title: Caregiver financial distress, depressive symptoms and limited social capital as barriers to children's dental care in a mid-western county in the United States.
abstract: OBJECTIVE
  To identify barriers to children's access to dental care.
  
  
  METHODS
  A cross-sectional health survey.
  
  
  METHODS
  All residential census tracts in Genesee County, Michigan, USA.
  
  
  METHODS
  498 adults who reported having children in their households, extracted from 2,932 randomly selected adult participants in the 2009 and 2011 surveys.
  
  
  METHODS
  Stepwise logistic regression was used to predict two dependent variables: children's lack of any visits to dentists' offices and unmet dental care needs (defined as needing dental care but not receiving it due to cost) in the previous year as reported by the adults. Independent variables included gender, age, education, race/ethnicity, financial planning, financial distress, fear of crime, stress, depressive symptoms, experiences of discrimination, and neighbourhood social capital.
  
  
  RESULTS
  Of the 498 adults, 29.9% reported that they had children who had not visited a dentist in the past 12 months and 13% reported that they had household children with unmet dental care needs in the past year. Adults who reported higher depressive symptoms, lower neighbourhood social capital, greater financial distress, and who were younger were more likely to have household children who did not visit a dentist in the past year. Financial distress was the only significant predictor when controlling for other variables to predict unmet dental care needs.
  
  
  CONCLUSIONS
  Factors beyond financial distress affect children's dental care; these include parental depressive symptoms and lower neighbourhood social capital. Interventions promoting parental mental health and social integration may increase dental care among children.
authors.forename: J S
authors.initials: JS
authors.lastname: Kruger
authors.forename: G D
authors.initials: GD
authors.lastname: Kodjebacheva
authors.forename: L
authors.initials: L
authors.lastname: Kunkel
authors.forename: K D
authors.initials: KD
authors.lastname: Smith
authors.forename: D J
authors.initials: DJ
authors.lastname: Kruger
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003415:Crime; D003430:Cross-Sectional Studies; D019140:Dental Care for Children; D003863:Depression / Q000523:psychology*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011287:Prejudice; D012737:Sex Factors; D012923:Social Class; D012931:Social Environment; D013315:Stress, Psychological / Q000523:psychology; D055815:Young Adult