Assessing the Oral Health Needs of African American Men in Low-Income, Urban Communities

Oral cavity and oropharyngeal cancers in Texas: examining incidence rates in dental health professional shortage areas

PURPOSE

Oral cavity (OC) and oropharyngeal (OP) cancer rates have increased annually rising in the U.S. and Texas. Dental providers could play a key role in lowering OC/OP cancer rates through prevention and screening, but Texas faces a significant shortage of dental health professionals, affecting access to dental care, including OC/OP cancer prevention and early detection. This study aims to explore the link between OC/OP cancer rates and these dental shortage areas in Texas.

METHODS

We analyzed OC/OP cancer incidence in Texas using SEER-Medicare data for patients aged 65 and over from 2012 to 2017. Rates per 100,000 were stratified by age, gender, and dental health provider shortage area (DHPSA) status (yes/no). Zero-Inflated Poisson Regression models were used to adjust for patient characteristics in studying cancer incidence, Late-stage diagnoses were assessed using logistic regression.

RESULTS

The incidence rate was 27.3 per 100,000 people in Texas. DHPSA counties had lower incidence rates (24.3 per 100,000) compared to non-DHPSA counties (29.8 per 100,000; p = 0.0423). Among patients with OC/OP diagnoses, those living in a DHPSA county had lower odds of advanced stage diagnoses (aOR: 0.79; CI: 0.64-0.96) than those in non-DHPSA counties.

CONCLUSION

The findings highlight the complex link between dental providers and OC/OP cancer diagnoses, noting differences in indicators of need based on DHPSA location. Limited local dental services may lead to underreported cancer cases. Further research on dental service usage could improve OC/OP outcomes by prioritizing interventions from dental professionals.

The Impact of Undermining Coparenting on the Mental and Physical Health Outcomes of Black Fathers: The Role of Depression and Restrictive Emotionality

The parenting literature has established the coparenting relationship as central to the parenting behaviors and outcomes of men. The construct of coparenting encompasses supportive efforts among individuals that facilitate the rearing of children and unsupportive actions that can undermine parenting efforts (Merrifield & Gamble, 2013). Few studies have examined undermining coparenting as an experience that shapes Black men's health outcomes. In this study, we apply the social determinants of health framework to examine the impact of Black fathers' perceptions of undermining coparenting on their self-reported ratings of mental and physical health. Using a nationally representative sample of Black men (n = 255), correlational analyses revealed perceptions of undermining coparenting to be a significant predictor of higher levels of anger and poorer perceptions of physical health. These relationships were found to be mediated by depressive symptoms and moderated by restrictive emotionality. It is recommended that the negative impact of undermining coparenting on health be considered as a potential comorbidity contributing to negative health outcomes for Black men. This study adds to the literature on coparenting, Black men's health, and Black fatherhood more generally and urges policymakers and practitioners to consider undermining as an often overlooked, but significant, social determinant of health impacting the well-being of Black men. We also offer recommendations for promoting Black men's health by educating families on the effects of undermining and offering the supports necessary for achieving positive coparenting dynamics.

Association between racial iniquities and oral health status: a systematic review

The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.

Neighborhood socioeconomic status and race are associated with incidence disparities in oral cavity cancers

OBJECTIVES

To determine the association between neighborhood socioeconomic status (nSES), race and incidence rate trends of oral cavity cancer (OCC).

MATERIALS AND METHODS

We used data from the SEER (Surveillance, Epidemiology, and End Results) 18 Census Tract-level SES and Rurality Database (2006-2018) database of the National Cancer Institute to create cohorts of OCC patients between 2006 and 2018. Annual incidence rates were calculated and trends in rates were estimated using joinpoints regression.

RESULTS

The incidence of OCC is the highest among low nSES White Americans (2.86 per 100 000 persons) and the lowest among high nSES Black Americans (1.17 per 100 000 persons). Incidence has significantly increased among Asian Americans (annual percent change [APC]: low nSES-2.4, high nSES-2.6) and White Americans (APC: low nSES-1.4, high nSES-1.6). Significant increases in the incidence of oral tongue cancer in these groups primarily drive this increase. Other increases were noted in alveolar ridge cancer among White Americans and hard palate cancer among Asian Americans. OCC incidence decreased significantly in Hispanic Americans of high nSES (APC: -2.5) and Black Americans of low nSES (APC: -2.7). Floor of mouth cancer incidence decreased among most groups.

CONCLUSION

Despite the overall decreasing incidence of OCC, these trends are inconsistent among all OCC subsites. Differences are seen by race, nSES, and subsite, indicating intersectional barriers that extend beyond nSES and race and ethnicity alone. Further research on risk factors and developing interventions targeting vulnerable groups is needed.

The community engagement course and action network: strengthening community and academic research partnerships to advance health equity

Background

Historically Black Colleges and Universities and Minority Serving Institutions are uniquely positioned to implement community-campus research partnerships based on a history of service, the pursuit of community trustworthiness and student demographics often similar to surrounding marginalized communities. The Morehouse School of Medicine Prevention Research Center collaborates with members of Historically Black Colleges and Universities, Minority Serving Institutes, and community organizations on the Community Engaged Course and Action Network. This network is the first of its kind and aims to strengthen members' ability to implement Community-Based Participatory Research (CBPR) principles and partnerships. Projects address public health priorities including mental health among communities of color, zoonotic disease prevention, and urban food deserts.

Materials and methods

To assess the effectiveness of the network, a Participatory Evaluation framework was implemented to conduct process evaluation which included review of partnership structures, operations, project implementation processes, and preliminary outcomes of the research collaborations. A focus group of Community Engagement Course and Action Network members (community and academic) was also conducted to identify benefits and challenges of the network with emphasis on key areas for improvement to further enhance the relationships between partners and to facilitate their subsequent community-campus research.

Results

Network improvements were tied to themes strengthening community-academic partnerships including sharing and fellowship, coalition building and collaboration, and greater connections and awareness of community needs through their current community-academic partnerships. The need to conduct ongoing evaluation during and after implementation, for determining the early adoption of CBPR approaches was also identified.

Conclusion

Evaluation of the network's processes, infrastructure, and operation provides early lessons learned to strengthen the network. Ongoing assessment is also essential for ensuring continuous quality improvement across partnerships such as determining CBPR fidelity, assessing partnership synergy, and dynamics, and for quality improvement of research protocol. The implications and potential for advancing implementation science through this and similar networks are great towards advancing leadership in modeling how foundations in community service can advance to CBPR partnership formation and ultimately, health equity approaches, that are local defined and assessed.

Establishing an antiracism framework for dental education through critical assessment of accreditation standards

PURPOSE

The purpose of this manuscript is to establish an antiracism framework for dental education. Since the accreditation process is an influential driver of institutional culture and policy in dental education, the focus of the framework is the Commission on Dental Accreditation (CODA) standards for predoctoral education.

METHODS

The authors of this manuscript reviewed each CODA predoctoral standard for opportunities to incorporate antiracism strategies. Eight standards were identified under themes of diversity (Standards 1-3, 1-4, 4-4), curriculum development (Standards 2-17, 2-26), and faculty recruitment and promotion (Standards 3-1, 3-4, 3-5). Guided primarily by National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, a logic model approach was used to critically assess those standards for opportunities to establish antiracism strategies, with anticipated outcomes and impacts.

RESULTS

Strategies highlighted a need to improve recruitment, admissions, and accountability among dental schools to address the low numbers of historically underrepresented racial and ethnic (HURE) students and faculty. They emphasized the inclusion of racism in curricula geared toward training dental students to provide care to HURE populations. Finally, there are opportunities to improve accountability that dental schools are providing equitable opportunities for career advancement among HURE faculty, with consideration of conflicting demands for scholarship with HURE student mentoring, role modeling, teaching, and/or service.

CONCLUSIONS

The framework identifies gaps in CODA standards where racism may be allowed to fester, provides specific antiracism strategies to strengthen antiracism through the accreditation process, and offers dental education programs, a process for evaluating and establishing their own antiracism strategies.

Periodontal Treatment Reduces Circulating Pro-Inflammatory Cytokine and Chemokine Levels in African American HIV+ Individuals with Virological Suppression

Introduction

Periodontal Disease (PD), a chronic inflammatory disease, is highly prevalent among Persons Living With HIV (PLWH) and is characterized by microbial symbiosis and oxidative stress. Our hypothesis stipulates that periodontal therapy attenuates systemic inflammatory and bacterial burden while improving periodontal status in PLWH.

Methods

Sixteen African Americans (AA) with suppressed HIV viremia on long-term Antiretroviral Therapy (ART) were recruited to this study. Participants were placed into two groups, based on their dental care status: group 1 (In-Care, IC) and group 2 (Out of Care, OC). Periodontal health was investigated at baseline, 3 months, 6 months, and 12 months. Cytokine/chemokines, microbial phyla, and Asymmetric Dimethylarginine (ADMA, a marker for endothelial cell dysfunction) levels were assessed in the serum. Statistical comparisons between groups and at different visits were performed using multiple comparison tests.

Results

Across longitudinal visits, periodontal treatment significantly reduced the levels of several cytokines and chemokines. At baseline, the out of care group had significantly higher blood levels of ADMA and actinobacteria than the IC group. Periodontal treatment significantly altered the abundance of circulating genomic bacterial DNA for various phyla in out of care group.

Conclusions

Periodontal treatment interventions effectively attenuated circulating pro-inflammatory cytokines and altered microbial translocation, both critical drivers of systemic inflammation in PLWH.

Oral Health Service Access in Racial/Ethnic Minority Neighborhoods: A Geospatial Analysis in Washington, DC, USA

Previous studies on individual-level variables have improved our knowledge base of oral health service use. However, environmental or contextual variables are also important in understanding oral health disparities in racial and ethnic neighborhoods. Based on Bronfenbrenner’s ecological framework, this study examines the geographic availability of oral health providers in Washing-ton DC, U.S.A. Census tract-level data were drawn from the American Community Survey, joined with tract-level shapefiles, and overlaid with the geographic location of dental services throughout the city. Visual maps, descriptive statistics, and spatial lag regression models showed that census tracts with higher concentrations of African Americans were significantly farther from their nearest oral health providers (r = 0.19, p < 0.001), after controlling for neighborhood poverty rate, median age, and gender. Such findings confirm that in urban areas with highly di-verse populations such as Washington DC, racial disparities in oral health care access are signifi-cant. The study highlights that identifying neighborhoods with limited oral health care providers should be a priority in diminishing racial disparities in oral health service access. Improving access to racial/ethnic minority communities, especially African American neighborhoods, will require changes in health policies and programs, workforce development, resource allocation, community outreach, and educational programs.

Addressing Black men's oral health through community engaged research and workforce recruitment

BACKGROUND

Racism negatively affects the life experiences and subsequent health of Black men, including oral disease prevalence and outcomes. Few examples in the literature discuss how racism may affect successful, unsuccessful, and non-attempts to address Black men's oral health.

AIMS

This commentary describes anti-racism approaches to address Black men's oral health through community-based participatory research, oral health promotion, and workforce recruitment.

MATERIALS AND METHODS

Stakeholders from two organizations and one dental school share their experiences and key insights on how to strengthen efforts while minimizing the influence of racism on Black men's participation.

RESULTS

Common insights identified were a need to engage a diverse range of Black men within varying social and economic contexts, race and gender concordance among program leaders and participants, and the value of partnership to reach Black men in places where they feel comfortable and supported.

DISCUSSION AND CONCLUSION

These examples stress the imperative of addressing racism among Black men in the development and improvement of targeted oral health interventions. They also emphasize the value of commitment from institutional leadership, relationship building with Black men, and the empowerment of Black men to lead program development and implementation efforts.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.

Men and Oral Health: A Review of Sex and Gender Differences

Sex and gender related health disparities in oral health remain an underappreciated and often over looked aspect of well-being. The goal of this narrative review is to identify sex and gender related oral health disparities by summarizing the current literature related to differences in oral health between men and women. The review identified that men are more likely to: ignore their oral health, have poorer oral hygiene habits, and experience higher rates of periodontal disease, oral cancer, and dental trauma. Men also visit dentists less frequently and compared to women seek oral treatment more often for an acute problem and less often for disease prevention. Women exhibit more positive attitudes about dental visits, greater oral health literacy, and demonstrate better oral health behaviors than men. Men disproportionately develop periodontal diseases due to a combination of biological and gender related reasons including immune system factors, hormone differences, poorer oral hygiene behaviors, and greater tobacco use. There is a male to female ratio of 2:1 for oral cancer, largely attributable to more tobacco use, heavier use of alcohol, and longer sun exposure. Minority men experience a disproportionate burden of oral health disparities because of both their gender and race/ethnic identities. In conclusion, this review identifies several differences between men and women related to oral health and highlights the need for further research to better understand these disparities and how to incorporate them into developing prevention, education and treatment strategies to improve oral health in men.

A Three-year Audit of Dental Services at Primary Health Care Facilities in Gauteng, South Africa: 2017 to 2019

Aim:

The aim of this study was to determine the types and trends of dental services offered over 3 months (April, May, and June) every year from 2017 till 2019 at all full-time primary oral health care facilities (POHCFs) in Gauteng Province, South Africa.

Materials and Methods:

This was a record-based retrospective study. Data were collected from April, May, and June in 2017, 2018, and 2019, from all full-time POHCFs in Gauteng. The data were obtained from the attendance registers at each facility and included the number of patients and personnel and the type and number of procedures performed.

Results:

A total of 90 POHCFs were included. The number of clinicians remained stable, whereas the mean number of patients per month increased from 587 (2017) to 654 (2019). This resulted in an increase in the mean monthly patient-to-clinician ratio from 376 (2017) to 428 (2019). On average, 459 extractions, 64 restorations, and 43 fissure sealants were performed monthly per district. Clinicians treated on average 19 patients per day and on average 15 extractions for every restoration. The mean operator-to-dental assistant ratio was 1.3:1.

Conclusion:

Although there were differences in the types of services rendered and the workloads of clinicians across the province, a significant increase was observed in the number of patients over the study period. The most common services rendered were extractions and the extraction-to-restoration ratio was fairly high. Managers need to carry out regular audits to ensure that the facilities are operating optimally.

No Longer an Island: A Social Network Intervention Engaging Black Men Through CBPR

The aim of this study was to assess outcomes from a multilevel social network intervention to promote the health of Black men. Through a community–academic collaboration and using a participatory research approach, we implemented the intervention over 4 years in a 110-block area of an urban neighborhood. The project aimed to implement a neighborhood peer outreach and leadership network to strengthen social support of Black men and increase community and family engagement. Intervention activities included three 12-month intergenerational peer support groups (N = 46), a door-to-door outreach campaign (N = 186), media and communication efforts, and a community partner network. Primary outcomes for the peer support groups were measured using a pretest/posttest cohort design and included social support, perceived stress, social capital, and global self-esteem. Primary outcomes for the door-to-door outreach campaign were measured using a repeated cross-sectional design and included a sense of community, neighborhood social interaction, perceived neighborhood control, and self-rated health status. Significant findings from the peer support groups included an increase in social support overall (p = .027), driven by improvements in guidance, reliable alliance, and reassurance of worth; and an improvement in perceived stress (p = .047). Significant findings from the door-to-door outreach campaign included increases in neighborhood social interaction (p < .0001) and perceived neighborhood control (p = .036). This project provides evidence that a participatory approach to planning and delivering a health promotion intervention aimed at creating positive social spaces and enhancing social connections can result in significant outcomes and successful engagement of Black men.

Barriers and Facilitators of Dental Care in African-American Seniors: A Qualitative Study of Consumers' Perspective

Objective

To identify African-American seniors' perceptions of the barriers and facilitators to their dental care.

Materials and Methods

In this cross-sectional qualitative study, we conducted in-depth interviews with 16 community-based, self-identified African-American seniors from March 2017 to August 2017 in Oregon. We coded data in ATLAS. ti and used thematic analysis to identify emergent themes within the social ecological framework and a cross-case comparative analysis to explore variation by participant characteristics.

Results

Regardless of dental insurance status, cost and perceived urgency of treatment were the primary drivers of participant's ability and interest in seeking dental care. Participants identified four solutions to improve oral health care in African-American seniors: affordable/free care and vouchers for dental work, better oral health education at a younger age, onsite community dental services, and navigators who can educate patients about insurance and dental providers who see low-income patients.

Conclusions

Oral health decisions by African-American seniors were primarily driven by cost and perceived urgency irrespective of insurance coverage. Affordable dental care, early intervention, on-site services, and navigation may help to address key barriers and reduce oral health disparities faced by African-Americans.

A Community-Based Participatory Approach to the Development and Implementation of an HIV Health Behavior Intervention: Lessons Learned in Navigating Research and Practice Systems from Project HAPPY

African American young adults continue to be disproportionately affected by HIV/AIDS. The Southern United States has been particularly affected by HIV/AIDS, accounting for 52% of the new HIV diagnoses. Efforts to reduce the burden of HIV among young African Americans are still needed. Project HAPPY (HIV/AIDS Prevention Project for Youth) was developed and implemented using a community-based participatory research (CBPR) model. There were several challenges that arose during implementation of Project HAPPY that included recruitment, partner engagement, and retention. The realities of implementing an HIV prevention project with urban adolescents is discussed in detail and strategies to overcome these challenges, using a CBPR approach are described. The lessons learned from CBPR implementation of Project HAPPY include: (1) Create a feedback loop to receive community input and guidance throughout the life of the project; (2) Periodic community inventory to determine who is providing similar services to avoid saturation; (3) Prepare for Alternative Partner Engagement; (4) Consult (formally and informally) with the Institutional Review Board prior to submitting proposed changes to avoid unnecessary delays in implementation; (5) Select meaningful incentives for your priority population; and (6) Maintain multiple points of contact with community partners to mitigate the effects of staff turnover.

A qualitative study of oral health knowledge among African Americans

OBJECTIVES

The purpose of this qualitative oral health needs assessment was to probe and better understand the oral health knowledge, beliefs, and barriers of District residents, particularly in DC wards where oral health disparities are most prevalent.

METHODS

Forty-eight (n = 48) participants were recruited for four focus groups. The focus group instrument consisted of a structured interview guide addressing the following topics: oral health history, perceived barriers to oral health, knowledge and perceptions about oral systemic health, and preferred message channels for receiving information on oral/dental health. Content analysis was performed using NVivo, a computerized, qualitative informatics tool.

RESULTS

The majority of participants in this study practiced both brushing and flossing in their daily dental routine and did not believe that tooth loss is a normal part of ageing. There was lack of knowledge on the connection between oral and systemic health, specifically impact of smoking, alcohol use, and sweets and sexual activity. Focus groups identified two main barriers to healthcare access-communication and affordability. Participants who had a dentist were satisfied and felt that their needs were met.

CONCLUSION

Our findings indicate a need for educational intervention and improved communication from oral health providers to increase awareness of the impact of systemic health and risky behaviors can have on oral health.

Household Income and Children's Unmet Dental Care Need; Blacks' Diminished Return

Background: Minorities’ Diminished Return theory is defined as the relative disadvantage of minority populations compared to Whites regarding health gains that follow socioeconomic status (SES). To test whether Minorities’ Diminished Return theory holds for unmet dental care needs (DCN), we investigated Black-White differences in the effects of family income on unmet DCN among children. Methods: Data from the National Survey of Children’s Health were used. Participants were either White or Black children age 1 to 18. Family income-to-needs ratio was the independent variable. Unmet DCN was the dependent variable. Covariates included age, gender, and parental educational attainment. Race was the focal moderator. We ran logistic regression for data analysis. Results: Higher income-to-needs ratio was associated with lower risk of unmet DCN in the pooled sample. We found an interaction between race and family income-to-needs ratio on unmet DCN, suggesting a stronger protective effect for Whites than Blacks. Conclusion: Minorities’ Diminished Return also holds for the effects of family income-to-needs ratio on unmet DCN. The relative disadvantage of Blacks compared to Whites in gaining oral health from their SES may reflect structural racism that systemically hinders Black families. There is a need for additional research on specific societal barriers that bound Blacks’ oral health gain from their SES resources such as income. Policies and programs should also help Black families to leverage their SES resources.

Oral Health Intervention for Low-Income African American Men in Atlanta, Georgia

OBJECTIVES

To describe the Minority Men's Oral Health Dental Access Program (MOHDAP) intervention and report participants' outcomes and satisfaction.

METHODS

MOHDAP was designed to increase the oral health knowledge of low-income, African American men in Atlanta, GA, in 2013. A community-based participatory approach and needs assessment guided the intervention development, which consisted of 3 educational modules delivered over a 2-day period. All participants (n = 45; mean age = 50 years) were African American men. We assessed changes in oral health knowledge and attitudes at baseline and postintervention via survey.

RESULTS

After the intervention, the percentage of correct responses to questions about gingivitis increased by 24.2% (P = .01), about use of a hard (instead of a soft) toothbrush increased by 42.2% (P < .01), and knowledge of ways to prevent gum diseases increased by 16.0% (P = .03). The percentage agreeing with erroneous statements decreased 11.3% (P = .02) regarding oral health-related fatalism and oral health self-care and 17.4% (P = .05) regarding saving front versus back teeth.

CONCLUSIONS

Community-based oral health educational interventions designed for African American men may reduce oral health disparities among this population.