title: Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis
abstract: The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children's Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children's dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers' associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children's ages, family income, parents' schooling, mothers' participation in their children's school activities, dental caries, and presence of workers' associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.
authors.affiliation: Faculdade São Lucas, Porto Velho, RO, Brazil.
authors.forename: Chaiana
authors.initials: C
authors.lastname: Piovesan
authors.affiliation: Universidade Federal de Santa Maria - UFSM, Department of Stomatology, Santa Maria, RS, Brazil.
authors.forename: Thiago Machado
authors.initials: TM
authors.lastname: Ardenghi
authors.affiliation: Universidade de São Paulo - USP, School of Dentistry, Departament of Pediatric Dentistry, São Paulo, SP, Brazil.
authors.forename: Fausto Medeiros
authors.initials: FM
authors.lastname: Mendes
authors.affiliation: Universidade Federal de Pelotas - UFPel, School of Medicine, Departament of Epidemiology, Pelotas, RS, Brazil.
authors.forename: Bernardo Antonio
authors.initials: BA
authors.lastname: Agostini
authors.affiliation: Universidade de São Paulo - USP, School of Dentistry, Departament of Social Dentistry, São Paulo, SP, Brazil.
authors.forename: Edgard
authors.initials: E
authors.lastname: Michel-Crosato
mesh_terms: D000367:Age Factors; D001938:Brazil; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019140:Dental Care for Children / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D055361:Multilevel Analysis; D010290:Parents; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors