Impact of Dental Care Access on Children's Oral Health and Academic Outcomes

项目总结/摘要 儿童时期口腔健康不良与更多的缺课和较低的学业成绩有关。那里 有证据表明，州一级的医疗补助政策，包括支付率牙医，成人牙科 覆盖率，以及非牙医初级保健提供者使用氟化物保护漆（FV）的覆盖率， 对低收入儿童接受推荐牙科服务的可能性产生有意义的影响。然而，在这方面， 很少有研究将增加牙齿护理的具体医疗补助政策与儿童口腔健康措施联系起来。 健康，而且，没有严格的，大规模的研究与合理的因果研究设计已经审查了 这些政策和学习成绩之间的联系。我们迫切需要严格的证据 国家一级的政策有可能改善这些成果。该提案将提供 关于牙科保健获得与口腔健康和学术措施之间联系的新证据 使用自然实验设计，利用州一级医疗补助支付率的变化， 1999 - 2016年期间牙医，成人牙科覆盖率和FV政策以及大规模国家数据集， 包括基于考试和行政成果措施。我们的研究期间捕获了大量的 国家一级的变化，同时也代表了一个相对较新的时间框架。我们的分析还将评估 按儿童性别、年龄组、种族和民族划分的重要亚组差异。在目标1中，我们将检查 每项政策与口腔健康措施之间的联系，包括父母报告的牙齿状况， 全国儿童健康调查（NSCH），未经治疗的龋齿的基于检查的客观措施， 存在来自国家健康和营养检查调查（NHANES）的牙科密封剂，以及 国家紧急状态下口腔疾病急诊科就诊的行政记录 部门数据库（SEDD）。在目标2中，我们将评估每项政策与学术 结果包括缺课、学校与家长的联系、家长对学前教育的关注 技能，并从NSCH，皮博迪个人成就测试成绩和等级保留等级保留 来自全国青年纵向调查-儿童和青年成人队列（CNLSY），以及学校 幼儿纵向研究-幼儿园队列（ECLS-K）。这将是第一 一项全国性的研究，以估计增加获得牙科保健和学术之间的因果关系 低收入儿童的表现。这项研究将提供关键的，及时的，与政策相关的新的 关于增加获得牙科保健的影响和公共健康保险政策作用的证据。

PROJECT SUMMARY/ABSTRACT Poor oral health in childhood is correlated with more school absences and lower academic achievement. There is evidence to suggest that state-level Medicaid policies, including payment rates to dentists, adult dental coverage, and coverage of fluoride varnish (FV) application by non-dentist primary care providers, have meaningful effects on the likelihood that low-income children receive recommended dental services. However, little research has linked specific Medicaid policies that increase dental care access to measures of child oral health, and further, no rigorous, large-scale studies with plausibly causal research designs have examined the connection between these policies and academic performance. There is a critical need for rigorous evidence on the potential for state-level policies to achieve improvements in these outcomes. This proposal will provide novel evidence on the link between dental care access and measures of oral health and academic performance using a natural experiment design that leverages state-level variation in Medicaid payment rates to dentists, adult dental coverage, and FV policies during 1999-2016 and large-scale national datasets that include exam-based and administrative outcome measures. Our study period captures a substantial number of state-level changes while also representing a relatively recent time frame. Our analysis will also assess important subgroup differences by child sex, age group, and race and ethnicity. In Aim 1, we will examine the link between each policy and oral health measures including the parent-reported condition of teeth from the National Survey of Children’s Health (NSCH), exam-based objective measures of untreated caries and the presence of dental sealants from the National Health and Nutrition Examination Survey (NHANES), and administrative records of emergency department visits for oral conditions from the State Emergency Department Databases (SEDD). In Aim 2, we will assess the connection between each policy and academic outcomes including school absences, school contacts with parents, parental concern about learning pre-school skills, and grade retention from the NSCH, Peabody Individual Achievement Test scores and grade retention from the National Longitudinal Survey of Youth – Child and Young Adult Cohort (CNLSY), and school absences from the Early Childhood Longitudinal Study – Kindergarten Cohort (ECLS-K). This will be the first national study to estimate the plausibly causal link between increased access to dental care and academic performance among low-income children. This research will provide critical, timely, and policy-relevant new evidence on the effects of increased access to dental care and the role for public health insurance policy.