Oral health and use of dental services among Hispanics

Acculturation and Dental Care-Related Anxiety: An Exploratory Assessment from the Hispanic Community Health Study / Study of Latinos

This study aimed to determine the associations between acculturation, dental anxiety, and dental utilization among Hispanics/Latinos living in the US. A proxy measure of dental anxiety was available for 7539 adults who had not visited a dentist within the last year. All completed the Short Acculturation Scale for Hispanics (SASH). Bivariate logistic regression and adjusted multivariable logistic regression analysis were conducted. Approximately 22% of the sample was dentally anxious. Dental anxiety was significantly associated with SASH language scale score (OR 1.09, 95%CI 1.02, 1.18, p = 0.04), years in US (OR 1.53, 95%CI 1.23, 1.91, p < 0.0001), and preferred Spanish language (OR 1.30, 95%CI 1.05, 1.63, p = 0.0192); lower acculturation corresponded to higher dental anxiety. Adjusting for sex, age, education, income, insurance, and oral health status, level of acculturation was associated with dental anxiety (AOR 0.87, 95%CI 0.75, 0.91, p = 0.009), but neither were associated with utilization. Acculturation may be an important predictor of dental anxiety for Hispanics/Latinos living in the US.

The interactive effects of oral health literacy and acculturation on dental care use among Hispanic adults

Objective

Assess whether there is an interactive effect between oral health literacy and acculturation on dental care use for Hispanic adults.

Methods

Self‐identifying Hispanic adults participated in this observational study (N = 338). Oral health literacy (low vs. high) was measured using the Comprehensive Measure of Oral Health Knowledge (CMOHK). Acculturation (low vs. high) was measured using the Short Acculturation Scale for Hispanics (SASH) and operationalized a second way by the language in which the survey was completed (English or Spanish). The outcome was dental care use in the past year (yes/no). Confounder‐adjusted modified Poisson regression models were run to generate risk ratios (RR) and to test the hypothesis that participants with high oral health literacy and high acculturation would be more likely to have used dental care in the past year than participants with low oral health literacy and low acculturation.

Results

About 65% of participants used dental care in the past year. The final models failed to show that participants with high oral health literacy and high acculturation were more likely to have used dental care than other participants. However, in the language proxy interaction model, participants with high oral health literacy and low acculturation were significantly more likely to have used dental care than participants with low oral health literacy and low acculturation.

Conclusion

There may be an interaction between oral health literacy and acculturation when modeling dental care use for Hispanic adults that should be further explored.

Informal caregivers' perceptions of oral care and their association with the use of oral health services: A cross‐sectional study among informal caregivers and their care recipients

Objective

This study aimed to describe informal caregivers' perceptions of the importance of oral care and investigate the association between these perceptions and the use of oral health services during the past year.

Background

There is limited research on informal caregivers' perceptions of oral care. These perceptions presumably influence oral self‐care along with caregivers' and care recipients' use of oral health services.

Materials and Methods

Baseline data from the multidisciplinary Lifestyle, Nutrition, and Oral health in caregivers (LENTO) intervention study were analyzed. Informal caregivers (n = 125) and care recipients (n = 120) ≥65 years of age and living in Eastern Finland participated in the study. Data were collected through semi‐structured interviews.

Results

A majority (81%) of the informal caregivers considered oral care very important. Informal caregivers who considered oral care very important had 10 or more years of education, and considered service fees reasonable were more likely to have visited oral health services during the past year than other caregivers. No association between informal caregivers' perceptions of oral care and care recipients' use of oral health services during the past year was observed.

Conclusions

The study provides insight into informal caregivers' perceptions of oral care, with most informal caregivers considering oral care to be very important. Our findings support what has been reported in previous studies in that favorable perceptions of oral care are associated with oral health service visits. This association, however, did not hold true for care recipients' use of services.

Addressing social determinants of oral health, structural racism and discrimination and intersectionality among immigrant and non-English speaking Hispanics in the United States

Background

The Hispanic population is the largest (18.5%) and fastest growing non‐majority ethnic group in the United States (US), about half of whom are non‐US born, and bears one of the highest oral disease burdens. Most current knowledge around oral health disparities in Hispanic populations examine the individual factors of culture, acculturation, and socioeconomic status. However, the root causes of this inequity; oral health literacy (OHL), social determinants of health (SDOH), structural racism and discrimination (SRD) and the intersectionality among the three, have not been well‐studied. Addressing this critical gap will be central to advancing health equity and reducing oral health‐related disparities in the Hispanic population, especially among immigrant and non‐English speaking Hispanics.

Results

Recommendations for future OHL/SDOH/SRD‐related research in oral health targeting Hispanic populations should include: (1) examining the direct and indirect effects of OHL/SDOH/SRD‐related factors and intersectionality, (2) assessing the impact of SRD on oral health using zip‐code level measures, (3) examining the role of OHL and SDOH as potential effect modifiers on the relationship between SRD and oral health outcomes, (4) conducting secondary data analysis to identify demographic, social and structural‐level variables and correlations between and among variables to predict oral health outcomes, and (5) obtaining a deeper understanding of how OHL/SDOH and SRD factors are experienced among Hispanic immigrant and migrant populations.

Conclusion

It is hoped these recommendations will lead to a better understanding of the mechanisms through which OHL, SDOH and SRD impact oral health outcomes among the largest minority population in the US so they can be addressed.

Men and Oral Health: A Review of Sex and Gender Differences

Sex and gender related health disparities in oral health remain an underappreciated and often over looked aspect of well-being. The goal of this narrative review is to identify sex and gender related oral health disparities by summarizing the current literature related to differences in oral health between men and women. The review identified that men are more likely to: ignore their oral health, have poorer oral hygiene habits, and experience higher rates of periodontal disease, oral cancer, and dental trauma. Men also visit dentists less frequently and compared to women seek oral treatment more often for an acute problem and less often for disease prevention. Women exhibit more positive attitudes about dental visits, greater oral health literacy, and demonstrate better oral health behaviors than men. Men disproportionately develop periodontal diseases due to a combination of biological and gender related reasons including immune system factors, hormone differences, poorer oral hygiene behaviors, and greater tobacco use. There is a male to female ratio of 2:1 for oral cancer, largely attributable to more tobacco use, heavier use of alcohol, and longer sun exposure. Minority men experience a disproportionate burden of oral health disparities because of both their gender and race/ethnic identities. In conclusion, this review identifies several differences between men and women related to oral health and highlights the need for further research to better understand these disparities and how to incorporate them into developing prevention, education and treatment strategies to improve oral health in men.

Impact of acculturation on oral health among immigrants and ethnic minorities: A systematic review

OBJECTIVE

Cultural changes faced by immigrants and ethnic minorities after moving to a host country may have a detrimental or beneficial influence on their oral health and oral health-related behaviors. Therefore, this paper reviews the literature to see the impact of acculturation on immigrants and ethnic minorities' oral health outcomes.

METHODS

We searched seven electronic databases up to January 2018. All cross-sectional and longitudinal quantitative studies that examined associations between acculturation and oral health status and/or oral health behaviors among ethnic minority and immigrant population[s] were included. Study selection, data extraction, and risk of bias assessment were completed in duplicate. The Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies. A meta-analytic approach was not feasible.

RESULTS

A total of 42 quantitative studies were identified. The studies showed a positive association between acculturation and oral health status/behaviors. The most frequently used acculturation indicators were language spoken by immigrant and ethnic minorities and length of stay at the host country. High-acculturated immigrant and ethnic minority groups demonstrated better oral health outcomes, oral health behaviors, dental care utilization, and dental knowledge.

CONCLUSIONS

According to existing evidence, a positive effect of acculturation on oral health status and behaviors was found.

PRACTICAL IMPLICATIONS

Dental practitioners should be culturally competent to provide the appropriate services and treatments to immigrant and ethnic minorities. Policymakers should also be sensitive to cultural diversities and properly address the unique needs of each group in order to maintain oral health equity.

Unfair Treatment and Periodontitis Among Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

This study investigates how perceived unfair treatment, towards self and observed towards others due to ethnicity, is associated with periodontitis among diverse Hispanic/Latino adults, accounting for sociodemographic, health behavior, and acculturation factors. Baseline (2008-2011) dental and survey data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter epidemiologic study, were analyzed (N = 12,750). Crude and adjusted prevalence ratios and confidence limits were estimated. Half (49%) reported never being treated unfairly, while 41% reported they were sometimes, and 10% reported it often/always. One third (32%) never saw others treated unfairly, while 42% reported it sometimes, and 26% reported it often/always. In the final fully adjusted model, the prevalence of periodontitis was higher among adults who were as follows: non-Dominican, older, male, had a past year dental visit, current and former smokers, and among those who observed unfair treatment towards others. Lower prevalence was associated with higher income, higher educational attainment, less than full-time employment, reporting experiencing unfair treatment, higher acculturation scores, and having health insurance. Perceived unfair treatment towards self was negatively associated with periodontitis prevalence, while observed unfair treatment towards others was positively associated with the outcome among diverse Hispanics/Latinos. The associations between unfair treatment and periodontitis warrant further exploration.

How does legal status matter for oral health care among Mexican-origin children in California?

This research examines the relationship between legal status and oral health care among Mexican-origin children. Using the 2001–2014 California Health Interview Surveys, the objectives are: (1) to demonstrate population-level changes in the legal statuses of parents, the legal statuses of children, and the likelihood of receiving dental care; (2) to reveal how the roles of legal status boundaries in dental care are changing; and (3) to determine whether the salience of these boundaries is attributable to legal status per se. The results reveal increases in the native-born share and dental care utilization for the total Mexican-origin population. Although dental care was primarily linked to parental citizenship early in this period, parental legal statuses are no longer a unique source of variation in utilization (despite the greater likelihood of insurance among citizens). These results imply that future gains in utilization among Mexican-origin children will mainly come from overcoming barriers to care among the native born.

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Speculation exists on the importance of documentation status for dental care.

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Parental documentation has not been uniquely important for dental care.

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Parental citizenship predicted differences in child dental care in the early 2000s.

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These differences subsequently decreased by 2014 when dental care rose for all children.

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Increases were especially prominent among categories of non-citizens.

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Declines in immigration imply that increasing attention to the native born is needed.

Acculturation and Pediatric Minority Oral Health Interventions

Immigrant populations are growing at a fast pace in the United States. Cultural variations can have implications on oral health of children from immigrant households. Length of stay in the United States and language spoken at home, proxies for measuring acculturation, are some of the crucial factors determining the level of acculturation in families. Higher acculturation generally has a positive impact on oral health utilization. Improving cultural competency of dental teams and involving the stakeholders in intervention design and implementation are some strategies that may increase the trust of ethnic minority patients and reduce barriers to access to care.

Psychological and behavioral acculturation in a social network of Mexican Americans in the United States and use of dental services

OBJECTIVES

We used data from the TalaSurvey study to examine associations between dental health experiences, social network characteristics, and levels of behavioral and psychological acculturation in one location in the American Midwest.

METHODS

Starting in parishes and community organizations, we identified adults of Mexican origin living in Indianapolis, who were 1st- or 2nd-generation immigrants from Tala, Mexico. Using a social networks methodology and following extensive formative research, we created an egocentric social network survey and administered it via face-to-face interviews. We identified the peers (alters) in interviewees' (egos) personal networks. We asked egos about multiple oral health and dental care variables for self and for alters. Acculturation (psychological and behavioral) was measured with a validated tool. Through logistic and negative binomial regression, we examined the effects of acculturation and network composition on ego's dental insurance status, dental office visits, and the reason for most recent dental office visit.

RESULTS

A total of 332 egos (mean age 36; 63% female) were interviewed: 90% were born in Mexico; 45% had completed elementary school or lower; and most had low income. Each ego named 3.9 (SD±1.9) alters in his/her personal network, for a total of 1299 alters (mean age 39; 61% female). Both behavioral acculturation and psychological acculturation were moderately associated with dental insurance coverage, and greater behavioral acculturation predicted more frequent dental care. More psychologically acculturated egos were more likely to seek preventive care. Further, egos with more highly educated networks sought care more frequently and for preventive purposes, net of ego's own education and acculturation.

CONCLUSIONS

This study contextualizes acculturation of Mexican Americans within the personal networks in which oral health discussion takes place. The findings underscore the critical importance of acculturation and social network factors in shaping a subgroup of Latinos' orientation toward dental care.

Acceptability of Salt Fluoridation in a Rural Latino Community in the United States: An Ethnographic Study

Compared to other population groups in the United States, caries (tooth decay) is a disproportionately prevalent disease among Latino populations, especially among low-income and rural sub-groups and children under five years of age. Fluoride is a primary preventive for caries. While water fluoridation is a major and effective public health means for delivering fluoride on a mass scale, it does not reach many rural areas or population groups such as Latinos who eschew drinking water from municipal sources. This study examines the acceptability to such groups of salt fluoridation, an alternate means of delivering fluoride long used on a global scale. An ethnographic study in California's rural Central Valley was performed. Thirty individual interviews and 5 focus groups (N = 61) were conducted in Spanish to investigate low-income Latino migrant caregivers' experiences, views and understandings of domestic salt, oral health, caries prevention and fluoride. Audio data were transcribed, translated, coded and thematically analyzed. Table salt was readily available and frequently consumed. Both adult and child daily sodium consumption was high. Despite a general feeling that it was good, and present in dentifrices or dietary supplements, most participants had little knowledge about fluoride. Concerns were raised about cardio-vascular and other possibly deleterious effects if an increase in salt consumption occurred because fluoridated salt was viewed as having 'extra' benefits. Once informed about fluoride's safety and role in caries prevention, most participants expressed willingness to use fluoridated salt, especially if it benefitted children. Reassurance about its safety and benefits, and demonstration of its taste, were important aspects of acceptance. Taste was paramount. Participants would not consume more fluoridated salt than their current salt as that would result in unpleasant changes in food flavor and taste. While salt fluoridation is acceptable, the feasibility of producing and distributing fluoridated salt in the United States is, however, complex and challenging.

Dental Care for Survivors of Adolescent and Young Adult Cancer: Special Considerations

PURPOSE

Oral health is important for quality of life, but may be undermanaged for survivors of cancer. We examine dental care use and barriers among long-term survivors of adolescent and young adult (AYA) cancer in comparison to individuals without a history of cancer.

METHODS

The 2008-2012 Medical Expenditure Panel Survey (MEPS) identified 1216 individuals diagnosed with cancer at AYA ages (15-39 years), who were at least 5 years from diagnosis. A comparison group was matched using age, sex, and other factors. We evaluated self-reported dental visits in the previous 12 months, and inability and delay in receiving necessary dental care among survivors and the comparison group. Furthermore, individual factors associated with dental care use were identified using multivariable logistic regressions.

RESULTS

Of survivors, 60.86% reported no dental visits in the previous year compared to 51.96% of the comparison individuals (p < 0.001). Survivors were more likely to report inability (10.71% vs. 6.29%, p = 0.001) and delay (8.12% vs. 4.45%, p = 0.001) in getting necessary dental care than the comparison group. Notably, survivors without dental insurance were more likely to report inability and delay. Female survivors were more likely to use dental care than males (odds ratio = 1.76, 95% confidence interval 1.15-2.71, p = 0.01). Hispanic survivors, those diagnosed at younger ages, and uninsured survivors were less likely to have at least one dental visit.

CONCLUSION

Survivors of AYA cancer need timely surveillance to manage late effects, including dental complications. Yet, these survivors, particularly those who are uninsured, delay dental care more often than individuals from the general population. Survivor-specific interventions are needed to reduce dental care barriers.

Prevalence of chronic periodontitis in an obese population: a preliminary study

Background

Chronic periodontitis (CP) is a global public health issue. Studies have suggested CP could be linked to obesity due to their similar pathophysiological pathway. The aim of this study is to determine the prevalence of CP and to assess the predictors for CP among the obese Malaysian population.

Methods

This is a cross-sectional study on obese participants. Obesity is defined as an individual who has Body Mass Index (BMI) ≥27.5 kg/m². A convenience sampling method was used. A total of 165 paricipants were recruited. This study involved answering questionnaires, obtaining biometric and clinical measurements of Visible plaque index (VPI), Gingival bleeding index (GBI), Probing pocket depth (PPD) and Clinical attachment loss (CAL). Data analysis was carried out using SPSS statistical software (SPSS Inc., version 20, US).

Results

A total of 165 participants; 67 (40.6 %) males and 98 (59.4 %) females participated in the study. Mean age of the participants was 43.9 (±8.9). The prevalence of CP among the obese population was found to be 73.9 %. Out of this, 43 and 55 % were categorised as moderate and severe CP respectively. Around 64 % of participants had sites with CAL ≥4 mm and participants with sites with PPD ≥4 mm were reported to be 25 %. Around 83 % of the participants had sites with GBI ≥30 and 92 % of participants had sites with VPI ≥20 %. GBI and VPI were found to have significantly higher odds for CP.

Conclusion

Prevalence of CP was high among obese Malaysians. GBI and VPI were potential predictors for CP in this obese population.

Views of pregnant women in South Western Sydney towards dental care and an oral-health program initiated by midwives

ISSUES ADDRESSED

Oral health during pregnancy is important, yet is often neglected by women. A program is currently being developed for midwives in Australia to promote maternal oral health. The aim of this study was to record the views of pregnant women in Australia towards dental care and midwives promoting oral health.

METHODS

Using convenience sampling, a cross-sectional survey was undertaken of 241 pregnant women attending a metropolitan hospital in South Western Sydney in 2010.

RESULTS

Only 10% of women received oral-health promotional material during pregnancy. More than 50% reported dental problems, yet only 17% had discussed this with their midwives and less than half (44.6%) had sought dental treatment. The main barriers to obtaining dental care were: lack of awareness, safety concerns about dental treatment and dental costs. Pregnant women were more likely (P<0.05) to see a dentist if they had received information about oral health (odds ratio (OR) 3.25, 95% CI 1.34-7.90) and had private health insurance (OR 2.47, 95% CI 1.26-4.85). Most women (>90%) were receptive to midwives providing oral-health education, assessments and referrals to affordable dental services.

CONCLUSION

This study has shown that pregnant women are receiving limited dental advice and are concerned about dental costs. It has also confirmed for the first time in Australia that women are very positive about receiving oral-health advice from midwives during their pregnancy. SO WHAT?: Oral-health promotion programs during pregnancy should consider using midwives to increase dental awareness among women and provide pathways to affordable dental services.

Access to oral health services for urban low-income Latino children: social ecological influences

OBJECTIVES

Using an ecological conceptual model, this study examined the social context, structural, and behavioral factors within an immigrant community that contribute to increased access and use of oral health services by Latino children. The predictors of health service use at the level of the individual, the family, the provider, and the health service system were studied for their effects on the initiation of care, continuity of care, and frequency of planned visits.

METHODS

In-depth face-to-face interviews were conducted with 320 Latino mothers regarding their use of oral health services for 4-8-year-old children [Mexican (n = 221), Puerto Rican (n = 69), and Central and South American (n = 30)]. Outcome measures of dental care utilization were early age at initiation of care, continuity of care, and frequency of planned dental visits.

RESULTS

Regular planned dental visits were significantly related to the structural variables of household income and provider availability. The initiation of dental care was related to the mother's beliefs about the value of early preventive dental care. Mothers were more likely to continue care if they believed that the purpose was to keep the child's teeth healthy and had satisfactory communication with the dentist.

CONCLUSIONS

Identifying the structural and behavioral factors that increase the likelihood of the use of oral health services can provide the basis for developing effective interventions specific to Latino children at the neighborhood level. The study findings can be also used for designing culturally appropriate oral health promotion programs and provider coordination of care.

A review on the oral health impacts of acculturation

The impact of acculturation on systemic health has been extensively investigated and is regarded as an important explanatory factor for health disparity. However, information is limited and fragmented on the oral health implications of acculturation. This study aimed to review the current evidence on the oral health impact of acculturation. Papers were retrieved from five electronic databases. Twenty-seven studies were included in this review. Their scientific quality was rated and key findings were summarized. Seventeen studies investigated the impacts of acculturation on the utilization of dental services; among them, 16 reported positive associations between at least one acculturation indicator and use of dental services. All 15 studies relating acculturation to oral diseases (dental caries and periodontal disease) suggested better oral health among acculturated individuals. Evidence is lacking to support that better oral health of acculturated immigrants is attributable to their improved dental attendance. Further researches involving other oral health behaviors and diseases and incorporating refined acculturation scales are needed. Prospective studies will facilitate the understanding on the trajectory of immigrants’ oral health along the acculturation continuum.

Maternal acculturation: could it impact oral health practices of mexican-american mothers and their children?

A mother's cultural beliefs can affect her infant's health, but the influence of acculturation of Mexican-American women on their young children's oral health is unknown. The authors hypothesized that maternal acculturation impacts very young children's oral health practices favoring, in particular, the mothers who are more Anglo-oriented. A convenience sample of 204 predominantly Mexican-American women attending the Women, Infants, and Children Clinic in San Antonio, Texas, completed the Knowledge, Attitudes, Beliefs, Social Support, and Self-Efficacy of Oral Health (KASE-OH) and Acculturation Questionnaires. Results indicated that mothers with strong Anglo orientation were more likely educated in the United States, first visited a dentist while in elementary school, and breast-fed their children. Children belonging to Anglo-oriented Mexican-American mothers had stronger oral health practices, were more likely to breast-feed, were exposed to more sugary and acidic drinks, consumed higher levels of candy, had Medicaid coverage, and had stronger supervisions of tooth brushing practices.

Impacto da saúde bucal no cotidiano de idosos institucionalizados e não institucionalizados da cidade do Recife (PE, Brasil)

Este artigo tem como objetivo avaliar a influência da saúde bucal no cotidiano de idosos institucionalizados e não institucionalizados da cidade do Recife (PE), bem como verificar se a saúde bucal tem a mesma relevância para os dois grupos estudados. Para avaliar a percepção de saúde bucal, utilizou-se o índice Geriatric Oral Health Assessment Index (GOHAI). As faixas do GOHAI foram categorizadas em baixa percepção (<= 50), média ou regular (51 a 60) e alta (57 a 60). As condições de saúde bucal foram representadas pelo índice CPO-D (dentes cariados, perdidos e obturados). Observou-se que o percentual dos que tinham o GOHAI até 50 pontos (baixa percepção de saúde bucal) foi bem elevado no grupo dos não institucionalizados em relação ao grupo dos institucionalizados (92,2% x 64,9%). As médias do CPO-D e do número de dentes perdidos foram correspondentemente mais elevadas no grupo de institucionalizados do que no grupo de não institucionalizados (96,01% x 87,87%). Conclusões: a percepção de saúde bucal foi baixa para mais da metade dos idosos examinados, existindo diferença significante entre os dois grupos em relação à categoria do GOHAI, sendo os valores mais baixos encontrados para o grupo não institucionalizado. O resultado da percepção de saúde foi compatível com o grande número de dentes cariados e perdidos.

Additional psychometric data for the Spanish Modified Dental Anxiety Scale, and psychometric data for a Spanish version of the Revised Dental Beliefs Survey

Background

Hispanics comprise the largest ethnic minority group in the United States. Previous work with the Spanish Modified Dental Anxiety Scale (MDAS) yielded good validity, but lower test-retest reliability. We report the performance of the Spanish MDAS in a new sample, as well as the performance of the Spanish Revised Dental Beliefs Survey (R-DBS).

Methods

One hundred sixty two Spanish-speaking adults attending Spanish-language church services or an Hispanic cultural festival completed questionnaires containing the Spanish MDAS, Spanish R-DBS, and dental attendance questions, and underwent a brief oral examination. Church attendees completed the questionnaire a second time, for test-retest purposes.

Results

The Spanish MDAS and R-DBS were completed by 156 and 136 adults, respectively. The test-retest reliability of the Spanish MDAS was 0.83 (95% CI = 0.60-0.92). The internal reliability of the Spanish R-DBS was 0.96 (95% CI = 0.94-0.97), and the test-retest reliability was 0.86 (95% CI = 0.64-0.94). The two measures were significantly correlated (Spearman's rho = 0.38, p < 0.001). Participants who do not currently go to a dentist had significantly higher MDAS scores (t = 3.40, df = 106, p = 0.003) as well as significantly higher R-DBS scores (t = 2.21, df = 131, p = 0.029). Participants whose most recent dental visit was for pain or a problem, rather than for a check-up, scored significantly higher on both the MDAS (t = 3.00, df = 106, p = 0.003) and the R-DBS (t = 2.85, df = 92, p = 0.005). Those with high dental fear (MDAS score 19 or greater) were significantly more likely to have severe caries (Chi square = 6.644, df = 2, p = 0.036). Higher scores on the R-DBS were significantly related to having more missing teeth (Spearman's rho = 0.23, p = 0.009).

Conclusion

In this sample, the test-retest reliability of the Spanish MDAS was higher. The significant relationships between dental attendance and questionnaire scores, as well as the difference in caries severity seen in those with high fear, add to the evidence of this scale's construct validity in Hispanic samples. Our results also provide evidence for the internal and test-retest reliabilities, as well as the construct validity, of the Spanish R-DBS.

Desigualdades socioeconómicas en la utilización de servicios de salud bucal: estudio en escolares mexicanos de 6 a 12 años de edad

El objetivo del estudio fue evaluar la asociación entre diversos indicadores socioeconómicos y la utilización de servicios de salud bucal. Se realizó un estudio transversal en 3.048 escolares. La variable utilización de servicios de salud bucal y las variables sociodemográficas y socioeconómicas se colectaron a través de un cuestionario dirigido a las madres. Para determinar las necesidades de salud se realizó un examen clínico bucal a los niños. Las asociaciones ajustadas fueron evaluadas con regresión logística politómica. Las variables asociadas a servicios preventivos y curativos fueron mayor edad, mayor frecuencia de cepillado y menor edad al inicio de cepillado dental, tener seguro público o privado, y mejor nivel socioeconómico. Además, sólo para los servicios preventivos, también se asoció estar inscrito en una escuela privada, y sólo para los servicios curativos, la posesión de automóvil y tener necesidades de salud bucal entre moderadas y muy altas. Los resultados sugieren la existencia de desigualdades socioeconómicas en la utilización de servicios de salud bucal en niños mexicanos.

The role of non-dental health professionals in providing access to dental care for low-income and minority patients

The disadvantaged suffer disproportionately from dental problems. These persons are more likely to have untreated oral health problems and associated pain, and also are more likely to forego dental treatment even when in pain. There has been increased emphasis on the potential role of physicians in alleviating oral health disparities, especially among children. In addition, many adults lacking access to traditional dental services seek care and consultation from hospital emergency departments, physicians, and pharmacists. The delivery of oral health care services by non-dental health professionals may assume increasing importance as the population continues to age and becomes more diverse. This is because, in general, the elderly and ethnic and racial minorities face significant economic barriers to accessing private dental services.

The association of immigration and acculturation attributes with oral health among immigrants in New York City

OBJECTIVES

We examined associations between immigration and acculturation attributes and oral disease among immigrants.

METHODS

We conducted a large cross-sectional study of 1318 immigrants in New York City. We performed comprehensive interviews and oral examinations of the participants and used linear regression models to assess differences in oral disease levels among immigrant subgroups. We also constructed proportional odds models to evaluate the association of oral disease level with length of stay in the United States, age at immigration, and language preference.

RESULTS

After we controlled for most known risk factors, country of birth and age at immigration were associated with variations in oral disease prevalence and need for oral health care. Length of stay was inversely associated with need for treatment of dental caries but not with any other indicator of oral disease. Language preference was not associated with any indicator of oral disease.

CONCLUSIONS

Immigrants' country of birth, length of stay in the United States, and age at immigration played important roles in their oral disease prevalence, independently of most known risk factors for oral diseases. Our findings emphasize the need for more studies to elucidate the complex relationships of ethnicity, socioeconomic status, and culturally influenced factors that impact immigrants' oral health.

Health status of Mexican-origin persons: do proxy measures of acculturation advance our understanding of health disparities?

OBJECTIVES

This paper compares select health status indicators between the U.S. and Mexico, and within the Mexican-origin population using proxy measures of acculturation.

METHODS

Statistical data were abstracted and a Medline literature review conducted of English-language epidemiologic articles on Mexican-origin groups published during 1976-2005.

RESULTS

U.S.-born Mexican-Americans have higher morbidity and mortality compared to Mexico-born immigrants. Mexico has lower healthcare resources, life expectancy, and circulatory system and cancer mortality rates, but similar infant immunization rates compared to the U.S. Along the U.S.-Mexico border, the population on the U.S. side has better health status than the Mexican side. The longer in the U.S., the more likely Mexican-born immigrants engage in behaviors that are not health promoting. Conclusions Researchers should consider SEP, community norms, behavioral risk and protective factors when studying Mexican-origin groups. It is not spending-time in the U.S. that worsens health outcomes but rather changes in health promoting behaviors.

Acculturation and orofacial pain among Hispanic adults

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

PERSPECTIVE

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

An ethnographic study of Latino preschool children's oral health in rural California: Intersections among family, community, provider and regulatory sectors

Background

Latino children experience a higher prevalence of caries than do children in any other racial/ethnic group in the US. This paper examines the intersections among four societal sectors or contexts of care which contribute to oral health disparities for low-income, preschool Latino¹ children in rural California.

Methods

Findings are reported from an ethnographic investigation, conducted in 2005–2006, of family, community, professional/dental and policy/regulatory sectors or contexts of care that play central roles in creating or sustaining low income, rural children's poor oral health status. The study community of around 9,000 people, predominantly of Mexican-American origin, was located in California's agricultural Central Valley. Observations in homes, community facilities, and dental offices within the region were supplemented by in-depth interviews with 30 key informants (such as dental professionals, health educators, child welfare agents, clinic administrators and regulatory agents) and 47 primary caregivers (mothers) of children at least one of whom was under 6 years of age.

Results

Caregivers did not always recognize visible signs of caries among their children, nor respond quickly unless children also complained of pain. Fluctuating seasonal eligibility for public health insurance intersected with limited community infrastructure and civic amenities, including lack of public transportation, to create difficulties in access to care. The non-fluoridated municipal water supply is not widely consumed because of fears about pesticide pollution. If the dentist brought children into the clinic for multiple visits, this caused the accompanying parent hardship and occasionally resulted in the loss of his or her job. Few general dentists had received specific training in how to handle young patients. Children's dental fear and poor provider-parent communication were exacerbated by a scarcity of dentists willing to serve rural low-income populations. Stringent state fiscal reimbursement policies further complicated the situation.

Conclusion

Several societal sectors or contexts of care significantly intersected to produce or sustain poor oral health care for children. Parental beliefs and practices, leading for example to delay in seeking care, were compounded by lack of key community or economic resources, and the organization and delivery of professional dental services. In the context of state-mandated policies and procedures, these all worked to militate against children receiving timely care that would considerably reduce oral health disparities among this highly disadvantaged population.

Awareness of genetic testing for cancer among United States Hispanics: the role of acculturation

BACKGROUND

The purpose of this study was to determine how acculturation affected awareness of genetic testing for cancer among Hispanic Americans.

METHODS

Subjects were 10,883 Hispanic respondents from the 2000 and 2005 National Health Interview Surveys. Acculturation was measured with language use and the length of time subjects had lived in the US. Weighted logistic regression was used to determine subjects' awareness of genetic susceptibility testing.

RESULTS

Greater use of English (adjusted odds ratio, OR = 1.25, 95% confidence interval, CI = 1.15-1.36) was associated with increased awareness of genetic testing. Residence in the US for less than 5 years (adjusted OR = 0.55, 95% CI 0.36-0.83) was associated with lower awareness of testing.

CONCLUSIONS

To better inform diverse American groups about genetic testing, intercultural variations and language skills must be taken into account.

Influences on children's oral health: a conceptual model

OBJECTIVES

Despite marked improvements over the past century, oral health in America is a significant problem: caries is the most common chronic disease of childhood. Much oral health research examines influences primarily in the oral cavity or focuses on a limited number of individual-level factors. The purpose of this article was to present a more encompassing conceptual model of the influences on children's oral health.

METHODS

The conceptual model presented here was derived from the population health and social epidemiology fields, which have moved toward multilevel, holistic approaches to analyze the complex and interactive causes of children's health problems. It is based on a comprehensive review of major population and oral health literatures.

RESULTS

A multilevel conceptual model is described, with the individual, family, and community levels of influence on oral health outcomes. This model incorporates the 5 key domains of determinants of health as identified in the population health literature: genetic and biological factors, the social environment, the physical environment, health behaviors, and dental and medical care. The model recognizes the presence of a complex interplay of causal factors. Last, the model incorporates the aspect of time, recognizing the evolution of oral health diseases (eg, caries) and influences on the child-host over time.

CONCLUSIONS

This conceptual model represents a starting point for thinking about children's oral health. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach. The study of children's oral health from a global perspective remains largely in its infancy and is poised for additional development. This work can help inform how best to approach and improve children's oral health.

Latino oral health: A research agenda toward eliminating oral health disparities

BACKGROUND

The Hispanic population has become the largest minority group in the United States, resulting in an increase in oral health care demands. Developing a research agenda and promoting collaboration on Latino oral health issues are crucial.

METHODS

The Hispanic Dental Association and the University of Puerto Rico, School of Dentistry, San Juan, convened a workshop of health care providers and other experts to examine the current state of Hispanic oral health research and identify gaps in existing data and research methods. Participants were asked to break out into small groups to discuss research priorities.

RESULTS

The participants discussed the following research areas: population-based studies, social and behavioral sciences, health promotion and communications, gene-environment interactions, and research training and workforce development. Participants emphasized the importance of understanding variations among subgroups within the Hispanic population in the development of future studies.

CONCLUSIONS

Participants recommended collaborative research studies to advance existing oral disease prevention and oral health promotion efforts, with a stronger focus on the development of a multidisciplinary pipeline of researchers participating in Latino oral health research to address the growing needs of this population. Practice Implications. Building an infrastructure for research training and workforce development would supply researchers with the necessary tools to develop new studies that could affect the overall oral health of the Latino population. The translation and dissemination of these research findings will benefit clinicians by leading to a better understanding of new trends and specific population needs, as well as appropriate targeted interventions.

Perceived social status, language and identified dental home among Hispanics in Florida

BACKGROUND

The authors conducted a study to examine the extent to which perceived social status in communities and in U.S. society in general and primary language are associated with having a dental home among four Hispanic groups.

METHODS

The authors used random-digit-dialing technology to select a probability sample of Hispanic adults in Miami-Dade County, Fla., for a telephone-based survey. Trained interviewers administered the pretested survey instrument in Spanish or English. The authors used bivariate contingency tables and multiple logistic regression modeling to analyze the data.

RESULTS

Eight hundred ten adults participated, and their nationality groups were as follows: Cuba (n = 450), Nicaragua (n = 139), Colombia (n = 132) and Puerto Rico (n = 89). After controlling for nationality group, the authors found that respondents who perceived themselves to be at a higher social status in the United States than in their own community were significantly more likely to have a dental home; those who reported having a higher community status were significantly less likely to have a dental home compared with respondents who perceived their national and community social status to be equal. Respondents who primarily spoke a language other than English at home were less likely than those who primarily spoke English to have a dental home. Female respondents were more likely than male respondents to have a dental home. Respondents with dental insurance were more likely to have a dental home than were those without dental insurance.

CONCLUSIONS

Perceived social status and acculturation may influence whether Hispanics have a dental home. However, because of the sample design, the findings may not be generalizable to all Hispanic populations in Florida or the United States.

CLINICAL IMPLICATIONS

Reducing disparities in oral health status and in use of dental services among Hispanics relative to non-Hispanic whites may require attention to cultural factors such as language, community structure and immigrants' degree of acculturation.

Changes over 5 years in utilization of dental care by a Swedish age cohort

OBJECTIVE

The purpose of this study was to investigate the temporal development of the utilization of dental care, in relation to socio-economic factors and also considering perceived oral health, attitudes to dental care, dental anxiety, care organisation and changes in the way that dental care is paid for. A conflict model was used as a theoretical framework.

METHODS

In 1992, a mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Orebro and Ostergotland, as part of a cross-sectional study. This study group numbered 8888 persons. In 1997, the same population was sent a new questionnaire. There were 5363 persons who completed the questionnaire in both 1992 and 1997. Changes in utilization of dental care were analysed.

RESULTS

An increase in personal expenditure for care was obvious, 42% paid more in 1997 compared with 1992. In the study, 7% had prolonged their time since most recent visit and 12% had less frequent visits. In regression models, education, occupation, place of residence, country of birth, marital status, gender, dental anxiety, having poor perceived oral health and poor general health were associated with utilization. Care organisation factors showed there was a greater probability of having higher utilization and higher cost of care when private practitioners provided the care.

CONCLUSION

Small changes in the utilization of dental care occurred during this study time. Inequality in utilization existed and socio-economic factors affected utilization as well as health perception and dental anxiety. Changes in the cost of care did not affect utilization appreciably, probably because of a selected population with high price elasticity. Having a private care provider compared with one in the public system affected the probability of having higher utilization and higher cost for care.

Effect of acculturation on objective measures of oral health in Haitian immigrants in New York City

Acculturation is a complex phenomenon that can serve as a proxy for cultural norms and behaviors affecting care-seeking, prevention behaviors, and, ultimately, health outcomes. The purpose of this study was to assess the effect of acculturation on the oral health of Haitian immigrants in New York City. We hypothesized that acculturation would be a predictor of the oral health status of the participating individuals. An acculturation scale was specifically developed and validated for this study. A sample of 425 adult Haitian immigrants living in NYC was obtained through outreach activities. Oral health examinations were conducted, and a questionnaire was administered to the participants. After adjustment for age, sex, education, income, and marital status, acculturation was negatively associated with measures of decayed teeth, periodontal attachment loss of > or = 4 mm, and the number of missing teeth. Results suggest a positive impact of acculturation on the oral health status of these individuals.

Utilisation of dental services in Turkey: a cross-sectional survey

AIM

To assess the factors affecting the utilisation of dental service in Turkey.

METHOD

A cross-sectional study using a sample of 866 adults randomly selected from nine provinces, collecting data on socio-demographic characteristics, frequency of dental visits and attitudes toward dental services in face-to-face interviews.

RESULTS

40.4% of adults had visited a dentist within the previous year. Logistic regression analysis showed that gender and educational level were significant factors affecting the utilisation of dental services, with women using dental services significantly more than men and those having higher education compared to those having low education. Satisfaction from the services of the private dental offices and private hospitals was higher than from state hospitals. Age, reasons for dental visit and the place of the last visit were found to be the most significant predictors of satisfaction.

CONCLUSION

Utilisation of dental services is low amongst Turkish adults. Women and individuals with higher levels of education use dental services more than others. The majority of the people prefer private dental offices, where the patient satisfaction is high.

Dental care use and self-reported dental problems in relation to pregnancy

OBJECTIVES

We examined the relationships between risk factors amenable to intervention and the likelihood of dental care use during pregnancy.

METHODS

We used data from the Washington State Department of Health's Pregnancy Risk Assessment Monitoring System.

RESULTS

Of the women surveyed, 58% reported no dental care during their pregnancy. Among women with no dental problems, those not receiving dental care were at markedly increased risk of having received no counseling on oral health care, being overweight, and using tobacco. Among women who received dental care, those with dental problems were more likely to have lower incomes and Medicaid coverage than those without dental problems.

CONCLUSIONS

There is a need for enhanced education and training of maternity care providers concerning oral health in pregnancy.