Year of Publication

2014

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Christina Studts, PhD

Committee Member

Pamela Teaster

Committee Member

Robin Vanderpool, DrPH, CHES

Committee Member

Corrine Williams

Abstract

Oral health is often considered merely the absence of disease. However, oral health involves much more. Good oral health facilitates very basic functions like eating and speaking; a healthy smile is also associated with good self-esteem and productivity.1 Most oral health diseases are largely preventable. Despite this, a large portion of the population in the United States still suffer from untreated dental decay.2 Poor oral health has a direct effect on systemic health, quality of nutrition, digestion, phonetics, selfimage and self-esteem.5 Whether considered individually or combined, each of these factors has a direct impact on the quality of life of children and adults. According to the Centers for Disease Control and Prevention (CDC), oral health in the United States has shown substantial improvements in the last two decades. However, racial and ethnic minorities have larger unmet oral health needs when compared to the general population.3 According to the CDC, Hispanic and African American populations are the most disproportionally affected groups. Between 1999 and 2004, 22.8% of non-Hispanic White adults between 35 and 44 years old had untreated dental decay, compared to 40.2% of Mexican Americans.3 Although Hispanic adults have nearly twice as much untreated dental decay as compared to White non-Hispanic adults,3 existing research has failed to determine the main factors explaining this disparity. According to Stewart et al. and Perez et al., acculturation plays a role in accessing dental care.7,8 In contrast, Jaramillo et al. found that acculturation assessed by language spoken was not associated with past dental visits.9 Other proposed explanatory factors include lack of dental insurance, poverty, and level of education.7 Furthermore, Cortes et al. detailed several specific barriers that Hispanics have to overcome in accessing oral health care, such as work schedule conflicts and dependence on public transportation.10 Finally, according to Allukian, Hispanics may have difficulty accessing dental services because of the lack of culturally competent providers4 To find appropriate solutions for current oral health disparities, it is necessary to develop a clear understanding of the issue. Factors underlying the difference in tooth decay incidence between Hispanic and non-Hispanic Whites must be identified, particularly because the importance of oral health goes beyond the mouth; it has a direct impact on systemic health as well as overall functioning. Increasing the proportion of Hispanics who access preventive dental care is critical. Prevention plays a crucial role in the remediation of oral health problems by decreasing health care costs and reducing potential complications later on.6 This study will compare factors affecting accessibility, affordability and availability of dental services between Hispanics and non-Hispanic Whites in the U.S. It will also assess differences between these groups in factors influencing the incidence of oral health problems. The primary hypothesis is that Hispanics will be more likely to report needing care but not being able to get it, compared to non-Hispanic Whites. In addition, the secondary hypothesis is that among all of the respondents who did not get care when they needed it, the respondent-identified factors reducing the availability, accessibility, and affordability of oral health care will differ between Hispanics and non- Hispanic Whites. The final hypothesis is that, among Hispanic respondents only, acculturation will play a direct role in whether participants needed but did not receive dental care. Given that current research on this topic is somehow contradictory, the results of this paper will help inform future solutions such as special interventions for minority groups, which may include community outreach programs, changes in current policies, and reduction of identified barriers, among others.

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