title: Single and Cumulative Relations of Social Risk Factors with Children's Dental Health and Care-Utilization Within Regions of the United States.
abstract: OBJECTIVE
  The purpose is to examine the relation of social risk factors, and the cumulative burden of social risk factors, on parent-reported dental health and dental care-seeking behavior.
  
  
  METHODS
  National Survey of Children's Health data (2011-2012) were analyzed for US children by Title V Block Grant regions. Multivariate logistic regressions were estimated for ten social risk factors, as well as a cumulative risk index, to find any associations with poor condition of teeth, presence of dental caries, and no dental care visits.
  
  
  RESULTS
  Almost all of the risk factors were significantly associated with poor condition of teeth and presence of dental caries for the US. Models associating no dental care visits suggested that low family income (OR 1.58), poor maternal mental health (OR 1.54), high school education or less (OR 1.34), and multi-racial/other race (OR 1.18) were significant factors for the US. Regional variation existed for those risk factors and their association with the outcomes, but income, education, and poor maternal mental health consistently played a significant role in adverse outcomes. The cumulative risk index was strongly related to poor oral health outcomes, with a weaker relationship to dental care utilization.
  
  
  CONCLUSIONS
  US children experiencing certain social risk factors, such as low family income, high school education or less, and poor maternal mental health, are likely to be at greater risk for poor dental health and low levels of dental-care seeking behavior. Children experiencing multiple social risks are at greater risk for poor oral outcomes than children who experience fewer social risks. An approach that involves the social determinants of health is needed to address these issues.
authors.affiliation: Urban Indian Health Institute, a Division of the Seattle Indian Health Board, Seattle, WA, USA. ayang1408@gmail.com.|Wisconsin Department of Health Services, Madison, WI, USA. ayang1408@gmail.com.
authors.forename: Alyssa J
authors.initials: AJ
authors.lastname: Yang
authors.affiliation: Wisconsin Department of Health Services, Madison, WI, USA. andrea.gromoske@dhs.wisconsin.gov.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Gromoske
authors.affiliation: Wisconsin Department of Health Services, Madison, WI, USA. Melissa.olson@dhs.wisconsin.gov.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Olson
authors.affiliation: Delta Dental of Iowa, Johnston, IA, USA. Jchaffin7@gmail.com.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Chaffin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019140:Dental Care for Children / Q000706:statistics & numerical data*; D003731:Dental Caries / Q000453:epidemiology*; D003753:Dental Health Surveys; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009909:Oral Health; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Dental caries; Dental health services; Oral health; Social risk factors