Caregivers who refuse preventive care for their children: the relationship between immunization and topical fluoride refusal.
OBJECTIVE
The aim of this study was to examine caregivers' refusal of preventive medical and dental care for children.


METHODS
Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs).


RESULTS
The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P < .001; caregiver self-report PRR = 6.20; 95% CI = 3.21, 11.98; P < .001). Caregivers younger than 35 years were significantly more likely than older caregivers to refuse both immunizations and topical fluoride (P < .05).


CONCLUSIONS
Caregiver refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children.
Donald L. Chi is with the Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle.
Donald L
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Chi
D000328:Adult; D000367:Age Factors; D017028:Caregivers / Q000706:statistics & numerical data*; D005460:Fluorides, Topical / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014611:Vaccination / Q000706:statistics & numerical data*
D005460:Fluorides, Topical