Predictors of the Utilization of Oral Health Services by Children of Low-income Families in the United States: Beliefs, Cost, or Provider?

  • Published : 2004.12.01

Abstract

Purpose. This study examined the predictive factors enabling access to children's oral health care at the level of financial barriers, beliefs, and the provider. Methods. In-depth interviews were conducted with 320 immigrant mothers of low-income families regarding their use of oral health services for children aged four to eight years old. Access to oral health care was measured with frequency of planned dental visits, continuity of care, and age at first visit to dentist. Results. The mother took her child to the dentist at a younger age if she received referrals to a dentist from pediatrician. Regular dental visits were significantly related to household income, provider availability on week-ends, and insurance coverage. The extended clinic hours in the evenings, and the belief in the importance of the child's regular dentist visits increased the likelihood of continuing care. The mothers perceiving a cost burden for the child's dental care were also less likely to return to the dentist. Conclusion. The available care delivery system, coordinated medical care, and health beliefs were among important predictors of the health service use. The study findings suggest need for culturally competent dental health interventions to enhance access to oral health care among particularly vulnerable populations such as low-income children in Korean communities.

Keywords

References

  1. Aday, L.A. & Forthofer R. N. (1992). A Profile of black and Hispanic subgroups' access to dental care: Findings from the national health interview survey. Journal of Public Health Dentistry, 52(4), 210-215
  2. American Dental Association. Your Child's Teeth: Baby-First-Visit. Academy of Pediatric Dentistry. Retrieved from the Web at May 10, 2003. http://WWW.ada.org.public/faq/infants.html
  3. Caplan, D.J. & Weintraub, J.A. (1993). The oral health burden in the United States: A summary of recent epidemiologic studies. Journal of Dental Education, 57(12), 853-862
  4. Davidson, P.L., Cunningham, W.E., Nakazono, T.T., & Andersen, RM. (1999). Evaluating the effects of usual sources of dental care on access to dental services: Comparison among diverse populations. Medical Care Research and Review, 56(1), 74-93
  5. Edelstein, B., & Douglass, C. (1995). Dispelling the myth that 50 percent of U.S. schoolchildren have never had a cavity. Public Health Reports, 110, 522-530
  6. Edelstein, B. (2002). Disparities in oral health and access to care: Findings of national surveys. Ambulatory pediatrics, 2002 (SuppI 2), 141-147
  7. Estrada, A.L., Trevino, F.M., & Ray, L.A. (1990). Health care utilization barriers among Mexican Americans: Evidence from HHANES 1982-1984. American Journal of Public Health, 80, 27-31
  8. Flores, G. & Vegas, A.K. (2000). Latino adult's health insurance coverage: An extension of Mexican and Puerto Rican subgroup difference. Journal of Health Care for the Poor and Underserved, 13(4), 505-525
  9. Garcia, J.A. & Juarez, R. Z. (1978) Utilization of dental services by Chicanos and Anglos. Journal of Health and Social Behavior, 19(4), 428-436
  10. Jin B.H., Ma D.S., Moon, H.S., Hahn, S.H., & Horowitz A.M. (2003). Early childhood caries: Prevalence and risk factors in Seoul, Korea. Journal of Public Health Dentistry, 63(3), 183-188 https://doi.org/10.1111/j.1752-7325.2003.tb03497.x
  11. Jones, J.A., Fedele, D.J., Bolden, A.J., & Bloom. B. (1994). Gains in dental care use not shared by minority elders. Journal of Public Health Dentistry, 54(1), 39-46
  12. Kaste, L.M. & Marianos, D., Chang, R, & Phipps, K.R (1992). The assessment of nursing caries and its relationship to high caries in the permanent dentition. Journal of Public Health Dentistry, 52(2), 64-68
  13. Ma, D.S., Park, D.Y., Park, J.A., & Horowitz, A.M. (2002). Early childhood caries among kindergarten children: prevalence and etiology in Kangnung, Korea. Paper presented at the 80th General Session of the International Association of Dental Research & American Association for Dental Research, San Diego, CA.
  14. Marin, G., Sabogal, F., Marin, B., & Ostero-Sabogal, R. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences, 9(3), 325-334
  15. Morales, L. S., Lara, M, Kington, R, Valdez, R, & Escarce, J. (2002). Socioeconomic, cultural and behavioral factors affecting Hispanic health outcomes. Journal of Health Care for the Poor and Underserved, 13(4), 477-499
  16. Mouradian, W.E., Wehr, E., & Crall, J. (2000). Disparities in children's oral health and access to dental care. Journal of the Americans Medical Association, 284(20), 2625-2631
  17. Nakazono, T.T., Davidson, P.L., & Andersen, R.M. (1997). Oral health beliefs in diverse populations. Advances Dental Research 11(2), 235-244 https://doi.org/10.1177/08959374970110020601
  18. Persky, Y. & Slezak, J. (1994). Hispanic subpopulations in the Chicago Public schools (Technical Report). Chicago, IL: School of Public Health, University of Illinois at Chicago
  19. Saha, S., Komaromy, M., Koepsell, T.D., & Bindman, A.B. (1999). Patient-physician racial concordance and the perceived quality and use of health care. Archives of Internal Medicine, 159(9), 997-1004
  20. Shiboski, C. H., Gansky, S.A., Ramos-Gomez, F., Ngo, L., Isman, R., & Pollick, H.F. (2003). The association of early childhood caries and race/ethnicity among California preschool children. Journal of Public Health Dentistry, 63(1), 38-46
  21. Starfield, B. (1995). Primary care: Concept, evaluation and policy. New York: Oxford University Press
  22. Stewart, D. C., Alexander, N., Ortega, A.N., Dausey, D., & Rosenheck, R. (2002). Oral health and use of dental service among Hispanics. J Public Health Dent, 62(2), 84-91
  23. Vazquez, L. & Swan, J.H. (2003). Access and attitudes toward oral health care among Hispanics in Wichita, Kansas. Journal of Dental Hygiene, 77(4), 85-96
  24. Vitullo, M.W. & Taylor, AX (2002). Latino adults' health insurance coverage: An examination of Mexican and Puerto Rican subgroup differences. Journal of Health Care for the Poor and Underserved, 13 (4), 504-525
  25. U. S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and Improving Health, (2th edition). Washington, DC: U.S. Government Printing Office