverage, there were no significant racial differences in the care received.

CONCLUSION

We observed substantial racial variations in the provision of root canal therapy among patients treated in Department of Veterans Affairs dental clinics. Future research should identify the causes of such variations.

Tooth retention as an indicator of quality dental care: development of a risk adjustment model

BACKGROUND

Retaining teeth improves oral health and quality of life. Thus, receipt of a root canal (vs. a tooth extraction) is a useful indicator of the quality of dental care. However, use of this quality measure without adjusting for the severity of oral disease could lead to spurious conclusions.

OBJECTIVES

This paper describes the development of a dental severity adjustment methodology.

RESEARCH DESIGN

Retrospective study.

SUBJECTS

54,423 users of Department of Veterans Affairs (VA) dental care who had either root canal therapy or a tooth extraction at a VA facility in Fiscal year 1998.

MEASURES

International Classification of Disease Clinical Modification codes for dental diagnoses and comorbid medical conditions. We modeled the effects of dental disease severity in logistic regression models of the probability of receiving a root canal, using both conceptual and Modified Delphi-Panel derived models, adjusting for age, and medical comorbidities.

RESULTS

Conceptual and Modified Delphi models performed similarly. The dental disease severity adjustments increased the fit in models of the probability of receiving a root canal (C-statistic = 0.822 for the conceptual model and 0.804 for the Modified Delphi Panel model) compared with the model including comorbid medical conditions alone (C-statistic = 0.561).

CONCLUSIONS

Risk adjustment for dental disease severity improves the fit of models of the probability of receiving a root canal. Studies of the quality of dental care should consider employing risk-adjusted models.

The paradox of dental need in a population-based study of dentate adults

BACKGROUND

Studies typically find that predisposing and enabling factors strongly predict dental utilization, but that need factors do not. However, few longitudinal studies have been conducted, and few have comprehensively measured dental need.

OBJECTIVES

To describe the paradox of dental need, and to test three hypotheses regarding need and dental care use.

MATERIALS AND METHODS

An observational study that included 873 persons who participated for interview and clinical examination at baseline and 24 months, with 6-month telephone interviews in between.

RESULTS

Persons who entered the dental care system during follow-up were actually in better dental health than those who did not. The ability of need factors to predict dental care use, and in which direction, varied with how dental need and the dental care use outcome were measured (eg, care of any type, problem-related care, to receive a dental cleaning, to get a dental checkup).

CONCLUSIONS

A substantial number of dental problems remained or developed among the population that did not enter the dental care system. The paradox of dental need has three components: (1) need predicts dental care use but is dependent upon how need is measured; (2) however, persons with a higher probability of new dental problems are actually less likely to seek dental care; and (3) self-reported disease and oral pain are associated with a higher likelihood of seeking care, whereas clinically-determined need, such as chewing difficulty, lower self-rating, and satisfaction with oral health, are actually associated with a lower likelihood, the former direction being the predominant and expected direction.

[The Bambuí Project: a population-based study of factors associated with regular utilization of dental services in adults]

A cross-sectional study was conducted in Bambuí, Minas Gerais, to identify factors associated with regular use of dental services. Participants were interviewed with a structured questionnaire and previously validated questions. 999/1,221 (81.8%) randomly selected individuals aged > 18 years participated in the Bambuí dental survey. Of these, 654 out of 656 individuals who had at least one natural tooth and had visited a dentist during their lifetime participated in the study. Results adjusted by multiple logistic regression showed that regular use of dental services was significantly related to having > 8 and 4-7 years of schooling (OR = 9.90; 95% CI = 2.90-33.77 and OR = 3.87; 95% CI = 1.11-13.51, respectively), having a preference for restorative treatment rather than extraction (OR = 4.91; 95% CI = 2.23-10.79), having no present need of dental treatment (OR = 4.87; 95% CI = 3.17-7.49), and belief that visiting the dentist prevents tooth decay and gum disease (OR = 1.73; 95% CI = 1.13-2.65). The results show that regular use of dental services was related to factors distributed in the Andersen and Newman model (1973) explaining use of dentistry services.

Self-reported and clinical oral health in users of VA health care

BACKGROUND

This article describes the oral health of users of Veterans Administration (VA) health care using both clinical and self-report measures, and models relationships between these measures and self-perceived oral health.

METHODS

We conducted a cross-sectional study of 538 male users of VA outpatient care in the Boston area. Questionnaires assessed self-reported oral health, oral-specific health-related quality of life, health behaviors, and sociodemographic information. Clinical data were collected on oral mucosa status, number of teeth and root tips, dental caries, and periodontal treatment need. We report clinical and self-reported oral health status by age group (era of military service). We regressed models of self-perceived oral health on clinical indices and self-reported measures of the impact of oral health on daily life, adjusting for sociodemographic characteristics and health behavior.

RESULTS

Among those participants aged 65 to 91 years old, 2.8%, 18.7%, and 41.5% rated their oral health as excellent, very good, or good, respectively. Among 50- to 64-year-old men, the corresponding values were 1.4%, 18.5%, and 40.4%, while among those aged 22 to 49 years old, the values were 2.3%, 17%, and 34.1%. Tooth loss was common among users of VA care; 34% of those aged 65-90 years, 28% of those aged 50-64 years, and 8% of those aged 25-49 years had no teeth. Periodontal treatment needs were uniformly high among persons with teeth; mild mucosal change was common, and 10% had root tips. Regression models showed self-perceived oral health was better in persons with more teeth and recent dental treatment, and worse with tooth mobility, coronal decay, and more medical problems. Measures of the impact of oral conditions on daily life added significantly to the amount of explained variance in self-perceived oral health.

CONCLUSIONS

Clinical conditions and the impact of oral health on daily life are important determinants of self-perceived oral health.

Evaluating the effect of usual source of dental care on access to dental services: comparisons among diverse populations

Data collected from the International Collaborative Study of Oral Health Outcomes USA (ICS-II) research locations were used to evaluate the relationship between having a usual source of dental care (USDC) and access to dental services. The robustness of the USDC effect after reducing simultaneity bias was tested in the population-based samples using sensitivity analysis. Logistic regression results provided evidence that USDC was the strongest and most consistent predictor of a dental visit in the past 12 months regardless of geographic location, dental care delivery system, or cultural diversity of the population. Even removing cases that had a USDC for less than 1 or 2 years, the effect remained. From a policy perspective, USDC remains critical to understanding and explaining dental are utilization patterns. The findings suggest the need for designing interventions to increase the availability of a regular provider among vulnerable populations.

Women's oral health awareness and care-seeking characteristics: a pilot study

The authors designed a pilot study to examine issues that affect women's oral health. They found a substantial lack of awareness regarding important oral health issues, and that 44 percent of the participants reportedly did not have regular dental care. High perceived dental need was reported concurrently with low dental care attendance. Additionally, reported lack of dental insurance and self-perception of low income and of poor dental health were important explanatory factors for the women who reportedly did not have regular dental care.

Determinants of dental care use in dentate adults: six-monthly use during a 24-month period in the Florida Dental Care Study

The objective of this study is to describe for a diverse sample of dentate adults the incidence of dental care use and predisposing, enabling, and need correlates of that use. The Florida Dental Care Study (FDCS) is a prospective longitudinal cohort study of persons who at baseline had at least one natural tooth, were 45 years or older, and who resided in north Florida, U.S.A. An in-person interview and clinical dental examination were conducted at baseline and 24 months after baseline, with 6-monthly telephone interviews between those times. Seventy-seven percent of subjects reported one or more dental visits during the 24 months of follow-up. Six-monthly use ranged from 46% to 55%. Incident perceived need for care and certain incident self-reported oral signs and symptoms were strongly predictive of incident dental care use. Decrements in oral functional limitation, oral disadvantage, and self-rated oral health were predictive of less care bivariately, but were not salient in a multivariate model, with two notable exceptions: two measures related to esthetics. The conclusions are that certain measures of need (perceived need and specific self-reported signs and symptoms) were important predictors of incident dental care. However, persons with need as determined by direct clinical examination and persons with need as determined by self-reported decrements in the more distal measures of oral health (oral functional limitation, oral disadvantage, and self-rated oral health) were actually less likely to seek dental care. The salience of esthetics in predicting use is consistent with cross-sectional findings that dental esthetic cues are important to oral "health". Typical approach to care, dental attitudes, ability to pay for care, race, and sex were also important for understanding incident dental care use.

Predisposing, enabling, and need for dental treatment characteristics of ICS-II USA ethnically diverse groups

Personal characteristics (predisposing, enabling, and need) are described for the population-based samples of adults interviewed in the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations. Differences in sample characteristics are compared by ethnic group (African-American, Native American, Hispanic, and White) and age cohort (35-44 and 65-74 years old) by means of Bonferroni multiple-means tests and Student's t tests. Differences in the personal characteristics of these diverse comparison groups abound. Bivariate results indicated that White adults from both age cohorts had higher socioeconomic levels, more positive self-rated health status, and greater proportions of individuals with dental benefits. Lakota adults from both age cohorts reported lower self-rated health status and were most likely to report total tooth loss. Hispanic persons were significantly less likely to report a usual source of dental care or dental benefits. Need for dental treatment (oral pain and oral symptoms index) was generally higher amng Native American and Hispanic groups. It is critical that the differences highlighted between the among these groups be studied in appropriate strategies for improving the oral health of USA adults are to be determined.

Dental health attitudes among dentate black and white adults

OBJECTIVES

Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use.

METHODS

As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried.

RESULTS

Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account.

CONCLUSIONS

Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.

Older Floridians' attitudes toward and use of dental care

Older Floridians (mean age 78 years) were interviewed regarding their use of dental care, attitudes toward dental care, and other characteristics hypothesized as being explanatory of dental care use. Fifty-two percent of respondents reported having been to a dentist within the past year, and 31% had not been within the previous 5 years. Five constructs measured attitudes toward dental care and dental health: (a) the importance placed on regular dental care and oral hygiene, (b) the importance of avoiding tobacco to prevent oral cancer, (c) the value of dental care, (d) negative aspects of dental care, and (e) satisfaction with the last dental visit. In a multivariate model, the value of dental care and importance of regular care and oral hygiene wer significantly correlated with dental care use. These findings are consistent with the conclusion that attitudes contribute to understanding dental care use in later life, a contribution that is independent of the direct effects of socioeconomic status and dentate status.