Race/Ethnicity, Socioeconomic Status and Oral Health

描述（由申请人提供）：一些研究报告称，种族/民族、社会经济地位（SES）和社区社会经济劣势与自我报告的一般健康有关，但很少有研究调查自评口腔健康和其他感知口腔健康指标之间的关系，特别是在低收入和种族和民族多样化的美国人群中。本研究的目的是估计成分（人的差异）和环境（人们居住的地方的差异）对低收入母亲及其子女口腔健康观念的影响。目标1将通过以下方式估计医疗补助覆盖的3-6岁儿童及其低收入母亲的构成效应：(a)描述母亲及其子女在种族/族裔群体和社会经济地位方面感知的口腔健康差异，包括每个群体中母亲对自己口腔健康的感知与孩子口腔健康之间的关联；(b)估计母亲的社会经济地位（收入、教育和就业状况）与她认为的口腔健康和对孩子口腔健康的看法之间是否存在梯度关系；(c)估计社会经济地位和种族/民族对感知口腔健康的相互作用。目的2解决上下文效应：控制个人水平的特征，我们将估计邻里社会经济劣势对3-6岁母亲及其子女感知口腔健康的独立影响。我们还将测试我们的发现是否与一般健康文献一致，通过重复目标1和目标2对母亲和她的孩子的一般健康评分。本研究的数据来自我们的NIDCR研究，连接母亲和儿童获得牙科保健(NIDCR批准号：R01 DE014400)，一项针对华盛顿州3-6岁接受医疗补助的儿童及其母亲的前瞻性队列研究。基于母亲和儿童口腔健康之间的生物学联系，其主要目的是确定母亲在基线时有常规牙科护理来源是否与1年后儿童的牙科护理水平提高有关。基线调查数据来自以下种族/族裔群体的4,373名儿童和母亲：西班牙裔母亲311名，白人母亲1,385名，黑人母亲818名，其他种族/族裔的母亲719名。感知口腔健康的措施包括口腔健康的自我评价、口腔健康的一般/差、牙齿状况的评价以及牙齿问题的数量和类型。在研究的概念模型的指导下，回归方程将被估计来检验假设。在目标1中，将使用二元和有序逻辑回归来估计种族/民族和社会经济地位对母亲对其及其子女健康的看法的影响，控制其他个人特征和风险因素。在目标2中，将使用混合效应多水平模型来估计社区社会经济劣势对个人水平特征控制的感知口腔健康的影响。

DESCRIPTION (provided by applicant): Several studies report that that race/ethnicity, socioeconomic status (SES), and neighborhood socioeconomic disadvantage are related to self-reports of general health, but very few studies have examined these relationships for self-rated oral health and other measures of perceived oral health, particularly among low-income and racially and ethnically diverse U.S. populations. The purpose of this study is to estimate composition (differences in people) and context (differences in places where people live) effects on low-income mothers' perceptions of oral health and their children's oral health. Aim 1 will estimate composition effects in a population of children aged 3-6 covered by Medicaid and their low-income mothers by: (a) describing the disparities in perceived oral health by racial/ethnic group and SES among mothers and their children, including the association between mother's perceptions of her oral health and her child's oral health in each group; (b) estimating whether a gradient relationship exists between mother's SES (income, education, and employment status) and her perceived oral health and perceptions of her child's oral health; and (c) estimating the interaction effects of SES and race/ethnicity on perceived oral health. Aim 2 addresses contextual effects: controlling for individual-level characteristics, we will estimate the independent effects of neighborhood socioeconomic disadvantage on the perceived oral health of mothers and their children aged 3-6. We also will test whether our findings are consistent with the general health literature by repeating Aims 1 and 2 for mother ratings of her and her child's general health. Data for this study come from our NIDCR study, Linking Mother and Child Access to Dental Care (NIDCR Grant No. R01 DE014400), a prospective cohorts udy of children aged 3-6 covered by Medicaid and their mothers in Washington state. Building on the biological connection between mother and child oral health, its main purpose is to determine whether having a me ther with a regular source of dental care at baseline is associated with greater dental care for the child af ter 1 year. Baseline survey data exist for 4,373 children and mothers in the following racial/ethnic groups: ,311 Hispanic mothers, 1,385 White mothers, 818 Black mothers, and 719 mothers from other racial/ethnic groups. Measures of perceived oral health include self- rating of oral health, fair/poor oral health, rating of condition of teeth, and number and type of dental problems. Guided by the study's conceptual model, regression equations will be estimated to test hypotheses. In Aim 1 binary and ordinal logistic regression will be used to estimate the effects of race/ethnicity and SES on mothers' perceptions of their and their children's health, controlling for other individual characteristics and risk factors. In Aim 2 mixed-effect multilevel models will be used to estimate the effects of neighborhood socioeconomic disadvantage on perceived oral health controlling for individual-level characteristics.