Download Slide 1 - Faculty Affairs

Race, Ethnicity, Culture and
Educational Research
Virginia J. Dodd, PhD, MPH
Educational Research Seminar Series 9/27/2013
Approach
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Race and health
Culture and dental care
Ethnicity and dental care
Race and dental care
Oral health and vulnerable populations
Oral health disparities
Going to the dentist
Social value and oral health
Dental care and extrinsic motivators
Dental care and intrinsic motivators
Race and Health
7000
6000
5780
5475
5179
5000
4696
4301
3911
3770
3418 3329
3043
2722
4000
3000
2000
1000
0
1860
1
1880
1900
2292
2242
1987
1817
1742
1572
1494
1345
1270
1259
1052
994
785
701
601
485
381
344
310
276
276
255
247
244
243
240
228
224
223
220
214
205
179
162
143
113
78
70
61
39
722
111 1 2 1 1 1 1 1 2 623586 3 121 310
1920
1940
1960
1980
2000
-1000
-2000
-3000
N = 72,331
1873 - 2013
1
2020
2040
Race and Oral Health
250
200
196
188
157
150
100
50
0
1900
1
1920
1940
123
122
121
120
110
104
102
95
93
88
83
75
71
6163
53
44 43
36
31
24
23
19
1716
14
1414
1112
11
11
10
10
9
9
9
7
2 12344 5 7 7 56
1960
1980
2000
2020
-50
-100
-150
N = 2466
1921 - 2013
Culture and Dental Care
• May 2013
– Understanding Muslim patients: crosscultural dental hygiene care
• 1967
The practice of dentistry in ancient Egypt
N=1322
100
Culture and Dental Care
80
80
81
73
68
64
62
60
54 54 55
50
51
69
66
57
45 45
40
39
36
32
27
23
20
0
1960
-20
1 1
1 2
1970
4 4 5 5
8
5
9
7 8 7 6 6
1980
15
11
18 1918
16
9
5
1990
N = 1322
2000
2010
2020
Summary: Culture and Dental Care
• Managing the socially deprived
patient.
• Social and attitudinal correlates of
health care among Mexican
Americans.
• Pain: anxiety and attitudes in Black,
White and Puerto Rican patients.
• The dental patient's cultural response
to the need for dental care.
Summary: Culture and Dental Care
• Predictors of multiple tooth loss among
socioculturally diverse elderly subjects.
• Transcultural dental training:
addressing the oral health care needs
of people from culturally diverse
backgrounds.
Summary: Culture and Dental Care
• Cross cultural adaptation of oral
health-related quality of life measures.
• A psychosocial approach to dentistry
for the underserved: incorporating
theory into practice.
• Screening for oral health literacy in an
urban dental clinic.
Ethnicity and Dental Care
• 2013 = 35 publications
– Evaluation of an oral health promotion
program at the time of birth on dental
caries in 5-year-old children in Vorarlberg,
Austria.
• 1966 = 1 publication
– Survey of needs for dental care, 1965. II.
Dental needs according to age and sex
of patients: Bureau of Economic Research
and Statistics.
N = 1443
Ethnicity and Dental Care
100
94
87
83
80
74 74
7675
74
63
60
5958
56
54
45
41
38
36
40
35
343433
31
21
20
17
11
0
1960
-20
24
3
11112 2
1970
5 54 4
3
8
67
1980
9
6
8
12 13
11
4
1990
2000
2010
2020
Summary: Ethnicity and Dental Care
• Burden of oral disease among older
adults and implications for public
health priorities.
• Edentulism trends among middle-aged
and older adults in the United States:
comparison of five racial/ethnic
groups.
Summary: Ethnicity and Dental Care
• A tool for assessing cultural
competence training in dental
education
• Are survivors who report cancerrelated financial problems more likely
to forgo or delay medical care?
• Are there differences in dental care
access, treatment, or treatment
response by ethnicity?
Race and Dental Care
140
131
120
100
80
66
60
56 545454
47 48
40
36
20
13
0
1960
1
5
1 1 3 1 2
1970
6 8 5 7
6 6 4 6 4 4
2
1
1980
9
40 39
34 35
29
25 25 24
2019
1716 17
12
9 1010
5
1990
-20
N = 985
1964 - 2013
2000
2010
2020
Summary: Race and Dental Care
• Early populations were Native
Americans.
• Racial similarities and differences in
family dental care patterns.
• Variations in use of dental care
facilities by low-income white and
black urban populations.
Summary: Race and Dental Care
• 1980s Hispanic populations
• 1990s “poor and underserved”
• 2000 Use of dental care by HIVinfected medical patients
• Rural-urban differences in Medicaid
use
Summary: Race and Dental Care
• 2012: Edentulism trends among adults.
• 2013: Social support and dental visits.
– Geographic differences rural vs. urban
“going to the dentist”
14
13
12
11
12
10
9
8
7
6
5
0
1940
-2
7
6
7
8
5 5 55 5
4
3
3
33
2
22
2
1 1 1 1 1111 1 1 1 1 1
1 1
4
2
6
9
1
1960
1980
-4
N = 167
1946-present
2000
2020
Topic Summary:
“going to the dentist”
• Much of the research involved
children.
• 1979: A two-wave interview study of
frequency of dental visits and dental
complaints.
• 1978: How are you going to keep
dentists down on the farm once
they’ve seen Chicago (or New York)?
Topic Summary:
“going to the dentist”
• 1990: Assessment of a single item
dental anxiety question.
• 1994: Today’s dental student is training
for tomorrow’s elderly baby boomer.
• 1997: Dental health attitudes among
dentate black and white adults.
Topic Summary:
“going to the dentist”
• 2002: Informed consent: optimism or
reality?
• 2004: Who is going to treat our
edentulous adults?
• 2005: An exploratory study on cultural
variations in oral health attitudes,
behaviors, and values of first-year
dental students.
Topic Summary:
“going to the dentist”
• 2005: People with disabilities: how are
we going to meet their needs?
• 2006: How did we get here? Where are
we going? Hopes and gaps in access
to oral health care.
• 2007: The vicious cycle of dental fear:
exploring the interplay between oral
health, service utilization and dental
fear.
Topic Summary:
“going to the dentist”
• 2009: Access to care: what are we
going to do about it?
• 2011: Thinking about going to the
dentist: a Contemplation Ladder to
assess dentally-avoidant individuals'
readiness to go to a dentist.
Topic Summary:
“going to the dentist”
• 2013: What goes around comes
around: revisiting the hypothesized
vicious cycle of dental fear and
avoidance.
• 2013: The oral health of vulnerable
older adults and persons with
disabilities.
Social Value and Oral Health
25
20
20
17
15
13
10
10
13
12
9
10 10
11
8
10
9
7
5
7
5
3
4
0
0
5
10
N = 253
1967 - 2013
15
20
Topic Summary:
Social Value and Oral Health
• Religious Leaders' Opinions and
Guidance Towards Oral Health
Maintenance and Promotion: A
Qualitative Study.
• Clinical status in adolescents: is its
impact on oral health-related quality
of life influenced by psychological
characteristics?
N = 253
1967 - 2013
Topic Summary:
Social Value and Oral Health
• Shaping the next generation of
'population oral healthers'.
• Access to oral health services for
urban low-income Latino children:
social ecological influences.
• How people on social assistance
perceive, experience, and improve
oral health.
Dental Care and Extrinsic Motivators
• 1994
– Obstacles to regular dental care related
to extrinsic and intrinsic motivation.
(Finland)
• 2012
– The impact of intrinsic and extrinsic factors
on the job satisfaction of dentists.
N=2
Dental Care and Intrinsic Motivators
• 2012
– Evaluating the effects of coaching to
improve motivational interviewing skills of
dental hygiene students.
• 1992
– Intrinsic motivation in dental care.
N=6
Oral Health and Vulnerable Populations
35
31
30
25
20
1920
15
15
10
8
5
0
1970
-5
-10
-15
-20
3030
28
26
1
1 11
1980
1990
1211
12
22312
2000
2010
2020
Oral Health and Vulnerable
Populations
• Disparities
• Literacy rates
• Role of the workforce
• Demographic issues
• Access barriers
N = 279
1973 - 2013
Oral Health Disparities
150
136
119
100
909595
50
0
1975
1
1980
50
44
36 37
2020 24
13
1 1
1 13 2322
1985
1990
1995
2000
-50
-100
N= 862
1977 - 2013
2005
2010
59
2015
Topic Summary:
Oral Health Disparities
• Increasing screening intentions for oral
and pharyngeal cancer
• The oral health of vulnerable older
adults and persons with disabilities
• Integrating oral and general health
screening at senior centers for minority
elders
• Distinct epidemiologic characteristics
of oral tongue cancer patients.
Topic Summary:
Oral Health Disparities
• Racial and ethnic disparities in
utilization of dental services among
children in Iowa: the Latino
experience.
• Head and neck cancer disparity in
underserved communities: probable
causes and the ethics involved.
• Social inequality in oral health.
Topic Summary:
Oral Health Disparities
• Racial/ethnic disparities in health and
health care among U.S. adolescents.
• Using telehealth technologies to
improve oral health for vulnerable and
underserved populations.
• Distribution of caries in children:
variations between and within
populations.
• Social disparity and oral health.
Topic Summary:
Oral Health Disparities
• Barriers impeding access to primary
oral health care among farm worker
families in Central Florida.
• Access to and utilization of oral health
care by homeless children/families.
• Socioeconomic factors in adolescents'
oral health: are they mediated by oral
hygiene behaviors or preventive
interventions?
Moving Forward
Moving Forward
• The majority of the literature on racial
and ethnic groups offers
epidemiologic data on health
disparities.
– Lacks depth
• Research offering findings on oral
health beliefs and practices of specific
racial, ethnic, and cultural groups is
sparse.
Moving Forward
• Use of theoretical or strong
conceptual frameworks is scarce.
• Current information available provides
a limited picture of oral health related
beliefs, thoughts, and behaviors for
specific population groups.
• Differences in use contribute to oral
health disparities– how do we remedy
the issues? Why are there differences?
Moving Forward
• How do we create dental consumers?
• Access barriers (intensity) have not
been identified for all population
groups.
– Methods for reducing/removing the
barriers are absent from the literature.
• Looking below the barriers– are there
other “undiscovered” reasons for
differences in access patterns?
Moving Forward
• Much of the literature employs
samples recruited from clinical
populations.
– Movement into the community will be
required to reach individuals who do not
seek regular dental care.
• Oral health literacy
– Related to treatment decisions… how?
– Tailored materials- do they make a
difference? What degree of tailoring?
Moving Forward
• Cultural competence
– Multi cultural office settings
• Does inclusiveness make a difference?
• Treatment by front office staff
– Staff trained in cultural competence vs.
untrained staff – is there a difference?
• Dignity, judgment
– How can these perceptual barriers?
Moving Forward
• Dentist/patient engagement during
appointment.
• Does provider training in cultural
competence improve case
acceptance and/or return visits?
• Extractions, tooth loss- what does this
mean to different population groups?
– Missing teeth: Scarlet letter of the poor?
Moving Forward
• Do patients who receive care for
acute dental problems in an
emergency department follow-up their
referral for definitive care?
– Why or why not?
• Do treatment decisions differ by level
of OHL?
• Identify oral health beliefs, values, and
practices of different population
groups.
• What are the factors associated with
missed dental appointments?
• What is the actual cost of ECC?
– DALY…
• Social and intellectual development affected
• Permanent teeth may be affected
• Malocclusion, missing teeth– self-esteem
• Early learning foundation poor– not much to
build on… prospects for college low… job
prospects questionable… missing teeth can
add to a lack of marketability.
– What is the cumulative cost of early and un or
under-treated dental disease?
Moving Forward
• It is time to apply some of the broad
concepts to determine how they work.
• Social, behavioral, environmental,
biological aspects must be
considered.
• Solutions will require an interdisciplinary
approach.
Different Perspectives
• Consideration of different
perspectives…..
• Coronary angioplasty is like going to
the dentist
(2000).
Any discussion or questions?
Thank you for your attention!