Neighborhood Characteristics and Adolescence Dental Visits: A Multilevel Approach

描述（由申请人提供）：本建议项目建立在横断面研究的基础上，该研究调查了美国成年人中牙科就诊与个人水平因素（如年龄、性别和婚姻状况）的关系。然而，个人层面的因素本身不足以解释牙科就诊的差异，特别是在寻求解决牙科就诊中种族和民族差异的解决方案时。从人口普查信息中获得的社区特征，如贫困、种族/民族组成和教育程度，尚未作为潜在的预测因素或牙科就诊的相关性进行调查。该项目的总体目标是获取初步数据，以便提交RO1拨款提案，以全面调查社区干预策略随时间对青少年牙科服务利用的关系。因此，我们研究的长期目标是通过纳入社区特征来扩展牙科就诊的科学。这个项目的短期目标是研究随着时间的推移，社区特征对青少年进入青年期的牙科就诊的影响。青春期和成年早期是口腔习惯形成的阶段，有利于在整个生命周期中促进积极的口腔健康生活方式和行为。这个项目是全国性的，对于制定适当的项目和口腔健康政策具有重要意义，其中包括以社区为基础的战略。它将使用国家青少年健康纵向研究（Add Health）的数据来执行，这是一个专门用于收集青少年进入青年期的信息的数据集。该项目将调查三个具体目标：1)检查青少年到青年时期牙科就诊的时间概况；2)在同一样本中，在调整个人因素后，调查社区特征对种族/民族牙科就诊差异的解释程度；3)评估个人层面因素与社区特征对青少年成人期牙科就诊的影响。建议用于本研究的健康数据分四波收集：第一波（1994- 95年）、第二波（1996年）、第三波（2001-2002年）、第四波（2007-2008年），并包含问卷调查结果和上下文信息。Add Health是唯一一个全面的数据库，它不仅允许对背景特征与应答结果的同期关联进行横断面分析，还允许对背景影响进行纵向和动态分析。多层分层模型将用于估计邻域特征对牙科就诊的影响。这个项目的发现将提高我们对从青春期到青年期这一关键时期的牙科就诊的认识和理解。

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.