Dental service utilization and immigrant family structure

Moving Toward Inclusion: Access to Care Models for Uninsured Immigrant Children

Policy Points Models for access to care for uninsured immigrant children that mitigate structural and sociopolitical barriers to inclusive health care include funding structures (e.g., state-sponsored coverage) and care delivery systems (e.g., federally qualified health centers,). Although the quintessential model of access to care necessitates health coverage for all children regardless of immigration status or date of United States entry, incremental policy change may more realistically and efficiently advance equitable access to high-quality health care. Intentional advocacy efforts should prioritize achievable goals that are grounded in data, are attentive to the sociopolitical milieu, are inclusive of diverse perspectives, and would meaningfully impact health care access and outcomes.

Accessibility to dental services by immigrant and refugee children residing in Turkey

BACKGROUND

Turkey is hosting the world's largest immigrant population under temporary and international protection. Due to the social inequalities contributing to early childhood dental caries, the effectiveness of dental care service for immigrant children should be evaluated.

AIM

To evaluate the accessibility of immigrant and refugee children residing in four different regions of Turkey to oral health products and dental treatment services.

DESIGN

A questionnaire consisting of 21 questions was administered: The first six questions elicited demographic data, and the remaining 15 questions asked about oral health habits, access to oral hygiene materials, and dental treatment services. Participants included the parents of 430 children under the age of 18, who were registered with migrant associations in the regions where they lived (Istanbul, Samsun, Hatay, or Ankara).

RESULTS

The majority of the participants were from Syria and Iraq. Of the participants, 42.1% reported that their children's oral hygiene habits had changed negatively after they migrated, 71.9% reported that they had not been to the dentist in the last year, and 82.8% reported that they had not been to the dentist for more than 12 months. Access to oral and dental hygiene products was not difficult for 68.4%. About 62.6%, however, reported that they had difficulty accessing dental treatment.

CONCLUSION

The findings showed that this disadvantaged group had difficulty accessing dental treatment. Therefore, there is a need for national and international health strategies to ensure that immigrant and refugee children have effective access to dental treatment.

Acculturation and Children's dental service utilization in the United States

OBJECTIVE

The study examined changes in acculturation level, socio-economic status, and their association with preventive dental service use, receipt of restorative, or surgical care, and unmet dental needs.

METHODS

Data from the Medical Expenditure Panel Survey (MEPS) for children aged 1 to 17 years from 2007 to 2015 were analysed. Firstly, a cross-sectional structural equation model (SEM) that included both a measurement model and a structural model was fitted simultaneously to obtain predicted latent variables for acculturation, socio-economic status (SES), dental service utilization, and unmet dental needs. Secondly, the change in acculturation, SES, dental service utilization, and unmet dental needs were calculated over two consecutive years within the same child. Finally, the structural model in these changes was fitted, and the indirect and direct pathways between acculturation and SES were tested with dental insurance as a mediator.

RESULTS

Data for 33 507 children in both panel years were analysed. An increase in family acculturation resulted in lower utilization of preventive dental service and more unmet dental need, with socio-economic status and dental insurance kept constant between the panel years, and after adjusting for race/ethnicity, gender, and age. In addition, increased acculturation was associated with higher SES, and a higher probability of having obtained dental insurance, both of which resulted in increased preventive dental service utilization and less unmet dental need. The positive direct effect and negative indirect effect of acculturation on unmet dental need cancelled each other out and resulted to almost zero total effect between acculturation and unmet dental need. Similarly, the negative direct effect and positive indirect effect of acculturation on preventive dental service cancelled each other out leading to a small increase in preventive dental service utilization.

CONCLUSION

Children of immigrant families are at risk of inadequate access to dental care as their families becomes more acculturated, without increase in SES and access to dental insurance. This study supports policies that promote immigrant family's adequate access to dental insurance and employment to improve their socio-economic status.

Effect of a Preventive Oral Health Program Starting during Pregnancy: A Case-Control Study Comparing Immigrant and Native Women and Their Children

The objective was to evaluate whether including pregnant women in a preventive dental program prevented the appearance of caries in their children up to the age of 6, and whether the effect was similar in children of immigrant and non-immigrant women. In phase I, 90 pregnant women, 45 immigrants and 45 natives, were taught about the development and prevention of caries. In phase II the oral health of their children at the age of 6 (n = 90) was evaluated, along with a control group of children of natives and immigrants of the same age (n = 90). A survey was used to determine participants' backgrounds and habits. A multivariate study of the results was performed using R-core software. The number of children without caries was 128 (71.1%), whereas 52 (28.9%) had caries, 15 from the protocol (16.67%) and 37 from the control group (41.11%), with statistically significant differences (p < 0.001). The mean number of caries for the children in the protocol was 0.62 ± 2 and in the control group it was 1.88 ± 2.9 (p = 0.001). In the multivariate analysis the risk of developing caries was higher for the condition of being the child of an immigrant (OR = 11.137), inadequate oral health (OR = 4.993), the children being overweight at the age of 6 (OR = 10.680), and the consumption of candies (OR = 5.042). In conclusion, the preventive protocols started during pregnancy reduced caries in participants' children, which suggests that these protocols should be encouraged. Because immigrant children are more vulnerable to caries, they and their parents should be included in preventive programs once they arrive in the host country.