Factors associated with use of preventive dental and health services among U.S. adolescents

Maternal and Child Health Bureau, Office of Data and Information Management, Rockville, Maryland 20857, USA.
Journal of Adolescent Health (Impact Factor: 3.61). 01/2002; 29(6):395-405.
Source: PubMed


To examine adolescents' use of preventive medical and dental services and its relationship to demographic characteristics and other variables reflecting access to and need for care.
Self- and parent-reported data from a sample of 5644 adolescents aged 11 to 21 years from the National Longitudinal Study of Adolescent Health (Add Health). Variables studied include the influence of both the adolescents' demographic and socioeconomic characteristics (age, race/ethnicity, place of birth, acculturation, insurance status, and perception of health), as well as those of their parents (race/ethnicity, income, level of education, place of birth) on their lifetime use and use within the past year of medical and dental services. Bivariate and logistic regression analyses were conducted using SAS and SUDAAN.
Approximately 32% of respondents had not had a physical examination in the year before the survey, and the same percentage had not had a dental examination. Approximately 2% reported never having had either a physical or a dental examination. Logistic regression reveals that lack of insurance, low family income, and low parental education level are significantly associated with the lack of preventive medical care. Lack of an annual dental visit was associated with male gender; black, Hispanic, or mixed race/ethnicity; and lack of insurance. Never having had a dental visit was the only dependent variable found to be associated with place of birth.
Health insurance and family income are most consistently related to adolescents' use of preventive medical and dental care. However, the relationship between lack of dental care and place of birth emphasizes the need to improve access to dental services for immigrant teens. These findings are particularly relevant as states design systems of care for adolescents under the State Children's Health Insurance Program.

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    • "English proficiency was associated with dental visit in Hispanic adults but not in Asians [35]. Among adolescents of various origins, those born in other countries were less likely to visit dentists [36]. "
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    ABSTRACT: The impact of acculturation on systemic health has been extensively investigated and is regarded as an important explanatory factor for health disparity. However, information is limited and fragmented on the oral health implications of acculturation. This study aimed to review the current evidence on the oral health impact of acculturation. Papers were retrieved from five electronic databases. Twenty-seven studies were included in this review. Their scientific quality was rated and key findings were summarized. Seventeen studies investigated the impacts of acculturation on the utilization of dental services; among them, 16 reported positive associations between at least one acculturation indicator and use of dental services. All 15 studies relating acculturation to oral diseases (dental caries and periodontal disease) suggested better oral health among acculturated individuals. Evidence is lacking to support that better oral health of acculturated immigrants is attributable to their improved dental attendance. Further researches involving other oral health behaviors and diseases and incorporating refined acculturation scales are needed. Prospective studies will facilitate the understanding on the trajectory of immigrants' oral health along the acculturation continuum.
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    • "About 35.7% of Hispanics were under 18 years of age. Immigrants face a range of health issues; especially those related to healthcare access and insurance (Kaiser Commission on Medicaid and the Uninsured, 2000; Huang, 1997; Yu et al., 2001; Carrasquillo, 2000). Nearly 14 million children in the United States are immigrants or had an immigrant parent in 2000, and almost 1 in 6 children under 18 live with a foreign-born householder (Schmidley, 2001). "
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    ABSTRACT: Using nationally representative National Health Interview Survey (NHIS) data from 1999 through 2002, this study examines the health services access and utilization patterns of U.S. Hispanic adolescents under age 18 years classified as: Cubans, Puerto Ricans and Dominicans, Mexicans or Mexican Americans, Central and South Americans, and mixed Hispanic and non-Hispanic White. Consistent with previous studies on ethnic patterns in child and adult health, Hispanic American children do better than non-Hispanic Whites with respect to certain health status measures such as school absence. There is considerable heterogeneity in health status and health care utilization in the Hispanic subgroup, indicating the necessity of separating Hispanic subgroups for analytic purposes.
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    ABSTRACT: Previous studies suggest that Medicaid-enrolled children have difficulties accessing dental care, which can lead to untreated dental disease, poor oral health, and compromised overall health status. While Medicaid-enrolled children with a chronic condition (CC) encounter additional barriers to dental care, most relevant studies on dental utilization fail to adopt risk adjustment methods. As such, the impact of CC status and CC severity on access to dental care for Medicaid-enrolled children is poorly understood. The main objectives of this dissertation were to: 1) compare dental utilization for Medicaid-enrolled children with and without a CC; 2) assess the relationship between CC severity and dental utilization; and 3) identify the other factors associated with dental utilization. The 3M Clinical Risk Grouping (CRG) Methods were applied to enrollee-level data from the Iowa Medicaid Program (2003-2008) to identify children with and without a CC and to classify children with a CC into a CC severity level. Three outcome measures were developed: 1) access to an annual dental visit; 2) use of dental services under general anesthesia (GA); and 3) time to the first dental visit after initial enrollment into the Medicaid program. We used multiple variable logistic regression models and survival analytic techniques to test our study hypotheses. Compared to Medicaid-enrolled children without a CC, those with a CC were more likely to have had an annual dental visit and earlier first dental visits. Having a CC was an important determinant of dental utilization under GA for older but not for younger Medicaid-enrolled children. In terms of CC severity, Medicaid-enrolled children with more severe CCs were less likely to have had an annual dental visit and more likely to have utilized dental services under GA. CC severity was not associated with the rate at which the first dental visit took place. Not residing in a dental Health Professional Shortage Area, previous use of dental care, and previous utilization of primary medical care were all positively associated with dental utilization. Identifying and understanding the determinants of access to dental care is an important first step in developing clinical interventions and policies aimed at improving access to dental care for all Medicaid-enrolled children. Future work should focus on identifying the socio-behavioral determinants of as well as the clinical outcomes associated with access to dental services for vulnerable children.
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