Affiliation:
1. Department of Clinical Services School of Dentistry, Marquette University Milwaukee Wisconsin Milwaukee Wisconsin United States
2. Department of Biostatistics, College of Public Health University of Nebraska Medical Center Omaha Nebraska United States
3. Joseph. J. Zilber School of Public Health University of Wisconsin‐Milwaukee Milwaukee Wisconsin United States
4. Department of Health Policy & Health Services Research Boston University Henry M. Goldman, School of Dental Medicine Massachusetts Boston Massachusetts United States
5. Institute of Health and Equity, Division of Biostatistics Medical College of Wisconsin Milwaukee Wisconsin United States
Abstract
AbstractObjectiveThe study examined changes in acculturation level, socio‐economic status, and their association with preventive dental service use, receipt of restorative, or surgical care, and unmet dental needs.MethodsData from the Medical Expenditure Panel Survey (MEPS) for children aged 1 to 17 years from 2007 to 2015 were analysed. Firstly, a cross‐sectional structural equation model (SEM) that included both a measurement model and a structural model was fitted simultaneously to obtain predicted latent variables for acculturation, socio‐economic status (SES), dental service utilization, and unmet dental needs. Secondly, the change in acculturation, SES, dental service utilization, and unmet dental needs were calculated over two consecutive years within the same child. Finally, the structural model in these changes was fitted, and the indirect and direct pathways between acculturation and SES were tested with dental insurance as a mediator.ResultsData for 33 507 children in both panel years were analysed. An increase in family acculturation resulted in lower utilization of preventive dental service and more unmet dental need, with socio‐economic status and dental insurance kept constant between the panel years, and after adjusting for race/ethnicity, gender, and age. In addition, increased acculturation was associated with higher SES, and a higher probability of having obtained dental insurance, both of which resulted in increased preventive dental service utilization and less unmet dental need. The positive direct effect and negative indirect effect of acculturation on unmet dental need cancelled each other out and resulted to almost zero total effect between acculturation and unmet dental need. Similarly, the negative direct effect and positive indirect effect of acculturation on preventive dental service cancelled each other out leading to a small increase in preventive dental service utilization.ConclusionChildren of immigrant families are at risk of inadequate access to dental care as their families becomes more acculturated, without increase in SES and access to dental insurance. This study supports policies that promote immigrant family's adequate access to dental insurance and employment to improve their socio‐economic status.
Funder
National Institute of Dental and Craniofacial Research
Subject
Public Health, Environmental and Occupational Health,General Dentistry
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