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Ethnicity and Self-Perceived Oral Health in Colombia: A Cross-Sectional Analysis
Abstract
Unlabelled:
To estimate the association between self-perceived oral health indicators and ethnic origin in Colombia, a cross-sectional study (Information from the 2007 National Public Health Survey) was conducted.
Variables:
belonging to an ethnic group (Exposure); oral health indicators (Outcomes); sex, age, education and self-rated health (control). Analyses were carried out separately for men (M) and women (W). The association between the exposure variable and the outcomes was estimated by means of adjusted odds ratio (OR) with confidence intervals (95% CI) using logistic regression. Men were more likely to report gum bleeding (aOR 1.78; 95% CI 1.44-2.23) and dental caries (aOR 1.69; 95% CI 1.42-2.02), while women were more likely to report unmet dental needs (aOR 1.43; 95% CI 1.27-1.49) and dental caries (aOR 1.34; 95% CI 1.22-1.47). Indigenous and Palenquero were more likely to report most of the indicators analyzed. Minority ethnic groups in Colombia were at risk to report oral health problems.
... Locker has also found that Canadian children had better oral health status and less presence of gingivitis compared to those immigrants with lower financial and social levels in Ontario (10), Andres study has showed that immigrants had 98% gingivitis and 85% periodontitis which were higher than Canadian society index rates (11).In 2015 a study on 13 poor cites in Brazil has showed relations between gingivitis among teenagers, and demographic and financial status (12), Another study in Brazil has showed the contra relation between gingivitis and the kids awareness of their oral hygiene and daily life (13). ...
... This was greater than the 74.3% among refugee students living in regular homes and the 72.7% among non-refugees. This indicates the role of refuge and place of residence (psychological and social factors) on increasing gingivitis, which agrees with multiple studies (11)(12)(13)(22)(23)(24), Andres(11) stated that gingivitis prevalence was at 98% among immigrants, which was higher than percentages among Canadian society. There were no significant differences for the prevalence of gingivitis between refugees living in regular homes and non-refugees. ...
... 16 Causes for disparities of these determinants are also influenced by biological, behavioural, political and socioeconomic factors, with gender, education, income, occupation and ethnicity playing a predominant role. 17 Cultural beliefs, values and practices are often implicated as causes of oral health disparities between various ethnic groups. [18][19][20] Malaysia offers a unique setting for gaining insight into the effect of ethnic diversity on oral health in an Asian population. ...
Background:
Poor oral health affects not only dietary choices but overall well-being. This study explores the influence of lifestyle, socio-demographics and utilization of dental services on the dentition status of an older urban Malaysian population.
Methods:
A total of 1210 participants 60 years and above, representing the three main ethnic groups were recruited from a larger cohort study. Weighted factors valued for comparison included socio demographics and health status. Knowledge of and attitude and behaviour towards personal oral health were also assessed. Dentition status, adapted from WHO oral health guidelines, was the dependent variable investigated. Data were analysed using descriptive chi square test and multivariate binary logistic regression.
Results:
Overall, 1187 respondents completed the study. The dentition status and oral health related knowledge, attitude and behaviour varied between the three ethnic groups. The Chinese were significantly less likely to have ≥13 missing teeth (OR = 0.698, 95% CI: 0.521-0.937) and ≥1 decayed teeth (0.653; 0.519-0.932) compared to the Malays, while the Indians were significantly less likely than the Malays to have ≥1 decayed teeth (0.695; 0.519-0.932) and ≥2 filled teeth (0.781; 0.540-1.128).
Conclusion:
Ethnic differences in dentition outcome are related to oral health utilization highlighting the influence of cultural differences and the need for culturally sensitivity interventions.
... Por otro lado, otros estudios muestran peores indicadores en la población afrodescendiente explicado por determinantes sociales, condiciones de vida y dificultades de acceso a los servicios de salud (14,15). En Colombia, han sido limitadas las investigaciones específicas enfocadas a poblaciones diversas étnica y culturalmente (16). Este estudio parte de un interés por conocer una realidad social en un grupo específico de escolares en el departamento del Chocó en la costa pacífica colombiana, con el fin de contribuir a la generación de estrategias de promoción y prevención, de acuerdo con la situación encontrada, y sensibilizar a los diferentes actores encargados de las políticas y estrategias en salud de la región. ...
RESUMEN. Antecedentes: Es necesario identificar la situación de salud bucal en grupos específicos para establecer programas efectivos. Objetivo: Describir el estado de higiene bucal, caries dental y de necesidades de tratamiento en escolares de 5, 7 y 12 años del municipio de Istmina (Chocó). Métodos: Se realizó un estudio descriptivo en 294 escolares (48 % niñas), seleccionados por conveniencia, de seis instituciones educativas oficiales. Por medio de encuesta y examen clínico se recogió información sociodemográfica, uso de elementos de higiene bucal, grado de higiene bucal, índices ceo-d y COP-D (y sus componentes) y necesidades de tratamiento. Se efectuó análisis descriptivo univariado y bivariado e inferencial mediante Chi cuadrado. Resultados: Dos terceras partes de la población analizada tenían una higiene oral regular (mayor porcentaje en niños y en escolares de 7 años). El promedio ceo-dM fue de 2,5 ± 3,2, lo cual equivale a una prevalencia y experiencia de caries dental del 57 % y 59 % respectivamente. El promedio COP-DM fue de 0,6 ± 1,2, con una prevalencia y experiencia de caries dental del 24 % y 28 % respectivamente. El índice significativo de caries fue de 1,9 ± 1,5. El 47 % requería obturaciones (promedio de 1,9 ± 1,5). Se presentaron diferencias significativas por edad y sexo tanto para caries dental como para necesidades de tratamiento. Conclusiones: Los indicadores de caries dental estaban en consonancia con las metas internacionales. Se identificaron algunas diferencias según factores sociodemográficos que requieren estudios a mayor profundidad desde la perspectiva de determinantes sociales.ABSTRACT. Background: It is necessary to identify the oral health situation in specific groups to establish effective programs. Objective: To describe the oral hygiene status, dental caries and treatment needs in 5-, 7-, and 12-year-old schoolers of the municipality of Istmina (Chocó). Methods: A descriptive study was conducted in 294 schoolchildren, selected by convenience, (48 % girls) from six official educational institutions. Sociodemographic information (age and sex), use of oral hygiene elements, oral hygiene level, dmf-t and DMT-F indexes (and their components), and treatment needs data were collected through survey and clinical examination. Descriptive univariate and bivariate and inferential (Chi-square test) analyses were carried out. Results: Two-thirds of the population analyzed had poor oral hygiene levels (higher percentage among boys and 7-year-olds). The dmf-tM was 2.5 ± 3.2, which is equivalent to dental caries prevalence and experience of 57 % and 59 %, respectively. The mean DMF-TM was 0.6 ± 1.2, with dental caries prevalence and experience of 24 % and 28 % respectively. The Significant Caries Index was 1.9 ± 1.5. 47 % required fillings (average 1.9 ± 1.5). Age and sex differences were found for dental caries and treatment needs. Conclusions: Although the indicators of dental caries were in accordance with the international goals, some differences according to sociodemographic factors were evidenced. Thus, more in-depth studies from the social determinants approach are required.
... Also, living in under-resourced communities was associated with greater decayed, missing and filled teeth among a birth cohort of Indigenous Australians aged 16-20 years [14]. Minority ethnic groups in Colombia were also at risk to report oral health problems [15]. Disparities have been attributed to a complicated network of social, psychological, and structural aspects, such as healthcare use or access, nutrition and oral hygiene [9,16]. ...
Regional contextual factors and dental caries using multilevel modeling related to adults in minority ethnic groups have been scantily explored. The influence of the socioeconomic context on self-reported dental caries (SRDC) in individuals of minority ethnic groups (IEG) in Colombia was studied. Data from the 2007 National Public Health Survey were collected in 34,843 participants of the population. The influence of different factors on SRDC in IEG was investigated with logistic and multilevel regression analyses. A total of 6440 individuals belonged to an ethnic group. Multilevel analysis showed a significant variance in SRDC that was smaller in IEG level than between states. Multilevel multivariate analysis also associated SRDC with increasing age, lower education level, last dental visit >1 year, unmet dental need and low Gross Domestic Product (GDP). Minority ethnic groups were at risk to report higher dental caries, where low GDP was an important variable to be considered.
Objectives
With the increasing number of family caregivers due to the ageing population, physical and mental health problems among caregivers are of concern. However, few studies have evaluated their oral health. This study aimed to evaluate the association between being a family caregiver and recent dental visits for dental symptoms in Japan, with consideration of gender.
Methods
A cross‐sectional study was conducted using the 2016 Comprehensive Survey of Living Conditions (CSLC) in Japan. Participants with dental symptoms were included in this study. The primary outcome was recent dental visits. The exposure variable of interest was being a primary caregiver for a family member requiring long‐term care. A logistic regression analysis was conducted adjusting for contributing factors such as age, gender, marital status, working hours per week, education, household expenditure per month, self‐rated health and the interaction between gender and caregiving. A stratified analysis by gender was also performed.
Results
Of the 5100 eligible participants, 233 (4.6%) were family caregivers. Of all participants, 2746 (53.8%) reported dental visits. The adjusted odds ratio (aOR) of family caregivers having recent dental visits was 0.83 (95% confidence interval [CI], 0.64–1.09). In a gender stratified analysis, family caregivers were less likely to visit dental clinics than were non‐family caregivers in the male subsample (aOR: 0.56, 95% CI: 0.34–0.92) but not in the female subsample (aOR: 0.99, 95% CI: 0.72–1.38).
Conclusions
The findings indicate that family caregivers, especially male caregivers, had fewer dental visits than non‐family caregivers. These findings suggest the need to improve the accessibility of dental clinics to family caregivers with dental symptoms.
Article Title and Bibliographic Information
Dental caries in South American Indigenous people: A systematic review. Soares GH, Pereira NF, Gabriela M, Biazevic H, Braga MM, Michel-Crosato E. Community Dent Oral Epidemiol 2019;47(2):142-52.
Source of Funding
Brazilian National Council for Scientific and Technological Development (CNPq).
Type of Study/Design
Systematic review with meta-analysis.
Background
Health inequalities, including inequalities in oral health, are problems of social injustice worldwide. Evidence on this issue from low-income and middle-income countries is still needed. We aimed to examine the relationship between oral health and different dimensions of socioeconomic position (SEP) in Colombia, a very unequal society emerging from a long-lasting internal armed conflict.
Methods
Using data from the last Colombian Oral Health Survey (2014), we analysed inequalities in severe untreated caries (≥3 teeth), edentulousness (total tooth loss) and number of missing teeth. Inequalities by education, income, area-level SEP and health insurance scheme were estimated by the relative index of inequality and slope index of inequality (RII and SII, respectively).
Results
A general pattern of social gradients was observed and significant inequalities for all outcomes and SEP indicators were identified with RII and SII. Relative inequalities were larger for decay by health insurance scheme, with worse decay levels among the uninsured (RII: 2.57; 95% CI 2.11 to 3.13), and in edentulousness (RII: 3.23; 95% CI 1.88 to 5.55) and number of missing teeth (RII: 2.08; 95% CI 1.86 to 2.33) by education, with worse levels of these outcomes among the lower educated groups. Absolute inequalities followed the same pattern. Inequalities were larger in urban areas.
Conclusion
Health insurance and education appear to be the main contributors to oral health inequalities in Colombia, posing challenges for designing public health strategies and social policies. Tackling health inequalities is crucial for a fairer society in a Colombian post-conflict era and our findings highlight the importance of investing in education policies and universal health care coverage.
This survey examined the oral health knowledge and psychological determinants of oral health behavior of 1019 undergraduate and postgraduate nursing students. Overall, most of the students perceived their oral health to be average, and their flossing and dental visiting frequencies were inadequate. Moreover, the students' oral health knowledge was suboptimal, regardless of the type of study, and it was not significantly associated with oral health behavior. Binary logistic regression showed that toothbrushing self-efficacy and the type of study were both significantly associated with toothbrushing behavior. Furthermore, flossing self-efficacy and dental visiting self-efficacy were both significantly associated with flossing and dental visiting behaviors, respectively.
© The Author(s) 2015.
This study aims to analyze the prevalence of use of oral health services in elderly population in Colombia according to selected socio-demographic and health outcomes. Cross-sectional analysis with information for 2650 subjects > 65 years provided by the 2007 National Public Health Survey. Variables: Use of oral health services, self-rated health, oral health problems, oral pain, dental caries, gum bleeding, sex, educative level and ethnic origin. Multivariate Logistic regressions were conducted for the use of health services and different demographic and health variables by means of Odds Ratio (OR), and 95% Confidence Intervals (95%CI). Analyses were conducted separately for men (M) and women (W). Logistic regression analysis showed that women with university studies (aOR 21.76; 95% CI 9.7248.73), with dental problems (aOR 3.29; 95% CI 2.264.77), specifically gum bleeding (aOR 4.91; 95% CI 1.8812.80) and men with dental caries (aOR 8.22; 95% CI 4.1114.41) were more likely to report the recent use of oral health services. Use of oral health services is higher in people belonging to minority groups, but no statistically significant differences were found. Differences in the usage profile for elderly people were found according to socio-demographic and health variables. More research is needed in order to explain some controversial results.
Background: oral health is integral to health from the eruption of the first tooth. To achieving, it is necessary an early establishment of healthy oral habits as regular dental checkups. In developed countries, caries is the most prevalent chronic pediatric disease and it may be increasing in preschool age. Objectives: a) assessing prevalence of oral health services use among Spanish preschool population, b) quantifying and analyzing the existence of variability among autonomous community and c) identifying variables associated with such use. Methods: cross-sectional study about Spanish National health Survey (2006). Sample: 2,172 children aged between 2 and 5 years (both inclusive). Dependent variable: have gone to dental services at least once during life. Independent variables: sociodemographic, self-referred dental health, habits and family socioeconomic status variables. Multivariate logistic regression analysis. Results: 20.8% of Spanish preschoolers reported had attended dental services. Probability of use increased with age (OR: 1,88; IC:1,53-2,31), frequency of daily tooth brushing (three or more times per day vrs less than once: OR: 2,94; IC: 1,47-5,87) and presence of caries (OR: 2,60; IC: 1,22-5,51). There is a socioeconomic gradient about probability of use: it increased with family socioeconomic status measured by social class (low vrs high: OR: 0,41; IC: 0,19-0,86) and maternal educational level (OR: 1,62; IC: 1,13-2,32). There was not variability in the oral health services use attributable to the autonomous community. Conclusions: the use of dental health services among Spanish preschool population is lower than desirable. The promotion of its use should be intensified in children from disadvantaged families.
Traducción del manuscrito en inglés de María Luisa Valencia) Resumen Este artículo revisa en primer lugar evidencia de la exclusion económica, política y social de los grupos descendientes de África e indígenas. A continuación se inspeccionan la multitud de reformas legales y políticas multiculturalistas que tuvieron lugar en la región durante los últimos 15 a 20 años, antes de analizar los diferentes argumentos que se han propuesto para explicar este cambio en las políticas del Estado hacia las minorías étnicas, balanceando argu-mentos que destacan los intereses del Estado y del capitalismo contra aquellos que enfatizan los organismos de los movimientos de minorías étnicas. Finalmente, el artículo intenta evaluar el impacto de las reformas sobre los pautas de exclusión social de las minorías étnicas, con enfoque especial en la región costera del Pacífico Colombiano como estudio de caso. Palabras clave: Grupos Afrodescendientes e Indígenas, Reformas legales y políticas multi-culturalistas, exclusión social de minorías étnicas, América Latina, región pacífica. Abstract The article first reviews evidence of the economic, political and social exclusion of Afro-descendent and indigenous groups in Latin America. Then it surveys the array of multiculturalist legal and political reforms that have taken place in the region in the last 15-20 years, before analyzing the various arguments that have been proposed to explain this shift in state policy towards ethnic minorities, balancing arguments that highlight the interests of the state and capitalism against those that emphasize the agency of ethnic minority movements. Finally, the article attempts to assess the impact of the reforms on patterns of social exclusion of ethnic minorities, with a focus on the Colombian Pacific coastal region as a case study.
The practice of dentistry has conducted reflexive process according the other academic disciplines. This paper proposes the implementation of a new political field in the oral health agenda in Colombia by means of exploring some social and health indicators. Furthermore, principles in collective oral health were raised: the oral health as a fundamental right, the community capacity for assuming the health control and their determinants, and the participation of social, economic, and academic actors and the health care services. A protagonist role in the society is required and a major collective consciousness concerning the professionals, the decision-makers and the health sector in general.
Objectives:
To analyze the variables associated with the use of oral health services in the last year by the population aged 6 to 15 years living in Spain and to determine whether there is variability in the use of these services among autonomous regions and, if so, whether this variability could be explained by variables related to the care model of the distinct autonomous regions.
Methods:
A cross-sectional study of the Spanish National Health Survey (2006) was carried out. Independent variables were individual (sociodemographic, dental disease, habits and socioeconomic) and contextual (type of dental care model and prevalence of unemployment in the autonomous region). Association was estimated by multilevel logistic regression.
Results:
Variance in the use of oral health services among autonomous regions was 0.16 (SE: 0.07), and 4.8% of the total variability was attributable to the autonomous region. The variables included in the model explained 83.11% of the variance. Individual variables associated with an increased likelihood of using dental services were the presence of disease and the frequency of brushing. Individual variables associated with a lower likelihood were age, origin, intake of sugary soft drinks and socioeconomic status. The contextual variables of being covered by a dental care model (of the type Childhood Dental Care Plan) older than 10 years doubled the likelihood of using oral health services compared with those without such coverage (OR=2.47, CI=2.04-2.99).
Conclusions:
The use of oral health services during the last year by the pediatric population in Spain is lower than recommended. This use is associated with individual variables (demographic, dental health, habits and socioeconomic factors) and contextual variables (dental care model).
El propósito de este estudio es: (1) analizar la asociación entre masculinidad y feminidad con salud; (2) explorar si hay diferencias en masculinidad y feminidad entre las personas de doscomunidades autónomas españolas. La muestra estaba formada por 533 personas de la población general. No se encontraron diferencias en masculinidad ni en feminidad entre las personas de ambas comunidades autónomas. Masculinidad se asociaba con autoestima en mujeres y hombres. En las mujeres, masculinidad se asociaba con mejor salud mental y feminidad se asociaba con autoestima. En la muestra de hombres, feminidad se asociaba con sintomatología de ansiedad y somática y con autoconfianza.
Background: oral health is integral to health from the eruption of the first tooth. To achieving, it is necessary an early establishment of healthy oral habits as regular dental checkups. In developed countries, caries is the most prevalent chronic pediatric disease and it may be increasing in preschool age. Objectives: a) assessing prevalence of oral health services use among Spanish preschool population, b) quantifying and analyzing the existence of variability among autonomous community and c) identifying variables associated with such use. Methods: cross-sectional study about Spanish National health Survey (2006). Sample: 2,172 children aged between 2 and 5 years (both inclusive). Dependent variable: have gone to dental services at least once during life. Independent variables: sociodemographic, self-referred dental health, habits and family socioeconomic status variables. Multivariate logistic regression analysis. Results: 20.8% of Spanish preschoolers reported had attended dental services. Probability of use increased with age (OR: 1,88; IC:1,53-2,31), frequency of daily tooth brushing (three or more times per day vrs less than once: OR: 2,94; IC: 1,47-5,87) and presence of caries (OR: 2,60; IC: 1,22-5,51). There is a socioeconomic gradient about probability of use: it increased with family socioeconomic status measured by social class (low vrs high: OR: 0,41; IC: 0,19-0,86) and maternal educational level (OR: 1,62; IC: 1,13-2,32). There was not variability in the oral health services use attributable to the autonomous community. Conclusions: the use of dental health services among Spanish preschool population is lower than desirable. The promotion of its use should be intensified in children from disadvantaged families.
We measured racial/ethnic inequalities in US children's dental health and quantified the contribution of conceptually relevant factors.
Using data from the 2007 National Survey of Children's Health, we investigated racial/ethnic disparities in selected child dental health and preventive care outcomes. We employed a decomposition model to quantify demographic, socioeconomic, maternal health, health insurance, neighborhood, and geographic effects.
Hispanic children had the poorest dental health and lowest preventive dental care utilization, followed by Black then White children. The model explanatory variables accounted for 58% to 77% of the disparities in dental health and 89% to 100% of the disparities in preventive dental care. Socioeconomic status accounted for 71% of the gap in preventive dental care between Black children and White children and 55% of that between Hispanic children and White children. Maternal health, age, and marital status; neighborhood safety and social capital; and state of residence were relevant factors.
Reducing US children's racial/ethnic dental health disparities-which are mostly socioeconomically driven-requires policies that recognize the multilevel pathways underlying them and the need for household- and neighborhood-level interventions.
To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents.
Secondary data analysis of the 2003 National Survey of Children's Health. The survey focus was children 0-17 years old.
Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/Pacific Islander, American Indian/Alaskan Native, and multiracial adolescents 10-17 years old (n = 48,742) to identify disparities in 40 measures of health and health care.
Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/Alaska Natives; and not receiving all needed dental care in multiracial youth.
U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents.
This document briefly describes the health conditions of the Colombian population and, in more detail, the characteristics of the Colombian health system. The description of the system includes its structure and coverage; financing sources; expenditure in health; physical material and human resources available; monitoring and evaluation procedures; and mechanisms through which the population participates in the evaluation of the system. Salient among the most recent innovations implemented in the Colombian health system are the modification of the Compulsory Health Plan and the capitation payment unit, the vertical integration of the health promotion enterprises and the institutions in charge of the provision of services and the mobilization of additional resources to meet the objectives of universal coverage and the homologation of health benefits among health regimes.
Identifying inequalities in gaining access to health services resulting from ethnicity in Bogota.
39 in-depth interviews with focus groups and six members of ethnic groups were conducted during 2007. Qualitative findings were contrasted with the results from statistically processing data from the Quality of Life Survey 2003 and characterising the Primary Health Care strategy called 'Health in your Home in Bogota', discriminating the following variables: demographic, socio-economic, needs, access and health outcomes.
The following ethnic groups were characterised: indigenous people, black people, gypsies and islanders. Differences in socioeconomic status, education, employment, access to health insurance, use of health services and outcomes were documented as these were considered to be inequities related to the following determinants: ethnic and racial discrimination, differences in social, economic and political status and violation of rights, interactions between immigration, acculturation and assimilation and differentials exposure.
There are ethnic inequities in gaining access to health services because there is no adequate access as required; there is violation of rights, discrimination, a lack of adaptation and appreciation of differences. These situations are considered to be examples of cultural and distributive injustice. Ethnicity determines levels of social vulnerability and takes specific forms regarding life, health and disease, thereby becoming a structural determinant of studying ethnic-equity in gaining access to health services.
An overview of some of the key processes and results of Colombia's National Health System is presented. A systematic review of the literature evaluating the quality of the evidence published in indexed journals and literature not published in journals was made. Health system financial resources have seen a sustained increase while spending on health has remained at around 8% of GNP. Coverage, measured by affiliation to contributory and subsidized regimes, is in the order of 92% of the total population. The Mandatory Health Plan, defining the benefits to which one has access, has been broadly maintained but has been hampered by mechanisms for making legal complaints, thereby leading to financial deficits. The health system has contributed towards improving the poorest sector's income, but inequalities persist due to the lack of universal coverage, differences in health plans and the system's expenditure according to the population's income. Advances made in the National Health System have been positive but universality has not been achieved and this has stagnated in matters regarding access to services and equality.
The 2002 Institute of Medicine (IOM) report Unequal Treatment summarized research on racial and ethnic disparities in health care defined as “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.”1 The report documented extensive disparities in health care; however, the mechanisms underlying these disparities are less well understood and are likely multifactorial. One possible mechanism may be systematic bias or discrimination within the healthcare context, which would decrease quality of care, or patient perceptions of discrimination, which would influence care-seeking behavior and adherence. Studies have documented an association between perceptions of racial/ethnic discrimination and a delay in seeking treatment,2–4 lower adherence to treatment regimens, 4,5 and lower rates of follow up.4 The great majority of research on perceptions and experiences of discrimination in healthcare has focused on blacks,3,6–21 and there is a “relative paucity” of research on other groups.
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.
There is insufficient empirical evidence which shows if and how there is an interrelation between acculturation and health care utilisation. The present study seeks to establish this evidence within first generation Turkish and Moroccan migrants, two of the largest migrant groups in present-day Western Europe.
Data were derived from the Amsterdam Health Monitor 2004, and were complete for 358 Turkish and 288 Moroccan foreign-born migrants. Use of health services (general practitioner, outpatient specialist and health care for mental health problems) was measured by means of self-report. Acculturation was measured by a structured questionnaire grading (i) ethnic self-identification, (ii) social interaction with ethnic Dutch, (iii) communication in Dutch within one's private social network, (iv) emancipation, and (v) cultural orientation towards the public domain.
Acculturation was hardly associated with the use of general practitioner care. However, in case of higher adaptation to the host culture there was less uptake of outpatient specialist care among Turkish respondents (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.82-0.99) and Moroccan male respondents (OR = 0.81, 95% CI = 0.71-0.93). Conversely, there was a higher uptake of mental health care among Turkish men (OR = 0.81, 95% CI = 0.71-0.93) and women (OR = 0.81, 95% CI = 0.71-0.93). Uptake of mental health care among Moroccan respondents again appeared lower (OR = 0.74, 95% CI = 0.55-0.99). Language ability appeared to play a central role in the uptake of health care.
Some results were in accordance with the popular view that an increased participation in the host society is concomitant to an increased use of health services. However, there was heterogeneity across ethnic and gender groups, and across the domains of acculturation. Language ability appeared to play a central role. Further research needs to explore this heterogeneity into more detail. Also, other cultural and/or contextual aspects that influence the use of health services require further identification.
Antecedentes: En los estudios transversales las medidas de asociación clásicamente descritas son la razón de odds (odds ratio, OR) y la razón de prevalencias (prevalence ratio, PR). Algunos estudios epidemiológicos con diseño transversal expresan sus resultados en forma de OR, pero utilizan la definición de PR. El objetivo principal de este trabajo es describir y comparar diferentes métodos de cálculo de la PR discutidos en la bibliografía reciente en dos escenarios (prevalencia < 20% y prevalencia > 20%). Material y métodos: Se realizó una búsqueda bibliográfica para conocer las técnicas más utilizadas para la estimación de la PR. Los 4 procedimientos más empleados fueron: a) seguir obteniendo OR mediante regresión logística no condicional, pero utilizando su definición correcta de OR; b) utilizar una regresión de Breslow-Cox; c) utilizar un modelo lineal generalizado con la transformación logaritmo y familia binomial, y d) utilizar una fórmula de conversión de una OR, obtenida mediante regresión logística tradicional, a una PR. Se han replicado para cada uno de los dos escenarios (prevalencia < 20% y prevalencia > 20%) los modelos hallados utilizando datos reales de la Encuesta de Salud de Catalunya de 1994. Resultados: No se observan grandes diferencias entre las estimaciones ni entre los errores estándar obtenidos al utilizar una u otra técnica cuando la prevalencia es baja. Cuando la prevalencia es alta existen diferencias entre los estimadores y entre los intervalos de confianza, aunque todas las medidas mantienen la significación estadística. Conclusión: Todos los métodos propuestos tienen sus pros y sus contras, y debe ser el propio investigador/a quien escoja la técnica que mejor se adapte a sus datos y ser coherente a la hora de utilizar un estimador y su interpretación.
The Millennium Development Goals (MDG) progress targets have not been met. Nevertheless, the United Nations (UN) has not yet undertaken in-depth review in order to discover the reasons behind this lack of progress in achieving the MDG. From a political epidemiology perspective, the intention here is to identify the political elements affecting the social factors impeding MDG fulfilment and, at the same time, to suggest future public policies and appropriate proposals that are both more coherent and supported by broader, empirical knowledge of the relevant issues.
The availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced. The market distribution of medical care is a primitive and historically outdated social form, and any return to it would further exaggerate the maldistribution of medical resources.
The importance of public policy as a determinant of health is routinely acknowledged, but there remains a continuing absence of mainstream debate about the ways in which the politics, power and ideology, which underpin public policy influence people's health. This paper explores the possible reasons behind the absence of a politics of health and demonstrates how explicit acknowledgement of the political nature of health will lead to more effective health promotion strategy and policy, and to more realistic and evidence-based public health and health promotion practice.
Ethnic minority patients seem to be confronted with barriers when using health services. Yet, care providers are often oblivious to these barriers, although they may share to some extent the burden of responsibility for them. In order to enlighten care providers, as to the potential pitfalls that may exist, there is a need to explore the different factors in the creation of the barriers.
Therefore, the objective of this paper is to present an overview of the potential barriers and the factors, which may restrict ethnic minority patients from using health services, according to the literature available.
Articles published from 1990 to 2003 were identified by searching electronic databases and selected through titles and abstracts. The articles were included if deemed to be relevant to study health services use by ethnic minorities, i.e. the different factors in the creation of a barrier.
There were 54 articles reviewed. They reported on studies carried out in different countries and among different ethnic minorities. Potential barriers occurred at three different levels: patient level, provider level and system level. The barriers at patient level were related to the patient characteristics: demographic variables, social structure variables, health beliefs and attitudes, personal enabling resources, community enabling resources, perceived illness and personal health practices. The barriers at provider level were related to the provider characteristics: skills and attitudes. The barriers at system level were related to the system characteristics: the organisation of the health care system.
This review has the goal of raising awareness about the myriad of potential barriers, so that the problem of barriers to health care for different ethnic minorities becomes transparent. In conclusion, there are many different potential barriers of which some are tied to ethnic minorities. The barriers are all tied to the particular situation of the individual patient and subject to constant adjustment. In other words, generalizations should not be made.
Dental caries, otherwise known as tooth decay, is one of the most prevalent chronic diseases of people worldwide; individuals are susceptible to this disease throughout their lifetime. Dental caries forms through a complex interaction over time between acid-producing bacteria and fermentable carbohydrate, and many host factors including teeth and saliva. The disease develops in both the crowns and roots of teeth, and it can arise in early childhood as an aggressive tooth decay that affects the primary teeth of infants and toddlers. Risk for caries includes physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty. The approach to primary prevention should be based on common risk factors. Secondary prevention and treatment should focus on management of the caries process over time for individual patients, with a minimally invasive, tissue-preserving approach.
The family is the basic institution of the society, the reproductive unit that keeps the human species, and thus, it constitutes the element that centered health production at microsocial scale. The family has important functions in the biological, psychological and social development of the individual and has assured, together with other social groups, the socialization and education of the human being for its integration into the social life and the transfer of cultural values from one generation to the other. We may say that the family is an ecological triade, still partly unknown, difficult to be managed by the dentist. The above-mentioned prompted us to make a literature review on the importance of family in the promotion and prevention of general and oral health status and to update knowledge on our country's situation. It was concluded that the role of the family should be improved in this regard by creating certain health culture that embraces all aspects of life including oral health, in order to better the results in the prevention of diseases and health promotion.
Objetive
To estimate caries prevalence and associated factors in children 2–5 years old in a deprived community.
Desing
Transversal, cross-sectional study.
Setting
Paediatric services. Health centres of Almanjáyar and Cartuja in Granada (Spain).
Patients
173 children attending to a pediatric revision.
Measurements
Children's odontological examination and revision of clinical records followed by structured interview with the mother or tutor. Target variables were caries, sociodemographic factors, nutritional habits, oral hygiene, medical antecedents, familiar experience of caries and use of dentistry services.
Results
Total prevalence of caries was 37%, but 29% among the majority population and 58% in the gipsy group. Statistically significant associated factors with caries were: increasing age (OR = 2,0, 95% CI = 1,2–3,2), father unemployment (OR = 3,1, 95% CI = 1,3–9,9), high consumption of sweets (OR = 3,3, 95% CI = 1,1–8,5), deficient oral hygiene (OR = 9,3, 95% CI = 3,4–24,7), mother's consultation for toothache or tooth extraction (OR = 2,9, 95% CI = 1,1–7,9) and not attendance to dentistry services due to high costs or fear (OR = 4,3, 95% CI = 1,5–12,4).
Conclusions
The prevalence of caries in the gipsy population is very high, and it is probabably associated with factors previously reported but not yet controlled. There is a need to initiate therapeutic and preventive measures in this community, and to detect barriers and facilitate the use of public dentistry services.
The article is based on the argument that labour market segregation is an important factor contributing to women’s inequality in the labour market. Therefore, any equal opportunities policy has to be combined with a policy to reduce segregation. But up to now segregation has been extremely persistent, as is shown in a short empirical overview of segregation in the Austrian labour market. It is argued that the roots of this phenomenon lie in the assignment of men and women to the market area and the reproduction area according to the breadwinner model. Labour market segregation by sex can be seen as a transformation and continuation of the asymmetrical gender relation in the family to the labour market. Most of the mechanisms and processes that occur every day in the labour market work together to preserve sex segregation. Strategies to reduce segregation should look at these historical roots of segregation and at the connection with the overall gender division of labour. Different perspectives on a reduction of labour market segregation are presented.
Objective Identifying inequalities in gaining access to health services resulting from ethnicity in Bogota. Methods 39 in-depth interviews with focus groups and six members of ethnic groups were conducted during 2007. Qualitative findings were contrasted with the results from statistically processing data from the Quality of Life Survey 2003 and characterising the Primary Health Care strategy called "Health in your Home in Bogota", discriminating the following variables: demographic, socio-economic, needs, access and health outcomes. Results The following ethnic groups were characterised: indigenous people, black people, gypsies and islanders. Differences in socioeconomic status, education, employment, access to health insurance, use of health services and outcomes were documented as these were considered to be inequities related to the following determinants: ethnic and racial discrimination, differences in social, economic and political status and violation of rights, interactions between immigration, acculturation and assimilation and differentials exposure. Conclusions There are ethnic inequities in gaining access to health services because there is no adequate access as required; there is violation of rights, discrimination, a lack of adaptation and appreciation of differences. These situations are considered to be examples of cultural and distributive injustice. Ethnicity determines levels of social vulnerability and takes specific forms regarding life, health and disease, thereby becoming a structural determinant of studying ethnic-equity in gaining access to health services.
"This new edition of Social Determinants of Health takes account of the most recent research in the field, and includes additional chapters on ethnicity and health, sexual behaviours, the elderly, housing, and neighbourhoods. It is written by acknowledged experts in each field, using non-technical language to make the book accessible to students and those with no previous expertise in epidemiology. This volume provides the evidence behind the WHO initiatives on the social determinants of health, known as The Solid Facts handbook.". "Social Determinants of Health is the most comprehensive, ground-breaking, and authoritative survey of research findings in this field, and is a must for everyone interested in the wellbeing of modern societies. Public health professionals, health promotion specialists, and anyone working in the many fields of public policy will engage with the issues raised in this book."--BOOK JACKET.
To analyze the variables associated with the use of oral health services in the last year by the population aged 6 to 15 years living in Spain and to determine whether there is variability in the use of these services among autonomous regions and, if so, whether this variability could be explained by variables related to the care model of the distinct autonomous regions.
A cross-sectional study of the Spanish National Health Survey (2006) was carried out. Independent variables were individual (sociodemographic, dental disease, habits and socioeconomic) and contextual (type of dental care model and prevalence of unemployment in the autonomous region). Association was estimated by multilevel logistic regression.
Variance in the use of oral health services among autonomous regions was 0.16 (SE: 0.07), and 4.8% of the total variability was attributable to the autonomous region. The variables included in the model explained 83.11% of the variance. Individual variables associated with an increased likelihood of using dental services were the presence of disease and the frequency of brushing. Individual variables associated with a lower likelihood were age, origin, intake of sugary soft drinks and socioeconomic status. The contextual variables of being covered by a dental care model (of the type Childhood Dental Care Plan) older than 10 years doubled the likelihood of using oral health services compared with those without such coverage (OR=2.47, CI=2.04-2.99).
The use of oral health services during the last year by the pediatric population in Spain is lower than recommended. This use is associated with individual variables (demographic, dental health, habits and socioeconomic factors) and contextual variables (dental care model).
Global Oral Health suffers from a lack of political attention, particularly in low- and middle-income countries. This paper analyses the reasons for this political neglect through the lens of four areas of political power: the power of the ideas, the power of the issue, the power of the actors, and the power of the political context (using a modified Political Power Framework by Shiffman and Smith. Lancet370 [2007] 1370). The analysis reveals that political priority for global oral health is low, resulting from a set of complex issues deeply rooted in the current global oral health sector, its stakeholders and their remit, the lack of coherence and coalescence; as well as the lack of agreement on the problem, its portrayal and possible solutions. The shortcomings and weaknesses demonstrated in the analysis range from rather basic matters, such as defining the issue in an agreed way, to complex and multi-levelled issues concerning appropriate data collection and agreement on adequate solutions. The political priority of Global Oral Health can only be improved by addressing the underlying reasons that resulted in the wide disconnection between the international health discourse and the small sector of Global Oral Health. We hope that this analysis may serve as a starting point for a long overdue, broad and candid international analysis of political, social, cultural, communication, financial and other factors related to better prioritisation of oral health. Without such an analysis and the resulting concerted action the inequities in Global Oral Health will grow and increasingly impact on health systems, development and, most importantly, human lives.
Petersen PE, Kwan S. Equity, social determinants and public health programmes – the case of oral health. Community Dent Oral Epidemiol 2011; 39: 481–487. © 2011 John Wiley & Sons A/S
Abstract – The WHO Commission on Social Determinants of Health issued the 2008 report ‘Closing the gap within a generation – health equity through action on the social determinants of health’ in response to the widening gaps, within and between countries, in income levels, opportunities, life expectancy, health status, and access to health care. Most individuals and societies, irrespective of their philosophical and ideological stance, have limits as to how much unfairness is acceptable. In 2010, WHO published another important report on ‘Equity, Social Determinants and Public Health Programmes’, with the aim of translating knowledge into concrete, workable actions. Poor oral health was flagged as a severe public health problem. Oral disease and illness remain global problems and widening inequities in oral health status exist among different social groupings between and within countries. The good news is that means are available for breaking poverty and reduce if not eliminate social inequalities in oral health. Whether public health actions are initiated simply depends on the political will. The Ottawa Charter for Health Promotion (1986) and subsequent charters have emphasized the importance of policy for health, healthy environments, healthy lifestyles, and the need for orientation of health services towards health promotion and disease prevention. This report advocates that oral health for all can be promoted effectively by applying this philosophy and some major public health actions are outlined.
Salud bucal colectiva, odontología en salud pública, salud colectiva, política de salud, salud bucal, Colombia.
Physical inactivity and an unhealthy diet have been implicated as risk factors for several chronic diseases that are known to be associated with periodontitis, such as cardiovascular diseases, obesity and diabetes. Studies investigating the relationship between periodontitis and physical activity and diet are limited. Therefore, this study was conducted to determine the relationship between physical activity, healthy eating habits and periodontal health status.
A systematic random sample of 340 persons, 18-70 years of age, was selected from persons accompanying their relative patients who attended the outpatient clinics in the medical center of Jordan University of Science and Technology in north of Jordan. Data collected included socio-demographic and clinical characteristics, anthropometric measurements, physical activity level and dietary assessment.
Individuals who were highly physically active had a significantly lower average plaque index, average gingival index, average clinical attachment loss (CAL) and percentage of sites with CAL ≥ 3 mm compared to individuals with a low level of physical activity and individuals with a moderate level of physical activity. Those who had a poor diet had a significantly higher average number of missing teeth and an average CAL compared with those who had a good diet. In the multivariate analysis, a low level of physical activity and a poor diet (diets with a healthy eating index score of < 50 points) were significantly associated with increased odds of periodontitis.
A low physical activity level and a poor diet were significantly associated with increased odds of periodontal disease. Further studies are needed to understand this relationship in greater detail.
In this day and age, public policies that aim to improve equity cannot limit themselves to seeking greater access for all to the job market; the lack of equity is also reflected in unequal access to health services, to education, and to political representation. In order to understand and attempt to correct this unequal access, an approach is needed that takes into account all the sociodemographic factors that shape inequality in the Region of the Americas, most notably sex, ethnic origin, and race. This paper is the product of a request by the Member States of the Pan American Health Organization for PAHO to make known the influence that race, ethnic origin, and sex have on the state of health and on access to health care services. The paper examines how racial discrimination and other forms of intolerance, the low socioeconomic and educational level of certain ethnic and racial groups, and cultural beliefs exert a decisive influence on individuals' search for health care and their possibilities of enjoying good health. This subject is particularly important this year, when the United Nations is holding its World Conference against Racism, Racial Discrimination, Xenophobia and Related Intolerance.
We examined associations between immigration and acculturation attributes and oral disease among immigrants.
We conducted a large cross-sectional study of 1318 immigrants in New York City. We performed comprehensive interviews and oral examinations of the participants and used linear regression models to assess differences in oral disease levels among immigrant subgroups. We also constructed proportional odds models to evaluate the association of oral disease level with length of stay in the United States, age at immigration, and language preference.
After we controlled for most known risk factors, country of birth and age at immigration were associated with variations in oral disease prevalence and need for oral health care. Length of stay was inversely associated with need for treatment of dental caries but not with any other indicator of oral disease. Language preference was not associated with any indicator of oral disease.
Immigrants' country of birth, length of stay in the United States, and age at immigration played important roles in their oral disease prevalence, independently of most known risk factors for oral diseases. Our findings emphasize the need for more studies to elucidate the complex relationships of ethnicity, socioeconomic status, and culturally influenced factors that impact immigrants' oral health.
Ethnic differences exist in oral health. However, the causes of the differences have not been adequately addressed. The objective of this study is to examine the effect of socioeconomic position on ethnic differences in oral health.
Data were from the Third National Health and Nutrition Examination Survey conducted in the USA (1988-94). The effects of income and education on ethnic differences in perceived oral health, gingival bleeding, periodontitis and tooth loss were analysed using a series of regression models.
The probabilities of poorer oral health were higher among African-American, Mexican-Americans and other ethnic groups than in White Americans. Adjusting for income and education resulted in a reduction in the ORs for having poorer perceived oral health (44%), tooth loss (29%), gingival bleeding (61%) and periodontitis (30%) among African-Americans than White Americans. Similar reductions in risk were observed among Mexican-Americans and other ethnic groups.
The results indicate that education and income play an important role in ethnic differences in oral health. Despite the major impact of socioeconomic position, the results imply that there are causes additional to socioeconomic position for ethnic differences in oral health.
The objective of this study is to verify empirically the existence of separate dimensions in the overall concept of health status by analyzing 10 variables included in a questionnaire that was applied to all adults in a simple random sample of households in St John's, Newfoundland. The response rate was 85% for a total of 3300 subjects. These data were analyzed by frequencies and by associations with sex, age and education. Nonparametric correlation, factor and cluster analyses on variables were used to verify if health status had identifiable dimensions. All these methods produced similar results showing five distinct factors. The first factor is composed of variables related to disease (disability/chronic conditions/worry about health); the second, to happiness (happiness/emotional); the third, to subjective appraisal of health (physical condition/comparative level of energy/self-rated health status). Finally, the fourth and fifth factors were single variables; restriction of normal activities and social contacts. An interesting finding was that self-rated health status was distributed with almost equal weight in both the first and third factors. A validation of the 10 variables and the 5 factors was undertaken by studying their association with health care utilization. Two measures of utilization were used; number of physicians' visits in a year and number of hospital days in a 4-year period. Number of chronic conditions, disability and self-rated health status were associated with both measures of utilization; factor 1 was the only summary construct showing association with utilization. This paper demonstrates that self-rated health status is valid as a single measure of overall health status in this sample, being associated with both disease and subjective assessment components.
Men in the United States suffer more severe chronic conditions, have higher death rates for all 15 leading causes of death, and die nearly 7 yr younger than women. Health-related beliefs and behaviours are important contributors to these differences. Men in the United States are more likely than women to adopt beliefs and behaviours that increase their risks, and are less likely to engage in behaviours that are linked with health and longevity. In an attempt to explain these differences, this paper proposes a relational theory of men's health from a social constructionist and feminist perspective. It suggests that health-related beliefs and behaviours, like other social practices that women and men engage in, are a means for demonstrating femininities and masculinities. In examining constructions of masculinity and health within a relational context, this theory proposes that health behaviours are used in daily interactions in the social structuring of gender and power. It further proposes that the social practices that undermine men's health are often signifiers of masculinity and instruments that men use in the negotiation of social power and status. This paper explores how factors such as ethnicity, economic status, educational level, sexual orientation and social context influence the kind of masculinity that men construct and contribute to differential health risks among men in the United States. It also examines how masculinity and health are constructed in relation to femininities and to institutional structures, such as the health care system. Finally, it explores how social and institutional structures help to sustain and reproduce men's health risks and the social construction of men as the stronger sex.
To estimate caries prevalence and associated factors in children 2-5 years old in a deprived community.
Transversal, cross-sectional study.
Paediatric services. Health centres of Almanjáyar and Cartuja in Granada (Spain).
173 children attending to a pediatric revision.
Children's odontological examination and revision of clinical records followed by structured interview with the mother or tutor. Target variables were caries, sociodemographic factors, nutritional habits, oral hygiene, medical antecedents, familiar experience of caries and use of dentistry services.
Total prevalence of caries was 37%, but 29% among the majority population and 58% in the gipsy group. Statistically significant associated factors with caries were: increasing age (OR = 2.0, 95% CI = 1.2-3.2), father unemployment (OR = 3.1, 95% CI = 1.3-9.9), high consumption of sweets (OR = 3.3, 95% CI = 1.1-8.5), deficient oral hygiene (OR = 9.3, 95% CI = 3.4-24.7), mother's consultation for toothache or tooth extraction (OR = 2.9, 95% CI = 1.1-7.9) and not attendance to dentistry services due to high costs or fear (OR = 4.3, 95% CI = 1.5-12.4).
The prevalence of caries in the gipsy population is very high, and it is probably associated with factors previously reported but not yet controlled. There is a need to initiate therapeutic and preventive measures in this community, and to detect barriers and facilitate the use of public dentistry services.
The aim of this preliminary study was to compare the perception of oral health among subgroups of Asian-American residents of New York City, USA.
A close-ended questionnaire was administered to 255 Chinese, 134 Indian and 84 Pakistani adults, aged 18-65 years, during 1994-95. A comprehensive dental and oral examination was also performed. The associations of demographic and oral health variables with perceived oral health were evaluated using multivariate ordinal regression models.
When data were analyzed in a multivariate context, only ethnicity and income were significant predictors of perceived oral health, after adjusting for DMFT. The within-group multivariate analysis of the three ethnic subgroups' results were as follows: Among the Chinese there were no significant predictors, only income was strongly suggestive; among the Indians, number of missing teeth and number of years in the USA were significant predictors; and within the Pakistani group, DMFT was the only significant predictor.
Results suggest that there are ethnic differences in the perception of oral health status even after adjusting for clinical variables as well as for demographic variables in this particular group of Asian-American residents of New York City. Predictors associated with the perception of oral health are different for each ethnic group. When designing oral health promotion activities to diverse ethnic groups, the cultural characteristics of each subgroup should be considered.
In this day and age, public policies that aim to improve equity cannot limit themselves to seeking greater access for all to the job market; the lack of equity is also reflected in unequal access to health services, to education, and to political representation. In order to understand and attempt to correct this unequal access, an approach is needed that takes into account all the sociodemographic factors that shape inequality in the Region of the Americas, most notably sex, ethnic origin, and race. This paper is the product of a request by the Member States of the Pan American Health Organization for PAHO to make known the influence that race, ethnic origin, and sex have on the state of health and on access to health care services. The paper examines how racial discrimination and other forms of intolerance, the low socioeconomic and educational level of certain ethnic and racial groups, and cultural beliefs exert a decisive influence on individuals' search for health care and their possibilities of enjoying good health. This subject is particularly important this year, when the United Nations is holding its World Conference against Racism, Racial Discrimination, Xenophobia and Related Intolerance.
This study aimed to evaluate gender differences in oral health behavior and general health habits in adults. The subjects were 207 males and 196 females aged 20-64 yrs who were public officials in the city or town administrations in Chiba Prefecture, Japan. The questionnaire survey included three items: (1) self assessment of oral health status, (2) oral health behavior and (3) general health habits. Statistical analysis was performed using the chi-square test for differences of responses between males and females. The proportion of subjects with cognition of symptoms of oral disease ranged from 14.3 to 23.0%. The percentage of those who had not visited a dentist in the last year were 52.7% for males and 36.7% for females (p < 0.01). Subjects who brushed their teeth almost every day at bed time were 60.9% of males and 88.8% of females (p < 0.01). A comparison of the numbers of positive responses regarding general health habits found no differences in the distribution of general health habits score between males and females. Examining the relationship between oral health behavior and general health habits revealed that males with general habit high scores tended to have positive oral hygiene behavior. These results support the thesis that gender specificities in oral health depend on individual attitudes to oral health and dental utilization. In addition, understanding the cognitive factors of males and females would accelerate dental approaches to modifying oral health behavior of both groups, thus contributing to lifelong health maintenance.
In recent years public health research has increasingly focused upon exploring the social determinants of health. This interest has partly arisen through an acknowledgement of the limitations of educational preventive approaches in improving population health and reducing health inequalities. Many health education interventions have been influenced by health behaviour research based upon psychological theories and models. These theories focus at an individual level and seek to explore cognitive and affective processes determining behaviour and lifestyle. Current psychological theories have only a limited value in the development of public health action on altering the underlying social determinants of health. New theoretical approaches have however, emerged which explore the relationship between the social environment and health. This paper aims to review and highlight the potential value to oral health promotion of three important public health theoretical approaches: life course analysis, salutogenic model and social capital. It is important that an informed debate takes place over the theoretical basis of oral health promotion. As the field of oral health promotion develops it is essential that it is guided by contemporary and appropriate theoretical frameworks to ensure that more effective action is implemented in the future.
The most commonly used measures of association in cross-sectional studies are the odds ratio (OR) and the prevalence ratio (PR). Some cross-sectional epidemiologic studies describe their results as OR but use the definition of PR. The main aim of this study was to describe and compare different calculation methods for PR described in literature using two situations (prevalence < 20% and prevalence > 20%).
A literature search was carried out to determine the most commonly used techniques for estimating the PR. The four most frequent methods were: 1) obtaining the OR using non-conditional logistic regression but using the correct definition; 2) using Breslow-Cox regression; 3) using a generalized linear model with logarithmic transformation and binomial family, and 4) using the conversion formula from OR into PR. The models found were replicated for both situations (prevalence less than 20% and greater than 20%) using real data from the 1994 Catalan Health Interview Survey.
When prevalence was low, no substantial differences were observed in either the estimators or standard errors obtained using the four procedures. When prevalence was high, differences were found between estimators and confidence intervals although all the measures maintained statistical significance.
All the methods have advantages and disadvantages. Individual researchers should decide which technique is the most appropriate for their data and should be consistent when using an estimator and interpreting it.
Approximately 25% of children under the age of 18 in the Municipality of Copenhagen have a non-Danish ethnic background, and it is suspected that there may be major inequalities in oral health as a result.
The objectives of this study were to describe the occurrence of dental caries in different ethnic minorities, and to analyse whether the dental caries experience of the children may be affected by cultural and behavioural differences.
The study was conducted in Copenhagen as a cross-sectional investigation of 794 children, aged 3 and 5 years old (preschool), 7 years old (Grade 1) and 15 years old (Grade 9). Children of Danish, Turkish, Pakistani, Albanian, Somali and Arabian backgrounds were selected by convenience sampling. Epidemiological data were retrieved from the Danish Recording System for the Public Dental Health Services (SCOR) and sociological data were collected by postal questionnaires.
Marked differences in dental caries prevalence were observed when different ethnic minorities were compared to Danish children. These were most prominent for the primary dentition. At age 7, 53% of the Danish and 84% of the Albanian children were affected by dental caries, the mean caries experience was 3.5 dmfs (decayed, missed and filled surfaces) and 13.8 dmfs, respectively. Caries in incisors and/or smooth surfaces was observed in 10% of the Danish children and 48% of the Albanian children. There were cultural differences in dental attendance and self-care practices of children and parents. These socio-behavioural factors may help to explain the differences in dental caries prevalence and severity.
Development of appropriate oral health promotion strategies is urgently needed to improve oral health behaviour and attitudes of parents and children of ethnic minorities. Preventive programs should be organized at local community level in close collaboration with key persons of ethnic minority societies.
Periodontal diseases are chronic inflammatory disorders encompassing destructive and nondestructive diseases of the periodontal supporting tissues of teeth. Gingivitis is a nondestructive disease ubiquitous in populations of children and adults globally. Aggressive periodontitis is characterized by severe and rapid loss of periodontal attachment often commencing at or after the circumpubertal age and is more prevalent among Latin Americans and subjects of African descent, and least common among Caucasians. Chronic periodontitis is a common disease and may occur in most age groups, but is most prevalent among adults and seniors world-wide. Approximately 48% of United States adults have chronic periodontitis, and similar or higher rates have been reported in other populations. Moderate and advanced periodontitis is more prevalent among the older age groups, and rates of 70% or more have been reported in certain populations. Chronic and aggressive periodontitis are multifactorial diseases caused primarily by dental plaque microorganisms, and with important modifying effects from other local and systemic factors. The study of the significance of demographic, environmental, and biologic variables is important for risk assessment and the control of periodontal diseases.
U.S. healthcare disparities may be in part the result of differential experiences of discrimination in health care. Previous research about discrimination has focused on race/ethnicity. Because immigrants are clustered in certain racial and ethnic groups, failure to consider immigration status could distort race/ethnicity effects.
We examined whether foreign-born persons are more likely to report discrimination in healthcare than U.S.-born persons in the same race/ethnic group, whether the immigration effect varies by race/ethnicity, and whether the immigration effect is "explained" by sociodemographic factors.
The authors conducted a cross-sectional analysis of the 2003 California Health Interview Survey consisting of 42,044 adult respondents. Logistic regression models use replicate weights to adjust for nonresponse and complex survey design.
The outcome measure of this study was respondent reports that there was a time when they would have gotten better medical care if they had belonged to a different race or ethnic group.
Seven percent of blacks and Latinos and 4% of Asians reported healthcare discrimination within the past 5 years. Immigrants were more likely to report discrimination than U.S.-born persons adjusting for race/ethnicity. For Asians, only the foreign-born were more likely than whites to report discrimination. For Latinos, increased perceptions of discrimination were attributable to sociodemographic factors for the U.S.-born but not for the foreign-born. Speaking a language other than English at home increased discrimination reports regardless of birthplace; private insurance was protective for the U.S.-born only.
Immigration status should be included in studies of healthcare disparities because nativity is a key determinant of discrimination experiences for Asians and Latinos.
The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.