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Factors associated with future dental care utilization among low-income smokers overdue for dental visits.

ABSTRACT: BACKGROUND:Smokers are at increased risk of oral disease. While routine dental care can help prevent and treat oral health problems, smokers have far lower rates of dental care utilization compared with non-smokers. We sought to better understand which factors may facilitate or hinder dental care utilization among low-income smokers participating in a randomized intervention trial in order to inform future intervention planning. METHODS:This is a secondary analysis of data collected between 2015 and 2017 as part of the OralHealth4Life trial. Participants were eligible callers to the Louisiana, Nebraska, and Oregon state tobacco quitlines who had no dental appointment in the prior or upcoming six months. We examined the association between participants' baseline characteristics and their receiving professional dental care between baseline and the 6-month follow-up survey. RESULTS:Participants were racially diverse (42% non-White) and two-thirds had an annual household income under $20,000. Most (86.7%) had not had a dental cleaning in more than one year. Commonly cited barriers to dental care included cost (83.7%) and no dental insurance (78.1%). Those with dental insurance were more likely to see a dentist at follow-up (RR 1.66). Similarly, those reporting a dental insurance barrier to care were less likely to see a dentist at follow-up (RR 0.69); however, there was no significant utilization difference between those reporting a cost barrier vs. those who did not. After controlling for these financial factors, the following baseline characteristics were significantly associated with a higher likelihood of dental care utilization at 6 months: higher motivation (RR 2.16) and self-efficacy (RR 1.80) to visit the dentist, having a disability (RR 1.63), having a higher education level (RR 1.52), and having perceived gum disease (RR 1.49). Factors significantly associated with a lower likelihood of dental care utilization included being married (RR 0.68) and not having a last dental cleaning within the past year (RR 0.47). CONCLUSIONS:Our findings provide important insight into factors that may facilitate or deter use of professional dental care among low-income smokers. This information could inform the development of future interventions to promote dental care utilization. TRIAL REGISTRATION:ClinicalTrials.gov : NCT02347124 ; registered 27 January 2015.

SUBMITTER: Blasi PR

PROVIDER: S-EPMC6211575 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Factors associated with future dental care utilization among low-income smokers overdue for dental visits.

Blasi Paula R PR Krakauer Chloe C Anderson Melissa L ML Nelson Jennifer J Bush Terry T Catz Sheryl L SL McClure Jennifer B JB

BMC oral health 20181101 1

<h4>Background</h4>Smokers are at increased risk of oral disease. While routine dental care can help prevent and treat oral health problems, smokers have far lower rates of dental care utilization compared with non-smokers. We sought to better understand which factors may facilitate or hinder dental care utilization among low-income smokers participating in a randomized intervention trial in order to inform future intervention planning.<h4>Methods</h4>This is a secondary analysis of data collect ...[more]

PMID: 30382910

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Project description:BACKGROUND:This study aims to explore the difference in the utilization pattern of dental services among pregnant, post-partum and six-month post-partum women. METHODS:This cross-sectional questionnaire survey was performed at two maternity and child care hospitals in India that primarily cater to middle and low income communities. Data were collected from 3 groups: 1) pregnant women in their first trimester; 2) post-partum women (<?48?h after delivery); and 3) six-month post-partum women. The primary outcome of interest was dental service utilization during pregnancy. Self-perceived oral health (SPOH) was calculated based on the four global dimensions- knowledge, function, quality of life and social. Multiple logistic regression analysis was carried out to assess the effect of each independent variable after adjustment for the effect of all other variables in the model. RESULTS:Responses of 450 (150 pregnant, 150 post-partum and 150 six-month post-partum) women were analyzed (response rate?=?72%). Significant differences in the dental attendance pattern was observed between the study groups (p?<?0.01). Dental attendance among pregnant and six-month post-partum women were 60 and 75%, respectively, however, only about 15% of the post-partum women reported to have sought dental care within the 6?months prior to the study. Post-partum women had the highest SPOH scores, indicating poor self-perceived oral health, followed by pregnant and then six-month post-partum women, which was statistically significant (p?< 0.05). A significantly higher percentage of post-partum women reported to have poor oral and general health, as compared to both, pregnant and six-month post-partum women (p?< 0.01). Higher percentage of women reporting 'good' oral and general health had sought dental care compared with others (p?< 0.01). After adjusting for all the other variables in the model, women with lower levels of education (ORa?=?1.42; 95% CI: 1.01-2.00), women with poor self-perceived oral health (ORa?=?1.08; 95% CI: 1.02-1.14) and post-partum women (ORa?=?0.15; 95% CI: 0.09-0.24) were found to be less likely to seek regular dental care. CONCLUSION:Pattern of dental service utilization among women in this population varied according to their pregnancy status, level of education and self-perceived oral health.

Project description:Highlights • Changes to access to care measures among low-income smokers following Medicaid expansion have not been characterized.• Health care access measures among smokers related to affordability of care and unmet needs improved following Medicaid expansion in Ohio.• The was no change in having a usual source of care, an important indicator of preventive care use.• A comprehensive improvement on access to care is essential for tobacco cessation efforts, early management of health problems, and reduction in smoking-related health care costs and disparities. Smokers are more likely to be low-income with limited access to health services. Although Medicaid expansion under the Patient Protection and Affordable Care Act improved access to care for low-income adults, long-term trends in health care access among low-income smokers remain uncharacterized. The study evaluated changes in five access measures among low-income nonelderly (19–64) adults (N = 28976) across smoking status using pooled data from a statewide survey in Ohio covering pre- (i.e., 2012) and post-Medicaid expansion periods (2015, 2017, and 2019) guided by a comprehensive framework of health care access. We found improvements in some, but not all, health care access measures among low-income smokers in the post-Medicaid-expansion period compared to the pre-expansion period. Compared to 2012, the odds for unmet dental care needs declined in 2015 (aOR = 0.67, 95 % CI = 0.45–1.01), 2017 (aOR = 0.53, 95 % CI = 0.35–0.81), and 2019 (aOR = 0.65, 95 % CI = 0.40–1.05) (p trend < 0.001). Similarly, the odds for unmet other health care needs (i.e., medical exams and supplies) were lower in 2015 (aOR = 0.64, 95 % CI = 0.39–1.06), 2017 (aOR = 0.56, 95 % CI = 0.34–0.93), and 2019 (aOR = 0.47, 95 % CI = 0.27–0.83) (p trend < 0.001). Difficulty paying medical bills was also significantly lower in 2015 (aOR = 0.62, 95 % CI = 0.43–0.89), 2017 (aOR = 0.57, 95 % CI = 0.39–0.83) and 2019 (aOR = 0.57, 95 % CI = 0.37–0.87) (p trend < 0.001). While there was notable progress in measures of affordability (i.e., paying medical bills) as well as care availability and accommodation (i.e., unmet needs), there were no meaningful changes in the approachability of care (i.e., having a usual source of care).

Project description:IntroductionTo study the association between health care utilization and menthol cigarette use and whether the association differed between African American (AA) and non-AA smokers.MethodsWe analyzed the three most recent 2005, 2010, and 2015 National Health Interview Survey Cancer Control Supplements. After incorporating propensity score weights adjusting for observed differences between menthol and non-menthol users, we estimated Zero-Inflated Poisson models on hospital nights, emergency department visits, doctor visits, and home visits as a function of menthol use status and other covariates separately for current cigarette smokers and recent quitters (former smokers quitting cigarette smoking ≤ 4 years).ResultsAlthough current menthol smokers smoked fewer cigarettes per day than current non-menthol smokers, they did not differ from current non-menthol smokers in health care utilization. Among recent quitters, those who used to smoke menthol cigarettes had higher odds of having hospital nights than those who used to smoke non-menthol cigarettes. However, we did not find any significant association between menthol use and other health care utilization-emergency department visits, doctor visits, and home visits-among recent quitters. Moreover, compared with non-AA recent quitters, AA recent quitters had higher odds of having home visits, but fewer home visits, if they used to smoke menthol cigarettes.ConclusionMenthol use was associated with greater hospitalization among recent quitters, and the association between home visits and menthol use differed between AA and non-AA recent quitters.ImplicationsThis is the first study that used econometric models to study the association between health care utilization and menthol cigarette use and examine whether the association differed between AA and non-AA smokers. Our study found health care utilization did not differ by menthol use status for current smokers, although current menthol smokers smoked fewer cigarettes per day than current non-menthol smokers. However, we found menthol use was associated with higher odds of having hospital nights for recent quitters. We also found AA recent quitters had a different association between home visits and menthol use compared with non-AA recent quitters.

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Factors associated with future dental care utilization among low-income smokers overdue for dental visits.

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Factors associated with future dental care utilization among low-income smokers overdue for dental visits.

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