TY - JOUR
T1 - Predictors of dental care utilization in north-central Appalachia in the USA
AU - Chen, Mengxia
AU - Wright, Casey D.
AU - Tokede, Oluwabunmi
AU - Yansane, Alfa
AU - Montasem, Alexander
AU - Kalenderian, Elsbeth
AU - Beaty, Terri H.
AU - Feingold, Eleanor
AU - Shaffer, John R.
AU - Crout, Richard J.
AU - Neiswanger, Katherine
AU - Weyant, Robert J.
AU - Marazita, Mary L.
AU - McNeil, Daniel W.
N1 - Funding Information:
Most of all, we thank those individuals and families who participated in the COHRA1 study, without whom this work would not be possible. Appreciation also is expressed to those community partners who provided research space and support in both West Virginia and Pennsylvania. Thanks also are extended to the West Virginia Rural Health Education Partnerships program and community advisory boards for the Center for Oral Health Research in Appalachia. The present research teams in West Virginia (Linda Brown, Dr. Elizabeth Kao, Renea LoPetrone, Natalie Marquart, Aliyah S. Pugh, Karolyn Ruggles and Barb Thaxton) and Pittsburgh (Jill Beach, Wendy Carricato, Zelda Dahl, Tonya Dixon, Jessica Ferraro, Jennifer Maurer, Chika Richter, Alicia Wicks, Lauren Winter and Jayme Zovko), and their predecessors, are recognized with appreciation. This research was supported by grants from the National Institute of Dental and Craniofacial Research (R01 DE014899) and the National Institute of General Medical Sciences (T32 GM081741).
Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2019/8
Y1 - 2019/8
N2 - Objectives: Dental utilization is an important determinant of oral health and well-being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north-central Appalachia, USA, a region where oral health disparities are profound. Methods: This study used household-based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north-central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best-fitting predictor model for dental utilization among adult family members. Results: On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3-year time period (OR = 2.20, 95% CI = 1.54, 3.14). When stratified by state, the association held for only West Virginia (OR = 2.41, 95% CI = 1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR = 1.50, 95% CI = 0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI = 1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR = 1.44, 95% CI = 1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR = 1.21, 95% CI = 1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR = 1.18, 95% CI = 1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR = 0.87, 95% CI = 0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR = 1.18, 95% CI = 1.13, 1.23). Conclusions: Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care-related anxiety and fear predicted dental care utilization in north-central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual-level fatalistic beliefs and oral health values may affect utilization of routine oral health care.
AB - Objectives: Dental utilization is an important determinant of oral health and well-being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north-central Appalachia, USA, a region where oral health disparities are profound. Methods: This study used household-based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north-central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best-fitting predictor model for dental utilization among adult family members. Results: On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3-year time period (OR = 2.20, 95% CI = 1.54, 3.14). When stratified by state, the association held for only West Virginia (OR = 2.41, 95% CI = 1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR = 1.50, 95% CI = 0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI = 1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR = 1.44, 95% CI = 1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR = 1.21, 95% CI = 1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR = 1.18, 95% CI = 1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR = 0.87, 95% CI = 0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR = 1.18, 95% CI = 1.13, 1.23). Conclusions: Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care-related anxiety and fear predicted dental care utilization in north-central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual-level fatalistic beliefs and oral health values may affect utilization of routine oral health care.
KW - Appalachia
KW - avoidance of dental care
KW - dental care-related anxiety and fear
KW - dental utilization
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U2 - 10.1111/cdoe.12453
DO - 10.1111/cdoe.12453
M3 - Article
C2 - 30993747
AN - SCOPUS:85064567158
SN - 0301-5661
VL - 47
SP - 283
EP - 290
JO - Community Dentistry and Oral Epidemiology
JF - Community Dentistry and Oral Epidemiology
IS - 4
ER -