Oral Health Disparities Due to Race, Ethnicity, and Class

A special issue of Dentistry Journal (ISSN 2304-6767).

Deadline for manuscript submissions: closed (30 November 2018) | Viewed by 23177

Special Issue Editor

Special Issue Information

Dear Colleagues,

Race, ethnicity, and class impact the oral health of populations in multiple ways. Although multiple mechanisms are involved, two major hypotheses are “Differential Exposure” and “Differential vulnerability”. According to the differential exposure hypothesis, race, ethnicity, and class impact exposure to a wide range of risk and protective factors that have oral health implications. In this view, distribution of risk and protective factors are not identical across social groups and depend on race and class. According to this hypothesis, differential exposures mediate the racial and class differences in oral health. According to the differential vulnerability hypothesis, however, race, ethnicity, and class alter populations vulnerability and resilience to a certain or a combination of risk/protective factors. Based on this hypothesis, the effects of risk and protective factors are not universal across groups but specific to each social group.

Recent research has shown that race, ethnicity, and class interact on various aspects of health. While class partially explains the effect of race and ethnicity on health, racial and ethnic groups differ in how they can translate their class to health. In this view, the effects of socioeconomic resources are smaller for minority populations compared to the majority group. In the United States, for instance, education, income, and employment may show stronger health effects in Whites than Blacks and Hispanics. This pattern is also called Minorities’ Diminished Return, or Unequal Gain of Equal Resources.

Finally, it is not just race, ethnicity, and class, but their intersections that shape life circumstances, and health needs. In this view, the effects of race, ethnicity, and class are different from algebraic sums of their effects. For instance, in the United States, the experiences of Black men are very different from Black women. Life experiences of Latino population depends on country of origin and nativity status. Same is true for ethnic groups of Blacks.

The Special Issue “Oral Health Disparities Due to Race, Ethnicity, and Class” invites state-of-the-art original and review articles on the above-mentioned topics. Potential papers of interest include: 1) studies testing differential exposure or differential vulnerability; 2) studies testing additive and multiplicative effects; 3) studies that compare countries or locations within countries; 4) studies that report mediators or moderators of disparities; 5) studies on tailored interventions for sub-populations; 6) studies using a national sample, or using longitudinal design; 7) studies using an intersectionality approach; and 8) studies on measurement and methodology issues.

Dr. Shervin Assari
Guest Editor

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Keywords

  • Racial Disparities
  • Economic disparities
  • Race
  • Ethnicity
  • Populations
  • Income
  • Class
  • Education

Published Papers (4 papers)

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Research

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8 pages, 1356 KiB  
Article
Socioeconomic Inequalities in Oral Health-Related Quality of Life among Brazilians: A Cross-Sectional Study
by Fabíola Bof de Andrade and Flavia Cristina Drumond Andrade
Dent. J. 2019, 7(2), 39; https://doi.org/10.3390/dj7020039 - 02 Apr 2019
Cited by 1 | Viewed by 3628
Abstract
Objective: Assess the magnitude of the socioeconomic inequalities related to the impact of oral health on quality of life among adults and elderly individuals. Methods: This was a cross-sectional study with data from the most recent oral health survey from the state of [...] Read more.
Objective: Assess the magnitude of the socioeconomic inequalities related to the impact of oral health on quality of life among adults and elderly individuals. Methods: This was a cross-sectional study with data from the most recent oral health survey from the state of Minas Gerais, Brazil. The sample included data on 2288 individuals—1159 adults in the 35–44 age group and 1129 adults in the 65–74 age group. Socioeconomic inequalities in Oral Impacts on Daily Performance ratings were measured using two inequality measures: the slope index of inequality (SII) and the relative index of inequality (RII). Results: The prevalence of negative impact of oral health on quality of life was 42.2% for the total sample, 44.9% among adults and 37.5% among elderly individuals. Significant absolute and relative income inequalities were found for the total sample (SII −27.8; RII 0.52) and both age groups (adults: SII −32.4; RII 0.49; elderly: SII −18.3; RI 0.63), meaning that individuals in the lowest income level had the highest prevalence of negative impacts. Regarding schooling, no significant differences were observed among the elderly. Conclusion: There were significant socioeconomic inequalities related to the negative impact of oral health-related quality of life in Brazil among both age groups. Full article
(This article belongs to the Special Issue Oral Health Disparities Due to Race, Ethnicity, and Class)
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10 pages, 241 KiB  
Article
Household Income and Children’s Unmet Dental Care Need; Blacks’ Diminished Return
by Shervin Assari and Neda Hani
Dent. J. 2018, 6(2), 17; https://doi.org/10.3390/dj6020017 - 04 Jun 2018
Cited by 54 | Viewed by 6292
Abstract
Background: Minorities’ Diminished Return theory is defined as the relative disadvantage of minority populations compared to Whites regarding health gains that follow socioeconomic status (SES). To test whether Minorities’ Diminished Return theory holds for unmet dental care needs (DCN), we investigated Black-White differences [...] Read more.
Background: Minorities’ Diminished Return theory is defined as the relative disadvantage of minority populations compared to Whites regarding health gains that follow socioeconomic status (SES). To test whether Minorities’ Diminished Return theory holds for unmet dental care needs (DCN), we investigated Black-White differences in the effects of family income on unmet DCN among children. Methods: Data from the National Survey of Children’s Health were used. Participants were either White or Black children age 1 to 18. Family income-to-needs ratio was the independent variable. Unmet DCN was the dependent variable. Covariates included age, gender, and parental educational attainment. Race was the focal moderator. We ran logistic regression for data analysis. Results: Higher income-to-needs ratio was associated with lower risk of unmet DCN in the pooled sample. We found an interaction between race and family income-to-needs ratio on unmet DCN, suggesting a stronger protective effect for Whites than Blacks. Conclusion: Minorities’ Diminished Return also holds for the effects of family income-to-needs ratio on unmet DCN. The relative disadvantage of Blacks compared to Whites in gaining oral health from their SES may reflect structural racism that systemically hinders Black families. There is a need for additional research on specific societal barriers that bound Blacks’ oral health gain from their SES resources such as income. Policies and programs should also help Black families to leverage their SES resources. Full article
(This article belongs to the Special Issue Oral Health Disparities Due to Race, Ethnicity, and Class)
12 pages, 294 KiB  
Article
Socioeconomic Status and Self-Rated Oral Health; Diminished Return among Hispanic Whites
by Shervin Assari
Dent. J. 2018, 6(2), 11; https://doi.org/10.3390/dj6020011 - 24 Apr 2018
Cited by 73 | Viewed by 6490
Abstract
Background. An extensive body of knowledge has documented weaker health effects of socio-economic status (SES) for Blacks compared to Whites, a phenomenon also known as Blacks’ diminished return. It is, however, unknown whether the same diminished return also holds for other ethnic minorities [...] Read more.
Background. An extensive body of knowledge has documented weaker health effects of socio-economic status (SES) for Blacks compared to Whites, a phenomenon also known as Blacks’ diminished return. It is, however, unknown whether the same diminished return also holds for other ethnic minorities such as Hispanics or not. Aim. Using a nationally representative sample, the current study aimed to compare Non-Hispanic and Hispanic Whites for the effects of SES on self-rated oral health. Methods. For the current cross-sectional study, we used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003. With a nationally representative sampling, CPES included 11,207 adults who were either non-Hispanic Whites (n = 7587) or Hispanic Whites (n = 3620. The dependent variable was self-rated oral health, treated as dichotomous measure. Independent variables were education, income, employment, and marital status. Ethnicity was the focal moderator. Age and gender were covariates. Logistic regressions were used for data analysis. Results. Education, income, employment, and marital status were associated with oral health in the pooled sample. Although education, income, employment, and marital status were associated with oral health in non-Hispanic Whites, none of these associations were found for Hispanic Whites. Conclusion. In a similar pattern to Blacks’ diminished return, differential gain of SES indicators exists between Hispanic and non-Hispanic Whites, with a disadvantage for Hispanic Whites. Diminished return of SES should be regarded as a systemically neglected contributing mechanism behind ethnic oral health disparities in the United States. Replication of Blacks’ diminished return for Hispanics suggests that these processes are not specific to ethnic minority groups, and non-White groups gain less because they are not enjoying the privilege and advantage of Whites. Full article
(This article belongs to the Special Issue Oral Health Disparities Due to Race, Ethnicity, and Class)

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10 pages, 365 KiB  
Review
Foreign-Trained Dentists in the United States: Challenges and Opportunities
by Sergio Varela Kellesarian
Dent. J. 2018, 6(3), 26; https://doi.org/10.3390/dj6030026 - 01 Jul 2018
Cited by 10 | Viewed by 5880
Abstract
The aim of the present study is to review the licensing process and challenges faced by foreign-trained dentists in United States (U.S.), and how incorporating foreign-trained dentists in the dental workforce in the U.S. impacts the population’s dental care. Foreign-trained dentists must complete [...] Read more.
The aim of the present study is to review the licensing process and challenges faced by foreign-trained dentists in United States (U.S.), and how incorporating foreign-trained dentists in the dental workforce in the U.S. impacts the population’s dental care. Foreign-trained dentists must complete additional training in a Commission of Dental Accreditation recognized program offered by a U.S. dental school in order to be eligible for licensing. Foreign-trained dentists interested in seeking employment in the U.S. face numerous challenges, including stringent admission processes, high tuition costs, immigration barriers and cultural differences. Opening the U.S. dental profession to foreign-trained dentists provides several advantages, such as increasing the diversity of dentists in the U.S., expanding access to underrepresented communities, and enhancing the expertise of the profession. Foreign-trained dentists are an important resource for a U.S. government seeking to build the human capital base and make the most of global trade opportunities through a “brain gain”. Increasing the diversity in the dental profession to match the general U.S. population might improve access to dental care for minorities and poor Americans, reducing disparities in dental care. Full article
(This article belongs to the Special Issue Oral Health Disparities Due to Race, Ethnicity, and Class)
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