Neighborhood Characteristics and Adolescence Dental Visits: A Multilevel Approach

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DESCRIPTION (provided by applicant): This proposed project builds upon cross-sectional studies that have investigated the relationship of dental visits to person level factors, such as age, gender, and marital status among adults in the United States. However, person level factors alone are insufficient to explain differences in dental visits, especially when seeking solutions to address racial and ethnic disparities in dental visits. Neighborhood characteristics like poverty, racial/ethnic composition, and educational attainment, available from census information, have not been investigated as potential predictors or correlates of dental visits. The overall goal of this project is to acquire preliminary data in order to submit an RO1 grant proposal to fully investigate the relationship of neighborhood intervention strategies over time on adolescents' dental service utilization. Therefore, the long-term goal of our research is to extend the science on dental visits by including neighborhood characteristics. The short-term goal of this project is to examine the influence of neighborhood characteristics on dental visits over time among adolescents progressing to young adulthood. The periods of adolescence and early adulthood represent stages in life for developing oral habits conducive for promoting positive oral health lifestyles and behavior over the full life span. This project is national in scope and could be significant to the development of appropriate programs and oral health policies that will include community grounded strategies. It will be executed using data from the National Longitudinal Study of Adolescent Health (Add Health) - a dataset specifically designed to collect information on adolescents progressing to young adulthood. This project will investigate three specific aims: 1) to examine the temporal profile of dental visits among adolescents progressing to young adulthood; 2) to investigate in the same sample the extent to which neighborhood characteristics explain racial/ethnic differences seen in dental visits after adjustment for person level factors; 3) to assess the association of person level factors and neighborhood characteristics on dental visits among adolescents progressing to adulthood. Add Health data proposed for use in this study was collected in four waves: Wave I (1994- 95), Wave II (1996), Wave III (2001-2002), Wave IV (2007-2008), and contains both questionnaire responses and contextual information. Add Health is the only comprehensive database that will allow for a wide range of analyses beyond cross-sectional analysis of contemporaneous associations of contextual characteristics with respondent outcomes, and allow for longitudinal and dynamic analyses of contextual influences. Multilevel hierarchical modeling will be used to estimate the influence of neighborhood characteristics on dental visits. Findings from this project will improve our knowledge and understanding of dental visits during the critical period from adolescence to young adulthood. PUBLIC HEALTH RELEVANCE: Identifying the different neighborhood characteristics associated with dental service utilization to improve program planning and policy development. Dental public health professionals and stakeholders will use the information to development appropriate intervention strategies including development of community grounded strategies to address disparities associated dental service utilization in adolescence progressing to young adulthood.