Using the Expanded Andersen Model to Determine Factors Associated with Mexican Adolescents' Utilization of Dental Services.

Many factors contribute as facilitators of or barriers to adolescents' use of dental services. Guided by the expanded Andersen model for dental service utilization, the aim of this study was to identify factors associated with the use of dental services among adolescents ages 12-16 in south Mexico City (n = 247). Adolescents answered a questionnaire on predisposing factors (age and gender), enabling factors (socioeconomic status, oral health support, parental years of education, and previous dental treatments), and psychosocial and behavioral factors (attitudes towards oral health; knowledge of gingivitis; alcohol, drug, and tobacco use; and depressive symptoms), and they underwent a visual clinical exam to determine their need factors (caries and gingivitis). The adolescents reported whether or not they had attended a dental visit in the last year for any reason. Multiple logistic regression was used to evaluate these factors. Having oral health support increased the odds of a dental visit by 2.69 (95% CI = 1.24-5.84). Previous dental treatment increased the odds of a dental visit by 2.25 (95% CI = 1.12-4.52). The presence of depressive symptoms reduced the odds of a dental visit by 4% (OR = 0.96, 95% CI = 0.94-0.99). Enabling and psychosocial factors of oral health support and previous dental treatment were positively associated with the utilization of dental services, while depressive symptoms were negatively associated.

Relationship Between Sexual Orientation and Human Papillomavirus-Related Oral Cancer Knowledge and Awareness.

Purpose: Human papillomavirus (HPV)-related oral cancers are increasing, and lesbian, gay, bisexual, and other people with a minority sexual orientation may be disproportionately impacted. This study examined the relationship between sexual orientation and HPV-related oral cancer knowledge. Methods: Data from 10,859 adult participants in the 2017-2019 Health Information National Trends Survey 5, cycles 1-3, were obtained. The three data sets were merged, and weighted multiple imputation (n = 15) was applied to address missingness. Weighted logistic regression analyses examined differences in HPV-related oral cancer knowledge between sexual minority versus heterosexual participants by sex, after adjustment for race, ethnicity, age, education, income, insurance, regular medical provider, and smoking status. Results: In this weighted sample, age ranged from 18 to 101 years (mean = 56.3 years); 42% were males, 5.2% were sexual minority men/women, and 94.8% were heterosexual/straight. Overall, only 19% of respondents were aware that HPV can cause oral cancer. After controlling for sociodemographic factors, there were no significant differences in HPV-related oral cancer knowledge for sexual minority men (adjusted odds ratio [AOR]: 1.10; 95% confidence interval [95% CI]: 0.86-1.42) or women (AOR: 0.98; 95% CI: 0.76-1.26) compared with those who were heterosexual/straight. Conclusion: Overall, knowledge of HPV-related oral cancer was low, regardless of sexual orientation. There were no differences in HPV-related oral cancer knowledge between sexual minority men and women compared with their heterosexual counterparts. Educational programs are needed to increase awareness of the HPV/oral cancer link. Further research on differences in HPV-related oral cancer knowledge and attitudes by sexual orientation and the intersection of other demographic factors is warranted.

Association between developmental dental anomalies, early childhood caries and oral hygiene status of 3-5-year-old children in Ile-Ife, Nigeria.

BACKGROUND: To determine the association between developmental dental anomalies (DDA), early childhood caries (ECC) and oral hygiene status of 3-5-year-old children resident in Ile-Ife, Nigeria. METHODS: This was a cross-sectional study. We analyzed data for 3-5-year-olds extracted from the dataset of a household survey collected to determine the association between ECC and maternal psychosocial wellbeing in children 0-5-year-old. The outcome variables for the study were ECC and poor oral hygiene. The explanatory variable was the presence of developmental dental anomalies (supernumerary, supplemental, mesiodens, hypodontia, macrodontia, microdontia, peg-shaped lateral, dens evaginatus, dens invaginatus, talons cusp, fusion/germination, hypoplasia, hypomineralized second molar, fluorosis, amelogenesis imperfecta). The prevalence of each anomaly was determined. Poisson regression analysis was conducted to determine the association between presence of developmental dental anomalies, ECC and oral hygiene status. The model was adjusted for sex, age and socioeconomic status. RESULTS: Of the 918 children examined, 75 (8.2%) had developmental dental anomalies, 43 (4.7%) had ECC, and 38 (4.1%) had poor oral hygiene. The most prevalent developmental dental anomalies was enamel hypoplasia (3.9%). Of the 43 children with ECC, 6 (14.0%) had enamel hypoplasia and 3 (7.6%) had hypomineralized second primary molar. There was a significant association between ECC and enamel hypoplasia (p < 0.001) and a borderline association between ECC and hypomineralized second primary molars (p = 0.05). The proportion of children with poor oral hygiene (PR: 2.03; 95% CI: 0.91-4.56; p = 0.09) and ECC (PR: 2.02; 95% CI: 0.92-4.46; p = 0.08) who had developmental dental anomalies was twice that of children with good oral hygiene and without ECC respectively, although the differences did not reach statistical significance. CONCLUSIONS: Enamel hypoplasia and hypomineralized second primary molars are developmental dental anomalies associated with ECC. developmental dental anomalies also increases the probability of having poor oral hygiene in the population studied.

Periodontal disease and its connection to systemic biomarkers of cardiovascular disease in young American Indian/Alaskan natives.

BACKGROUND: Periodontal disease has been shown to be associated with cardiovascular disease (CVD). No known studies evaluate the relationship between periodontal disease status and biomarkers of CVD risk in the American Indian/Alaskan Native (AI/AN) population despite their disproportionately high rates of poor oral health and cardiovascular disease-related outcomes. This study compared levels of interleukin (IL)-6 and C-reactive protein (CRP) across increasing severity of periodontal disease status among younger adults between the ages of 21 and 43 years. METHODS: Plasma levels of IL-6 and CRP were measured in adult participants (ages 21 to 43 years) as part of a study of periodontal disease and CVD risk among an AI/AN population in southern California (n = 59). Periodontal evaluations were performed and disease status was classified into three categories based on highest probing depth (none/mild: < 3 mm; moderate: 4 to 5 mm; severe: ≥6 mm). Participants with known systemic disease or active infection were excluded. RESULTS: Severe periodontitis was significantly associated with increased levels of IL-6 compared with those with none or mild periodontitis before controlling for other variables (P = 0.02), but lacked significance after controlling for sex, BMI, smoking status, and high-density lipoprotein (P = 0.09). Moderate periodontal disease was positively associated with IL-6 levels after controlling for potential confounders (P = 0.01). Periodontal status was not associated with CRP, before or after adjusting for covariates. CONCLUSIONS: In this otherwise healthy AI/AN adult sample, moderate periodontal disease compared with none or mild periodontal disease was associated with increased levels of IL-6. High levels of CRP found in this population warrant further research.

Factors Affecting Implementation of the California Childhood Obesity Research Demonstration (CA-CORD) Project, 2013.

INTRODUCTION: Ecological approaches to health behavior change require effective engagement from and coordination of activities among diverse community stakeholders. We identified facilitators of and barriers to implementation experienced by project leaders and key stakeholders involved in the Imperial County, California, Childhood Obesity Research Demonstration project, a multilevel, multisector intervention to prevent and control childhood obesity. METHODS: A total of 74 semistructured interviews were conducted with project leaders (n = 6) and key stakeholders (n = 68) representing multiple levels of influence in the health care, early care and education, and school sectors. Interviews, informed by the Multilevel Implementation Framework, were conducted in 2013, approximately 12 months after year-one project implementation, and were transcribed, coded, and summarized. RESULTS: Respondents emphasized the importance of engaging parents and of ensuring support from senior leaders of participating organizations. In schools, obtaining teacher buy-in was described as particularly important, given lower perceived compatibility of the intervention with organizational priorities. From a program planning perspective, key facilitators of implementation in all 3 sectors included taking a participatory approach to the development of program materials, gradually introducing intervention activities, and minimizing staff burden. Barriers to implementation were staff turnover, limited local control over food provided by external vendors or school district policies, and limited availability of supportive resources within the broader community. CONCLUSION: Project leaders and stakeholders in all sectors reported similar facilitators of and barriers to implementation, suggesting the possibility for synergy in intervention planning efforts.

Association of diabetes with tooth loss in Hispanic/Latino adults: findings from the Hispanic Community Health Study/Study of Latinos.

OBJECTIVES: To investigate the association between diabetes mellitus and missing teeth in Hispanic/Latino adults from diverse heritage groups who reside in the USA. RESEARCH DESIGN AND METHODS: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multicenter, population-based study of 18-74 years old who underwent a physical and oral examination (n=15 945). Glycemic status was categorized as diabetes, impaired, or normal, based on medication use, and American Diabetes Association criteria for fasting glucose and glycosylated hemoglobin (HbA1c). HbA1c<7% indicated good glycemic control, and HbA1c>7% indicated uncontrolled diabetes. We estimated ORs and 95% CIs for missing >9 teeth and being edentulous (missing all natural teeth), after adjustment for age, income, education, Hispanic background, study site/center, nativity, last dental visit, health insurance, diet quality, cigarette smoking, obesity, periodontitis, and C reactive protein. RESULTS: Persons with uncontrolled diabetes had a significant increased likelihood of missing >9 teeth and being edentulous as compared with persons with normal glycemic status (adjusted OR=1.92, 95% CI 1.44 to 2.55 and adjusted OR=1.73, 95% CI 1.22 to 2.46, respectively). The association appeared to be stronger at younger ages (18-44 years old; p for interaction <0.0001). However, we found no associations of either impaired glycemia or controlled diabetes with tooth loss in adjusted models. CONCLUSIONS: Dentists should be aware of their Hispanic patients' diabetes status and whether or not they are well controlled, because these may affect tooth loss and impair oral function, which can lead to poor nutrition and complications of diabetes.

Correlates of past year dental health visits: findings from the Indiana black men's health study.

OBJECTIVES: To examine the role of social support and additional predisposing, enabling and need factors that may be associated with past year dental visits among adult Black men. METHODS: Data came from a 2011 study of 1,444 Black men from 12 Indiana counties. Based on Andersen's Behavioral Model of Health Service Utilization, we conducted multivariable logistic regression analyses examining predisposing (age, sex, marital status, education), enabling (income, employment, health insurance, place of sick care, social support) and need factors (self-reported smoking status, health status, mental health days, and fruit and vegetable consumption). RESULTS: Overall, 42% of African American males sought dental care in the past year. Several predisposing (being married, having a college degree), enabling (being unemployed, having higher income, having health insurance and reporting high levels of social support) and need (increased fruit consumption) factors were found to be positively associated (P < 0.05) with past year dental care utilization in the fully adjusted model. Vegetable consumption was not significantly associated with past year dental use. CONCLUSION: Adult black men in this sample underutilized dental services. Results suggest several factors that can be used to target Black men to increase utilization rates. In particular, social support may be a promising factor that should be explored in further studies.

Adult oral health status in California, 1995-2006: demographic factors associated with tooth loss due to disease.

The most recent 2006 estimates indicate that 60 percent of California adults did not experience tooth loss due to disease. However, about 39 percent were missing one or more teeth due to disease, and another 1 percent were edentulous. In an 11-year (1995-2006) pooled multivariate analysis, California adults who were older, less educated, racial/ethnic minorities, current or former smokers, or had lower annual incomes were more likely to be missing teeth.

Correlates of cigarette smoking among low-income African American women.

OBJECTIVE: This study examines individual and contextual correlates of cigarette smoking in a randomly selected, community-based sample of low-income African American women. DESIGN: The study sample was selected by using a two-stage area probability sample design. SETTING: Participants were recruited from > 12,000 housing units selected from 39 census tracts in the city of Detroit. PARTICIPANTS: Participants for this study include a total of 921 women who completed the baseline assessment of a randomized clinical trial aimed at improving the oral health of African American families. MAIN OUTCOME MEASURES: Past month prevalence of cigarette use and number of cigarettes smoked during this period. RESULTS: Data were analyzed with fixed-effects and multilevel statistics. Social support was the only variable associated, inversely, with current smoking. Self-reported feelings of anger were positively associated, though marginally, with current smoking. Between-neighborhood variance was small, and no neighborhood level variables were associated with cigarette smoking. CONCLUSIONS: Previously established risk factors did not predict cigarette use in this randomly selected, community-based sample of low-income African American women. Further research is needed to identify risk and protective factors that might be unique to low-income African American populations in order to better inform preventive and cessation interventions.

Cigarette smoking among low-income African Americans: a serious public health problem.

BACKGROUND: This study examines the current prevalence of cigarette smoking and the number of cigarettes smoked in a community-based sample of 1021 low-income African-American men and women. METHODS: Participants were selected using a two-stage, area probability sample design. Data were collected in 2002-2003 in face-to-face interviews and analyzed in 2005. All data and analyses were weighted to account for the complex sampling design. RESULTS: Fifty-nine percent of men and 41% of women were current smokers, with younger individuals apparently initiating smoking at an earlier age than older individuals. CONCLUSIONS: The high prevalence of cigarette use provides further evidence that the excess burden of tobacco-related disease among low-income African-American families may be on the rise. This is of great concern, and if confirmed by further research, indicates an urgent need for preventive intervention.