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Brooks CV, Maupomé G. Social support associated with restorative treatment, professionally applied fluoride and flossing: A cross-sectional analysis including recent immigrants from Central America and Mexico in the Midwest USA. Community Dent Oral Epidemiol 2024; 52:187-195. [PMID: 37779340 PMCID: PMC10939981 DOI: 10.1111/cdoe.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/08/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES This study examined how Mexican and Central American immigrants' social support was associated with three selected dental outcomes among recent immigrants, prior to the 2020 COVID-19 pandemic. METHODS Using baseline wave data from the 2017-2022 VidaSana study about the health and social networks of Mexican and Central American immigrants living in Indiana, this study utilized logistic and ordinal logistic regression to predict lifetime fluoride use, lifetime dental restoration and flossing frequency, across levels of social support and differences between Mexican and Central American immigrants. RESULTS Data from 547 respondents were included in the present analysis (68% women; mean age 34.4 years [SD 11.2]; Central American 42%; Mexican 58%). Results show a high level of social support was associated with increased probability of fluoride use, dental restoration and higher flossing frequency for Mexican immigrants. However, social support for Central American immigrants was associated with a decreased likelihood of fluoride use, more infrequent flossing, and had no significant association with dental restorations experience. What would be a negative association between Central American immigrants and dental restoration was accounted for by education level and never having been to a dentist. CONCLUSIONS While higher social support was linked to beneficial outcomes for oral health in Mexican immigrants, the opposite was found in Central Americans. These findings highlighted the complexities of social relationships among new immigrants, and potential heterogeneity within the Hispanic population, particularly regarding social and behavioural measures as they pertain to oral health. Further research is needed to identify the underlying mechanisms producing both differences in social support and oral health outcomes.
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Affiliation(s)
- Caroline V. Brooks
- Indiana University, Department of Sociology, 1020 E. Kirkwood Ave., Bloomington, IN 47405, USA
| | - Gerardo Maupomé
- Indiana University-Purdue University Indianapolis, Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd., Indianapolis, IN 46202, USA
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Skandrani A, Pichot H, Pegon-Machat E, Pereira B, Tubert-Jeannin S. Influence of an oral health promotion program on the evolution of dental status in New Caledonia: A focus on health inequities. PLoS One 2023; 18:e0287067. [PMID: 37788243 PMCID: PMC10547163 DOI: 10.1371/journal.pone.0287067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/30/2023] [Indexed: 10/05/2023] Open
Abstract
New Caledonia is a sui generis collectivity of overseas France situated in the south Pacific Ocean. Geographical and social inequalities are superimposed on ethnic disparities with high prevalence of chronic diseases such as oral diseases. In 2012, the health agency has evaluated the children's health status. Then, an oral health promotion program was developed in 2014. Another study was conducted in 2019 in New Caledonia to appreciate the evolution of children's oral health. A sample of 488 9-years-old children was randomly selected. Dental status was clinically recorded, families and children answered questionnaires about oral health determinants. The methodology (sampling, study variables…) was similar to the one used in the 2012 study. Multivariate mixed-models were conducted to compare 2012 and 2019 dental status and to explore the determinants of caries experience in 2019. Results indicated that caries prevalence and experience decreased between 2012 and 2019, with nonetheless various trends depending on the province or type of indexes. The number of carious lesions (d3t + D3T) in 2019 was used as an outcome variable in four models. Model 1 integrated social variables; ethnicity was found to be the only significant determinant. Model 2 was related to oral health care; participation in the program & and access to oral health care was found to be significant. For oral health behaviours (model 3), tooth brushing frequency and consumption of sugary snacks were significant risk factors. In a final model with significant variables from the previous models, ethnicity, accessibility of oral health care, number of sealed molars, consumption of sugary snacks remained explanatory factors. Five years after the implementation of the oral health promotion program, positive changes in oral health have been observed. However, health equity is still an issue with varying health status depending on ethnicity, behavioural factors and accessibility to oral health care.
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Affiliation(s)
- Amal Skandrani
- Université Clermont Auvergne, CROC, F-63000, Clermont-Ferrand, France
| | - Helene Pichot
- Health and Social Agency of New Caledonia (ASS-NC), Nouméa, New Caledonia, France
| | | | - Bruno Pereira
- CHU of Clermont-Ferrand, Clinical Research and Innovation Direction (DRCI), F-63003, Clermont-Ferrand, France
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3
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Foley MA, Sexton C, Spencer AJ, Lalloo R, Do LG. Water fluoridation, dental caries and parental ratings of child oral health. Community Dent Oral Epidemiol 2022; 50:493-499. [PMID: 34514625 DOI: 10.1111/cdoe.12697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/20/2021] [Accepted: 09/05/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Previous studies have identified many demographic, socioeconomic, behavioural and clinical variables associated with subjective parental ratings of child oral health. This study investigated associations between children's lifetime exposure to fluoridated drinking water (LEFW) and dental caries prevalence and parental ratings. METHODS Australia's National Child Oral Health Study 2012-2014 conducted oral epidemiological examinations for 24 664 children aged 5-14 and investigated risk factors for child oral health and disease through questionnaires. Parents also subjectively rated their child's oral health. This cross-sectional study estimated prevalence ratios for associations between LEFW and prevalence of dental caries in the primary and permanent dentitions and parental oral health ratings for 5-8 year old and 9-14 year old children. E-value sensitivity analyses helped assess whether observed effect sizes may have arisen through unmeasured confounding. RESULTS Children aged 5-8 with 0%-10% or 11%-89% LEFW are respectively 1.5 (95% CI 1.2-1.8) and 1.5 (95% CI 1.1-2.0) times more likely than children with 90%-100% LEFW to receive a fair or poor parental oral health rating. Children aged 9-14 with 0%-10% or 11%-89% LEFW are 1.2 (95% CI 1.0-1.4) times more likely than children with 90%-100% LEFW to receive a fair or poor parental oral health rating. Children aged 5-8 with 0%-10% or 11%-89% LEFW are respectively 1.4 (1.3-1.6) and 1.3 (95% CI 1.1-1.4) times more likely than children with 90%-100% LEFW to experience caries in their primary teeth. Children aged 9-14 with 0%-10% or 11%-89% LEFW are respectively 1.4 (95% CI 1.3-1.5) and 1.1 (95% CI 1.0-1.2) times more likely than children with 90%-100% LEFW to experience caries in their permanent teeth. CONCLUSIONS Longer lifetime exposure to fluoridated drinking water is causally associated with a lower childhood dental caries prevalence and more positive parental ratings of child oral health. The associations are stronger for younger children.
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Affiliation(s)
- Michael Anthony Foley
- Australian Research Centre for Population Oral Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Metro North Oral Health Services, Queensland Health, Brisbane, QLD, Australia.,School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - Christopher Sexton
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - Andrew John Spencer
- Australian Research Centre for Population Oral Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - Loc Giang Do
- Australian Research Centre for Population Oral Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
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Park L, Gomaa N, Quinonez C. Racial/ethnic inequality in the association of allostatic load and dental caries in children. J Public Health Dent 2022; 82:239-246. [PMID: 34254682 DOI: 10.1111/jphd.12470] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/28/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Allostatic load (AL), defined as the overtime "wear and tear" on biological systems due to stress, disproportionately affects racial/ethnic minorities and has been shown to associate with racial inequality in oral health in the adult population. This study aims to assess racial/ethnic inequality in AL and untreated dental caries (UD) in children, and to assess the association between allostatic load and UD, and whether it varies by race/ethnicity. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) (2001-2010) for 8-17-year-old children (n = 11,378) was used. AL scores were generated using cardiovascular, metabolic and immune biomarkers. Multivariable log binomial regression models adjusted for age, sex, poverty: income ratio (PIR), health insurance status and the frequency of healthcare visits, were used to assess the relationships of interest. RESULTS Racial/ethnic inequality was evident in UD and AL, where Mexican American and black children exhibited more UD and a higher AL score than white. AL was associated with UD in fully adjusted models. This association was significant across all racial/ethnic groups, but was stronger in Mexican American and black children, compared to their white counterparts. CONCLUSIONS Similar racial inequality is evident in AL and UD that is not explained by poverty and/or behavioral factors. Racial/ethnic inequality is also evident in the association between AL and UD.
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Affiliation(s)
- Leslie Park
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Noha Gomaa
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Carlos Quinonez
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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Lumsden C, Andrews H, Leu CS, Edelstein B. Changes in knowledge and beliefs of community health workers following an oral health intervention training program. J Prev Interv Community 2020; 47:54-65. [PMID: 30806193 DOI: 10.1080/10852352.2018.1547309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Greater acknowledgement of the ways in which social determinants influence health has led to increased engagement of Community Health Workers (CHWs) in health promotion activities. This study sought to evaluate changes in CHW knowledge and beliefs via pre-/post-training surveys immediately following a four-day (∼20 hour) oral health intervention training and to gather CHW feedback on training. Significant increases in summary scores for 19 knowledge (t(9) = -6.715, p < .001) and four belief (t(9) = -2.994, p = .015) measures, using four-point Likert scales, were observed post-training. Feedback was overwhelmingly positive, with the majority of CHWs reporting confidence in understanding the material and study purpose. Findings support the effectiveness and acceptability of a brief training program to prepare CHWs to deliver an oral health intervention. CHWs hold promise to effectively engage populations in which the impact of interventions delivered by traditional oral healthcare team members has shown limited success.
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Affiliation(s)
- Christie Lumsden
- a Section of Population Oral Health , Columbia University College of Dental Medicine , New York , NY , USA
| | - Howard Andrews
- b Department of Neurobiology (in Psychiatry and in Biostatistics), Columbia University Medical Center , New York , NY , USA
| | - Cheng-Shiun Leu
- c Department of Biostatistics (in Psychiatry) , Columbia University Medical Center , New York , NY , USA
| | - Burton Edelstein
- d Section of Population Oral Health , Columbia University College of Dental Medicine , New York , NY , USA
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Foley MA, Spencer AJ, Lalloo R, Do LG. A Causative Approach to Demographic and Socioeconomic Factors Affecting Parental Ratings of Child Oral Health. JDR Clin Trans Res 2020; 6:68-76. [PMID: 32176558 DOI: 10.1177/2380084420914248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Many studies have investigated associations between demographic, socioeconomic status (SES), behavioral, and clinical factors and parental ratings of child oral health. Caries experience, pain, missing teeth, malocclusions, and conditions and treatments likely to negatively affect the child or family in the future have been consistently associated with poorer parental ratings. In contrast, effect sizes for associations between demographic and SES indicators (race/ethnicity, country of birth, family structure, household income, employment status, and parental education levels) and parental ratings vary greatly. OBJECTIVES The primary objectives of this study were to estimate effect sizes for associations between demographic and SES variables and parental ratings of child oral health and then to consider possible causal implications. METHODS This article uses a nationally representative data set from 24,664 Australian children aged 5 to 14 y, regression analyses guided by a directed acyclic graph causal model, and sensitivity analyses to investigate effects of demographic and SES factors on parental ratings of oral health. RESULTS One in 8 children had oral health rated as fair or poor by a parent. Indigenous children, older boys, young children with a migrant parent, children from single-parent families, low-income households and families where no parent worked full-time, and children whose parents had lower education levels were much more likely to receive a fair or poor parental oral health rating in crude and adjusted models. CONCLUSION This cross-sectional study helps to clarify inconsistent findings from previous research and shows many demographic and SES variables to be strong determinants of parental ratings of child oral health, consistent with the effects of these variables on other health outcomes. Sensitivity analyses and consideration of the potential for chance and bias to have affected these findings suggest that many of these associations may be causal. KNOWLEDGE TRANSFER STATEMENT Based on regression analyses driven by a directed acyclic graph causal model, this research shows a strong impact of demographic and socioeconomic determinants on parental ratings of child oral health, consistent with associations between these variables and other oral and general health outcomes. Many of these associations may be causal. We demonstrate the value of causal models and causal thinking when analyzing complex multilevel observational data.
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Affiliation(s)
- M A Foley
- Australian Research Centre for Population Oral Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,Metro North Oral Health Services, Queensland Health, Brisbane, Australia
| | - A J Spencer
- Australian Research Centre for Population Oral Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - R Lalloo
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - L G Do
- Australian Research Centre for Population Oral Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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Lam PC, John DA, Galfalvy H, Kunzel C, Lewis-Fernández R. Oral Health-Related Quality of Life Among Publicly Insured Mental Health Service Outpatients With Serious Mental Illness. Psychiatr Serv 2019; 70:1101-1109. [PMID: 31522632 DOI: 10.1176/appi.ps.201900111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study investigated factors associated with unmet need for dental care and oral health-related quality of life (OHQoL) among individuals with serious mental illness receiving outpatient care in a public mental health program serving a largely low-income population, mostly from racial-ethnic minority groups. METHODS Cross-sectional interview data were collected from a convenience sample (N=150) of outpatients. Adjusted risk ratios (ARRs) and adjusted risk differences (ARDs) were estimated by logistic regression models to examine the independent contribution of sociodemographic and clinical factors to low OHQoL and past-year unmet dental need, defined as inability to obtain all needed dental care. RESULTS More than half of participants reported low OHQoL (54%) and a past-year dental visit (61%). Over one-third (39%) had past-year unmet dental need. Financial barriers (ARR=3.16) and nonfinancial barriers (ARR=2.18) were associated with greater risk for past-year unmet dental need after control for age, gender, high dental anxiety, and limited English proficiency. ARDs for financial and nonfinancial barriers indicated absolute differences of 40 and 27 percentage points, respectively. Unmet dental need (ARR=1.31), xerostomia severity (ARR=1.20), and a schizophrenia spectrum diagnosis (ARR=1.33) were associated with low OHQoL, after control for age and current smoking, with ARDs ranging from 11 to 15 percentage points. CONCLUSIONS Improving oral health promotion, oral health service access, and the integration of the mental and oral health systems may help reduce the high prevalence of low OHQoL in this population, given that low OHQoL is partly driven by unmet dental need.
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Affiliation(s)
- Peter C Lam
- New York State Center of Excellence for Cultural Competence (Lam, John, Lewis-Fernández) and Anxiety Disorders Clinic and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York; Department of Psychiatry, Vegelos College of Physicians and Surgeons (Galfalvy, Lewis-Fernández), Department of Biostatistics (Galfalvy) and Department of Sociomedical Sciences (Kunzel), Mailman School of Public Health, and Division of Foundational Sciences, Section of Oral, Diagnostic, and Rehabilitation Sciences, College of Dental Medicine (Kunzel), all at Columbia University, New York
| | - Dolly A John
- New York State Center of Excellence for Cultural Competence (Lam, John, Lewis-Fernández) and Anxiety Disorders Clinic and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York; Department of Psychiatry, Vegelos College of Physicians and Surgeons (Galfalvy, Lewis-Fernández), Department of Biostatistics (Galfalvy) and Department of Sociomedical Sciences (Kunzel), Mailman School of Public Health, and Division of Foundational Sciences, Section of Oral, Diagnostic, and Rehabilitation Sciences, College of Dental Medicine (Kunzel), all at Columbia University, New York
| | - Hanga Galfalvy
- New York State Center of Excellence for Cultural Competence (Lam, John, Lewis-Fernández) and Anxiety Disorders Clinic and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York; Department of Psychiatry, Vegelos College of Physicians and Surgeons (Galfalvy, Lewis-Fernández), Department of Biostatistics (Galfalvy) and Department of Sociomedical Sciences (Kunzel), Mailman School of Public Health, and Division of Foundational Sciences, Section of Oral, Diagnostic, and Rehabilitation Sciences, College of Dental Medicine (Kunzel), all at Columbia University, New York
| | - Carol Kunzel
- New York State Center of Excellence for Cultural Competence (Lam, John, Lewis-Fernández) and Anxiety Disorders Clinic and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York; Department of Psychiatry, Vegelos College of Physicians and Surgeons (Galfalvy, Lewis-Fernández), Department of Biostatistics (Galfalvy) and Department of Sociomedical Sciences (Kunzel), Mailman School of Public Health, and Division of Foundational Sciences, Section of Oral, Diagnostic, and Rehabilitation Sciences, College of Dental Medicine (Kunzel), all at Columbia University, New York
| | - Roberto Lewis-Fernández
- New York State Center of Excellence for Cultural Competence (Lam, John, Lewis-Fernández) and Anxiety Disorders Clinic and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York; Department of Psychiatry, Vegelos College of Physicians and Surgeons (Galfalvy, Lewis-Fernández), Department of Biostatistics (Galfalvy) and Department of Sociomedical Sciences (Kunzel), Mailman School of Public Health, and Division of Foundational Sciences, Section of Oral, Diagnostic, and Rehabilitation Sciences, College of Dental Medicine (Kunzel), all at Columbia University, New York
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9
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Assari S, Hani N. Household Income and Children's Unmet Dental Care Need; Blacks' Diminished Return. Dent J (Basel) 2018; 6:dj6020017. [PMID: 29867015 PMCID: PMC6023279 DOI: 10.3390/dj6020017] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/27/2018] [Accepted: 05/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Minorities’ Diminished Return theory is defined as the relative disadvantage of minority populations compared to Whites regarding health gains that follow socioeconomic status (SES). To test whether Minorities’ Diminished Return theory holds for unmet dental care needs (DCN), we investigated Black-White differences in the effects of family income on unmet DCN among children. Methods: Data from the National Survey of Children’s Health were used. Participants were either White or Black children age 1 to 18. Family income-to-needs ratio was the independent variable. Unmet DCN was the dependent variable. Covariates included age, gender, and parental educational attainment. Race was the focal moderator. We ran logistic regression for data analysis. Results: Higher income-to-needs ratio was associated with lower risk of unmet DCN in the pooled sample. We found an interaction between race and family income-to-needs ratio on unmet DCN, suggesting a stronger protective effect for Whites than Blacks. Conclusion: Minorities’ Diminished Return also holds for the effects of family income-to-needs ratio on unmet DCN. The relative disadvantage of Blacks compared to Whites in gaining oral health from their SES may reflect structural racism that systemically hinders Black families. There is a need for additional research on specific societal barriers that bound Blacks’ oral health gain from their SES resources such as income. Policies and programs should also help Black families to leverage their SES resources.
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Affiliation(s)
- Shervin Assari
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
- BRITE Center, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2700, USA.
| | - Neda Hani
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave Boston, MA 02115, USA.
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10
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Assari S. Socioeconomic Status and Self-Rated Oral Health; Diminished Return among Hispanic Whites. Dent J (Basel) 2018; 6:E11. [PMID: 29695074 PMCID: PMC6023433 DOI: 10.3390/dj6020011] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 12/12/2022] Open
Abstract
Background. An extensive body of knowledge has documented weaker health effects of socio-economic status (SES) for Blacks compared to Whites, a phenomenon also known as Blacks’ diminished return. It is, however, unknown whether the same diminished return also holds for other ethnic minorities such as Hispanics or not. Aim. Using a nationally representative sample, the current study aimed to compare Non-Hispanic and Hispanic Whites for the effects of SES on self-rated oral health. Methods. For the current cross-sectional study, we used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001⁻2003. With a nationally representative sampling, CPES included 11,207 adults who were either non-Hispanic Whites (n = 7587) or Hispanic Whites (n = 3620. The dependent variable was self-rated oral health, treated as dichotomous measure. Independent variables were education, income, employment, and marital status. Ethnicity was the focal moderator. Age and gender were covariates. Logistic regressions were used for data analysis. Results. Education, income, employment, and marital status were associated with oral health in the pooled sample. Although education, income, employment, and marital status were associated with oral health in non-Hispanic Whites, none of these associations were found for Hispanic Whites. Conclusion. In a similar pattern to Blacks’ diminished return, differential gain of SES indicators exists between Hispanic and non-Hispanic Whites, with a disadvantage for Hispanic Whites. Diminished return of SES should be regarded as a systemically neglected contributing mechanism behind ethnic oral health disparities in the United States. Replication of Blacks’ diminished return for Hispanics suggests that these processes are not specific to ethnic minority groups, and non-White groups gain less because they are not enjoying the privilege and advantage of Whites.
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Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor 48109-2700, MI, USA.
- Department of Psychiatry, University of Michigan, Ann Arbor 48109-2700, MI, USA 4250 Plymouth Rd., Ann Arbor, MI 48109-2700, USA.
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11
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Singelis TM, Garcia RI, Barker JC, Davis RE. An Experimental Test of the Two-Dimensional Theory of Cultural Sensitivity in Health Communication. JOURNAL OF HEALTH COMMUNICATION 2018; 23:321-328. [PMID: 29509068 PMCID: PMC6101005 DOI: 10.1080/10810730.2018.1443526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Based on a theoretical framework describing culturally sensitive (CS) health communication, this experiment tested the relative contributions of surface structure and deep structure in the recall of oral health information from pamphlets varied in written message and images. Using a 2 × 2 factorial design, Spanish-speaking Mexican heritage mothers of children under six (n = 160) were randomly assigned to read one of four 12-page pamphlets containing the same oral health information in Spanish: (1) standard written message/standard images; (2) standard written message/CS images; (3) CS written message/standard images; and (4) CS written message/CS images. Participants completed a 22-item oral health knowledge questionnaire before and after reading the pamphlet. Controlling for the effects of pretest scores, acculturation, and educational level on information recall, findings showed significant positive main effects for CS images (F(1, 152) = 5.03, p = .026, partial ŋ2 = .032) and CS written message (F(1, 152) = 5.21, p = .024, partial ŋ2 = .033). There was no interaction. These results support the two dimensions of CS and their independent effects. They should be applicable to a variety of health communication channels. Further research is needed to investigate the causal mechanism behind the observed effects.
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Affiliation(s)
- Theodore M. Singelis
- Corresponding Author, Department of Psychology, CSU, Chico, 400 West 1st Street, Chico, CA 95929; Tel: 530 898 4009;
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12
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Shi C, Faris P, McNeil DA, Patterson S, Potestio ML, Thawer S, McLaren L. Ethnic disparities in children's oral health: findings from a population-based survey of grade 1 and 2 schoolchildren in Alberta, Canada. BMC Oral Health 2018; 18:1. [PMID: 29301577 PMCID: PMC5753483 DOI: 10.1186/s12903-017-0444-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/07/2017] [Indexed: 12/04/2022] Open
Abstract
Background Although oral health has improved remarkably in recent decades, not all populations have benefited equally. Ethnic identity, and in particular visible minority status, has been identified as an important risk factor for poor oral health. Canadian research on ethnic disparities in oral health is extremely limited. The aim of this study was to examine ethnic disparities in oral health outcomes and to assess the extent to which ethnic disparities could be accounted for by demographic, socioeconomic and caries-related behavioral factors, among a population-based sample of grade 1 and 2 schoolchildren (age range: 5-8 years) in Alberta, Canada. Methods A dental survey (administered during 2013-14) included a mouth examination and parent questionnaire. Oral health outcomes included: 1) percentage of children with dental caries; 2) number of decayed, extracted/missing (due to caries) and filled teeth; 3) percentage of children with two or more teeth with untreated caries; and 4) percentage of children with parental-ratings of fair or poor oral health. We used multivariable regression analysis to examine ethnic disparities in oral health, adjusting for demographic, socioeconomic and caries-related behavioral variables. Results We observed significant ethnic disparities in children’s oral health. Most visible minority groups, particularly Filipino and Arab, as well as Indigenous children, were more likely to have worse oral health than White populations. In particular, Filipino children had an almost 5-fold higher odds of having severe untreated dental problems (2 or more teeth with untreated caries) than White children. Adjustment for demographic, socioeconomic, and caries-related behavior variables attenuated but did not eliminate ethnic disparities in oral health, with the exception of Latin American children whose outcomes did not differ significantly from White populations after adjustment. Conclusions Significant ethnic disparities in oral health exist in Alberta, Canada, even when adjusting for demographic, socioeconomic and caries-related behavioral factors, with Filipino, Arab, and Indigenous children being the most affected. Electronic supplementary material The online version of this article (10.1186/s12903-017-0444-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Congshi Shi
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Peter Faris
- Alberta Health Services, Calgary, AB, Canada
| | - Deborah A McNeil
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Alberta Health Services, Calgary, AB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Steven Patterson
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Melissa L Potestio
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Salima Thawer
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.
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Matsuo G, Rozier RG, Kranz AM. Dental Caries: Racial and Ethnic Disparities Among North Carolina Kindergarten Students. Am J Public Health 2015; 105:2503-9. [PMID: 26469649 DOI: 10.2105/ajph.2015.302884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We examined racial/ethnic disparities in dental caries among kindergarten students in North Carolina and the cross-level effects between students' race/ethnicity and school poverty status. METHODS We adjusted the analysis of oral health surveillance information (2009-2010) for individual-, school-, and county-level variables. We included a cross-level interaction of student's race/ethnicity (White, Black, Hispanic) and school National School Lunch Program (NSLP) participation (< 75% vs ≥ 75% of students), which we used as a compositional school-level variable measuring poverty among families of enrolled students. RESULTS Among 70,089 students in 1067 schools in 95 counties, the prevalence of dental caries was 30.4% for White, 39.0% for Black, and 51.7% for Hispanic students. The adjusted difference in caries experience between Black and White students was significantly greater in schools with NSLP participation of less than 75%. CONCLUSIONS Racial/ethnic oral health disparities exist among kindergarten students in North Carolina as a whole and regardless of school's poverty status. Furthermore, disparities between White and Black students are larger in nonpoor schools than in poor schools. Further studies are needed to explore causal pathways that might lead to these disparities.
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Affiliation(s)
- Go Matsuo
- At the time of the study, Go Matsuo was with the Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. R. Gary Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Ashley M. Kranz is with the School of Dentistry, University of North Carolina, Chapel Hill
| | - R Gary Rozier
- At the time of the study, Go Matsuo was with the Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. R. Gary Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Ashley M. Kranz is with the School of Dentistry, University of North Carolina, Chapel Hill
| | - Ashley M Kranz
- At the time of the study, Go Matsuo was with the Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. R. Gary Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Ashley M. Kranz is with the School of Dentistry, University of North Carolina, Chapel Hill
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14
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Sohn W. Caregiver's Education Level is Associated With a Child's Dental Caries, in Part, Mediated by Dental Care Use Behaviors in Low-income African American Populations. J Evid Based Dent Pract 2015; 15:128-30. [PMID: 26337586 DOI: 10.1016/j.jebdp.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Woosung Sohn
- Associate Professor, Department of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, 560 Harrison Ave., 3rd Floor (Rm. 327), Boston, MA 02118, USA, Tel.: +1 617 414 1156; fax: +1 617 638 6381.
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15
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Chalmers NI, Oh K, Hughes CV, Pradhan N, Kanasi E, Ehrlich Y, Dewhirst FE, Tanner ACR. Pulp and plaque microbiotas of children with severe early childhood caries. J Oral Microbiol 2015; 7:25951. [PMID: 25651832 PMCID: PMC4317471 DOI: 10.3402/jom.v7.25951] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 11/23/2022] Open
Abstract
Background and objective Bacterial invasion into pulps of primary teeth can lead to infection and premature tooth loss in children. This pilot study aimed to explore whether the microbiota of carious exposures of dental pulps resembles that of carious dentin or that of infected root canals. Design Children with severe early childhood caries were studied. Children were consented and extent of caries, plaque, and gingivitis measured. Bacteria were sampled from carious lesion biofilms and vital carious exposures of pulps, and processed by anaerobic culture. Isolates were characterized from partial sequences of the 16S rRNA gene and identified by comparison with taxa in the Human Oral Microbiome Database (http://www.HOMD.org). The microbiotas of carious lesions and dental pulps were compared using univariate and multivariate approaches. Results The microbiota of cariously exposed pulps was similar in composition to that of carious lesion biofilms except that fewer species/taxa were identified from pulps. The major taxa identified belonged to the phyla Firmicutes (mainly streptococci) and Actinobacteria (mainly Actinomyces species). Actinomyces and Selenomonas species were associated with carious lesions whereas Veillonella species, particularly Veillonella dispar was associated with pulps. Other bacteria detected in pulps included Streptococcus mutans, Parascardovia denticolens, Bifidobacterium longum, and several Lactobacillus and Actinomyces species. By principal, component analysis pulp microbiotas grouped together, whereas those in caries biofilms were widely dispersed. Conclusions We conclude that the microbiota of cariously exposed vital primary pulps is composed of a subset of species associated with carious lesions. Vital primary pulps had a dominant Firmicutes and Actinobacteria microbiota which contrasts with reports of endodontic infections which can harbor a gram-negative microbiota. The microbiota of exposed primary pulps may provide insight into bacterial species at the forefront of caries invasion in dentinal lesions that can invade into the pulp and the nature of species that need suppressing for successful pulp therapy.
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Affiliation(s)
- Natalia I Chalmers
- NIDCR, NIH, Bethesda MD, USA.,Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA
| | - Kevin Oh
- School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | | | - Eleni Kanasi
- Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA.,Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - Ygal Ehrlich
- School of Dentistry, Indiana University, Indianapolis, IN, USA
| | - Floyd E Dewhirst
- Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA.,School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Anne C R Tanner
- Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA.,School of Dental Medicine, Harvard University, Boston, MA, USA;
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16
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Isong I, Dantas L, Gerard M, Kuhlthau K. Oral Health Disparities and Unmet Dental Needs among Preschool Children in Chelsea, MA: Exploring Mechanisms, Defining Solutions. JOURNAL OF ORAL HYGIENE & HEALTH 2015; 2:1000138. [PMID: 25614878 PMCID: PMC4299657 DOI: 10.4172/2332-0702.1000138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Significant disparities exist in children's receipt of preventive dental care (PDC) in the United States. Many of the children at greatest risk of dental disease do not receive timely PDC; when they do receive dental care, it is often more for relief of dental pain. Chelsea is a low-income, diverse Massachusetts community with high rates of untreated childhood caries. There are various dental resources available in Chelsea, yet many children do not access dental care at levels equivalent to their needs. OBJECTIVE Using Chelsea as a case-study, to explore factors contributing to forgone PDC (including the age 1 dental visit) in an in-depth way. METHODS We used a qualitative study design that included semi-structured interviews with parents of preschool children residing in Chelsea, and Chelsea-based providers including pediatricians, dentists, a dental hygienist and early childhood care providers. We examined: a) parents' dental attitudes and oral health cultural beliefs; b) parents' and providers' perspectives on facilitators and barriers to PDC, reasons for unmet needs, and proposed solutions to address the problem. We recorded, transcribed and independently coded all interviews. Using rigorous, iterative qualitative data analyses procedures, we identified emergent themes. RESULTS Factors perceived to facilitate receipt of PDC included Head-Start oral health policies, strong pediatric primary care/dental linkages, community outreach and advertising, and parents' own oral health experiences. Most parents and providers perceived there to be an adequate number of accessible dental services and resources in Chelsea, including for Medicaid enrollees. However, several barriers impeded children from receiving timely PDC, the most frequently cited being insurance related problems for children and adults. Other barriers included limited dental services for children <2 years, perceived poor quality of some dental practices, lack of emphasis on prevention-based dental care, poor care-coordination, and insufficient culturally-appropriate care. Important family-level barriers included parental oral health literacy, cultural factors, limited English proficiency and competing priorities. Several solutions were proposed to address identified barriers. CONCLUSION Even in a community with a considerable number of dental resources, various factors may preclude access to these services by preschool-aged children. Opportunities exist to address modifiable factors through strategic oral health policies, community outreach and improved care coordination between physicians, dentists and early childhood care providers.
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Affiliation(s)
- Inyang Isong
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laila Dantas
- Cambridge Health Alliance, Cambridge, MA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Macda Gerard
- Department of Public Health, Brown University, Providence, RI, USA
| | - Karen Kuhlthau
- Harvard Medical School, Boston, MA, USA
- Center for Child & Adolescent Health Research and Policy, MGHfC, Boston, MA, USA
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17
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Masterson EE, Barker JC, Hoeft KS, Hyde S. Shades of Decay: The Meanings of Tooth Discoloration and Deterioration to Mexican Immigrant Caregivers of Young Children. HUMAN ORGANIZATION 2014; 73:82-93. [PMID: 26279585 PMCID: PMC4537173 DOI: 10.17730/humo.73.1.861831136642q074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this article is to investigate parental understanding of tooth discoloration and decay and their related care seeking for young, Mexican-American children. The research design entailed semi-structured, face-to-face interviews conducted in Spanish with a convenience sample of 37 Mexican immigrant mothers of young children in a low-income urban neighborhood. Five major color terms - white, off-white, yellow, brown, and black - were used to describe tooth discoloration, the causes of which were mainly unrecognized or attributed to poor oral hygiene and exposure to sweet substances. Mothers also described three major levels of deterioration of the structural integrity of teeth due to caries, from stains to decayed portions to entirely rotten. A trend was observed between use of darker discoloration terms and extensive carious lesions. Teeth described as both dark in color and structurally damaged resulted in seeking of professional care. The paper concludes with the finding that Spanish terms used to describe tooth discoloration and carious lesions are broad and complex. Mexican immigrant mothers' interpretations of tooth discoloration and decay may differ from dental professionals' and result in late care seeking. Increased understanding between dental practitioners and caregivers is needed to create educational messages about the early signs of tooth decay.
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Affiliation(s)
- Erin E Masterson
- Department of Epidemiology at the University of Washington's School of Public Health
| | - Judith C Barker
- Department of Anthropology, History & Social Medicine and Department of Preventive & Restorative Dental Sciences at the University of California San Francisco (UCSF)
| | - Kristin S Hoeft
- Department of Preventive & Restorative Dental Sciences and a doctoral candidate in the Epidemiology & Translational Science Program at UCSF
| | - Susan Hyde
- Division of Oral Epidemiology and Dental Public Health in the Department of Preventive & Restorative Dental Sciences at UCSF
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18
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Price JH, Khubchandani J, McKinney M, Braun R. Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States. BIOMED RESEARCH INTERNATIONAL 2013; 2013:787616. [PMID: 24175301 PMCID: PMC3794652 DOI: 10.1155/2013/787616] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/08/2013] [Indexed: 01/08/2023]
Abstract
Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.
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Affiliation(s)
- James H. Price
- Health Education and Public Health, University of Toledo, Toledo, OH 43606, USA
| | | | - Molly McKinney
- Public Health, Eastern Kentucky University, Richmond, KY 40475, USA
| | - Robert Braun
- Health Sciences, Otterbein University, Westerville, OH 43081, USA
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19
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Zoorob R, Buchowski MS, Beech BM, Canedo JR, Chandrasekhar R, Akohoue S, Hull PC. Healthy families study: design of a childhood obesity prevention trial for Hispanic families. Contemp Clin Trials 2013; 35:108-21. [PMID: 23624172 PMCID: PMC3749297 DOI: 10.1016/j.cct.2013.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 04/16/2013] [Accepted: 04/20/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The childhood obesity epidemic disproportionately affects Hispanics. This paper reports on the design of the ongoing Healthy Families Study, a randomized controlled trial testing the efficacy of a community-based, behavioral family intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach. METHODS The study will enroll 272 Hispanic families with children ages 5-7 residing in greater Nashville, Tennessee, United States. Families are randomized to the active weight gain prevention intervention or an alternative intervention focused on oral health. Lay community health promoters implement the interventions primarily in Spanish in a community center. The active intervention was adapted from the We Can! parent program to be culturally-targeted for Hispanic families and for younger children. This 12-month intervention promotes healthy eating behaviors, increased physical activity, and decreased sedentary behavior, with an emphasis on parental modeling and experiential learning for children. Families attend eight bi-monthly group sessions during four months then receive information and/or support by phone or mail each month for eight months. The primary outcome is change in children's body mass index. Secondary outcomes are changes in children's waist circumference, dietary behaviors, preferences for fruits and vegetables, physical activity, and screen time. RESULTS Enrollment and data collection are in progress. CONCLUSION This study will contribute valuable evidence on efficacy of a childhood obesity prevention intervention targeting Hispanic families with implications for reducing disparities.
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Affiliation(s)
- Roger Zoorob
- Meharry Medical College, Department of Family and Community Medicine, Nashville, TN 37208, USA.
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20
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Dawkins E, Michimi A, Ellis-Griffith G, Peterson T, Carter D, English G. Dental caries among children visiting a mobile dental clinic in South Central Kentucky: a pooled cross-sectional study. BMC Oral Health 2013; 13:19. [PMID: 23639250 PMCID: PMC3653808 DOI: 10.1186/1472-6831-13-19] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental caries is one of the most common chronic childhood diseases affecting a large portion of children in the United States. The prevalence of childhood dental caries in Kentucky is among the highest in the nation. The purposes of this study are to (1) compare sociodemographic differences between caries and no caries groups and (2) investigate factors associated with untreated dental caries among children who visited a mobile dental clinic in South Central Kentucky. METHODS Study subjects were children aged 6 to 15 years who participated in the school-based dental sealant program through the mobile dental clinic operated by the Institute for Rural Health at Western Kentucky University between September 2006 and May 2011 (n = 2,453). Descriptive statistics were calculated for sociodemographic factors (age, gender, race/ethnicity, insurance status, and urban versus rural residential location) and caries status. We used chi-square tests to compare sociodemographic differences of children stratified by caries and no caries status as well as three levels of caries severity. We developed a logistic regression model to investigate factors associated with untreated dental caries while controlling for sociodemographic characteristics. RESULTS The proportion of children having untreated dental caries was 49.7% and the mean number of untreated dental caries was 2.0. The proportion of untreated dental caries was higher in older children, children with no insurance and living in rural residential locations, and caries severity was also higher in these groups. Odds ratio indicated that older ages, not having private insurance (having only public, government-sponsored insurance or no insurance at all) and rural residential location were associated with having untreated dental caries after controlling for sociodemographic characteristics of children. CONCLUSIONS Untreated dental caries was more likely to be present in older children living in rural areas without insurance. Health interventionists may use this information and target rural children without having proper insurance in order to reduce geographic disparities in untreated dental caries in South Central Kentucky.
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Affiliation(s)
- Erika Dawkins
- Department of Public Health, College of Health and Human Services, Western Kentucky University, Bowling Green, KY 42101, USA
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21
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Hull PC, Reece MC, Patton M, Williams J, Beech BM, Canedo JR, Zoorob R. A community-based oral health self-care intervention for Hispanic families. Int J Public Health 2013; 59:61-6. [PMID: 23612890 DOI: 10.1007/s00038-013-0470-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/03/2013] [Accepted: 04/09/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES A community-based intervention is described that targets oral health self-care practices among Hispanic children in the United States and is being tested in an ongoing trial. Descriptive results of baseline oral health variables are presented. METHODS As of January 2013, 284 Hispanic children of ages 5-7 enrolled in the Healthy Families Study in Nashville, TN, USA. Families are randomized to one of two culturally appropriate interventions. RESULTS At baseline, 69.6 % of children brushed at least twice daily, and 40.6 % brushed before bed daily. One-third of parents did not know if their children's toothpaste contained fluoride. CONCLUSIONS This intervention fills the need for community-based interventions to improve oral health self-care practices that are culturally appropriate in Hispanic families.
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Affiliation(s)
- Pamela C Hull
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End, Suite 800, Nashville, TN, 37203-1738, USA,
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Abstract
OBJECTIVE To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents. DATA SOURCE Secondary data analysis of the 2003 National Survey of Children's Health. The survey focus was children 0-17 years old. STUDY DESIGN Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/Pacific Islander, American Indian/Alaskan Native, and multiracial adolescents 10-17 years old (n = 48,742) to identify disparities in 40 measures of health and health care. PRINCIPAL FINDINGS Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/Alaska Natives; and not receiving all needed dental care in multiracial youth. CONCLUSIONS U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents.
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Affiliation(s)
- May Lau
- Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA.
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23
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Fisher-Owens SA, Isong IA, Soobader MJ, Gansky SA, Weintraub JA, Platt LJ, Newacheck PW. An examination of racial/ethnic disparities in children's oral health in the United States. J Public Health Dent 2012; 73:166-74. [PMID: 22970900 PMCID: PMC3702186 DOI: 10.1111/j.1752-7325.2012.00367.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the extent factors other than race/ethnicity explain apparent racial/ethnic disparities in children's oral health and oral health care. METHODS Data were from the 2007 National Survey of Children's Health, for children 2-17 years (n=82,020). Outcomes included parental reports of child's oral health status, receiving preventive dental care, and delayed dental care/unmet need. Model-based survey-data-analysis examined racial/ethnic disparities, controlling for child, family, and community/state (contextual) factors. RESULTS Unadjusted results show large racial/ethnic oral health disparities. Compared with non-Hispanic White people, Hispanic and non-Hispanic-Black people were markedly more likely to be reported in only fair/poor oral health [odds ratios (ORs) (95% confidence intervals) 4.3 (4.0-4.6), 2.2 (2.0-2.4), respectively], lack preventive care [ORs 1.9 (1.8-2.0), 1.4 (1.3-1.5)], and experience delayed care/unmet need [ORs 1.5 (1.3-1.7), 1.4 (1.3-1.5)]. Adjusting for child, family, and community/state factors reduced racial/ethnic disparities. Adjusted ORs (AORs) for Hispanics and non-Hispanic Blacks attenuated for fair/poor oral health, to 1.6 (1.5-1.8) and 1.2 (1.1-1.4), respectively. Adjustment eliminated disparities for lacking preventive care [AORs 1.0 (0.9-1.1), 1.1 (1.1-1.2)] and in Hispanics for delayed care/unmet need (AOR 1.0). Among non-Hispanic Blacks, adjustment reversed the disparity for delayed care/unmet need [AOR 0.6 (0.6-0.7)]. CONCLUSIONS Racial/ethnic disparities in children's oral health status and access were attributable largely to socioeconomic and health insurance factors. Efforts to decrease disparities may be more efficacious if targeted at social, economic, and other factors associated with minority racial/ethnic status and may have positive effects on all who share similar social, economic, and cultural characteristics.
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Affiliation(s)
- Susan A Fisher-Owens
- School of Medicine, Department of Pediatrics, University of California, San Francisco, CA 94110, USA.
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Isong IA, Soobader MJ, Fisher-Owens SA, Weintraub JA, Gansky SA, Platt LJ, Newacheck PW. Racial disparity trends in children's dental visits: US National Health Interview Survey, 1964-2010. Pediatrics 2012; 130:306-14. [PMID: 22753556 PMCID: PMC3408679 DOI: 10.1542/peds.2011-0838] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Research that has repeatedly documented marked racial/ethnic disparities in US children's receipt of dental care at single time points or brief periods has lacked a historical policy perspective, which provides insight into how these disparities have evolved over time. Our objective was to examine the im-pact of national health policies on African American and white children's receipt of dental care from 1964 to 2010. METHODS We analyzed data on race and dental care utilization for children aged 2 to 17 years from the 1964, 1976, 1989, 1999, and 2010 National Health Interview Survey. Dependent variables were as follows: child's receipt of a dental visit in the previous 12 months and child's history of never having had a dental visit. Primary independent variable was race (African American/white). We calculated sample prevalences, and χ(2) tests compared African American/white prevalences by year. We age-standardized estimates to the 2000 US Census. RESULTS The percentage of African American and white children in the United States without a dental visit in the previous 12 months declined significantly from 52.4% in 1964 to 21.7% in 2010, whereas the percentage of children who had never had a dental visit declined significantly (P < .01) from 33.6% to 10.6%. Pronounced African American/white disparities in children's dental utilization rates, whereas large and statistically significant in 1964, attenuated and became nonsignificant by 2010. CONCLUSIONS We demonstrate a dramatic narrowing of African American/white disparities in 2 measures of children's receipt of dental services from 1964 to 2010. Yet, much more needs to be done before persistent racial disparities in children's oral health status are eliminated.
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Affiliation(s)
- Inyang A. Isong
- MassGeneral Hospital Center for Child and Adolescent Health Research and Policy, Harvard Medical School, Boston, Massachusetts
| | | | | | - Jane A. Weintraub
- The University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, North Carolina; and
| | - Stuart A. Gansky
- Center to Address Disparities in Children’s Oral Health, School of Dentistry, University of California, San Francisco, California
| | - Larry J. Platt
- Philip R. Lee Institute for Health Policy, School of Medicine, University of California, San Francisco, California
| | - Paul W. Newacheck
- Department of Pediatrics and,Philip R. Lee Institute for Health Policy, School of Medicine, University of California, San Francisco, California
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Guarnizo-Herreño CC, Wehby GL. Explaining racial/ethnic disparities in children's dental health: a decomposition analysis. Am J Public Health 2012; 102:859-66. [PMID: 22420801 DOI: 10.2105/ajph.2011.300548] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We measured racial/ethnic inequalities in US children's dental health and quantified the contribution of conceptually relevant factors. METHODS Using data from the 2007 National Survey of Children's Health, we investigated racial/ethnic disparities in selected child dental health and preventive care outcomes. We employed a decomposition model to quantify demographic, socioeconomic, maternal health, health insurance, neighborhood, and geographic effects. RESULTS Hispanic children had the poorest dental health and lowest preventive dental care utilization, followed by Black then White children. The model explanatory variables accounted for 58% to 77% of the disparities in dental health and 89% to 100% of the disparities in preventive dental care. Socioeconomic status accounted for 71% of the gap in preventive dental care between Black children and White children and 55% of that between Hispanic children and White children. Maternal health, age, and marital status; neighborhood safety and social capital; and state of residence were relevant factors. CONCLUSIONS Reducing US children's racial/ethnic dental health disparities-which are mostly socioeconomically driven-requires policies that recognize the multilevel pathways underlying them and the need for household- and neighborhood-level interventions.
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Cortés DE, Réategui-Sharpe L, Spiro Iii A, García RI. Factors affecting children's oral health: perceptions among Latino parents. J Public Health Dent 2011; 72:82-9. [PMID: 22316378 DOI: 10.1111/j.1752-7325.2011.00287.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study is to understand factors that influence the oral health-related behaviors of Latino children, as reported by their parents. METHODS Focus groups and in-depth interviews assessed parental perceptions, experiences, attributions, and beliefs regarding their children's oral health. Guiding questions focused on a) the participant's child dental experiences; b) the impact of dental problems on the child's daily activities, emotions, self-esteem; c) parental experiences coping with child's dental problems; and d) hygienic and dietary habits. Participants were purposively sampled from dental clinics and public schools with a high concentration of Latinos; 92 urban low-income Latino Spanish-speaking parents participated. Transcriptions of the audio files were thematically analyzed using a grounded theory approach. RESULTS Parents' explanations of their children's dental experiences were categorized under the following themes: caries and diet, access to dental care, migration experiences, and routines. CONCLUSIONS Findings revealed fundamental multilevel (i.e., individual/child, family, and community) factors that are important to consider for future interventions to reduce oral health disparities: behaviors leading to caries, parental knowledge about optimal oral health, access to sugary foods within the living environment and to fluoridated water as well as barriers to oral health care such as lack of health insurance or limited health insurance coverage, among others.
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Carrion IV, Castañeda H, Martinez-Tyson D, Kline N. Barriers impeding access to primary oral health care among farmworker families in Central Florida. SOCIAL WORK IN HEALTH CARE 2011; 50:828-844. [PMID: 22136348 DOI: 10.1080/00981389.2011.594491] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Oral health care is critical for farmworkers' families in Central Florida. There is little research regarding the access to primary oral health care, barriers, and behaviors of Mexican migrant families. Forty semi-structured interviews were conducted with parents who are farmworkers in order to understand the factors that impact dental service utilization. Other factors that were also examined related to parental decisions regarding visits to the dentist with their children. This study highlights the inconsistent and inadequate patterns of dental health care services available for women, men, and children of farmworkers in Central Florida.
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Affiliation(s)
- Iraida V Carrion
- School of Social Work, University of South Florida, Tampa, Florida 33620-6600, USA.
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Piovesan C, Marquezan M, Kramer PF, Bönecker M, Ardenghi TM. Socioeconomic and clinical factors associated with caregivers’ perceptions of children’s oral health in Brazil. Community Dent Oral Epidemiol 2010; 39:260-7. [DOI: 10.1111/j.1600-0528.2010.00598.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hoeft KS, Barker JC, Masterson EE. Urban Mexican-American mothers' beliefs about caries etiology in children. Community Dent Oral Epidemiol 2010; 38:244-55. [PMID: 20156233 DOI: 10.1111/j.1600-0528.2009.00528.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Caries is a severe condition which disproportionately affects Latino children in the US. This study sought contextual understanding of urban, low-income Mexican-American mothers' beliefs, perceptions, knowledge and behavior surrounding causes of caries. METHODS In urban San José, CA, a qualitative study was conducted with a convenience sample of Mexican-American mothers of young children about their beliefs and knowledge about the causes of caries. Audio-taped in-depth interviews with open-ended questions, primarily in Spanish, were translated to English and then transcribed verbatim. Texts were independently read and thematically analyzed by two researchers. RESULTS Even while expressing uncertainty, all 48 mothers mentioned specific causes of caries, most frequently citing candy or juice consumption (85%), poor oral hygiene (65%) and use of the bottle (52%). Mothers rarely recognized cariogenic foods beyond candy, did not know or perform recommended oral hygiene routines, and demonstrated confusion and uncertainty about exactly how baby bottles are detrimental to teeth. Nearly half of these mothers also mentioned secondary cavity causes, such as genetics, lack of calcium, not going to the dentist or lack of fluoride. Mothers did not mention the role of bacteria. While mothers recognized that oral hygiene can counteract the detrimental effects of candy consumption, they did not recognize its beneficial effects in other contexts. Nor did they know about other preventive activities. CONCLUSIONS Mothers recognized the three major important factors causing caries: sugar consumption, poor oral hygiene and bottle use. However, their knowledge is limited in depth and specificity which restricts development of caries prevention behaviors. More comprehensive education is needed, including about caries prevention (oral hygiene) behaviors, which could lead to an increased sense of self-efficacy with respect to their children's oral health.
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Affiliation(s)
- Kristin S Hoeft
- Department of Preventive & Restorative Dental Sciences and Center to Address Disparities in Children's Oral Health, University of California San Francisco, San Francisco, CA, USA Department of Anthropology, History & Social Medicine and Center to Address Disparities in Children's Oral Health, University of California San Francisco, San Francisco, CA, USA
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