Dental Utilization by Children in Hispanic Agricultural Worker Families in California

J Dent Oral Craniofac Epidemiol. Author manuscript; available in PMC 2015 January 21.

Published in final edited form as:

PMCID: PMC4301614

NIHMSID: NIHMS649067

Dental utilization by children in Hispanic agricultural worker families in California

Tracy L. Finlayson, PhD, Associate Professor, Health Direction & Policy, Stuart A. Gansky, DrPH, MS, Sara G. Shain, DrPH, Statistician, and Jane A. Weintraub, DDS, MPH, Dean and Alumni Distinguished Professor

Tracy L. Finlayson

Graduate School of Public Wellness San Diego State University 5500 Campanile Bulldoze San Diego CA 92182-4162

Stuart A. Gansky

University of California San Francisco Schoolhouse of Dentistry John C. Greene Professor of Master Intendance Dentistry Associate Manager, Middle to Address Disparities in Children'south Oral Health Banana Director, CTSI Mentor Development Programme Sectionalisation of Oral Epidemiology & Dental Public Health ude.fscu@yksnag.trauts

Abstract

Background

Agricultural worker families meet multiple barriers to accessing all needed dental care. This study investigated predisposing, enabling, and need factors associated with children's past yr dental utilization among Hispanic agronomical worker families in central California.

Methods

Oral health survey and clinical information were collected from families participating in a larger, population-based report in 2006-7. Generalized estimating equation logit regression assessed effects on a dental visit amongst children aged 0-17 (n=405). Analyses adjusted for clustering of children in the same household. Predisposing (sociodemographics), enabling (kid's dental insurance, usual source of dental intendance, caregiver by year dental visit, acculturation level, income and educational activity), and demand (caregiver'south oral health rating, perception of cavities, and clinically-adamant treatment urgency) factors were examined.

Results

One-half (51%) the children had a by year dental visit, while 23% had never been to a dentist. In the last model, children were less likely to have a past year dental visit if they were foreign-born, male, had caregivers that thought they had cavities or were unsure, and if the dentist recommended treatment 'at earliest convenience'. Children aged 6-12, with a regular dental care source, and whose caregivers had a recent dentist visit were more likely to accept a by year dental visit.

Conclusions

Children were more probable to have a past twelvemonth dental visit if they had a usual source of dental intendance (OR =4.78, CI=2.51-9.08), and if the caregiver had a past year dental visit (OR=1.88, CI=1.04-iii.38). Emphasis should exist placed on these 2 modifiable factors to increment children's dental utilization.

Keywords: Cross-Sectional Studies/utilization, Dental Health Surveys/utilization, Hispanic Americans

The poor oral wellness status of children in agricultural worker families has been well documented (1-vii), only less is known about their dental service utilization patterns. Arcury and Quandt (8) recently evaluated the healthcare delivery organization available to these families, and called for more research on dental utilization. Agricultural worker families encounter many of the same major barriers to care as other lower socioeconomic status groups in the U.S.: issues with price, insurance, transportation, bachelor providers and clinic hours, also equally time off to seek care (viii-12).

Oral health is the most common unmet health need in all U.S. children (thirteen) and it is frequently an unmet demand among agricultural workers of all ages (9, 11, 14-16). Access to regular, timely dental care is ane important determinant of oral wellness. Children'south caregivers play a major role in deciding to seek care and bringing their children to the dentist. Benefits to regular dental intendance access from an early on age include early identification and handling of dental problems before they become severe and costly to treat. Longitudinal studies report that young children with early childhood caries (ECC) are at a college hazard for dental bug and disease in their permanent teeth (17-19). Regular dental visits in childhood support utilization into adulthood, and provide opportunities for preventive interventions, age-appropriate education for the child and child's caregiver, and didactics on proper hygiene technique.

Although some studies advise that children in agricultural worker families may receive more preventive dental sealants than the general population (1), and more dental care on a regular basis than their parents (5), about inquiry indicates that admission is still problematic for many of these children. Mexican-American children of migrant workers from depression-income families were found to visit the dentist less frequently than higher income children and their counterparts in the Hispanic Wellness and Nutrition Examination Survey (HHANES) (half-dozen). Among children in migrant families in Northward Carolina, 79% had never been to a dentist (20).

Dental coverage for children is a mandated Medicaid and State Children's Health Insurance Programs (CHIP) do good. Notwithstanding, in many states, few dentists participate in Medicaid or other public programs due to the low reimbursements and other factors (21). General dentists may not be comfy or willing to see younger children, despite American Academy of Pediatric Dentistry (AAPD) guidelines recommending get-go dental visits by age one (22). Pediatric dentists also have a low participation charge per unit in Medicaid in California (23).

The purpose of the present analysis is to examine correlates of dental visits amid a sample of children from agricultural-worker families in cardinal California using the Behavioral Model of Wellness Services Utilization (24-26). This model asserts that care-seeking behavior is a function of predisposing, enabling, and need (PEN) factors, and has been applied in other research using caregiver-reported information to examine children's dental visit patterns (twenty, 27).

Predisposing factors include individual demographic characteristics such as historic period. Enabling factors include whether or non a child has dental insurance or regular dental provider, and other family resources like income. The need component includes both perceived and evaluated health status. Perceived need is frequently a strong correlate in the decision to seek care. A caregiver's perception of her/his child's dental status and need is of import to assess. Some studies support that caregivers' assessments of preschool-anile children's oral health is associated with disease level, demand for care, and care-seeking (28-xxx). However, some enquiry with older child-parent pairs suggests that in that location may exist differences in perceived oral health status between parents and adolescents (31).

METHODS

Sample

Data are from the Clearing to California: Agricultural Condom and Acculturation (MICASA) study of agronomical families led by the University of California (UC) Davis (32). The UC San Francisco Middle to Accost Disparities in Children's Oral Health (as well called Tin can DO) led the dental component of MICASA and provided the dental exam and survey data analyzed in the present study. The UC San Francisco Institutional Review Lath approved the dental component of MICASA. The participating families were from Mendota, California, a rural community in central San Joaquin Valley in Fresno County. The overall research design and household enumeration process have been described in depth elsewhere (32). In brief, adults between 18-55 years old, who self-identified as Hispanic, engaged in farmwork in the U.S. for at least 45 days in the prior yr, and a Mendota resident at the time of the interview were eligible for MICASA.

From the 445 MICASA households, families were eligible for the dental study if at that place was at least 1 child nether age xviii. A random, community-based sample of 335 farmworker families in Mendota was selected every bit the terminal MICASA written report cohort. Data were collected on 213 families (representing 64% of the 335 eligible). These families were invited to participate in the dental component. Local bilingual interviewers contacted the family, and obtained additional informed consent for the dental component. A Community Informational Board provided input into written report activities.

Data collection

1 dentist completed all exams for this report in the field part with portable dental equipment. The experienced dentist received training and followed universal infection control guidelines and National Health and Diet Examination Survey (NHANES) criteria (33). Intra-examiner reliability was fantabulous. Cluster adjusted kappas were calculated using a Generalized Estimating Equation (GEE) model with polytomous link function (34) for the twenty children in the study who had echo dental caries exams i to two months later the original examination. The GEE amassed kappa=0.93 (95% (confidence interval) CI: 0.86-1.00). All clinical data were entered onto a secure computer past an assistant. Virtually interviews were conducted in participants' homes, or sometimes the field office as requested, past trained bilingual interviewers from the local surface area. Data were collected in 2006-vii. Adults were interviewed contiguous virtually themselves and each child or boyish in the family living at home. Nearly all (98%) interviews about the child were completed by the mother; in vi cases it was the begetter, and in 3 cases it was another relative who was a main caregiver. Each study participant in a family unit received toothbrushes and a $15 gift certificate every bit bounty for their fourth dimension.

Measures

Caregiver report of whether or not the child had a dental visit in the past year was the chief outcome. Dental utilization information was dichotomized equally a past year dental visit or not since this is the American Academy of Pediatric Dentistry (AAPD) guideline (35) and Salubrious People 2020 objective OH-seven and Leading Health Indicator (36).

Some additional descriptive information about children's dental utilization was collected for subsets of the sample based on visit history, so were not included in the PEN Models. Among children that had been to a dentist, a caregiver reported the child'due south age at his/her first dental visit. Among children that had not been to a dentist in the last yr, the inability to obtain needed intendance and open-ended responses about barriers to care for children were also summarized.

The PEN Model guided the inclusion of independent variables. Predisposing factors included the kid'due south socio-demographic characteristics: age groups (0-five, 6-12, thirteen-17), sex (female person or male), and nascency country (U.South. born or non). Boosted predisposing information included the number of days the caregiver worked in farming in the last year (continuous).

Enabling factors included the child's dental insurance status (recoded as none, Medicaid, or other, which mostly encompassed those with Children's Health Insurance Program coverage, private insurance, or something else), whether or not the child had a usual source of dental intendance (USC), and if the child participated in the free/reduced cost dejeuner program. Caregiver level enabling factors included whether or not the caregiver had a past year dental visit, the caregiver's highest grade level of didactics completed (continuous), almanac household income (recoded equally <$10,000, $ten,000-$xx,000, or >$xx,001), household size (numeric), and caregiver'south Anglo/Mexican acculturation level as assessed by the Acculturation Rating Calibration for Mexican Americans-2 (ARSMA-II)(37) (numeric). The validated 12-item ARSMA-II asks well-nigh individuals' preference for thinking, reading, writing, speaking, and watching television in Spanish and English on a 5-bespeak Likert scale. Mean scores for the six Spanish-preference items were calculated and subtracted from the mean score of the six English-preference items to create an overall score (−5 to +5). Scores less than zero betoken stronger Mexican orientation.

Need factors included a dental examiner's clinical assessment of handling urgency and two caregiver-assessment measures of the child'due south current dental need. Handling urgency was rated by the dentist using the NHANES cess and categorized each child'south need to see a dentist for intendance into 1 of the post-obit timeframes: 1) immediately, 2) within the next ii weeks, 3) at their primeval convenience, or 4) to go along regular intendance (33). The dentist categorized children with caries as needing to run across a dentist inside two weeks, and those that had not had a visit in a yr only did non have obvious decay to go at their earliest convenience to become a total examination and radiographs. Very few children needed immediate attention, so they were grouped with those needing handling in the side by side 2 weeks and both were classified every bit 'urgent'. The ii other kid need factors were based on caregiver perceptions. Caregivers were asked "do you call back your child has any cavities now that may need treatment?", and possible responses were yep, no, or don't know. Caregivers also subjectively rated the child'due south oral health status from poor to excellent, which was recoded as off-white/poor versus skillful/very adept/first-class.

Data Assay

The final sample (n=405) included all children aged 0-17 who had at least one tooth for a dental exam and survey information. Overall, included measures had very few missing items; the gratis/reduced cost lunch program variable had the most missing at vii%. To utilize all bachelor data, maintain the maximum sample size, and reduce possible non-response bias, the few missing items were imputed using the SAS-callable IVEware (38) multiple imputation procedure with v replicate datasets using variables from all the analytic models before scales were constructed or whatever analyses were conducted. IVEware was used to correctly aggregate results across multiple imputations. The distributions of all variables were explored. Descriptive statistics and bivariable associations between each variable of involvement and the dependent variable were analyzed.

Generalized estimating equation (GEE) logit regression analyses assessed the associations of predisposing, enabling, and need factors on the likelihood of a child'southward past yr dental visit, using SAS version 9.1 PROC GENMOD to account for clustering of children within households (39). Model ane included simply predisposing factors, Model 2 included predisposing and enabling factors, and Model three included predisposing, enabling and need factors together. No multicollinearity issues were found in the models. Mediation betwixt models and associations between predisposing, enabling, and need variables were also explored. Utilization was not found to be mediated past need factors, thus all predisposing, enabling and need factors were included in the last model.

RESULTS

Table ane summarizes the characteristics of the report sample overall and by past yr dental visit. Children's mean age was ix years (range 0-17), and half were male. A quarter of the children were non born in the U.S. Most non-U.Southward. built-in children were born in United mexican states (87%), and 13% were born in El Salvador (not shown). Only 14% had no dental insurance, and although 71% had Medicaid, just over half (53%) had a reported regular source of dental care. The bulk (77%) of children participated in the free/reduced cost lunch plan.

Table i

Distribution of Predisposing, Enabling, and Need factors

VARIABLE	n=405						Dental visit last year n=205						No dental visit last yr due north=200						t-examination or chi-sq p-value
	N	%	hateful	sd	min	max	Northward	%	mean	sd	min	max	N	%	hateful	sd	min	max
Predisposing factors
CHILD LEVEL
Child's historic period			9.0	4.6	0	17			9.0	iv.1	two	17			8.6	5.0	0	17	0.005
age 0-5	128	31.6					51	24.9					77	38.5					0.002
historic period 6-12	179	44.ii					107	52.2					72	36.0
age 13-17	98	24.2					47	22.9					51	25.five
Male	210	51.eight					99	48.3					111	55.5					0.147
Non-US born	105	25.9					27	13.2					78	39.0					<0.001
CAREGIVER LEVEL
Days worked farming			111.0	83.0	0	250			109.2	84.0	0	250			112.iv	83.0	0	250	0.903
Enabling factors
CHILD LEVEL
Kid'due south dental insurance																			0.003
No dental insurance	55	13.six					xix	9.iii					36	18.0
Medicaid	288	71.1					161	78.v					127	63.5
Private/other/SCHIP	62	15.3					25	12.two					37	18.five
Usual source of dental care	215	53.ane					147	71.7					68	34.0					<0.001
Free Lunch programme	312	77.0					171	83.4					141	70.5					0.002
CAREGIVER LEVEL
caregiver past year dental visit	153	37.8					94	45.9					59	29.5					<0.001
Didactics (yrs)			6.iv	iii.8	0	22			six.7	four.0	0	22			vi	3.5	0	15	0.049
Acculturation (ARSMA-II)			−3.iv	1.0	−4	0.5			−3.three	1.2	−4	0.5			−3.six	0.8	−4	0.17	<0.001
Family Income																			0.520
$ten,000 or less	147	30.half-dozen					72	35.2					75	37.5
$10,001-$20,000	163	40.2					79	38.five					84	42.0
$xx,001 or more	95	23.v					54	26.3					41	20.5
Approx. Household size			5.half-dozen	one.8	2	12			5.6	1.eight	3	12			5.vi	1.8	2	12	0.917
Need factors
Treatment Urgency
Urgent - next 2 wks	132	32.6					62	xxx.two					70	35.0					0.3073
Primeval convenience	151	37.3					60	28.3					91	45.5					0.0007
Continue routine	122	thirty.1					83	40.5					39	19.5
Parent thinks kid has cavities now																			0.0005
No	129	31.viii					82	40.0					47	23.5
Yes	151	37.iii					61	29.8					90	45.0
Don't Know	125	thirty.9					62	30.2					63	31.v
Fair/poor oral health	107	26.four					54	26.three					53	26.v					0.9711

Caregivers worked in agronomics for a hateful of 111 days in the prior year. But over one third (38%) of caregivers had a past year dental visit. Caregivers reported an average of most half-dozen years of didactics, only there was a wide range (0-22 years). Most families were low-income, with almost one-third reporting earning almanac incomes below $ten,000 supporting an average household of half dozen individuals. The ARSMA-2 acculturation scale scores indicated caregivers' loftier orientation to Mexican rather than Anglo culture.

Children's clinically determined handling demand cess indicated that 33% needed urgent intendance, 37% should run into a dentist at their earliest convenience, while but 30% should keep their routine care. Caregivers believed 37% had cavities and 31% were unsure whether or not the kid had cavities, and 1 quarter of the children were rated every bit having fair/poor oral health condition. Additionally, there were several significant differences between the groups of children with and without a by year dental visit across many factors. Children with a past year dental visit were more likely to be: older, US-born, accept dental insurance, have a regular dental care source, participate in the free/reduced cost dejeuner program, and demand routine intendance. In that location were differences by caregiver factors besides, and children with by year dental visits were more likely to have caregivers with a recent dental visit, higher education level, more The states-oriented acculturation level, and not think the child has cavities.

Half the children had a past year dental visit. Figure 1 displays the fourth dimension since last dental visit. Most a quarter (23%) had never been to a dentist. Sixty per centum of children that accept never been to a dentist were age v or under. Although most professional provider organizations recommend the commencement dental visit by historic period one, many have not sought care, and more often than not, a college proportion of younger children had never had dental care. While not included in the PEN model analyses, boosted data was collected in the surveys almost dental utilization in this group of children. Among the 312 children that had ever been to the dentist, almost 8% went for their first dental visit at historic period 1, 14% at historic period 2, 23% at historic period iii, 19% at age four, 14% at historic period 5, sixteen% age 6-8, and 5% at age 9 or older. Among the 200 children who never had a dental visit or had not been in more than a year, 97 caregivers supplied reasons why they had not taken their child for dental care recently. The about frequent (31%) reason for not going was that the kid was too young, followed past price (16%), did not remember about it (14%), no insurance (12%), no dental problem (nine%), no time or no date (half-dozen%), fear or non wanting to have the child (half-dozen%), or other reasons (1%). Additionally, 16% of caregivers reported that at that place was a time in the last year that the child needed care but did not get it, suggesting in that location are unmet needs. Notably, near half this group includes children that did have a past year dental visit, suggesting underutilization amongst those that were able to seek intendance.

Time since child's last dental visit (n=405)

The GEE logit regression PEN Model findings are presented in Tabular array ii. Model iii (total model) includes all predisposing, enabling and need variables together simultaneously. No testify of mediation was found. Almost all significant findings from Models 1 and 2 persisted in Model 3, and enabling and need variables appear to explicate some of the predisposing variables since at that place is some change in estimates for age, male person, and non-Usa born. In Model 3, child's age, sex, and state of nativity were significant predisposing factors, a USC and caregiver's by year dental visit were significant enabling factors, and perceptions virtually whether or not the child had cavities and needing treatment at earliest convenience were pregnant need factors. Children were less likely to accept a past year dental visit if the child was male (Odds Ratio (OR)=0.55, 95% Confidence Interval (CI)=0.34-0.89, p=0.015), strange-born (OR=0.21, CI=0.09-0.45, p<0.001), if caregiver thought child had cavities (OR=0.31, CI=0.16-0.61, p=0.001) or was unsure if kid had cavities (OR=0.40, CI=0.20-0.79, p=0.008), and if child should run across a dentist 'at earliest convenience' (OR=0.43, CI=0.23-0.80, p=0.008). Visits were about 2.5 times every bit likely if children were ages 6-12 years (OR=2.45, CI=ane.37-4.37, p=0.002, relative to children 5 and under. Past year dental visits were also more probable if children had a USC (OR=iv.78, CI=2.51-nine.07, p<0.001), and if their caregivers had a by year dental visit (OR=1.87, CI one.03-3.38, p=0.038). Whether or non children had a USC (a child-level enabling factor) had the largest impact on past year dental utilization.

TABLE 2

Logistic regression results of past yr dental visit (n=405)

	MODEL 1: Predisposing				MODEL 2: Predisposing & Enabling				MODEL 3: Predisposing, Enabling & Need
	Estimate	Confidence Limits		p-value	Estimate	Conviction Limits		p-value	Estimate	Confidence Limits		p-value
Kid age half dozen-12	three.61	2.23	5.82	<0.0001	2.31	1.33	iv.00	0.0029	2.45	one.37	4.37	0.0024
Child age 13-17	3.25	one.66	6.35	0.0006	1.87	0.86	four.06	0.1159	2.32	0.95	5.64	0.0633
Male child	0.64	0.43	0.97	0.0345	0.59	0.38	0.93	0.0225	0.55	0.34	0.89	0.0145
Child non-Usa born	0.xv	0.09	0.28	<0.0001	0.26	0.13	0.53	0.0002	0.21	0.09	0.45	<0.0001
Days caregiver worked	i.00	1.00	1.00	0.5596	1.00	1.00	1.00	0.5853	1.00	ane.00	1.00	0.5907
Child no dental ins.					0.76	0.33	i.72	0.5046	0.90	0.38	2.13	0.8054
Child other dental ins.					ane.01	0.49	2.07	0.9708	ane.32	0.59	2.96	0.4952
Child usual source of dental intendance					4.17	ii.34	7.46	<0.0001	four.78	2.51	9.07	<0.0001
Costless Lunch program					1.24	0.62	2.48	0.5389	1.17	0.55	2.52	0.6807
Caregiver by dental visit					2.03	one.15	3.58	0.0151	1.87	1.03	3.38	0.0375
Caregiver education (yrs)					1.03	0.96	1.11	0.4128	i.02	0.95	1.11	0.5560
Caregiver acculturation					1.20	0.95	i.52	0.1260	1.17	0.91	i.51	0.2234
Income $10,001-$20,000					0.95	0.52	i.76	0.8795	0.85	0.44	1.64	0.6310
Income $20,001 +					one.25	0.62	two.53	0.5336	0.94	0.43	2.07	0.8781
Household size					0.96	0.84	one.09	0.5125	0.97	0.85	1.eleven	0.6823
Remember child has cavities									0.31	0.sixteen	0.61	0.0007
Don't know if has cavities									0.40	0.20	0.79	0.0083
Urgent handling needed									0.56	0.29	1.06	0.0766
At earliest convenience									0.43	0.23	0.80	0.0084
Kid oral health fair/poor									ane.50	0.74	iii.05	0.2618

Reference groups: age 0-five, female, US born, Medicaid, no regular source of dental care, No free/reduced lunch program, <$10,000 annual income, no cavities, no urgent dental needs, child has good or better oral health status Continuous variables: days worked in farming last year, ARSMA-2 acculturation scores, household size.

DISCUSSION

A usual source of dental care was the strongest positive correlate of past year dental utilization amidst children in these agronomical families that should be encouraged and supported. This finding underscores the importance of obtaining a dental home for every child, an identified regular clinic or provider that can attend to all aspects of oral health for an individual (35, 40). The AAPD adapted the ideal dental dwelling house characteristics from the American University of Pediatrics (AAP) medical home, to include comprehensive, continuously attainable, coordinated, empathetic, culturally- effective, family-centered oral health intendance provided past a licensed dentist (22, 41). A dental dwelling can take substantial clinical and financial implications for improving children's oral health; some bear witness suggests that for college risk young children, early preventive dental visits are associated with lower handling costs and more preventive oriented utilization patterns later (42). However, for families that exercise not already have a dental home for their kid, overcoming the many access to care barriers to institute one may only happen if financial and other major barriers begin to be addressed at the policy level.

A dental habitation is correlated with having a recent dental visit. Nonetheless, not all children with a recent visit have a dental domicile. Although the relationship between a usual source of dental care and dental utilization is complex, analyses of factors relating to utilization to assess simultaneity bias past comparing models of all participants, people with a USC in the past twelvemonth, and those with a source in the past 2 years found a fairly robust relationship between USC and utilization among Hispanics from San Antonio (odds ratios from 10.ii-12.3; (43)). Amongst children in this sample with a by year dental visit, 72% had a regular source of dental care and 28% did non. It is surprising that many caregivers did non feel these children had a USC. Nigh all children without a USC went in for an exam and/or cleaning recently; only six children had a toothache or problem. Additionally, several children (34%) with a reported USC had not been to a dentist within the last twelvemonth. Hereafter studies should explore this further.

Most children in this study had dental coverage through Medicaid. Nevertheless, somewhat surprisingly, the child'southward dental insurance status was not a primal correlate in this analysis as it oft is for utilization (27). This may be because of the paucity of dentists willing to have Medicaid and see children in their practices. There were very few local dentists, not all necessarily accepted young children or had staff able to speak Spanish, and the closest pediatric dentist was about 50 miles abroad. For the families with a usual dentist or dental clinic for their kid, most (ninety%) were nearby in Mendota or Fresno. Thus, many children appeared to have local dental homes. Firebaugh/Mendota is designated every bit a dental wellness professional shortage area (DHPSA) in California, co-ordinate to the Role of Statewide Health Planning and Development. The Health Resources and Services Administration applies this designation when in that location is a 1:5000 dentist-to-population ratio or worse. While this DHSPA designation helps heighten awareness of the lack of providers, and offers various programs for these areas and incentives like loan repayment to entice providers to serve at that place, simply information technology is not enough. This community, and other underserved areas, would benefit from policy changes that heighten the incentives offered through these programs.

Even if there were more than dentists in this area, more of them would also need to participate in the Medicaid programme. California is one of the bottom 10 states where children on Medicaid are least likely to take a by yr dental visit, based on estimates indicating 59% did not accept a visit in 2011 (44). Further, contempo policy changes in California affect Medicaid and Healthy Families (the land's Children'south Health Insurance Plan). Children in the Healthy Families program are transitioning to Medicaid in phases during 2013, according to California Assembly Bill (AB) 1494. This means that more than lower income children in California will need to seek care from Medicaid dentists. In that location will be a growing need for dental intendance from the small network of Medicaid dental providers in the state. The state's reimbursements for services under Medicaid are low, and would likely need to be raised to attract more providers to the plan.

One strategy to establish a dental habitation for every child may be to encourage anybody in the family to observe a regular source of dental intendance. A regular source of care was an of import positive correlate of utilization for adults in this study sample (45). Some other recent study in a diverse Medicaid sample institute that if Hispanic mothers had a regular source of intendance, their children were afterwards more than likely to also utilise dental services (46). Other studies with lower income families have found similar positive effects on young children'southward dental utilization when caregivers get regular preventive dental care as well (47). National data also support this positive association betwixt caregiver and kid dental utilization (48). In this written report, caregivers with past year dental visits had children who were virtually twice equally likely to take been to the dentist. Enabling caregivers to maintain regular dental care has a positive affect on child dental utilization. However, the state of California cut optional developed dental benefits on Denti-Cal (Medicaid) and the California Children's Dental Disease Prevention Programme (CCDDPP) in 2009 (49), thus eliminating coverage for many adult caregivers and preventive services for children. Addressing caregivers' dental needs volition be important for improving children's oral health status in this sample also; mothers' untreated caries was positively associated with untreated caries in their children (fifty). Several costs and negative consequences associated with Medicaid developed dental do good cuts take been documented (51). California plans to allocate funds in the side by side ii years for select adult dental benefits under Medicaid. It will be disquisitional to monitor the touch of these cuts on both adults and children, and in DHPSA communities in particular where in that location are fewer providers and access is already a claiming. Kid'due south nativity country also emerged as an important correlate of utilization. Children not born in the U.Southward. were far less likely to seek care. Other studies have also documented relatively lower medical and dental utilization among non-US built-in children (half-dozen, 20). Families may see pregnant linguistic communication barriers, as many in this study were Spanish-speaking. Culturally competent providers or staff members may besides exist lacking; this means more being able to speak the language. Providers may not empathise the cultural values and beliefs that influence decisions to seek intendance.

Male children were less likely to have a past year dental visit than females in this sample. It is non clear why there was a gender divergence. While not a statistically pregnant departure, more Mexican-American females (ages 2-17) had a by twelvemonth dental visit than males (58% vs. 49%) based on 1999-2002 NHANES data (52).

Some other factor to consider is the caregiver's perception of their kid's demand. This potential determinant of utilization may be more than important for younger children that may not be as able to tell a parent when a tooth hurts. Nearly i-tertiary of caregivers did not know whether or not their child had cavities. In one study of Latino families with preschool aged children, many caregivers believed that teeth but needed cleaning instead of treatment if they appeared stained (53). The large proportion of caregivers that did not know if the child had cavities suggests a need for more education about identifying the early signs of disuse. While caregiver perceptions may not be totally accurate, it is noteworthy that 37% of caregivers thought their kid had cavities. This perception was associated with a lower likelihood of a past year visit, suggesting some possible reverse causation; i.e. caregivers may know children are crenel-gratis because of a recent dental visit in which previously existing cavities were treated. Simply thinking the child has cavities does not in and of itself stop someone from visiting the dentist, just many parents practice not think that baby teeth are important and do not visit the dentist unless a child complains of hurting (53). Notwithstanding, in a high caries-risk population, not visiting the dentist leads to a college chance of disease, and decreases opportunities for both caries prevention and remineralization of early lesions. Causality can not be determined in this study given its cross-sectional nature, but these caregiver perceived needs reinforce the other cardinal finding of many unmet dental needs in this sample.

The results must be interpreted with study strengths and limitations in listen. The strengths of this analysis were the inclusion of clinical information near the child, a clinically-based treatment urgency measure of need, and caregiver-reported information from a large population-based sample of children in agricultural worker families. A total age range of 0-17 year old children was included. The limitations are that survey data are subject field to remember and social desirability response biases, and as already noted, no causal relationships could be adamant, and a having a USC is inter-related with having a contempo visit.

The dentist-determined treatment urgency ratings indicated that the majority of children needed to see a dentist soon. Visiting a dentist within the adjacent 2 weeks was recommended for 33% of the children, and another 37% were recommended to go at their earliest convenience. While this rating may be subjective, the assessments were all performed by one trained dentist and reverberate a need for professional person care sooner rather than later for almost children.

CONCLUSION

In this population of Hispanic 0-17 year olds in agricultural worker families, many predisposing, enabling and need factors were associated with past year dental utilization. The strongest modifiable correlates were a regular source of dental care for the child and the caregivers' by year dental utilization. Accent needs to be placed on these ii factors to improve children's dental utilization.

Acknowledgements

This research was part of a larger, population-based study supported by the USDHHS/NIH#U54DE014251, NIOSH#2U50OH007550-06 & California Endowment, conducted by the University of California San Francisco's Centre to Accost Disparities in Children's Oral Health (Tin Exercise, Jane Weintraub, PI) in partnership with colleagues from the Academy of California, Davis. We wish to thank all the study participants and Marguerite Laccabue. An earlier version of this paper was presented at the 2011 International Association for Dental Enquiry meeting, and we thank the audience for thoughtful feedback.

Contributor Information

Tracy L. Finlayson, Graduate School of Public Health San Diego State University 5500 Campanile Drive San Diego CA 92182-4162.

Stuart A. Gansky, University of California San Francisco School of Dentistry John C. Greene Professor of Master Care Dentistry Acquaintance Director, Center to Address Disparities in Children's Oral Health Banana Director, CTSI Mentor Development Program Division of Oral Epidemiology & Dental Public Health ude.fscu@yksnag.trauts.

Sara G. Shain, University of California San Francisco School of Dentistry ude.fscu@niahS.araS.

Jane A. Weintraub, The Academy of Northward Carolina at Chapel Hill School of Dentistry ude.cnu@buartnieW_enaJ.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301614/