Dental service utilization and neighborhood characteristics in young adults in the United States: a multilevel approach.
OBJECTIVE
To investigate the association between neighborhood level factors and dental visits in young adults in the United States after adjusting for individual level factors.


METHODS
The National Longitudinal Study of Adolescent Health Wave 1 (1994-1995) to Wave III (2001-2002) was analyzed. The primary outcome of having had at least one dental visit in the previous 12 months was analyzed via a multilevel random-effects logistic model accounting for geographic clustering in Wave III and survey design clustering from Wave I. Neighborhood level covariates were defined at the census tract level.


RESULTS
Overall rate of dental visits was 57 percent, highest among 18-20 year olds (65 percent) and lowest in 23-26 year olds (52 percent). Increased proportion of African-Americans (≤5 percent to ≥20 percent) and Hispanics (≤5 percent to ≥20 percent) in a neighborhood corresponded with a decrease in dental visits (60 percent versus 52 percent) and (58 percent versus 51 percent), respectively. Neighborhoods with a high proportion of college-educated residents had a higher percentage of dental visits. Similar differences were found when comparing the lowest and highest tertiles defined by poverty level and unemployment with dental visits. Neighborhood education was significantly associated with dental service utilization after adjustment for individual level factors and dental utilization in adolescence (Waves I and II) in the random effects model.


CONCLUSIONS
This study demonstrates that the education level of residents within a neighborhood was associated with dental service utilization in young adults in the United States.
Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA.
Christopher
C
Okunseri
Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.
Raul I
RI
Garcia
Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA.
Elaye
E
Okunseri
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.
Alexis
A
Visotcky
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.
Aniko
A
Szabo
D000293:Adolescent; D000328:Adult; D003752:Dental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012111:Residence Characteristics; D014481:United States; D055815:Young Adult
adolescence; adulthood; dental visit; life-course