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Luo H, Wu B, Wu Y, Moss ME. Dental Caries and Preventive Dental Visits Among Children in the U.S.: The Impact of Race/Ethnicity and Immigration. AJPM FOCUS 2024; 3:100230. [PMID: 38766463 PMCID: PMC11099302 DOI: 10.1016/j.focus.2024.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Introduction National data on dental caries and dental service use among immigrant children in U.S. are limited. It is not known whether race/ethnicity would interact with immigration status to increase these disparities. Using a nationally representative sample, this study assessed the interaction effects of immigrant generation status and race/ethnicity on dental caries and dental visits among children in the U.S. Methods Data were from the 2020 and 2021 National Survey of Children's Health. All data were self-reported by parents/guardians. The 2 outcomes were (1) dental caries (yes/no) in the past 12 months and (2) preventive dental visits (yes/no) in the past 12 months. Racial/ethnic groups included non-Hispanic White, Black, Hispanics, and Asian Americans. The analytical sample included 66,167 children aged 2-17 years, including 1,243 first-generation immigrant children; 11,017 second-generation immigrant children; and 53,907 nonimmigrant children. Study authors ran separate multiple logistic regression models for the 2 outcome variables. All analyses accounted for the survey design of National Survey of Children's Health. Results First-generation immigrant children were more likely to have dental caries than nonimmigrant children (AOR=1.44). The interaction of race/ethnicity and immigrant generation status was significant (p=0.04) in the preventive dental visits model, indicating increased challenges in getting dental visits among minority immigrant children in comparison with that among non-Hispanic White immigrant children, especially among first-generation immigrant children of Asian Americans (AOR=0.41) and non-Hispanic Black immigrant children (AOR=0.37). Conclusions First-generation immigrant children were less likely to see a dentist and more likely to have dental caries than nonimmigrants. Moreover, first-generation immigrant children from minority racial/ethnic groups were the least likely to seek dental services. To further reduce disparities in oral health and dental use among children in the U.S., culturally sensitive health promotion is warranted to improve oral health literacy and reduce barriers to dental care for immigrants, especially immigrant children of the minority groups.
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Affiliation(s)
- Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Yanyan Wu
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Mark E. Moss
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina
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2
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Goswami S, Tseveenjav B, Kaila M. Non-utilization of oral health services and associated factors among children and adolescents: an integrative review. Acta Odontol Scand 2023; 81:105-118. [PMID: 35841154 DOI: 10.1080/00016357.2022.2095020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To review publications exploring non-utilization of oral health services and to identify factors associated with non-utilization of oral health services among children and adolescents. MATERIALS AND METHODS An integrative review design was adopted. A search was conducted for research articles published during the period from 2000 to April 2021 in five databases, Medline via Ovid, Scopus, CINAHL, Cochrane Library and Web of Science. Inclusion criteria were original articles examining non-utilization of oral health services among 0-19 years old and studies published in peer-reviewed journals in English. Thematic analysis was undertaken to identify common themes. The Newcastle-Ottawa scale was used to evaluate the quality of the studies. RESULTS Twenty-one geographically diverse articles were included. Nineteen studies were cross-sectional, one was a prospective cohort and one a case-control study. Non-utilization of dental health services tended to be higher in children than adolescents. There were predisposing (age, gender, ethnicity, parent's level of education), enabling (family income, dental insurance) and need factors (subjective and objective oral health related parameters) that had been shown to be associated with non-utilization of dental services among children and adolescents. CONCLUSIONS This integrative review found predisposing, enabling and need factors to be associated with dental health service non-utilization.
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Affiliation(s)
- Shweta Goswami
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Battsetseg Tseveenjav
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Department of Maxillofacial Surgery, Päijät-Häme Central Hospital, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - Minna Kaila
- Clinicum, University of Helsinki, Helsinki, Finland.,Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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3
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Goodwin M, Henshaw M, Borrelli B. Inequities and oral health: A behavioural sciences perspective. Community Dent Oral Epidemiol 2023; 51:108-115. [PMID: 36753398 DOI: 10.1111/cdoe.12826] [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: 11/19/2021] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The importance of tackling ongoing dental health inequities, observed both within and across countries, cannot be overstated. Alarmingly, health inequities in some areas are widening, resulting in an urgent need to act. The objective of this commentary is to explore oral health inequities through the lens of behavioral science and discuss adapting evidence based interventions for populations experiencing health inequities. METHOD/RESULTS The first section of this paper aims to describe the role of health disparities and inequities within oral health, with a specific focus on behaviours. The determinants, from upstream to downstream, and the interplay between these levels of intervention are discussed. This is followed by an overview of oral health promotion interventions, again with a focus on behaviours, which could potentially improve oral health while also taking into account oral health inequities. It is essential to translate evidence-based interventions (EBIs) to populations that have the greatest burden of disease. The second section of this paper discusses the rationale for cultural adaption of EBIs, criteria to justify EBIs and considers different cultural adaptation strategies necessary for the development and testing of effective, engaging, equitable and culturally relevant interventions. CONCLUSIONS We conclude with future directions for the development of theory-based multi-level interventions, guided by extent evidence-based interventions, and transdisciplinary approaches to science and key stakeholders such as patients, providers and payers.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Michelle Henshaw
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Belinda Borrelli
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.,The University of Manchester, Manchester, UK
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4
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Seligman LD, Talavera-Garza L, Geers AL, Murray AB, Ibarra M, Hovey JD. Development of a Measure of Fearful Implicit Associations with Dental Stimuli in Youth. Child Psychiatry Hum Dev 2021; 54:665-671. [PMID: 34724135 DOI: 10.1007/s10578-021-01269-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022]
Abstract
Youth with dental anxiety are at an increased risk of poor oral health but current tools used to identify dental anxiety in children in clinical settings are hampered by several limitations. This study assessed the psychometric properties of a measure of implicit associations with dental stimuli, the Affective Misattribution Procedure for dental stimuli (AMP-D) in 68 youth between the ages of 9 and 17 years. Measures of self-reported dental anxiety and parental perceptions of child dental anxiety were also administered. The internal consistency of the AMP-D was high (KR-20 = 0.96) and 1-week test-retest reliability was in the acceptable range (r = 0.75). The AMP-D was correlated with self-reported dental anxiety, providing evidence of construct validity. The psychometric properties of the AMP-D suggest it could be a useful tool in identifying youth with dental anxiety, particularly when concerns regarding self-representation may compromise the validity of self-reported anxiety.
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Affiliation(s)
- Laura D Seligman
- Department of Psychological Science, The University of Texas Rio Grande Valley, 1201 W University Dr, Edinburg, TX, 78539, USA.
| | - Liza Talavera-Garza
- Department of Psychological Science, The University of Texas Rio Grande Valley, 1201 W University Dr, Edinburg, TX, 78539, USA
| | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | | | - Marina Ibarra
- Department of Psychological Science, The University of Texas Rio Grande Valley, 1201 W University Dr, Edinburg, TX, 78539, USA
| | - Joseph D Hovey
- Department of Psychological Science, The University of Texas Rio Grande Valley, 1201 W University Dr, Edinburg, TX, 78539, USA
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5
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Siddiqui Z, Wang Y, Patel J, Thyvalikakath T. Differences in medication usage of dental patients by age, gender, race/ethnicity and insurance status. Technol Health Care 2021; 29:1099-1108. [PMID: 33896855 DOI: 10.3233/thc-202171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Limited studies have investigated the medication profile of young adult dental patients despite the high prevalence of prescription opioid abuse in this population. OBJECTIVE This study investigated the extent and differences in medication usage of dental patients older than 18 years by age, race/ethnicity, gender, insurance status and mechanism of action in an academic dental clinic setting. METHODS Using an automated approach, medication names in the Electronic Dental Record were retrieved and classified according to the National Drug Code directory. Descriptive statistics, multivariable ANOVA and Post hoc tests were performed to detect differences in the number of medications by patient demographics. RESULTS Of the 11,220 adult patients, 53 percent reported taking at least one medication with significant differences in medication usage by demographics. Hydroxymethylglutaryl-coenzyme A reductase inhibitors (21-36%), and angiotensin-converting enzyme inhibitors (19-23%) ranked the top two medication classes among patients 55 years and older. Opioid agonists (7-14%), and Selective Serotonin Reuptake Inhibitors (SSRIs) (5-12%) ranked the top two medication classes among patients aged 18-54 years. CONCLUSIONS The results underscore the importance of dental providers to review medical and medication histories of patients regardless of their age to avoid adverse events and to determine patient's risk for opioid abuse.
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Affiliation(s)
- Zasim Siddiqui
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, IUPUI Indianapolis, IN, USA
| | - Yue Wang
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, IUPUI Indianapolis, IN, USA
| | - Jay Patel
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, IUPUI Indianapolis, IN, USA
| | - Thankam Thyvalikakath
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, IUPUI Indianapolis, IN, USA.,Research Scientist, Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Tiwari T, Poravanthattil A, Rai N, Wilson A. Association of Acculturation and Latino Parents' Oral Health Beliefs and Knowledge. CHILDREN-BASEL 2021; 8:children8030243. [PMID: 33810091 PMCID: PMC8004731 DOI: 10.3390/children8030243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 12/04/2022]
Abstract
The purpose of our study was to explore the association of acculturation and Latino parent behavioral and psychosocial characteristics. A cross-sectional survey was conducted with 197 parent-children triads. Participating parents completed survey questions encompassing oral health knowledge, behaviors and beliefs from a validated oral health instrument. The mean score for acculturation in this sample was 3.8, where acculturation was dichotomized to a categorical variable. The bivariate associations between the independent variables (caregiver psychosocial factors and socio-economic factors (SES) factors) and acculturation (more/less acculturated) were conducted using logistic regression analysis, and for the final model a multivariate logistic regression model was used. In the bivariate analyses, less acculturated parents reported lower oral health knowledge (p = 0.02), higher social support (p = 0.028) and chronic stress (p = 0.015) and lower perceived susceptibility to dental caries in their children (p = 0.039). The bivariate analysis demonstrated that less acculturated parents had less education and employment (p < 0.0001) than more acculturated parents. The multivariate logistic model demonstrated that social support (p = 0.028), chronic stress (p = 0.015) and health beliefs as barriers to access dental care (p = 0.039) were higher in less acculturated parents compared to more acculturated parents. Less acculturated parents demonstrated lower oral health knowledge, higher stress and more barriers to accessing oral health care for their children. Oral health interventions for Latino families should incorporate strategies that include consideration of parental oral health beliefs.
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Affiliation(s)
- Tamanna Tiwari
- School of Dental Medicine, University of Colorado, Aurora, CO 80045, USA; (N.R.); (A.W.)
- Correspondence: ; Tel.: +1-303-724-9539
| | | | - Nayanjot Rai
- School of Dental Medicine, University of Colorado, Aurora, CO 80045, USA; (N.R.); (A.W.)
| | - Anne Wilson
- School of Dental Medicine, University of Colorado, Aurora, CO 80045, USA; (N.R.); (A.W.)
- Children’s Hospital, University of Colorado, Aurora, CO 80045, USA;
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7
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Floríndez LI, Floríndez DC, Floríndez FM, Como DH, Pyatak E, Baezconde-Garbanati L, Polido JC, Cermak SA. Oral Care Experiences of Latino Parents/Caregivers with Children with Autism and with Typically Developing Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2905. [PMID: 31416123 PMCID: PMC6721061 DOI: 10.3390/ijerph16162905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/03/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
As a result of various barriers, several pediatric populations are at risk for poor oral health, including children with disabilities and children from under-represented populations, such as Latinos. To this end, this study aimed to better understand the factors that affect the oral health experiences of 32 Latino parents/caregivers from 18 families (n = 8 with a typically developing child and n = 10 with a child with Autism). Using a qualitative descriptive methodology, each family was interviewed twice. Interviews were audio-recorded, transcribed verbatim, and coded thematically to identify the individual, social, systemic, and culturally rooted factors contributing to oral health disparities in the families. The three themes that arose were "Why would I want to start trouble?": Latino parents' dissatisfaction with dental treatments, costs, and fear of the dentist and health care providers because of their ethnic minority status as key factors inhibiting receipt of dental care; "We have to put our children first": prioritizing the oral care activities of their children over their own individual oral care needs; and "We always keep baking soda around": familial and cultural influences on oral care habits. Understanding the oral health beliefs and experiences of Latino parents and caregivers of children with and without autism is critical for developing targeted prevention and intervention programs and reducing oral health disparities.
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Affiliation(s)
- Lucía I Floríndez
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA.
| | | | | | - Dominique H Como
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | - Elizabeth Pyatak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | | | - Jose C Polido
- Division of Dentistry, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Sharon A Cermak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
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8
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Craig MH, Scott JM, Slayton RL, Walker AL, Chi DL. Preventive dental care use for children with special health care needs in Washington's Access to Baby and Child Dentistry program. J Am Dent Assoc 2019; 150:42-48. [PMID: 30528747 PMCID: PMC6321780 DOI: 10.1016/j.adaj.2018.08.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preschool-aged children with special health care needs (CSHCN) from low-income households are at increased risk of developing poor oral health. The study goal was to assess preventive dental care use for CSHCN enrolled in Medicaid within Washington state's Access to Baby and Child Dentistry (ABCD) program. METHODS The authors analyzed 2012 Medicaid eligibility and claims files for children younger than 6 years in the ABCD program (N = 206,488). The authors used medical diagnosis and eligibility data to identify each child's special needs status (no or yes). The outcome was preventive dental care use (no or yes). The authors used modified Poisson regression models to estimate crude and covariate-adjusted prevalence rate ratios. RESULTS Of the 206,488 children in the study, 2.1% were CSHCN, and 114,570 used preventive dental care (55.5%). CSHCN used preventive care at rates similar to those of children without special health care needs (SHCN) (54.7% and 55.5%, respectively; P = .32). After adjustment for confounding variables, CSHCN were significantly less likely to use preventive dental care than were children without SHCN (prevalence rate ratio, 0.91; 95% confidence interval, 0.88 to 0.94; P < .001). Older preschool-aged children were significantly more likely to use preventive dental care than were younger preschool-aged children. A significantly higher proportion of preventive medical care users also used preventive dental care. CONCLUSIONS CSHCN who were enrolled in Medicaid in Washington's ABCD program were less likely to use preventive dental care than were children without SHCN who were enrolled in Medicaid. PRACTICAL IMPLICATIONS Future intervention research investigators should evaluate ways to improve access to preventive dental care for CSHCN. Additional strategies may be needed to improve oral health behaviors for preschool-aged CSHCN receiving Medicaid.
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Watt RG, Mathur MR, Aida J, Bönecker M, Venturelli R, Gansky SA. Oral Health Disparities in Children: A Canary in the Coalmine? Pediatr Clin North Am 2018; 65:965-979. [PMID: 30213357 DOI: 10.1016/j.pcl.2018.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite being largely preventable, oral diseases are still a major public health problem in child populations in many parts of the world. Increasingly, however, oral diseases disproportionately affect socially disadvantaged groups in society. It is unjust and unfair that children and families from disadvantaged backgrounds experience high levels of oral diseases. This article analyzes oral diseases through a health disparities lens. Action to combat oral health disparities requires a radical multifaceted strategy that addresses the shared underlying root causes of oral diseases, the social determinants of health inequality.
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Affiliation(s)
- Richard G Watt
- Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | - Manu Raj Mathur
- Department of Dental Public Health, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Gurgaon, Haryana 122002, India
| | - Jun Aida
- Department of International Health, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Marcelo Bönecker
- Dental Faculty, Av. Prof Lineu Prestes 2227 - University of Sao Paulo, Sao Paulo 05508-900, Brazil
| | - Renato Venturelli
- Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Stuart A Gansky
- Division of Oral Epidemiology and Dental Public Health, Center to Address Disparities in Children's Oral Health (Known As CAN DO), Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, Box #1361, San Francisco, CA 94143, USA
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YOON S, CHOI T, ODLUM M, MITCHELL DA, KRONISH IM, DAVIDSON KW, FINKELSTEIN J. Machine Learning to Identify Behavioral Determinants of Oral Health in Inner City Older Hispanic Adults. Stud Health Technol Inform 2018; 251:253-256. [PMID: 29968651 PMCID: PMC6211787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We applied machine learning techniques to a community-based behavioral dataset to build prediction models to gain insights about minority dental health and population aging as the foundation for future interventions for urban Hispanics. Our application of machine learning techniques identified emotional and systemic factors such as chronic stress and health literacy as the strongest predictors of self-reported dental health among hundreds of possible variables. Application of machine learning algorithms was useful to build prediction models to gain insights about dental health and minority population aging.
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Affiliation(s)
- Sunmoo YOON
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Thomas CHOI
- Department of Medicine, College of Dental Medicine, Columbia University, New York, NY, USA
| | - Michelle ODLUM
- School of Nursing, Columbia University, New York, NY, USA
| | - Dennis A. MITCHELL
- Department of Medicine, College of Dental Medicine, Columbia University, New York, NY, USA
| | - Ian M. KRONISH
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Karina W. DAVIDSON
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Joseph FINKELSTEIN
- Department of Medicine, College of Dental Medicine, Columbia University, New York, NY, USA
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11
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Wilson AR, Mulvahill MJ, Tiwari T. The Impact of Maternal Self-Efficacy and Oral Health Beliefs on Early Childhood Caries in Latino Children. Front Public Health 2017; 5:228. [PMID: 28894733 PMCID: PMC5581360 DOI: 10.3389/fpubh.2017.00228] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/14/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Latino children experience one of the highest rates of early childhood caries requiring interventions based on valid conceptual frameworks. The Health Belief Model has relevance as a predictor of compliance with health recommendations based on perceptions of a health condition and behaviors to avoid the condition. The model encompasses four perceptual constructs (susceptibility, severity, benefits, barriers) and, for complex conditions, includes self-efficacy as an extended model. This study evaluated individual (self-efficacy and health beliefs) and cultural (acculturation status) level factors and the inter-relationship to determine if items assessed for the Extended Health Belief Model (EHBM) were valid measures of maternal factors. METHODS A cross-sectional study was conducted with 100 mother-child dyads at the Dental Center of Children's Hospital Colorado, Aurora, CO, USA. Participating mothers completed a survey in English or Spanish with items from the Basic Research Factors Questionnaire encompassing sociodemographic characteristics, oral health knowledge and behavior, and psychosocial measures including the EHBM. Language preference was a proxy for maternal acculturation. Children were examined to measure decayed, missing, and filled tooth surfaces. Internal consistency reliability of each subscale was evaluated using Cronbach's alpha. Convergent validity was assessed using linear regression to evaluate the association of the EHBM subscales with oral health-related measures and language preference. RESULTS The benefits and self-efficacy scales reflected good reliability. Maternal education was the strongest predictor of health beliefs with significant associations for barriers, benefits, and susceptibility. Perceived benefits increased with each additional year in the household. There was a significant association between maternal oral health knowledge and higher perceived benefits and increased self-efficacy, and the same was found for higher knowledge of dental utilization which was also associated with children perceived as having increased susceptibility to early childhood caries. Less acculturated participants perceived more barriers to behavioral adherence and fewer barriers as knowledge increased. As dental utilization knowledge improved for Spanish-speaking participants, they perceived greater benefits from adherent oral health behavior compared to English-speaking participants. CONCLUSION Items assessed for the EHBM were valid as measures of maternal factors influencing children's oral health outcomes in a Latino population.
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Affiliation(s)
- Anne R. Wilson
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Matthew J. Mulvahill
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Tamanna Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Tiwari T, Wilson AR, Mulvahill M, Rai N, Albino J. Maternal Factors Associated with Early Childhood Caries in Urban Latino Children. JDR Clin Trans Res 2017; 3:83-90. [PMID: 29276778 DOI: 10.1177/2380084417718175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of this investigation was to describe maternal psychosocial, behavioral, and acculturation factors associated with early childhood caries in a sample of urban Latino mother-child dyads. A cross-sectional survey was conducted with 100 mothers whose children (under the age of 6 y) were patients at the Dental Center at Children's Hospital Colorado in Aurora, Colorado. All children participating in the study received an oral examination to measure decayed, missing, filled, surfaces (dmfs). Participating mothers were given the option to sign the consent form and complete the survey in English or Spanish, according to their preferred language. The survey used demographic, behavioral, knowledge, and several psychosocial variables. Bivariate analysis was conducted with dmfs as a dependent variable. The associations between independent variables and dmfs were modeled using negative binomial regression. Mean ± SD dmfs for the entire sample was about 11 ± 16.85. The mothers who spoke Spanish had children with significantly (P = 0.046) higher dmfs scores (15.2) compared to mothers who spoke English (7.56). Preference of Spanish language was significantly associated with self-efficacy (P = 0.0043), oral health knowledge (P = 0.0024), and 3 subscales of the health belief model: perceived severity (P = 0.057), perceived barriers (P = 0.0002), and perceived susceptibility (P = 0.008). Both in the univariate and the multivariate models, oral health behavior and preferential use of Spanish remained significantly associated with higher dmfs scores. Results of this study demonstrate that maternal oral health behaviors and preferred language are significant factors associated with early childhood caries in urban Latino children. Knowledge Transfer Statement: Results of this study indicate that maternal oral health behaviors and the level of acculturation are significantly associated with caries in urban Latino children. Caries prevention efforts in this population could use this information to tailor oral health messaging according to the level of acculturation in mothers.
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Affiliation(s)
- T Tiwari
- School of Dental Medicine, University of Colorado Anschutz, Medical Campus, Aurora, Colorado, USA
| | - A R Wilson
- School of Dental Medicine, University of Colorado Anschutz, Medical Campus, Aurora, Colorado, USA
| | - M Mulvahill
- School of Medicine, University of Colorado Anschutz, Medical Campus, Aurora, Colorado, USA
| | - N Rai
- Colorado School of Public Health, University of Colorado Anschutz, Medical Campus, Aurora, Colorado, USA
| | - J Albino
- Center for Native Oral Health Research, University of Colorado Anschutz, Medical Campus, Aurora, Colorado
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Abstract
Immigrant populations are growing at a fast pace in the United States. Cultural variations can have implications on oral health of children from immigrant households. Length of stay in the United States and language spoken at home, proxies for measuring acculturation, are some of the crucial factors determining the level of acculturation in families. Higher acculturation generally has a positive impact on oral health utilization. Improving cultural competency of dental teams and involving the stakeholders in intervention design and implementation are some strategies that may increase the trust of ethnic minority patients and reduce barriers to access to care.
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Affiliation(s)
- Tamanna Tiwari
- Department of Applied Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical Campus, 13065 East 17th Avenue, Room 104T, Aurora, CO 80045, USA.
| | - Judith Albino
- Center for Native Oral Health Research, Colorado, Colorado School of Public Health University of Colorado Anschutz Medical Campus, Building 500, 3rd Floor, Suite 3000, Aurora, CO 80045, USA
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Seligman LD, Hovey JD, Chacon K, Ollendick TH. Dental anxiety: An understudied problem in youth. Clin Psychol Rev 2017; 55:25-40. [PMID: 28478271 DOI: 10.1016/j.cpr.2017.04.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 04/10/2017] [Accepted: 04/14/2017] [Indexed: 12/16/2022]
Abstract
Dental anxiety and dental phobia typically emerge during childhood; the associated avoidance of dental care can result in oral health problems and is associated with lower quality of life. In this review, we discuss the definition of dental phobia and dental anxiety and issues related to their differentiation. We then review the literature on dental anxiety and dental phobia, including its prevalence, assessment, and sequalae. Moreover, we provide a synthesis of findings on the etiology and maintenance of dental phobia and propose a comprehensive cognitive behavioral model to guide further study. We also present a systematic qualitative and a quantitative review of the treatment literature, concluding that although we have made strides in learning how to prevent dental anxiety in youth, the methods effective in preventing anxiety may not be equally effective in treating youth with dental phobia. We propose a multidisciplinary approach, including those with expertise in pediatric anxiety as well as pediatric dentistry, is likely required to move forward.
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Affiliation(s)
- Laura D Seligman
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, TX 78539, USA.
| | - Joseph D Hovey
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, TX 78539, USA
| | - Karina Chacon
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, TX 78539, USA
| | - Thomas H Ollendick
- Child Study Center, Department of Psychology, Virginia Tech, Blacksburg, VA 24060, USA
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Merritt JM, Greenlee G, Bollen AM, Scott JM, Chi DL. Racial disparities in orthodontic service use for Medicaid-enrolled children: An evaluation of the Washington Medicaid program. Am J Orthod Dentofacial Orthop 2016; 149:516-22. [PMID: 27021456 DOI: 10.1016/j.ajodo.2015.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We assessed the relationship between race and orthodontic service use for Medicaid-enrolled children. METHODS This cross-sectional study focused on 570,364 Medicaid-enrolled children in Washington state, ages 6 to 19 years. The main predictor variable was self-reported race (white vs nonwhite). The outcome variable was orthodontic service use, defined as children who were preauthorized for orthodontic treatment by Medicaid in 2012 and subsequently received orthodontic records and initiated treatment. Logistic regression models were used to test the hypothesis that nonwhites are less likely to use orthodontic care than are whites. RESULTS A total of 8223 children were approved by Medicaid for orthodontic treatment, and 7313 received records and began treatment. Nonwhites were significantly more likely to use orthodontic care than were whites (odds ratio [OR] = 1.18; 95% confidence interval [CI] = 1.02, 1.36; P = 0.031). Hispanic nonwhite children were more likely to use orthodontic care than were non-Hispanic white children (OR = 1.42; 95% CI = 1.18, 1.70; P <0.001). CONCLUSIONS In 2012, nonwhite children in the Washington Medicaid program were significantly more likely to use orthodontic care than were white children. The Washington Medicaid program demonstrates a potential model for addressing racial disparities in orthodontic service use. Future research should identify mechanisms underlying these findings and continue to monitor orthodontic service use for minority children in Medicaid.
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Affiliation(s)
- Jantraveus M Merritt
- Resident, Graduate Program in Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
| | - Geoffrey Greenlee
- Clinical associate professor, Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
| | - Anne Marie Bollen
- Professor, Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
| | - JoAnna M Scott
- Acting assistant professor, Department of Pediatric Dentistry, School of Dentistry, University of Washington, Seattle, Wash
| | - Donald L Chi
- Associate professor, Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Wash.
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Yun K, Chesnokova A, Shults J, Pinto A, Rubin DM. Use of preventive dental care among medicaid-enrolled, school-aged US children in immigrant and nonimmigrant families: trends in Pennsylvania From 2005 through 2010. Am J Public Health 2014; 104:2400-8. [PMID: 25322290 PMCID: PMC4232125 DOI: 10.2105/ajph.2014.302157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We describe trends in receipt of preventive dental care among Medicaid-enrolled children in Pennsylvania between 2005 and 2010, comparing the US children of immigrants with their co-ethnic peers in nonimmigrant families. METHODS We analyzed Pennsylvania Medicaid claims, birth records, and census data for children born in Pennsylvania and enrolled in Medicaid for 10 or more months during any of the calendar years assessed. RESULTS Receipt of preventive dental care was more likely among Latino children in immigrant families than among their peers in nonimmigrant families; also, it was more likely among White children in immigrant families than among their peers in nonimmigrant families. Rates of preventive dental care use among African American and Asian children in immigrant and nonimmigrant families were comparable. From 2005 to 2010, the percentage of Latino children in nonimmigrant families who received preventive dental care increased from 33% to 61%. Changes in other groups were significant but less dramatic. CONCLUSIONS Receipt of preventive dental care has increased among Medicaid-enrolled children in Pennsylvania, with marked gains among Latino children. Within each racial/ethnic group, the children of immigrants were either more likely than or equally likely as children in nonimmigrant families to receive care.
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Affiliation(s)
- Katherine Yun
- Katherine Yun, Arina Chesnokova, and David M. Rubin are with the Division of General Pediatrics, PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA. Justine Shults is with the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia. Andres Pinto is with the Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH
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17
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Maupome G, Aguirre-Zero O, Westerhold C. Qualitative description of dental hygiene practices within oral health and dental care perspectives of Mexican-American adults and teenagers. J Public Health Dent 2014; 75:93-100. [PMID: 25329495 DOI: 10.1111/jphd.12076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 08/30/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of this study were to identify dental hygiene themes voiced by adults and teenagers of Mexican origin [or Mexican Americans (MAs)] and place these themes within the larger landscape of oral health and dental care perceptions. METHODS Interviews with urban-based MAs were analyzed to identify barriers, beliefs, and behaviors influencing engagement in dental hygiene practices. RESULTS Adult (n = 16, ages 33-52) and teenage (n = 17, ages 14-19) MAs reported themes pertaining to structural factors (financial and economic-related barriers, the dual challenges of reduced access to care vis-à-vis successfully navigating the dental care system, and the effects of reduced social support derived from migration) and to individual factors (different agendas between MAs and health systems for dental care utilization and indications for oral self-care, including limited dental hygiene instruction from professionals and larger impacts from school-based and mass media). Also, prior experiences with dental hygiene, prevention, and associated themes were characterized by a range of attitudes from fatalistic to highly determined agency. Good family upbringing was instrumental for appropriate dental hygiene, anteceding good oral health; and outlining a loose structure of factors affecting oral health such as diet, having "weak" teeth, or personal habits. CONCLUSIONS Themes from adults and teenagers in the Midwest United States were generally similar to other groups of MA parents and younger children. Dental hygiene was not salient relative to other oral health and dental care matters. Several opportunities for improvement of knowledge and enhancing motivation for dental hygiene practices were identified, both within and outside professional resources.
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Affiliation(s)
- Gerardo Maupome
- Preventive and Community Dentistry, Indiana University School of Dentistry, Indianapolis, IN, USA
| | | | - Chi Westerhold
- Preventive and Community Dentistry, Indiana University School of Dentistry, Indianapolis, IN, USA
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18
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Chi DL, Ko A, Kim JY. Bilingual flipcharts help improve oral health-related knowledge and self-efficacy of Korean-American caregivers of preschoolers. J Public Health Dent 2014; 74:261-5. [PMID: 25219757 DOI: 10.1111/jphd.12073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We have limited knowledge on ways to improve oral health-related behaviors for caregivers of minority preschoolers. Our objective was to evaluate the effectiveness of a bilingual educational flipchart. METHODS We piloted a bilingual flipchart with Korean-American caregivers of preschoolers (n=219) and administered pre-/post-intervention surveys. The paired t-test evaluated changes in knowledge and self-efficacy (for all caregivers and stratified by acculturation). RESULTS There were significant improvements in knowledge on the bacterial etiology of tooth decay (P=0.02), mother-to-child transmission of tooth decay (P=0.03), fluoride toothpaste safety (P<0.0001), and dental visit frequency (P<0.0001). Caregivers' self-efficacy to keep their child's teeth healthy also improved (P<0.0001). There were differences in knowledge measures based on caregivers' acculturation. CONCLUSIONS Bilingual educational materials help improve the oral health-related knowledge and self-efficacy of Korean-American caregivers of preschoolers. Larger confirmatory studies are needed and future work should evaluate clinical outcomes associated with improved knowledge and self-efficacy.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
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Lin Y, Yen Y, Chang C, Ting C, Chen P, Chen C, Peng W, Chen F, Hu C, Huang H. Oral Health Disparities of Children among Southeast Asian Immigrant Women in Arranged Transnational Marriages in Taiwan. Caries Res 2014; 48:575-83. [DOI: 10.1159/000351680] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/25/2013] [Indexed: 11/19/2022] Open
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Abstract
Early childhood caries (ECC), common in preschoolers, can lead to pain and infection if left untreated. Yet, ECC is largely preventable, and if it is identified early and the responsible risk factors are addressed, its progression can be halted or slowed. This article reviews the rationale for a first dental visit by age 1 year, caries risk assessment, and risk-based prevention and management of ECC and discusses strategies for providers to implement these contemporary evidence-based concepts into clinical practice.
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Affiliation(s)
- Man Wai Ng
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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