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Race, Ethnicity, Culture and Educational Research Virginia J. Dodd, PhD, MPH Educational Research Seminar Series 9/27/2013.

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Presentation on theme: "Race, Ethnicity, Culture and Educational Research Virginia J. Dodd, PhD, MPH Educational Research Seminar Series 9/27/2013."— Presentation transcript:

1 Race, Ethnicity, Culture and Educational Research Virginia J. Dodd, PhD, MPH Educational Research Seminar Series 9/27/2013

2 Approach Race and health Culture and dental care Ethnicity and dental care Race and dental care Oral health and vulnerable populations Oral health disparities Going to the dentist Social value and oral health Dental care and extrinsic motivators Dental care and intrinsic motivators

3 Race and Health N = 72,331 1873 - 2013

4 Race and Oral Health N = 2466 1921 - 2013

5 Culture and Dental Care May 2013 –Understanding Muslim patients: cross- cultural dental hygiene care 1967 The practice of dentistry in ancient Egypt N=1322

6 Culture and Dental Care N = 1322

7 Summary: Culture and Dental Care Managing the socially deprived patient. Social and attitudinal correlates of health care among Mexican Americans. Pain: anxiety and attitudes in Black, White and Puerto Rican patients. The dental patient's cultural response to the need for dental care.

8 Summary: Culture and Dental Care Predictors of multiple tooth loss among socioculturally diverse elderly subjects. Transcultural dental training: addressing the oral health care needs of people from culturally diverse backgrounds.

9 Cross cultural adaptation of oral health-related quality of life measures. A psychosocial approach to dentistry for the underserved: incorporating theory into practice. Screening for oral health literacy in an urban dental clinic. Summary: Culture and Dental Care

10 Ethnicity and Dental Care 2013 = 35 publications –Evaluation of an oral health promotion program at the time of birth on dental caries in 5-year-old children in Vorarlberg, Austria. 1966 = 1 publication –Survey of needs for dental care, 1965. II. Dental needs according to age and sex of patients: Bureau of Economic Research and Statistics. N = 1443

11 Ethnicity and Dental Care

12 Summary: Ethnicity and Dental Care Burden of oral disease among older adults and implications for public health priorities. Edentulism trends among middle-aged and older adults in the United States: comparison of five racial/ethnic groups.

13 Summary: Ethnicity and Dental Care A tool for assessing cultural competence training in dental education Are survivors who report cancer- related financial problems more likely to forgo or delay medical care? Are there differences in dental care access, treatment, or treatment response by ethnicity?

14 Race and Dental Care N = 985 1964 - 2013

15 Summary: Race and Dental Care Early populations were Native Americans. Racial similarities and differences in family dental care patterns. Variations in use of dental care facilities by low-income white and black urban populations.

16 Summary: Race and Dental Care 1980s Hispanic populations 1990s “poor and underserved” 2000 Use of dental care by HIV- infected medical patients Rural-urban differences in Medicaid use

17 Summary: Race and Dental Care 2012: Edentulism trends among adults. 2013: Social support and dental visits. –Geographic differences rural vs. urban

18 “going to the dentist” N = 167 1946-present

19 Topic Summary: “going to the dentist” Much of the research involved children. 1979: A two-wave interview study of frequency of dental visits and dental complaints. 1978: How are you going to keep dentists down on the farm once they’ve seen Chicago (or New York)?

20 Topic Summary: “going to the dentist” 1990: Assessment of a single item dental anxiety question. 1994: Today’s dental student is training for tomorrow’s elderly baby boomer. 1997: Dental health attitudes among dentate black and white adults.

21 Topic Summary: “going to the dentist” 2002: Informed consent: optimism or reality? 2004: Who is going to treat our edentulous adults? 2005: An exploratory study on cultural variations in oral health attitudes, behaviors, and values of first-year dental students.

22 Topic Summary: “going to the dentist” 2005: People with disabilities: how are we going to meet their needs? 2006: How did we get here? Where are we going? Hopes and gaps in access to oral health care. 2007: The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear.

23 Topic Summary: “going to the dentist” 2009: Access to care: what are we going to do about it? 2011: Thinking about going to the dentist: a Contemplation Ladder to assess dentally-avoidant individuals' readiness to go to a dentist.

24 Topic Summary: “going to the dentist” 2013: What goes around comes around: revisiting the hypothesized vicious cycle of dental fear and avoidance. 2013: The oral health of vulnerable older adults and persons with disabilities.

25 Social Value and Oral Health N = 253 1967 - 2013

26 Topic Summary: Social Value and Oral Health Religious Leaders' Opinions and Guidance Towards Oral Health Maintenance and Promotion: A Qualitative Study. Clinical status in adolescents: is its impact on oral health-related quality of life influenced by psychological characteristics? N = 253 1967 - 2013

27 Topic Summary: Social Value and Oral Health Shaping the next generation of 'population oral healthers'. Access to oral health services for urban low-income Latino children: social ecological influences. How people on social assistance perceive, experience, and improve oral health.

28 Dental Care and Extrinsic Motivators 1994 –Obstacles to regular dental care related to extrinsic and intrinsic motivation. (Finland) 2012 –The impact of intrinsic and extrinsic factors on the job satisfaction of dentists. N = 2

29 Dental Care and Intrinsic Motivators 2012 –Evaluating the effects of coaching to improve motivational interviewing skills of dental hygiene students. 1992 –Intrinsic motivation in dental care. N = 6

30 Oral Health and Vulnerable Populations

31 Disparities Literacy rates Role of the workforce Demographic issues Access barriers N = 279 1973 - 2013

32 Oral Health Disparities N= 862 1977 - 2013

33 Topic Summary: Oral Health Disparities Increasing screening intentions for oral and pharyngeal cancer The oral health of vulnerable older adults and persons with disabilities Integrating oral and general health screening at senior centers for minority elders Distinct epidemiologic characteristics of oral tongue cancer patients.

34 Topic Summary: Oral Health Disparities Racial and ethnic disparities in utilization of dental services among children in Iowa: the Latino experience. Head and neck cancer disparity in underserved communities: probable causes and the ethics involved. Social inequality in oral health.

35 Topic Summary: Oral Health Disparities Racial/ethnic disparities in health and health care among U.S. adolescents. Using telehealth technologies to improve oral health for vulnerable and underserved populations. Distribution of caries in children: variations between and within populations. Social disparity and oral health.

36 Topic Summary: Oral Health Disparities Barriers impeding access to primary oral health care among farm worker families in Central Florida. Access to and utilization of oral health care by homeless children/families. Socioeconomic factors in adolescents' oral health: are they mediated by oral hygiene behaviors or preventive interventions?

37 Moving Forward

38 The majority of the literature on racial and ethnic groups offers epidemiologic data on health disparities. –Lacks depth Research offering findings on oral health beliefs and practices of specific racial, ethnic, and cultural groups is sparse.

39 Moving Forward Use of theoretical or strong conceptual frameworks is scarce. Current information available provides a limited picture of oral health related beliefs, thoughts, and behaviors for specific population groups. Differences in use contribute to oral health disparities– how do we remedy the issues? Why are there differences?

40 Moving Forward How do we create dental consumers? Access barriers (intensity) have not been identified for all population groups. –Methods for reducing/removing the barriers are absent from the literature. Looking below the barriers– are there other “undiscovered” reasons for differences in access patterns?

41 Moving Forward Much of the literature employs samples recruited from clinical populations. –Movement into the community will be required to reach individuals who do not seek regular dental care. Oral health literacy –Related to treatment decisions… how? –Tailored materials- do they make a difference? What degree of tailoring?

42 Moving Forward Cultural competence –Multi cultural office settings Does inclusiveness make a difference? Treatment by front office staff –Staff trained in cultural competence vs. untrained staff – is there a difference? Dignity, judgment –How can these perceptual barriers?

43 Moving Forward Dentist/patient engagement during appointment. Does provider training in cultural competence improve case acceptance and/or return visits? Extractions, tooth loss- what does this mean to different population groups? –Missing teeth: Scarlet letter of the poor?

44 Moving Forward Do patients who receive care for acute dental problems in an emergency department follow-up their referral for definitive care? –Why or why not? Do treatment decisions differ by level of OHL?

45 Identify oral health beliefs, values, and practices of different population groups. What are the factors associated with missed dental appointments?

46 What is the actual cost of ECC? –DALY… Social and intellectual development affected Permanent teeth may be affected Malocclusion, missing teeth– self-esteem Early learning foundation poor– not much to build on… prospects for college low… job prospects questionable… missing teeth can add to a lack of marketability. –What is the cumulative cost of early and un or under-treated dental disease?

47 Moving Forward It is time to apply some of the broad concepts to determine how they work. Social, behavioral, environmental, biological aspects must be considered. Solutions will require an interdisciplinary approach.

48 Different Perspectives Consideration of different perspectives….. Coronary angioplasty is like going to the dentist (2000).

49 Any discussion or questions? Thank you for your attention!

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