1
|
Sengupta K, Bihrmann K, Christensen LB, Mortensen LH, Andersen I, Ersbøll AK. Development of geographic inequality in dental caries and its association with socioeconomic factors over an 18-year period in Denmark. BMC Oral Health 2023; 23:662. [PMID: 37704997 PMCID: PMC10500719 DOI: 10.1186/s12903-023-03373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Few studies have examined the development of geographic and socioeconomic inequalities in caries over time or have simultaneously assessed individual-level socioeconomic position (SEP) and neighborhood-level factors as a multi-layered phenomenon influencing caries inequalities. This study examined (i) the trends in geographic inequalities in caries among adolescents in Denmark and (ii) how the association between SEP and caries has progressed over time, when accounting for individual and neighborhood-level confounding factors. METHODS This nationwide repeated cross-sectional study included 15-year-olds in Denmark from 1995, 2003, and 2013 (n = 149,808). The outcome was caries experience (measured by the decayed, missing, and filled tooth surfaces [DMFS] index). The exposure of interest was SEP, indicated by the previous year's parental education, occupational social class, and (equivalized) disposable household income. Covariates included individual-level factors (immigration status, country of origin, number of children and persons in the family, and household type) and neighborhood (residence municipality)-level factors (Gini index; proportion of unemployed, low-educated, and unmarried/non-cohabiting individuals; proportion of single-parent households and households with overcrowding). Data sources included the Danish national dental and administrative social registers and Statistics Denmark's statistics database (StatBank). Data were analyzed using spatial and spatiotemporal modelling utilizing zero-inflated negative binomial regressions and integrated nested Laplace approximations for Bayesian parametric inference. Observed caries experience geo-maps of the Danish municipalities for 1995, 2003, and 2013 were created. RESULTS Between 1995 and 2013, caries prevalence in the 15-year-olds declined sharply (1995, 71%; 2013, 45%). Caries experience declined in nearly all socioeconomic subgroups and municipalities. However, geographic inequalities persisted with higher caries levels largely concentrated in the relatively deprived areas of Denmark. Increasing relative socioeconomic inequalities in caries over time were observed with significant graded associations between SEP and caries despite adjustment for the various individual and neighborhood-level covariates and the effect of assessment year (e.g., 15-year-olds with parents having basic education had 1.91-fold [95% CI: 1.86-1.95] higher caries experience than those having parents with high education). CONCLUSIONS Reducing these enduring inequalities will likely require additional resources and targeted supportive and preventive measures for adolescents from lower SEP backgrounds and those residing in municipalities with higher caries prevalence.
Collapse
Affiliation(s)
- Kaushik Sengupta
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lisa Bøge Christensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
2
|
Todem D, Hsu WW, Kim K. Nonparametric scanning tests of homogeneity for hierarchical models with continuous covariates. Biometrics 2023; 79:2063-2075. [PMID: 36454666 PMCID: PMC10232678 DOI: 10.1111/biom.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/31/2022] [Indexed: 12/03/2022]
Abstract
In many applications of hierarchical models, there is often interest in evaluating the inherent heterogeneity in view of observed data. When the underlying hypothesis involves parameters resting on the boundary of their support space such as variances and mixture proportions, it is a usual practice to entertain testing procedures that rely on common heterogeneity assumptions. Such procedures, albeit omnibus for general alternatives, may entail a substantial loss of power for specific alternatives such as heterogeneity varying with covariates. We introduce a novel and flexible approach that uses covariate information to improve the power to detect heterogeneity, without imposing unnecessary restrictions. With continuous covariates, the approach does not impose a regression model relating heterogeneity parameters to covariates or rely on arbitrary discretizations. Instead, a scanning approach requiring continuous dichotomizations of the covariates is proposed. Empirical processes resulting from these dichotomizations are then used to construct the test statistics, with limiting null distributions shown to be functionals of tight random processes. We illustrate our proposals and results on a popular class of two-component mixture models, followed by simulation studies and applications to two real datasets in cancer and caries research.
Collapse
Affiliation(s)
- David Todem
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Wei-Wen Hsu
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
3
|
Kaushik M, Sood S. A Systematic Review of Parents' Knowledge of Children's Oral Health. Cureus 2023; 15:e41485. [PMID: 37551253 PMCID: PMC10404335 DOI: 10.7759/cureus.41485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
Young children's oral health is maintained mainly by adults' knowledge and attitude. This study evaluated parents' attitudes, actions, and knowledge regarding their children's dental health. We searched the electronic MEDLINE, Embase, Cochrane, and PubMed databases. Additionally, each relevant article's and book's bibliography was thoroughly searched. Included were the phrases "Knowledge" [MeSH] ", Attitude" [MeSH] ", Parents" [MeSH] ", Children" [MeSH] "And Oral Health" [MeSH]. This review emphasizes the growing global interest in parents' contributions to children's dental health. It is necessary to raise awareness about the knowledge and significance of deciduous teeth, frequent dental appointments throughout society, and implement parental oral health education programs because parents need more awareness.
Collapse
Affiliation(s)
- Manisha Kaushik
- Pediatric and Preventive Dentistry, Manav Rachna Dental College, Faridabad, IND
| | - Shveta Sood
- Pediatric and Preventive Dentistry, Manav Rachna Dental College, Faridabad, IND
| |
Collapse
|
4
|
Lin YC, Huang ST, Yen CW, Huang YK, Shieh TM, Chi WH, Yao WL, Ho PS. Comparing individual-, family-, and community-level effects on the oral health of preschool children: a multilevel analysis of national survey data. BMC Oral Health 2023; 23:353. [PMID: 37268948 DOI: 10.1186/s12903-023-03077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Early childhood is a critical stage for the prevention of dental caries. The prevalence of caries in preschool children is still high in Taiwan, where National Health Insurance covers 99% of the population. The effort to improve the oral health of preschool children should be based on conceptual model that encompasses more than individual-level factors. This study input nationwide survey data in a conceptual model to evaluate the effects of comprehensive factors related to the high prevalence of caries in preschool children. METHODS This observation study examined factors related to the oral health of preschool children by employing a comprehensive multilevel model to analyse nationally representative data from the Taiwan Oral Health Survey of Preschool Children (TOHPC) 2017-2018. Individual-level, family-level and community-level contextual effects were evaluated through multilevel analysis in this study. The proportional change in variance (PCV) was used to compare the multilevel model with the null model and individual-level, family-level, and community-level context effects. RESULTS The estimated deft index for preschool children was 1.34 (1.22-1.47) at age 3, 2.20 (2.08-2.32) at age 4, and 3.05 (2.93-3.18) at age 5. The overall prevalence of caries in preschool children in Taiwan was 34.27% (30.76%, 37.78%) at age 3, 51.67% (48.99%, 54.35%) at age 4, and 62.05% (59.66%, 64.44%) at age 5. The model that included the individual-, family-, and community-context levels exhibited the highest reduction of variance (PCV = 53.98%). The PCV was further reduced to 35.61% when only the level of accessibility to dental services for individuals, families, and the community was considered. For the model in which no community-context cofactors were considered and the model considering only the individual level, the PCVs were 20.37% and 5.52%, respectively. CONCLUSIONS Our findings indicate the key components that affect oral health in preschool children and can serve as a reference for policy makers. The most notable finding of this study is that to improve the oral health of preschool children, community-level factors should be targeted. To rely solely on dentists for leading oral health education programs for children is impractical and inefficient. Training more professional oral health educators to provide additional community-based oral health promotion campaigns is critical. We suggest training more professional oral health educators to provide more community-based oral health promotion campaigns.
Collapse
Affiliation(s)
- Ying-Chun Lin
- Department of Oral Hygiene, Shu-Zen College of Medical and Management, Kaohsiung, Taiwan
| | - Shun-Te Huang
- Division of Pediatric and Special Needs Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Wei Yen
- Division of Pediatric and Special Needs Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yung-Kai Huang
- Department of Oral Hygiene, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Wei-Hsueh Chi
- Department of Oral Hygiene, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wu-Lin Yao
- Department of Oral Hygiene, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Shan Ho
- Department of Oral Hygiene, Kaohsiung Medical University, Kaohsiung, Taiwan.
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
5
|
Broomhead T, Ballas D, Baker SR. Neighbourhoods and oral health: Agent-based modelling of tooth decay. Health Place 2021; 71:102657. [PMID: 34543838 DOI: 10.1016/j.healthplace.2021.102657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
This research used proof of concept agent-based models to test various theoretical mechanisms by which neighbourhoods may influence tooth decay in adults. Theoretical pathways were constructed using existing literature and tested in two study areas in Sheffield, UK. The models found a pathway between shops and sugar consumption had the most influence on adult tooth decay scores, revealing that similar mechanisms influence this outcome in different populations. This highlighted the importance of the interactions between neighbourhood features and individual level variables in influencing outcomes in tooth decay. Further work is required to improve the accuracy and reliability of the models.
Collapse
Affiliation(s)
- T Broomhead
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, S10 2TA, United Kingdom.
| | - D Ballas
- Department of Economic Geography, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747 AD, Groningen, the Netherlands
| | - S R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, S10 2TA, United Kingdom
| |
Collapse
|
6
|
Shi C, Aparicio-Ting F, Faris P, Patterson S, McLaren L. Small-area contextual effects on children's dental caries in Alberta: a multilevel analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:773-781. [PMID: 33844239 PMCID: PMC8225721 DOI: 10.17269/s41997-021-00485-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this study was to examine the presence of small-area-level effects on children's dental caries in Alberta, Canada, where dental public health programming is targeted in nature, based on an area-level measure of socio-economic circumstances. METHODS This cross-sectional study included data on tooth decay (from an intra-oral examination conducted by dental hygienists at school) and socio-demographic and behavioural information (from a parent questionnaire) from 5677 grade 1 and 2 schoolchildren attending schools in public or Catholic school systems in Calgary and Edmonton in 2013/2014. Area-level socio-economic circumstances were quantified using the Pampalon Material Deprivation Index derived from census data, applied to the dissemination area (DA) of the child's school. The outcome variable was presence (vs. absence) of tooth decay (cavitation). Data were analyzed using multilevel modeling with two levels: individual level (level 1) and school dissemination area (DA) (level 2). RESULTS We observed a small but statistically significant area-level effect on children's caries experience, above and beyond individual-level characteristics. CONCLUSION Study findings are relevant to dental public health programming in Alberta and other jurisdictions that use targeted strategies. Multilevel interventions, including universal approaches, are necessary to reduce inequities in children's dental caries.
Collapse
Affiliation(s)
- Congshi Shi
- Alberta Health Services, Calgary, Alberta Canada
| | - Fabiola Aparicio-Ting
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, Alberta T2N 4Z6 Canada
| | - Peter Faris
- Alberta Health Services, Calgary, Alberta Canada
| | - Steven Patterson
- School of Dentistry, University of Alberta, Edmonton, Alberta Canada
| | - Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, Alberta T2N 4Z6 Canada
| |
Collapse
|
7
|
Selvaraj D, Curtan S, Copeland T, McNamee E, Debelnogich J, Kula T, Momotaz H, Nelson S. Caries disparities among Medicaid-enrolled young children from pediatric primary care settings. J Public Health Dent 2021; 81:131-142. [PMID: 33135213 PMCID: PMC8756375 DOI: 10.1111/jphd.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/09/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of this study are to determine the overall and racial differences in the extent of caries experience and to examine the association between child and parent/caregiver characteristics and caries among 3-6-year-old Medicaid-enrolled children. METHODS This study reports baseline cross-sectional data from a larger pragmatic clinical trial in pediatric primary care practices. Child-level clinical dental exams included decayed and filled teeth (dft) using ICDAS criteria and parent/caregiver questionnaire collected information on socio-demographics, child oral health behaviors, oral health related quality of life (OHQoL), and food environment. RESULTS A total of 1,024 parent/caregiver-child dyads participated in the study. The overall caries experience (dft) was 49 percent and untreated decay was 42 percent. Children who were Black had 1.3 and 1.2 times significantly higher frequency of untreated primary decay and caries experience compared to non-Black children. An overall logistic regression model predicted that race, increased age, receiving dental care in the past 12 months for a cavity/toothache, and lower caregiver OHQoL was significantly associated with increased odds of the child having caries. Non-Black caregivers with less education, whose child was older, and lower child OHQoL had increased odds of having a child with caries, but these same variables were not predictive for the Black children. CONCLUSIONS Racial disparities exist with respect to caries experience and untreated decay within a Medicaid-enrolled population of young children attending well-child visits. Pediatric primary care offices are well-positioned to provide dental surveillance and preventive care and could play an important role in decreasing oral health inequities.
Collapse
Affiliation(s)
- David Selvaraj
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Shelley Curtan
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Tashyana Copeland
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Erin McNamee
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Jelena Debelnogich
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Taylor Kula
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Hasina Momotaz
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Suchitra Nelson
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
8
|
Hsu WW, Todem D, Mawella NR, Kim KM, Rosenkranz RR. A robust score test of homogeneity for zero-inflated count data. Stat Methods Med Res 2020; 29:3653-3665. [PMID: 32646310 PMCID: PMC9939047 DOI: 10.1177/0962280220937324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In many applications of zero-inflated models, score tests are often used to evaluate whether the population heterogeneity as implied by these models is consistent with the data. The most frequently cited justification for using score tests is that they only require estimation under the null hypothesis. Because this estimation involves specifying a plausible model consistent with the null hypothesis, the testing procedure could lead to unreliable inferences under model misspecification. In this paper, we propose a score test of homogeneity for zero-inflated models that is robust against certain model misspecifications. Due to the true model being unknown in practical settings, our proposal is developed under a general framework of mixture models for which a layer of randomness is imposed on the model to account for uncertainty in the model specification. We exemplify this approach on the class of zero-inflated Poisson models, where a random term is imposed on the Poisson mean to adjust for relevant covariates missing from the mean model or a misspecified functional form. For this example, we show through simulations that the resulting score test of zero inflation maintains its empirical size at all levels, albeit a loss of power for the well-specified non-random mean model under the null. Frequencies of health promotion activities among young Girl Scouts and dental caries indices among inner-city children are used to illustrate the robustness of the proposed testing procedure.
Collapse
Affiliation(s)
- Wei-Wen Hsu
- Department of Statistics, Kansas State University, Manhattan, KS, USA
| | - David Todem
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Nadeesha R Mawella
- Department of Mathematics and Statistics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kyung Mann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard R Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
| |
Collapse
|
9
|
Folayan MO, El Tantawi M, Ramos-Gomez F, Sabbah W. Early childhood caries and its associations with sugar consumption, overweight and exclusive breastfeeding in low, middle and high-income countries: an ecological study. PeerJ 2020; 8:e9413. [PMID: 33062406 PMCID: PMC7533058 DOI: 10.7717/peerj.9413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
Abstract
Aim This ecological study examined the associations between the prevalence of early childhood caries (ECC), overweight, country’s per capita sugar consumption and duration of exclusive breastfeeding. Methods Per capita consumption of sugar in kilograms, percentage of children exclusively breastfed until 6 months of age, percentage of 0–5-year-old children with overweight status, and percentage of 3–5-year-old children with ECC were compared among low-income countries (LICs), middle-income countries (MICs) and high-income countries (HICs). The association between the prevalence of ECC and the study variables, and the effect modification by income region were assessed using multivariable linear regression models. Regression coefficients, confidence intervals, partial eta squared and P-values for effect modification were calculated. Results The per capita sugar consumption in LICs was significantly lower than in MICs (P = 0.001) and HICs (P < 0.001). The percentage of infants who exclusively breastfed up to 6 months was significantly lower in HICs than in LICs (P < 0.001) and MICs (P = 0.003). The prevalence of overweight was significantly lower in LICs than in MICs (P < 0.001) and HICs (P = 0.021). The prevalence of ECC was significantly lower in HICs than in MICs (P < 0.001). Income was a significant modifier of the associations between the prevalence of ECC, per capita sugar consumption (P = 0.005), and exclusive breastfeeding up to 6 months (P = 0.03). The associations between the prevalence of ECC and per capita sugar consumption at the global level and for MICs were stronger (partial eta squared = 0.05 and 0.13 respectively) than for LICs and HICs (partial eta squared <0.0001 and 0.003 respectively). Only in MICs was there a significant association between the prevalence of ECC and per capita sugar consumption (P = 0.002), and between the prevalence of ECC and the percentage of children exclusively breastfed up to 6 months (P = 0.02). Conclusion Though the quantity of sugar consumption and exclusive breastfeeding may be a significant risk indicator for ECC in MICs, sugar consumption may be more of a risk indicator for ECC in HICs than in LICs, and vice versa for exclusive breastfeeding. Although ECC and overweight are both sugar-related diseases, we found no significant relationship between them.
Collapse
Affiliation(s)
- Morenike O Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Francisco Ramos-Gomez
- Division of Growth & Development, Section of Pediatric Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, University of London, London, UK
| |
Collapse
|
10
|
Bastos JL, Constante HM, Celeste RK, Haag DG, Jamieson LM. Advancing racial equity in oral health (research): more of the same is not enough. Eur J Oral Sci 2020; 128:459-466. [PMID: 32969112 DOI: 10.1111/eos.12737] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 12/19/2022]
Abstract
By critically appraising the literature on the oral health effects of race-based oppression, this focus article makes four recommendations that may both facilitate more nuanced research on the topic and mitigate racial/ethnic inequities in (oral) health. The first is recognizing that science itself may perpetuate racial/ethnic injustice, such that adopting a 'neutral' position must be replaced with actively fostering anti-racist narratives. The second is to not imply that racial oppression is bad because it harms oral health. Rather, studies should help build a fairer world, wherein oral health inequities would not abound. The third recommendation is encouraging initiatives that understand systems of oppression as conjointly operating to shape oral health. The fourth and final recommendation is taking race-based oppression as a multi-level system that operates on three inter-related conceptual levels - intra-personal, inter-personal, and structural. The extent to which scholars, practitioners, and policymakers are willing to follow these recommendations may determine how successful attempts to eradicate (oral) health inequities might be. Learning from, and avoiding mistakes made in, previous publications is one ethical pathway towards this end.
Collapse
Affiliation(s)
- João L Bastos
- Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Helena M Constante
- Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Roger K Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Dandara G Haag
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
11
|
DALLA NORA Â, DALMOLIN A, GINDRI LD, MOREIRA CHC, ALVES LS, ZENKNER JEDA. Oral health status of schoolchildren living in rural and urban areas in southern Brazil. Braz Oral Res 2020; 34:e060. [DOI: 10.1590/1807-3107bor-2020.vol34.0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/04/2020] [Indexed: 11/22/2022] Open
|
12
|
Dahlan R, Ghazal E, Saltaji H, Salami B, Amin M. Impact of social support on oral health among immigrants and ethnic minorities: A systematic review. PLoS One 2019; 14:e0218678. [PMID: 31220165 PMCID: PMC6586326 DOI: 10.1371/journal.pone.0218678] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/06/2019] [Indexed: 11/21/2022] Open
Abstract
Objective Adaptation to social life changes after migration may be beneficial or detrimental to migrants’ oral health outcomes and related behaviors. This systematic review aims to synthesize the scientific literature on the impact of social support on immigrants’ and ethnic minorities’ oral health status and/or behaviors. Methods A comprehensive electronic search, up to November 2018, was conducted using five electronic databases. We included cross-sectional and longitudinal quantitative studies that examine associations between social support and oral health outcomes among immigrants and ethnic minorities. Study selection, data extraction, and risk of bias assessment were completed in duplicate and the Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies. Results A total of 26 studies met the eligibility criteria. Included studies examined multiple oral health outcomes such as dental care utilization, oral health behaviors, oral health problems, self-rated oral health, oral health knowledge, and oral health-related quality of life among immigrants and ethnic minorities. The social support level is assessed either by social support indicators or by adapting certain scales. Overall, social support was found to be positively associated with dental care utilization, number of carious teeth, periodontal disease, oral health behaviors, oral health knowledge, oral health-related quality of life, and self-rated oral health. Conclusion Although immigrants and ethnic minorities encounter several challenges after migration to a new country that could affect their oral health, social support from their surrounding environment in the form of structural or functional support plays an important role in improving their oral health outcomes.
Collapse
Affiliation(s)
- Rana Dahlan
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ebtehal Ghazal
- School of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Humam Saltaji
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Amin
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| |
Collapse
|
13
|
Abstract
Together with other social categories, race has been at the core of much scholarly work in the area of humanities and social sciences, as well as a host of applied disciplines. In dentistry, debates have ranged from the use of race as a criterion for the recommendation of specific dental procedures to a means of assessing inequalities in a variety of outcomes. What is missing in these previous discussions, though, is a broader understanding of race that transcends relations with genetic makeup and other individual-level characteristics. In this review, we provide readers with a critique of the existing knowledge on race and oral health by answering the following 3 guiding questions: (1) What concepts and ideas are connected with race in the field of dentistry? (2) What can be learned and what is absent from the existing literature on the topic? (3) How can we enhance research and policy on racial inequalities in oral health? Taken together, the reviewed studies rely either on biological distinctions between racial categories or on other individual characteristics that may underlie racial disparities in oral health. Amidst a range of individual-level factors, racial inequalities have often been attributed to lower socioeconomic status and “health-damaging” cultural traits, for instance, patterns of and reasons for dental visits, dietary habits, and oral hygiene behaviors. While this literature has been useful in documenting large and persistent racial gaps in oral health, wider sociohistorical processes, such as systemic racism, as well as their relationships with economic exploitation, social stigmatization, and political marginalization, have yet to be operationalized among studies on the topic. A nascent body of research has recently begun to address some of these factors, but limited attention to structural theories of racism means that many more studies are needed to effectively mitigate racial health differentials.
Collapse
Affiliation(s)
- J.L. Bastos
- Department of Public Health, Federal University of Santa Catarina, Brazil
| | - R.K. Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Brazil
| | - Y.C. Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Australia
| |
Collapse
|
14
|
Todem D, Hsu WW, Fine JP. A quasi-score statistic for homogeneity testing against covariate-varying heterogeneity. Scand Stat Theory Appl 2017; 45:465-481. [PMID: 30275656 DOI: 10.1111/sjos.12308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In statistical modeling, it is often of interest to evaluate non-negative quantities that capture heterogeneity in the population such as variances, mixing proportions and dispersion parameters. In instances of covariate-dependent heterogeneity, the implied homogeneity hypotheses are nonstandard and existing inferential techniques are not applicable. In this paper, we develop a quasi-score test statistic to evaluate homogeneity against heterogeneity that varies with a covariate profile through a regression model. We establish the limiting null distribution of the proposed test as a functional of mixtures of chi-square processes. The methodology does not require the full distribution of the data to be entirely specified. Instead, a general estimating function for a finite dimensional component of the model that is of interest is assumed but other characteristics of the population are left completely unspecified. We apply the methodology to evaluate the excess zero proportion in zero-inflated models for count data. Our numerical simulations show that the proposed test can greatly improve efficiency over tests of homogeneity that neglect covariate information under the alternative hypothesis. An empirical application to dental caries indices demonstrates the importance and practical utility of the methodology in detecting excess zeros in the data.
Collapse
Affiliation(s)
- David Todem
- Michigan State University, East Lansing, USA
| | | | | |
Collapse
|
15
|
Kharazifard MJ, Holakouie-Naieni K, Mansournia MA. Application of Multilevel Models in Dentistry. JOURNAL OF DENTISTRY (TEHRAN, IRAN) 2017; 14:352-360. [PMID: 29942330 PMCID: PMC6015589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Multilevel analysis which was primarily introduced to deal with hierarchical data was later applied extensively for research in other fields of science and not only for nested data, but also for repeated measurements or clustered trials. This method of statistical analysis was applied in dental studies in the 1991 for the first time but despite its value for data analysis in dental studies, its application for dental studies remains limited until now. This manuscript reviews the applications of this method in dental studies.
Collapse
Affiliation(s)
- Mohammad Javad Kharazifard
- PhD Candidate of Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author: MJ. Kharazifard, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,
| | - Kurosh Holakouie-Naieni
- Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Assistant Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Chala S, El Aidouni M, Abouqal R, Abdallaoui F. U-shaped association between untreated caries and body mass index in adults at Rabat dental University hospital, Morocco: cross sectional study. BMC Res Notes 2017; 10:5. [PMID: 28057060 PMCID: PMC5217218 DOI: 10.1186/s13104-016-2356-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 12/20/2016] [Indexed: 11/23/2022] Open
Abstract
Background Many previous studies estimating the relationship between body mass index (BMI) and dental decay are conflicting. Most studies, however, examine the relationship using BMI as a categorical variable. This study evaluated the non-linear association between body mass index as a continuous variable and untreated dental decay. Methods Cross-sectional study of adults free of diseases attending a tertiary dental clinic was conducted. The number of untreated caries at the time of consultation was assessed using the WHO criteria. A multivariable Poisson regression model for severity of untreated dental decay was first established. Restricted cubic spline functions were used to consider potential non-linear associations between BMI and untreated dental caries. Results After multivariable adjustment, the prevalence ratios (PR) for the number of dental decay remained significantly associated with the age at beginning tooth brushing (PR = 1.15, 95% CI 1.05–1.25), BMI < normal (PR = 1.66, 95% CI 1.30–2.12), BMI > normal (PR = 1.30, 95% CI 1.03–1.65), SDI (PR = 0.61, 95% CI 0.50–0.75) and GI (PR = 1.59, 95% CI 1.30–1.94). When BMI was evaluated as continuous variable, it exhibited a significant U-shaped pattern with the number of untreated dental decay both in univariable and multivariable analysis. Conclusion The rate of untreated tooth decay was associated with both under- and overweight status.
Collapse
Affiliation(s)
- Sanaa Chala
- Research Team on Oral Ecosystem, Department of Endodontics and Restorative Dentistry, Faculty of Dental Medicine, Laboratory of Clinical and Epidemiological Research, Mohammed V University in Rabat, 6212, Rabat, Morocco. .,Mohammed V Military Teaching Hospital, Rabat, Morocco.
| | - Manal El Aidouni
- Research Team on Oral Ecosystem, Department of Endodontics and Restorative Dentistry, Faculty of Dental Medicine, Laboratory of Clinical and Epidemiological Research, Mohammed V University in Rabat, 6212, Rabat, Morocco
| | - Redouane Abouqal
- Laboratory of Clinical and Epidemiological Research. Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Faïza Abdallaoui
- Research Team on Oral Ecosystem, Department of Endodontics and Restorative Dentistry, Faculty of Dental Medicine, Laboratory of Clinical and Epidemiological Research, Mohammed V University in Rabat, 6212, Rabat, Morocco
| |
Collapse
|
17
|
Todem D, Kim K, Hsu WW. Marginal mean models for zero-inflated count data. Biometrics 2016; 72:986-94. [PMID: 26890497 PMCID: PMC4988952 DOI: 10.1111/biom.12492] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/01/2016] [Accepted: 01/01/2016] [Indexed: 11/29/2022]
Abstract
Zero-inflated regression models have emerged as a popular tool within the parametric framework to characterize count data with excess zeros. Despite their increasing popularity, much of the literature on real applications of these models has centered around the latent class formulation where the mean response of the so-called at-risk or susceptible population and the susceptibility probability are both related to covariates. While this formulation in some instances provides an interesting representation of the data, it often fails to produce easily interpretable covariate effects on the overall mean response. In this article, we propose two approaches that circumvent this limitation. The first approach consists of estimating the effect of covariates on the overall mean from the assumed latent class models, while the second approach formulates a model that directly relates the overall mean to covariates. Our results are illustrated by extensive numerical simulations and an application to an oral health study on low income African-American children, where the overall mean model is used to evaluate the effect of sugar consumption on caries indices.
Collapse
Affiliation(s)
- David Todem
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan 48824, U.S.A..
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin 53792, U.S.A
| | - Wei-Wen Hsu
- Department of Statistics, Kansas State University, Manhattan, Kansas 66506, U.S.A
| |
Collapse
|
18
|
Qiu RM, Tao Y, Zhou Y, Zhi QH, Lin HC. The relationship between children's oral health-related behaviors and their caregiver's social support. BMC Oral Health 2016; 16:86. [PMID: 27585709 PMCID: PMC5009697 DOI: 10.1186/s12903-016-0270-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/10/2016] [Indexed: 11/30/2022] Open
Abstract
Background Social support might play a role in helping people adopt healthy behaviors and improve their health. Stronger social support from mothers has been found to be positively related to higher tooth brushing frequency in 1- to 3-year-old children. However, little is known regarding the relationship between the caregiver’s social support and the oral health-related behaviors of 5-year-old children in China. This study aimed to investigate this relationship. Methods A cross-sectional study was conducted among 1332 5-year-old children and their caregivers in Guangzhou, southern China. Data were collected using questionnaires that were completed by the caregivers and the children’s caries status were examined. The caregivers’ social support was measured using the Social Support Rating Scale. The measurements of the children’s oral health-related behaviors included the frequencies of sugary snack intake and tooth brushing, utilization of dental services, and patterns of dental visits. Univariate and multiple logistic regression analyses were used to analyze the relationships between the variables. Results No association was found between the caregiver’s social support and the child’s oral health-related behaviors in a multiple logistic regression analysis. However, other factors, particularly the oral health-related behaviors of the caregiver, were found to be significantly linked to the child’s oral health-related behaviors. Conclusions The oral health-related behaviors of 5-year-old children in Guangzhou are unrelated to the caregiver’s social support but are related to other specific factors, particularly the caregiver’s oral health-related behaviors.
Collapse
Affiliation(s)
- Rong Min Qiu
- Department of Preventive Dentistry, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, 56 Ling Yuan Road West, 510055, Guangzhou, Guangdong Province, China.,Department of Pediatric Dentistry, College of Stomatology, Guangxi Medical University, Nanning, China
| | - Ye Tao
- Department of Preventive Dentistry, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, 56 Ling Yuan Road West, 510055, Guangzhou, Guangdong Province, China
| | - Yan Zhou
- Department of Preventive Dentistry, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, 56 Ling Yuan Road West, 510055, Guangzhou, Guangdong Province, China
| | - Qing Hui Zhi
- Department of Preventive Dentistry, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, 56 Ling Yuan Road West, 510055, Guangzhou, Guangdong Province, China
| | - Huan Cai Lin
- Department of Preventive Dentistry, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, 56 Ling Yuan Road West, 510055, Guangzhou, Guangdong Province, China.
| |
Collapse
|
19
|
Akintobi TH, Hoffman LM, McAllister C, Goodin L, Hernandez ND, Rollins L, Miller A. Assessing the Oral Health Needs of African American Men in Low-Income, Urban Communities. Am J Mens Health 2016; 12:326-337. [PMID: 27008993 DOI: 10.1177/1557988316639912] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite improvements in oral health status in the United States, pronounced racial/ethnic disparities exist. Black men are less likely to visit the dentist, are twice as likely to experience tooth decay, and have a significantly lower 5-year oral cancer survival rate when compared to White men. The Minority Men's Oral Health Dental Access Program employed a community-based participatory research approach to examine the oral health barriers and opportunities for intervention among Black men in a low-income, urban neighborhood. A cross-sectional study design was implemented through a self-administered survey completed among 154 Black males. The majority reported not having dental insurance (68.8%). Most frequently cited oral health care barriers were lack of dental insurance and not being able to afford dental care. Attitudes related to the significance of dental care centered on cancer prevention and feeling comfortable with one's smile. The impact of oral health on daily life centered on social interaction, with men citing insecurities associated with eating, talking, and smiling due to embarrassment with how their teeth/mouth looked to others. Multivariate logistic regression revealed that those who had difficulty finding dental care were 4.81 times (odds ratio = 4.65, 95% confidence interval [1.80, 12.85]) more likely to report no dental insurance, and 2.73 times (odds ratio = 3.72; 95% confidence interval [1.12, 6.70]) more likely to report poor oral health. Community-based participatory approaches include assessment of neighborhood residents affected by the health issue to frame interventions that resonate and are more effective. Social, physical, and infrastructural factors may emerge, requiring a multilevel approach.
Collapse
Affiliation(s)
| | | | | | - Lisa Goodin
- 3 Fulton County Department of Health and Wellness, Atlanta, GA, USA
| | | | | | - Assia Miller
- 4 McKing Consulting Corporation, Atlanta, GA, USA
| |
Collapse
|
20
|
Engelmann JL, Tomazoni F, Oliveira MDM, Ardenghi TM. Association between Dental Caries and Socioeconomic Factors in Schoolchildren - A Multilevel Analysis. Braz Dent J 2016; 27:72-8. [DOI: 10.1590/0103-6440201600435] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/10/2015] [Indexed: 11/21/2022] Open
Abstract
Abstract This study aimed to assess the association between dental caries, socioeconomic individual and contextual factors in 12-years-old children. A representative sample of 1,134 children enrolled in public schools from Santa Maria, RS, Brazil, was obtained from a multistage random sampling. Four calibrated dentists examined participants at schools. Data about dental caries (DMF-T index) and dental plaque (present or absent) were assessed. Children's parents or guardians answered questions regarding their demographics and socioeconomic status. Context variables were also collected from official publications of the city. Data analyses were performed using multilevel logistic regression models. Caries prevalence in this sample (DMF-T≥1) was 49.9% (95%CI: 45.05% - 54.77%), and mean DMF-T was 1.15 (95%CI: 1.01-1.29) with 0.068 standard error. Children of the 3rd and 2nd tertile of income represented by the rich and intermediate categories, showed, respectively, a 50% (OR 0.50: CI95 % 0.35-0.71) and 39% (OR 0.61: CI95% 0.45-0.82) lower chance to present untreated caries compared with the poorest portion of the sample represented by the 1st tertile of income. Regarding the context covariates, children from lower income neighborhood presented a higher chance for having untreated dental caries compared with their counterpart (OR 1.70: CI95% 1.19 to 2.43). Inequalities in the distribution of dental caries continue affecting children from poorer socioeconomic profiles. There is need for planning public interventions for oral health promotion that take into account individual and contextual socioeconomic characteristics.
Collapse
|
21
|
Abstract
This article provides a brief introduction to various aspects of oral health care in children, with emphasis on the epidemiology, risk assessment, prevention, and treatment modalities for dental caries. In addition, barriers to dental care and the involvement of pediatricians in advocating for and providing preventive dental care for children are reviewed. Oral health care is one of the most prevalent unmet needs among infants, toddlers, and adolescents in the United States. Routine or preventive dental visits are important for early diagnosis, prevention, and treatment of oral diseases, and for establishing and maintaining good oral health and overall well-being.
Collapse
Affiliation(s)
- Christopher Okunseri
- Department of Clinical Services, School of Dentistry, Marquette University, Room 356, PO Box 1881, Milwaukee, WI 53201-1881, USA.
| | - Cesar Gonzalez
- Department of Developmental Sciences, School of Dentistry, Marquette University, PO Box 1881, Milwaukee, WI 53201, USA
| | - Brian Hodgson
- Department of Developmental Sciences, School of Dentistry, Marquette University, PO Box 1881, Milwaukee, WI 53201, USA
| |
Collapse
|
22
|
Silva JVD, Machado FCDA, Ferreira MAF. As desigualdades sociais e a saúde bucal nas capitais brasileiras. CIENCIA & SAUDE COLETIVA 2015. [DOI: 10.1590/1413-81232015208.12052014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ResumoApesar da melhoria das condições de vida dos brasileiros, ainda persiste um panorama de iniquidades em saúde bucal. Este estudo ecológico avaliou a relação das condições socioeconômicas e de política de saúde pública com as de saúde bucal nas capitais brasileiras. Foi realizada análise fatorial com os indicadores de condições socioeconômicas, revelando dois fatores comuns: deprivação econômica e condição sociossanitária. Em seguida, executou-se análise de regressão linear múltipla para os indicadores de saúde bucal (média CPO-D 12 anos, média de dentes perdidos e taxa de população livre de cárie) com os dois fatores em comum e a fluoretação da água de abastecimento. A análise de regressão linear múltipla para o CPO-D das capitais foi estimado pelas condições sociossanitárias e fluoretação, ajustado pela deprivação econômica; enquanto que o modelo para a média de dentes perdidos foi estimado apenas pela fluoretação e deprivação econômica, e, por fim, o modelo para a taxa da população livre de cárie nas capitais brasileiras foi estimado pela condição econômica e sociossanitária ajustadas pelo abastecimento de água fluoretada. Portanto, os resultados apontam a necessidade de ações sociais que impactem nas condições de vida da população para redução da cárie dentária.
Collapse
|
23
|
Ardila CM, Agudelo-Suárez AA. Association between dental pain and caries: a multilevel analysis to evaluate the influence of contextual and individual factors in 34 843 adults. ACTA ACUST UNITED AC 2015; 7:410-416. [PMID: 26084783 DOI: 10.1111/jicd.12168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos Martín Ardila
- Biomedical Stomatology Research Group; Universidad de Antioquia U de A; Medellín Colombia
| | | |
Collapse
|
24
|
Ardila CM, Posada-López A, Agudelo-Suárez AA. A Multilevel Approach on Self-Reported Dental Caries in Subjects of Minority Ethnic Groups: A Cross-Sectional Study of 6440 Adults. J Immigr Minor Health 2015; 18:86-93. [PMID: 25963050 DOI: 10.1007/s10903-015-0217-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Regional contextual factors and dental caries using multilevel modeling related to adults in minority ethnic groups have been scantily explored. The influence of the socioeconomic context on self-reported dental caries (SRDC) in individuals of minority ethnic groups (IEG) in Colombia was studied. Data from the 2007 National Public Health Survey were collected in 34,843 participants of the population. The influence of different factors on SRDC in IEG was investigated with logistic and multilevel regression analyses. A total of 6440 individuals belonged to an ethnic group. Multilevel analysis showed a significant variance in SRDC that was smaller in IEG level than between states. Multilevel multivariate analysis also associated SRDC with increasing age, lower education level, last dental visit >1 year, unmet dental need and low Gross Domestic Product (GDP). Minority ethnic groups were at risk to report higher dental caries, where low GDP was an important variable to be considered.
Collapse
Affiliation(s)
- Carlos M Ardila
- Biomedical Stomatology Research Group, Universidad de Antioquia (U de A), Calle 70 No. 52-21, Medellín, Colombia. .,Department of Periodontology, School of Dentistry, Universidad de Antioquia (U de A), Medellín, Colombia.
| | - Adriana Posada-López
- Basic Studies Department, School of Dentistry, Universidad de Antioquia (U de A), Medellín, Colombia
| | - Andrés A Agudelo-Suárez
- Research Department, School of Dentistry, Universidad de Antioquia (U de A), Medellín, Colombia
| |
Collapse
|
25
|
Okunseri C, Garcia RI, Okunseri E, Visotcky A, Szabo A. Dental service utilization and neighborhood characteristics in young adults in the United States: a multilevel approach. J Public Health Dent 2015; 75:282-90. [PMID: 25929275 DOI: 10.1111/jphd.12097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the association between neighborhood level factors and dental visits in young adults in the United States after adjusting for individual level factors. METHODS The National Longitudinal Study of Adolescent Health Wave 1 (1994-1995) to Wave III (2001-2002) was analyzed. The primary outcome of having had at least one dental visit in the previous 12 months was analyzed via a multilevel random-effects logistic model accounting for geographic clustering in Wave III and survey design clustering from Wave I. Neighborhood level covariates were defined at the census tract level. RESULTS Overall rate of dental visits was 57 percent, highest among 18-20 year olds (65 percent) and lowest in 23-26 year olds (52 percent). Increased proportion of African-Americans (≤5 percent to ≥20 percent) and Hispanics (≤5 percent to ≥20 percent) in a neighborhood corresponded with a decrease in dental visits (60 percent versus 52 percent) and (58 percent versus 51 percent), respectively. Neighborhoods with a high proportion of college-educated residents had a higher percentage of dental visits. Similar differences were found when comparing the lowest and highest tertiles defined by poverty level and unemployment with dental visits. Neighborhood education was significantly associated with dental service utilization after adjustment for individual level factors and dental utilization in adolescence (Waves I and II) in the random effects model. CONCLUSIONS This study demonstrates that the education level of residents within a neighborhood was associated with dental service utilization in young adults in the United States.
Collapse
Affiliation(s)
- Christopher Okunseri
- Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA
| | - Raul I Garcia
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - Elaye Okunseri
- Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA
| | - Alexis Visotcky
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
26
|
Dietary Research to Reduce Children's Oral Health Disparities: An Exploratory Cross-Sectional Analysis of Socioeconomic Status, Food Insecurity, and Fast-Food Consumption. J Acad Nutr Diet 2015; 115:1599-604. [PMID: 25840937 DOI: 10.1016/j.jand.2015.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/04/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tooth decay is the most common childhood disease and it disproportionately affects low-income children. The dietary risk factors associated with socioeconomic status (SES), such as food insecurity and fast-food consumption, are poorly understood. OBJECTIVE To better understand how upstream social factors are related to dietary behaviors by testing the hypothesis that food insecurity mediates the SES-fast-food consumption relationship. DESIGN A 36-item survey was administered to caregivers of children younger than age 18 years (n=212). The predictor variable was SES, measured by whether the child was insured by Medicaid (no/yes). Food insecurity, the potential dietary mediator, was measured using the six-item US Department of Agriculture Household Food Security Survey (food secure/food insecure without hunger/food insecure with hunger). The outcome variable was whether the household reported eating at a fast-food restaurant ≥2 times a week (no/yes). We used logistic structural equation and mediation models to test our hypothesis. RESULTS About 63% of children were classified as low SES. Thirty percent of caregivers reported food insecurity (with or without hunger) and 18.6% of households consumed fast food ≥2 times per week. Lower SES was significantly associated with food insecurity (odds ratio [OR] 3.03, 95% CI 1.51 to 6.04; P=0.002), but SES was not related to fast-food consumption (OR 1.94, 95% CI 0.86 to 4.36; P=0.11). Food insecurity was not associated with fast-food consumption (OR 1.76, 95% CI 0.86 to 3.62; P=0.12). The mediation analyses suggest food insecurity does not mediate the relationship between SES and fast-food consumption. However, there are important potential differences in fast-food consumption by SES and food insecurity status. CONCLUSIONS Future dietary research focusing on tooth decay prevention in vulnerable children may need to account for the differential effects of SES on food insecurity and dietary behaviors like fast-food consumption. Studies are needed to further elucidate the mechanisms linking SES, dietary behaviors, and tooth decay in children.
Collapse
|
27
|
Villa Nova FA, Ambrosano GMB, Pereira SM, Pereira AC, Meneghin MDC. Associação do risco familiar com saúde bucal, qualidade de vida e variáveis socioeconômicas. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2015. [DOI: 10.5712/rbmfc10(34)970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: avaliar a relação do risco familiar com saúde bucal, qualidade de vida e variáveis socioeconômicas. Métodos: estudo observacional transversal com 311 indivíduos com idade entre 18 e 71 anos, residentes na área de abrangência de quatro unidades de saúde da família (USF), localizadas em dois municípios do estado de São Paulo. Os voluntários foram avaliados de acordo com: (1) situação clínica (CPO-D e necessidade de tratamento), (2) autopercepção de saúde bucal (OHIP-14), (3) qualidade de vida (WHOQOL-BREF), e (4) condição socioeconômica. Para avaliar o risco familiar, utilizou-se a Escala de Coelho. Os dados foram analisados por meio de modelo multinível formado por componentes fixos (representados pelas variáveis estudadas) e componentes aleatórios (representados pelos bairros e pelas variâncias nos diferentes níveis). Resultados: a média de idade dos participantes foi de 36,7 anos (dp=13), com CPO-D médio de 12,9 (dp=7,0). A média da Escala de Risco de Coelho entre os voluntários foi de 2,67 com erro padrão de 0,32. Apresentaram maior escore de risco total os indivíduos de maior idade (p=0,0486), que moravam em casas com mais residentes (p<0,001), com menos anos de escolaridade (p=0,0137), que não possuíam automóvel (p=0,0048) e com maior escore de OHIP-14 (p=0,0130). Conclusão: a escala de risco familiar associou-se positivamente às variáveis socioeconômicas, e os indivíduos com maior risco familiar apresentaram pior autopercepção da saúde bucal, mas não percebiam uma pior qualidade de vida em geral.
Collapse
|
28
|
Vazquez FDL, Cortellazzi KL, Kaieda AK, Bulgareli JV, Mialhe FL, Ambrosano GMB, da Silva Tagliaferro EP, Guerra LM, de Castro Meneghim M, Pereira AC. Individual and contextual factors related to dental caries in underprivileged Brazilian adolescents. BMC Oral Health 2015; 15:6. [PMID: 25604304 PMCID: PMC4320574 DOI: 10.1186/1472-6831-15-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 01/09/2015] [Indexed: 12/25/2022] Open
Abstract
Background Investigate the individual and contextual variables related to caries in underprivileged adolescents, and the disparity in distribution of the disease. Methods Cross-sectional analytical study, conducted in the city of Piracicaba, SP, Brazil, in 2012. The probabilistic sample was composed of 1,179 adolescents from 15–19 years of age, randomly selected from 21 state schools and 34 Primary Health Units – Family Health (PHU-FH). The dependent variables studied were number of decayed teeth and caries experience (DMFT). The independent variables were classified into individual (clinical, sociodemographic, psychosocial, self-perception, impact on oral health, access to services, and quality of life) and contextual (social exclusion index, total number of residents in suburb, literacy rate, and the following variables given in percentages: residences in the home ownership category, provision of domestic sewerage, trash collection, families with income of over 1 minimum wage per month, and families without monthly income) variables. The multilevel regression model was estimated by the PROC GLIMMIX (Generalized Linear Models-Mixed) procedure, considering the individual variables as Level 1 and the contextual variables of the suburbs as Level 2. Adjustment of the model was evaluated by -2 Res Log Likelihood with α = 0.05. Results As regards the individual variables, adolescents who declared having a prison inmate in the Family and resided in homes with a larger number of persons, showed a higher number of decayed teeth. There were a larger number of decayed teeth, a higher DMFT value, and worse self-perception as regards the health of their teeth and mouth. Other variables, such as being of the female gender, age and time since last visit to the dentist were related to the DMFT index. As regards the contextual variables, the DMFT was lower in suburbs with greater access to domestic sewage, and the number of decayed teeth was higher in suburbs with the worst social exclusion indices. Conclusion Individual and contextual variables were associated with the presence of caries and DMFT index in underprivileged adolescents, indicating that they must be taken into consideration in the formulation of policies directed towards oral health promotion and prevention activities in this group.
Collapse
Affiliation(s)
- Fabiana de Lima Vazquez
- Department of Community Dentistry, Piracicaba Dental School, State University of Campinas, São Paulo, Brazil, Av, Limeira 901, P,O, BOX 52, CEP: 13414-903 Piracicaba, SP, Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Rouxel PL, Heilmann A, Aida J, Tsakos G, Watt RG. Social capital: theory, evidence, and implications for oral health. Community Dent Oral Epidemiol 2014; 43:97-105. [DOI: 10.1111/cdoe.12141] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Anja Heilmann
- Department of Epidemiology and Public Health; UCL; London UK
| | - Jun Aida
- Department of International and Community Oral Health; Tohoku University; Sendai Japan
| | - Georgios Tsakos
- Department of Epidemiology and Public Health; UCL; London UK
| | - Richard G. Watt
- Department of Epidemiology and Public Health; UCL; London UK
| |
Collapse
|
30
|
Quality of life and socio-dental impact among underprivileged Brazilian adolescents. Qual Life Res 2014; 24:661-9. [PMID: 25173682 DOI: 10.1007/s11136-014-0795-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the influence of clinical variables, individual and contextual characteristics on the quality of life (QL) of underprivileged adolescents in a municipality in the interior of the State of São Paulo, Brazil. METHODS An analytical cross-sectional study was conducted in Piracicaba, in 2012, with 1,172 adolescents aged 15-19 years, from 21 state schools and 34 Family Health Units. The dependent variables included the socio-dental impact (OIDP) and quality of life (WHOQOL-bref) indices. The dependent variables were classified as individual (DMFT index, CPI Index, age, sex, income, parents' educational level) and contextual (Social Exclusion Index) variable. The multilevel regression model was estimated by the PROC GLIMMIX ("Generalized Linear Models-Mixed") procedure, considering the individuals' variables as being Level 1 and the contextual variables as being Level 2, and the statistical significance was evaluated at level of significance of 5 %. RESULTS Girls were found to have the worst QL (p < 0.000) and greatest OIDP (p = 0.000). There was an increase in OIDP (p < 0.001) and diminished QL (p < 0.052) with an increase in the periodontal index. This result is marginally significant since the significance probability is marginally greater than 0.05. In turn, there was an increase in QL (p = 0.000) and reduction in OIDP (p < 0.000) with an increase in the family income. Adolescents who resided in areas of greatest social exclusion (p = 0.031) and with greater OIDP (p < 0.000) presented the worst QL. CONCLUSION Individual and contextual variables were related to the OIDP and QL in underprivileged Brazilian adolescents.
Collapse
|
31
|
Abstract
Tooth loss in adults diminishes quality of daily life, affecting eating, speaking, appearance, and social interactions. Tooth loss is linked to severe periodontitis and caries; and to risk of stroke, cardiovascular disease, rheumatoid arthritis, and dementia. At the national (USA) level, poverty and African-American race have been linked to lower utilization of dental services, suggesting that the 7.5 million residents of publicly supported housing may be at risk of tooth loss and poor overall oral health. We assessed whether residence in publicly supported housing in Boston was associated with four oral health-related indicators. Compared to residents of nonpublicly supported housing, after adjusting for covariates residents of both public housing developments (PHDs) and rental assistance units (RAUs) had significantly lower odds of having had a dental cleaning in the past year (PHD, OR = 0.64 (95 % CI, 0.44-0.93); RAU, OR = 0.67 (95 % CI, 0.45-0.99))-despite parity in having had a past year dental visit. Further, residents of RAUs had double the odds of having had six or more teeth removed (OR = 2.20 (95 % CI, 1.39-3.50)). Associations of race/ethnicity and housing type with dental insurance were interrelated. Unadjusted results document a deficit in oral health-related indicators among public housing residents, taken as a group, giving a clear picture of an oral health care gap and identifying a defined real-world population that could benefit from services. Existing public housing infrastructure could provide both a venue and a foundation for interventions to reduce oral health disparities on a broad scale.
Collapse
Affiliation(s)
- Nancy Irwin Maxwell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA,
| | | | | | | | | |
Collapse
|
32
|
Bezerra IA, Goes PSAD. [Association between social capital and oral health conditions and behavior]. CIENCIA & SAUDE COLETIVA 2014; 19:1943-50. [PMID: 24897493 DOI: 10.1590/1413-81232014196.06242013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/15/2013] [Indexed: 11/22/2022] Open
Abstract
The theory of social capital seeks to explain social inequality in health through the interaction of social, economic and environmental factors and has been associated with many health problems, though there is still little research in the area of oral health. The scope of this study was to evaluate the association between social capital and socio-demographic and behavioral factors related to oral health among schoolchildren aged from 15 to 19. A random sample of 1,417 adolescents filled out a self-administered survey and the data were descriptively analyzed (simple frequencies, central tendency and variability measurement) and inferential statistics (Pearson's chi-square test). The results showed that the social capital which is more prevalent among adolescents was intermediate level, as well as between each of its dimensions, except for social action where the majority were classified as lower-leveled. Among the variables analyzed, social capital was statistically associated only with sex, with women being more likely to be classified under the 'low social capital' label. This area still needs considerable research to increase theoretical-conceptual and methodological maturity in order to better understand the social contexts that are essential for formulating effective public health policies.
Collapse
|
33
|
Chi DL, Masterson EE, Carle AC, Mancl LA, Coldwell SE. Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007-2008. Am J Public Health 2014; 104:860-4. [PMID: 24625141 DOI: 10.2105/ajph.2013.301699] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We examined associations of household socioeconomic status (SES) and food security with children's oral health outcomes. METHODS We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship. RESULTS About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES-caries relationship. CONCLUSIONS Interventions and policies to ensure food security may help address the US pediatric caries epidemic.
Collapse
Affiliation(s)
- Donald L Chi
- Donald L. Chi, Erin E. Masterson, Lloyd A. Mancl, and Susan E. Coldwell are with the Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle. Adam C. Carle is with the Department of Pediatrics, School of Medicine, and the Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH
| | | | | | | | | |
Collapse
|
34
|
Duijster D, van Loveren C, Dusseldorp E, Verrips GHW. Modelling community, family, and individual determinants of childhood dental caries. Eur J Oral Sci 2014; 122:125-33. [DOI: 10.1111/eos.12118] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Denise Duijster
- Department of Preventive Dentistry; Academic Centre for Dentistry Amsterdam; University of Amsterdam and VU University; Amsterdam the Netherlands
| | - Cor van Loveren
- Department of Preventive Dentistry; Academic Centre for Dentistry Amsterdam; University of Amsterdam and VU University; Amsterdam the Netherlands
| | | | - Gijsbert H. W. Verrips
- TNO; Leiden the Netherlands
- Department of Social Dentistry and Behavioural Sciences; Academic Centre for Dentistry Amsterdam; University of Amsterdam and VU University; Amsterdam the Netherlands
| |
Collapse
|
35
|
Cao G, Hsu WW, Todem D. A score-type test for heterogeneity in zero-inflated models in a stratified population. Stat Med 2014; 33:2103-14. [PMID: 24488881 DOI: 10.1002/sim.6092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 10/30/2013] [Accepted: 12/16/2013] [Indexed: 11/12/2022]
Abstract
We propose a score-type statistic to evaluate heterogeneity in zero-inflated models for count data in a stratified population, where heterogeneity is defined as instances in which the zero counts are generated from two sources. Evaluating heterogeneity in this class of models has attracted considerable attention in the literature, but existing testing procedures have primarily relied on the constancy assumption under the alternative hypothesis. In this paper, we extend the literature by describing a score-type test to evaluate homogeneity against general alternatives that do not neglect the stratification information under the alternative hypothesis. The limiting null distribution of the proposed test statistic is a mixture of chi-squared distributions that can be well approximated by a simple parametric bootstrap procedure. Our numerical simulation studies show that the proposed test can greatly improve efficiency over tests of heterogeneity that ignore the stratification information. An empirical application to dental caries data in early childhood further shows the importance and practical utility of the methodology in using the stratification profile to detect heterogeneity in the population.
Collapse
Affiliation(s)
- Guanqun Cao
- Department of Mathematics and Statistics, Auburn University, Auburn, AL 36849, U.S.A
| | | | | |
Collapse
|
36
|
Jordão LMR, Saraiva LM, Sheiham A, Freire MCM. Relationship between rates of attending religious services and oral health in Brazilian adolescents. Community Dent Oral Epidemiol 2014; 42:420-7. [DOI: 10.1111/cdoe.12098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/02/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Laís M. Saraiva
- School of Dentistry; Federal University of Goiás; Goiânia-GO Brazil
| | - Aubrey Sheiham
- Department of Epidemiology and Public Health; University College London; London UK
| | | |
Collapse
|
37
|
Borenstein H, Renahy E, Quiñonez C, O'Campo P. Oral health, oral pain, and visits to the dentist: neighborhood influences among a large diverse urban sample of adults. J Urban Health 2013; 90:1064-78. [PMID: 23615780 PMCID: PMC3853181 DOI: 10.1007/s11524-013-9802-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to assess the association between oral health and individual-level characteristics as well as both socioeconomic position (SEP) and service provision characteristics at the neighborhood level. Multilevel logistic analysis was undertaken of data from the Neighbourhood Effects on Health and Well-being Study in Toronto comprising 2,412 participants living in 47 neighborhoods and 87 census tracts. Three oral health outcomes were investigated: last dental visit, self-rated oral health, and self-rated oral pain. Results indicated that SEP was significantly associated with no dental visits in the last year, poor self-rated oral health, and experiencing oral pain after adjusting for age, gender, and immigrant status. Lack of dental insurance was associated with no visits to the dentist in the last year and poor self-rated oral health; however, no association was observed with oral pain. In adjusted regression models, few neighborhood level variables were significantly associated with dental visits and self-rated oral health and no neighborhood variables were associated with oral pain. Based on these results, SEP appears to be important in evaluating oral health outcomes. While insignificant in this study, neighborhood factors are important when considering the impact of service provision on oral health.
Collapse
Affiliation(s)
- Heidi Borenstein
- Centre for Research on Inner City Health, St. Michael's Hospital, 209 Victoria Street, Third Floor, Toronto, Ontario, Canada, M5C 1N8,
| | | | | | | |
Collapse
|
38
|
Brizon VSC, Cortellazzi KL, Vazquez FL, Ambrosano GMB, Pereira AC, Gomes VE, Oliveira AC. Fatores individuais e contextuais associados à má oclusão em crianças brasileiras. Rev Saude Publica 2013; 47 Suppl 3:118-28. [DOI: 10.1590/s0034-8910.2013047004426] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 03/04/2013] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a associação entre a prevalência de má oclusão em crianças aos 12 anos de idade com variáveis individuais e contextuais. MÉTODOS: Foi realizado um estudo transversal analítico com dados da Pesquisa Nacional de Saúde Bucal – SBBrasil 2010. O desfecho estudado foi a má oclusão, categorizada em ausente, definida, severa e muito severa. As variáveis independentes foram classificadas em individuais e contextuais. Os dados foram analisados por meio de modelo multinível, considerando nível de 5% de significância. RESULTADOS: A prevalência de má oclusão severa e muito severa nas crianças com 12 anos de idade não diferiu entre as regiões brasileiras, mas sim entre as cidades (p < 0,001). Crianças do sexo masculino (p = 0,033), de menor renda (p = 0,051), que consultaram o dentista (p = 0,009), com menor satisfação com a boca e os dentes (p < 0,001) e com vergonha de sorrir (p < 0,001) apresentaram má oclusão de maior gravidade. As características das cidades também afetaram a gravidade da má oclusão; cidades com mais famílias com benefício social por 1.000 habitantes, com menores notas do índice de desempenho do sistema de saúde e menor renda per capita foram estatisticamente associadas com a má oclusão. CONCLUSÕES: Associações significativas entre a presença e gravidade da má oclusão foram observadas em nível individual e contextual.
Collapse
|
39
|
Schuller AA, van Buuren S. Estimation of caries experience by multiple imputation and direct standardization. Caries Res 2013; 48:91-5. [PMID: 24296647 DOI: 10.1159/000353140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/20/2013] [Indexed: 11/19/2022] Open
Abstract
Valid estimates of caries experience are needed to monitor oral population health. Obtaining such estimates in practice is often complicated by nonresponse and missing data. The goal of this study was to estimate caries experiences in a population of children aged 5 and 11 years, in the presence of nonresponse and missing data. Four estimation methods are compared. Each method makes implicit assumptions about the processes that caused the nonresponse and the missing data. Three of the four methods are based on unrealistic assumptions about the missing data and underestimate caries experience. Under the missing at random assumption, multiple imputation in combination with direct standardization corrects for the deficiencies of current methodology. In the presence of missing data and nonresponse, we recommend a combination of multiple imputation and direct standardization to obtain correct estimates of caries experience.
Collapse
Affiliation(s)
- A A Schuller
- Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
| | | |
Collapse
|
40
|
Armfield JM, Mejía GC, Jamieson LM. Socioeconomic and psychosocial correlates of oral health. Int Dent J 2013; 63:202-9. [DOI: 10.1111/idj.12032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
41
|
Lamarca GA, Leal MDC, Leao ATT, Sheiham A, Vettore MV. The different roles of neighbourhood and individual social capital on oral health-related quality of life during pregnancy and postpartum: a multilevel analysis. Community Dent Oral Epidemiol 2013; 42:139-50. [DOI: 10.1111/cdoe.12062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Gabriela A. Lamarca
- Escola Nacional de Saúde Pública FIOCRUZ; Rio de Janeiro RJ Brazil
- Department of Epidemiology and Public Health; University College London; London UK
| | - Maria do C. Leal
- Escola Nacional de Saúde Pública FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Anna T. T. Leao
- Faculdade de Odontologia; Universidade Federal do Rio de Janeiro; Rio de Janeiro RJ Brazil
| | - Aubrey Sheiham
- Department of Epidemiology and Public Health; University College London; London UK
| | - Mario V. Vettore
- Unit of Dental Public Health; School of Clinical Dentistry; University of Sheffield; Sheffield UK
| |
Collapse
|
42
|
Maupome G, Martínez-Mier EA, Holt A, Medina-Solís CE, Mantilla-Rodríguez A, Carlton B. The association between geographical factors and dental caries in a rural area in Mexico. CAD SAUDE PUBLICA 2013; 29:1407-14. [DOI: 10.1590/s0102-311x2013000700014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 03/04/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the association between markers of oral disease and geographical factors influencing access to dental care (DMFT score) among school children in Central Mexico. Retrospective data were collected during an international service-learning program between 2002 and 2009. A sample of 1,143 children (55% females; mean age 12.7±13.1years) was analyzed. The mean DMFT score, represented largely by untreated tooth decay, was 4.02 (4.76). The variables that had the most significant effect on the DMFT score were proportion of paved roads between the community and dental services, and the availability of piped potable water. The DMFT score increased in proportion to the percentage of paved roads. In contrast, the DMFT score decreased with the availability of piped potable water. Similar results were found for untreated tooth decay. The main variable associated with a significant increase in dental fillings was proportion of paved roads. Together with Brazilian reports, this is one of the first investigations of the association between geographical factors and oral health in an underdeveloped setting.
Collapse
|
43
|
Castilho ARFD, Mialhe FL, Barbosa TDS, Puppin-Rontani RM. Influence of family environment on children's oral health: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
44
|
Castilho ARFD, Mialhe FL, Barbosa TDS, Puppin-Rontani RM. Influence of family environment on children's oral health: a systematic review. J Pediatr (Rio J) 2013; 89:116-23. [PMID: 23642420 DOI: 10.1016/j.jped.2013.03.014] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/17/2012] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To review current models and scientific evidence on the influence of parents' oral health behaviors on their children's dental caries. SOURCES MEDLINE articles published between 1980 and June, 2012. Original research articles on parents' oral health behavior were reviewed. A total of 218 citations were retrieved, and 13 articles were included in the analysis. The studies were eligible for review if they matched the following inclusion criteria: (1) they evaluated a possible association between dental caries and parents' oral-health-related behaviors, and (2) the study methodology included oral clinical examination. The main search terms were "oral health", "parental attitudes", "parental knowledge", and "dental caries". SUMMARY OF THE FINDINGS : 13 experimental studies contributed data to the synthesis. Original articles, reviews, and chapters in textbooks were also considered. CONCLUSION Parents' dental health habits influence their children's oral health. Oral health education programs aimed at preventive actions are needed to provide children not only with adequate oral health, but better quality of life. Special attention should be given to the entire family, concerning their lifestyle and oral health habits.
Collapse
|
45
|
Iida H, Rozier RG. Mother-perceived social capital and children's oral health and use of dental care in the United States. Am J Public Health 2013; 103:480-7. [PMID: 23327253 DOI: 10.2105/ajph.2012.300845] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between mother-perceived neighborhood social capital and oral health status and dental care use in US children. METHODS We analyzed data for 67 388 children whose mothers participated in the 2007 National Survey of Children's Health. We measured mothers' perceived social capital with a 4-item social capital index (SCI) that captures reciprocal help, support, and trust in the neighborhood. Dependent variables were mother-perceived ratings of their child's oral health, unmet dental care needs, and lack of a previous-year preventive dental visit. We performed bivariate and multivariable logistic regression analyses for each outcome. RESULTS After we controlled for potential confounders, children of mothers with high (SCI = 5-7) and lower levels (SCI ≥ 8) of social capital were 15% (P = .05) and about 40% (P ≤ .02), respectively, more likely to forgo preventive dental visits than were children of mothers with the highest social capital (SCI = 4). Mothers with the lowest SCI were 79% more likely to report unmet dental care needs for their children than were mothers with highest SCI (P = .01). CONCLUSIONS A better understanding of social capital's effects on children's oral health risks may help address oral health disparities.
Collapse
Affiliation(s)
- Hiroko Iida
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, NC 27599-7450, USA.
| | | |
Collapse
|
46
|
Santiago BM, Valença AMG, Vettore MV. Social capital and dental pain in Brazilian northeast: a multilevel cross-sectional study. BMC Oral Health 2013; 13:2. [PMID: 23289932 PMCID: PMC3543847 DOI: 10.1186/1472-6831-13-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 01/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence on possible associations between social determinants and dental pain. This study investigated the relationship of neighborhood and individual social capital with dental pain in adolescents, adults and the elderly. METHODS A population-based multilevel study was conducted involving 624 subjects from 3 age groups: 15-19, 35-44 and 65-74 years. They were randomly selected from 30 census tracts in three cities in the State of Paraíba, Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. The outcome of study was the presence of dental pain in the last 6 months. Information on dental pain, demographic, socio-economic, health-related behaviors, use of dental services, self-perceived oral health and social capital measures was collected through interviews. Participants underwent a clinical examination for assessment of dental caries. Neighborhood social capital was evaluated using aggregated measures of social trust, social control, empowerment, political efficacy and neighborhood safety. Individual social capital assessment included bonding and bridging social capital. Multilevel logistic regression was used to test the relationship of neighborhood and individual social capital with dental pain after sequential adjustment for covariates. RESULTS Individuals living in neighborhoods with high social capital were 52% less likely to report dental pain than those living in neighborhoods with low social capital (OR = 0.48, 95% CI = 0.27-0.85). Bonding social capital (positive interaction) was independently associated with dental pain (OR = 0.88, 95% CI = 0.80-0.91). Last dental visit, self-perceived oral health and number of decayed teeth were also significantly associated with dental pain. CONCLUSIONS Our findings suggest that contextual and individual social capital are independently associated with dental pain.
Collapse
Affiliation(s)
- Bianca Marques Santiago
- Department of Clinic and Social Dentistry, Federal University of Paraíba, Manaíra, João Pessoa, PB, Brazil.
| | | | | |
Collapse
|
47
|
Bhagavatula P, Xiang Q, Szabo A, Eichmiller F, Kuthy RA, Okunseri CE. Rural-urban differences in dental service use among children enrolled in a private dental insurance plan in Wisconsin: analysis of administrative data. BMC Oral Health 2012; 12:58. [PMID: 23259637 PMCID: PMC3548684 DOI: 10.1186/1472-6831-12-58] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 12/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies on rural-urban differences in dental care have primarily focused on differences in utilization rates and preventive dental services. Little is known about rural-urban differences in the use of wider range of dental procedures. This study examined patterns of preventive, restorative, endodontic, and extraction procedures provided to children enrolled in Delta Dental of Wisconsin (DDWI). METHODS We analyzed DDWI enrollment and claims data for children aged 0-18 years from 2002 to 2008. We modified and used a rural and urban classification based on ZIP codes developed by the Wisconsin Area Health Education Center (AHEC). We categorized the ZIP codes into 6 AHEC categories (3 rural and 3 urban). Descriptive and multivariable analysis using generalized linear mixed models (GLMM) were used to examine the patterns of dental procedures provided to children. Tukey-Kramer adjustment was used to control for multiple comparisons. RESULTS Approximately, 50%, 67% and 68% of enrollees in inner-city Milwaukee, Rural 1 (less than 2500 people), and suburban-Milwaukee had at least one annual dental visit, respectively. Children in inner city-Milwaukee had the lowest utilization rates for all procedures examined, except for endodontic procedures. Compared to children from inner-city Milwaukee, children in other locations had significantly more preventive procedures. Children in Rural 1-ZIP codes had more restorative, endodontic and extraction procedures, compared to children from all other regions. CONCLUSIONS We found significant geographic variation in dental procedures received by children enrolled in DDWI.
Collapse
Affiliation(s)
- Pradeep Bhagavatula
- Department of Clinical Services, Marquette University School of Dentistry, Milwaukee, WI 53201-1881, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Brumback BA, Zheng HW, Dailey AB. Adjusting for confounding by neighborhood using generalized linear mixed models and complex survey data. Stat Med 2012; 32:1313-24. [DOI: 10.1002/sim.5624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 08/27/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Babette A. Brumback
- Department of Biostatistics; University of Florida; Gainesville FL 32611 U.S.A
| | - Hao W. Zheng
- Department of Biostatistics; University of Florida; Gainesville FL 32611 U.S.A
| | - Amy B. Dailey
- Department of Health Sciences; Gettysburg College; Gettysburg PA 17325 U.S.A
| |
Collapse
|
49
|
Bhagavatula P, Xiang Q, Eichmiller F, Szabo A, Okunseri C. Racial/ethnic disparities in provision of dental procedures to children enrolled in Delta Dental insurance in Milwaukee, Wisconsin. J Public Health Dent 2012; 74:50-6. [PMID: 22970893 PMCID: PMC4121860 DOI: 10.1111/j.1752-7325.2012.00366.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Most studies on the provision of dental procedures have focused on Medicaid enrollees known to have inadequate access to dental care. Little information on private insurance enrollees exists. This study documents the rates of preventive, restorative, endodontic, and surgical dental procedures provided to children enrolled in Delta Dental of Wisconsin (DDWI) in Milwaukee. METHODS We analyzed DDWI claims data for Milwaukee children aged 0-18 years between 2002 and 2008. We linked the ZIP codes of enrollees to the 2000 U.S. Census information to derive racial/ethnic estimates in the different ZIP codes. We estimated the rates of preventive, restorative, endodontic, and surgical procedures provided to children in different racial/ethnic groups based on the population estimates derived from the U.S. Census data. Descriptive and multivariable analysis was done using Poisson regression modeling on dental procedures per year. RESULTS In 7 years, a total of 266,380 enrollees were covered in 46 ZIP codes in the database. Approximately, 64 percent, 44 percent, and 49 percent of White, African American, and Hispanic children had at least one dental visit during the study period, respectively. The rates of preventive procedures increased up to the age of 9 years and decreased thereafter among children in all three racial groups included in the analysis. African American and Hispanic children received half as many preventive procedures as White children. CONCLUSION Our study shows that substantial racial disparities may exist in the types of dental procedures that were received by children.
Collapse
Affiliation(s)
| | - Qun Xiang
- Division of Biostatistics, Medical College of Wisconsin
| | | | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin
| | | |
Collapse
|
50
|
Isong IA, Soobader MJ, Fisher-Owens SA, Weintraub JA, Gansky SA, Platt LJ, Newacheck PW. Racial disparity trends in children's dental visits: US National Health Interview Survey, 1964-2010. Pediatrics 2012; 130:306-14. [PMID: 22753556 PMCID: PMC3408679 DOI: 10.1542/peds.2011-0838] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Research that has repeatedly documented marked racial/ethnic disparities in US children's receipt of dental care at single time points or brief periods has lacked a historical policy perspective, which provides insight into how these disparities have evolved over time. Our objective was to examine the im-pact of national health policies on African American and white children's receipt of dental care from 1964 to 2010. METHODS We analyzed data on race and dental care utilization for children aged 2 to 17 years from the 1964, 1976, 1989, 1999, and 2010 National Health Interview Survey. Dependent variables were as follows: child's receipt of a dental visit in the previous 12 months and child's history of never having had a dental visit. Primary independent variable was race (African American/white). We calculated sample prevalences, and χ(2) tests compared African American/white prevalences by year. We age-standardized estimates to the 2000 US Census. RESULTS The percentage of African American and white children in the United States without a dental visit in the previous 12 months declined significantly from 52.4% in 1964 to 21.7% in 2010, whereas the percentage of children who had never had a dental visit declined significantly (P < .01) from 33.6% to 10.6%. Pronounced African American/white disparities in children's dental utilization rates, whereas large and statistically significant in 1964, attenuated and became nonsignificant by 2010. CONCLUSIONS We demonstrate a dramatic narrowing of African American/white disparities in 2 measures of children's receipt of dental services from 1964 to 2010. Yet, much more needs to be done before persistent racial disparities in children's oral health status are eliminated.
Collapse
Affiliation(s)
- Inyang A. Isong
- MassGeneral Hospital Center for Child and Adolescent Health Research and Policy, Harvard Medical School, Boston, Massachusetts
| | | | | | - Jane A. Weintraub
- The University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, North Carolina; and
| | - Stuart A. Gansky
- Center to Address Disparities in Children’s Oral Health, School of Dentistry, University of California, San Francisco, California
| | - Larry J. Platt
- Philip R. Lee Institute for Health Policy, School of Medicine, University of California, San Francisco, California
| | - Paul W. Newacheck
- Department of Pediatrics and,Philip R. Lee Institute for Health Policy, School of Medicine, University of California, San Francisco, California
| |
Collapse
|