Tracy L. Finlayson

Oral Health Disparities and Psychosocial Correlates of Self-Rated Oral Health in the National Survey of American Life

OBJECTIVES We sought to better understand the determinants of oral health disparities by examining individual-level psychosocial stressors and resources and self-rated oral health in nationally representative samples of Black American, Caribbean Black, and non-Hispanic White adults. METHODS We conducted logistic regression analyses on fair or poor versus better oral health using data from the National Survey of American Life (n = 6082). RESULTS There were no significant racial differences. Overall, 28% of adults reported having fair or poor oral health. Adults with lower income and less than a high school education were each about 1.5 times as likely as other adults to report fair or poor oral health. Higher levels of chronic stress, depressive symptoms, and material hardship were associated with fair or poor oral health. Adults living near more neighborhood resources were less likely to report fair or poor oral health. Higher levels of self-esteem and mastery were protective, and more-religious adults were also less likely to report fair or poor oral health. CONCLUSIONS Social gradients in self-rated oral health were found, and they have implications for developing interventions to address oral health disparities.

Dental utilization among Hispanic adults in agricultural worker families in California's Central Valley

OBJECTIVE To examine past-year dental visits among underserved, Hispanic farm-worker families using the Andersen Behavioral Model of Health Services Utilization, which posits that predisposing, enabling, and need factors influence care-seeking behavior. METHODS Oral health survey and clinical data were collected in 2006-2007 from families in Mendota, California (Fresno County) as part of a larger, population-based study. Generalized estimating equation logit regression assessed effects of factors on having a dental visit among adults (N = 326). Predisposing variables included sociodemographic characteristics, days worked in agriculture, self-rated health status, and dental beliefs. Enabling factors included resources to obtain services (dental insurance, income, acculturation level, regular dental care source). Need measures included perceived need for care and reported symptoms, along with clinically determined untreated caries and bleeding on probing. RESULTS Only 34% of adults had a past-year dental visit, despite 44% reporting a regular dental care source. Most (66%) lacked dental insurance, and nearly half (46%) had untreated caries. Most (86%) perceived having current needs, and on average, reported a mean of 4.2 dental symptoms (of 12 queried). Regression analyses indicated those with more symptoms were less likely to have a past-year dental visit. Those who would ask a dentist for advice and had a regular dental care source were more likely to have a past-year dental visit. CONCLUSIONS The final model included predisposing, enabling, and need factors. Despite low utilization and prevalent symptoms, having a regular source of care helps break this pattern and should be facilitated.

Heterogeneity in periodontitis prevalence in the Hispanic Community Health Study/Study of Latinos.

PURPOSE The aim of the study was to examine acculturation and established risk factors in explaining variation in periodontitis prevalence among Hispanic/Latino subgroups. METHODS Participants were 12,730 dentate adults aged 18-74 years recruited into the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from four U.S. field centers between 2008 and 2011. A standardized periodontal assessment measured probing pocket depth and gingival recession at six sites per tooth for up to 28 teeth. Periodontitis was defined according to the Centers for Disease Control and Prevention and American Academy of Periodontology case classifications developed for population surveillance. Covariates included acculturation indicators and established periodontitis risk factors. Survey estimation procedures took account of the complex sampling design. Adjusted multivariate binomial regression estimated prevalence ratios and 95% confidence limits (CLs). RESULTS Unadjusted prevalence of moderate and severe periodontitis was 38.5% and ranged from 24.7% among Dominicans to 52.1% among Cubans. Adjusted prevalence ratios for subgroups relative to Dominicans were as follows: (1) 1.34 (95% CL, 1.13-1.58) among South Americans; (2) 1.37 (95% CL, 1.17-1.61) among Puerto Ricans; (3) 1.43 (95% CL, 1.25-1.64) among Mexicans; (4) 1.53 (95% CL, 1.32-1.76) among Cubans; and (5) 1.55 (95% CL, 1.35-1.78) among Central Americans. CONCLUSIONS Heterogeneity in prevalence of moderate/severe periodontitis among Hispanic/Latino subpopulations was not explained by acculturation or periodontitis risk factors.

Periodontitis and sleep disordered breathing in the Hispanic Community Health Study/Study of Latinos

STUDY OBJECTIVES To investigate the association between sleep disordered breathing (SDB) and severe chronic periodontitis. DESIGN Cross-sectional data analysis from the Hispanic Community Health Study/Study of Latinos. SETTING Community-based setting with probability sampling from four urban US communities. PARTICIPANTS 12,469 adults aged 18-74 y. INTERVENTIONS None. MEASUREMENTS AND RESULTS Severe chronic periodontitis was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology case classification based on full-mouth periodontal assessments performed by calibrated dentists. SDB was evaluated in standardized home sleep tests, and defined as the number of apnea plus hypopnea events associated with ≥ 3% desaturation, per hour of estimated sleep. SDB was quantified using categories of the apnea-hypopnea index (AHI): 0.0 events (nonapneic); 0.1-4.9 (subclinical); 5.0-14.9 (mild); and ≥ 15 (moderate/severe). Covariates were demographic characteristics and established periodontitis risk factors. C-reactive protein was a potential explanatory variable. Using survey estimation, multivariable binary logistic regression estimated odds ratios (OR) and 95% confidence limits (CL). Following adjustment for confounding, the SDB and periodontitis relationship remained statistically significant, but was attenuated in strength and no longer dose-response. Compared with the nonapneic referent, adjusted odds of severe periodontitis were 40% higher with subclinical SDB (OR = 1.4, 95% CL: 1.0, 1.9), 60% higher with mild SDB (OR = 1.6, 95% CL: 1.1, 2.2) and 50% higher with moderate/severe SDB (OR = 1.5, 95% CL: 1.0, 2.3) demonstrating an independent association between SDB and severe periodontitis. CONCLUSIONS This study identifies a novel association between mild sleep disordered breathing and periodontitis that was most pronounced in young adults.

Use of conventional care and complementary/alternative medicine among US adults with arthritis

OBJECTIVE Managing arthritis and co-morbid conditions is of public health importance. It is therefore critical to have a comprehensive understanding of healthcare utilization among US adults with arthritis. Thus, the present study identified characteristics associated with using both complementary and alternative medicine (CAM) and conventional healthcare. METHOD Using 2007 National Health Interview Survey data, multinomial logistic regression was performed to compare four categories of past year healthcare use (both CAM and conventional care vs. conventional care only, CAM only, and no healthcare use) on their potential correlates. RESULTS The sample (n=3850) was 62.8% female and 80.4% non-Hispanic White. Nearly half were at least 65 years old, and had used both CAM and conventional services in the previous year. The following characteristics were associated with having used neither CAM nor conventional care in the previous year (vs. having used both CAM and conventional care): being from an ethnic and racial minority group (ORs=2.44, 3.26, and 3.91) and being uninsured (OR=4.06), identifying individuals potentially at risk for unmet need. CONCLUSION To ensure access to comprehensive care, potentially underserved populations should be targeted with outreach (e.g., providing low-cost, accessible care, and education about benefits of various treatments for arthritis and co-morbid conditions).

The basic research factors questionnaire for studying early childhood caries

BackgroundWe describe development of the Early Childhood Caries (ECC) Basic Research Factors Questionnaire (BRFQ), a battery of measures assessing common potential predictors, mediators, and moderators of ECC. Individual-, family-, and community-level factors that are linked to oral health outcomes across at-risk populations are included. Developing standard measures of factors implicated in ECC has the potential to enhance our ability to understand mechanisms underlying successful prevention and to develop more effective interventions.MethodsThe Early Childhood Caries Collaborating Centers (EC4), funded by National Institute of Dental and Craniofacial Research, developed the BRFQ, which was used across four randomized trials to develop and test interventions for reducing ECC in at-risk populations. Forty-five investigators from across the centers and NIDCR were involved in the development process. Eight “measures working groups” identified relevant constructs and effective measurement approaches, which were then categorized as “essential” or “optional” common data elements (CDEs) for the EC4 projects.ResultsEssential CDEs include 88 items, with an additional 177 measures categorized as optional CDEs. Essential CDEs fell under the following domains: oral health knowledge, oral health behavior, utilization/insurance and cost, parent/caregiver dental self-efficacy, quality of life, caregiver and family characteristics, and child characteristics.ConclusionsThe BRFQ makes available a battery of measures that support efforts to understand population risk factors for ECC and to compare oral health outcomes across populations at risk. The BRFQ development process may be useful to other clinical research networks and consortia developing CDEs in other health research fields.Trial registrationAll the trial that used the BRFQ were registered at Clinicaltrial.gov NCT01116726, April 29, 2010; NCT01116739, May 3, 2010; NCT01129440, May 21, 2010; and NCT01205971, September 19, 2010.

Prenatal Maternal Factors, Intergenerational Transmission of Disease, and Child Oral Health Outcomes

This article reviews maternal prenatal risk factors for caries in children and intergenerational transmission of caries, emphasizing early interventions for pregnant women and mother-infant pairs. A growing body of evidence focuses on maternal interventions. Studies suggest that early prenatal clinical and educational interventions are effective at reducing mother-child mutans streptococci (MS) transmission and delaying colonization and caries in young children. Dental screenings and anticipatory guidance about maternal and infant oral health should be included in prenatal care and pediatric well visits. Dental care during pregnancy is safe and recommended and can reduce maternal MS levels. Infants should visit a dentist by age 1.

Unfair Treatment and Periodontitis Among Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

This study investigates how perceived unfair treatment, towards self and observed towards others due to ethnicity, is associated with periodontitis among diverse Hispanic/Latino adults, accounting for sociodemographic, health behavior, and acculturation factors. Baseline (2008–2011) dental and survey data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter epidemiologic study, were analyzed (N = 12,750). Crude and adjusted prevalence ratios and confidence limits were estimated. Half (49%) reported never being treated unfairly, while 41% reported they were sometimes, and 10% reported it often/always. One third (32%) never saw others treated unfairly, while 42% reported it sometimes, and 26% reported it often/always. In the final fully adjusted model, the prevalence of periodontitis was higher among adults who were as follows: non-Dominican, older, male, had a past year dental visit, current and former smokers, and among those who observed unfair treatment towards others. Lower prevalence was associated with higher income, higher educational attainment, less than full-time employment, reporting experiencing unfair treatment, higher acculturation scores, and having health insurance. Perceived unfair treatment towards self was negatively associated with periodontitis prevalence, while observed unfair treatment towards others was positively associated with the outcome among diverse Hispanics/Latinos. The associations between unfair treatment and periodontitis warrant further exploration.

Facilitators and Barriers to Dental Care Among Mexican Migrant Women and Their Families in North San Diego County

To qualitatively examine facilitators and barriers to dental care access and quality services among Mexican migrant women and their families living in North San Diego County, California. Six focus groups were conducted, with 52 participants. Three focus groups were with community residents (average group size of 10), and three were with community health workers/leaders (called Lideres; average group size of 7). The behavioral model for vulnerable populations theoretical framework guided qualitative data analyses. Predisposing factors to dental care access varied and included immigration status, language, and dental care experiences. Barriers to accessing quality dental services included high cost, lack of insurance coverage, dissatisfaction with providers, long wait times and discrimination. Participants expressed a desire for health policy changes, including affordable coverage for immigrants and their families. This study provided insights into how dental care providers, community health centers, and policymakers can improve dental care access and services to migrant populations.

Formative Research: Using a Community-Based Participatory Research Approach to Develop an Oral Health Intervention for Migrant Mexican Families.

Oral health is a leading unmet health need among migrant families. This article describes the 1-year, community-based participatory research (CBPR) approach employed to plan and develop a Líder Communitario (lay community health worker)–led educational intervention for Mexican migrant adult caregivers and their families in three underserved, remote communities in North San Diego County, California. Four partner organizations collaborated, reviewed existing oral health curricula, and sought extensive input on educational topics and research design from key informants, migrant caregivers, and Líderes Communitarios. Based on community stakeholder input, partners developed a logic model and drafted educational intervention materials. Key informants (n = 28), including several members from two community advisory boards, ranked program priorities and intervention subgroup population via online survey. Three focus groups were conducted with Líderes Communitarios (n = 22) and three with migrant families (n = 30) regarding the oral health program’s design and content. Twelve Líderes Communitarios reviewed draft intervention materials during two focus groups to finalize the curriculum, and their recommended changes were incorporated. Formative research results indicated that community stakeholders preferred to focus on adult caregivers and their families. A 5-week educational intervention with hands on demonstrations and colorful visuals was developed, covering the following topics: bacteria and tooth decay, oral hygiene, nutrition, gum disease, and dental services. The CBPR process engaged multiple community stakeholders in all aspects of planning and developing the educational intervention.