Neighborhood Characteristics and Adolescence Dental Visits: A Multilevel Approach

描述(由申请人提供)：这个拟议的项目建立在横断面研究的基础上，这些研究调查了牙科就诊与个人水平因素的关系，如年龄、性别和美国成年人的婚姻状况。然而，人的水平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。从人口普查信息中可以获得的社区特征，如贫困、种族/民族构成和教育程度，尚未被调查为牙科就诊的潜在预测因素或相关因素。该项目的总体目标是获得初步数据，以便提交RO1赠款提案，以全面调查社区干预策略随时间推移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邻里特征来扩展关于牙科就诊的科学。这个项目的短期目标是研究社区特征对青春期青少年牙科就诊的影响。青春期和成年期早期是发展口腔习惯的人生阶段，有利于在一生中促进积极的口腔健康、生活方式和行为。该项目是全国性的，可能对制定适当的项目和口腔健康政策具有重要意义，这些项目和政策将包括社区基础战略。它将使用国家青少年健康纵向研究(Add Health)的数据执行-这是一个专门为收集青少年成长为青壮年的信息而设计的数据集。该项目将调查三个具体目标：1)检查青少年成年期牙科就诊的时间分布；2)在同一样本中调查在对人的水平因素进行调整后，邻里特征在多大程度上解释了在牙科就诊中出现的种族/民族差异；3)评估个人水平因素和邻里特征对成年期青少年牙科就诊的关联。本研究中建议使用的ADD健康数据分四波收集：第一波(1994-95)、第二波(1996)、第三波(2001-2002)、第四波(2007-2008)，包含问卷回复和背景信息。Add Health是唯一一个全面的数据库，它将允许进行广泛的分析，而不仅仅是对当时的背景特征与受访者结果的关联进行横断面分析，并允许对背景影响进行纵向和动态分析。将使用多层递阶模型来估计邻里特征对牙科就诊的影响。这个项目的发现将提高我们对青春期到青壮年关键时期牙科就诊的认识和理解。 公共卫生相关性：确定与牙科服务利用相关的不同社区特征，以改进项目规划和政策制定。牙科公共卫生专业人员和利益攸关方将利用这些信息制定适当的干预战略，包括制定以社区为基础的战略，以解决青春期和青壮年期间相关牙科服务利用的差异。

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.