This article describes dental visits among Hispanics and Hispanic subgroups in the United States.
Methods
This study is based on an analysis of data regarding dental visits among Hispanics two years of age and older from the National Health Interview Survey of 1999. The authors compared the 1999 data with a combined sample from 1978 through 1980.
Results
Although the level of dental visits for all Hispanic subgroups increased between the period of 1978 through 1980 and 1999, the level of dental visits was lowest among Mexican-Americans. For Mexican-Americans born outside the United States, the longer they had lived in the United States, the more likely they were to have visited a dentist.
Conclusions
Increases in the utilization of dental services among Hispanics provide some optimism for reductions in the level of untreated oral disease among Hispanics in the future. However, if increases in dental care utilization among Mexican-Americans fail to keep pace with those among other segments of the U.S. population, this population group risks falling further behind.
Practice implications
Hispanic patients will make up a greater percentage of all dental patients in the future. The impact of this growth will vary greatly by state.
Section snippets
METHOD
The NHIS is a multipurpose survey conducted annually by the National Center for Health Statistics, or NCHS, and the Centers for Disease Control and Prevention, or CDC, and is the principal source of information on the health of the civilian, noninstitutionalized household population of the United States. NHIS data are collected through personal household interviews. Most information about oral health in the NHIS is obtained for all people two years of age and older. Data are released on an
RESULTS
Whereas the percentage with a dental visit during the past year was lowest among blacks in 1989, Hispanics reported the lowest level of dental visits in 1999 (Figure 1). An 11.7 percentage point increase in the level of dental visits from 1989 to 1999 among blacks combined with a 6.7 percentage point increase among whites reduced the difference between these two groups from 14.8 to 9.8 percentage points in 1999.
However, the 5.5 percentage point increase in visits among Hispanics combined with
DISCUSSION
Projections presented in the introduction to this article indicate that Hispanics will grow from just less than 11.8 percent of the population to 24.3 percent by the year 2050. This increase from 32.4 million to 98.2 million Hispanics accounts for approximately one-half of the total expected growth in the U.S. population from 275 million in 2000 to 404 million in 2050. However, as the percentage of Hispanics increases, the percentage of Hispanics who are born outside of the United States is
CONCLUSION
The fact that Hispanics as a group reported the lowest level of dental care utilization in 1999 was due primarily to low utilization among Mexicans in the United States. Because Mexicans make up two-thirds of all Hispanics in the United States, they have a dominant impact on overall dental visit estimates for Hispanics.
However, the trends presented in this article provide some reason for satisfaction. Firstly, the utilization of dental services by all Hispanic subgroups increased from 1978–1980
Mr. Wall is the manager, Statistical Research, Health Policy Resources Center, American Dental Association, 211 E. Chicago Ave., Chicago, Ill. 60611. Address reprint requests to Mr. Wall.
Studies from across the United States have noted that children in migrant farmworker families are more likely than their counterparts to suffer from tooth decay (Call, Entwistle, & Swanson, 1987; Chaffin, Pai, & Bargamian, 2003; Lukes & Simon, 2006; Ramos-Gomez et al., 1999). Mexican-origin children have poorer levels of oral health than children from any other racial/ethnic group (USDHHS, 2000) and persistently lower dental care utilization rates, even after adjusting for age, income, education, and dental insurance coverage (Wall & Brown, 2004). Barriers to health care access for migrants in general have been well-documented in the literature and include immigration status, linguistic barriers, lack of insurance, lack of transportation, fear of deportation, and lack of familiarity with the U.S. health system and available services (Arcury & Quandt, 2007; Pew Hispanic Center, 2009).
Few studies have engaged issues of social class and access related to dental health care policy from an ethnographic perspective. The state of Florida in the US has one of the poorest records in the nation for providing dental care for low-income children, falling especially short for Medicaid-enrolled children. In this paper, we discuss unmet dental health needs of children in migrant farmworker families. Although one of the most marginalized populations, most are eligible for Medicaid and are thus covered for dental services. However, serious disparities have been linked to the lack of access through the public insurance system. This study was informed by participant observation at dental clinics and a Migrant Head Start Center and interviews with dental health providers (n = 19) and migrant farmworker parents (n = 48) during 2009. Our results indicate that some typical factors associated with poor oral health outcomes, such as low dental health literacy, may not apply disproportionately to this population. Instead, we argue that structural features and ineffective policies contribute to oral health care disparities. Dental Medicaid programs are chronically underfunded, resulting in low reimbursement rates, low provider participation, and a severe distribution shortage of dentists within poor communities. We characterize the situation for families in Florida as one of “false hope” because of the promise of services with neither adequate resources nor the urgency to provide them. The resulting system of charity care, which leads dentists to provide pro bono care instead of accepting Medicaid, serves to only further persistent inequalities. We provide several recommendations, including migrant-specific efforts such as programs for sealants and new mothers; improvements to the current system by removing obstacles for dentists to treat low-income children; and innovative models to provide comprehensive care and increase the number of providers.
Those who flossed more frequently, had dental insurance, had a regular source of care and had more filled teeth were more likely to have visited a dentist during the previous year than were their counterparts. Contrary to many published reports,9,10,16,24,25 age at immigration and preferred language were not independent predictors of utilization of oral health care services across all racial/ethnic groups in this study. Because we did not ask respondents for the language spoken by their dental care provider and all participants were recruited in predominantly ethnic neighborhoods, it is possible that those who accessed care during the previous year may have sought an oral health care provider who spoke their native language or sought dental practices within their neighborhood that provided culturally appropriate care.
Few studies have examined utilization of oral health care services among immigrants. The authors examined the determinants of utilization of oral health care among a diverse group of immigrants in New York City.
The authors examined and interviewed 1,417 foreign-born people, aged 18 to 65 years, who were residents of New York City. They conducted examinations by using criteria established by the National Institute of Dental and Craniofacial Research, Bethesda, Md. The authors used unconditional logistic regression to estimate odds ratios (ORs) and 95 percent confidence intervals for having visited a dentist within the previous year for each of the independent variables.
More than 70 percent of the participants lacked dental insurance and only about 31 percent reported that they had visited a dentist within the previous year. Flossing (OR = 1.18), dental insurance (OR = 1.58), having a regular source of dental care (OR = 4.76) and more filled teeth (1.33) were independent predictors of utilization of services.
Having a regular source of dental care and having dental insurance are important predictors of immigrants' utilization of oral health care services in New York City.
The study results suggest the importance of establishing affordable, culturally appropriate, community-based oral health care services to improve the oral health of vulnerable populations.
For example, the authors reported that the percentage of children who had never visited a dentist was highest among Mexican children (17.7 percent).9 A previous study also reported that Mexican-Americans have had the lowest levels of dental visits in the United States.10 Cultural differences among Hispanic subgroups, as well as different expectations regarding their dental care needs, might result in a differential in access to dental care.9
The Hispanic population has become the largest minority group in the United States, resulting in an increase in oral health care demands. Developing a research agenda and promoting collaboration on Latino oral health issues are crucial.
The Hispanic Dental Association and the University of Puerto Rico, School of Dentistry, San Juan, convened a workshop of health care providers and other experts to examine the current state of Hispanic oral health research and identify gaps in existing data and research methods. Participants were asked to break out into small groups to discuss research priorities.
The participants discussed the following research areas: population-based studies, social and behavioral sciences, health promotion and communications, gene-environment interactions, and research training and workforce development. Participants emphasized the importance of understanding variations among subgroups within the Hispanic population in the development of future studies.
Participants recommended collaborative research studies to advance existing oral disease prevention and oral health promotion efforts, with a stronger focus on the development of a multidisciplinary pipeline of researchers participating in Latino oral health research to address the growing needs of this population.
Building an infrastructure for research training and workforce development would supply researchers with the necessary tools to develop new studies that could affect the overall oral health of the Latino population. The translation and dissemination of these research findings will benefit clinicians by leading to a better understanding of new trends and specific population needs, as well as appropriate targeted interventions.
Mr. Wall is the manager, Statistical Research, Health Policy Resources Center, American Dental Association, 211 E. Chicago Ave., Chicago, Ill. 60611. Address reprint requests to Mr. Wall.
Dr. Brown is associate executive director, Health Policy Resources Center, American Dental Association, Chicago.
