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Banihashem Rad SA, Esteves-Oliveira M, Maklennan A, Douglas GVA, Castiglia P, Campus G. Oral health inequalities in immigrant populations worldwide: a scoping review of dental caries and periodontal disease prevalence. BMC Public Health 2024; 24:1968. [PMID: 39044172 PMCID: PMC11267954 DOI: 10.1186/s12889-024-19354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 07/03/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Inequalities in immigrants' oral health are often masked in population-level data. Therefore, this paper was planned to assess the prevalence data on oral health diseases, namely dental caries, and periodontitis, among immigrants worldwide. METHODS Following a systematic search in Scopus, Embase, and PubMed for studies published between 2011 and 2023, 1342 records were identified. Following title and abstract screening, 76 studies remained for full-text eligibility-screening based on predefined inclusion criteria. Thirty-two studies were included in the review. RESULTS Dental caries figures were higher in immigrant populations compared to the local population, regardless of host countries, age, gender, or nationality. In children, the overall mean and standard deviation (SD) for decayed, missing, and filled teeth in the primary dentition (d3mft) was 3.63(2.47), and for D3MFT (permanent dentition), it was 1.7(1.2). Upon comparing overall mean caries counts in children and adults with their control groups in the included studies, untreated dental caries (D3T and d3t) constituted the dominant share of caries experience (D3MFT and d3mft) in immigrant children. For the local population, the highest proportion of caries experience was attributed to filled teeth (FT and ft). Dentin caries prevalence among immigrants ranged from 22% to 88.7% in the primary dentition and 5.6% to 90.9% in the permanent dentition. Gingivitis ranged from 5.1% to 100%. Oral health varied greatly between studies. Regarding oral health accessibility, 52% to 88% of immigrant children had never been to a dentist, suggesting a very limited level of accessibility to dental health services. CONCLUSION It is imperative to develop interventions and policies that have been customized to address the oral health disparities experienced by immigrant populations. Additionally, host countries should actively implement measures aimed at enhancing the accessibility of oral health care services for these individuals. The utilization of available data is crucial in establishing a hierarchy of objectives aimed at enhancing the oral health of immigrant populations. TRIAL REGISTRATION The Scoping review protocol was registered at OSF Registries with registration number ( https://doi.org/10.17605/OSF.IO/MYXS4 ).
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Affiliation(s)
- Seyed Ahmad Banihashem Rad
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, Bern, 3012, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Marcella Esteves-Oliveira
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, Bern, 3012, Switzerland
- Department of Restorative Dentistry and Endodontology, Justus-Liebig-University Giessen, Giessen, Germany
- Department of Conservative Dentistry, Periodontology and Endodontology, Oral Medicine and Maxillofacial Surgery (UZMK), University Centre of Dentistry, University of Tübingen, Tübingen, Germany
| | - Anastasia Maklennan
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, Bern, 3012, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Gail V A Douglas
- Department of Dental Public Health, University of Leeds School of Dentistry, Leeds, UK
| | - Paolo Castiglia
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, Bern, 3012, Switzerland
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Department of Cariology, Saveetha Dental College and Hospitals, SIMATS, Chennai, 600077, India
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Van Dam L, Diab E, Johnson J. Canadian immigrants' oral health and oral health care providers' cultural competence capacity. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2024; 58:34-47. [PMID: 38505317 PMCID: PMC10946319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/23/2023] [Accepted: 11/22/2023] [Indexed: 03/21/2024]
Abstract
Background Immigrants to Canada count among the socially disadvantaged groups experiencing higher rates of oral disease. Culturally competent oral health care providers (OHCPs) stand to be allies for immigrant oral health. The literature reveals limited knowledge of practising OHCPs' cultural competency, and little synthesis of the topic has been completed. A scoping review is warranted to identify and map current knowledge of OHCPs' understanding of culturally competent care along with barriers and facilitators to developing capacity. Methods This study was conducted between December 2022 and April 2023 using Arksey and O'Malley's 5-step framework and PRISMA-ScR checklist. Four databases were searched using keywords related to 4 themes: population, provider, oral health, and cultural competence. Peer-reviewed articles published in English in the last 10 years were included. Results Search results yielded 74 articles. Title and abstract review was completed and an author-developed critical appraisal tool was applied. Forty-six (46) articles were subject to full-text review and 14 met eligibility criteria: 7 qualitative and 7 quantitative. Six barriers and six facilitators at individual and systemic levels were identified, affecting oral care for immigrants and providers' ability to work cross-culturally. Discussion Lack of cultural or linguistically appropriate resources, guidance, and structural supports were identified as contributing to low utilization of services and to lack of familiarity between providers and immigrants. Conclusion OHCPs' cultural competency development is required to improve oral health care access and outcomes for diverse populations. Further research is warranted to identify factors impeding OHCPs' capacity to provide culturally sensitive care. Intentional policy development and knowledge mobilization are needed.
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Affiliation(s)
- Lindsay Van Dam
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Elizabet Diab
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Johnson
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
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Doucette H, Yang S, Spina M. The impact of culture on new Asian immigrants' access to oral health care: a scoping review. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2023; 57:33-43. [PMID: 36968804 PMCID: PMC10032640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 03/29/2023]
Abstract
Background Immigration has accounted for three-quarters of Canada's population growth since 2016, more than half of which has been from Asian countries. Newcomers from Asia have been reported to experience oral health disparities. The objective of this scoping review was to examine the literature discussing how culture affects access to oral health care for new immigrants from Asia and to identify knowledge gaps. Methods The review was conducted from December 2021 to April 2022 following the Arskey and O'Malley approach and PRISMA-ScR guideline. Five databases were searched using the search parameter "Asian+ AND Immigrant+ AND oral care+". Only peer-reviewed articles published in English between 2011 and 2021 were included. Results The search strategy yielded 736 articles. Duplicates were removed, titles and abstracts were reviewed, and the full text of 69 articles examined, leaving 26 articles that met eligibility criteria: 18 quantitative studies, 4 qualitative studies, and 4 reviews. Discussion Four themes were identified: language barriers, oral health care access and service utilization, oral health beliefs and behaviour, and immigrant children's oral health. Most new immigrants from Asia have limited English proficiency, are of low socioeconomic status, and have difficulty developing trusting relationships with care providers. Immigrant children's oral health is impacted by their parents' beliefs. Conclusion More research is needed on cultural barriers to and facilitators of access to oral health care for newcomers from Asia to Canada to aid in the development and implementation of policies and to inform practice and curriculum.
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Affiliation(s)
- Heather Doucette
- *School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Sijie Yang
- §Alumna, Dental Hygiene Degree Program, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
- =These authors contributed equally.
| | - Miriam Spina
- §Alumna, Dental Hygiene Degree Program, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
- =These authors contributed equally.
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Wang J, Zhao J, Tian T, Jiang X, Li H, Pang M, Kong F. The effects of oral health and social support on health-related quality of life of migrant older with children in Weifang, China. BMC Public Health 2022; 22:1505. [PMID: 35933414 PMCID: PMC9357308 DOI: 10.1186/s12889-022-13843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background With the accelerated urbanization and aging population in China, more and more migrant older with children (MOC) moved to new cities. Previous studies mainly explored the acculturation of MOC, yet few focused on the health conditions of this vulnerable group. This study aimed to investigate the effects of oral health and social support on health-related quality of life (HRQOL) of MOC in Weifang, China. Method This study was a cross-sectional study and participants were selected by multi-stage cluster random sampling in Weifang, China. The HRQOL was assessed via the 12-item Short-Form Health Survey (SF-12) which included the mental component summary (MCS) and the physical component summary (PCS). The oral health was evaluated by the Geriatric Oral Health Assessment Index (GOHAI). The social support was administered using the Social Support Rating Scale (SSRS). Descriptive analysis was used to describe participants’ sociodemographic variables, oral health and social support. Univariate analysis and binary logistic regression analysis was used to investigate the association between the social support, oral health and HRQOL. Results and discussion It was found that 25.0% of MOC were defined as MCS poor and PCS poor, respectively. Those participants with average and low monthly household income compared to those around them, average and poor oral health, and low levels of social support were more likely to have poor PCS. Those with temporary residence permits, fair and poor oral health, and medium and low levels of social support were more likely to report poor MCS. Conclusion Results indicated that better social support and oral health led to higher HRQOL of MOC. Implications for the government, communities and families of MOC were given to improve their HRQOL. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13843-0.
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Affiliation(s)
- Jieru Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Jinfeng Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Tingting Tian
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Xiaoxu Jiang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Hexian Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Mingli Pang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Fanlei Kong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
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Agudelo-Suárez AA, Muñoz-Pino N, Vivares-Builes AM, Ronda-Pérez E. Oral Health and Oral Health Service Utilization in Native and Immigrant Population: A Cross-Sectional Analysis from the PELFI Cohort in Spain. J Immigr Minor Health 2021; 22:484-493. [PMID: 31919785 DOI: 10.1007/s10903-020-00972-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study analyzes associated factors to self-perceived oral health and use of oral health services in native and immigrant adults from the PELFI cohort in Spain. A cross-sectional analysis was conducted (401 adults ≥ 18 years, from Spain, Ecuador, Colombia and Morocco). Frequencies for sociodemographic, self-perceived general and oral health variables were calculated. The association between oral health/oral health services use and origin country was estimated by logistic regression (adjusted odds ratio-aOR-; 95% confidence intervals -95%CI-). Ecuadorian men were more likely to report dental caries (aPR 2.75; 95%CI 1.30-5.80) and Moroccan women were more likely to report gingival bleeding (aPR 3.61; 95%CI 1.83-7.15) and the use of oral health services ≥ 1 year/never (aPR 1.69; 95%CI 1.06-2.69). Colombian women were less likely to report missing teeth (aPR 0.73; 95%CI 0.56-0.95). Poor self-perceived oral health indicators were observed in immigrants and were modified for sociodemographic and general health variables.
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Affiliation(s)
- Andrés A Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Calle 70 N° 52-21, 05010, Medellín, Antioquia, Colombia. .,Public Health Research Group, University of Alicante, Alicante, Spain.
| | - Natalia Muñoz-Pino
- Faculty of Dentistry, University of Antioquia, Calle 70 N° 52-21, 05010, Medellín, Antioquia, Colombia
| | - Annie M Vivares-Builes
- Faculty of Dentistry, University of Antioquia, Calle 70 N° 52-21, 05010, Medellín, Antioquia, Colombia
| | - Elena Ronda-Pérez
- Public Health Research Group, University of Alicante, Alicante, Spain.,Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Psychological sense of community and oral health problems among older Chinese Americans: Family reunification matters. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wu B, Mao W, Qi X, Pei Y. Immigration and Oral Health in Older Adults: An Integrative Approach. J Dent Res 2021; 100:686-692. [PMID: 33541196 DOI: 10.1177/0022034521990649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to develop an integrative framework on aging, immigration, and oral health. The methodology was a critical review that used immigration as a social determinant framework through which to evaluate its impact on the oral health of older immigrants. We reviewed recent empirical evidence on factors related to oral health in older immigrants. In a systematic search across multiple databases, we identified 12 eligible studies in this review. Among the eligible studies, most were conducted among East Asian immigrants (8 articles), followed by non-Hispanic White/European origin (2 articles), Mexican origins (1 article), and Iran and other Middle East regions (1 article). The research revealed knowledge gaps in the evidence base, including the dynamic relationship between acculturation and oral health, the role of environmental factors on oral health for immigrants, psychosocial stressors and their relationship with oral health, and oral health literacy, norms, and attitude to dental care utilization and oral hygiene practices. The development of the integrative framework suggests the pathways/mechanisms through which immigration exerts influences on oral health in later life. This provides opportunities for researchers, practitioners, and policy makers to gain greater insights into the complex associations between immigration and oral health among older adults.
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Affiliation(s)
- B Wu
- Rory Meyers College of Nursing and College of Dentistry, New York University, New York, NY, USA
| | - W Mao
- School of Social Work, University of Nevada, Reno, NV, USA
| | - X Qi
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Y Pei
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Northridge ME, Wu Y, Troxel AB, Min D, Liu R, Liang LJ, Metcalf SS, Seyedzadeh Sabounchi S, Yi S. Acceptability of a community health worker intervention to improve the oral health of older Chinese Americans: A pilot study. Gerodontology 2020; 38:117-122. [PMID: 33368603 DOI: 10.1111/ger.12522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/01/2020] [Accepted: 12/12/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the acceptability of a community health worker (CHW) intervention designed to improve the oral health of low-income, urban Chinese immigrant adults. BACKGROUND Given that both dental caries and periodontitis are behaviourally mediated, biofilm-based diseases that are largely preventable with attention to regular oral hygiene practices and preventive dental visits, strategies to arrest or even heal carious lesions and high-quality maintenance care and plaque control without the need to resort to aerosol-generating surgical approaches are evidence-based best practices. Older immigrants have poorer oral health than older US-born natives, motivating the need for delivery of more effective and affordable services to this vulnerable population. MATERIALS AND METHODS CHWs were trained by the NYU College of Dentistry dental hygienist faculty members using dental models and flip charts to instruct patients on proper brushing and flossing techniques. In addition, they discussed the presented oral health promotion information one-on-one with patients, addressed any expressed concerns and encouraged prevention of oral conditions through regular dental visits and brushing with fluoride toothpaste. RESULTS More than 98% of the 74 older Chinese adult participants strongly agreed/agreed that the CHWs helped them to improve how they take care of their health, the CHWs answered their questions and concerns, the information and topics were informative, and the in-person demonstrations were helpful in improving oral health. CONCLUSION The health of all communities depends on access to comprehensive care, including oral health care, in the wake of COVID-19. CHW interventions are acceptable to and may reach marginalised and immigrant communities.
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Affiliation(s)
- Mary E Northridge
- Division of Dental Medicine, Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Yinxiang Wu
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Andrea B Troxel
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Deborah Min
- Division of Health and Behavior, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Rong Liu
- Division of Health and Behavior, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Li Juan Liang
- Division of Health and Behavior, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Sara S Metcalf
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Shabnam Seyedzadeh Sabounchi
- Division of Dental Medicine, Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Stella Yi
- Division of Health and Behavior, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Taylor EV, Vaidyanathan A, Flanders WD, Murphy M, Spencer M, Noe RS. Differences in Heat-Related Mortality by Citizenship Status: United States, 2005-2014. Am J Public Health 2018; 108:S131-S136. [PMID: 29072944 PMCID: PMC5920731 DOI: 10.2105/ajph.2017.304006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether non-US citizens have a higher mortality risk of heat-related deaths than do US citizens. METHODS We used place of residence reported in mortality data from the National Vital Statistics System from 2005 to 2014 as a proxy for citizenship to examine differences in heat-related deaths between non-US and US citizens. Estimates from the US Census Bureau American Community Survey of self-reported citizenship status and place of birth provided the numbers for the study population. We calculated the standardized mortality ratio and relative risk for heat-related deaths between non-US and US citizens nationally. RESULTS Heat-related deaths accounted for 2.23% (n = 999) of deaths among non-US citizens and 0.02% (n = 4196) of deaths among US citizens. The age-adjusted standardized mortality ratio for non-US citizens compared with US citizens was 3.4 (95% confidence ratio [CI] = 3.2, 3.6). This risk was higher for Hispanic non-US citizens (risk ratio [RR] = 3.6; 95% CI = 3.2, 3.9) and non-US citizens aged 18 to 24 years (RR = 20.6; 95% CI = 16.5, 25.7). CONCLUSIONS We found an increased mortality risk among non-US citizens compared with US citizens for heat-related deaths, especially those younger and of Hispanic ethnicity.
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Affiliation(s)
- Ethel V Taylor
- Ethel V. Taylor, Ambarish Vaidyanathan, W. Dana Flanders, Matthew Murphy, and Rebecca S. Noe are with the Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Merianne Spencer is with the Division of Vital Statistics, National Center for Health Statistics, CDC, Hyattsville, MD
| | - Ambarish Vaidyanathan
- Ethel V. Taylor, Ambarish Vaidyanathan, W. Dana Flanders, Matthew Murphy, and Rebecca S. Noe are with the Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Merianne Spencer is with the Division of Vital Statistics, National Center for Health Statistics, CDC, Hyattsville, MD
| | - W Dana Flanders
- Ethel V. Taylor, Ambarish Vaidyanathan, W. Dana Flanders, Matthew Murphy, and Rebecca S. Noe are with the Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Merianne Spencer is with the Division of Vital Statistics, National Center for Health Statistics, CDC, Hyattsville, MD
| | - Matthew Murphy
- Ethel V. Taylor, Ambarish Vaidyanathan, W. Dana Flanders, Matthew Murphy, and Rebecca S. Noe are with the Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Merianne Spencer is with the Division of Vital Statistics, National Center for Health Statistics, CDC, Hyattsville, MD
| | - Merianne Spencer
- Ethel V. Taylor, Ambarish Vaidyanathan, W. Dana Flanders, Matthew Murphy, and Rebecca S. Noe are with the Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Merianne Spencer is with the Division of Vital Statistics, National Center for Health Statistics, CDC, Hyattsville, MD
| | - Rebecca S Noe
- Ethel V. Taylor, Ambarish Vaidyanathan, W. Dana Flanders, Matthew Murphy, and Rebecca S. Noe are with the Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Merianne Spencer is with the Division of Vital Statistics, National Center for Health Statistics, CDC, Hyattsville, MD
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