Gender-stratified models to examine the relationship between financial hardship and self-reported oral health for older US men and women

Food insecurity and its relationship to mental health and oral health in older adults

BACKGROUND AND OBJECTIVES

Poor oral health disproportionately affects low-income older adults, for whom food insecurity and poor mental health may affect dental health. We explored the associations between food insecurity, mental health, and dental health. Furthermore, we examined whether mental health impacted the associations between food insecurity and dental health.

MATERIALS AND METHODS

We conducted a cross-sectional study with a convenience sample of 226 older adults (aged 50+), employing survey and dental screening data. Participants were recruited from seven community-based organisations in Washington State, USA. We calculated descriptive statistics and conducted Chi-square tests, t tests, and logistic regression analyses to assess the associations between aspects of dental health (untreated decay, gum disease, and unmet dental needs), mental health (depression and cognitive function), and food insecurity.

RESULTS

In our sample, food insecurity was observed in 28.4%, 40.6% had untreated decay, 31.6% gum disease, and 42.5% unmet dental needs. Food insecurity was associated with a higher occurrence of untreated decay and unmet dental needs. Participants experiencing food insecurity had higher odds of gum disease (aOR = 2.3; 95% CI: 1.1, 5.2) and unmet dental needs (aOR = 3.2; 95% CI:1.4, 7.6). Greater gum disease due to food insecurity was observed among individuals with lower levels of cognitive impairment.

CONCLUSION

Food insecurity is associated with poorer oral health among older adults and cognitive function may modify this relationship. These findings underscore the importance of addressing both food insecurity and cognitive impairment as integral components of efforts to improve the oral health of older adults.

Financial strain measures and associations with adult health: A systematic literature review

Despite growing attention to other social needs like food and housing insecurity, financial strain, defined as having difficulty making ends meet or lacking money for basic needs, is under-recognized. Inconsistent labels and measures have made the literature difficult to unify. We used many synonyms for financial strain to systematically identify 199 U.S. studies (316 papers) that used financial strain measures that were operationally consistent with our definition as predictors of health among adults. We thematically coded financial strain measures for content and synthesized evidence based on measure and methods. Financial strain was measured by self-reported lacking money for basic needs (119 studies) and/or difficulty making ends meet (n = 132), and less commonly additionally based on coping strategies (n = 23), satisfaction with finances (n = 14), worry about finances (n = 22), the anticipation of strain (n = 14), and/or lacking money for leisure (n = 29). Regardless of measure, financial strain was associated with poorer mental, physical, biological, and functional health, worse health behaviors and more social needs. Associations were found across diverse and population-based samples and when accounting for other socioeconomic factors and even intermediating health factors. Results demonstrate predictive validity for two different one-item screening tools. Furthermore, the vast evidence linking financial strain to health highlights an urgent need for policy action addressing financial strain to advance health equity.

Social determinants of health linked with oral health in a representative sample of U.S. adults

BACKGROUND

Oral diseases remain a significant public health problem worldwide, with growing gaps in oral health status among various socioeconomic groups. The objective of the current study is to analyze the impact of different social determinants of health (SDOH) on oral health outcomes (frequency of dental visits, self-reported oral health status, embarrassment because of oral health status, and tooth loss) among a representative sample of United States (U.S.) adults.

METHODS

Cross-sectional data for this observational study came from adults aged 18 and above (N = 5,320) participating in the nationally representative 2021 State of Oral Health Equity in America survey. Bivariate and multivariable analyses were conducted to examine the associations between oral health outcomes (dependent variables) and SDOH independent variables: structural (race/ethnicity, income, education); and intermediary (lack of transportation, food insecurity, racial discrimination, and housing instability), controlling for the confounding variables of age, gender, employment status, dental insurance, self-rated mental/emotional health, self-rated physical health, presence of one or more chronic conditions, and having had a routine physical examination in the past year.

RESULTS

When controlling for confounding variables, Black adults were less likely than White adults to have had a dental visit in the last year (odds ratio (OR) = 0.72 (95% confidence interval (CI) = 0.57-0.92, p < 0.05), more likely to report feeling self-conscious or embarrassed due to their oral health (OR = 1.67 (95% CI = 1.31-2.12, p < 0.05), and more likely to have at least one permanent tooth removed (OR = 1.67 (95% CI = 1.31-2.13, p < 0.05). Higher income and more education were significantly associated with greater odds of rating one's oral health positively and having had a dental visit in the past year and lesser odds of feeling self-conscious or having at least one tooth removed (p's < 0.05). All four intermediary determinants were associated with significant (p < 0.05) and negative odds of having a dental visit in the past year and reporting positive oral health, and with positive odds of having at least one permanent tooth removed. The odds of feeling self-conscious or embarrassed due to their oral health were significantly and positive associated with all intermediary determinants except for racial discrimination (OR = 1.21, 95% CI = 1.00-1.46).

CONCLUSIONS

Significant inequities still exist in the U.S. regarding SDOH and their relationship to oral health. Improving oral health will involve addressing SDOH. Successful policy and public health interventions must address not only structural factors but also intermediary SDOH.

Food insecurity and oral health in older adults

Introduction

Household food insecurity, defined as inconsistent access to sufficient food in a household, affects 1 in 15 individuals over the age of 60 years in the US. In these individuals it is associated with numerous chronic conditions, medication underuse leading to poorly controlled conditions such as diabetes and hypertension, and poor oral health. However, the relationship between food insecurity and oral health is understudied. We therefore evaluated the associations between food insecurity and aspects of oral health in older US adults.

Methods

We prospectively evaluated a subset of participants of the Health and Retirement Study (HRS) who responded to questions evaluating food insecurity in 2013 and a supplemental questionnaire regarding dental health and dental health services in 2018 (N = 472).

Results

Approximately 1 in 5 people in our study reported being food insecure in the last year. Food insecurity was correlated with poor oral health-related quality of life scores and more tooth loss. Individuals who were food insecure reported worse self-rated oral health (OR = 2.67), greater odds of losing 8 or more teeth (OR = 2.35), and lower odds of receiving oral care (OR = 0.60) compared to their food secure peers.

Conclusions

Though individuals experiencing food insecurity were likely to have more unmet oral health needs than their peers, they were less likely to seek dental care. To improve the oral health status of this group, in addition to making oral health care more accessible, it may also be necessary to address the social and environmental factors preventing these people from seeking oral health care.

The association between the supplemental nutrition assistance programme participation and dental caries among U.S. adults

INTRODUCTION

The Supplemental Nutrition Assistance Programme (SNAP) is a federal programme aimed to alleviate hunger and improve food insecurity. The impact of SNAP participation on overall health has been studied. However, little is known about the effects of SNAP participation on oral health. We aimed to investigate the association between participating in SNAP and dental caries and to explore the role of food insecurity as a moderator in this relationship.

METHODS

We obtained data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014.The primary outcome was untreated dental caries (none vs. one or more). Self-reported SNAP participation status in the past 12 months was the predictor, and food security was the moderator. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low and very low). Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship between SNAP and dental caries, and whether food insecurity moderates this relationship. Statistical analysis was carried out in September 2020.

RESULTS

Our results suggested that after adjusting for potential confounders, SNAP participants were more likely to have untreated dental caries than non-SNAP participants (odds ratio: 1.6; 95% CI: 1.2-2.0). Food security status did not alter the relationship between SNAP participation and untreated dental caries.

CONCLUSIONS

Food security status did not alter the relationship between SNAP participation and untreated dental caries. SNAP participation was associated with untreated dental caries among U.S. adults, and this was not affected by their food security status.

Understanding the association between unmet dental care needs and household food security status among older people in Ghana

The literature recognizes food insecurity as a barrier to access to health care services. However, we know very little about the association between food insecurity and unmet dental care needs among older people in Ghana. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana to examine whether older people who experienced household food insecurity differently report unmet dental care needs in comparison to their counterparts without any food insecurity. We find that 40% of older adults reported unmet dental care needs. Results from logistic regression analysis show that older people who experienced severe household food insecurity were more likely to report unmet dental care needs, compared to those who did not experience any type of food insecurity, even after accounting for theoretically relevant variables (OR = 1.94, p < 0.05). Based on these findings, we discuss several implications for policymakers and directions for future research.

Edentulous disparities among geriatric population according to the sexual difference in South Korea: a nationwide population-based study

The proportion aged 60 years or older in the world's population is expected to double by 2050. In general, they have many complex diseases and poor oral health status. Oral health is one of the important health indicators of elderly people and it is affected by diverse factors, such as socioeconomic status. In this study, sexual difference was considered as an associated factor that is closely related to edentulism. The sexual difference might be more influential within the geriatric population because of lower economic and educational backgrounds at this stage. Edentulism was significantly higher among elderly females than males when combined with the education level. The lower the level of education, the higher the prevalence of edentulism as much as 24 ~ 28 times, especially in females (P = 0.002). These findings suggest a more complex relationship between oral health, socioeconomic status, and sexual difference.

Understanding the Link between Household Food Insecurity and Self-Rated Oral Health in Ghana

There is increasing scholarly attention on the role of food insecurity on the health of older adults in sub-Saharan Africa, including Ghana. Yet, we know very little about the association between food insecurity and self-rated oral health. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana to examine whether respondents who experienced household food insecurity rated their oral health as poor compared to their counterparts who did not. We found that 34% of respondents rated their oral health as poor, while 7%, 21%, and 36% experienced mild, moderate, and severe food insecurity, respectively. Moreover, the results from the logistic regression analysis showed that older adults who experienced mild (OR = 1.66, p < 0.05), moderate (OR = 2.06, p < 0.01), and severe (OR = 2.71, p < 0.01) food insecurity were more likely to self-rate their oral health as poor, compared to those who did not experience any type of food insecurity. Based on these findings, we discuss several implications for policymakers and directions for future research.

Modeling the impact of financial hardship and age on self-rated health and depressive symptoms pre/post the great recession

Stressful life events such as a recession, could be devastating on a macro and micro level. Although there have been a number of articles written examining the health effects of the recession, little is known about age differences in the relationship between financial stressors and health pre and post the 2008 recession. Using the Health and Retirement study, we investigated the relationship between two forms of financial hardships, mental and physical health among middle aged (N = 4403) and older adults) (N = 2709). Our findings indicate that with regard to financial hardships experienced pre/post recessionary periods there are differences by age. Specifically, older adults tend to report having less financial hardship than their younger counterparts. Additionally, reduced medication use due to costs was a significant predictor of poor self-rated health among middle aged participants compared to older adults. These results highlight the selective impact of recessions on certain age groups. They also suggests that economic recessions may also produce short-term procyclical health effects. Future research should focus on the relationship between other sources of financial hardship among middle-aged and older adults pre/post-recession at shorter time intervals.

Food insecurity and oral health care experiences during pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System

BACKGROUND

Food insecurity has emerged as a salient risk factor for poor oral health in adult populations. A separate area of research also details that both poor oral health and food insecurity during pregnancy can have adverse consequences for maternal and infant well-being. The authors examine the connection between food insecurity and women's oral health care experiences during pregnancy.

METHODS

Data from 2016 through 2019 came from the Pregnancy Risk Assessment Monitoring System (N = 21,080). Multivariable logistic regression analyses were used to assess the association between food insecurity and 6 indicators of oral health care experiences during pregnancy.

RESULTS

Food-insecure women reported worse oral health care experiences during pregnancy, including being more likely to need to see a dentist for a problem, going to see a dentist for a problem, not receiving dental prophylaxis, not talking with an oral health care provider about dental health, not knowing it was important to care for teeth, and having unmet oral health care needs.

CONCLUSIONS

Food-insecure women exhibit worse overall oral health outcomes and unmet oral health care needs during pregnancy.

PRACTICAL IMPLICATIONS

Considering the risk that both food insecurity and oral health problems pose for maternal and infant health, interventions that can reduce food insecurity and improve oral health and oral health care access among pregnant women are important steps in promoting greater health equity.

Socio-Economic Determinants of Dental Service Expenditure: Findings from a French National Survey

(1) Background: This study investigated how individual enabling resources influence (i) their probability of using dental services and (ii) consumers’ expenditure on dental treatment. (2) Methods: Data were derived from a self-administered national health survey questionnaire and from expenditure data from national health insurance. Multiple linear regression methods were used to analyze entry into the dental health system (yes/no) and, independently, the individual expenditure of dental care users. (3) Results: People with the highest incomes were more likely to use dental service (aOR = 1.59; 95% CI = 1.28, 1.97), as were those with complementary health insurance and the lowest deprivation scores. For people using dental services, good dental health status was associated with less expenditure (−70.81 EUR; 95% CI = −116.53, −25.08). For dental service users, the highest deprivation score was associated with EUR +43.61 dental expenditure (95% CI = −0.15; 87.39). (4) Conclusion: Socioeconomic determinants that were especially important for entry into the dental health service system were relatively insignificant for ongoing service utilization. These results are consistent with our hypothesis of a dental care utilization process in two steps. Public policies in countries with private fees for dentistry should improve the clarity of dental fees and insurance payments.

The association between food insecurity and dental caries among U.S. adults: Data from the National Health and Nutrition Examination survey

OBJECTIVES

The purpose of this study was to examine the association between food insecurity and untreated dental caries using a nationally representative sample of US adults.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014 on adults aged 18 years and older were analysed (n = 10 723). Primary predictors were overall food security (food-secure/ food-insecure) and household food security (full, marginal, low and very low). The main outcome was any untreated dental caries (none/ ≥ one). Multiple logistic regression analyses were done to estimate the adjusted odds ratio after controlling for confounders.

RESULTS

Food-insecure adults were more likely to have untreated dental caries than food-secure adults after adjusting for potential confounders (OR: 1.2; 95% CI: 0.9-1.5). Adults from households with marginal (OR:1.4; 95% CI:1.5-2.2), low (OR:1.3, 95% CI:1.3-2.0) and very low food security (OR:1.3; 95% CI:0.9-1.5) had higher odds of untreated caries than adults from households with full food security. Following age stratification, marginal, low and very low food-secure adults had higher prevalence of untreated dental caries than full food-secure adults across all age groups.

CONCLUSIONS

Our findings suggest that food-insecure adults had higher odds of untreated dental caries than food-secure adults. These findings highlight the importance of assessing food insecurity as a risk factor for dental caries. Longitudinal cohort studies are recommended to determine causal mechanisms.

High financial hardship and mental health burden among gay, bisexual and other men who have sex with men

Prior research has documented the ways in which financial hardships negatively impact health, particularly mental health. However, this association between financial hardships and mental health outcomes has rarely been examined in sexual minorities. The purpose of this study was to examine associations between financial hardships and mental health burdens among a sample of gay, bisexual and other men who have sex with men (MSM) in Paris, France. Participants (n = 580) completed a cross-sectional survey advertised on a geosocial networking application. Participants responded to measures of mental health, financial hardship, and socio-demographics. Modified Poisson models were used to estimate risk ratios (RRs) and 95% confidence intervals (CI) for the associations between financial hardship and the following outcomes: 1) depressive symptoms, 2) anxiety symptoms, and 3) psychological distress. After adjusting for socio-demographics, high financial hardships were associated with depressive symptoms (aRR: 1.48, 95% CI: 1.04, 2.11) and psychological distress (aRR: 1.56, 95% CI: 1.09, 2.23). Analyses also demonstrated that stress acts as a mediating variable. These preliminary results suggest that future interventions to reduce financial hardships may have positive effects on the mental health of such a population.

Household food insecurity, dental caries and oral-health-related quality of life in Brazilian Indigenous adults

Food insecurity is a complex phenomenon that affects the health and wellbeing of vulnerable families. The aim of this study was to investigate the relationship between household food insecurity, dental caries, oral health-related quality of life, and social determinants of health among Indigenous adults. A cross-sectional study was conducted among Kaingang adults aged 35-44 years old from the Guarita Indigenous Land, Brazil. Food insecurity was assessed through the EBIA scale. Dental caries was assessed using the DMFT index. Participants answered the OHIP-14 questionnaire and a structured interview. Descriptive and multivariate analyzes using Poisson regression models were performed. The final sample included 107 adults from 97 households. Approximately 95% lived in food insecure families. Severe food insecurity was present in 58% of the households. The phenomenon was associated to the Bolsa Família benefit, household size, and greater perception of oral health impacts on quality of life. The high number of families affected by food insecurity reveals the social vulnerability of the Kaingang people. Food insecurity in Kaingangs adults is associated to oral health perception and social determinants of health.

The association between hardship and self-rated health: does the choice of indicator matter?

PURPOSE

The purpose of this study was to investigate the association between four specific forms of hardship (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) and self-rated health among older men and women.

METHODS

Cross-sectional logistic regression analysis was conducted using the 2010 wave of the Health and Retirement Study Leave-Behind Questionnaire (N = 7619) to determine the association between four hardship indicators and self-rated health. Hardship indicators (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) were dichotomized (0 = no hardship, 1 = yes hardship) for this analysis.

RESULTS

After adjusting for sociodemographic factors, participants reporting difficulty paying bills had an 1.8 higher odds of reporting poor self-rated health (95% confidence intervals [CI]: 1.57, 2.15) and those reporting taking less medication due to cost had a 2.5 times higher odds of poor self-rated health (95% CI: 1.97, 3.09) compared to those not reporting these hardships. When stratified by gender, and adjusting for sociodemographic factors, men who took less medication due to cost had a 1.93 higher odds of low self-rated health (95% CI: 1.39, 2.67) and women who took less medications due to cost had a 2.9 higher odds of reporting poor self-rated health (95% CI: 2.23, 2.70) compared to women not reporting these hardships.

CONCLUSIONS

Research in this area can provide greater conceptual and measurement clarity on the hardship experience and further elucidate the pathway between specific hardships and poor health outcomes to inform intervention development.

Financial Hardship, Condomless Anal Intercourse and HIV Risk Among Men Who Have Sex with Men

The objective of this study was to examine the association between financial hardship, condomless anal intercourse and HIV risk among a sample of men who have sex with men (MSM). Users of a popular geosocial networking application in Paris were shown an advertisement with text encouraging them to complete a anonymous web-based survey (n = 580). In adjusted multivariate models, high financial hardship (compared to low financial hardship) was associated with engagement in condomless anal intercourse (aRR 1.28; 95% CI 1.08-1.52), engagement in condomless receptive anal intercourse (aRR 1.34; 95% CI 1.07-1.67), engagement in condomless insertive anal intercourse (aRR 1.30; 95% CI 1.01-1.67), engagement in transactional sex (aRR 2.36; 95% CI 1.47-3.79) and infection with non-HIV STIs (aRR 1.50; 95% CI 1.07-2.10). This study suggests that interventions to reduce financial hardships (e.g., income-based strategies to ensure meeting of basic necessities) could decrease sexual risk behaviors in MSM.

Association of financial hardship with poor sleep health outcomes among men who have sex with men

Previous studies have identified an association between socioeconomic status and sleep health. While some research has studied this association among sexual minority groups, including men who have sex with men (MSM), they exclusively focused on US-based populations. The interplay between the two in shaping sleep health has not been previously examined on populations residing outside the US. This study considers both determinants, by investigating whether financial hardship is associated with sleep health among a sample of MSM in Paris, France. Broadcast advertisements were placed on a popular geosocial-networking smartphone application for MSM to direct users in Paris to a web-based survey measuring financial hardship and five dimensions of sleep health as well as socio-demographic characteristics. Modified Poisson models with robust error variance were computed to estimate risk ratios (RRs) and 95% confidence intervals (CI) for the associations between financial hardship and the following self-reported outcomes: 1) poor sleep quality, 2) short sleep duration; and 3) sleep problems. In total, 580 respondents completed the survey. In this sample, both financial hardship and poor sleep health were common - 45.5% reported that it was extremely, very, or somewhat difficult for them to meet their monthly payments on bills (referred to as "high financial hardship") and 30.1% rated their sleep as fairly bad or very bad (referred to as "poor sleep quality"). Multivariate models revealed that, compared to participants who reported low financial hardship, those who reported high financial hardship were more likely to report poor sleep quality (aRR: 1.35, 95% CI: 1.04, 1.77), to report problems falling asleep (aRR: 1.23, 95% CI: 1.02, 1.49), and to report problems staying awake in the daytime (aRR: 3.12, 95% CI: 1.83, 5.31). Future research should investigate whether this relationship is causal and determine whether interventions to reduce financial hardships could promote sleep health among MSM.

The deterioration of Canadian immigrants' oral health: analysis of the Longitudinal Survey of Immigrants to Canada

OBJECTIVE

To examine the effect of immigration on the self-reported oral health of immigrants to Canada over a 4-year period.

METHODS

The study used Statistics Canada's Longitudinal Survey of Immigrants to Canada (LSIC 2001-2005). The target population comprised 3976 non-refugee immigrants to Canada. The dependent variable was self-reported dental problems. The independent variables were as follows: age, sex, ethnicity, income, education, perceived discrimination, history of social assistance, social support, and official language proficiency. A generalized estimation equation approach was used to assess the association between dependent and independent variables.

RESULTS

After 2 years, the proportion of immigrants reporting dental problems more than tripled (32.6%) and remained approximately the same at 4 years after immigrating (33.3%). Over time, immigrants were more likely to report dental problems (OR = 2.77; 95% CI 2.55-3.02). An increase in self-reported dental problems over time was associated with sex, history of social assistance, total household income, and self-perceived discrimination.

CONCLUSION

An increased likelihood of reporting dental problems occurred over time. Immigrants should arguably constitute an important focus of public policy and programmes aimed at improving their oral health and access to dental care in Canada.

Visits to physicians for oral health-related complaints in Ontario, Canada

OBJECTIVE

Canada's national system of health insurance facilitates equitable access to health care; however, since dental care is generally privately financed and delivered, access to oral health care remains uneven and inequitable. To avoid the upfront costs, many argue that socially marginalized groups should seek oral health care from medical providers. This study therefore explored the rates and numbers of visits to physicians for oral health-related diagnoses in Ontario, Canada's most populated province.

METHODS

A retrospective secondary data analysis of health system utilization in Ontario was conducted for visits to physicians for oral health-related diagnoses. Data for all Ontario Health Insurance Plan (OHIP) approved billing claims were accessed over 11 fiscal years (2001-2011). Age- and sex-adjusted rates were calculated.

RESULTS

Approximately 208,375 visits per year, with an average of 1,298/100,000 persons, were made to physicians for oral health-related diagnoses. Women, irrespective of the year, made more visits, and there was an increasing trend in visits made by elderly people.

CONCLUSION

The number of people visiting physicians for oral health reasons is arguably high. The public health system is being billed for services for oral health issues that the provider is not appropriately trained to treat. Provision of timely and accessible oral health care for socially marginalized populations needs to be prioritized in health care policy.

Nursing identity and patient-centredness in scholarly health services research: a computational text analysis of PubMed abstracts 1986-2013

BACKGROUND

The most important and contested element of nursing identity may be the patient-centredness of nursing, though this concept is not well-treated in the nursing identity literature. More conceptually-based mapping of nursing identity constructs are needed to help nurses shape their identity. The field of computational text analytics offers new opportunities to scrutinise how growing disciplines such as health services research construct nursing identity. This paper maps the conceptual content of scholarly health services research in PubMed as it relates to the patient-centeredness of nursing.

METHODS

Computational text analytics software was used to analyse all health services abstracts in the database PubMed since 1986. Abstracts were treated as indicative of the content of health services research. The database PubMed was searched for all research papers using the term "service" or "services" in the abstract or keywords for the period 01/01/1986 to 30/06/2013. A total of 234,926 abstracts were obtained. Leximancer software was used in 1) mapping of 4,144,458 instances of 107 concepts; 2) analysis of 106 paired concept co-occurrences for the nursing concept; and 3) sentiment analysis of the nursing concept versus patient, family and community concepts, and clinical concepts.

RESULTS

Nursing is constructed within quality assurance or service implementation or workforce development concepts. It is relatively disconnected from patient, family or community care concepts.

CONCLUSIONS

For those who agree that patient-centredness should be a part of nursing identity in practice, this study suggests that there is a need for development of health services research into both the nature of the caring construct in nursing identity and its expression in practice. More fundamentally, the study raises questions about whether health services research cultures even value the politically popular idea of nurses as patient-centred caregivers and whether they should.

Health literacy: a pathway to better oral health

OBJECTIVES

We examined whether health literacy was associated with self-rated oral health status and whether the relationship was mediated by patient-dentist communication and dental care patterns.

METHODS

We tested a path model with data collected from 2 waves of telephone surveys (baseline, 2009-2010; follow-up, 2011) of individuals residing in 36 rural census tracts in northern Florida (final sample size n = 1799).

RESULTS

Higher levels of health literacy were associated with better self-rated oral health status (B = 0.091; P < .001). In addition, higher levels of health literacy were associated with better patient-dentist communication, which in turn corresponded with patterns of regular dental care and better self-rated oral health (B = 0.003; P = .01).

CONCLUSIONS

Our study showed that, beyond the often-reported effects of gender, race, education, financial status, and access to dental care, it is also important to consider the influence of health literacy and quality of patient-dentist communication on oral health status. Improved patient-dentist communication is needed as an initial step in improving the population's oral health.