title: Geography matters: state-level variation in children's oral health care access and oral health status.
abstract: OBJECTIVE
  To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences.
  
  
  METHODS
  Observational study using cross-sectional surveys.
  
  
  METHODS
  Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation.
  
  
  RESULTS
  Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ∼¼ of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation.
  
  
  CONCLUSIONS
  Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health.
authors.affiliation: University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA. Electronic address: fisherowens@peds.ucsf.edu.
authors.forename: S A
authors.initials: SA
authors.lastname: Fisher-Owens
authors.affiliation: Statworks, Boston, MA, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Soobader
authors.affiliation: Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA; Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Gansky
authors.affiliation: MGH Center for Child and Adolescent Health Policy, Boston, MA, USA.
authors.forename: I A
authors.initials: IA
authors.lastname: Isong
authors.affiliation: Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Weintraub
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, San Francisco, CA, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Platt
authors.affiliation: University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
authors.forename: P W
authors.initials: PW
authors.lastname: Newacheck
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D055361:Multilevel Analysis; D009909:Oral Health / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D014481:United States
keywords: Children's oral health; State variation