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Van Dam L, Diab E, Johnson J. Canadian immigrants' oral health and oral health care providers' cultural competence capacity. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2024; 58:34-47. [PMID: 38505317 PMCID: PMC10946319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/23/2023] [Accepted: 11/22/2023] [Indexed: 03/21/2024]
Abstract
Background Immigrants to Canada count among the socially disadvantaged groups experiencing higher rates of oral disease. Culturally competent oral health care providers (OHCPs) stand to be allies for immigrant oral health. The literature reveals limited knowledge of practising OHCPs' cultural competency, and little synthesis of the topic has been completed. A scoping review is warranted to identify and map current knowledge of OHCPs' understanding of culturally competent care along with barriers and facilitators to developing capacity. Methods This study was conducted between December 2022 and April 2023 using Arksey and O'Malley's 5-step framework and PRISMA-ScR checklist. Four databases were searched using keywords related to 4 themes: population, provider, oral health, and cultural competence. Peer-reviewed articles published in English in the last 10 years were included. Results Search results yielded 74 articles. Title and abstract review was completed and an author-developed critical appraisal tool was applied. Forty-six (46) articles were subject to full-text review and 14 met eligibility criteria: 7 qualitative and 7 quantitative. Six barriers and six facilitators at individual and systemic levels were identified, affecting oral care for immigrants and providers' ability to work cross-culturally. Discussion Lack of cultural or linguistically appropriate resources, guidance, and structural supports were identified as contributing to low utilization of services and to lack of familiarity between providers and immigrants. Conclusion OHCPs' cultural competency development is required to improve oral health care access and outcomes for diverse populations. Further research is warranted to identify factors impeding OHCPs' capacity to provide culturally sensitive care. Intentional policy development and knowledge mobilization are needed.
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Affiliation(s)
- Lindsay Van Dam
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Elizabet Diab
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Johnson
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
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Li Q, Du M, Knight JC, Yi Y, Wang Q, Wang PP, Zhu Y. Dental Insurance Coverage, Dentist Visiting, and Oral Health Status among Asian Immigrant Women of Childbearing Age in Canada: A Comparative Study. Healthcare (Basel) 2023; 11:2666. [PMID: 37830703 PMCID: PMC10572324 DOI: 10.3390/healthcare11192666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES This study examined the dental insurance coverage, dentist visits, self-perceived oral health status, and dental problems among Asian immigrant women of childbearing age in contrast to Canadian women of childbearing age and non-Asian immigrant women of childbearing age. Potential barriers to dental care services among Asian immigrant women were explored. METHODS This analysis utilized data from the combined Canadian Community Health Survey from 2011 to 2014. The analytical sample consisted of 5737 females whose age was between 20 and 39 years. Multivariable logistic regression models assessed immigrant status and other factors in relation to the indicators of dental health (i.e., dental visit, self-perceived oral health, acute teeth issue, and teeth removed due to decay). RESULTS Amongst Asian women immigrants of childbearing age, there was a significantly lower frequency of dentist visits compared to non-immigrant counterparts (OR = 0.53; 95% CI: 0.37-0.76). The most commonly reported reason for not seeking dental care in the last three years was that the "respondent did not think it was necessary". Relative to Canadian born women of same age bracket, Asian women of childbearing age reported fewer acute teeth issues (OR = 0.67; 95% CI: 0.49-0.91) and had a greater risk of tooth extracted due to tooth decay (OR = 3.31; 95% CI: 1.64-6.68). Furthermore, for Asian women immigrants, their major barriers to dental care included low household income (≤$39,999 vs. $40,000-$79,999 OR = 0.26) and a lack of dental insurance (no vs. yes OR = 0.33). CONCLUSIONS Asian immigrant women showed lower utilization of dental services than non-immigrant women. A perceived lack of necessity, lower household income, and dental insurance coverage were major barriers to professional dental usage for most Asian immigrants of childbearing age.
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Affiliation(s)
- Qianqian Li
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Meizhi Du
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - John C. Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Qi Wang
- Centre for New Immigrant Wellbeing, Markham, ON L3R 9V1, Canada
| | - Peizhong Peter Wang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
- Centre for New Immigrant Wellbeing, Markham, ON L3R 9V1, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Yun Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China
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Choi Y, Kim I, Song J. Association between long working hours and unmet dental needs in wage workers. BMC Oral Health 2023; 23:570. [PMID: 37574543 PMCID: PMC10424332 DOI: 10.1186/s12903-023-03289-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Many previous studies on the reasons behind unmet dental needs focus on economic issues. However, in this research, we aimed to investigate the relationship between long working hours and unmet dental needs while considering the influence of occupational factors in wage workers. METHODS This study used data from the Korea National Health and Nutrition Examination Survey (2012-2018) and analyzed a sample of 12,104 wage workers. Unmet dental needs were defined as cases in which individuals did not receive dental care, despite their need for examination or treatment, within the last year. Long working hours were defined as exceeding 52 h per week, based on the standard working hours stipulated by the Labor Standards Act. A binomial model was applied to calculate the prevalence ratio through multivariate logistic regression analysis. RESULTS The prevalence of unmet dental needs was observed in 3,948 cases (32.5%), among which 1,478 attributed their presence to lack of time. The prevalence of unmet dental needs showed an inverse relationship with the education level and household income. The wage workers who worked long hours had the highest prevalence of unmet dental needs. Long working hours were found to be 1.18 times (95% CI 1.07-1.29) more likely to result in unmet dental care compared to working less than 40 h. The relationship between long working hours and unmet dental needs were statistically significant only in men (PR 1.24, 95% CI 1.07-1.43). However, the relationship between long working hours and unmet dental needs owing to time were in both men and women (men: PR 1.59, 95% CI 1.20-2.11, women: PR 1.90, 95% CI 1.48-2.43). CONCLUSIONS This study confirmed that long working hours and unmet dental needs are related when occupational factors are taken into consideration, despite the absence of oral health indicators. Using this study as a reference, further research is necessary to identify the underlying causes of unmet dental care and to improve access to dental services in the future.
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Affiliation(s)
- Youngjin Choi
- Department of Public Health Sciences, Hanyang University Graduate School, Seoul, South Korea
| | - Inah Kim
- Department of Public Health Sciences, Hanyang University Graduate School, Seoul, South Korea.
- Hanyang University Graduate School of Public Health, Seoul, South Korea.
- Department of Occupational and Environmental Medicine, Hanyang University Medical Center, Seoul, South Korea.
| | - Jaechul Song
- Department of Public Health Sciences, Hanyang University Graduate School, Seoul, South Korea
- Hanyang University Graduate School of Public Health, Seoul, South Korea
- Department of Occupational and Environmental Medicine, Hanyang University Medical Center, Seoul, South Korea
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Li Q, Wang Y, Knight JC, Yi Y, Ozbek S, Shariati M, Wang PP, Zhu Y. Dental health status, dentist visiting, and dental insurance of Asian immigrants in Canada. Int J Equity Health 2023; 22:73. [PMID: 37098603 PMCID: PMC10131415 DOI: 10.1186/s12939-023-01863-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/16/2023] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVE This study examined the dental care utilization and self-preserved dental health of Asian immigrants relative to non-immigrants in Canada. Factors associated with oral health-related disparities between Asian immigrants and other Canadians were further examined. METHODS We analyzed 37,935 Canadian residents aged 12 years and older in the Canadian Community Health Survey 2012-2014 microdata file. Factors (e.g., demographics, socioeconomic status, lifestyles, dental insurance coverage, and year of immigration) associated with disparities in dental health (e.g., self-perceived teeth health, dental symptoms during past one month, and teeth removed due to decay in past one year) and service utilization (e.g., visiting dentist within the last three years, visiting dentist more than once per year) between Asian immigrants and other Canadians were examined using multi-variable logistic regression models. RESULTS The frequency of dental care utilization was significantly lower in Asian immigrants than their non-immigrant counterparts. Asian immigrants had lower self-perceived dental health, were less likely to be aware of recent dental symptoms, and more likely to report tooth extractions due to tooth decay. Low education (OR = 0.42), male gender(OR = 1.51), low household income(OR = 1.60), non-diabetes(OR = 1.87), no dental insurance(OR = 0.24), short immigration length (OR = 1.75) may discourage Asian immigrants from dental care utilization. Additionally, a perceived lack of necessity to dentist-visiting was a crucial factor accounting for the disparities in dental care uptake between Asian immigrants and non-immigrants. CONCLUSION Asian immigrants showed lower dental care utilization and oral health than native-born Canadians.
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Affiliation(s)
- Qianqian Li
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Yu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - John C Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Sara Ozbek
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Matin Shariati
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Peizhong Peter Wang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 534, Toronto, ON, M5T 3M7, Canada.
- Centre for New Immigrant Wellbeing, 200-80 Acadia Ave, Markham, ON, L3R 9V1, Canada.
| | - Yun Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
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Okunseri C, Zheng C, Zhang Y, Okunseri E, Garcia R, Szabo A. Acculturation and Children's dental service utilization in the United States. Community Dent Oral Epidemiol 2023; 51:380-387. [PMID: 37038268 DOI: 10.1111/cdoe.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/28/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
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.
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Affiliation(s)
- Christopher Okunseri
- Department of Clinical Services, School of Dentistry, Marquette University Milwaukee Wisconsin, Milwaukee, Wisconsin, United States
| | - Cheng Zheng
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Yiwen Zhang
- Joseph. J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States
| | - Elaye Okunseri
- Department of Clinical Services, School of Dentistry, Marquette University Milwaukee Wisconsin, Milwaukee, Wisconsin, United States
| | - Raul Garcia
- Department of Health Policy & Health Services Research, Boston University Henry M. Goldman, School of Dental Medicine Massachusetts, Boston, Massachusetts, United States
| | - Aniko Szabo
- Institute of Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Kim NH, Elani HW, Kawachi I. Did Dental Insurance Expansion Improve Dental Care Needs Among Korean Adults? Difference in Difference Analysis. J Epidemiol 2023; 33:101-108. [PMID: 34121050 PMCID: PMC9794449 DOI: 10.2188/jea.je20200596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2012, the Korean government expanded dental insurance for the elderly to promote improved access to dental care. We examined the causal effect of this policy on dental care needs, focusing on low-income older adults. METHODS We compared data before and after policy implementation using double difference (DD) and triple difference (DDD) analyses. We used the nationally representative data from the Korea National Health and Nutrition Examination Survey from 2010 and 2016-2018. Individuals aged ≥65 years were included in the treatment group, and individuals aged <65 years were included in the control group. RESULTS Dental insurance expansion was associated with a paradoxical increase in perceived unmet dental needs among elderly individuals (8.8 percentage points increase, 95% CI: 4.7 to 13.0). However, there were improvements in dental prosthetics outcomes (denture wearing [4.0 percentage points, 95% CI: 0.2 to 7.9] and dental implants [5.0 percentage points, 95% CI: 2.1 to 7.9]; P < 0.01). Upon analyzing low-income elderly individuals using DDD analysis, we found that the insurance expansion led to a 21.6% smaller increase in unmet dental needs among low-income adults, compared to high-income adults (95% CI, -35.0 to -8.5; P < 0.01). CONCLUSION Dental insurance expansion in South Korea resulted in improvements in access to dental prosthetic services overall. It also led to a smaller increase in unmet dental needs among low-income older adults, compared to high-income adults.
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Affiliation(s)
- Nam-Hee Kim
- Department of Dental Hygiene, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Hawazin W. Elani
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Doucette H, Yang S, Spina M. The impact of culture on new Asian immigrants' access to oral health care: a scoping review. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2023; 57:33-43. [PMID: 36968804 PMCID: PMC10032640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 03/29/2023]
Abstract
Background Immigration has accounted for three-quarters of Canada's population growth since 2016, more than half of which has been from Asian countries. Newcomers from Asia have been reported to experience oral health disparities. The objective of this scoping review was to examine the literature discussing how culture affects access to oral health care for new immigrants from Asia and to identify knowledge gaps. Methods The review was conducted from December 2021 to April 2022 following the Arskey and O'Malley approach and PRISMA-ScR guideline. Five databases were searched using the search parameter "Asian+ AND Immigrant+ AND oral care+". Only peer-reviewed articles published in English between 2011 and 2021 were included. Results The search strategy yielded 736 articles. Duplicates were removed, titles and abstracts were reviewed, and the full text of 69 articles examined, leaving 26 articles that met eligibility criteria: 18 quantitative studies, 4 qualitative studies, and 4 reviews. Discussion Four themes were identified: language barriers, oral health care access and service utilization, oral health beliefs and behaviour, and immigrant children's oral health. Most new immigrants from Asia have limited English proficiency, are of low socioeconomic status, and have difficulty developing trusting relationships with care providers. Immigrant children's oral health is impacted by their parents' beliefs. Conclusion More research is needed on cultural barriers to and facilitators of access to oral health care for newcomers from Asia to Canada to aid in the development and implementation of policies and to inform practice and curriculum.
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Affiliation(s)
- Heather Doucette
- *School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Sijie Yang
- §Alumna, Dental Hygiene Degree Program, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
- =These authors contributed equally.
| | - Miriam Spina
- §Alumna, Dental Hygiene Degree Program, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
- =These authors contributed equally.
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Anticona C, Lif Holgerson P, Gustafsson PE. Assessing inequities in unmet oral care needs among adults in Sweden: An intersectional approach. Community Dent Oral Epidemiol 2022; 51:428-435. [PMID: 36583509 DOI: 10.1111/cdoe.12836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/23/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The goal of the Swedish oral healthcare system is to achieve good oral health and equitable access to care for the entire population. However, considerable inequities in oral health and care are evident and occur across a range of social dimensions. This study uses an intersectional approach to examine complex inequities in unmet oral care needs among adults in Sweden over the period 2004-2021. METHODS Data were obtained from 14 Health on Equal Terms surveys conducted during 2004-2021. The final sample was 129 473 individuals aged 26-84 years. Applying intersectional analysis of individual heterogeneity and discriminatory accuracy, inequities in unmet oral care needs were estimated across 48 intersectional strata defined by gender, age, educational level, individual disposable income and immigrant status. RESULTS A high risk of unmet oral care needs was found among strata consisting of immigrants and those with low income. However, being an immigrant and/or having a low income did not universally entail a high risk but varied by the social position along other axes, particularly age and education. The discriminatory accuracy was moderate. CONCLUSION Groups with certain social disadvantages are highly heterogeneous themselves. An intersectionality approach is important to prevent the risk of stigmatizing large heterogenous groups while failing to identify the most vulnerable strata. The discriminatory accuracy analysis suggested that further policy and/or interventions may be the most effective if approaching the whole population, combined with selected targeted interventions directed at the most disadvantaged social strata.
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Affiliation(s)
| | | | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Kidane YS, Ziegler S, Keck V, Benson-Martin J, Jahn A, Gebresilassie T, Beiersmann C. Eritrean Refugees' and Asylum-Seekers' Attitude towards and Access to Oral Healthcare in Heidelberg, Germany: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11559. [PMID: 34770072 PMCID: PMC8583548 DOI: 10.3390/ijerph182111559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/01/2021] [Indexed: 11/21/2022]
Abstract
Oral health concerns in Eritrean refugees have been an overlooked subject. This qualitative study explored the access of Eritrean refugees and asylum-seekers (ERNRAS) to oral health care services in Heidelberg, Germany, as well as their perceptions and attitudes towards oral health care. It involved 25 participants. We employed online semi-structured interviews (n = 15) and focus group discussions (n = 2). The data was recorded, transcribed, and analysed, using thematic analysis. The study found out that most of the participants have a relatively realistic perception and understanding of oral health. However, they have poor dental care practices, whilst a few have certain misconceptions of the conventional oral hygiene tools. Along with the majority's concerns regarding psychosocial attributes of poor oral health, some participants are routinely consuming Berbere (a traditional spice-blended pepper) to prevent bad breath. Structural or supply-side barriers to oral healthcare services included: communication hurdles; difficulty in identifying and navigating the German health system; gaps in transculturally, professionally, and communicationally competent oral health professionals; cost of dental treatment; entitlement issues (asylum-seekers); and appointment mechanisms. Individual or demand-side barriers comprised: lack of self-sufficiency; issue related to dental care beliefs, trust, and expectation from dentists; negligence and lack of adherence to dental treatment follow-up; and fear or apprehension of dental treatment. To address the oral health burdens of ERNRAS, it is advised to consider oral health education, language-specific, inclusive, and culturally and professionally appropriate healthcare services.
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Affiliation(s)
- Yonas Semere Kidane
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120 Heidelberg, Germany; (Y.S.K.); (V.K.); (J.B.-M.); (T.G.); (C.B.)
| | - Sandra Ziegler
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120 Heidelberg, Germany; (Y.S.K.); (V.K.); (J.B.-M.); (T.G.); (C.B.)
| | - Verena Keck
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120 Heidelberg, Germany; (Y.S.K.); (V.K.); (J.B.-M.); (T.G.); (C.B.)
| | - Janine Benson-Martin
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120 Heidelberg, Germany; (Y.S.K.); (V.K.); (J.B.-M.); (T.G.); (C.B.)
- Department of General Practice and Health Services Research, Section Health Equity Studies & Migration, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.Z.)
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120 Heidelberg, Germany; (Y.S.K.); (V.K.); (J.B.-M.); (T.G.); (C.B.)
| | - Temesghen Gebresilassie
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120 Heidelberg, Germany; (Y.S.K.); (V.K.); (J.B.-M.); (T.G.); (C.B.)
| | - Claudia Beiersmann
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120 Heidelberg, Germany; (Y.S.K.); (V.K.); (J.B.-M.); (T.G.); (C.B.)
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Sano Y, Antabe R. Regular Dental Care Utilization: The Case of Immigrants in Ontario, Canada. J Immigr Minor Health 2021; 24:162-169. [PMID: 34453263 DOI: 10.1007/s10903-021-01265-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
Considering the critical role of oral health on people's well-being, access to regular dental care to improve oral health may be a useful medium for improving immigrant integration and settlement in Canada. Using the 2013-14 Canadian Community Health Survey, this study contributes to the literature and policy by examining if there are disparities in regular utilization of dental care among recent immigrants, established immigrants, and the native-born in Ontario, Canada. Adopting Andersen's behavioural model of health services use as a conceptual framework, we introduce three sets of variables in our statistical analysis including predisposing, need, and enabling factors. At the bivariate level, recent (OR = 0.42, p < 0.001) and established immigrants (OR = 0.81, p < 0.001) are less likely to use dental care at least once a year than their native-born counterparts. Once accounting for enabling characteristics, however, we observe that the direction of the association becomes positive for established immigrants (OR = 1.15, p < 0.05). The difference between recent immigrants and the native-born is partially attenuated when we control for enabling characteristics but remains statistically significant (OR = 0.73, p < 0.05). Based on these findings, we provide several implications for policymakers and future research.
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Affiliation(s)
- Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, North Bay, ON, Canada.
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
- Graduate Department of Geography and Planning, University of Toronto, Toronto, ON, Canada
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Merry L, Pelaez S. Knowledge translation and better health and health care for migrants in Canada: What is the responsibility of health funders and researchers? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:403-405. [PMID: 34127460 DOI: 10.46747/cfp.6706403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lisa Merry
- Assistant Professor in the Faculty of Nursing at the University of Montreal in Quebec.
| | - Sandra Pelaez
- Assistant Professor in the Faculty of Nursing at the University of Montreal in Quebec
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Merry L, Pelaez S. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:411-413. [PMID: 34127462 PMCID: PMC8202737 DOI: 10.46747/cfp.6706411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lisa Merry
- Professeure adjointe à la Faculté des sciences infirmières de l'Université de Montréal (Québec).
| | - Sandra Pelaez
- Chercheuse au Centre de recherche du CHU Sainte-Justine à Montréal
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Agudelo-Suárez AA, Muñoz-Pino N, Vivares-Builes AM, Ronda-Pérez E. Oral Health and Oral Health Service Utilization in Native and Immigrant Population: A Cross-Sectional Analysis from the PELFI Cohort in Spain. J Immigr Minor Health 2021; 22:484-493. [PMID: 31919785 DOI: 10.1007/s10903-020-00972-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study analyzes associated factors to self-perceived oral health and use of oral health services in native and immigrant adults from the PELFI cohort in Spain. A cross-sectional analysis was conducted (401 adults ≥ 18 years, from Spain, Ecuador, Colombia and Morocco). Frequencies for sociodemographic, self-perceived general and oral health variables were calculated. The association between oral health/oral health services use and origin country was estimated by logistic regression (adjusted odds ratio-aOR-; 95% confidence intervals -95%CI-). Ecuadorian men were more likely to report dental caries (aPR 2.75; 95%CI 1.30-5.80) and Moroccan women were more likely to report gingival bleeding (aPR 3.61; 95%CI 1.83-7.15) and the use of oral health services ≥ 1 year/never (aPR 1.69; 95%CI 1.06-2.69). Colombian women were less likely to report missing teeth (aPR 0.73; 95%CI 0.56-0.95). Poor self-perceived oral health indicators were observed in immigrants and were modified for sociodemographic and general health variables.
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Affiliation(s)
- Andrés A Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Calle 70 N° 52-21, 05010, Medellín, Antioquia, Colombia. .,Public Health Research Group, University of Alicante, Alicante, Spain.
| | - Natalia Muñoz-Pino
- Faculty of Dentistry, University of Antioquia, Calle 70 N° 52-21, 05010, Medellín, Antioquia, Colombia
| | - Annie M Vivares-Builes
- Faculty of Dentistry, University of Antioquia, Calle 70 N° 52-21, 05010, Medellín, Antioquia, Colombia
| | - Elena Ronda-Pérez
- Public Health Research Group, University of Alicante, Alicante, Spain.,Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Okechukwu CE, Ells C, Newbold KB, Joe-Ikechebelu N, Manneh B. Recency of immigration and utilization of dental care services in Canada. Community Dent Oral Epidemiol 2021; 49:487-493. [PMID: 33543793 DOI: 10.1111/cdoe.12625] [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: 08/10/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the association between recency of immigration to Canada and the utilization of dental health services. METHODS The cross-sectional study sample (n = 2137) was drawn from the 2015-2016 Canadian Community Health Survey (CCHS). It consisted of Canadian residents aged 12 years and older who resided in the two provinces and one territory who opted into the optional dental module and gave valid responses to the questions 'How often do you usually see a dental professional, such as a dentist, a dental hygienist or a denturologist?' and 'Length of time since immigration to Canada?' for the outcome and independent variable, respectively. Multinomial logistic regression was used to analyse the data, and all statistics were weighted using sampling weights provided by Statistics Canada. RESULTS The adjusted odds ratios were lower for recent immigrants than for established immigrants and for visits more than once per year (OR = 0.35; 95% CI 0.14, 0.92), about once per year (OR = 0.34; 95% CI 0.13, 0.90) and for less than once per year (OR = 0.22; 95% CI 0.07, 0.64) than for those who never visited a dental professional. Recent immigrants, males, individuals aged 70 years or more and those with a low household income were less likely to visit a dental professional than established immigrants, females, younger age groups or those with higher incomes. CONCLUSION Better policies are needed to address the dental health concerns of recent immigrants who may suffer from poorer dental health, to ensure that they receive the care they require.
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Affiliation(s)
| | - Carolyn Ells
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | | | - Balanding Manneh
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Chowdhury N, Naeem I, Ferdous M, Chowdhury M, Goopy S, Rumana N, Turin TC. Unmet Healthcare Needs Among Migrant Populations in Canada: Exploring the Research Landscape Through a Systematic Integrative Review. J Immigr Minor Health 2020; 23:353-372. [DOI: 10.1007/s10903-020-01086-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
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Unmet Dental Care Needs among Korean National Health Insurance Beneficiaries Based on Income Inequalities: Results from Five Waves of a Population-Based Panel Study. Healthcare (Basel) 2020; 8:healthcare8020124. [PMID: 32380767 PMCID: PMC7349312 DOI: 10.3390/healthcare8020124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 02/03/2023] Open
Abstract
This study investigates whether self-employed beneficiaries experience greater difficulties in accessing dental care than insured employees based on their income level. This analysis uses 2011–2015 data from the Korea Health Panel, a population-based and nationally representative sample, covering 7083 participants aged 18 years and older. We measured barriers to dental access based on unmet needs or the inability to receive necessary dental care owing to the past year’s economic burdens. The type of health insurance and household income are considered independent variables. We applied multiple panel logistic regressions and two-panel logistic regression models with a fixed-effects approach to analyze the data. Self-employed beneficiaries were 1.16 times (95% confidence interval (CI) = 1.08–1.24) more likely to experience unmet dental needs than were insured employees. Insured employees and self-employed beneficiaries belonging to the lowest income bracket were 1.76 times (95% CI = 1.53–2.03) and 2.33 times (95% CI = 1.89–2.87) more likely to have unmet needs than those in the highest income bracket. Self-employed beneficiaries were 1.31 times (95% CI = 1.21–1.43) more likely to experience unmet dental needs caused by economic burdens than are insured employees. Insured employees of the lowest income quintile were 4.15 times (95% CI = 3.41–5.05) more likely to experience unmet needs caused by economic burdens, while the odds ratio for self-employed beneficiaries was 5.47 (95% CI = 4.05–7.39). Our findings indicate gaps in unmet dental needs between self-employed beneficiaries and insured employees. The government should adopt strategies to reduce unmet needs among marginalized groups and redefine the role of national health insurance.
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Che X, Sohn M, Park HJ. Unmet dental care needs in South Korea: how do they differ by insurance system? J Health Serv Res Policy 2019; 24:164-171. [DOI: 10.1177/1355819619835260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives This study aimed to analyse and compare the influence of National Health Insurance and Medical Aid coverage on the persistency of unmet dental care needs in South Korea. Methods This study was based on a longitudinal sample of 4461 adults aged 19 years and older who participated in the South Korea Health Panel from 2011 to 2014, using weights to make the data nationally representative. Propensity score matching was used to adjust the demographic, socioeconomic and health status information of National Health Insurance and Medical Aid groups. Panel logistic regression analyses were conducted to examine the association between health insurance type and unmet dental needs for three consecutive years. Results The odds of the lowest income group reporting unmet dental care needs compared with the highest income group was 6.75 (confidence interval 5.94−7.67), which reduced to 4.19 (confidence interval 3.76−4.67) in the models including health insurance schemes. Additionally, Medical Aid recipients (odds ratio 2.49; 95% confidence interval 2.18−2.48) were more likely to have unmet needs than those covered by National Health Insurance. Conclusions The dental care needs of Medical Aid beneficiaries were not being met, unlike those of the National Health Insurance beneficiaries. Such evidence suggests that increasing health insurance coverage to include several essential dental services would improve the accessibility of dental care services for Medical Aid beneficiaries.
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Affiliation(s)
- Xianhua Che
- Researcher, BK21PLUS Program in ‘Embodiment: Health-Society Interaction’, Department of Public Health Sciences, Graduate School, Korea University, Republic of Korea
| | - Minsung Sohn
- Professor, Department of Health and Care Administration, The Cyber University of Korea, Seoul, Republic of Korea
| | - Hee-Jung Park
- Professor, Department of Dental Hygiene, College of Health Science, Kangwon National University, Republic of Korea
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Zhang W, Wu YY, Wu B. Racial/Ethnic Disparities in Dental Service Utilization for Foreign-Born and U.S.-Born Middle-Aged and Older Adults. Res Aging 2019; 41:845-867. [PMID: 31272288 DOI: 10.1177/0164027519860268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study examines racial/ethnic disparities of dental service utilization for foreign-born and U.S.-born dentate residents aged 50 years and older. Generalized linear mixed-effects models (GLMM) were used to perform longitudinal analyses of five-wave data of dental service utilization from the Health and Retirement Study (HRS). We used stratified analyses for the foreign-born and U.S.-born and assessed the nonlinear trend in rates of dental service utilization for different racial/ethnic groups. Findings indicate that Whites had higher rates of service utilization than Blacks and Hispanics regardless of birthplace. For all groups, the rates of service utilization decreased around age 80, and the rates of decline for Whites were slower than others. The U.S.-born showed the trend of higher rates of service utilization than the foreign-born for all racial/ethnic groups. These findings suggest the importance of developing culturally competent programs to meet the dental needs of the increasingly diverse populations in the United States.
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Affiliation(s)
- Wei Zhang
- 1 Department of Sociology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Yan Yan Wu
- 2 Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Bei Wu
- 3 Rory Meyers College of Nursing, New York University, New York, NY, USA
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Kim DY, Kim DH, Yoon HJ, Lee WJ, Woo SH, Seol SH, Kim HJ. Factors associated with delayed emergency room visits in adult immigrant patients with mild abdominal pain in Korea. Clin Exp Emerg Med 2019; 6:138-143. [PMID: 31261484 PMCID: PMC6614051 DOI: 10.15441/ceem.18.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/26/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the factors associated with unmet needs in immigrant patients complaining of abdominal pain, by analyzing those associated with the time from symptom onset to emergency room visit. Methods We retrospectively reviewed the medical records of immigrants with abdominal pain who visited a tertiary hospital emergency department from January to December 2016. The dependent variable was the time from symptom onset to emergency room visit. The independent variables were age, sex, vital signs, disposition, health insurance status, date of visit, time of visit, level of education, employment status, economic satisfaction, marital status, living with family, duration of residence, having a native spouse, and subjective proficiency in Korean. We analyzed the association of the dependent variable with each independent variable. Results In total, 102 immigrant patients with abdominal pain were enrolled in this study. The patients who had earlier visits had good subjective proficiency in Korean, high economic satisfaction, longer durations of residence, a tendency to have a native spouse, and a high employment rate. After linear regression analysis, the time from symptom onset to emergency room visit was negatively associated with employment (adjusted odds ratio, -13.67; 95% confidence interval, -23.25 to -4.09; P=0.006) and having a native spouse (adjusted odds ratio, -11.7; 95% confidence interval, -20.61 to -2.8; P=0.011). Conclusion The factors influencing the time from symptom onset to emergency room visit in immigrant patients with abdominal pain are associated with social capital, which improves access to emergency care. Policies that improve immigrant access to emergency care should be considered.
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Rodriguez-Alvarez E, Lanborena N, Borrell LN. Place of Birth Inequalities in Dental Care Use before and after the Economic Crisis in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101691. [PMID: 31091780 PMCID: PMC6572320 DOI: 10.3390/ijerph16101691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/30/2019] [Accepted: 05/12/2019] [Indexed: 12/20/2022]
Abstract
This study evaluates inequalities in the use of dental services according to place of birth before and after the economic crisis in Spain. A cross-sectional study was performed in adults aged 18 to 65 years in Spain. We used data from three Spanish National Health Surveys for the years 2006 (before the crisis), 2014, and 2017 (after the crisis). Log-binomial regression was used to quantify the association between place of birth and use of dental care services before and after controlling for the selected covariates. In 2006, we found a greater probability of not using dental care services in immigrants from Asia (PR: 1.36, 95% CI: 1.10-1.67) and Africa (PR: 1.16, 95% CI: 1.05-1.28) compared to the natives. For 2014, the probability of not using dental care services was greater for all immigrants relative to natives, with the greatest probability for those from Africa (PR: 1.71, 95% CI: 1.46-2.01) and Asia (PR: 1.3, 95% CI: 1.23-1.47). The associations for 2017 were weaker in magnitude than the ones observed for 2014, although stronger than for 2006. This study suggests that the economic recovery did not have the same impact for natives and immigrants regardless of regions of origin, given the observed inequalities in use of dental services.
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Affiliation(s)
- Elena Rodriguez-Alvarez
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Bizkaia, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
| | - Nerea Lanborena
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Bizkaia, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
| | - Luisa N Borrell
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, USA.
- Department of Surgery, Medical and Social Science. University of Alcalá, 28871 Madrid, Spain.
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21
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Mehra VM, Costanian C, Khanna S, Tamim H. Dental care use by immigrant Canadians in Ontario: a cross-sectional analysis of the 2014 Canadian Community Health Survey (CCHS). BMC Oral Health 2019; 19:78. [PMID: 31068166 PMCID: PMC6505204 DOI: 10.1186/s12903-019-0773-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ontario is home to the largest number of immigrants in Canada. However, very little is known about their dental care utilization patterns. The purpose of this study is to determine the prevalence of poor dental health care use among the immigrant population of Ontario and how various socio-demographic, socio-economic and health-related factors are associated with it. METHODS Analysis was performed on a total of 4208 Ontarian immigrants who participated in the dental care module of the 2014 cycle of the Canadian Community Health Survey. Poor dental care use was defined by the two variables: not visiting the dentist in the past year and/or visiting the dentist only for emergency purposes. Multivariable logistic regression was performed to assess the associations between the two outcomes and the socio-demographic, socio-economic and health-related factors. RESULTS Thirty three percent of immigrants reported not visiting the dentist in the past year and 25% reported visiting only for emergencies. The leading components associated with poor dental care utilization were being a new immigrant, of male gender, having low educational attainment, low household income and lacking dental insurance. CONCLUSIONS This study is the first to highlight oral health care use patterns amongst immigrants in Ontario. Given that a large proportion of the immigrant population in Ontario have poor dental care use, education and outreach programs informing incoming immigrants of preventative dental care may improve overall dental health.
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Affiliation(s)
- Vrati M Mehra
- School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Christy Costanian
- School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Siya Khanna
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Hala Tamim
- School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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Choi JW, Choi Y, Lee TH, Lee HJ, Ju YJ, Park EC. Employment status and unmet dental care needs in South Korea: a population-based panel study. BMJ Open 2019; 9:e022436. [PMID: 30928921 PMCID: PMC6475345 DOI: 10.1136/bmjopen-2018-022436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study was designed to evaluate whether employment status is associated with the experience of unmet dental care needs. METHODS A total of 4620 workers were retrieved from Korea Health Panel data (2010-2013), and potential relationships were explored among their income levels, changes in employment and unmet dental care needs. RESULTS Among the 4620 workers, 17.3% said they had failed at least once to get dental treatment or check-up, despite their needs. Precarious workers and those not in employment were more likely to experience unmet dental care needs due to economic burden compared with permanent workers (OR 1.36, 1.40, respectively). In addition, people in low-income group were 4.46 times more likely to experience unmet dental care needs caused by economic burden, compared with those with the highest income. CONCLUSION This disparity means that precarious workers and those not in employment are more likely to face barriers in obtaining needed health services. Given the insecure employment status of low income people, meeting their healthcare needs is an important consideration.
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Affiliation(s)
- Jae Woo Choi
- Department of Health Administration, Dongseo University, Busan, South Korea
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Young Choi
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, South Korea
| | - Tae-Hoon Lee
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Hyo Jung Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
| | - Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, South Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Moreau AM, Hennous F, Dabbagh B, Ferraz Dos Santos B. Oral Health Status of Refugee Children in Montreal. J Immigr Minor Health 2018; 21:693-698. [PMID: 30406328 DOI: 10.1007/s10903-018-0835-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to assess the oral health status of refugee children in comparison with that of Canadian children. In addition, we investigated the extent to which demographic factors are associated with caries experience in this population. Children with a confirmed refugee status and Canadian children (control group) matched for age and sex composed the study population. A comprehensive review of dental charts was completed to assess children's demographic data, caries experience, oral hygiene and gingival health status. The majority of refugee children had never seen a dentist before their arrival to Canada. Refugee children had significant higher dmft/DMFT scores than Canadian children (7.29 ± 5.1 and 4.47 ± 5, respectively; p < 0.0001). Furthermore, individual factors, such as refugee status (OR = 5.08; 95% CI = 2.31-11.1) and child age (OR = 2.17; 95% CI = 1.04-4.51) were significantly associated with caries experience. Access to appropriate dental care to refugee children should be a key priority for health care providers and policy makers.
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Affiliation(s)
- Anne-Marie Moreau
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada
| | - Fatima Hennous
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada
| | - Basma Dabbagh
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada
| | - Beatriz Ferraz Dos Santos
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada.
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Aarabi G, Reissmann DR, Seedorf U, Becher H, Heydecke G, Kofahl C. Oral health and access to dental care - a comparison of elderly migrants and non-migrants in Germany. ETHNICITY & HEALTH 2018; 23:703-717. [PMID: 28277023 DOI: 10.1080/13557858.2017.1294658] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare oral health, access barriers to dental care, oral health behavior and oral hygiene behavior of elderly German residents with and without immigration background. DESIGN In this cross-sectional explorative study, a convenience sample (N = 112, age ≥ 60 years, 54% immigrants) was recruited in four dental practices in Hamburg, Germany. Oral health was assessed with Decayed/Missing/Filled Teeth (DMFT), Papillary Bleeding Index (PBI), and Approximal Plaque Index (API). Dental health was operationalized as number of decayed teeth, and poor oral hygiene based on a PBI ≥ 40%. Access barriers and oral health behavior were assessed with a standardized questionnaire. RESULTS While caries experience was similar in migrants and non-migrants (DMFT mean: 24.8 vs. 23.4, n.s.), significantly more teeth were decayed (5.3 vs. 2.1, p < 0.001), and API (55.3% vs. 33.0%, p = 0.002) and PBI (46.3% vs. 30.5%, p = 0.016) were significantly higher in migrants. After adjusting for age, sex, income, education, and number of teeth, migrants still had on average 3 decayed teeth more than non-migrants. However, impact of migration background on poor oral health changed from OR = 3.61 (p = 0.007) to OR = 1.05 (n.s.) after adjusting for confounders, mainly due to lower income in migrants. Fewer migrants had visited a dentist within the past 12 months, and migrants were less likely to have a regular dentist that they visit and more often indicated language or cost barriers than non-migrants. CONCLUSION Elderly German migrants have higher treatment needs than non-migrants. Likely causes are poorer oral hygiene and lower utilization of dental care services. Specific prevention programs targeting migrants are warranted to improve oral health in this disadvantaged group.
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Affiliation(s)
- Ghazal Aarabi
- a Department of Prosthetic Dentistry, Center for Dental and Oral Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Daniel R Reissmann
- a Department of Prosthetic Dentistry, Center for Dental and Oral Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Udo Seedorf
- a Department of Prosthetic Dentistry, Center for Dental and Oral Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Heiko Becher
- b Department of Medical Biometry and Epidemiology, Center for Experimental Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Guido Heydecke
- a Department of Prosthetic Dentistry, Center for Dental and Oral Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Christopher Kofahl
- c Department of Medical Sociology, Center for Psychosocial Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Chen W, Zhang XH, Houser SH, Zhou XD, Qu X. [Dental care utilization of immigrants in Chengdu, China]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:428-434. [PMID: 30182572 DOI: 10.7518/hxkq.2018.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study considered Chengdu, Sichuan, China as an example to investigate the dental service utilization by foreigners and its influencing factors. Results of the study can be referred by dental practitioners to explore international development of dental services and can be provided for health policy makers to formulate oral health policies for immigrants. METHODS A simple random sampling method with a questionnaire was designed based on Anderson's health utilization model and "Oral Health Questionnaire for Adults" by the World Health Organization. Oral health condition, consciousness, and demographic data were collected. Binary Logistic regression and stratified analysis with SPSS 20.0 were performed. RESULTS A total of 654 immigrants repre-senting 75 countries participated in the study. Among all participants, 102 (15.6%) experienced dental problems while in residence in China but paid no visit to dentists. Female immigrants, who spent considerable time living in Chengdu, experienced oral problems in a year, used dental floss, and reported family members in Chengdu, were more likely to visit Chinese dentists. Participants who lived in Chengdu for at least 10.5 months were the threshold distinguishing differences in dental visits in the country. CONCLUSIONS The policymakers in Chengdu should consider creating a convenient and conducive dental care environment for immigrants. Additional information related to urgent oral and routine care should be provided to short- and long-term living immigrants in China. Dental practitioners in China should also contemplate on collaborating with foreign dental insurance companies to ensure better dental care access for immigrant patients.
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Affiliation(s)
- Wen Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xiao-Han Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Shannon-H Houser
- Dept. of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham 35205, USA
| | - Xue-Dong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xing Qu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Evidence Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Disparities in oral health by immigration status in the United States. J Am Dent Assoc 2018; 149:414-421.e3. [PMID: 29615187 DOI: 10.1016/j.adaj.2018.01.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few investigators have explored differences in oral health status between immigrants and natives. To address this gap, the authors used nationally representative data to characterize disparities in oral health among noncitizens, naturalized citizens, and native adults. METHODS The 2013 to 2014 National Health and Nutrition Examination Survey, a nationally representative in-person survey, provides oral health data for US natives, naturalized citizens, and noncitizens. Univariate and multivariate regression analyses were conducted to compare evidence of caries and periodontal disease, as well as recommendations for oral health care, stratified by immigration status for adults. RESULTS More than one-half of noncitizens (50.5%) received a diagnosis of periodontal disease, and 38.0% had caries; for natives, these rates were 34.4% and 27.0%, respectively. Differences between natives and naturalized citizens were not statistically significant. After adjusting for age, sex, race or ethnicity, education, poverty, tobacco smoking status, and number of permanent teeth, noncitizens still had 45% higher adjusted odds of periodontal disease and 60% higher odds of receiving recommendations for oral health care than natives. However, differences between noncitizens and natives were no longer important after adjusting for insurance. CONCLUSIONS Noncitizen immigrants reported having substantially poorer oral health than natives in the United States. However, disparities between noncitizens and natives are no longer important when accounting for health insurance. PRACTICAL IMPLICATIONS Although noncitizen adults have a higher likelihood of poor oral health than native adults, having insurance may close this gap. Health care reform initiatives should provide dental benefits for adults to help mitigate the current economic and legal barriers that many immigrants face when accessing oral health care.
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Developing a Research Agenda on the Political Economy of Immigrants' Oral Health. J Immigr Minor Health 2017; 20:759-761. [PMID: 29101516 DOI: 10.1007/s10903-017-0666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acculturation has been widely used in health research to explain oral health disparities between immigrants and their native born counterparts. However, immigrants' oral health studies have not clearly defined the acculturation construct. Also, a narrow focus on cultural oral health behaviours is likely to be inadequate for explaining immigrants' oral health inequities, which are also rooted in societal, political and economic factors produced across the globe. In this brief report, we discuss the use of the acculturation framework in the dental public health literature, note gaps in this approach, and argue for the need to incorporate the political economy lens to help better understand the complexities of immigrants' oral health.
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Singhal S, McLaren L, Quinonez C. Trends in emergency department visits for non-traumatic dental conditions in Ontario from 2006 to 2014. Canadian Journal of Public Health 2017; 108:e246-e250. [PMID: 31583607 DOI: 10.17269/cjph.108.5950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/18/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In Canada, non-traumatic dental conditions (NTDCs) presenting in emergency departments (EDs) are dealt with by non-dental professionals who are generally not equipped to deal with such emergencies, resulting in an inefficient usage of heath care resources. This study aimed to assess the burden of ED visits for NTDCs in Ontario by observing trends from 2006 to 2014. METHODS Aggregate data for Ontario were obtained from the Canadian Institute for Health Information's National Ambulatory Care Reporting System. Data were examined for the whole of Ontario and stratified by 14 Local Health Integration Networks. Descriptive analysis was conducted for both number of people and number of visits, stratified by sex and age groups (0-5, 6-18, 19-64, and 65+ years). Numbers were also examined by neighbourhood stratifications, including urban/rural, income quintile and immigrant tercile. RESULTS Over the study period, an upward trend of visiting EDs for NTDCs was observed. Approximately 403 628 people in Ontario made 482 565 visits over the period of nine years. On average, 341 per 100 000 people, per year, visited. Young children, people living in neighbourhoods with lower income and higher immigrant concentration, and people living in the rural regions, visited EDs more for NTDCs during 2006-2014. CONCLUSION The upward and inequitable trends of utilization of EDs for NTDCs reinforce recognition of the important need for both universal and targeted approaches for primary prevention of dental conditions. To enhance equitable access to dental care, policy advocacy is required for publicly funding essential and emergency dental services for all.
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Affiliation(s)
- Sonica Singhal
- Dental Public Health, University of Toronto, 124 Edward Street, Toronto, ON, M5G 1G6, Canada. .,Health Promotion, Chronic Disease and Injury Prevention Department, Public Health Ontario, Toronto, ON, Canada.
| | - Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Carlos Quinonez
- Dental Public Health, University of Toronto, 124 Edward Street, Toronto, ON, M5G 1G6, Canada
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Park HJ, Lee JH, Park S, Kim TI. Changes in dental care access upon health care benefit expansion to include scaling. J Periodontal Implant Sci 2016; 46:405-414. [PMID: 28050318 PMCID: PMC5200866 DOI: 10.5051/jpis.2016.46.6.405] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/22/2016] [Indexed: 11/08/2022] Open
Abstract
Purpose This study aimed to evaluate the effects of a policy change to expand Korean National Health Insurance (KNHI) benefit coverage to include scaling on access to dental care at the national level. Methods A nationally representative sample of 12,794 adults aged 20 to 64 years from Korea National Health and Nutritional Examination Survey (2010–2014) was analyzed. To examine the effect of the policy on the outcomes of interest (unmet dental care needs and preventive dental care utilization in the past year), an estimates-based probit model was used, incorporating marginal effects with a complex sampling structure. The effect of the policy on individuals depending on their income and education level was also assessed. Results Adjusting for potential covariates, the probability of having unmet needs for dental care decreased by 6.1% and preventative dental care utilization increased by 14% in the post-policy period compared to those in the pre-policy period (2010, 2012). High income and higher education levels were associated with fewer unmet dental care needs and more preventive dental visits. Conclusions The expansion of coverage to include scaling demonstrated to have a significant association with decreasing unmet dental care needs and increasing preventive dental care utilization. However, the policy disproportionately benefited certain groups, in contrast with the objective of the policy to benefit all participants in the KNHI system.
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Affiliation(s)
- Hee-Jung Park
- Department of Health Policy and Management, Korea University College of Health Sciences, Seoul, Korea
| | - Jun Hyup Lee
- Department of Health Policy and Management, Korea University College of Health Sciences, Seoul, Korea.; BK21 PLUS Program in Embodiment: Health-Society Interaction, Department of Public Health Sciences, Korea University Graduate School, Seoul, Korea
| | - Sujin Park
- Department of Health Policy and Management, Korea University College of Health Sciences, Seoul, Korea
| | - Tae-Il Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea
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Wilson FA, Wang Y, Stimpson JP, McFarland KK, Singh KP. Use of dental services by immigration status in the United States. J Am Dent Assoc 2015; 147:162-9.e4. [PMID: 26562731 DOI: 10.1016/j.adaj.2015.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/12/2015] [Accepted: 08/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is limited research with mixed findings comparing differences in oral health outcomes and the use of dental services by immigration status. The authors conducted a study by reviewing nationally representative data to describe differences in dental care among noncitizens, naturalized citizens, and US-born citizens in the United States. METHODS The authors used nationally representative data from the 2008-2012 Medical Expenditure Panel Survey to examine dental care for US-born citizens, naturalized citizens, and noncitizens 18 years and older. Total analytical sample size was 98,107 adults. They used multivariate logistic regression to model dental service use adjusting for confounding factors. RESULTS Naturalized citizens and noncitizens were significantly less likely to have at least 1 dental visit within 12 months (39.5% and 23.1%, respectively) compared with US-born citizens (43.6%; P < .001). Among users, a smaller proportion of comprehensive examination visits were for naturalized citizens and noncitizens (75.9% and 71.4%, respectively) compared with US-born citizens (82.8%; P < .01). Noncitizen visits to dentists were also more likely to involve tooth extraction compared with those of US-born citizens (11.3% versus 8.8%; P < .01). Multivariate logistic regression suggests both non- and naturalized citizens had lower adjusted odds of having a comprehensive examination compared with US-born citizens during a visit (P < .01). CONCLUSIONS Noncitizens and naturalized citizens had a lower rate of dental service use, and noncitizens were more likely to have had tooth extraction compared with US-born citizens. PRACTICAL IMPLICATIONS Increased outreach efforts tailored to noncitizens and naturalized citizens who are at high risk of experiencing dental problems are needed, particularly to address misperceptions on the necessity of preventive dental visits.
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Calvasina P, Muntaner C, Quiñonez C. Transnational dental care among Canadian immigrants. Community Dent Oral Epidemiol 2015; 43:444-51. [DOI: 10.1111/cdoe.12169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Paola Calvasina
- Faculty of Dentistry & Global Health Division; Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - Carles Muntaner
- Bloomberg Faculty of Nursing; Institute for Global Health Equity and Innovation; Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - Carlos Quiñonez
- Discipline of Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto ON Canada
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