Determinants of dental care utilization among low-income African-American women
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OBJECTIVES: To investigate determinants of dental care utilization among low-income African-American women, focusing on psychosocial factors and predictors relevant to this population. METHODS: We used data from Wave I and II of the Detroit Dental Health Project. Participants were selected to represent African-American women caring for young children, and living in Detroit households below 250% of the federal poverty level. Papers I and II are cross-sectional, using baseline data from 969 women. Paper III follows 736 women longitudinally. Our main outcome variable was dental care utilization. The main independent variable in paper I was depression. The role of social support as a moderator was also assessed in that paper. In paper II, the main independent variables were depression, perceived discrimination, and food insufficiency, both individually and in combination. Paper III employs the framework of the Behavioral Model for Vulnerable Populations to assess predisposing, enabling and need factors predicting the incidence of dental visits. RESULTS: Only 41.8% of the women had a dental visit within the past year. Cross-sectional analyses indicated that depressed women had lower odds of having a dental visit within the past year (OR=0.71, 95%CI=0.53-0.94). Emotional social support attenuated the effect of depression on dental visits. Women with high levels of perceived discrimination and those with food insufficiency were less likely to have dental visits in the past year (OR=0.65, 95%CI=0.44-0.95, and OR=0.64, 95%CI=0.44-0.93, respectively). Depression and perceived discrimination were also associated with less preventive visits. When psychosocial stressors were combined, they acted synergistically to lower the odds of having dental visits, including preventive and treatment visits. Longitudinal analyses of the data identified significant interactions between dental insurance and perceived discrimination (P =0.02) and between dental insurance and having a dental home (P =0.04). Experiencing pain in the teeth or gums was also a significant predictor of future dental visits. CONCLUSIONS: Our findings indicate the importance of considering psychosocial factors when studying dental care utilization among low-income African-American women. Our findings also suggest that establishing dental homes, graduating culturally competent dental providers, and providing emotional support resources might improve dental care utilization among these women.