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

项目摘要/摘要 儿童时期口腔健康状况不佳与更多的缺课和学习成绩较低有关。那里 有证据表明，州一级的医疗补助政策，包括支付给牙医的费率，成人牙科 非牙医初级保健提供者的氟化物清漆(FV)应用的覆盖范围，有 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， 很少有研究将增加牙齿护理机会的具体医疗补助政策与儿童口腔措施联系起来 健康，而且，没有严格的大规模研究，具有可信的因果研究设计，检查了 这些政策与学业成绩之间的联系。迫切需要有确凿的证据 关于国家一级政策改善这些成果的潜力。这项提案将提供 关于获得牙科护理与口腔健康和学术措施之间联系的新证据 使用自然的实验设计，利用医疗补助付款率的州水平差异来实现性能 1999-2016年的牙医、成人牙科保险和FV政策以及大规模的国家数据集 包括以考试为基础的和行政结果措施。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范围。我们的分析还将评估 按儿童性别、年龄组以及种族和民族划分的重要亚组差异。在目标1中，我们将研究 每项政策与口腔健康措施之间的联系，包括父母报告的 全国儿童健康调查(NSCH)，以考试为基础的未治疗龋齿的客观衡量标准和 是否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》口腔急诊科就诊管理记录 部门数据库(Sedd)。在目标2中，我们将评估每项政策与学术之间的联系 结果包括缺课、学校与家长的联系、家长对学龄前学习的关注 技能和NSCH的等级保留，皮博迪个人成就测试分数和等级保留 来自全国青少年儿童和青壮年队列纵向调查(CNLSY)和学校 缺席幼儿纵向研究--幼儿园队列(ECLS-K)。这将是第一次 一项全国性研究，旨在评估获得牙科保健的机会增加与学术研究之间看似合理的因果关系 在低收入儿童中的表现。这项研究将提供关键的、及时的和与政策相关的 增加获得牙科保健的机会的效果和公共健康保险政策的作用的证据。

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.