Huabin Luo

Racial and Ethnic Variations in Preventive Dental Care Utilization among Middle-Aged and Older Americans, 1999–2008

Objective: This study examined recent trends of preventive dental care utilization among Americans aged 50 and above, focusing on variations across racial and ethnic groups including Whites, Blacks, Hispanics, American Indians/Alaska Natives, and Asians. Methods: Self-reported information on oral health behaviors was collected from 644,635 participants in the Behavioral Risk Factor Surveillance System between 1999 and 2008. Results: Despite a significant upward trend of frequency of dental cleaning from 1999 to 2008 (OR = 1.02), in 2008 still only 56–77% of any ethnic or racial group reported having had a dental cleaning in the previous 12 months. Relative to Whites, Blacks (OR = 0.65) were less likely to have a dental cleaning in the previous 12 months. These variations persisted even when SES, health conditions, health behaviors, and number of permanent teeth were controlled. In contrast, Hispanics, Asians, and American Indians/Alaskan Natives did not differ from Whites in dental cleanings. Discussion: This is the first study to provide national estimates of the frequency of dental cleaning and associated trends over time for five major ethnic groups aged 50 and above in the U.S. simultaneously. Our findings suggest that public health programs with an emphasis on educating middle-aged and older minority populations on the benefits of oral health could have a large impact, as there is much room for improvement. Given the importance of oral health and a population that is rapidly becoming older and more diverse, the need for improved dental care utilization is significant.

Forty-Year Trends in Tooth Loss Among American Adults With and Without Diabetes Mellitus: An Age-Period-Cohort Analysis

Introduction This study aimed to assess the trends in tooth loss among adults with and without diabetes mellitus in the United States and racial/ethnic disparities in tooth loss patterns, and to evaluate trends in tooth loss by age, birth cohorts, and survey periods. Methods Data came from 9 waves of the National Health and Nutrition Examination Survey (NHANES) from 1971 through 2012. The trends in the estimated tooth loss in people with and without diabetes were assessed by age groups, survey periods, and birth cohorts. The analytical sample was 37,609 dentate (ie, with at least 1 permanent tooth) adults aged 25 years or older. We applied hierarchical age-period-cohort cross-classified random-effects models for the trend analysis. Results The estimated number of teeth lost among non-Hispanic blacks with diabetes increased more with age than that among non-Hispanic whites with diabetes (z = 4.05, P < .001) or Mexican Americans with diabetes (z = 4.38, P < .001). During 1971–2012, there was a significant decreasing trend in the number of teeth lost among non-Hispanic whites with diabetes (slope = −0.20, P < .001) and non-Hispanic blacks with diabetes (slope = −0.37, P < .001). However, adults with diabetes had about twice the tooth loss as did those without diabetes. Conclusion Substantial differences in tooth loss between adults with and without diabetes and across racial/ethnic groups persisted over time. Appropriate dental care and tooth retention need to be further promoted among adults with diabetes.

Racial/Ethnic Disparities in Preventive Care Practice Among U.S. Nursing Home Residents

Objective: To assess racial/ethnic disparities in preventive care practices among U.S. nursing home residents. Method: To implement the Institute of Medicine definition of health care disparity, we used the rank-and-replace adjustment method to assess the disparity in receipt of eight preventive care services among residents and evaluate trends in disparities. The sampling design (stratification and clustering) was accounted for using Stata 11. Results: The 2004 National Nursing Home Surveys data show White residents were more likely to have pain management, scheduled toilet plan/bladder retraining, influenza vaccination, and pneumococcal vaccination than Black residents. White residents were also more likely to have scheduled toilet plan/bladder retraining than residents of Other race/ethnicity. Significant Black–White disparities in receipt of influenza vaccination and pneumococcal vaccination were found. Time trend analysis showed that disparities were neither exacerbated nor reduced. Conclusion: Persistent racial/ethnic disparities in preventive care among nursing home residents exist. We urge the development and implementation of targeted interventions to improve the quality of preventive care in nursing homes.

Addressing psychological, mental health and other behavioural healthcare needs of the underserved populations in the United States: the role of local health departments.

Aims: (1) To assess the extent to which local health departments (LHDs) implement and evaluate strategies to target the behavioural healthcare needs for the underserved populations and (2) to identify factors that are associated with these undertakings. Methods: Data for this study were drawn from the 2013 National Profile of Local Health Departments Study conducted by National Association of County and City Health Officials. A total of 505 LHDs completed the Module 2 questionnaire of the Profile Study, in which LHDs were asked whether they implemented strategies and evaluated strategies to target the behavioural healthcare needs of the underserved populations. To assess LHDs’ level of engagement in assuring access to behavioural healthcare services, descriptive statistics were computed, whereas the factors associated with assuring access to these services were examined by using logistic regression analyses. To account for complex survey design, we used SVY routine in Stata 11. Results: Only about 24.9% of LHDs in small jurisdiction (<50,000 population) and 35.3% of LHDs in medium-size jurisdiction implemented/evaluated strategies to target the behavioural healthcare services needs of underserved populations in their jurisdiction in 2013. Logistic regression model results showed that LHDs having city/multicity jurisdiction (adjusted odds ratio (AOR) = .16, 95% confidence interval (CI): .04–.77), centralised governance (AOR = .12, 95% CI: .02–.85), and those located in South Region (AOR = .25, 95% CI: .08–.74) or the West Region (AOR = .36, 95% CI: 14–.94), were less likely to have implemented/evaluated strategies to target the behavioural healthcare needs of the underserved. Conclusions: The extent to which the LHDs implemented or evaluated strategies to target the behavioural healthcare needs of the underserved population varied by geographic regions and jurisdiction types. Different community needs or different state Medicaid programmes may have accounted for these variations. LHDs could play an important role in improving equity in access to care, including behavioural healthcare services in the communities.

Acculturation and Dental Service Use Among Asian Immigrants in the U.S

INTRODUCTION The objective of this study was to assess dental service utilization across different Asian immigrant groups and to examine the relationship between acculturation and dental service utilization among Asian immigrants in the U.S. METHODS Data were from the 2013 and 2014 National Health Interview Surveys. Multiple logistic regression models were used to examine the association between acculturation and having a dental visit in the previous 12 months, controlling for predisposing, enabling, and need factors. Acculturation was measured by length of stay in the U.S., English language proficiency, and U.S. citizenship. The sample was 2,948 adult Asian immigrants who were dentate. Data were analyzed in 2016. RESULTS Dental service utilization varied across Asian immigrant groups. High English proficiency and longer length of stay were significantly associated with having a dental visit (p<0.05). In the final model, after adding enabling factors-dental insurance and family income levels-length of stay in the U.S. (≥5 years) remained significant, whereas English language proficiency was not a significant correlate of having a dental visit. CONCLUSIONS Length of stay in the U.S. is a significant factor affecting dental service utilization among Asian immigrants.

Dental Care Utilization Among Caregivers Who Care for Older Adults

The goal of this study was to investigate individual and contextual factors associated with dental care utilization by U.S. informal caregivers. The sample included all 2010 Behavioral Risk Factor Surveillance System respondents who completed the caregiver module and reported providing care for 1 year or more to an individual aged ≥ 50 years or older (n = 1,196). Multiple logistic regressions were used to examine associations of caregiver and care characteristics and county-level contextual characteristics (from Area Resource File data) with two outcomes: dental visits and dental cleaning during previous year. Caregivers with health insurance coverage and higher education were more likely to use dental care; those who had lost more teeth and who were spouse caregivers were less likely to do so. Community characteristics were not correlated with caregivers’ use of dental care. Our findings suggest that better access to dental care could improve dental care utilization by caregivers.

Gestational Diabetes and Health Behaviors Among Women: National Health and Nutrition Examination Survey, 2007–2014

Introduction Women with gestational diabetes are at 7 times greater risk of developing type 2 diabetes than are women without gestational diabetes. The objectives of this study were to examine recent changes in the prevalence of gestational diabetes mellitus among women of reproductive age in the United States and assess the prevalence of factors associated with participating in healthy lifestyle behaviors. Methods Data were from 4 waves of the National Health and Nutrition Examination Survey (2007–2014). Gestational diabetes was identified by participants’ response to whether they were ever told by a health care professional that they had diabetes during pregnancy. The health behaviors were participation in physical activity, healthy dietary patterns (intake of cholesterol, sodium, and fiber within recommended guidelines), and smoking. The analytical sample included 3,034 women aged 20 to 44 years. Multivariate logistic regression was used to assess the association between gestational diabetes and health behaviors. Results The overall prevalence of gestational diabetes was 8.9% (95% confidence interval [CI], 7.6%–10.4%) during 2007–2014. The prevalence increased from 8.4% in 2007–2008 to 10.4% in 2013–2014, an increase of 24%, but the change was not significant (P = .28). The proportions of women meeting recommended guidelines for the health behaviors did not change significantly. We found no significant difference in practicing healthy behaviors between women with gestational diabetes and women without gestational diabetes. Conclusion The prevalence of gestational diabetes increased slightly in recent years, and women with the condition were generally not meeting guidelines for healthy behaviors. Coordinated interventions are needed to promote healthy lifestyle behaviors among women with gestational diabetes because they are at increased risk for diabetes.

Self-Reported Cognitive Impairment Across Racial/Ethnic Groups in the United States, National Health Interview Survey, 1997–2015

Introduction The primary objectives of this study were 1) to examine trends of self-reported cognitive impairment among 5 major racial/ethnic groups during 1997–2015 in the United States and 2) to examine differences in the trends across these groups. Methods Data were from the National Health Interview Survey (NHIS). The sample consisted of 155,682 people aged 60 or older. Respondents were asked to report whether any family member was “limited in any way because of difficulty remembering or because of experiencing periods of confusion.” Race/ethnicity categories were non-Hispanic white, non-Hispanic black, Native American, Hispanic, and Asian. We applied hierarchical age–period–cohort cross-classified random-effects models for the trend analysis. All analyses accounted for the complex survey design of NHIS. Results The overall rate of self-reported cognitive impairment increased from 5.7% in 1997 to 6.7% in 2015 (P for trend <.001). Among non-Hispanic white respondents, the rate increased from 5.2% in 1997 to 6.1% in 2015 (slope = 0.14, P for trend <.001). We observed no significant trend in rate of cognitive impairment in other groups. After we controlled for covariates, we found that Asian (B = 0.31), non-Hispanic black (B = 0.37), Hispanic (B = 0.25), and Native American (B = 0.87) respondents were more likely than non-Hispanic white respondents to report cognitive impairment (P <.001 for all). Conclusion We found an increased rate of self-reported cognitive impairment in older adults of 5 major racial/ethnic groups from 1997 through 2015 in the United States. However, the rate of self-reported cognitive impairment was low, which may suggest underreporting. There is a need to further promote awareness of the disease among individuals, family members, and health care providers.

Validation of a combined health literacy and numeracy instrument for patients with type 2 diabetes

OBJECTIVES This study aimed to validate a new consolidated measure of health literacy and numeracy (health literacy scale [HLS] plus the subjective numeracy scale [SNS]) in patients with type 2 diabetes (T2DM). METHODS A convenience sample (N = 102) of patients with T2DM was recruited from an academic family medicine center in the southeastern US between September-December 2017. Participants completed a questionnaire that included the composite HLS/SNS (22 questions) and a commonly used objective measure of health literacy-S-TOFHLA (40 questions). Internal reliability of the HLS/SNS was assessed using Cronbachs alpha. Criterion and construct validity was assessed against the S-TOFHLA. RESULTS The composite HLS/SNS had good internal reliability (Cronbachs alpha = 0.83). A confirmatory factor analysis revealed there were four factors in the new instrument. Model fit indices showed good model-data fit (RMSEA = 0.08). The Spearmans rank order correlation coefficient between the HLS/SNS and the S-TOFHLA was 0.45 (p < 0.01). CONCLUSIONS Our study suggests that the composite HLS/SNS is a reliable, valid instrument.

Self-awareness of "Gum Disease" Among US Adults.

Background: To assess the extent of self-awareness of gum disease among adults in the United States. Methods: Data were from the 2009-2012 National Health and Nutrition Examination Survey. The outcome variable is self-awareness of gum disease. Multivariate logistic regression models were used to examine the relationship between self-awareness and clinically diagnosed periodontitis. The analytical sample included 6876 participants. Results: Among those participants (30 years or older) who were classified as having periodontitis, 27% (95% confidence interval [CI], 24.4-29.8) were self-aware of the disease (positive predicted value = 25%). Of those who self-reported having gum disease, 14.1% had a diagnosis of periodontitis (sensitivity = 75%). Older adults were less likely to be aware of gum disease (P < .05). Non-Hispanic blacks (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.53-0.85) were less likely to be aware of the disease than non-Hispanic whites. Adults with diabetes (AOR = 1.61; 95% CI, 1.25-2.06), or with lung disease (AOR = 1.61; 95% CI, 1.25-2.08), or current smokers (AOR = 1.72; 95% CI, 1.29-2.31) were more likely to be aware of the disease. Conclusion: The study showed that self-awareness of gum disease among adults was low. Our study findings suggest that there is a great need to improve oral health knowledge and awareness among the adult population in the United States.