Assessment of the relationship between neighborhood characteristics and dental caries severity among low-income African-Americans: a multilevel approach.
OBJECTIVE
To assess the relationship between neighborhood effects and the severity of dental caries among low-income African-Americans.


METHODS
A multistage probability sample of African-American families living in the poorest 39 census tracts in Detroit was drawn. During 2002-03, cross-sectional data of a cohort that includes 1021 caregivers were collected in the first of three waves of interviews and examinations. Multilevel analyses focused on 27 neighborhood clusters and involved a combination of individual (Level-1) and neighborhood (Level-2) data including census and geocoded (address matching to census geographic areas) information.


RESULTS
There is significant variation in the severity of caries between low-income neighborhood clusters. Caries severity decreases with a higher number of churches, while it increases with a higher number of grocery stores in the clusters after accounting for individual characteristics. Only 14% of the inter-individual variability in caries was explained by classical individual risk factors for this condition.


CONCLUSIONS
Neighborhoods contribute something unique to caregivers' oral health, beyond socioeconomic position and individual risk factors. Multilevel interventions are necessary to reduce disparities among African-Americans and churches may offer a promising venue from which to conduct them.
Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, 1101 N. University, Ann Arbor, MI 48109, USA. mtellez@umich.edu
Marisol
M
Tellez
Woosung
W
Sohn
Brian A
BA
Burt
Amid I
AI
Ismail
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D017028:Caregivers; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000145:classification* / Q000208:ethnology; D019422:Dietary Sucrose / Q000008:administration & dosage; D004651:Employment; D005260:Female; D005523:Food Supply; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009909:Oral Health; D009910:Oral Hygiene; D011203:Poverty; D012067:Religion; D012111:Residence Characteristics; D012944:Social Support
D019422:Dietary Sucrose