1
|
Cheng TC, Lo CC. Factors Associated with Insured Children's Use of Physician Visits, Dentist Visits, Hospital Care, and Prescribed Medications in the United States: An Application of Behavioral Model of Health-Services Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:427. [PMID: 38673338 PMCID: PMC11050310 DOI: 10.3390/ijerph21040427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
This study is the first to examine factors in the utilization of physician services, dentist services, hospital care, and prescribed medications focusing exclusively on insured children in the United States. Data describing 48,660 insured children were extracted from the 2021 National Survey of Children's Health. Children in the present sample were covered by private health insurance, public health insurance, or other health insurance. Logistic regression results showed self-reported health to be negatively associated with physician visits, hospital-care use, and prescription use, but teeth condition to be positively associated with dentist visits. Physician visits were associated negatively with age, Hispanic ethnicity, Asian ethnicity, family income at or below 200% of the federal poverty level, and other health insurance, but positively with parental education and metropolitan residency. Dentist visits were associated positively with girls, age, and parental education, but negatively with Asian ethnicity and public health insurance. Use of hospital care was associated negatively with age and Asian ethnicity, but positively with parental education and public health insurance. Use of prescriptions was associated positively with age, Black ethnicity, parental education, and public health insurance, but negatively with Hispanic ethnicity, Asian ethnicity, and family income at or below 200% of the federal poverty level. Implications included the expansion of public health insurance, promotion of awareness of medicine discount programs, and understanding of racial/ethnic minorities' cultural beliefs in health and treatment.
Collapse
Affiliation(s)
- Tyrone C. Cheng
- Little Hall, School of Social Work, University of Alabama, Tuscaloosa, AL 35401, USA
| | - Celia C. Lo
- Defense Personnel and Security Research Center, Peraton, Seaside, CA 93955, USA;
| |
Collapse
|
2
|
Kim A, Zhao L. Examining the effects of the Medicaid expansion on health outcomes. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Andrew Kim
- Central Michigan University Mount Pleasant Michigan USA
| | - Liang Zhao
- City University of New York Graduate Center New York City New York USA
| |
Collapse
|
3
|
Martin M, Frese W, Lumsden C, Sandoval A. Building a Pediatric Oral Health Training Curriculum for Community Health Workers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:e9-e18. [PMID: 28628586 PMCID: PMC5732891 DOI: 10.1097/phh.0000000000000582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Community health workers (CHWs) are a promising approach to oral health promotion in high-risk populations. This article describes the process of creating a pediatric oral health CHW training curriculum. DESIGN Existing curricula were identified through outreach efforts to experts in the oral health and CHW fields, as well as PubMed and Google searches. After coding basic information, curricula were mapped to define oral health domains. Then group discussion was employed to determine final curriculum contents. SETTING United States. INCLUSION CRITERIA Curricula were included if they addressed oral health, were in English or Spanish, involved US populations, did not target dental clinicians, and whether sufficient data could be obtained. MAIN OUTCOME MEASURES Curricula were evaluated for delivery format, number of hours, target audience, inclusion of CHWs, completeness, and oral health content. RESULTS Eighteen unique curricula were identified; 14 (78%) were CHW specific. Pathologic factors, caries formation, toothbrushing basics, flossing, nutrition, sugar-sweetened beverages, oral health recommendations, baby bottle tooth decay, fluoride treatments, and fluoride were covered to some extent in 75% of curricula. More than half did not mention types of teeth, oral health during pregnancy, antifluoride, cultural humility, and special needs populations. After comparing CHW curricula with non-CHW curricula, the original 26 oral health domains were condensed into 10 CHW training domains. CONCLUSION Using existing evidence and expert insight, an oral health CHW training curriculum outline was created that emphasizes behaviors, social support, and navigation assistance to promote preventive oral health behaviors in families of young children. This has implications beyond oral health. CHW programs are expanding to address the social determinants of health. The process of creating this curriculum and its basic elements can be applied to other disease areas. Clearly defined trainings that are made publicly available, such as this one, support efforts to standardize the CHW field in preparation for CHW certification and reimbursement in the future.
Collapse
Affiliation(s)
- Molly Martin
- Department of Pediatrics (Drs Martin and Frese) and Institute for Health Research and Policy (Dr Sandoval), University of Illinois at Chicago, Chicago, Illinois; and Section of Population Oral Health, Columbia University College of Dental Medicine, New York City, New York (Dr Lumsden)
| | | | | | | |
Collapse
|
4
|
Reich SM, Ochoa W, Gaona A, Salcedo Y, Espino Bardales G, Newhart V, Lin J, Díaz G. Disparities in Caregivers' Experiences at the Dentist With Their Young Child. Acad Pediatr 2019; 19:969-977. [PMID: 30904582 PMCID: PMC6828576 DOI: 10.1016/j.acap.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To understand the experiences of diverse families when taking their young children to the dentist and to document their prevalence. METHODS An exploratory sequential design was used. First, 4 focus groups (N = 33) comprised of low-income female caregivers of children under 6 years of age were conducted in English and Spanish. Discussions centered around facilitators and barriers to taking children to the dentist. Themes derived from the groups were then used to create a survey that was given to 1184 caregivers in English, Spanish, or Vietnamese. RESULTS Thematic coding of focus groups found little support for typically reported barriers to pediatric oral health care utilization (eg, transportation, cost, knowledge); instead, caregivers reported negative experiences (eg, restraint, separation) as barriers. In the surveys, 66% of caregivers reported being separated from their children, 25% reported that their children were restrained (53.7% for cleanings), 26% of children were given sedating medication for cleanings, and 22% of the caregivers reported experiences that made them not want to return to the dentist. The prevalence of these experiences differed significantly among Latino, Asian, and Caucasian families and for annual incomes under or above $50,000. CONCLUSIONS Families with lower incomes and/or from ethnic and linguistic minority groups were more likely to report negative experiences at the dentist than higher income and Caucasian families. These data document the high prevalence of negative experiences and suggest ethnic, financial, and linguistic disparities in the quality of experiences. More research is needed on the role of dentists in facilitating or hindering oral health care utilization among diverse families.
Collapse
Affiliation(s)
- Stephanie M Reich
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz),.
| | - Wendy Ochoa
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| | - Amy Gaona
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| | - Yesenia Salcedo
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| | | | - Veronica Newhart
- Department of Health Informatics (V Newhart), University of California, Irvine
| | - Joyce Lin
- Department of Human Development and Family Studies (J Lin), Purdue University, Lafayette, Ind
| | - Guadalupe Díaz
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| |
Collapse
|
5
|
Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23:e1-e9. [DOI: 10.1097/phh.0000000000000403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Amin MS, Perez A, Nyachhyon P. Parental awareness and dental attendance of children among African immigrants. J Immigr Minor Health 2016; 17:132-8. [PMID: 24057752 DOI: 10.1007/s10903-013-9912-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To assess parental awareness of their child's dental status and the relationship between parental awareness and children's dental attendance. Participants were children aged 6 years or younger and their African parents who had lived in Canada for up to 10 years. Demographics and parents' perceived dental status were collected. Children's normative dental status was determined by dental examinations. 125 pairs of parents and children aged 21-72 months were included. 52% of the children never had a dental visit. Dental status of 44% of children was rated as good by parents, among them, 56% had dental decay. Parental assessments did not coincide with the clinical assessments of 62% of children. No correlation was found between parental awareness and children's dental attendance. Children of African immigrants are at high risk for developing severe dental decay because of low parental awareness and lack of regular dental visits.
Collapse
Affiliation(s)
- Maryam S Amin
- Division of Pediatric Dentistry, University of Alberta, 5-513 Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, AB, T6G 1C9, Canada,
| | | | | |
Collapse
|
7
|
Chi DL, Momany ET, Mancl LA, Lindgren SD, Zinner SH, Steinman KJ. Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program. Am J Prev Med 2016; 50:609-615. [PMID: 26514624 PMCID: PMC4838561 DOI: 10.1016/j.amepre.2015.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/05/2015] [Accepted: 08/25/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities. METHODS Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015. RESULTS In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively). CONCLUSIONS Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care.
Collapse
Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington.
| | | | - Lloyd A Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | | | - Samuel H Zinner
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Kyle J Steinman
- Department of Neurology, University of Washington, and Seattle Children's Research Institute, Seattle, Washington
| |
Collapse
|
8
|
Lai H, Fann JCY, Yen AMF, Chen LS, Lai MH, Chiu SYH. Long-term effectiveness of school-based children oral hygiene program on oral health after 10-year follow-up. Community Dent Oral Epidemiol 2015; 44:209-15. [DOI: 10.1111/cdoe.12207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/16/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Hongmin Lai
- Department of Dentistry; Shuang-Ho Hospital; Taipei Medical University; New Taipei City Taiwan
- School of Dentistry; National Yang-Ming University; Taipei Taiwan
- School of Dentistry; College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Taiwan Dental Health Care Organization; Taipei Taiwan
| | | | - Amy Ming-Fang Yen
- School of Dentistry; College of Oral Medicine; Taipei Medical University; Taipei Taiwan
| | - Li-Sheng Chen
- School of Dentistry; College of Oral Medicine; Taipei Medical University; Taipei Taiwan
| | - Min-Hua Lai
- Taiwan Dental Health Care Organization; Taipei Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management; College of Management; Chang Gung University; Tao-Yuan Taiwan
| |
Collapse
|
9
|
Abstract
OBJECTIVE The unmet need for dental care is one of the greatest public health problems facing U.S. children. This issue is particularly concerning for children with special health care needs (CSHCN), who experience higher prevalence of unmet dental care needs. The primary purpose of this study was to investigate regional differences in unmet dental care needs for CSHCN. Using the Social Ecological Model as a framework, additional variables were analyzed for regional differences. It was hypothesized that (H1) unmet dental care needs would be high in the CSHCN population, (H2) there would be regional differences in unmet dental care needs in CSHCN, and (H3) there would be differences in specific individual, interpersonal (family), community (state), and policy level factors by region. METHODS Data were obtained from the 2009-2010 National Survey of CSHCN. SPSS was used for data management and analysis. RESULTS Each of the study hypotheses was supported for the sample of 40,242 CSHCN. The West region was more likely to have more unmet needs for preventive and specialized dental care in CSHCN than the reference region (Northeast). The South region followed the West region in unmet dental care needs. Statistically significant differences in individual, interpersonal (family), community (state) and policy factors were found by region. CONCLUSION Further research is recommended. Effective strategies that include policy to address unmet dental care needs at multiple levels of intervention are suggested.
Collapse
|
10
|
Lee JY, Divaris K, DeWalt DA, Baker AD, Gizlice Z, Rozier RG, Vann WF. Caregivers' health literacy and gaps in children's Medicaid enrollment: findings from the Carolina Oral Health Literacy Study. PLoS One 2014; 9:e110178. [PMID: 25303271 PMCID: PMC4193870 DOI: 10.1371/journal.pone.0110178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/18/2014] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Recent evidence supports a link between caregivers’ health literacy and their children’s health and use of health services. Disruptions in children’s health insurance coverage have been linked to poor health care and outcomes. We examined young children’s Medicaid enrollment patterns in a well-characterized cohort of child/caregivers dyads and investigated the association of caregivers’ low health literacy with the incidence of enrollment gaps. Methods We relied upon Medicaid enrollment data for 1208 children (mean age = 19 months) enrolled in the Carolina Oral Health Literacy project during 2008–09. The median follow-up was 25 months. Health literacy was measured using the Newest Vital Sign (NVS). Analyses relied on descriptive, bivariate, and multivariate methods based on Poisson modeling. Findings One-third of children experienced one or more enrollment gaps; most were short in duration (median = 5 months). The risk of gaps was inversely associated with caregivers’ age, with a 2% relative risk decrease for each added year. Low health literacy was associated with a modestly elevated risk increase [Incidence Rate Ratio (IRR) = 1.17 (95% confidence interval (CI) 0.88–1.57)] for enrollment disruptions; however, this estimate was substantially elevated among caregivers with less than a high school education [IRR = 1.52 (95% CI 0.99–2.35); homogeneity p<0.2]. Conclusions Our findings provide initial support for a possible role of caregivers’ health literacy as a determinant of children’s Medicaid enrollment gaps. Although the association between health literacy and enrollment gaps was not confirmed statistically, we found that it was markedly stronger among caregivers with low educational attainment. This population, as well as young caregivers, may be the most vulnerable to the negative effects of low health literacy.
Collapse
Affiliation(s)
- Jessica Y. Lee
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
| | - Kimon Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Darren A. DeWalt
- School of Medicine and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - A. Diane Baker
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - R. Gary Rozier
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - William F. Vann
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| |
Collapse
|
11
|
Machry RV, Tuchtenhagen S, Agostini BA, da Silva Teixeira CR, Piovesan C, Mendes FM, Ardenghi TM. Socioeconomic and psychosocial predictors of dental healthcare use among Brazilian preschool children. BMC Oral Health 2013; 13:60. [PMID: 24171711 PMCID: PMC3816203 DOI: 10.1186/1472-6831-13-60] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 10/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disparities in utilization of oral healthcare services have been attributed to socioeconomic and individual behavioral factors. Parents' socioeconomic status, demographics, schooling, and perceptions of oral health may influence their children's use of dental services. This cross-sectional study assessed the relationships between socioeconomic and psychosocial factors and the utilization of dental health services by children aged 1-5 years. METHODS Data were collected through clinical exams and a structured questionnaire administered during the National Day of Children's Vaccination. A Poisson regression model was used to estimate prevalence ratios and 95% confidence intervals. RESULTS Data were collected from a total of 478 children. Only 112 (23.68%) were found to have visited a dentist; 67.77% of those had seen the dentist for preventive care. Most (63.11%) used public rather than private services. The use of dental services varied according to parental socioeconomic status; children from low socioeconomic backgrounds and those whose parents rated their oral health as "poor" used dental services less frequently. The reason for visiting the dentist also varied with socioeconomic status, in that children of parents with poor socioeconomic status and who reported their child's oral health as "fair/poor" were less likely to have visited the dentist for preventive care. CONCLUSION This study demonstrated that psychosocial and socioeconomic factors are important predictors of the utilization of dental care services.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Thiago Machado Ardenghi
- Department of Stomatology, Federal University of Santa Maria, UFSM, Rua Cel, Niederauer 917/208, Santa Maria, RS, Brazil.
| |
Collapse
|
12
|
Ramraj CC, Quiñonez CR. Emergency room visits for dental problems among working poor Canadians. J Public Health Dent 2013; 73:210-6. [DOI: 10.1111/jphd.12015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 03/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Chantel C. Ramraj
- Discipline of Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - Carlos R. Quiñonez
- Discipline of Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| |
Collapse
|
13
|
Health insurance, socio-economic position and racial disparities in preventive dental visits in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:178-91. [PMID: 23282482 PMCID: PMC3564136 DOI: 10.3390/ijerph10010178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/25/2012] [Accepted: 12/25/2012] [Indexed: 11/17/2022]
Abstract
This study sought to determine the contributions of socio-economic position and health insurance enrollment in explaining racial disparities in preventive dental visits (PDVs) among South Africans. Data on the dentate adult population participating in the last South African Demographic and Health Survey conducted during 2003–2004 (n = 6,312) was used. Main outcome measure: Reporting making routine yearly PDVs as a preventive measure. Education, material wealth index and nutritional status indicated socio-economic position. Multi-level logistic regression analysis was conducted to determine the predictors of PDVs. A variant of Blinder-Oaxaca decomposition analysis was also conducted. Health insurance coverage was most common among Whites (70%) and least common among black Africans (10.1%) in South Africa. Similarly, a yearly PDV was most frequently reported by Whites (27.8%) and least frequently reported among black Africans (3.1%). Lower education and lower material wealth were associated with lower odds of making PDVs. There was significant interaction between location (urban/rural) and education (p = 0.010). The racial and socio-economic differences in PDVs observed in urban areas were not observed in rural areas. In the general dentate population, having health insurance significantly increased the odds of making PDVs (OR = 4.32; 3.04–6.14) and accounted for 40.3% of the White/non-White gap in the probability of making PDVs. Overall, socio-economic position and health insurance enrollments together accounted for 55.9% (95% CI = 44.9–67.8) of the White/non-White gap in PDVs. Interventions directed at improving both socio-economic position and insurance coverage of non-White South Africans are likely to significantly reduce racial disparities in PDVs.
Collapse
|
14
|
Chi DL, Leroux B. County-level determinants of dental utilization for Medicaid-enrolled children with chronic conditions: how does place affect use? Health Place 2012; 18:1422-9. [PMID: 22981229 DOI: 10.1016/j.healthplace.2012.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/11/2012] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
Abstract
Little is known about how place affects childrens' access to dental care. We analyzed data for 25,908 Iowa Medicaid-enrolled children with chronic conditions to identify the county-level determinants of dental utilization. Our analyses suggest that higher levels of poverty and designation as a dental health professional shortage area at the county-level are associated with lower probability of child-level dental use. There are significant interactions between child-level race/ethnicity and county-level poverty as well as between child-level disability and county-level unemployment. We present a new descriptive model on dental utilization that emphasizes county-level factors as well as interactions between county-level and child-level factors.
Collapse
Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195, USA.
| | | |
Collapse
|
15
|
Keeton V, Soleimanpour S, Brindis CD. School-based health centers in an era of health care reform: building on history. Curr Probl Pediatr Adolesc Health Care 2012; 42:132-56; discussion 157-8. [PMID: 22677513 PMCID: PMC3770486 DOI: 10.1016/j.cppeds.2012.03.002] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
School-based health centers (SBHCs) provide a variety of health care services to youth in a convenient and accessible environment. Over the past 40 years, the growth of SBHCs evolved from various public health needs to the development of a specific collaborative model of care that is sensitive to the unique needs of children and youth, as well as to vulnerable populations facing significant barriers to access. The SBHC model of health care comprises of on-school site health care delivery by an interdisciplinary team of health professionals, which can include primary care and mental health clinicians. Research has demonstrated the SBHCs' impacts on delivering preventive care, such as immunizations; managing chronic illnesses, such as asthma, obesity, and mental health conditions; providing reproductive health services for adolescents; and even improving youths' academic performance. Although evaluation of the SBHC model of care has been complicated, results have thus far demonstrated increased access to care, improved health and education outcomes, and high levels of satisfaction. Despite their proven success, SBHCs have consistently faced challenges in securing adequate funding for operations and developing effective financial systems for billing and reimbursement. Implementation of health care reform (The Patient Protection and Affordable Care Act [P.L. 111-148]) will profoundly affect the health care access and outcomes of children and youth, particularly vulnerable populations. The inclusion of funding for SBHCs in this legislation is momentous, as there continues to be increased demand and limited funding for affordable services. To better understand how this model of care has and could further help promote the health of our nation's youth, a review is presented of the history and growth of SBHCs and the literature demonstrating their impacts. It may not be feasible for SBHCs to be established in every school campus in the country. However, the lessons learned from the synergy of the health and school settings have major implications for the delivery of care for all providers concerned with improving the health and well-being of children and adolescents.
Collapse
Affiliation(s)
- Victoria Keeton
- Department of Family Health Care Nursing, University of California, San Francisco, California, USA
| | | | | |
Collapse
|
16
|
Chi DL, Momany ET, Neff J, Jones MP, Warren JJ, Slayton RL, Weber-Gasparoni K, Damiano PC. Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children. Med Care 2011; 49:180-92. [PMID: 21150799 PMCID: PMC3095041 DOI: 10.1097/mlr.0b013e3181f81c16] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although Medicaid-enrolled children with a chronic condition (CC) may be less likely to use dental care because of factors related to their CC, dental utilization for this population is poorly understood. OBJECTIVE To assess the relationship between CC status and CC severity, respectively, on dental utilization for Iowa Medicaid-enrolled children. RESEARCH DESIGN Retrospective cohort study of Iowa Medicaid data (January 1, 2003 to December 31, 2006). SUBJECTS Medicaid-enrolled children aged 3 to 14 (N = 71,115) years. MEASURES The 3M Corporation Clinical Risk Grouping methods were used to assess CC status (no/yes) and CC severity (episodic/life-long/malignancy/complex). The outcome variable was any dental utilization in 2006. Secondary outcomes included use of diagnostic, preventive, routine restorative, or complex restorative dental care. RESULTS After adjusting for model covariates, Iowa Medicaid-enrolled children with a CC were significantly more likely to use each type of dental care except routine restorative care (P = 0.86) than those without a CC, although the differences in the odds were small (4%-6%). Compared with Medicaid-enrolled children with an episodic CC, children with a life-long CC were less likely to use routine restorative care (P < 0.0001), children with a malignancy were more likely to use complex restorative care (P < 0.03), and children with a complex CC were less likely to use each type of dental care except complex restorative care (P = 0.97). CONCLUSIONS There were differences in dental utilization for Iowa Medicaid-enrolled children by CC status and CC severity. Children with complex CCs were the least likely to use dental care. Future research efforts should seek to understand why subgroups of Medicaid-enrolled children with a CC exhibit lower dental utilization.
Collapse
Affiliation(s)
- Donald L Chi
- Department of Dental Public Health Sciences, School of Dentistry, The University of Washington, Seattle, WA 98185, USA.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Paschal AM, Johnston J, Fisher MA, Ablah E, Sellers A, Walker K, Hsiao T. Examining the relationship between oral health issues and history of dental insurance among uninsured children. Prev Med 2010; 51:436-7. [PMID: 20655947 DOI: 10.1016/j.ypmed.2010.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/14/2010] [Accepted: 07/15/2010] [Indexed: 11/29/2022]
|
18
|
Ramirez JH, Arce R, Contreras A. Why must physicians know about oral diseases? TEACHING AND LEARNING IN MEDICINE 2010; 22:148-155. [PMID: 20614382 DOI: 10.1080/10401331003656744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Poor oral health reflects social inequalities, hence the prevention of oral diseases should be a priority in developed and underdeveloped countries around the world. Medical practitioners must play an active role in oral health promotion. SUMMARY Proper knowledge of oral diseases is crucial in medical practice due to the following reasons: (a) Periodontal disease is associated with multiple systemic conditions of medical interest, (b) a large number of systemic diseases have oral manifestations, (c) many drugs are associated with oral adverse drug reactions, (d) physicians are generally not sufficiently trained to detect oral cancer manifestations, (e) physicians could play a pivotal role in oral public health, and (f) early detection of oral diseases by physicians could improve the oral health status of the population. CONCLUSIONS Physicians need to get more involved in oral health promotion. Moreover, oral health education should be included in the curriculum of future medical students.
Collapse
Affiliation(s)
- Jorge Hernán Ramirez
- Peridontal Medicine Group, School of Dentistry, Universidad del Valle, Cali, Colombia.
| | | | | |
Collapse
|
19
|
Grineski SE, Staniswalis JG, Peng Y, Atkinson-Palombo C. Children's asthma hospitalizations and relative risk due to nitrogen dioxide (NO2): effect modification by race, ethnicity, and insurance status. ENVIRONMENTAL RESEARCH 2010; 110:178-88. [PMID: 19944410 PMCID: PMC2819647 DOI: 10.1016/j.envres.2009.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 10/25/2009] [Accepted: 10/28/2009] [Indexed: 05/18/2023]
Abstract
BACKGROUND This study explores the role of race, ethnicity, and insurance status in modifying the effects of air pollution on children's asthma hospitalizations in Phoenix, Arizona (US) between 2001 and 2003. While controlling for weather, interactions between nitrous dioxide (NO(2)) and race, ethnicity, and insurance status are used to predict relative risk for subgroups of children. METHODS The generalized logit regression model for nominal categorical data within a multinomial likelihood framework was used. This model is specifically suited to small counts and the reporting of 95% confidence intervals for the odds ratio of hospital admission for one group as compared to another. The odds ratio is known to approximate relative risk for rare events. RESULTS Several significant findings were found for race, ethnicity, and insurance status as modulators for the effect of NO(2) on children's risk for asthma hospitalization: (1) children without insurance have 1.4 (95% CI: 1.1-1.8) times higher risk of asthma admissions than those with private insurance at exceedances of 0.02 parts per million (ppm) of NO(2) above the seasonal mean; the same finding holds for children without insurance as compared to those with Medicaid; (2) black children have 2.1 (95% CI: 1.3-3.3) times higher risk of hospitalization than Hispanic children at seasonal mean NO(2) levels, but this disproportionate risk shrinks to 1.7 with exceedances of 0.02 ppm of NO(2) above the seasonal mean. Specific to finding (1) among those children without health insurance, Hispanic children have 2.1 (95% CI: 1.1-3.8) times higher risk of hospitalization than white children. Among all Hispanic children, those without health insurance have 1.9 (95% CI: 1.3-3.0) times greater risk than those with private insurance; the same finding holds for Hispanic children without insurance as compared to Hispanic children with Medicaid. Specific to finding (2), among children with private insurance, the disproportionate risk of black children as compared to Hispanic children is magnified by a factor of 1.3 (95% CI: 1.0-1.8) for exceedances of 0.02 ppm of NO(2) above the seasonal mean. CONCLUSIONS Although we cannot confirm a cause-effect relationship, this analysis suggests that increasing insurance enrollment for all children, and specifically Hispanic children, may reduce their disproportionate risk from exceedances of air pollution. There are few black children in Phoenix, so further studies are needed to investigate the increasing risk of black children with private insurance as compared to Hispanics at exceedances of NO(2).
Collapse
Affiliation(s)
- Sara E Grineski
- Department of Sociology and Anthropology, University of Texas at El Paso, TX, USA.
| | | | | | | |
Collapse
|
20
|
A comparison of medical and dental outcomes for Medicaid-insured and uninsured Medicaid-eligible children: a U.S. population-based study. J Am Dent Assoc 2010; 140:1403-12. [PMID: 19884400 DOI: 10.14219/jada.archive.2009.0078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In a population-based study of Medicaid-eligible children, the authors described and compared sociodemographic attributes, medical and dental health care utilization, and health status between Medicaid-insured and uninsured Medicaid-eligible children. METHODS The authors analyzed data from 2,491 poor Medicaid-eligible children 2 to 16 years of age who participated in the 1999-2004 National Health and Nutrition Examination Survey. They quantified the association of medical and dental health care utilization, health status and treatment needs with Medicaid insurance status by using multivariable logistic regression modeling, taking into account the complex survey design and sample weights. RESULTS Approximately 40 percent of Medicaid-eligible children were uninsured. Medicaid-insured children were more likely to have an annual physician visit but no more or less likely to have good general or oral health, asthma or dental caries, or treatment needs than were uninsured Medicaid-eligible children. Medicaid-insured older children (9-16 years old) were more likely to have an annual dentist visit than were uninsured Medicaid-eligible older children. CONCLUSIONS Children with Medicaid coverage were more likely to use health care services but no more or less likely to have good general health, good oral health, asthma treatment needs or dental treatment needs. PRACTICE IMPLICATIONS To improve health care use, more poor children need to be enrolled in Medicaid.
Collapse
|
21
|
Hallas D, Shelley D. Role of pediatric nurse practitioners in oral health care. Acad Pediatr 2009; 9:462-6. [PMID: 19945081 DOI: 10.1016/j.acap.2009.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 07/01/2009] [Accepted: 09/03/2009] [Indexed: 11/25/2022]
Abstract
Dental caries remain the most prevalent unmet health need in US children. Access to care is particularly problematic for poor children and is compounded by the shortage of dentists to meet the needs of this patient population. Expanding the roles of pediatricians, family physicians, and pediatric nurse practitioners (PNPs) who provide primary care services to children may be a strategy to address in this issue. Enhancements in current PNP education and certification processes are needed to support the expansion of oral health-related clinical responsibilities. Although oral health is included in the published curriculum for PNPs and certification exams require specific oral health knowledge, gaps in postgraduate training persist and few data document the extent to which current oral health-related educational goals are being achieved. We recommend enhancements in oral health education and research to evaluate curriculum innovations, the development of partnerships between stakeholder groups to leverage existing resources, and ongoing surveillance of oral health-related practice patterns among PNPs. Leadership at the national level is needed to develop policies that support curriculum changes and the implementation of oral health practice guidelines for PNPs that will improve access and reduce health disparities.
Collapse
Affiliation(s)
- Donna Hallas
- New York University College of Nursing at the College of Dentistry, New York, NY 10003, USA.
| | | |
Collapse
|
22
|
Milgrom P, Ly KA, Tut OK, Mancl L, Roberts MC, Briand K, Gancio MJ. Xylitol pediatric topical oral syrup to prevent dental caries: a double-blind randomized clinical trial of efficacy. ACTA ACUST UNITED AC 2009; 163:601-7. [PMID: 19581542 DOI: 10.1001/archpediatrics.2009.77] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a xylitol pediatric topical oral syrup to reduce the incidence of dental caries among very young children and to evaluate the effect of xylitol in reducing acute otitis media in a subsequent study. DESIGN Double-blind randomized controlled trial. SETTING Communities in the Republic of the Marshall Islands. PARTICIPANTS One hundred eight children aged 9 to 15 months were screened, and 100 were enrolled. Intervention Children were randomized to receive xylitol topical oral syrup (administered by their parents) twice a day (2 xylitol [4.00-g] doses and 1 sorbitol dose) (Xyl-2 x group) or thrice per day (3 xylitol [2.67-g] doses) (Xyl-3x group) vs a control syrup (1 xylitol [2.67-g] dose and 2 sorbitol doses) (control group). MAIN OUTCOME MEASURES The primary outcome end point of the study was the number of decayed primary teeth. A secondary outcome end point was the incidence of acute otitis media for reporting in a subsequent report. RESULTS Ninety-four children (mean [SD] age, 15.0 [2.7] months at randomization) with at least 1 follow-up examination were included in the intent-to-treat analysis. The mean (SD) follow-up period was 10.5 (2.2) months. Fifteen of 29 of the children in the control group (51.7%) had tooth decay compared with 13 of 32 children in the Xyl-3x group (40.6%) and eight of 33 children in the Xyl-2x group (24.2%). The mean (SD) numbers of decayed teeth were 1.9 (2.4) in the control group, 1.0 (1.4) in the Xyl-3x group, and 0.6 (1.1) in the Xyl-2x group. Compared with the control group, there were significantly fewer decayed teeth in the Xyl-2x group (relative risk, 0.30; 95% confidence interval, 0.13-0.66; P = .003) and in the Xyl-3x group (0.50; 0.26-0.96; P = .04). No statistical difference was noted between the 2 xylitol treatment groups (P = .22). CONCLUSION Xylitol oral syrup administered topically 2 or 3 times daily at a total daily dose of 8 g was effective in preventing early childhood caries.
Collapse
Affiliation(s)
- Peter Milgrom
- Northwest Center to Reduce Oral Health Disparities, Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle, WA 98195-7475, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Muirhead V, Quiñonez C, Figueiredo R, Locker D. Oral health disparities and food insecurity in working poor Canadians. Community Dent Oral Epidemiol 2009; 37:294-304. [DOI: 10.1111/j.1600-0528.2009.00479.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Chi D, Milgrom P. Preventive dental service utilization for Medicaid-enrolled children in New Hampshire: a comparison of care provided by pediatric dentists and general dentists. J Health Care Poor Underserved 2009; 20:458-72. [PMID: 19395842 DOI: 10.1353/hpu.0.0139] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this study, we compared preventive dental utilization through visits to a pediatric dentist (PD) vs. visits to a general dentist (GD) among Medicaid-enrolled children in New Hampshire (n = 12,964). Dental claims were analyzed using conditional logistic regression models. After adjusting for covariates, children seen by a PD were 51% more likely to have received fluoride treatment, 26% more likely to have had at least two dental examinations, and 19% more likely to have received a sealant than children seen by a GD. Overall, our results suggest that children seen by a PD were more likely to have received preventive services than those seen by a GD. Because Medicaid-enrolled children are at increased risk for poor oral health, policies should be enacted to ensure that high-risk children receive appropriate and regular prevention-oriented dental care.
Collapse
Affiliation(s)
- Donald Chi
- University of Iowa, College of Dentistry, Department of Pediatric Dentistry, Iowa City, USA
| | | |
Collapse
|
25
|
Brito A, Grant R, Overholt S, Aysola J, Pino I, Spalding SH, Prinz T, Redlener I. The enhanced medical home: the pediatric standard of care for medically underserved children. Adv Pediatr 2008; 55:9-28. [PMID: 19048725 DOI: 10.1016/j.yapd.2008.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Arturo Brito
- The Children's Health Fund, 215 West 125th Street, Suite 301, New York, NY 10017, USA.
| | | | | | | | | | | | | | | |
Collapse
|