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Examining the relationship between oral health issues and history of dental insurance among uninsured children
Preventive Medicine 51 (2010) 436–437
Contents lists available at ScienceDirect
Preventive Medicine j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / y p m e d
Letter to the Editor Examining the relationship between oral health issues and history of dental insurance among uninsured children
Keywords: Oral health Dental care Dental Children Disadvantaged Insurance Uninsured Low-income Community Coalition
Adequate oral health care is one of the largest unmet public health issues faced by low-income populations in the U.S., including children (Treadwell and Northridge, 2007). Approximately 80% of tooth decay is found in 25% of children, primarily in those in low-income families (Beltrán-Aguilar et al., 2005). Among children from low-income families, about 1/3 have untreated caries in primary teeth (Watson et al, 2008). While dental caries can usually be prevented, affordable dental insurance and/or accessible dental care services are significant barriers for economically disadvantaged families (Fisher and Mascarenhas, 2009; 2007). The purpose of this pilot study was to examine the relationship between dental insurance and oral health issues among uninsured children. University researchers in collaboration with the Wichita–Sedgwick County (Kansas) Oral Health Coalition sponsored an annual one-day event, Give Kids a Smile (GKAS), to provide free preventive and restorative dental care to low income, uninsured children. Modeled after the American Dental Association's GKAS, recruitment focused primarily on low-income neighborhoods through radio and newsletter ads, schools, primary health care facilities, social service organizations, and faith-based communities. To be eligible, children had to lack dental insurance, be ≤10 years old, and reside in Sedgwick County. All GKAS staff were volunteers, including dentists. In the 2010 GKAS, 213 children participated. For each child, parents/guardians were asked to complete a 46item survey, available in English and Spanish, which inquired about the child's oral health status, past and current oral health behaviors, and demographics. A response rate of 86% (n = 183) was obtained and SPSS 17.0 was used to analyze the data. Among the children, 51% were male and 69% were 5–9 years old. The primary languages spoken in the home were English (49%) and Spanish (48%). Fifty-seven percent (57%) were Hispanic, 22% White non-Hispanic, 10% Black non-Hispanic, 7% Asian/ Pacific Islander, and 4% Other. Parents/guardians' highest level of education was: 40% high school or GED; 25% less than high school; 20% some college or technical school; and 15% college degree or higher. Among parents/guardians, 63% were employed, 29% unemployed, and 6% were disabled, retired, or homemakers. Annual 0091-7435/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2010.07.014
household incomes were: ≤$19,000 (43%); $20–29,000 (29%); $30– $39,000 (13%); $40–49,000 (8%); and ≥$50,000 (6%). Although all children lacked dental insurance at the time of the event, 52% did not have a history of dental insurance (hx of DI). Children without a history of dental insurance (hx of DI) were more likely to have lower household incomes (p = 0.008). Among children without a hx of DI, 75% never had dental sealants compared to 48% of those with a hx of DI (p = 0.012); 30% did not floss compared to 25% with a hx of DI (p b 0.0001); 26% expressed fear of going to a dentist compared to 20% with a hx of DI (p b 0.001); 91% did not have a current ‘dental home’ compared to 78% with a hx of DI (p b 0.023); and 58% did not see a dentist until 3–5 years old compared to 32% with a hx of DI (p b 0.0001). Previous studies have investigated the impact of DI and general health insurance coverage on oral health status and access to care (Fisher and Mascarenhas, 2007, 2009; Macias and Morales, 2001; Mouradian, 2001). Results of the current pilot study also emphasize the importance of examining a child's hx of DI and its relationship with certain oral health factors. Current findings indicated that children without a hx of DI were more likely to have some unmet dental needs and poorer oral health behaviors. These findings underscore the importance of providing DI or adequate services to uninsured children (Guay, 2004) and for further research on DI and oral health in this population. Considering the consequences of poor oral health (US DHHS, 2000), the current findings support the need to promote regular access to dental health care and public dental health education initiatives.
Conflict of interest statement The authors declare there is no conflict of interest associated with this study or manuscript.
References Beltrán-Aguilar, E.D., Barker, L.K., Canto, M.T., Dye, B.A., Gooch, B.F., Griffin, S.O., Hyman, J., Jaramillo, F., Kingman, A., Nowjack-Raymer, R., Selwitz, R.H., Wu, T., 2005. Surveillance for dental caries, dental sealants, retention edentulism, and enamel fluorosis — United States, 1988–1994 and 1999–2002. MMWR 54, 1–44. Fisher, M.A., Mascarenhas, A.K., 2007. Does Medicaid improve utilization of medical and dental services and health outcomes for Medicaid-eligible children in the United States? Community Dent. Oral Epidemiol. 35, 263–271. Fisher, M.A., Mascarenhas, A.K., 2009. A comparison of medical and dental outcomes for Medicaid-insured and uninsured Medicaid-eligible children: a U.S. populationbased study. J. Am. Dent. Assoc. 140, 1403–1412. Guay, A.H., 2004. Access to dental care solving the problems for the underserved populations. J. Am. Dent. Assoc. 135, 1599–1605. Macias, E.P., Morales, L.S., 2001. Crossing the border for healthcare. J. Health Care Poor Underserved 12, 77–87. Mouradian, W.E., 2001. The face of a child: children's oral health and dental education. J. Dent. Educ. 65, 821–831. Treadwell, H.M., Northridge, M.E., 2007. Oral health is a measure of a just society. J. Health Care Poor Underserved 18, 12–20. U.S. Department of Health and Human Services (US DHHS), 2000. Oral Health in America: a Report of the Surgeon General. U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, Rockville, MD.
Letter to the Editor Watson, J.M., Logan, H.L., Tomar, S.L., 2008. The influence of active coping and perceived stress on health disparities in multi-ethnic low income sample. BMC Public Health 8 (41), 1–9.
Angelia M. Paschal Mississippi University for Women, Health and Kinesiology, 1100 College St., MUW-1636, columbus, MS 39702, USA Corresponding author. Fax: +1 662 329 8554. E-mail address: [email protected]. Judy Johnston1 Monica A. Fisher1 Elizabeth Ablah2 University of Kansas School of Medicine-Wichita, Preventive Medicine and Public Health, 1010 N. Kansas, Wichita, KS 67214, USA E-mail addreses: [email protected] (J. Johnston), mfi[email protected] (M.A. Fisher), [email protected] (E. Ablah). 1 Fax: +1 316 293 2695. 2 Fax: +1 316 425 8000.
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Amber Sellers Child Start, Inc., 1069 S. Glendale St., Wichita, KS 67218, USA E-mail address: [email protected]. Fax: +1 316 425 8000. Kimberly Walker Sedgwick County Health Department; 1530 S. Oliver, Suite 270, Wichita, KS 67218, USA E-mail address: [email protected]. Fax: +1 316 660 7431. Tracy Hsiao University of Kansas School of Medicine-Wichita, Preventive Medicine and Public Health, 1010 N. Kansas, Wichita, KS 67214, USA E-mail address: [email protected]. Fax: +1 316 293 2695.
Available online 23 July 2010
Contents lists available at ScienceDirect
Preventive Medicine j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / y p m e d
Letter to the Editor Examining the relationship between oral health issues and history of dental insurance among uninsured children
Keywords: Oral health Dental care Dental Children Disadvantaged Insurance Uninsured Low-income Community Coalition
Adequate oral health care is one of the largest unmet public health issues faced by low-income populations in the U.S., including children (Treadwell and Northridge, 2007). Approximately 80% of tooth decay is found in 25% of children, primarily in those in low-income families (Beltrán-Aguilar et al., 2005). Among children from low-income families, about 1/3 have untreated caries in primary teeth (Watson et al, 2008). While dental caries can usually be prevented, affordable dental insurance and/or accessible dental care services are significant barriers for economically disadvantaged families (Fisher and Mascarenhas, 2009; 2007). The purpose of this pilot study was to examine the relationship between dental insurance and oral health issues among uninsured children. University researchers in collaboration with the Wichita–Sedgwick County (Kansas) Oral Health Coalition sponsored an annual one-day event, Give Kids a Smile (GKAS), to provide free preventive and restorative dental care to low income, uninsured children. Modeled after the American Dental Association's GKAS, recruitment focused primarily on low-income neighborhoods through radio and newsletter ads, schools, primary health care facilities, social service organizations, and faith-based communities. To be eligible, children had to lack dental insurance, be ≤10 years old, and reside in Sedgwick County. All GKAS staff were volunteers, including dentists. In the 2010 GKAS, 213 children participated. For each child, parents/guardians were asked to complete a 46item survey, available in English and Spanish, which inquired about the child's oral health status, past and current oral health behaviors, and demographics. A response rate of 86% (n = 183) was obtained and SPSS 17.0 was used to analyze the data. Among the children, 51% were male and 69% were 5–9 years old. The primary languages spoken in the home were English (49%) and Spanish (48%). Fifty-seven percent (57%) were Hispanic, 22% White non-Hispanic, 10% Black non-Hispanic, 7% Asian/ Pacific Islander, and 4% Other. Parents/guardians' highest level of education was: 40% high school or GED; 25% less than high school; 20% some college or technical school; and 15% college degree or higher. Among parents/guardians, 63% were employed, 29% unemployed, and 6% were disabled, retired, or homemakers. Annual 0091-7435/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2010.07.014
household incomes were: ≤$19,000 (43%); $20–29,000 (29%); $30– $39,000 (13%); $40–49,000 (8%); and ≥$50,000 (6%). Although all children lacked dental insurance at the time of the event, 52% did not have a history of dental insurance (hx of DI). Children without a history of dental insurance (hx of DI) were more likely to have lower household incomes (p = 0.008). Among children without a hx of DI, 75% never had dental sealants compared to 48% of those with a hx of DI (p = 0.012); 30% did not floss compared to 25% with a hx of DI (p b 0.0001); 26% expressed fear of going to a dentist compared to 20% with a hx of DI (p b 0.001); 91% did not have a current ‘dental home’ compared to 78% with a hx of DI (p b 0.023); and 58% did not see a dentist until 3–5 years old compared to 32% with a hx of DI (p b 0.0001). Previous studies have investigated the impact of DI and general health insurance coverage on oral health status and access to care (Fisher and Mascarenhas, 2007, 2009; Macias and Morales, 2001; Mouradian, 2001). Results of the current pilot study also emphasize the importance of examining a child's hx of DI and its relationship with certain oral health factors. Current findings indicated that children without a hx of DI were more likely to have some unmet dental needs and poorer oral health behaviors. These findings underscore the importance of providing DI or adequate services to uninsured children (Guay, 2004) and for further research on DI and oral health in this population. Considering the consequences of poor oral health (US DHHS, 2000), the current findings support the need to promote regular access to dental health care and public dental health education initiatives.
Conflict of interest statement The authors declare there is no conflict of interest associated with this study or manuscript.
References Beltrán-Aguilar, E.D., Barker, L.K., Canto, M.T., Dye, B.A., Gooch, B.F., Griffin, S.O., Hyman, J., Jaramillo, F., Kingman, A., Nowjack-Raymer, R., Selwitz, R.H., Wu, T., 2005. Surveillance for dental caries, dental sealants, retention edentulism, and enamel fluorosis — United States, 1988–1994 and 1999–2002. MMWR 54, 1–44. Fisher, M.A., Mascarenhas, A.K., 2007. Does Medicaid improve utilization of medical and dental services and health outcomes for Medicaid-eligible children in the United States? Community Dent. Oral Epidemiol. 35, 263–271. Fisher, M.A., Mascarenhas, A.K., 2009. A comparison of medical and dental outcomes for Medicaid-insured and uninsured Medicaid-eligible children: a U.S. populationbased study. J. Am. Dent. Assoc. 140, 1403–1412. Guay, A.H., 2004. Access to dental care solving the problems for the underserved populations. J. Am. Dent. Assoc. 135, 1599–1605. Macias, E.P., Morales, L.S., 2001. Crossing the border for healthcare. J. Health Care Poor Underserved 12, 77–87. Mouradian, W.E., 2001. The face of a child: children's oral health and dental education. J. Dent. Educ. 65, 821–831. Treadwell, H.M., Northridge, M.E., 2007. Oral health is a measure of a just society. J. Health Care Poor Underserved 18, 12–20. U.S. Department of Health and Human Services (US DHHS), 2000. Oral Health in America: a Report of the Surgeon General. U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, Rockville, MD.
Letter to the Editor Watson, J.M., Logan, H.L., Tomar, S.L., 2008. The influence of active coping and perceived stress on health disparities in multi-ethnic low income sample. BMC Public Health 8 (41), 1–9.
Angelia M. Paschal Mississippi University for Women, Health and Kinesiology, 1100 College St., MUW-1636, columbus, MS 39702, USA Corresponding author. Fax: +1 662 329 8554. E-mail address: [email protected]. Judy Johnston1 Monica A. Fisher1 Elizabeth Ablah2 University of Kansas School of Medicine-Wichita, Preventive Medicine and Public Health, 1010 N. Kansas, Wichita, KS 67214, USA E-mail addreses: [email protected] (J. Johnston), mfi[email protected] (M.A. Fisher), [email protected] (E. Ablah). 1 Fax: +1 316 293 2695. 2 Fax: +1 316 425 8000.
437
Amber Sellers Child Start, Inc., 1069 S. Glendale St., Wichita, KS 67218, USA E-mail address: [email protected]. Fax: +1 316 425 8000. Kimberly Walker Sedgwick County Health Department; 1530 S. Oliver, Suite 270, Wichita, KS 67218, USA E-mail address: [email protected]. Fax: +1 316 660 7431. Tracy Hsiao University of Kansas School of Medicine-Wichita, Preventive Medicine and Public Health, 1010 N. Kansas, Wichita, KS 67214, USA E-mail address: [email protected]. Fax: +1 316 293 2695.
Available online 23 July 2010