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Serban N, Ma S, Yu J, Anderson A, Pospichel K, Solipuram SR, Tomar SL. Dental care access for children in the United States. J Public Health Dent 2024. [PMID: 39011783 DOI: 10.1111/jphd.12635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES To evaluate access to dental care for children in the United States. METHODS The study population included children in 48 states and the District of Columbia. Using multiple data sources, dental care access was estimated at the community level by matching dental care supply and demand using mathematical modeling accounting for access constraints. Outcome measures included percent-met demand, travel distance, and percentage of underserved and unserved communities. Multiple scenarios to improve Medicaid/CHIP participation of dentists were evaluated. RESULTS Medicaid-insured and CHIP-insured children exhibited lower access compared to those privately insured. The percent-met demand was lower than 50% for Medicaid-insured children and CHIP-insured children for 42 and 34 states, respectively. Percent-met demand was higher than 50% for private-insured children except for Texas and West Virginia. Increasing Medicaid/CHIP participation of dentists resulted in improving access for public-insured children. At 100% Medicaid/CHIP participation, all states exhibited different degrees of percent-met demand increase for publicly insured children, from 7% to 46%. The percent-met demand across all children ranged in 23.8%-82.9% under 70% participation rate versus 22%-83% under 100% participation rate. No single participation rate improved access for all children uniformly across all states. CONCLUSIONS This study found that dental care access was lower for children with public insurance than those with private access across all states, although states responded differently to changes in Medicaid/CHIP participation. Increasing access for children with public insurance would reduce disparities, but overall children's access to dental care would be better improved by expanding the oral health workforce.
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Affiliation(s)
- Nicoleta Serban
- Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Northwest Georgia, USA
| | - Simin Ma
- Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Northwest Georgia, USA
| | - Jiaxi Yu
- Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Northwest Georgia, USA
| | - Annalea Anderson
- Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Northwest Georgia, USA
| | - Katrine Pospichel
- Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Northwest Georgia, USA
| | - Shalini R Solipuram
- Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Northwest Georgia, USA
| | - Scott L Tomar
- Department of Prevention and Public Health Sciences, College of Dentistry, University of Illinois, Chicago, Illinois, USA
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Testa A, Jackson DB, Gutierrez C, Fahmy C, Maroufy V, Samper-Ternent R, Neumann AC. History of Incarceration and Dental Care Use Among Older Adults in the United States. Am J Prev Med 2024:S0749-3797(24)00223-X. [PMID: 38960292 DOI: 10.1016/j.amepre.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/26/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Dental care is a critical component of healthy aging; however, emerging evidence suggests that having been previously incarcerated is a risk factor for not using dental care services. This study investigates the relationship between prior incarceration and dental care among older adults and assesses whether wealth and dental insurance explain this relationship. METHODS Data are from the Health and Retirement Study, a nationally representative sample of community-dwelling older adults in the United States, collected in 2012 and 2014. Multivariable logistic regression is used to assess the relationship between a history of incarceration and dental care. Mediation analyses were conducted using the Karlson-Holm-Breen method of indirect effects in non-linear models. Statistical analyses were conducted from February to April 2024. RESULTS Adjusting for potential confounding variables, a respondent's prior incarceration is associated with a 25% lower odds of dental care use (adjusted odds ratio [aOR] = 0.748, 95% CI = 0.624, 0.896). The relationship between incarceration and dental care use is fully mediated-over 90% is explained by-wealth and having dental care insurance. Prior incarceration decreased the likelihood of dental care only among non-Hispanic White respondents. CONCLUSIONS The findings offer new evidence that prior incarceration is a risk factor for lacking the ability to utilize dental care among older adults and suggest that broader consequences of incarceration for wealth accumulation and access to dental insurance underpin this relationship. These results suggest the urgent need to expand access to affordable dental care services for older adults with a history of incarceration.
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Affiliation(s)
- Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carmen Gutierrez
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chantal Fahmy
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, Texas
| | - Vahed Maroufy
- Department of Biostatistics & Data Science, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rafael Samper-Ternent
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Ana C Neumann
- School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas
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Fleming E, Taylor GW, Neighbors HW. Systemic racism and racial inequities in periodontal health: The long journey from upstream determinants to downstream treatment. Periodontol 2000 2024. [PMID: 38501675 DOI: 10.1111/prd.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/11/2024] [Indexed: 03/20/2024]
Abstract
Racial disparities in the prevalence of periodontal disease are consistent and persistent. The epidemiology of periodontal disease demonstrates racial inequities: non-Hispanic Black (14.7%), Mexican American (13.4%), and other Hispanic adults (7.8%) experience a higher prevalence of severe periodontal disease than non-Hispanic White adults (5.9%). Epidemiologic and clinical research on periodontal health suffers from the same problem that has plagued the health equity movement, an over emphasis on describing racial inequities coupled with few interventions that reduce racial health inequity. Over the decades that racial inequities in periodontal disease have been observed, many have argued that systemic racism is the fundamental driver of racial health inequity. This paper interrogates the roles of systemic racism, dental education, clinical treatment, and patient behavior in periodontal disease. We describe how, together, these mechanisms contribute to racial disparities in periodontal outcomes. However, it is insufficient for oral health equity scientists to only describe and discuss the negative effects of systemic racism. The imperative is to create antiracist strategies designed to eliminate systemic racism. Health equity scientists must also specify how dental systems operate in a racist manner and create effective clinical strategies designed to reduce racial disparities in periodontal disease.
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Affiliation(s)
- Eleanor Fleming
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - George W Taylor
- Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, University of California San Francisco School of Dentistry, San Francisco, California, USA
| | - Harold Woody Neighbors
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Kranz AM, Evans LA, Geissler KH. Changes in dental visits and oral health for children by race and ethnicity during the COVID-19 pandemic. J Am Dent Assoc 2024; 155:195-203.e4. [PMID: 38206256 PMCID: PMC11476772 DOI: 10.1016/j.adaj.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The COVID-19 pandemic created new barriers to oral health care, which may worsen oral health and exacerbate disparities. The authors quantified changes in children's dental care receipt and oral health outcomes during the pandemic and examined differences among racial and ethnic groups. METHODS Using the National Survey of Children's Health (163,948 child observations from 2017-2021), the authors used weighted modified Poisson models to examine caregiver-reported receipt of a dental visit (for any reason and for preventive care) and adverse oral health outcomes (teeth in fair or poor condition; difficulty with toothaches, cavities, or bleeding gums) from 2017 through 2019 (prepandemic) compared with 2020 and 2021. The authors examined outcomes within and across racial and ethnic groups. RESULTS Children from all racial and ethnic groups experienced declines in receipt of dental visits, but there were limited changes in adverse oral health outcomes during 2020 and 2021. Prepandemic disparities in receipt of dental visits persisted for Black children and Asian children compared with White children. Hispanic children experienced larger increases in risk of experiencing both adverse oral health outcomes compared with White children in 2020 and in having teeth in fair or poor condition in 2021. CONCLUSIONS The pandemic did not create new disparities in receipt of dental visits or oral health outcomes, but disparities in care persisted, and the oral health of Hispanic children was affected differentially. PRACTICAL IMPLICATIONS Continued monitoring of dental visits and adverse oral health outcomes by race and ethnicity is critical to ensuring all children have access to oral health care. This information can help develop targeted interventions to improve children's oral health, including for minoritized racial and ethnic groups.
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Albandar JM. Disparities and social determinants of periodontal diseases. Periodontol 2000 2024. [PMID: 38217495 DOI: 10.1111/prd.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/08/2023] [Indexed: 01/15/2024]
Abstract
Periodontal diseases are highly prevalent in populations worldwide and are a major global public health problem, with major negative impacts on individuals and communities. This study investigates evidence of disparities in periodontal diseases by age groups, gender, and socioeconomic factors. There is ample evidence that these diseases disproportionally affect poorer and marginalized groups and are closely associated with certain demographics and socioeconomic status. Disparities in periodontal health are associated with social inequalities, which in turn are caused by old age, gender inequality, income and education gaps, access to health care, social class, and other factors. In health care, these factors may result in some individuals receiving better and more professional care compared to others. This study also reviews the potential causes of these disparities and the means to bridge the gap in disease prevalence. Identifying and implementing effective strategies to eliminate inequities among minorities and marginalized groups in oral health status and dental care should be prioritized in populations globally.
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Affiliation(s)
- Jasim M Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, Pennsylvania, USA
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Llaneza AJ, Holt A, Stephens L, Seward J. Native American Community Perspectives on Oral Health Access: Understanding the Impact of Rurality. Healthcare (Basel) 2023; 11:2788. [PMID: 37893863 PMCID: PMC10606298 DOI: 10.3390/healthcare11202788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Oral health disparities related to access persist for American Indian/Alaska Native (AI/AN) communities compared to the general population, especially in rural areas of the United States. The objective of this study was to better understand community perspectives of oral health, how rurality impacts access to care, and attitudes towards the implementation of dental therapists in Oklahoma, particularly among the AI/AN population. METHODS A descriptive, observational study design was utilized. An exploratory survey was conducted online and comprised of qualitative and quantitative data. The total frequencies and percentages were evaluated for the quantitative questions. The qualitative data was analyzed using thematic analysis. Utilizing descriptive and qualitative research methods, the focus was to describe the experiences of the respondents and their characteristics related to oral health in Oklahoma. RESULTS A total of 201 responses were obtained, where 65% (n = 131) identified as an enrolled member or employee of a tribe represented in Oklahoma. Key qualitative themes included community access to care, community concerns, and community motivated solutions. CONCLUSIONS AI/AN communities are an underserved group in healthcare. Although communities in rural areas face major barriers to oral health services, evidence-based solutions can be implemented.
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Affiliation(s)
- Amanda J. Llaneza
- Southern Plains Tribal Health Board, Oklahoma City, OK 73114, USA; (A.J.L.); (A.H.)
| | - Alex Holt
- Southern Plains Tribal Health Board, Oklahoma City, OK 73114, USA; (A.J.L.); (A.H.)
| | - Lancer Stephens
- Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Julie Seward
- Southern Plains Tribal Health Board, Oklahoma City, OK 73114, USA; (A.J.L.); (A.H.)
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Testa A, Lee JG, Jackson DB, Mungia R, Ganson KT, Nagata JM. Physical intimate partner violence and prenatal oral health experiences in the United States. BMC Oral Health 2023; 23:749. [PMID: 37828499 PMCID: PMC10568803 DOI: 10.1186/s12903-023-03491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a significant public health issue, and when experienced during pregnancy, IPV substantially harms maternal health. Still, limited research has examined how IPV may influence prenatal oral health and dental care utilization. This study investigates the relationship between IPV during pregnancy and women's oral health experiences. DATA Data are from 31 states from 2016-2019 in the United States that participated in the Pregnancy Risk Assessment Monitoring System (N = 85,289)-a population-based surveillance system of live births conducted annually by the Centers for Disease Control and Prevention and state health departments. Multivariable logistic regression analyses were used to examine the association between physical IPV during pregnancy (measured by being pushed, hit, slapped, kicked, choked, or physically hurt any other way by a current or ex-husband/partner) and various oral health experiences. FINDINGS Women who experienced prenatal physical IPV reported worse oral health experiences during pregnancy, including being more likely to report not knowing it was important to care for their teeth, not talking about dental health with a provider, needing to see a dentist for a problem, going to see a dentist for a problem, as well as having more unmet dental care needs. CONCLUSIONS Together, these findings indicate that women who experience physical IPV during pregnancy have lower knowledge of prenatal oral health care, more oral health problems, and greater unmet dental care needs. Given the risk of IPV and oral health problems for maternal and infant health, the study findings point to greater attention toward the oral health needs of IPV-exposed pregnant women.
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Affiliation(s)
- Alexander Testa
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jacqueline G Lee
- Department of Criminal Justice, Boise State University, Boise, ID, USA
| | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rahma Mungia
- School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
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