Acculturation and the oral health of a nationally representative sample of Hispanic children in the United States: an analysis of 2011-2012 National Survey of Children's Health data

Dental Caries and Preventive Dental Visits Among Children in the U.S.: The Impact of Race/Ethnicity and Immigration

Introduction

National data on dental caries and dental service use among immigrant children in U.S. are limited. It is not known whether race/ethnicity would interact with immigration status to increase these disparities. Using a nationally representative sample, this study assessed the interaction effects of immigrant generation status and race/ethnicity on dental caries and dental visits among children in the U.S.

Methods

Data were from the 2020 and 2021 National Survey of Children's Health. All data were self-reported by parents/guardians. The 2 outcomes were (1) dental caries (yes/no) in the past 12 months and (2) preventive dental visits (yes/no) in the past 12 months. Racial/ethnic groups included non-Hispanic White, Black, Hispanics, and Asian Americans. The analytical sample included 66,167 children aged 2-17 years, including 1,243 first-generation immigrant children; 11,017 second-generation immigrant children; and 53,907 nonimmigrant children. Study authors ran separate multiple logistic regression models for the 2 outcome variables. All analyses accounted for the survey design of National Survey of Children's Health.

Results

First-generation immigrant children were more likely to have dental caries than nonimmigrant children (AOR=1.44). The interaction of race/ethnicity and immigrant generation status was significant (p=0.04) in the preventive dental visits model, indicating increased challenges in getting dental visits among minority immigrant children in comparison with that among non-Hispanic White immigrant children, especially among first-generation immigrant children of Asian Americans (AOR=0.41) and non-Hispanic Black immigrant children (AOR=0.37).

Conclusions

First-generation immigrant children were less likely to see a dentist and more likely to have dental caries than nonimmigrants. Moreover, first-generation immigrant children from minority racial/ethnic groups were the least likely to seek dental services. To further reduce disparities in oral health and dental use among children in the U.S., culturally sensitive health promotion is warranted to improve oral health literacy and reduce barriers to dental care for immigrants, especially immigrant children of the minority groups.

Oral health inequalities in immigrant populations worldwide: a scoping review of dental caries and periodontal disease prevalence

BACKGROUND

Inequalities in immigrants' oral health are often masked in population-level data. Therefore, this paper was planned to assess the prevalence data on oral health diseases, namely dental caries, and periodontitis, among immigrants worldwide.

METHODS

Following a systematic search in Scopus, Embase, and PubMed for studies published between 2011 and 2023, 1342 records were identified. Following title and abstract screening, 76 studies remained for full-text eligibility-screening based on predefined inclusion criteria. Thirty-two studies were included in the review.

RESULTS

Dental caries figures were higher in immigrant populations compared to the local population, regardless of host countries, age, gender, or nationality. In children, the overall mean and standard deviation (SD) for decayed, missing, and filled teeth in the primary dentition (d3mft) was 3.63(2.47), and for D3MFT (permanent dentition), it was 1.7(1.2). Upon comparing overall mean caries counts in children and adults with their control groups in the included studies, untreated dental caries (D3T and d3t) constituted the dominant share of caries experience (D3MFT and d3mft) in immigrant children. For the local population, the highest proportion of caries experience was attributed to filled teeth (FT and ft). Dentin caries prevalence among immigrants ranged from 22% to 88.7% in the primary dentition and 5.6% to 90.9% in the permanent dentition. Gingivitis ranged from 5.1% to 100%. Oral health varied greatly between studies. Regarding oral health accessibility, 52% to 88% of immigrant children had never been to a dentist, suggesting a very limited level of accessibility to dental health services.

CONCLUSION

It is imperative to develop interventions and policies that have been customized to address the oral health disparities experienced by immigrant populations. Additionally, host countries should actively implement measures aimed at enhancing the accessibility of oral health care services for these individuals. The utilization of available data is crucial in establishing a hierarchy of objectives aimed at enhancing the oral health of immigrant populations.

TRIAL REGISTRATION

The Scoping review protocol was registered at OSF Registries with registration number ( https://doi.org/10.17605/OSF.IO/MYXS4 ).

Triple Jeopardy in Oral Health: Additive Effects of Immigrant Status, Education, and Neighborhood

PURPOSE

To estimate the additive effects of parent's nativity status/language spoken at country of birth, education, and area-level socioeconomic status (SES) on untreated dental caries among children aged 5 to 9 y in Australia.

METHODS

Cross-sectional population-based data were obtained from the 2014 National Child Oral Health Study (N = 12,140). Indicators of social position used to explore additive effects on dental caries included nativity status, language, university degree, and neighborhood socioeconomic level. Multiple-way interactions were examined, and departure from additivity resulting from 2- and 3-way interactions were estimated as relative excess risk due to interaction (RERI).

RESULTS

Children marginalized across multiple layers of disadvantage had substantially higher frequencies of dental caries compared with children in the most advantaged category. RERI for the 3-way interaction between immigrant status, education, and neighborhood SES was negative (RERI3: -0.14; 95% confidence interval [CI]: -1.68, 1.40). When operationalizing language, education, and neighborhood SES, the joint effect of the 3 marginalized positions was additive (RERI3: 0.43; 95% CI: -2.08, 2.95).

CONCLUSION

Children marginalized across multiple intersecting axes of disadvantage bear the greatest burden of dental caries, with frequencies surpassing the cumulative effect of each social position alone. Findings emphasize the need to account for intersecting inequities and their oral health effects among children with immigrant backgrounds.

KNOWLEDGE TRANSFER STATEMENT

Our analysis underscores the necessity for policies and public health strategies targeting dental caries-related inequities to comprehensively account for various indicators of social disadvantage, particularly encompassing language proficiency, educational attainment, and neighborhood socioeconomic status. Within the intricate interplay of these factors, we identify a vulnerable subgroup comprising children with the highest prevalence of dental decay. Therefore, prioritizing this specific demographic should be the focal point of policies and public health initiatives aimed at fostering equitable oral health outcomes.

Vision Loss in Children from Immigrant and Nonimmigrant Households: Evidence from the National Survey of Children's Health 2018-2020

The aim of this study was to determine whether immigrant generation is associated with caregiver-reported vision loss in children adjusting for sociodemographic characteristics. Nationally representative data from the National Survey of Children's Health (2018-2020) was used. The primary exposure was immigrant generation defined as: first (child and all reported parents were born outside the United States); second (child was born in the United States and at least one parent was born outside the United States); third or higher (all parents in the household were born in the United States). The main outcome was caregiver-reported vision loss in child. Adjusted odds ratios (aOR) and 95% confidence intervals were computed based on immigration generation. The study sample included 84,860 US children aged 3-17 years. First generation children had higher adjusted odds of caregiver-reported vision loss (aOR 2.30; 95% CI 1.21, 4.35) than third or higher generation children after adjusting for demographic characteristics and social determinants of health. For Hispanic families, first generation (aOR 2.99; 95% CI 1.34, 6.66), and second-generation children (aOR 1.70; 95% CI 1.06, 2.74) had a higher adjusted odds of vision loss compared with third or higher generation children. Even when adjusting for sociodemographic characteristics, first generation children had greater odds of vision loss, especially in Hispanic households, than third generation children. Immigration generation should be treated as an independent risk factor for vision loss for children and is a social determinant of eye health.

The Impact of Primary Language Spoken on the Pain Experience of Children With Cancer

The purpose of the current prospective cohort study was to determine if acculturation, measured by primary language spoken, impacts the pain response of children being treated for cancer during an experimental pain task. Sixty-seven Spanish-speaking and English-speaking children ages 6 to 18 years being treated for cancer provided ratings of pain and upset severity during the completion of the cold pressor task (CPT). One week following the CPT, participants provided their recollection of average pain and upset during the CPT. Repeated measures analysis of variance revealed Spanish-speaking children reported significantly higher pain (F1,64=5.58, P=0.02) and upset (F1,64=7.69, P=0.007) ratings during the CPT compared with English-speaking children. Also, Spanish-speaking children were over 4 times as likely to remove their hands from the water before the CPT 4-minute uninformed ceiling compared with English-speaking children (P=0.002). These findings suggest that cultural and contextual factors, including the level of acculturation, are important considerations in the assessment and management of pain in children with cancer. Future research should continue to examine the mechanisms underlying the association between acculturation and the symptom experience for children receiving treatment for cancer.

Effect of pH-sensitive nanoparticles on inhibiting oral biofilms

Dental caries is a biofilm-related preventable infectious disease caused by interactions between the oral bacteria and the host’s dietary sugars. As the microenvironments in cariogenic biofilms are often acidic, pH-sensitive drug delivery systems have become innovative materials for dental caries prevention in recent years. In the present study, poly(DMAEMA-co-HEMA) was used as a pH-sensitive carrier to synthesize a chlorhexidine (CHX)-loaded nanomaterial (p(DH)@CHX). In vitro, p(DH)@CHX exhibited good pH sensitivity and a sustained and high CHX release rate in the acidic environment. It also exhibited lower cytotoxicity against human oral keratinocytes (HOKs) compared to free CHX. Besides, compared with free CHX, p(DH)@CHX showed the same antibacterial effects on S. mutans biofilms. In addition, it had no effect on eradicating healthy saliva-derived biofilm, while free CHX exhibited an inhibitory effect. Furthermore, the 16s rDNA sequencing results showed that p(DH)@CHX had the potential to alter oral microbiota composition and possibly reduce caries risk. In conclusion, the present study presents an alternative option to design an intelligent material to prevent and treat dental caries.

Relationship between the Appearance of Symptoms and Hospital Visits in Childhood Based on Japanese Statistical Data

BACKGROUND

Childhood health problems affect healthy growth. This study aimed to assess the symptoms and diseases requiring hospital visits commonly found in children in Japan and analyze their effects on health status.

METHODS

Anonymized data on 1315 children aged 6-14 years were obtained from a national survey questionnaire. The survey items addressed symptoms, disease names, and hospital visits. Associations between symptoms and other factors were examined by means of a contingency table analysis and logistic regression.

RESULTS

The proportions of responses for health status were compared for each question item; significant differences were found in age group (p < 0.01), subjective symptoms (p < 0.01), hospital visits (p < 0.01), and lifestyle (p < 0.01). The proportion of responses indicating "poor" perceived health status was high among those with subjective symptoms (4.8%) and hospital visits (4.7%). From the logistic regression, significant odds ratios were found for subjective symptoms (2.10, 95% confidence interval (C.I.) 1.15-3.83) and age group (1.98, 95% C.I. 1.05-3.72).

CONCLUSION

Among measures to improve quality of life from childhood, comprehensive health guidance that emphasizes understanding symptoms and includes age and living conditions is important.

Dental service utilization and immigrant family structure

OBJECTIVES

To determine the patterns and time trends of dental services received and access to dental care among immigrant and US-born children living in the United States.

METHODS

We analyzed the nationally representative Medical Expenditure Survey data for 2007-2015. Survey weighted mean and frequency were calculated for all the years and for each year for the complete cohort and for the four subgroups of children categorized based on the child's and parents' birthplace (United States or Foreign). These groups were compared to detect differences in dental service received.

RESULTS

Overall 34,482 children aged <18 years were included in the analysis representing the weighted sample size of 564,255,643. Utilization of preventive dental services increased from 37.2 percent in 2007 to 44.4 percent in 2015 overall (P < 0.0001), with similar trend seen within all subgroups. Immigrant children compared to US-born children had higher numbers of surgical and restorative procedures (17 versus 16 per 100-person years, P = 0.03), fewer had at least one preventive dental visit in a year (32.8 percent versus 43.0 percent, P < 0.0001) and were less likely be unable to access dental care (3.0 percent versus 1.7 percent, P = 0.005). Fewer children had delayed access to dental care in recent years (2.0 percent in 2007 to 1.5 percent in 2015) and the decline was consistent in all the subgroups.

CONCLUSION

Stratification into the different subgroups allowed for improved understanding of dental procedure utilization and dental services utilization in all subgroups increased over time. Immigrant children had lower utilization of preventive procedures and higher utilization of surgical and restorative procedures.

Association of Acculturation and Latino Parents' Oral Health Beliefs and Knowledge

The purpose of our study was to explore the association of acculturation and Latino parent behavioral and psychosocial characteristics. A cross-sectional survey was conducted with 197 parent-children triads. Participating parents completed survey questions encompassing oral health knowledge, behaviors and beliefs from a validated oral health instrument. The mean score for acculturation in this sample was 3.8, where acculturation was dichotomized to a categorical variable. The bivariate associations between the independent variables (caregiver psychosocial factors and socio-economic factors (SES) factors) and acculturation (more/less acculturated) were conducted using logistic regression analysis, and for the final model a multivariate logistic regression model was used. In the bivariate analyses, less acculturated parents reported lower oral health knowledge (p = 0.02), higher social support (p = 0.028) and chronic stress (p = 0.015) and lower perceived susceptibility to dental caries in their children (p = 0.039). The bivariate analysis demonstrated that less acculturated parents had less education and employment (p < 0.0001) than more acculturated parents. The multivariate logistic model demonstrated that social support (p = 0.028), chronic stress (p = 0.015) and health beliefs as barriers to access dental care (p = 0.039) were higher in less acculturated parents compared to more acculturated parents. Less acculturated parents demonstrated lower oral health knowledge, higher stress and more barriers to accessing oral health care for their children. Oral health interventions for Latino families should incorporate strategies that include consideration of parental oral health beliefs.