1
|
McLean C, Slack-Smith L, Matic Girard I, Ward PR. A Qualitative Study of Naturally Living Parents and Child Oral Health: Omissions and Commissions. JDR Clin Trans Res 2024:23800844241266498. [PMID: 39267434 DOI: 10.1177/23800844241266498] [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: 09/17/2024] Open
Abstract
BACKGROUND Oral health continues to be one of the most common and costly diseases in early childhood, and there is a need for further, innovative research. PURPOSE We explored the ways naturally living parents (those who embody the "natural" within their parenting ideology and behavior) navigated and perceived their children's oral health. METHODS Twelve participants who identified as being "naturally living parents" participated in semistructured interviews. Data were thematically analyzed, and findings were aligned to an omissions and commissions framework to exhibit the complexity of parent decision-making. RESULTS Parents performed distinct omissions, including omitting fluoride, sugar, and "toxins" to maintain their children's oral health. Parents talked about having a commitment to knowledge building to protect their children's oral health (e.g., ingredient label reading and increasing knowledge of "safe" ingredients). Findings also provide insight into how parents consider and trust health information and health care providers and ways they gather information relating to oral health. CONCLUSIONS Analysis indicated that although parents navigated both omissions and commissions, omissions were more overtly present. Compared to previous health research using this framework, omissions and commissions were not as clearly demarcated in relation to oral health. The results show that oral health is a complex interplay of omissions and commissions, and parents must navigate not only discrete elements that affect the oral health of their children but also how these are influenced by considerations including social well-being. KNOWLEDGE TRANSFER STATEMENT The study highlights the need for dentists and early childhood health professionals to consider the complex way some parents perceive, inform, and rationalize decisions regarding their children's oral health. There is a need for nuance when considering children's oral health and naturally living parenting, especially in relation to effectively communicating health information that fosters trust and is considerate of broader lifestyle and health factors.
Collapse
Affiliation(s)
- C McLean
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| | - L Slack-Smith
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
- Equity and Oral Health Group, School of Population and Global Health, Population and Public Health, The University of Western Australia, Perth, WA, Australia
| | - I Matic Girard
- Equity and Oral Health Group, School of Population and Global Health, Population and Public Health, The University of Western Australia, Perth, WA, Australia
| | - P R Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| |
Collapse
|
2
|
Almatkyzy G, Thomsen K, Orack JC, Soper JK, Chi DL. Examining the association between untreated caries in children and parent fluoride treatment refusal. J Am Dent Assoc 2024; 155:774-780. [PMID: 39023483 DOI: 10.1016/j.adaj.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND In this case-control study, the authors examined the relationship between untreated caries in children and parent fluoride treatment refusal. The authors hypothesized that parents of children with a history of untreated caries would be less likely to refuse topical fluoride for their children than parents of children with no history of untreated caries. METHODS The study included children (≤ 18 years old) who were patients at a university dental clinic from January 2016 through June 2020. Children whose parents refused fluoride treatment were age-matched with children whose parents did not refuse fluoride treatment (n = 356). The outcome variable was parent topical fluoride refusal for their children (no, yes). The predictor variable was a history of untreated caries (no, yes). Confounding variable-adjusted modified Poisson regression models were used to estimate the prevalence ratio of parent fluoride refusal by means of children's untreated caries status. RESULTS Approximately 46.3% of children had a history of untreated caries. The prevalence of parent fluoride refusal for children with a history of untreated caries was significantly lower than that for children with no history of untreated caries (adjusted prevalence ratio, 0.79; 95% CI, 0.64 to 0.98; P = .03). CONCLUSIONS Parents of children with a history of caries are less likely to refuse topical fluoride treatment, which suggests that untreated caries may motivate parents to accept preventive dental treatments like fluoride. PRACTICAL IMPLICATIONS Dental care professionals should assess caries risk and communicate a child's caries risk before making a recommendation regarding topical fluoride treatment.
Collapse
|
3
|
Bass T, Hill CM, Cully JL, Li SR, Chi DL. A cross-sectional study of physicians on fluoride-related beliefs and practices, and experiences with fluoride-hesitant caregivers. PLoS One 2024; 19:e0307085. [PMID: 39028748 PMCID: PMC11259263 DOI: 10.1371/journal.pone.0307085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/29/2024] [Indexed: 07/21/2024] Open
Abstract
The goal of this study was to describe medical providers' fluoride-related beliefs and practices, experiences with fluoride-hesitant caregivers, and barriers to incorporating oral health activities into their practice. In this cross-sectional study, we specifically tested the hypothesis of whether these factors differed between pediatric and family medicine providers. A 39-item online survey was administered to a convenience sample of pediatric and family medicine providers in Washington state and Ohio (U.S.A.). Responses to the fluoride survey were compared between pediatric and family medicine providers with a chi-square test (α = 0.05). Of the 354 study participants, 45% were pediatric providers and 55% were family medicine providers. About 61.9% of providers believed fluoridated water was highly effective at preventing tooth decay while only 29.1% believed prescription fluoride supplements were highly effective. Nearly all providers recommend over-the-counter fluoride toothpaste (87.3%), 44.1% apply topical fluoride in clinic, and 30.8% prescribe fluoride supplements. Most providers reported fluoride hesitancy was a small problem or not a problem (82.5%) and the most common concerns patients raise about fluoride were similar to those raised about vaccines. Lack of time was the most commonly reported barrier to incorporating oral health into practice, which was more commonly reported by family medicine providers than pediatric providers (65.6% vs. 50.3%; p = .005). Pediatric and family medicine providers have early and frequent access to children before children visit a dentist. Improving the use of fluorides through children's medical visits could improve pediatric oral health and reduce oral health inequities, especially for vulnerable populations at increased risk for tooth decay.
Collapse
Affiliation(s)
- Tiffany Bass
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
| | - Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| | - Jennifer L. Cully
- Division of Oral Health, Children’s National Hospital, Washington, DC, United States of America
- Department of Pediatrics, George Washington University, Washington, DC, United States of America
| | - Sophie R. Li
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| | - Donald L. Chi
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
4
|
Cruz S, Ko A, Chi D. A Qualitative Study on Dentists' Communication Approaches in Managing Fluoride-Hesitant Caregivers. JDR Clin Trans Res 2024; 9:212-220. [PMID: 37908047 PMCID: PMC11318380 DOI: 10.1177/23800844231203673] [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] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES Guidelines on effective provider-led communication are available but may be underused in dentistry, even if such guidelines could help dentists manage complex clinical scenarios like topical fluoride hesitancy. The purpose of this study was to investigate current chairside communication approaches used by dentists with fluoride-hesitant caregivers. METHODS A 27-item semistructured interview script was developed and pretested with 3 dentists, revised, and finalized. One-on-one interviews were conducted with a purposive sample of pediatric dentists and general dentists from April to June 2020. Interviews were digitally recorded, transcribed, and analyzed to identify dentists' communication approaches used during clinical interactions with fluoride-hesitant caregivers. Thematic analyses identified themes and subthemes, and exemplary quotes were provided to illustrate each theme. RESULTS Twenty-seven dentists participated (21 pediatric dentists and 6 general dentists). The mean age of participants was 43.0 ± 8.2 y (range, 30-73). Most participants were women (88.9%), white (51.9%), and non-Hispanic (85.2%). Participants had been practicing dentistry for a mean of 13.2 ± 10.5 y (range, 2-40). There were 4 themes: leaving topical fluoride decisions completely up to the caregiver, educating the caregiver about fluoride, insisting that the caregiver accept fluoride, and engaging the caregiver and child. CONCLUSION Most communications approaches used by interviewed dentists to manage fluoride hesitancy in clinical settings are not evidence based. Future dental education efforts should ensure that trainees are exposed to and can demonstrate competency in appropriate, evidence-based patient-provider communication strategies. KNOWLEDGE TRANSFER STATEMENT The study highlights the need for dentists to apply evidence-based communication strategies when managing difficult clinical scenarios like fluoride hesitancy, which is important in optimizing dentist-patient trust.
Collapse
Affiliation(s)
- S. Cruz
- Department of Oral Health Sciences at the University of Washington, Seattle, WA, USA
| | - A. Ko
- Department of Oral Health Sciences at the University of Washington, Seattle, WA, USA
| | - D.L. Chi
- Department of Oral Health Sciences at the University of Washington, Seattle, WA, USA
| |
Collapse
|
5
|
Carle AC, Pallotto I, Edwards TC, Carpiano R, Kerr DC, Chi DL. Psychometric properties of the Fluoride Hesitancy Identification Tool (FHIT). PLoS One 2024; 19:e0297188. [PMID: 38232098 PMCID: PMC10793896 DOI: 10.1371/journal.pone.0297188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Some caregivers are hesitant about topical fluoride for their children despite evidence that fluoride prevents caries and is safe. Recent work described a five domain model of caregivers' topical fluoride hesitancy. We developed the Fluoride Hesitancy Identification Tool (FHIT) item pool based on the model. This study sought to evaluate the FHIT's psychometric properties in an effort to generate a short, simple to score, reliable, and valid tool that measures caregivers' topical fluoride hesitancy. METHODS In 2021 and 2022, we conducted an observational, cross-sectional study of caregivers, collecting data from two independent caregiver samples (n1 = 523; n2 = 612). The FHIT item pool included 33 items. We used confirmatory factor analyses (CFA) to examine whether the FHIT items measured five separate domains as hypothesized and to reduce the number of items. We then fit item response theory (IRT) models and computed Cronbach's alpha for each domain. Last, we examined the construct validity of the FHIT and evaluated scoring approaches. RESULTS After dropping 8 items, CFA supported a five factor model of topical fluoride hesitancy, with no cross-loadings (RMSEA = 0.079; SRMR = 0.057; CFI = 0.98; TLI = 0.98). We further reduced the items to four per domain (20 items total). Marginal alphas showed that the item sets provided reliability of ≥0.90 at hesitancy levels at and above average. The domains correlated more strongly with each other and topical fluoride refusal than with other questions on the survey. DISCUSSION Our results support the FHIT's ability to reliably and validly measure five domains of topical fluoride hesitancy using the average score of the four items in each domain.
Collapse
Affiliation(s)
- Adam C. Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, United States of America
| | - Isabella Pallotto
- Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, United States of America
| | - Todd C. Edwards
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Richard Carpiano
- School of Public Policy, University of California, Riverside, Riverside, California, United States of America
| | - Darragh C. Kerr
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Donald L. Chi
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States of America
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| |
Collapse
|
6
|
Tayhan A, Çetinkaya A. Development and psychometric analysis: Fluoride varnish parent attitude, belief scale. Public Health Nurs 2024; 41:1-9. [PMID: 37655433 DOI: 10.1111/phn.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To develop a scale to determine parents' attitudes and beliefs regarding fluoride varnish. DESIGN AND METHODS This study had a cross-sectional design and was conducted between 2019 and 2021. A total of 810 parents were included in the study sample. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), discriminant validity, and convergent validity methods were used to estimate the scale validity. For reliability, the Cronbach alpha coefficient, item-total correlation coefficients, and test-retest method were used. RESULTS As a result of psychometric analysis, the scale was found to have a three-factor structure. The factor loads of the items were between 0.838 and 0.715. The three-factor construct showed a good fit in confirmatory factor analysis (X2 (41): 110.06, p <.001; RMSEA: 0.065; RMSR, 0.02; GFI, 0.95; and NFI, 0.94). Cronbach's α coefficient on the scale was 0.85. The item-total correlation of the scale was found to be between 0.355 and 0.626. The test-retest intra-class correlation coefficient of the scale was 0.72. CONCLUSIONS This study suggests that the developed scale is a reliable tool to evaluate the attitudes and beliefs of parents toward fluoride varnish. It is thought that the scale will make a contribution to public health.
Collapse
Affiliation(s)
- Ali Tayhan
- Department of Public Health Nursing, Faculty of Health Sciences, Manisa Celal Bayar University, Manisa, Turkey
| | - Aynur Çetinkaya
- Department of Public Health Nursing, Faculty of Health Sciences, Manisa Celal Bayar University, Manisa, Turkey
| |
Collapse
|
7
|
Koh M, Kerr D, Hill CM, Chi DL. A Mixed-Methods Study on Topical Fluoride Beliefs and Refusal Behaviors for Caregivers of Children with Special Health Care Needs. Matern Child Health J 2024; 28:104-115. [PMID: 37966559 PMCID: PMC10876822 DOI: 10.1007/s10995-023-03806-1] [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] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To understand topical fluoride-related beliefs and refusal behaviors for caregivers of children with special health care needs (CSHCN). METHODS This was an explanatory sequential mixed methods study. For the quantitative analyses, we surveyed 520 caregivers to (a) compare fluoride-related beliefs between caregivers of CSHCN and caregivers of healthy children and (b) evaluate the association between special health care need (SHCN) status and topical fluoride refusal. We used logistic regression models to generate unadjusted odds ratios, confounder-adjusted odds ratios (AOR), and 95% confidence intervals (CI). For the qualitative analyses, we interviewed 56 caregivers who refused or were hesitant about topical fluoride. Data were coded deductively and compared by SHCN status to an existing conceptual model of topical fluoride refusal. RESULTS In the quantitative analysis, 41.3% of caregivers refused or thought about refusing topical fluoride. There were no significant differences in fluoride beliefs by SHCN status (p-values > 0.05) nor was there a significant association between SHCN status and topical fluoride refusal (AOR: 0.65, 95% CI 0.37-1.14; p = 0.13). In the qualitative analysis, the relative importance of each domain of the conceptual model was similar between the caregiver groups. Two differences were that all caregivers of CSHCN thought fluoride was unnecessary and wanted to keep chemicals out of their child's body. CONCLUSIONS FOR PRACTICE While caregivers of CSHCN were not more likely to refuse topical fluoride than caregivers of healthy children, there may be important differences in the underlying reasons for refusing topical fluoride.
Collapse
Affiliation(s)
- Madelyn Koh
- Department of Oral Health Sciences, School of Dentistry, University of Washington, B530D, Box 357475, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Darragh Kerr
- Department of Oral Health Sciences, School of Dentistry, University of Washington, B530D, Box 357475, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Courtney M Hill
- Department of Oral Health Sciences, School of Dentistry, University of Washington, B530D, Box 357475, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Donald L Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, B530D, Box 357475, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| |
Collapse
|
8
|
Ko A, Chi DL. Fluoride hesitancy: A mixed methods study on decision-making about forms of fluoride. Community Dent Oral Epidemiol 2023; 51:997-1008. [PMID: 36219463 DOI: 10.1111/cdoe.12800] [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: 05/05/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To investigate whether professionally applied topical fluoride-hesitant caregivers are also hesitant about other forms of fluoride for their child. METHODS This was a mixed methods study of 56 caregivers hesitant about professionally applied topical fluoride for their child recruited from the University of Washington Center for Paediatric Dentistry and Seattle Children's Hospital's Odessa Brown Children's Dental Clinic. A 32-item semi-structured interview script was piloted and finalized. One-time interviews with caregivers were conducted by phone in 2019. Associations between hesitancy of topical fluoride, fluoridated water and toothpaste were assessed quantitatively via two-tailed chi-squared tests. Qualitative data were coded using an inductive approach and content analytic methods to investigate reasons for hesitancy. RESULTS There were significant associations between hesitancy in all three pairwise comparisons of fluoride form (p < .01). Similar proportions of caregivers strongly or somewhat opposed fluoridated water compared with toothpaste (75% and 65%, respectively), but four times as many caregivers strongly or somewhat favoured fluoridated toothpaste compared to water for their child (25% and 7%, respectively). Concerns about harm were the most common reason caregivers opposed both fluoridated water and toothpaste. However, fluoride-hesitant caregivers reported being more comfortable with fluoridated toothpaste because amount and frequency can be controlled, and ingestion can be prevented. CONCLUSIONS Professionally applied topical fluoride hesitancy is significantly associated with fluoridated water and toothpaste hesitancy, but caregivers who were hesitant about topical fluoride was more comfortable with fluoridated toothpaste than fluoridated water for their child.
Collapse
Affiliation(s)
- Alice Ko
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| |
Collapse
|
9
|
Bhoopathi V, Wells C, Atchison KA. Dental care utilization among developmentally disabled adolescents experiencing difficulty with decayed teeth: A population-level study. SPECIAL CARE IN DENTISTRY 2023; 43:619-627. [PMID: 36575154 DOI: 10.1111/scd.12817] [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: 09/01/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
AIMS To determine if adolescents with developmental disabilities (DDs) who experienced difficulty with dental caries differed by dental visits in the past 12 months and receipt of preventive services (fluoride treatment and dental sealants) during those visits compared to adolescents with no DDs or difficulty with dental caries. METHODS AND RESULTS A cross-sectional study was conducted using data of 91 196 adolescents aged 10-17 years from the 2016-2020 National Survey of Children's Health. Descriptive and bivariate statistics and multivariable regression models were conducted. We derived the odds ratio for visiting a dental office (OR: 0.76, 95% CI: 0.57-1.03, p = .07), receiving fluoride treatments (OR: 1.20, 95% CI: 1.01-1.43, p = .04), and dental sealants (OR: 1.44, 95% CI: 1.19-1.75, p < .001) for DD adolescents who experienced difficulty with dental caries compared to adolescents with no DDs or difficulty with dental caries. CONCLUSIONS DD adolescents who experienced difficulty with dental caries were more likely to receive fluoride treatments and sealants during dental visits but were equally likely to have a dental visit in the past 12 months than adolescents with no DDs or difficulty with dental caries.
Collapse
Affiliation(s)
- Vinodh Bhoopathi
- Section of Public and Population Health, University of California at Los Angeles School of Dentistry, Los Angeles, California, USA
| | - Christine Wells
- Statistical Methods and Data Analytics, University of California at Los Angeles Office of Advanced Research Computing, Los Angeles, California, USA
| | - Kathryn Ann Atchison
- Section of Public and Population Health, University of California at Los Angeles School of Dentistry, Los Angeles, California, USA
| |
Collapse
|
10
|
Edwards TC, Carle A, Kerr D, Carpiano RM, Nguyen DP, Orack JC, Chi DL. Topical fluoride hesitancy among caregivers: Development of a content-valid topical fluoride hesitancy identification item pool. J Public Health Dent 2023; 83:116-122. [PMID: 36719013 PMCID: PMC10501325 DOI: 10.1111/jphd.12558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/17/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To develop a content-valid set of items to characterize different types of topical fluoride hesitancy among caregivers. We will use this information to develop and test tailor-made interventions directed to caregivers with varied types and levels of topical fluoride hesitancy, to ultimately improve child oral health. METHODS Caregivers participated in three study activities, in the following order: (1) semi-structured concept elicitation interviews (n = 56), (2) cognitive interviews (n = 9), and (3) usability interviews (n = 3). Interviews were conducted via telephone and audio-recorded and transcribed for qualitative analysis. Twelve pediatric dental providers and researchers participated in item review. An assessment of reading level of items was made with goal of 6th grade reading level or less. RESULTS Based on elicitation interviews, we initially developed 271 items, which the investigative team evaluated for conceptual clarity, specificity to topical fluoride hesitancy, and sensitivity to potential interventions. After four rounds of review and cognitive interviews, we retained 33 items across five previously identified domains. Changes after cognitive interviews included item revision to improve comprehension and item re-ordering to avoid order effects. Changes after usability testing including clarification regarding referent child for families with multiple children. The reading level of the item pool is grade 3.2. CONCLUSIONS The resulting 33-item fluoride hesitancy item pool is content valid and will address an important need for identifying and addressing topical fluoride hesitancy in the context of dental research and clinical practice. Next steps include psychometric evaluation to assess scale and test-retest reliability and construct validity.
Collapse
Affiliation(s)
- Todd C Edwards
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Adam Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Darragh Kerr
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Richard M Carpiano
- School of Public Policy, University of California, Riverside, Riverside, California, USA
| | - Daisy Patiño Nguyen
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Joshua C Orack
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Donald L Chi
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| |
Collapse
|
11
|
Leung E, Kerr D, Askelson N, Chi DL. Understanding topical fluoride hesitancy and refusal behaviors through the extended parallel process model and health belief model. J Public Health Dent 2023; 83:3-8. [PMID: 35288941 PMCID: PMC9470784 DOI: 10.1111/jphd.12512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Topical fluoride helps prevent dental caries. However, many caregivers are hesitant about topical fluoride for their children and may refuse it during clinic visits. In this qualitative study, we assessed the relevance of the extended parallel process model (EPPM) and health belief model (HBM) in caregivers' decision-making about topical fluoride. METHODS We interviewed 56 fluoride-hesitant or fluoride-refusing caregivers using a semi-structured interview script that included questions based on select constructs from the EPPM (perceived severity, susceptibility, response efficacy) and HBM (perceived benefits and consequences). Two team members conducted a thematic analysis of the interview data. RESULTS Most caregivers acknowledged the severity of cavities but did not believe their child was susceptible. Caregivers also understood the general benefits of fluoride in preventing tooth decay, but reported low response efficacy of fluoride for their children especially compared to the other ways of reducing caries risk like reducing sugar intake and toothbrushing. Many caregivers had concerns about topical fluoride, especially regarding safety, with the potential consequences of fluoride outweighing its benefits. CONCLUSION Our findings were generally consistent with the EPPM and HBM, which appear to be relevant in understanding fluoride hesitancy behaviors. Additional research is needed on ways to improve provider communications about topical fluoride with caregivers.
Collapse
Affiliation(s)
- Esther Leung
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Darragh Kerr
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Natoshia Askelson
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| |
Collapse
|
12
|
Saini SJ, Carle AC, Forsyth AR, Chi DL. Association between caregiver opposition to topical fluoride and COVID-19 vaccines. Vaccine 2023; 41:1035-1041. [PMID: 36567141 PMCID: PMC9747692 DOI: 10.1016/j.vaccine.2022.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Caregivers who oppose topical fluoride in dental settings may be opposed to other preventive health treatments, including COVID-19 vaccines. The study objective was to examine the association between caregiver opposition to topical fluoride and COVID-19 vaccines. METHODS The study took place at the University of Washington in Seattle, WA. English-speaking caregivers of children aged < 18 years were eligible to participate. An 85-item REDCap survey was administered from February to September 2021. The predictor variable was topical fluoride opposition (no/yes). The outcome was COVID-19 vaccine opposition (no/yes). The models included the following covariates: child and caregiver age; caregiver race and ethnicity, education level, dental insurance type, parenting style, political ideology, and religiosity; and household income. Logistic regression models generated odds ratios (OR) and 95 % confidence intervals (α = 0.05). RESULTS Six-hundred-fifty-one caregivers participated, and 403 caregivers with complete data were included in the final regression model. Mean child age was 8.5 years (SD 4.2), mean caregiver age was 42.1 years (SD 9.1), 53.0 % of caregivers were female, 57.3 % self-reported as white, and 65.5 % were insured by Medicaid. There was a significant positive association between topical fluoride and COVID-19 vaccine opposition (OR = 3.13; 95 % CI: 1.87, 5.25; p < 0.001). Other factors associated with COVID-19 vaccine opposition included conservative political views (OR = 2.77; 95 % CI: 1.26, 6.08; p < 0.011) and lower education (OR = 3.47; 95 % CI: 1.44, 8.38; p < 0.006). CONCLUSIONS Caregivers opposed to topical fluoride in dental settings were significantly more likely to oppose COVID-19 vaccines for their child. Future research should identify ways to address both topical fluoride and vaccine opposition to prevent diseases in children.
Collapse
Affiliation(s)
- Sapna J Saini
- Department of Pediatric Dentistry, University of Washington School of Dentistry, 6222 NE 74th St #8158, Seattle, WA 98115, USA.
| | - Adam C Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 7014, Cincinnati, OH 45229-3039, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA; Department of Psychology, University of Cincinnati College of Arts and Sciences, 1 Edwards Center, Cincinnati, OH 45221, USA.
| | - Anna R Forsyth
- Department of Pediatric Dentistry, University of Washington School of Dentistry, 6222 NE 74th St #8158, Seattle, WA 98115, USA.
| | - Donald L Chi
- Department of Pediatric Dentistry, University of Washington School of Dentistry, 6222 NE 74th St #8158, Seattle, WA 98115, USA; Department of Oral Health Sciences, University of Washington, 1959 NE Pacific Street, Box 357475, Seattle, WA 98195, USA; Department of Health Systems and Population Health, University of Washington, 1959 NE Pacific St., Box 357660, Seattle, WA, 98195, USA.
| |
Collapse
|
13
|
Chi DL, Kerr D, Patiño Nguyen D, Shands ME, Cruz S, Edwards T, Carle A, Carpiano R, Lewis F. A conceptual model on caregivers' hesitancy of topical fluoride for their children. PLoS One 2023; 18:e0282834. [PMID: 36947522 PMCID: PMC10032489 DOI: 10.1371/journal.pone.0282834] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/23/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Topical fluoride hesitancy is a well-documented and growing public health problem. Despite extensive evidence that topical fluoride is safe and prevents tooth decay, an increasing number of caregivers are hesitant about their children receiving topical fluoride, leading to challenges in clinical settings where caregivers refuse preventive care. PURPOSE To explore the determinants of topical fluoride hesitancy for caregivers with dependent children. METHODS In this qualitative study, we interviewed 56 fluoride-hesitant caregivers to develop an inductive conceptual model of reasons why caregivers are hesitant. RESULTS The core construct of the conceptual model of topical fluoride hesitancy centered on caregivers "wanting to protect and not mess up their child". Six domains comprised this core construct: thinking topical fluoride is unnecessary, wanting to keep chemicals out of my child's body, thinking fluoride is harmful, thinking there is too much uncertainty about fluoride, feeling pressured to get topical fluoride, and feeling fluoride should be a choice. CONCLUSIONS Topical fluoride hesitancy is complex and multifactorial. Study findings provide insight for future efforts to understand and optimize caregivers' preventive care decision making.
Collapse
Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Darragh Kerr
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Daisy Patiño Nguyen
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Mary Ellen Shands
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Stephanie Cruz
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Todd Edwards
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Adam Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, United States of America
| | - Richard Carpiano
- University of California Riverside, School of Public Policy, Riverside, California, United States of America
| | - Frances Lewis
- Department of Child, Family and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, United States of America
| |
Collapse
|
14
|
KINAY TARAN P, BAKKAL M, MAMMADLİ N. Fluoride and the internet: an assessment of online information available to the public. ACTA ODONTOLOGICA TURCICA 2022. [DOI: 10.17214/gaziaot.947860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
15
|
Weijs C, Thawer S, Fundytus K, McLaren L. Advancing public health communication in the era of empowered health consumerism: insights from dental hygienist-client interactions around community water fluoridation. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1791315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Cynthia Weijs
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Salima Thawer
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Katrina Fundytus
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Lindsay McLaren
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| |
Collapse
|
16
|
Souza Neto ACD, Frazão P. Liberties, rights, public policies and water fluoridation. Rev Saude Publica 2020; 54:51. [PMID: 32491111 PMCID: PMC7244233 DOI: 10.11606/s1518-8787.2020054001804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/03/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To discuss the negative and positive concepts of liberty and postulate its interdependent and complementary relationship in the evaluation of public policy intersectoral actions, taking water fluoridation as a case. METHOD To describe scopes and limits regarding 1950s Isaiah Berlin's distinction, showing its validity in facing the harmful effects of an uncontrolled market economy and an autocratic political regime. RESULTS Both the rights that protect citizens against a powerful state and the rights that protect the state against powerful citizens were equally acknowledged as crucial. CONCLUSION We argued that, in a context in which negative and positive liberties are balanced, regulatory policies have double meaning. Thus, there should be a balance between the establishment of necessary rules for social protection and limits for them not to violate individuals' rights.
Collapse
Affiliation(s)
- Antonio Carlos de Souza Neto
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Paulo Frazão
- Departamento de Política, Gestão e Saúde, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
17
|
Chi DL, Basson AA. Surveying Dentists' Perceptions of Caregiver Refusal of Topical Fluoride. JDR Clin Trans Res 2019; 3:314-320. [PMID: 30938597 DOI: 10.1177/2380084418761846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to assess dentists' perceptions of caregiver topical fluoride refusal behaviors. We administered an 8-item survey in 2015 and 2016 ( N = 582) and asked dentists about the extent to which fluoride refusal is a problem, refusal trends, comfort talking to caregivers who refuse, and perceived reasons why caregivers refuse. To examine geographic variation, we ran χ2 tests between dentists' location (US West vs. non-West) and the first 3 perception measures (α = 0.05). Nearly 80% of dentists believed fluoride refusal was a problem, and 42.3% believed it was a growing problem. A significantly larger proportion of dentists who saw fluoride refusal as a problem also believed refusal was a growing problem compared to those who thought refusal was not a problem (89.6% and 41.2%, respectively; P < 0.0001). Caregiver characteristics perceived to be associated with fluoride refusal included immunization refusal (41.3%), White race (37.6%), and high income (33.7%). Thirty-seven percent of surveyed dentists were uncomfortable talking to caregivers who refused. There were no geographic differences in perceptions of fluoride refusal as a problem ( P = 0.52). A significantly larger proportion of non-West dentists believed fluoride refusal has gotten worse (non-West: 65.5%, West: 41.2%; P < 0.0001), but more dentists from the West were uncomfortable talking to caregivers who refused (West: 86%, non-West: 67.4%; P < 0.0001). Caregiver refusal of topical fluoride may be a growing problem, and many dentists are uncomfortable talking to caregivers who refuse. Additional interdisciplinary research is needed to identify the reasons why caregivers refuse fluoride, which is an important next step in developing chairside interventions that address fluoride refusal behaviors. Knowledge Transfer Statement: The results of this study can be used by researchers to develop chairside strategies to help dentists identify and manage fluoride refusal behaviors in clinical settings. This could help preserve topical fluoride as an evidence-based preventive therapy and address a growing public health problem.
Collapse
Affiliation(s)
- D L Chi
- 1 University of Washington, Seattle, WA, USA
| | - A A Basson
- 1 University of Washington, Seattle, WA, USA
| |
Collapse
|
18
|
Chi DL, Rosenfeld M, Mancl L, Chung WO, Presland RB, Sarvas E, Rothen M, Alkhateeb A, McNamara S, Genatossio A, Virella-Lowell I, Milla C, Scott J. Age-related heterogeneity in dental caries and associated risk factors in individuals with cystic fibrosis ages 6-20 years: A pilot study. J Cyst Fibros 2018; 17:747-759. [PMID: 30005828 PMCID: PMC6589399 DOI: 10.1016/j.jcf.2018.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/26/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The literature conflicts regarding dental caries risk in cystic fibrosis (CF) relative to controls. METHODS Prospective, observational study of age-related heterogeneity in caries rates and potential risk factors in individuals with CF ages 6-20 at a single clinic in Washington state (N=85). Caries rates for enrolled CF participants and historical controls from NHANES were compared using cubic spline regression models. Generalized linear regression models identified correlates of age and caries in CF. RESULTS Children ages 6-9 with CF had significantly lower caries than controls (Holm's P<0.05). There was no difference for ages 10-20 by CF status (Holm's P>0.05). Various biological/intraoral, medical, and behavioral factors were associated with caries and age in CF. CONCLUSIONS Younger children with CF may be protected from caries, but there is apparent loss of protection in early adolescence associated with multiple risk factors. Additional studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Donald L Chi
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA.
| | - Margaret Rosenfeld
- Seattle Children's Hospital, Cystic Fibrosis Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Lloyd Mancl
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA
| | - Whasun O Chung
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA
| | - Richard B Presland
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; University of Washington, Department of Medicine, Division of Dermatology, Box 356524, Seattle, WA 98195, USA
| | - Elise Sarvas
- University of Minnesota, School of Dentistry, Department of Pediatric Dentistry, 515 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Marilynn Rothen
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA
| | - Alaa Alkhateeb
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA
| | - Sharon McNamara
- Seattle Children's Hospital, Cystic Fibrosis Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Alan Genatossio
- Seattle Children's Hospital, Cystic Fibrosis Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Isabel Virella-Lowell
- University of Alabama - Birmingham, Division of Pediatric Pulmonology and Sleep Medicine, 1600 7th Ave S, Birmingham, AL 35233, USA
| | - Carlos Milla
- Stanford University Medical School, 770 Welch Rd, Ste. 350, Palo Alto, CA 94304, USA
| | - JoAnna Scott
- University of Missouri - Kansas City, School of Dentistry, Department of Dental Public, Health and Behavioral Science, 650 E. 25th St., Kansas City, MO 64108, USA
| |
Collapse
|
19
|
Chi DL, Richman J, Senturia K, Zahlis E. Caregivers' understanding of fluoride varnish: implications for future clinical strategies and research on preventive care decision making. J Public Health Dent 2018; 78:282-286. [PMID: 30152869 PMCID: PMC6279504 DOI: 10.1111/jphd.12277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/30/2018] [Accepted: 05/25/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe caregivers' understanding of fluoride varnish. METHODS We administered the Oral Health Literacy Inventory for Parents within a pediatric dental clinic (N = 113). Caregivers were asked to read and define each item. Interviews were audio recorded, transcribed, and coded inductively. The main analyses focused on responses to "fluoride varnish" and were conducted at the response level. RESULTS Of the 140 responses, 22.1 percent of the responses indicated lack of knowledge about fluoride varnish, 23.6 percent that it was for teeth, 8.6 percent as something in toothpaste or water, and 45.7 percent as something that helps teeth. About 52.7 percent of responses indicated lack of knowledge, incomplete, or incorrect understanding. At the caregiver-level, 50.4 percent did not know what fluoride varnish was or provided an incorrect or incomplete response. CONCLUSION Many caregivers have an incomplete or inaccurate understanding of fluoride varnish, which has implications for how healthcare providers communicate about preventive care and future research on caregiver decision making.
Collapse
Affiliation(s)
- Donald L Chi
- Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Julia Richman
- Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Kirsten Senturia
- Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Ellen Zahlis
- Oral Health Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
20
|
Carpiano RM, Chi DL. Parents' attitudes towards topical fluoride and vaccines for children: Are these distinct or overlapping phenomena? Prev Med Rep 2018; 10:123-128. [PMID: 29755930 PMCID: PMC5945909 DOI: 10.1016/j.pmedr.2018.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 11/27/2022] Open
Abstract
Despite attention paid to parental refusal of child vaccines, the phenomenon of topical fluoride refusal is poorly understood. We examine the extent to which parent attitudes and Internet use regarding topical fluoride treatment and vaccines may overlap and, in turn, uniquely or distinctly correlate with fluoride and vaccine refusal for the child. In 2017, we analyzed data collected from 2011 to 12 for 361 children from three Washington state dental clinics. The instrument included analogous measures of topical fluoride and vaccine safety concerns, perceived severity of preventable cavities/disease, and Internet use for fluoride/vaccine information; and measures of non-fluoridated toothpaste use, attitudes towards dental x-rays and amalgam and composite fillings. We assessed dental chart-based topical fluoride refusal occurring in 2009 or 2010 and parent-reported vaccine refusal. All analogous fluoride and vaccine items were substantively correlated. However, in a series of adjusted models, none of these items were significantly associated with fluoride refusal. Multiple fluoride and vaccine items were associated with vaccine refusal in unadjusted models; but only vaccine safety concerns, perceived severity of a preventable cavity, and Internet use for vaccine information remained significant in adjusted models. Although there is concordance between the two refusal behaviors as well as analogous attitudes and Internet use, these findings challenge the idea that fluoride refusal should be addressed with interventions focusing on vaccine refusal. Further research is required on the factors underlying refusal of preventive dental care. Studies find that parental refusal of child topical fluoride and vaccines correlate. We tested overlap of factors possibly underlying refusal of both treatments. Analogous fluoride and vaccine attitudes and Internet use items correlated. None of these items were significantly associated with fluoride refusal. Few vaccine- and fluoride-related items were associated with vaccine refusal.
Collapse
Affiliation(s)
- Richard M Carpiano
- School of Public Policy, University of California, Riverside, Riverside, CA, USA.,Department of Sociology, University of California, Riverside, USA.,Center for Healthy Communities, University of California, Riverside, USA.,Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Donald L Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| |
Collapse
|
21
|
Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance. Matern Child Health J 2017; 21:1079-1084. [PMID: 28054156 DOI: 10.1007/s10995-016-2205-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011-2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation.
Collapse
|
22
|
Chi DL. Parent Refusal of Topical Fluoride for Their Children: Clinical Strategies and Future Research Priorities to Improve Evidence-Based Pediatric Dental Practice. Dent Clin North Am 2017; 61:607-617. [PMID: 28577640 DOI: 10.1016/j.cden.2017.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits. This nascent clinical and public health problem warrants attention from dental professionals and the scientific community. Clinical and community-based strategies are available to improve fluoride-related communications with parents and the public. In terms of future research priorities, there is a need to develop screening tools to identify parents who are likely to refuse topical fluoride and diagnostic instruments to uncover the reasons for topical fluoride refusal. This knowledge will lead to evidence-based strategies that can be widely disseminated into clinical practice.
Collapse
Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Box 357475, B509 Health Sciences Building, Seattle, WA 98195-7475, USA.
| |
Collapse
|
23
|
Amit Aharon A, Nehama H, Rishpon S, Baron-Epel O. Parents with high levels of communicative and critical health literacy are less likely to vaccinate their children. PATIENT EDUCATION AND COUNSELING 2017; 100:768-775. [PMID: 27914735 DOI: 10.1016/j.pec.2016.11.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 11/08/2016] [Accepted: 11/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the relationship between parents' health literacy and decision-making regarding child vaccinations. METHODS A cross-sectional survey was conducted among 731 parents of children aged 3-4 years. Functional, communicative, and critical health literacy (HL), knowledge, beliefs, reliability of the vaccine's information resources, and vaccine's attitudes were measured. Attitudes included three types: pro-vaccine attitudes, anti-vaccine attitudes, and attitudes regarding mandatory vaccination. Path analysis was conducted to explore direct and indirect associations of compliance with childhood vaccinations and HL. RESULTS Communicative HL has a significant negative direct association with compliance with vaccinations (ß=-0.06, p<0.05). High functional and critical HL have significant negative indirect associations with vaccinations through parents' attitudes regarding vaccines. Higher levels of perception of reliability of informal information resources are associated with non-compliance. CONCLUSIONS The results indicate that parents with high functional, communicative, and critical HL are more at risk of not vaccinating their children. The results are contrary to expectations in which people with high HL adopt more positive health behaviors. PRACTICAL IMPLICATIONS Public health professionals may need more sophisticated communication methods to transfer messages regarding vaccines to parents in order to prevent decline in vaccine coverage rates, taking into account levels of trust and health literacy.
Collapse
Affiliation(s)
- Anat Amit Aharon
- Public Health Department, Tel-Aviv Yafo Municipality, Israel; School of Public Health, Faculty of Welfare and Health Studies, Haifa University, Israel.
| | - Haim Nehama
- Public Health Department, Tel-Aviv Yafo Municipality, Israel
| | - Shmuel Rishpon
- School of Public Health, Faculty of Welfare and Health Studies, Haifa University, Israel; Ministry of Health, Hifa District, Israel
| | - Orna Baron-Epel
- School of Public Health, Faculty of Welfare and Health Studies, Haifa University, Israel
| |
Collapse
|
24
|
Cuevas J, Chi DL. SBIRT-Based Interventions to Improve Pediatric Oral Health Behaviors and Outcomes: Considerations for Future Behavioral SBIRT Interventions in Dentistry. CURRENT ORAL HEALTH REPORTS 2016; 3:187-192. [PMID: 27857880 PMCID: PMC5108451 DOI: 10.1007/s40496-016-0106-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dental caries is the most common chronic disease in children and is caused by poor oral health behaviors. These behaviors include high-sugar diet, inadequate exposure to topical fluorides, and irregular use of professional dental care services. A number of behavioral intervention approaches have been used to modify health behaviors. One example is the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, which has been widely used to reduce substance abuse in both adults and children. SBIRT is a promising behavior change approach that could similarly be used to address problematic oral health behaviors. In this paper, we will review oral health studies that have adopted SBIRT components, assess if these interventions improved oral health behaviors and outcomes, and outline considerations for researchers interested in developing and testing future oral health-related SBIRT interventions in dentistry.
Collapse
Affiliation(s)
- Josué Cuevas
- Undergraduate Research Assistant, University of Washington, School of Public Health, Cell: 509-366-2996
| | - Donald L. Chi
- Associate Professor, Department of Oral Health Sciences, University of Washington, School of Dentistry, Box 357475, B509f Health Sciences Building, Seattle, WA 98195-7475, Office: 206-616-4332, Cell: 206-650-7652, Fax: 206-685-4258
| |
Collapse
|
25
|
Chi DL, Momany ET, Mancl LA, Lindgren SD, Zinner SH, Steinman KJ. Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program. Am J Prev Med 2016; 50:609-615. [PMID: 26514624 PMCID: PMC4838561 DOI: 10.1016/j.amepre.2015.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/05/2015] [Accepted: 08/25/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities. METHODS Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015. RESULTS In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively). CONCLUSIONS Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care.
Collapse
Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington.
| | | | - Lloyd A Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | | | - Samuel H Zinner
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Kyle J Steinman
- Department of Neurology, University of Washington, and Seattle Children's Research Institute, Seattle, Washington
| |
Collapse
|
26
|
Chi DL, Chen CY. Initial nonresponse and survey response mode biases in survey research. J Public Health Dent 2015; 75:169-74. [DOI: 10.1111/jphd.12090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 01/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Donald L. Chi
- School of Dentistry, Department of Oral Health Sciences; University of Washington; Seattle WA USA
| | - Chao Ying Chen
- School of Dentistry, Department of Oral Health Sciences; University of Washington; Seattle WA USA
| |
Collapse
|
27
|
Seymour B, Getman R, Saraf A, Zhang LH, Kalenderian E. When advocacy obscures accuracy online: digital pandemics of public health misinformation through an antifluoride case study. Am J Public Health 2015; 105:517-23. [PMID: 25602893 DOI: 10.2105/ajph.2014.302437] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In an antifluoridation case study, we explored digital pandemics and the social spread of scientifically inaccurate health information across the Web, and we considered the potential health effects. METHODS Using the social networking site Facebook and the open source applications Netvizz and Gephi, we analyzed the connectedness of antifluoride networks as a measure of social influence, the social diffusion of information based on conversations about a sample scientific publication as a measure of spread, and the engagement and sentiment about the publication as a measure of attitudes and behaviors. RESULTS Our study sample was significantly more connected than was the social networking site overall (P<.001). Social diffusion was evident; users were forced to navigate multiple pages or never reached the sample publication being discussed 60% and 12% of the time, respectively. Users had a 1 in 2 chance of encountering negative and nonempirical content about fluoride unrelated to the sample publication. CONCLUSIONS Network sociology may be as influential as the information content and scientific validity of a particular health topic discussed using social media. Public health must employ social strategies for improved communication management.
Collapse
Affiliation(s)
- Brittany Seymour
- Brittany Seymour and Elsbeth Kalenderian are with the Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA. Rebekah Getman is with the Harvard Global Health Institute, Cambridge, MA. Avinash Saraf and Lily H. Zhang are students at Harvard College, Cambridge, and interns at the Harvard Global Health Institute, Cambridge
| | | | | | | | | |
Collapse
|
28
|
Chi DL. Topical fluoride varnish every 6 months is not more effective than placebo varnish at preventing dental caries in preschoolers in Brazil. J Evid Based Dent Pract 2014; 14:142-4. [PMID: 25234217 DOI: 10.1016/j.jebdp.2014.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Donald L Chi
- Associate Professor, Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 9819507475, USA; Adjunct Associate Professor, Department of Pediatric Dentistry, University of Washington, Box 357475, Seattle, WA 9819507475, USA; Adjunct Associate Professor, Department of Health Services, University of Washington, Box 357475, Seattle, WA 9819507475, USA; Adjunct Associate Professor, Department of Pediatrics, University of Washington, Box 357475, Seattle, WA 9819507475, USA.
| |
Collapse
|