Examining California's Oral Health Disparities: New Models and Methods

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DESCRIPTION (provided by applicant): The 2005 California Oral Health Needs Assessment of Children (COHNAC), a complex statewide health examination survey of over 21,000 kindergarten and third grade children, has shown decreases in the prevalence of untreated caries and slight decreases in caries experience since the 1993-4 COHNAC. However, these prevalences have not met Healthy People 2010 Objectives, California's children have the 2nd worst oral health of the 25 states reporting data, and children in families with low income and children of color continue to have worse oral health. Overall goals of this proposed project are to apply state-of-the-art HD methods in the 2005 COHNAC, to assess associations of some particular factors of acculturation, parental health literacy, and social environment in relation to oral health, to test and evaluate HD methods applied to oral health, and to provide a suite of methods/tools to colleagues that can be used in similar state oral health surveys and beyond. Specific Aims are: 1) To estimate oral health disparities (OHD) with traditional regression based measures as well as state-of-the art disparities measures (e.g. HCI and Thiel's index) in the 2005 statewide California Oral Health Needs Assessment of Children; 2) To use multiple imputation for missing questionnaire data and models to examine child, family, neighborhood and school factors (including acculturation and health literacy related measures) associated with California OHD; 3) To validate a multi-level ensemble statistical modeling approach combining recursive partitioning methods with complex survey sampling regression using computer simulations; and 4) To disseminate a) multiple imputed 2005 COHNAC data according to the UCSF CAN-DO data use policy and b) computer programs and documentation for HD indices and survey regression portion of ensemble models freely on the UCSF CAN-DO website. An overarching goal for HP 2010 is the elimination or reduction of health disparities (HDs) in the US population. More specific objectives include Objectives 21-1b and 21- 2b: to reduce the percentage of children with caries and untreated caries, respectively. Objective 11-2 is a developmental objective to improve health literacy among those with inadequate health literacy levels. This proposed research is responsive to those objectives.