The purpose of the proposed study is to empirically test the relative effects of socioenvironmental, delivery system and personal/lifestyle factors on oral health status within and among twelve industrialized and middle-income countries, and to develop a theoretical model of determinants of dental health status. The data will be collected through International Collaborative Study of Oral Health Outcomes (ICS II) a cross-national project to be conducted by WHO and the University of Chicago. Data sources include the following: 1) consumers' oral health status obtained, using trained clinical examiners, from 4,000 subjects in each system (1000 from each age group: 6-7, 12-13, 35-44, and 65-74); 2) consumers' socioeconomic characteristics, oral health beliefs and knowledge, and dental behaviors obtained by questionnaires and interviews; 3) delivery system structure and socioenvironmental factors obtained by interviews of randomly selected providers, administrators, and secondary data collection. These data will be collected from communities chosen from each participating country to exemplify the predominant dental delivery system. Univariate and multivariate analyses will be used to examine the relative effects of the individual level variables (e.g., SES, health beliefs, dental insurance, oral hygiene practices and dental utilization) on oral health status. Linear Structural Relations system (LISREL), a causal modeling technique, will be employed to test various causal models between major variables. The relative magnitude of the regressional or causal coefficients will be compared across countries. The structural relationships between oral health status and delivery system and socioenvironmental variables will be inferred with individual level variables controlled. Finally, a dental health status model will be developed by synthesizing the empirical findings of the proposed study with the insights gained from the dental and health literature.
