Psychosocial factors and early childhood caries among low-income African-American children in Detroit
Psychosocial factors and early childhood caries among low-income African-American children in Detroit
复制标题
DOI：
10.1111/j.1600-0528.2006.00352.x
复制
发表时间：
2007-12-01
影响因子：
2.3
通讯作者：
Sohn, Woosung
中科院分区：
文献类型：
--
作者：
Finlayson, Tracy L.;Siefert, Kristine;Sohn, Woosung
目的：这项研究试图通过调查几个特定的母亲健康信念、行为和心理社会因素与低收入非裔美国人人群中幼儿早期儿童龋齿(ECC)状况的关系，来促进对口腔健康的社会决定因素的了解。方法：数据由底特律牙科健康项目(NIDCR Grant)收集，该项目是一项基于人口的研究，涉及1021个非裔美国家庭，他们至少有一个6岁以下的孩子，生活在密歇根州底特律的39个低收入人口普查地区。分析限于719名1-5岁的儿童及其亲生母亲，并在Sudaan进行，以说明复杂的抽样设计。调查数据包括母亲自我效能感、宿命感、适当使用奶瓶和儿童口腔卫生需求的知识、刷牙习惯、抑郁症状的心理社会测量(CES-D)、育儿压力和工具性社会支持的可获得性。孩子的年龄、牙科保险状况、牙科就诊史和一周刷牙频率也包括在模型中。根据牙科检查，儿童的ECC状况是主要结果。牙科团队使用国际龋齿检测和评估系统(ICDAS)标准进行龋齿检测。根据专家小组为学龄前儿童研究提出的ECC病例定义，将每个儿童分为无龋组、ECC组和重度ECC组(S-ECC)。结果：牙科团队遵循了特定的检查方案，并根据ICDAS标准建立了可靠和一致的ECC评级。评分员间信度Kappa值为0.83，评分员内信度Kappa值为0.74。三分之一的儿童患有ECC，20%的儿童患有严重的ECC。孩子的年龄和较低的育儿压力得分都与ECC呈正相关，而较高的教育程度和收入则具有保护性。母亲口腔健康宿命论和对儿童卫生需求的了解与学龄前儿童的ECC有关。接受过恢复性护理的年幼儿童的ECC较高。结论：这些发现提醒人们注意ECC在该人群中的高患病率，以及在制定干预措施以减少口腔健康差异时需要考虑心理社会和传统风险因素。
Objectives: This study sought 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), a population-based study of 1021 African-American families with at least one child under 6 years of age and living in 39 low-income Census tracts in Detroit, Michigan. Analyses were limited to 719 children aged 1-5 years 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, 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 1-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 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 0.83 overall, and the intra-rater reliability kappa was 0.74 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.