title: The relationship of oral health literacy with oral health-related quality of life in a multi-racial sample of low-income female caregivers.
abstract: BACKGROUND
  To investigate the association between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) and explore the racial differences therein among a low-income community-based group of female WIC participants.
  
  
  METHODS
  Participants (N = 1,405) enrolled in the Carolina Oral Health Literacy (COHL) study completed the short form of the Oral Health Impact Profile Index (OHIP-14, a measure of OHRQoL) and REALD-30 (a word recognition literacy test). Socio-demographic and self-reported dental attendance data were collected via structured interviews. Severity (cumulative OHIP-14 score) and extent of impact (number of items reported fairly/very often) scores were calculated as measures of OHRQoL. OHL was assessed by the cumulative REALD-30 score. The association of OHL with OHRQoL was examined using descriptive and visual methods, and was quantified using Spearman's rho and zero-inflated negative binomial modeling.
  
  
  RESULTS
  The study group included a substantial number of African Americans (AA = 41%) and American Indians (AI = 20%). The sample majority had a high school education or less and a mean age of 26.6 years. One-third of the participants reported at least one oral health impact. The OHIP-14 mean severity and extent scores were 10.6 [95% confidence limits (CL) = 10.0, 11.2] and 1.35 (95% CL = 1.21, 1.50), respectively. OHL scores were distributed normally with mean (standard deviation, SD) REALD-30 of 15.8 (5.3). OHL was weakly associated with OHRQoL: prevalence rho = -0.14 (95% CL = -0.20, -0.08); extent rho = -0.14 (95% CL = -0.19, -0.09); severity rho = -0.10 (95% CL = -0.16, -0.05). "Low" OHL (defined as < 13 REALD-30 score) was associated with worse OHRQoL, with increases in the prevalence of OHIP-14 impacts ranging from 11% for severity to 34% for extent. The inverse association of OHL with OHIP-14 impacts persisted in multivariate analysis: Problem Rate Ratio (PRR) = 0.91 (95% CL = 0.86, 0.98) for one SD change in OHL. Stratification by race revealed effect-measure modification: Whites--PRR = 1.01 (95% CL = 0.91, 1.11); AA--PRR = 0.86 (95% CL = 0.77, 0.96).
  
  
  CONCLUSIONS
  Although the inverse association between OHL and OHRQoL across the entire sample was weak, subjects in the "low" OHL group reported significantly more OHRQoL impacts versus those with higher literacy. Our findings indicate that the association between OHL and OHRQoL may be modified by race.
authors: Department of Pediatric Dentistry, 228 Brauer Hall, CB#7450, UNC School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. divarisk@dentistry.unc.edu
authors: Kimon
authors: K
authors: Divaris
authors: Jessica Y
authors: JY
authors: Lee
authors: A Diane
authors: AD
authors: Baker
authors: William F
authors: WF
authors: Vann
mesh_terms: D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D017028:Caregivers / Q000523:psychology*; D005260:Female; D057220:Health Literacy; D006801:Humans; D007407:Interviews as Topic; D015999:Multivariate Analysis; D009657:North Carolina; D009909:Oral Health / Q000208:ethnology*; D011203:Poverty; D011788:Quality of Life; D011795:Surveys and Questionnaires