Salud oral en contexto: an exploration of socio-structural factors impacting the oral health of Latino/a/e adults
Embargo Date
2030-09-30
OA Version
Citation
Abstract
As a visible and often overlooked marker of social inequity, oral health reflects broader systemic inequities and influences a wide range of biopsychosocial outcomes and overall quality of life. Latino/a/e adults in the United States experience persistent oral health inequities shaped by an interplay of structural (political/economic) and social (cultural) factors. Guided by the Intersectional Approach to Health Justice, this dissertation examines how structural legislative environments and cultural identity intersect to shape oral health behaviors, values, and outcomes among Latino/a/e adults. By integrating policy analysis and mixed-methods primary data collection, this dissertation aims to advance a more comprehensive understanding of oral health inequities and inform interventions that are structurally grounded and culturally responsive. The first study uses data from the National Conference of State Legislators (NCSL) and the Behavioral Risk Factor Surveillance System (BRFSS) from 2010 to 2022 to explore how state-level immigrant-related legislative actions and Medicaid adult dental coverage influence oral health outcomes for Latino/a/e adults across the U.S. A novel scoring scheme was developed to assess state legislative action across three domains: access to services, economic opportunity, and social equity. Findings revealed that more generous Medicaid dental coverage was associated with increased dental care utilization, but had no significant association with tooth loss, highlighting the limitations of short-term policies in addressing long-term oral health inequities. More inclusive immigration policies were associated with higher dental utilization in lagged models, suggesting delayed effects of structural change. However, findings regarding tooth loss were mixed. Interaction effects indicated that the impact of Medicaid coverage on utilization was weaker in states with more inclusive immigration policies, suggesting that broader contexts shape policy effectiveness. The second study builds on these structural findings by examining how Latino/a/e cultural identity influences oral health values and experiences, using a convergent mixed-methods design that included surveys (N = 134) and interviews (N = 20) with Latino/a/e adults in Philadelphia, PA. Latent class analysis identified two identity profiles based on self-perceived race, socially assigned race, and skin tone, which varied in nativity, language, and socioeconomic status, but showed no significant association with oral health outcomes. Interviews revealed four key themes, highlighting the connections between oral health and cultural identity through the influence of family, external perceptions, psychosocial factors, and structural trade-offs. Despite valuing oral health, participants faced emotional, financial, and systemic barriers to care. This dissertation highlights that oral health inequities are not solely the result of individual behaviors or isolated policies but emerge at the intersection of cultural identity, political belonging, and economic factors. This dissertation advances an intersectional framework for oral health justice that recognizes the cumulative and relational nature of inequities, calling for policy, practice, and research efforts grounded in the lived realities, diversity, and intersectional experiences of Latino/a/e communities.
Description
2025
License
Attribution 4.0 International