Latinos in the US experience substantial oral health disparities (OHD). They face barriers to accessing oral health services (e.g., among the lowest rates of dental insurance among any racial or ethnic group), and are disproportionately less likely to seek regular and preventive dental care. Latino children and adults also experience higher rates of dental caries, gingivitis, and/or chronic periodontitis. Studies of oral health among Latinos have been limited to identifying individual-level socioeconomic and sociocultural mechanisms, with little attention to broader personal and community network contexts. Viewed from a network science perspective, the health behaviors, beliefs, and attitudes of individuals are shaped through contact and communication with others; there is a strong relationship between social networks and health outcomes. The current oral health research toolbox does not adequately capture the multiple nested levels of influence embodied in OHD. We propose to apply Social Network Analysis (SNA) methods to address the critical need to understand how social norms, attitudes, resources, and information around dental care and oral health propagate through personal and community networks, and affect individual behavior and outcomes. In the proposed research we will build on our completed formative project (NIDCR DE022096), a pioneer study using SNA methods in OHD research targeting people of Mexican descent (or Mexican-Americans [MAs]) in the US. In that prior cross-sectional design we characterized experiences about food, oral health behaviors, and dental care in the context of the networks they live in. Describing OHD factors and mechanisms affecting MAs has great public health significance because the MA sub-group makes up about 60% of Latinos in the US. In the present longitudinal design, we will develop a strong causal model of OHD by focusing on the dynamic processes underlying the coevolution of networks, oral health culture, and dental care attitudes and behaviors over time among MAs who have recently immigrated.
Our specific aims are to: 1) characterize the norms, attitudes, behaviors, and perceptions of barriers around dental care and oral health among MA immigrants, with specific attention to associations between these factors and personal social network features; and 2) determine the relationships between acculturation, personal and community network dynamics, diffusion of norms and resources, and evolving oral health behaviors, attitudes, and outcomes over time among MA immigrants. Having additional, and more accurate knowledge about the complex and dynamic mechanisms underlying OHD will provide a foundation to develop four aspects: effective public policy, efficient clinical guidelines, culturally-sensitive clinical and preventive care, and futur research directions with practical applications. Moreover, drawing on the rich body of existing research on network interventions and diffusion of innovation from other health areas, our findings can be applied to tailoring programs that leverage the strengths and resources of MA communities to improve population oral health.
The Latino population - the largest and fastest growing ethnic group in the US - has significant barriers to dental services and is afflicted by large oral health disparities. Attempts to address such problems through individual behavior change have been largely unsuccessful because little is known about the complex network dimensions in which patterns of oral health self-care and dental services utilization take place. The proposed research will study one Latino community to trace relationships over time between acculturation, personal and community network dynamics, diffusion of norms and resources, and experiences of oral health, to yield a solid base for effective public policy and culturally-sensitive clinicalcare.
| Maupome, G; McConnell, W R; Perry, B L (2016) Dental problems and Familismo: social network discussion of oral health issues among adults of Mexican origin living in the Midwest United States. Community Dent Health 33:303-308 |
