The Persistence of Oral Health Disparities for African American Children: A Scoping Review
Abstract
:1. Introduction
2. Methods
2.1. Step One: Identifying the Research Question
2.2. Step Two: Identifying Relevant Studies
2.3. Step Three: Study Selection
2.4. Step Four: Charting the Data
2.5. Step Five: Collating, Summarizing, and Reporting the Results
3. Results
3.1. Descriptive Summary
3.1.1. Familial
3.1.2. Sociocultural
3.1.3. Structural
4. Discussion
Future Directions
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Reference | Purpose | Population | Study Design | Key Findings | Category |
---|---|---|---|---|---|
Behrens et al. [16] | To explore factors and identify strategies that could improve the oral health of low income and minority children | 25 state and federal policy makers, workforce experts, foundation officials, educators, researchers with interest in children’s oral health | Qualitative Study; interviews with stakeholder and policy makers | Policy stakeholders believe that improving oral health for children requires addressing: both consumer demand and provider supply, lack of outcry for accessible oral health, undervaluing oral health, health literacy and outreach campaigns | Structural |
Bhagavatula et al. [17] | To document the rates of prevention, restoration, and surgical dental procedures provided to children enrolled in private insurance, Delta Dental | 266,380 children (age 0–18) (12% African American), that received care from 2002–2008 in Milwaukee | Descriptive study; registry summary design | 44% of AA had one dental visit during study period; rates of preventative procedures increased to age 9 and then decreased | Structural |
Collins et al. [18] | To understand what parents consider to be important factors and resources that influence their child’s oral care | Utilized Photovoice with 10 parents of infants and toddlers; five group sessions were conducted | Qualitative Study; participatory research approach | Poor oral health was associated with avoidance of problems; financial constraints, time constraints, and occasional parental frustration completing child’s oral hygiene routines | Familial, Sociocultural, Structural |
Dawkins et al. [19] | To compare sociodemographic differences between caries and no caries groups and investigate factors associated with untreated dental caries | 2453 participants (5.8% African American), children (age 6–15), school-based dental sealant program in KY | Observational Study; pooled cross-sectional design | Older children living in rural areas were more likely to have untreated dental caries and lack insurance | Structural |
Dodd et al. [20] | To explore oral health perceptions and dental care behaviors among rural adolescents | 100 rural youth (age 12–18), (80% Black), low SES | Qualitative study; emergent thematic approach | Perceived threat from oral disease was low, esthetics main reason for seeking care; access, finances, transportation, and fear were also noted | Sociocultural |
Eisen et al. [21] | Examine relationship between race and dental services | 1408 participants (59.3% African American) | Observational Study; cross-sectional analysis of data from The Exploring Health Disparities in Integrated Communities (Baltimore, MD) | More AA used dental services in previous 2 years; place of living an important factor to consider when seeking to understand race difference in dental service use | Structural |
Fisher-Owens et al. [22] | To assess the extent that factors other than race explain disparities in children’s oral health | Data from National Survey of Children’s Health Children (n = 82,020) (age 2–17) | Observational Study; model based survey data analysis | AA more likely to report poor oral health, lack preventative care, and experience unmet need. However, these are attenuated, to varying degrees, when researchers adjust for socioeconomic status | Structural |
Flores et al. [23] | To identify racial/ethnic disparities in medical and oral health, access to care, and uses of services in U.S. children | Sample from National Surveys of Children’s Health, parents of 90,117 children (age 0–17), (9.84% African American) | Descriptive study; secondary analysis | Disparities continue to exist, with increased use of services disparities decreased; however, several new disparities for African American children including uninsurance rates and difficulty getting specialty care | Structural |
Flores et al. [24] | To examine parental awareness of and the reasons for lack of insurance coverage in eligible communities | 97 recruitment sites; 267 participants (age 0–18) (35% African American) | Observational Study; cross-sectional design | Half the participants were unaware that their children were eligible for federally funded insurance | Structural |
Guarnizo-Herreño et al. [25] | To measure inequalities in children’s dental health based on racial/ethnic identity | Representative sample of children and adolescents (age 2–11); White, Black, Hispanic | Observational Study; decomposition model for analysis | SES accounted for 71% of the gap in preventive dental care between AA and White | Structural |
Isong et al. [26] | To examine the impact of national health policies on AA children’s receipt of dental care | Children 2–17 years old; from 1964 to 2010 | Observational study | Percent of AA children without a dental visit declined significantly over time | Sociocultural, Structural |
Lau et al. [27] | To examine racial/ethnic disparities in medical and oral health status, access to care and use of services in U.S. adolescents | 47,728 parent responses from National Surveys of Children’s Health for adolescents (age 10–17), (9.84% African American) | Descriptive study; secondary analysis | Suboptimal health and lack of personal doctor were found to be one of the most profound disparities to exist | Structural |
Pourat et al. [28] | To look at racial and ethnic differences between children with private insurance and those in Medicaid or CHIP | Sample from the California Survey of Health, 10,805 children (age 0–11) (7% African American) | Descriptive study | AA with Medicare more likely to have longer intervals between visits than Caucasian children with Medicare | Structural |
Reference | Purpose | Population | Study Design | Key Findings | Category |
---|---|---|---|---|---|
Adams et al. [29] | To determine AA parents’ treatment acceptability and treatment preferences to prevent early childhood caries | 48 parents/caregivers with an African American child (age 1–5) | Mixed method study; concurrent triangulation design | All treatments were acceptable; parents strongly preferred tooth brushing rather than fluoride varnish and the use of xylitol in gum or food | Familial |
Baker et al. [30] | Provide developmental program focused on promoting healthy lifestyles to inner-city youth including one module focused on oral hygiene | 46 African American youth (age 11–14) | Experimental study; non-randomized controlled trial; 5-week module intervention | Surveys indicated that 42% of the participants exhibited positive behavioral change following completion of the oral hygiene module | Sociocultural |
Devlin et al. [31] | To evaluate school-based dental sealant programs | Framingham school district 2nd graders (≈6% African American) with dental sealants | Experimental; non-randomized controlled trial | School based dental sealant programs can help decrease barriers for access to dental services | Structural |
Ghazal et al. [32] | To assess the relationship between behavioral factors and caries in AA preschoolers | 96 African American children (age 3–22 months) | Observational study; longitudinal cohort study | Living in a non-fluoridated community, more frequent consumption of sweetened food, less frequent consumption of 100% juice, less frequent tooth brushing, significantly associated with greater ECC incidence. | Sociocultural, Structural |
Heima et al. [33] | To investigate the influence of caregiver education level on dental caries | 423 children (age 5–6) and caregiver dyads (94% African American), low income, urban | Cross-sectional design; secondary analysis of longitudinal study data | Caregiver education level was associated with 34% less untreated decayed teeth | Familial |
Ismail et al. [34] | To evaluate the effectiveness of a tailored intervention on oral health behaviors and new untreated caries | 1021 randomly selected African American children (age 0–5) and their caregivers | Experimental study; randomized controlled trial | Caregivers receiving motivational interviewing and watching DVD more likely to report checking for “pre-cavities” | Familial |
Johansson et al. [35] | To investigate the association between snacking and caries | 1206 preschool children (age 1–4) (61% African American) | Observational study; cross-sectional design | Presence of plaque, sugar intake and SES were associated; consumption of chips was associated with caries | Sociocultural, Structural |
Nelson et al. [36] | To assess follow-up dental care received by children given baseline screening and referrals as part of an ongoing clinical trial | 303 participants (age 5–6), (96% African American), who had at least one dental visit | Observational study; retrospective cohort design | Utilization of dental services was low for poor minority inner city kindergarten children despite school screening referrals and parental reminders | Structural |
Weatherwax et al. [37] | To identify possible relationships between parent/guardian sociodemographic, intention, knowledge, and oral health status of their child | 181 child (age 3–5) and parent/ caregiver dyad (31% African American), Head Start program | Observational study; cross-sectional design | Caregiver race/ethnicity and years of education were inversely significantly associated with decayed, missing or filled teeth | Familial, Structural |
Yuen et al. [38] | To explore behavioral factors associated with toothaches among African American adolescents | Convenience sample of 156 African American adolescents (age 10–18) | Observational study; cross-sectional design | Age and consumption of cariogenic snacks and soda are related to toothache pain | Sociocultural, Structural |
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Como, D.H.; Stein Duker, L.I.; Polido, J.C.; Cermak, S.A. The Persistence of Oral Health Disparities for African American Children: A Scoping Review. Int. J. Environ. Res. Public Health 2019, 16, 710. https://doi.org/10.3390/ijerph16050710
Como DH, Stein Duker LI, Polido JC, Cermak SA. The Persistence of Oral Health Disparities for African American Children: A Scoping Review. International Journal of Environmental Research and Public Health. 2019; 16(5):710. https://doi.org/10.3390/ijerph16050710
Chicago/Turabian StyleComo, Dominique H., Leah I. Stein Duker, José C. Polido, and Sharon A. Cermak. 2019. "The Persistence of Oral Health Disparities for African American Children: A Scoping Review" International Journal of Environmental Research and Public Health 16, no. 5: 710. https://doi.org/10.3390/ijerph16050710