title: An explanatory model of the dental care utilization of low-income children.
abstract: OBJECTIVE
  Factors related to the utilization of dental care by 5- to 11-year-old children from low-income households were investigated using a comprehensive multivariate model that assessed the contribution of structure, history, cognition, and expectations. The influence of dentist-patient interactions, psychosocial and health beliefs, particularly fear of the dentist, on utilization were investigated.
  
  
  METHODS
  Children were chosen randomly from public schools, and 895 mothers were surveyed and their children were interviewed in the home. Utilization was studied during the 1991-1992 school year, including a 6-month follow-up period after the interview.
  
  
  RESULTS
  The overall utilization rate was 63.2%, and the rate for nonemergent (preventive) visits was 59.9%. Utilization was unrelated to actual oral health status. Race and years the guardian lived in the United States were predictive of an episode of care. Preventive medical visits and perceived need were strong predictors of a visit to the dentist, as were beliefs in the efficacy of dental care. Mothers who were satisfied with their own care and oral health and whose children were covered by insurance were more likely to utilize children's dental care. In contrast, child dental fear and absences from school for family problems were associated with lower rates of utilization.
  
  
  CONCLUSIONS
  Mutable factors that govern the use of care in this population were identified. These findings have implications for the design of dental care delivery systems for children and their families.
authors.affiliation: Department of Dental Public Health Sciences, University of Washington, Seattle 98195-7475, USA. dfrc@u.washington.edu
authors.forename: P
authors.initials: P
authors.lastname: Milgrom
authors.forename: L
authors.initials: L
authors.lastname: Mancl
authors.forename: B
authors.initials: B
authors.lastname: King
authors.forename: P
authors.initials: P
authors.lastname: Weinstein
authors.forename: N
authors.initials: N
authors.lastname: Wells
authors.forename: E
authors.initials: E
authors.lastname: Jeffcott
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003752:Dental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017060:Patient Satisfaction; D011203:Poverty; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology