Acculturation and Dental Caries Among Children in Spain

Triple Jeopardy in Oral Health: Additive Effects of Immigrant Status, Education, and Neighborhood

PURPOSE

To estimate the additive effects of parent's nativity status/language spoken at country of birth, education, and area-level socioeconomic status (SES) on untreated dental caries among children aged 5 to 9 y in Australia.

METHODS

Cross-sectional population-based data were obtained from the 2014 National Child Oral Health Study (N = 12,140). Indicators of social position used to explore additive effects on dental caries included nativity status, language, university degree, and neighborhood socioeconomic level. Multiple-way interactions were examined, and departure from additivity resulting from 2- and 3-way interactions were estimated as relative excess risk due to interaction (RERI).

RESULTS

Children marginalized across multiple layers of disadvantage had substantially higher frequencies of dental caries compared with children in the most advantaged category. RERI for the 3-way interaction between immigrant status, education, and neighborhood SES was negative (RERI3: -0.14; 95% confidence interval [CI]: -1.68, 1.40). When operationalizing language, education, and neighborhood SES, the joint effect of the 3 marginalized positions was additive (RERI3: 0.43; 95% CI: -2.08, 2.95).

CONCLUSION

Children marginalized across multiple intersecting axes of disadvantage bear the greatest burden of dental caries, with frequencies surpassing the cumulative effect of each social position alone. Findings emphasize the need to account for intersecting inequities and their oral health effects among children with immigrant backgrounds.

KNOWLEDGE TRANSFER STATEMENT

Our analysis underscores the necessity for policies and public health strategies targeting dental caries-related inequities to comprehensively account for various indicators of social disadvantage, particularly encompassing language proficiency, educational attainment, and neighborhood socioeconomic status. Within the intricate interplay of these factors, we identify a vulnerable subgroup comprising children with the highest prevalence of dental decay. Therefore, prioritizing this specific demographic should be the focal point of policies and public health initiatives aimed at fostering equitable oral health outcomes.

Immigrant Status and Ethnic Inequities in Dental Caries in Children: Bilbao, Spain

This study examined the migratory status/ethnic inequities in dental caries in school children aged 4–9 years (n = 1388) and the impact of the Children’s Oral Health Program in the Municipality of Bilbao in the Basque Country Region, Spain. Using the 2017 Children’s Oral Health Survey, log binomial regression was used to quantify the association of parental immigration status/ethnicity with tooth decay for (1) the primary and the permanent dentitions, separately, in children 4–9 years old; and (2) for the permanent dentition in children aged 7–9 years. Compared with Spanish children, Spanish Roma and immigrant children had a higher probability of tooth decay in primary and permanent teeth after adjustment. Similarly, Spanish Roma and immigrant children had a higher probability of caries experience in primary and permanent teeth. In children aged 7–9 years, Spanish Roma children had a greater probability of tooth decay and caries experience (DMFT index ≥ 1; PR: 6.20; 95% CI: 3.18, 12.12; and PR: 4.52; 95% CI: 2.46, 8.32; respectively) compared with Spanish Children. These associations were not observed in immigrant children. This study shows that parental immigration status and/or ethnicity affect caries outcomes in immigrant and Roma children in both primary and permanent dentition.

Parental acculturation and oral health of children among immigrants

OBJECTIVES

This cross-sectional study aimed to examine the associations between parental acculturation level and strategies and children's caries experience and oral health (OH) behaviors.

METHODS

Participants were immigrant parents of children aged 2-12 years. Data were collected by validated questionnaires gathering information on socio-demographics, child's OH behaviors, and parents'; acculturation and dental examinations determining child's caries experience using DMFT/dmft index. Univariate and multivariate regression analyses were used.

RESULTS

Three hundred and thirty-six parent/child dyads completed the study. Length of residency (B = 0.103; 95% CI: 0.064, 0.141) parents' education (B = 1.691; 95% CI: 1.228, 2.155), and household income (B = -0.959; 95% CI: -1.566, -0.352) significantly predicted acculturation level. Parents with high Canadian cultural knowledge reported higher frequency of children's toothbrushing (p-value = 0.015). Parents of children who consumed sugar >1/day had higher mean scores of acculturation to Canadian culture (p-value = 0.016), English language proficiency (p-value = 0.024), and Canadian food adoption (p-value = 0.046). Parents of children who visited the dentist within last 12 months had significantly higher assimilation and lower separation mean scores. Parents of children who visited dentist because of dental problems had higher marginalization mean score than those who went for check-ups (p-value = 0.046). Parental acculturation was not significantly correlated with their children's dmft/DMFT level.

CONCLUSIONS

Children of highly acculturated parents reported higher toothbrushing frequency and were more likely to consume sugar than children of less acculturated parents. Assimilated parents reported more and marginalized parents reported less favorable OH behaviors than other categories. Parental acculturation level or strategy was not associated with children's caries experience.