Predicting dental treatment workload of U.S. military personnel.

As the demographic composition of the U.S. armed forces shifts, so does dental treatment workload (DTW). To date, the effects of such shifts on DTW have been speculative. This study seeks to build regression models to predict the DTW of recruit and active duty military personnel as service demographic factors shift. The data come from a 1994-1995 random sample of 13,050 active duty and 2,711 recruit personnel. Dental treatment needs were charted for all participants. Patient demographic variables--age, sex, race, education, branch of service, and annual dental utilization (for all); home region and marital status (recruits only); and rank (active duty only)--were noted. Treatment needs were converted to composite time values. Respondent demographic factors were regressed on composite time values to determine which factors influence DTW using backward, stepwise, linear regression. Results show that DTW varies across demographic categories. The magnitude and direction of change in DTW as service demographic variables shift can be predicted with linear regression models.

Put more "bite" into health promotion: a campaign to revitalize health promotion in the Army Dental Care System. Part IV. Implementation.

During the course of 1998, the Army Dental Care System (ADCS), in collaboration with the U.S. Army Center for Health Promotion and Preventive Medicine, launched Put More "Bite" into Health Promotion, a campaign to revitalize health promotion in the ADCS. This article discusses implementation issues for health promotion campaigns.

Put more "bite" into health promotion: a campaign to revitalize health promotion in the Army Dental Care System. Part I. The mouthguard, sealant, and nursing caries initiatives.

During the course of 1998, the Army Dental Care System launched "Put More 'Bite' into Health Promotion," a campaign to revitalize health promotion in the Army Dental Care System. In this paper, we discuss the content, rationale, and evidence base for three of five health promotion initiatives that are part of the campaign: mouthguard fabrication and counseling, sealant placement and education, and nursing caries education.

Dental health promotion and preventive dentistry practices of U.S. Army dentists.

In May 1997, all Army dentists assigned full-time to clinical duties (1,100) were sent a mail survey that queried how often they deliver dental health promotion and preventive dentistry services and the type and source of their patient educational materials. By August, 606 dentists had responded. Simple frequencies were generated using SPSS. Results show that tobacco, oral hygiene, and periodontal counseling and oral cancer and blood pressure screening are delivered frequently, whereas nursing caries, mouthguard, sealant, and nutrition services are delivered infrequently. Army dentists relied almost exclusively on oral presentations to deliver health promotion messages. Few used more than one source for health promotion materials. These results suggest that the delivery of dental health promotion and preventive dentistry services in the Army is suboptimal. A campaign to heighten provider awareness of the importance of delivering these services should be launched. The campaign should also teach providers how to make their health promotion efforts maximally effective through the application of proven health marketing techniques.

Do military dentists advise tobacco users to quit? The patient's perspective.

This study explores whether tobacco users in the US military report having been counseled against tobacco use by a military dentist. The data come from a 26-site survey of active duty Army, Navy, Marine, and Air Force personnel conducted from April 1994 to January 1995. A prestratified, random sample was drawn. Women and minorities were oversampled. Respondents provided demographic and tobacco use data by self-administered questionnaires. Of 12 950 respondents (81% response rate), 4777 reported using some type of tobacco. Prior to analysis, the data were weighted to reflect the military population. Bivariate and logistic regression analysis were employed to determine what demographic and clinical factors are associated with having been counseled against tobacco use. Results show that among tobacco users, cigarettes (73%) are the most popular type of tobacco consumed followed by snuff (23%), pipes (12%), chewing tobacco (8%), and cigars (5%). Advisement to cease tobacco use varies across type of tobacco consumed, with snuff users (72%) most likely and pipe smokers (57%) least likely being advised to quit. Logistic regression results show that advisement to quit tobacco use varies across patient demographics but is unrelated to periodontal health status. Military dentists should be encouraged to counsel all patients who use tobacco to quit.

Estimated cost of dental treatment for active duty and recruit U.S. military personnel.

This paper estimates the cost of restoring U.S. military personnel to optimal oral health. The data come from a 30-site oral health survey of Army, Navy, Marine Corps, and Air Force personnel conducted from February 1994 to January 1995. A systematic random sample of 2,711 recruits was drawn. From a prestratified, random sample of 15,924 active duty personnel, 13,050 (82% response rate) participated in the survey. Applying their best clinical judgment, one dentist per site charted comprehensive dental treatment needs on each service member. Radiographs were used. After the samples were weighted to reflect the 1994 population of recruits (202,144) and active duty personnel (1,699,662), treatment costs were calculated applying median fees reported by U.S. general dentists in 1995. Results show total estimated costs of $1.9 billion for active duty personnel and $203 million for recruits. Periodontal disease accounts for the greatest proportion (47%) of active duty treatment costs, and oral surgery accounts for the greatest proportion (32%) of recruit treatment costs. The cost of restoring U.S. service members to optimal oral health is substantial.

Put More "Bite" into Health Promotion: a campaign to revitalize health promotion in the Army Dental Care System. II. The cancer initiatives.

During the course of 1998, the Army Dental Care System launched Put More "Bite" into Health Promotion, a campaign to revitalize health promotion in the Army Dental Care System. In this paper, we discuss the content, rationale, and evidence base for one of five health promotion initiatives that are part of the campaign: lip, oral, and skin cancer screening and counseling.

U.S. service members' satisfaction with family dental care.

This paper reports on U.S. service members' satisfaction with family dental care. The data come from a 26-site survey of active duty Army, Navy, Marine, and Air Force personnel conducted from April 1994 to January 1995. Of 12,050 respondents (81% response rate) to a prestratified, random sample, 4,412 had at least one child younger than age 21 or a nonmilitary spouse and answered 16 questions on satisfaction with family dental care. We derived simple distributions and an overall composite satisfaction score using factor analysis. Composite scores, transformed into a continuous variable with a mean of 100 and a standard deviation of 10, were regressed on respondent demographic and other factors to determine which factors influence overall satisfaction. Descriptive results show high satisfaction with family dental care. Regression results show that overall satisfaction varies with sex, branch of service, perceived barriers to dental care, and family dental insurance status. Because this survey was conducted before the change to the current dental insurance contractor, these findings may not reflect current service members' satisfaction with family dental care.

Satisfaction of active duty U.S. service members with military dental care.

This study explores the satisfaction of active duty service members with military dental care. The data were collected from April 1994 to January 1995. A prestratified, random sample of 15,915 service members was drawn. Of 12,050 respondents (81% response rate), 11,200 had an annual dental visit and answered 22 questions on satisfaction with military dental care. We calculated simple descriptive statistics and derived a composite overall satisfaction score using factor analysis. We then converted composite scores into a satisfaction index, a continuous variable with a mean of 100 and a standard deviation of 10. The satisfaction index was regressed on respondent demographics to determine which factors influence service members' overall satisfaction with military dental care. Results show that satisfaction with military dental care is high and consistent across respondent demographics. However, because this study was conducted before the recent, sizable drawdown of military dental personnel, these findings may not describe the current state of satisfaction with military dental care.

Determinants of dental insurance status for U.S. military families.

This study explores what factors influence whether active duty U.S. military personnel enroll their families in Department of Defense (DoD) or non-DoD dental insurance plans. The data come from a 26-site, cross-sectional survey of U.S. service members conducted from April 1994 to January 1995. A prestratified, randomly selected target sample of 15,915 service members yielded 12,950 respondents (81% response rate); 7,243 of these had insurance-eligible families. Age, gender, ethnicity, education, rank, marital status, branch of service, number of children, number of years of military service, and insurance status of respondents were collected on self-administered questionnaires. We performed stepwise, backward, logistic regression analysis to determine which factors influence a military family's dental insurance status. Results show that enrollment in DoD insurance is influenced by every demographic factor collected; enrollment in non-DoD insurance is influenced by fewer factors. The decision by U.S. service members to enroll their families in dental insurance plans is subject to many and complex influences.

Comparing tobacco use among incoming recruits and military personnel on active duty in the United States.

OBJECTIVE: To compare the tobacco use profile of recruits with that of military personnel on active duty to determine whether the military environment in some way induces service members to initiate tobacco use. DESIGN AND SETTING: Cross-sectional survey of United States armed forces active duty and recruit personnel in 1994-95. SUBJECTS: 2711 military recruits and 4603 military personnel on active duty. MAIN OUTCOME MEASURES: Comparative cigarette smoking and smokeless tobacco use prevalence between recruits and personnel on active duty controlling for age, sex, and race. Impact of demographic factors on the odds of smoking or using smokeless tobacco. RESULTS: Increases in tobacco use in American military personnel occurred exclusively in men. The highest tobacco use resided with white men on active duty (43% cigarette smoking; 24% smokeless tobacco use) and represents a doubling of tobacco use seen among white male recruits. Among non-white men, tobacco use increased 2-4 times between recruits and personnel on active duty. CONCLUSIONS: Efforts to reduce tobacco use by American military personnel on active duty should focus more on discouraging the initiation of tobacco use.

Factors influencing perceived need for dental care by United States military recruits.

This study explores factors that influence perceived need for dental care among US military recruits. The data were collected on a systematic random sample of 2711 US Army, Air Force, Navy, and Marine Corps recruits between February and July 1994. Participants received a comprehensive oral examination from a dentist and answered perceived need queries on self-administered questionnaires. Using bivariate and logistic regression analyses, we examined the association between demographic and clinical measures and perceived need for dental care. Bivariate results show that, overall, 61% of US military recruits perceive a need for dental care, with statistically significant differences across many demographic and clinical factors. Logistic regression results show that the likelihood of perceived need is influenced by gender, branch of service, dental health class, home region of the US, calculus, bleeding gums, level of decay, and dental utilization.

Dental sealants: prevalence and need in U.S. military recruits.

This paper explores the need for and the prevalence of dental sealants in U.S. military recruits. The data come from the 1994 Tri-Service Comprehensive Oral Health Survey. Data were collected on 2,711 Army, Air Force, Marine Corps, and Navy recruits at one recruit in-processing center per service. Women and minorities were oversampled. Both bivariate and logistic regression analysis were done on the need for at least one dental sealant and the prevalence of at least one dental sealant in recruits. Weighted data (101,072) were used for the bivariate analyses; unweighted data were used in the regressions. Results show that 8.7% of recruits need dental sealants and that 14.8% have dental sealants. Need for dental sealants varies across branch of service only, whereas prevalence of dental sealants varies across age, race, and branch of service. The cost-effectiveness of dental sealants in this population should be established.

Comparing annual dental utilization rates of active duty U.S. military personnel and their employed civilian cohorts.

This study compares annual dental utilization rates between a representative sample of active duty U.S. military personnel (N = 11,765) and a national sample of employed U.S. civilians (N = 10,798). Military data were collected between April 1994 and January 1995 at 26 sites using self-administered questionnaires on a prestratified, random sample of Army, Air Force, Navy, and Marine personnel. Women and blacks were oversampled. Civilian data are from the most recent U.S. oral health survey of working adults. Results show that annual dental utilization rates of service members exceed those of their employed civilian cohorts. Overall, 86% of active duty military personnel have seen a dentist in the past year versus barely half of employed civilians. For service members, annual dental utilization is invariant across age, sex, race, education, branch of service, and rank. Dental health class and perceived need for dental care are inversely related to annual dental utilization.

Dental utilization by spouses of active duty U.S. military personnel.

This study explores dental utilization and access barriers to dental care for spouses of active duty U.S. military personnel as reported by their military sponsor. It also compares dental utilization of spouses and civilians. The data, collected using self-administered questionnaires between April 1994 and January 1995, are from 5,732 Army, Air Force, Navy, and Marine personnel with nonmilitary spouses. Comparative civilian data are from the most recent (1985-1986) U.S. oral health survey of working adults. Results show that dental utilization of military spouses parallels that of civilians. Cost was the most commonly cited barrier to dental care for spouses. Logistic regression results show that the likelihood of a spouse having seen a dentist within the past year is influenced by insurance status, sex, branch of service of sponsor, and rank of sponsor. Insurance status is the strongest predictor of dental utilization for spouses.

The need for and prevalence of dental sealants in active duty U.S. military personnel.

This paper explores the need for and the prevalence of dental sealants in active duty U.S. military personnel. The data come from the 1994 Tri-Service Comprehensive Oral health Survey. Data were collected on 13,050 Army, Air Force, Marine Corps, and Navy active duty personnel at 26 sites. Women and minorities were oversampled. Both bivariate and logistic regression analyses were done on the need for at least one dental sealant and the prevalence of at least one dental sealant in service members. Weighted data (1,669,662) were used for the bivariate analyses; unweighted data were used for the regressions. Results show that 3.6% of service members need dental sealants and that 6.8% have dental sealants. The need for dental sealants varies across age, rank, and branch of service. The prevalence of dental sealants varies across age, race, rank, and branch of service. The cost-effectiveness of dental sealants in this population should be established.

Factors influencing perceived need for dental care by active duty U.S. military personnel.

This study explores factors that influence perceived need for dental care among active duty U.S. military personnel. The data were collected on a prestratified random sample of 12,950 (76% response rate) service members between April 1994 and January 1995. Participants received a comprehensive oral examination from a dentist and answered queries concerning perceived need on self-administered questionnaires. Using bivariate and logistic regression analyses, we examined the association between demographic and clinical measures and perceived need for dental care. Bivariate results show that half of all U.S. military personnel perceive a need for dental care, with statistically significant differences across race, rank, education, branch of service, dental health class, and dental utilization. Logistic regression results show that the likelihood of perceived need is influenced by age, race, rank, branch of service, dental disease, dental health class, and dental utilization. Extensive dental decay is the strongest predictor of perceived need in this population.

Satisfaction of active duty soldiers with family dental care.

In the fall of 1992, a random, worldwide sample of 6,442 married and single parent soldiers completed a self-administered survey on satisfaction with 22 attributes of family dental care. Simple descriptive statistics for each attribute were derived, as was a composite overall satisfaction score using factor analysis. Composite scores were regressed on demographics, annual dental utilization, and access barriers to identify those factors having an impact on a soldier's overall satisfaction with family dental care. Separate regression models were constructed for single parents, childless couples, and couples with children. Results show below-average satisfaction with nearly all attributes of family dental care, with access attributes having the lowest average satisfaction scores. Factors influencing satisfaction with family dental care varied by family type with one exception: dependent dental utilization within the past year contributed positively to satisfaction across all family types.

Comparing dental utilization of United States of America military recruits with their employed civilian cohorts.

This study compares the dental utilization of United States of America (USA) military recruits with that of their employed civilian cohorts. Military data were collected between February and June 1994 at one recruit in processing site per service, using self-administered questionnaires on a prestratified, systematic, random sample of 2369 Army, Air Force, Navy, and Marine recruits. Women and blacks were oversampled. Civilian data come from the most recent oral health survey of working adults in the USA. Results show that annual dental utilization rates of military recruits equal or are less than those of their employed civilian cohorts. Overall, 38% of recruits have seen a dentist in the past year, while 30% have not seen a dentist in 3 or more years. Such low consumption of dental care suggests that dental utilization habits prior to service entry do not contribute appreciably to the high dental utilization rates seen among active duty US military personnel.

Factors influencing dental utilization by U.S. military recruits.

This study identifies factors that influence dental utilization by U.S. military recruits prior to entering military service. Data were collected between February and June 1994 at one recruit in-processing site per service using self-administered questionnaires. A prestratified, systematic, random sample of 2,711 Army, Air Force, Navy, and Marine recruits was drawn. Women and minorities were oversampled. Using logistic regression to determine what factors contribute to the likelihood of recruits having seen a dentist over the past year reveals that the likelihood is greater for females, singles, Air Force personnel, Native Americans, and the better educated; the likelihood is less for recruits who are black, above 19 years old, from the Midwest, Southwest, or Pacific regions of the U.S., and who perceive a need for dental care. Education is the strongest predictor of dental utilization prior to entering military service.