This application addresses the broad challenge area: Health Disparities (09);Challenge Topic: Behavioral and Social Sciences to Reduce Oral Health Disparities (09-DE-101). Title: First preventive dental visit: Disparities in needs, costs + behavioral insights This study investigates the predictors and outcomes of age at first preventive dental visit (AFPDV) for Medicaid-enrolled children-a dentally underserved population. The age when a child receives their first dental check-up helps establish a dental home for the child and provides important preventive counseling for the mother. Medicaid-enrolled children are known to have less access to dental care. Of particular interest in this study are five Medicaid subpopulations at high risk of disparities in access to dental care and resulting oral health status: 1) Racial and ethnic minority children, 2) Rural children, 3) Children in federally designated Dental Health Professions Shortage Areas (HPSAs), 4) Children with less access to medical care and associated well child visits, and 5) Children who receive care at a Community Health Center (CHC). Since one in four children in the United States are enrolled in Medicaid, this study could potentially impact a large population of the most vulnerable children in the country. We are proposing a multifaceted, interdisciplinary set of studies to explore this issue: Study 1: Determinants of the age at first preventive dental visit for Medicaid-enrolled children. The first study investigates the predictors of age at first preventive dental visit using Iowa Medicaid claims data for preschool age children who were enrolled in the program within a month of birth in 2004. We will follow these children in the claims database until they have their first preventive dental visit, are no longer enrolled in Medicaid or turn six years old. Factors previously identified in dental use models will be included in these analyses with the added factor of utilization of well-child visits. We will use survival analyses to model these relationships. Study 2: An evaluation of the effectiveness of earlier FPDVs on the need for dental care at the first visit and the successful completion of treatment plans for Medicaid-enrolled children who sought care at a CHC in Iowa. Chart reviews will be used to find out how the needs of children at the time of their first dental visit and whether AFPDV affects outcomes, in particular, the completion of the treatment plan. The chart reviews will be performed at 9 Community Health Centers (CHCs) with electronic health records for 270 children in Iowa. Study 3: Impact of the AFPDV on future dental and medical care utilization and costs. Iowa Medicaid claims and administrative data will be used to determine if AFPDV affects future dental and medical care costs for preschool children. Using instrumental variable analyses we will model the factors related to dental use and cost with special attention to AFPDV. Study 4: Using the Health Belief Model and the Extended Parallel Process Model to determine factors associated with mothers'decision-making and preventive dental care seeking behavior related to FPDV. Focus groups will be used to help us understand what factors encourage and discourage parents from taking their children for preventive dental care. The results of these three studies will serve to inform the contents of a survey of parents with children in Medicaid. Previous results will help us to include the most critical factors and tailor the surveys to issues important to parents with children in Medicaid. These surveys will be designed to find out what prompts parents to take their children to the dentist for their first preventive dental visit and what might discourage them from preventive dental care. These data will be analyzed with OLS regression to determine what psycho-social factors are related to AFPDV. Goal: This program of research is designed to help us understand the most effective age for the first preventive dental visit. This work ultimately culminates in the design of an intervention with parents and providers to encourage the effective timing of children's first preventive dental visit. This study builds on extensive previous research by this team who has demonstrated the ability to successfully conduct studies regarding dental care for underserved children combining these large administrative databases and primary data collection methodologies.
This research project will investigate the predictors and outcomes of preschool age children's first preventive dental visit, improving our understanding of how age at first preventive dental visit is affected by the psychosocial, behavioral, and social factors and affects the outcomes of dental care over time. We will use this information to design an intervention to encourage the appropriate timing of a child's first preventive dental visit through education of the parent and providers.
