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Alshamary S, Bashir E, Salami B. Barriers and facilitators to health care access for migrant children in Canada: A scoping review. J Pediatr Nurs 2024:S0882-5963(24)00211-2. [PMID: 38824079 DOI: 10.1016/j.pedn.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
PROBLEM Migrant children face numerous challenges when settling in their new home. One of the challenges that exists is difficulties accessing health care, with many barriers existing and few facilitators to ease access. The goal of this paper is to analyze previous literature related to migrants' access to access to health care in Canada to better understand the barriers they face, and the factors that help them access services, or the facilitators. ELIGIBILITY CRITERIA Arksey and O'Malley's stages in scoping reviews was employed to search CINAHL, PubMed, Sociological Abstract, SocIndex, Scopus, Cochrane Library, Ovid MEDLINE(R), and Ovid Embase from 1997 to February 2020. SAMPLE A total of 26 Canadian studies met the inclusion criteria. RESULTS The review revealed the following barriers: language and culture barriers, low socioeconomic status, lack of health insurance, transportation, shortage of social support, lack of knowledge, fear of service providers/authorities, and discrimination. The facilitators for accessing health care for this population included outreach, benefit and assistance programs, cultural training, strengthening education, and various services. CONCLUSION The abundance of barriers to health care access and the existence of few facilitators may worsen migrant children's health, however further research is required to understand the impact. IMPLICATION There is a need to increase the understanding of migrant children's experiences with accessing health care services in order to inform policy, educate providers, and improve access and health outcomes.
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Affiliation(s)
| | - Elhan Bashir
- Faculty of Nursing, University of Alberta, Canada.
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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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Alzaghoul A, Rahimpoor-Marnani P, Yunis K, Alamgir A, Alghalyini B, Tamim H. Characteristics of Self-Rated Oral Health among Syrian Refugee Parents in Ontario. Int J Dent 2023; 2023:4136520. [PMID: 38047273 PMCID: PMC10691882 DOI: 10.1155/2023/4136520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/16/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Background Canada has been hosting Syrian refugees since early 2015. Almost half of the Syrian refugee population lives in Ontario, with dental health being at the top of the list of important immediate needs. The objective of the study was to evaluate self-rated oral health and its associated factors among Syrian refugee parents residing in Ontario. Methods This was a cross-sectional study where 540 Syrian refugee parents, residing in Ontario and with at least one child less than 18 years of age, were interviewed. Information about self-rated oral health was collected based on the question "In general, how would you rate the health of your teeth and mouth?" with answers ranging from 1 representing "excellent" and 5 representing "very poor." Multiple linear regression analysis was performed to assess the independent relationship between each of the sociodemographic-, migration-, health-, dental-related factors, and self-rated oral health. Results The overall prevalence of poor and very poor self-rated oral health was 43.5%. The results showed that the presence of dental health insurance, private sponsorship, improved physical and mental health, and regular visits to the dentist were factors related to improved oral health. Discussion. To achieve better oral health outcomes among refugee populations, including Syrian refugees, efforts should be focused on improving dental care and dental insurance for vulnerable populations.
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Affiliation(s)
- Aseel Alzaghoul
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, PQ, Canada H3A 1A2
| | | | - Khalid Yunis
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Akm Alamgir
- Access Alliance Multicultural Health and Community Services, 340 College Street, Suite 500, Toronto, ON, Canada M5T 3A9
| | - Baraa Alghalyini
- Family Medicine, Alfaisal University, Riyadh 50927, Saudi Arabia
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, Canada M3J 1P3
- College of Medicine, Alfaisal University, Riyadh 50927, Saudi Arabia
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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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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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Marcus K, Balasubramanian M, Short S, Sohn W. Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed-methods systematic review. Community Dent Oral Epidemiol 2023; 51:327-344. [PMID: 35342972 DOI: 10.1111/cdoe.12745] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers. METHODS Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed-method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review. RESULTS A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual-family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial-system, provider and individual-family levels and illustrated in the rainbow model of CALD oral health. CONCLUSION The review strengthens evidence for multilayered, system-related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.
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Affiliation(s)
- Kanchan Marcus
- Faculty of Medicine and Health, School of Dentistry, The University of Sydney, Surry Hills, New South Wales, Australia
| | - Madhan Balasubramanian
- Health Care Management, College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
- Faculty of Medicine and Health, Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Short
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Woosung Sohn
- Faculty of Medicine and Health, School of Dentistry, The University of Sydney, Surry Hills, New South Wales, Australia
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Dahal R, Thapa Bajgain K, Bahadur Bajgain B, Adhikari K, Naeem I, Chowdhury N, Turin TC. Patient-reported experiences in primary health care access of Nepalese immigrant women in Canada. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2022. [DOI: 10.1108/ijmhsc-03-2021-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Purpose
Canada has a globally recognized universal health-care system. However, immigrants experience a number of obstacles in obtaining primary health care (PHC) that may differ within various communities due to the intersection of culture, gender and other identities. To date, no research has been done on the difficulties Nepalese immigrant women in Canada may face accessing PHC. The purpose of this study was to learn about their perceptions of barriers to PHC access and to share the findings with a wide range of stakeholders, including health-care providers and policymakers.
Design/methodology/approach
The authors conducted a community-engaged qualitative study in Calgary, Alberta, Canada. A total of six focus group discussions (FGD) among 34 participants (each FGD consisted of 5–7 participants) were conducted. The authors collected demographic information before each focus group. The FGDs were audio recorded and transcribed verbatim. The transcriptions were coded and analysed thematically.
Findings
The focus groups identified long wait times as a major barrier to receiving PHC services. Long wait times in emergency rooms, unable to see family doctors when they were sick, tedious referral procedures, long waits at the clinic even after scheduling an appointment, family responsibilities and work all impacted their access to PHC. Further, a lack of proficiency in English was another significant barrier that impeded effective communication between physicians and immigrant women patients, thus compromising the quality of care. Other barriers mentioned included lack of access to medical records for walk-in doctors, insufficient lab/diagnostic services, a lack of urgent care services and unfamiliarity with the Canadian health-care system.
Originality/value
Accessible PHC is essential for the health of immigrant populations in Canada. This study recognizes the extent of the barriers among a relatively less studied immigrant population group, Nepalese immigrant women, which will help effectively shape public policy and improve access to PHC for the versatile immigrant population fabric in Canada.
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AlRatroot S, Alotaibi G, AlBishi F, Khan S, Ashraf Nazir M. Dental Anxiety Amongst Pregnant Women: Relationship With Dental Attendance and Sociodemographic Factors. Int Dent J 2021; 72:179-185. [PMID: 34253341 PMCID: PMC9275180 DOI: 10.1016/j.identj.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction : Access to oral care during pregnancy is important for the maintenance of optimal oral health. Objective : The aim of this study was to estimate dental anxiety (DA) and its association with previous dental visits and sociodemographic factors amongst pregnant women. Methods : A cross-sectional study was conducted (June through August 2019) amongst pregnant women (N = 825) attending hospitals and health centres in Dhahran, Khobar, and Dammam cities in the Eastern province of Saudi Arabia. The Modified Dental Anxiety Scale (MDAS) was used to assess DA and the World Health Organization Oral Health Survey for Adults was administered to evaluate patterns of dental attendance. Results : DA was found in 90.9% of the pregnant women. The mean DA score of the sample was 12.53 ± 5.33 (range, 5 to 25) and it was significantly higher amongst non-Saudi (13.21 ± 5.24) vs Saudi women (12.15 ± 5.34) (P = .006), those who had negative dental experience (13.99 ± 5.62) vs those without such experience (12.2 ± 5.21) (P < .001), and those with dental pain or discomfort (13.18 ± 5.46) vs without pain or discomfort (11.94 ± 5.14) (P = .001). The study found a significant relationship between DA and reasons for dental attendance before pregnancy (P = .002) and time since the last dental visit (P = .009). Multiple logistic regression analysis showed significantly increased odds (OR, 1.69; 95% CI, 1.25 to 2.27) of experiencing moderate to extreme DA amongst pregnant women who visited the dentist after a year/never visited compared to those who visited in less than a year. Similarly, participants with negative dental experience were significantly more likely to have moderate to extreme DA (OR, 1.49; 95% CI, 1.02 to 2.20) than those without negative experience after adjusting for sociodemographic factors. Conclusions : DA was highly prevalent amongst pregnant women, which was significantly associated with negative dental experience, dental pain or discomfort, and reasons for and time since the last dental visit.
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Affiliation(s)
- Soha AlRatroot
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Gadah Alotaibi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fai AlBishi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shahd Khan
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Ashraf Nazir
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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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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