Psychosocial factors and Early Childhood Caries
among low-income African American children in Detroit
Authors
Tracy L. Finlayson, PhDKristine Siefert, PhD, MPH
Amid I. Ismail, BDS, MPH, DrPH, MBA
Woosung Sohn, DDS, PhD, DrPH
Abstract
Objectives:
This study seeks to advance knowledge of the social
determinants of oral health, by examining how several specific maternal
health beliefs, behaviors, and psychosocial factors relate to young
children's Early Childhood Caries (ECC) status in a lower income African
American population.
Methods:
Data were collected by the Detroit Dental Health Project (NIDCR
grant U-54 DE 14261-01), a population-based study of 1,021
African-American families with at least one child under six and living in
39 low-income Census tracts in Detroit, Michigan. Analyses were limited
719 children aged 1-5 and their biological mothers and conducted in SUDAAN
to account for the complex sampling design.
Survey data included health belief scales on mothers' self-efficacy,
feelings of fatalism, knowledge about appropriate bottle use and
children's oral hygiene needs, brushing habits, and psychosocial measures
of depressive symptoms (CES-D), parenting stress, and availability of
instrumental social support. The child's age, dental insurance status,
dental visit history, and one-week brushing frequency were also included
in the model. Children's ECC status, based on a dental examination, was
the main outcome.
The dental team used the International Caries Detection and Assessment
System (ICDAS) criteria for caries detection. Each child was classified
as either caries-free or having Early Childhood Caries (ECC) or severe ECC
(S-ECC) based on the case definition of ECC proposed by an expert panel
for research purposes with preschool-aged children.
Results:
The dental team followed a specific examination protocol and
established reliable and consistent ratings of ECC based on the ICDAS
criteria. The inter-rater reliability Kappa was .83 overall, and the
intra-rater reliability Kappa was .74 overall.
One-third of the children had ECC, and 20% had severe ECC. Age of the
child and lower parenting stress scores were each positively associated
with ECC, while higher education and income were protective. Maternal
oral health fatalism and knowledge of children's hygiene needs were
associated with ECC among preschool-aged children. ECC was higher among
younger children who had past restorative care.
Conclusions:
These findings call attention to the high prevalence of ECC
in this population and the need to consider psychosocial as well as
traditional risk factors in developing interventions to reduce oral health
disparities.
This paper is scheduled to be published in 2007
in Community Dentistry and Oral Epidemiology.