Impact of acculturation on oral health among immigrants and ethnic minorities: A systematic review

Health disparities between native and foreign-born older population in India: Does migration status matter in later life?

BACKGROUND

Ageing and migration are both contemporary phenomena and challenging for modern society in the 21st century. Persons ageing with migration status might have a double risk of vulnerability to poor health outcomes. This study examines the health disparities between foreign-born and native populations in India.

METHODS

The data drawn for the study from the Longitudinal Ageing Study in India (LASI) Wave-I (2017-18). The study used univariate and bivariate analysis to examine health disparities between native and foreign-born groups, and logistic regression analysis was used to examine the association between migration status and health outcomes of older persons.

RESULTS

Over fifty percent (56.5%) of the older persons (age 60+ years) were migrants; of these migrants of older persons, 55% were internally migrated, and 1.5% were foreign-born migrants in India. The foreign-born migrants persons showed a higher prevalence of poor SRH, chronic conditions, depression symptoms, and physical limitations than internal migrants and non-migrant groups. Further, the logistic regression result shows that foreign-born migrants were more likely to have poor SRH [AOR:1.72; CI: 1.45-2.04], chronic conditions [AOR=1.56; CI: 1.26-1.81], depression symptoms [AOR 1.14; CI: 1.07-1.21], and physical limitations [AOR 1.29; CI: 1.21-1.38], than non-migrants. Moreover, the study shows that the migrants' health disparities also vary with their length of stay and country of origin.

CONCLUSIONS

This cross-sectional study suggests that persons with internal and foreign-born migrant status were more vulnerable to poor health outcomes than non-migrants in their later life. This study predicts that migrants need separate health policies as they are in poorer health conditions than non-migrants. Policymakers should initiate equal access to healthcare services for older internal and foreign-born migrants in India.

Development of new bilingual oral health behavior social support (OHBSS) scales in English and Spanish

This paper describes the simultaneous co-development of Oral Health Behavior Social Support (OHBSS) scales in English and Spanish. OHBSS scales assess social support for toothbrushing, flossing, and dental care utilization, which are targets for interpersonal-level interventions to promote oral health among Hispanic/Latino adults. The focus was on Mexican-origin adults, who comprise the largest United States Hispanic/Latino subgroup and experience a high oral disease burden. All participants self-identified as Mexican-origin adults (ages 21-40 years old), living along the California-Arizona-Mexico border. Independent samples were recruited for each study partnering with Federally Qualified Health Centers. First, we conducted semi-structured interviews about social support for oral health behaviors in August to November 2018 (Study 1, N = 72). Interviews were audio recorded, transcribed (in original language, Spanish or English), and qualitative data were coded and analyzed in Dedoose following three topical codebooks; excerpts were used to co-create the large bilingual item data bank (OHBSSv1). The item bank was pre-tested via 39 cognitive interviews between December 2019 to March 2020, reviewed by an expert panel with several bilingual members, reduced to 107 Spanish/109 English items (OHBSSv2), then pilot tested in January to December 2021 (Study 2, N = 309). Pilot survey data were analyzed through Exploratory Factor Analysis and Horn's parallel analysis, overall and by language, to examine response patterns and inform item selection (OHBSSv3). The scales queried social support for toothbrushing, flossing, and dental care utilization across 39 items from three sources (family, health providers, others/friends), plus up to nine optional dental care-related items (Study 3, conducted April 2022 to February 2023, N = 502). Confirmatory Factor Analysis (CFA) assessed model fit, overall and by language (multiple group CFA). Final OHBSS scales include 37 items, plus seven optional items. Acceptable model fit for three-factor structures for each oral health behavior was found, providing evidence of the scales' construct validity. Cronbach's alphas and McDonald's omegas were tabulated; all were above 0.95, overall and by language, supporting scales' internal consistency.

Effects of an intervention on immigrant parents' knowledge and attitudes toward their children's oral health: A cluster randomized trial in Norway

There are no interventional studies on the oral health of immigrant children in Norway. This study aimed to assess the effectiveness of a culturally adapted oral health intervention for parental knowledge, attitude to oral hygiene, attitude to diet, and indulgence (permissiveness toward oral hygiene and sugar intake) concerning their children's oral health. A cluster randomized control trial, including immigrant parents of newborns, was conducted at seven health centers in Bergen (Norway) involving a 2-session one-to-one motivational interviews, toothbrushing demonstrations and pamphlets in the participants' native languages at baseline and after 6 months. Mean differences in outcome scores were assessed and compared between intervention and control groups using generalized linear mixed model. In an intention-to-treat (ITT) analysis (n = 345), the estimated mean difference in parental attitude to diet and indulgence between the groups indicated more improvement in the control than in the intervention group in the adjusted models. For all outcomes within both groups, a slight positive change was observed in marginal mean scores from baseline to follow-up. The two culturally adapted intervention sessions had no impact on oral health-related knowledge, attitudes, and indulgence of immigrant parents. These findings suggest that more comprehensive interventions may be needed to improve parental knowledge and attitudes toward children's oral health. Trial Registration number: ClinicalTrials.gov Identifier: NCT05758454.

An Intersectional Approach to Examining Breast Cancer Screening among Subpopulations of Black Women in the United States

This study examines breast cancer screening behavior among subpopulations of Black women in the United States. Binary logistic regression was used to analyze breast cancer screening among a nationally-representative sample (n = 9,783) of Black women-US-born, non-US-born Caribbean, and non-US-born African-from the 2011-2017 National Health Interview Survey dataset. Non-US-born African Black women were less likely to have breast cancer screening, compared to US-born Black women. Among non-US-born Black women, non-US-born Caribbean Black women were more likely to have had breast cancer screening. Differential healthcare access associated with nativity differences among Black women can be informing their breast cancer screening behaviors. Efforts to improve breast cancer outcomes among Black women can benefit from interventions that account for differential access to healthcare and breast cancer screening behaviors among subgroups of Black women.

Predictors of oral healthcare utilization and satisfaction among Indian migrants and the host population in the Netherlands

BACKGROUND

The aim of this study was to explore predictors associated with reasons for visiting an oral healthcare professional (OHP) and satisfaction with OHPs in the Netherlands among the Indian migrants and the host population.

METHODS

A random sample was obtained for this cross-sectional questionnaire study. Variables were classified according to the Andersen Behavioural Model of Health Services Utilization. Multivariable binary logistic regression analysis was conducted to identify significant predictors for reasons for visiting an oral healthcare professional (OHP) (routine checkups and preventive care or visiting only for pain and/or treatment) and satisfaction with OHPs (satisfied or dissatisfied).

RESULTS

The sample consisted of 391 participants (Indian migrants = 147 and host population = 244). Indian migrants with higher internal locus of control (LoC) [OR = 7.73 (95% CI: 2.13;27.99)], more trust in OHPs [OR = 4.12 (95% CI:1.68;10.14)] and higher integration level [OR = 1.09 (95% CI:1.03;1.17)] had higher odds of visiting an OHP for routine checkups and preventive care. In the host population, having dental insurance [OR = 2.64 (95% CI:1.00;6.95)] was significantly associated with increased odds of visiting an OHP for routine checkups and preventive care. For satisfaction, Indians with low paid jobs [OR = 16.26 (95% CI:2.83;93.36)] and those with higher integration levels [OR = 1.29 (95% CI:1.16;1.42)] had higher odds of being satisfied with the Dutch OHPs. Among the host population, those with more trust in OHPs [OR = 2.86 (95% CI:1.19;6.88)] had higher odds of being satisfied.

CONCLUSION

Our study emphasize that integration levels and trust emerged as two crucial factors, policy makers can leverage upon to improve access to care for Indian migrants.

CLINICAL TRIAL

N.A as this is a survey based cross sectional study.

Sociocultural determinants of children's oral health among immigrants in Canada

OBJECTIVE

A conceptual model was designed and tested to predict immigrant children's oral health in Canada by examining parental acculturation and perceived social support (PSS) using structural equation modelling.

METHODS

A convenience sample of first-generation immigrant parents and their children aged 2-12 years were recruited by multilingual community workers in Edmonton, Canada. Parents completed a validated questionnaire on demographics, child's oral health (OH) behaviours, parental acculturation and PSS. Dental examinations determined children's dental caries rate using DMFT/dmft index. Structural equation modelling (SEM) was used to analyse the data.

RESULTS

A total of 336 families participated in this study. The average parental acculturation level was 10.46 with a maximum of 15, and the average PSS was 63.27 with a maximum of 75. SEM showed that 77% of the variance of DMFT/dmft scores in children was explained by parental PSS, acculturation level, immigration-related variables, socioeconomic variables and children's OH behaviours. The direct effect of parental PSS was associated with a significantly reduced rate of dental caries (β = -.076, p-value = .008) and lower sugar consumption (β = -.17, p-value = .04). While the mediation effect of parental acculturation on PSS was associated with positive OH behaviours of children (e.g., toothbrushing frequency and dental care utilization), the indirect effect was negatively associated with caries rate (β = .77, p-value = .00).

CONCLUSIONS

The direct effect of Parental Perceived Stress Scale (PSS) was associated with more favourable oral health behaviours and a lower prevalence of dental caries, while the mediation effect of acculturation was linked to a higher prevalence of dental caries.

Barriers and mediators for routine dental care visits from the experiences of immigrant parents of autistic children living in the United States

INTRODUCTION

Immigrants are reluctant to attend routine dental care visits. Moreover, children with autism have a higher chance of developing periodontal disease. In this study, we describe the experiences of immigrant parents with autistic children and the barriers and mediators to routine dental care visits for their children in the United States.

METHOD

We conducted semistructured interviews with 19 immigrants who have children with autism.

RESULTS

We found that lack of transportation, support system, and insurance; prioritization of basic needs; and a mistrust of healthcare providers are the main barriers to attending routine dental care visits for autistic children of immigrant parents. Moreover, staff who consider the needs of children with autism, spend ample time with children with autism, and help with navigating the health system can improve access to routine dental care visits for autistic children with immigrant parents. This study found that despite their immigration status, all parents want to see improvements in the oral health of their children with special needs.

CONCLUSION

This study aimed to unpack the structural barriers and mediators to routine dental care visits for autistic children of immigrant parents. We found that removing structural barriers to care and utilizing mediators will enhance the outcome of routine dental care, resulting in healthier oral hygiene.

Oral Health Status, Behaviours and Oral Healthcare Utilization among Indian Migrants Compared to the Host Population in the Netherlands: A Descriptive Cross-sectional Study

The aim of this study was to assess the oral health status, oral health behaviours and oral healthcare utilization among Indian migrants living in the Netherlands and how they compare with the host population. Based on a random sample from Dutch municipalities, cross-sectional data were obtained for the Indian migrants living in the Netherlands (n = 148) and the host population (n = 244). A questionnaire was used to collect information on socio-demographic, self-reported oral health status, oral health behaviours and oral healthcare utilization. The distribution of self-reported oral health variables for both groups were tabulated and compared using logistic, ordinal and multinomial regression analysis. When adjusted for covariates such as age, gender, marital status, education, income, occupation and dental insurance, regression analysis for oral health status showed that the odds of reporting oral impact on daily performances (OIDP) was 5.87 times higher for Indians compared to the host population (95%CI:3.45;9.65). In contrast, the odds of Indians reporting bleeding gums [OR = 0.44 (95%CI:0.27;0.73)] and diagnosed with gum diseases [OR = 0.23(95%CI:0.13;0.39)] were lower than the host population. Also, the odds of consuming alcohol and cakes or chocolates was significantly lower among Indian migrants compared to the host population [(OR = 0.15(95%CI:0.09;0.25)] and [OR = 0.33(95%CI:0.21;0.52)], respectively. But the odds of consuming sugar in hot beverages were significantly higher among Indians [OR = 10.44(95%CI:5.99;18.19)]. The odds of Indians visiting a dental professional were 9.22 times (95%CI:4.62;18.40) lower compared to the host population. We found that oral health status and behaviours among Indian migrants were different in certain aspects compared to the host population. However, their oral healthcare utilization remained overall lower. The underlying determinants for such observations merit further research. Migrant friendly approach from both the dental professionals and policy makers can encourage dental visits and improve the utilization patterns among Indians migrants in the future.

Association of integration with oral health among Indian migrants living in the Netherlands

BACKGROUND

Limited data exist about the relationship between acculturation and oral health. Hence, the aim of this study was to assess the association of integration with self-reported oral health, behaviours, and oral healthcare utilization among Indian migrants living in the Netherlands, a cross sectional survey study.

METHODS

Between February and April 2021, a random sample from Dutch municipalities was obtained for the Indian migrants living in the Netherlands (n = 147). A validated questionnaire was used to collect information on independent variables, namely socio-demographic, integration assessment tool: Immigration Policy Lab (IPL-12) and everyday discrimination scale (EDS). The outcome variables were self-reported oral health, oral health behaviours, and oral healthcare utilization. Multiple regression analysis was used to assess the associations.

RESULTS

Higher integration among Indian migrants was associated with longer stay in the Netherlands, having a Dutch passport, intention to settle in the Netherlands, and having a permanent residence. After adjusting for covariates such as age, gender, marital status, education, income, occupation, and dental insurance, regression analysis showed that Indians with higher integration had lower odds of reporting their oral health as fair to poor [OR = 0.92(95%CI:0.0.85;0.99)] than the Indians with low integration scores. Also, Indians with higher integration had lower odds of using a manual toothbrush as compared to an electric toothbrush or use of both [OR = 0.86(95%CI:0.76;0.97)]. Highly integrated Indians had lower odds of consuming Indian sweets than lower integrated Indians (OR = 0.91; 95%CI:0.86;0.97). Indians with higher integration had 1.15 times (95% CI:1.03;1.29) higher odds of visiting a Dutch dental professional than visiting a dentist in both places (India and the Netherlands). No significant association was found between discrimination and the three outcome variables.

CONCLUSION

Integration is positively association with self-reported oral health outcomes among the Indian migrants. Measure to improve integration among Indian migrants may help to promote healthy oral health behaviours and improve their oral health care utilization.

Impact of English Proficiency on Health Literacy in Older Korean Immigrants: Mediating Effects of Social Support and Acculturation

Limited English proficiency (LEP) is one of the most influencing factors of personal health literacy (PHL) in the older immigrant population. Over the years, the proportion of older Korean immigrants with LEP has not improved and it is still noted as a major barrier to PHL. Therefore, organizational approaches are needed to enhance the PHL of older immigrants with LEP. This study aims to find the mediating effect of social support and acculturation between LEP and PHL by conceptualizing social support and acculturation as an organizational health literacy strategy. Data from 244 older Korean immigrants living in the states of Alabama and Georgia, USA, were used to conduct the study. Korean version of the Multidimensional Scale of Perceived Social Support (MSPSS), East Asian Acculturation Measure (EAAM), and Health Literacy Survey-12 Questionnaires (HLS-Q12) were used to measure the variables. The path analysis was conducted to find the serial mediation effects of social support and acculturation. The results showed that 77.5% of the participants reported not having fluent English proficiency. English proficiency (β =- 0.21, p = 0.007), social support (β = 0.17, p = 0.004), and acculturation (β = 0.18, p = 0.011) significantly predicted the PHL, and social support (β = 0.04, p = 0.028) and acculturation (β = 0.14, p < 0.001) mediated the relationship between LEP and PHL. Discussion: Health-related organizations and communities are encouraged to provide external social support and acculturation opportunities to enhance PHL in older Korean immigrants with LEP.

Association between acculturation, dental floss use, dental visits and unmet dental needs among Asians in the United States: Findings from National Health and Nutrition Examination Survey (NHANES) 2011-2018

OBJECTIVES

The objectives of this study were to examine the associations between acculturation and dental floss, regular dental visits and unmet dental care needs among Asian Americans, as well as the moderating effects of these associations.

METHODS

This study analysed national representative samples from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. A total of 2763 Asian Americans aged 20 and older were included in this analysis. The primary predictor, acculturation score, was determined by three questions: (i) language spoken at home (higher score for English), (ii) country of birth (higher score for United States) and (iii) length of time in the United States. Dental floss use, dental visits and unmet dental care needs were included as outcomes in this study. Descriptive statistics and logistic regressions were used to analyse the samples.

RESULTS

Acculturation was significantly associated with dental health behaviours: Individuals with higher levels of acculturation were more likely than less acculturated individuals to use dental floss (81.0% vs. 63.9%, respectively) and visit the dentist regularly (76.7% vs. 66.9% respectively). Insurance status moderated the association between acculturation and dental visits: Acculturation was significantly associated with dental visits in the past year among insured individuals (OR = 1.70, 95% CI: 1.29-2.23), but not among uninsured individuals. Unmet dental care needs were present in 11.1% of participants. While costs and insurance were the top two determinants of access to care, individuals with and without insurance differed with regard to their third major reason for unmet dental care needs: Being 'too busy' and not wanting to spend money on dental care.

CONCLUSIONS

Among the Asian population in the United States, those with high acculturation scores were more likely to engage in dental flossing and visit the dentist regularly compared to those Asians with lower acculturation scores. To encourage dental flossing and regular dental visits among Asians with lower acculturation scores, cultural adaptation and language accessibility suggests being considered. Future research is necessary to confirm the moderating effect of insurance status on the association between acculturation and regular dental visits. Additionally, our findings emphasize the impact of costs and insurance on access to dental care among Asians in the United States, highlighting the importance of future public health programmes in addressing these barriers.

The significance of green exercise for the health and wellbeing of Italian immigrants in Norway: a mixed-methods study

BACKGROUND

Green exercise (physical activity in presence of nature) has beneficial effects for health and wellbeing. Green exercise is a popular form of recreation in the Nordic countries, but participation is lower among the immigrant population from non-Western countries. However, no attention has been given to immigrants from the European Economic Area regarding this topic. Given the cultural and structural differences that surround green exercise in Italy and Norway, the case of the Italian immigrants in Norway is of interest to enrich our understanding of green exercise and its significance for health and wellbeing among immigrants in the Nordic countries.

METHODS

This convergent mixed methods study investigated the pathways that link green exercise to health and wellbeing among Italian immigrants in Norway. Quantitative data were collected through an online survey (n = 321), which was oversampled to better reflect the sociodemographic profile of the reference population. Logistic regression was used to model the association of green exercise with self-rated health (SRH) or satisfaction with life (SWL) before and after controlling for selected confounders (age, gender, educational level, language proficiency, social support, and childhood experiences with green exercise). Qualitative data were collected through semi-structured in-depth interviews (n = 14) and analysed thematically. Merging of the two strands was done using a simultaneous bidirectional approach.

RESULTS

The logistic regression found a significant bivariate association of green exercise with both SRH and SWL, though the association remained significant only for SWL after controlling for confounders. From the thematic analysis, three themes were identified: Green exercise opportunities contributing to overall satisfaction, Closeness to nature, and Embracing a new lifestyle. The integrated findings indicate that green exercise supported the immigrants' wellbeing, especially by providing stress relief, though socioeconomic status and acculturation may have a major impact on general health. Familiarity, appreciation of nature benefits, social support, and acculturation were identified as facilitating factors.

CONCLUSIONS

This study provides novel insights into how green exercise supports health, wellbeing, and inclusion among immigrants to the Nordic countries and emphasizes the importance of developing culturally adapted strategies to enhance this health-promoting activity among immigrant populations.

Factors of Dental Care Utilization in Foreign-Born Older Chinese Americans

Good oral health is essential for healthy aging. Regular dental care utilization is instrumental to good oral health. Older immigrants tend to experience poorer oral health and less dental care use as compared with their native-born counterparts in the host country. Older immigrants are particularly vulnerable to interrupted or lost social ties and acculturation challenges after immigration to a new country. This study examined whether and to what extent social relations, acculturation, and perceived oral health needs are associated with dental care utilization in foreign-born older Chinese Americans. Data came from the Population Study of Chinese Elderly in Chicago, which were collected between 2017 and 2019 (N = 3,000). Dental care utilization was dichotomized into "yes" versus "no" in the past 2 y. Social relations were measured by positive and negative relations with spouse, family, and friends. Acculturation was measured by length of stay, behavioral acculturation, and residence in Chinatown. Perceived oral health needs were measured by the presence of problems related to teeth, gums, or bleeding. As guided by the Andersen model, separate logistic regression models were used to investigate factors of dental care utilization. An overall 23.1% reported dental care utilization. Individuals with no negative relations with spouse, family, and friends were 31%, 36%, and 38% less likely to visit a dentist, respectively. Individuals with higher levels of behavioral acculturation were 4% more likely to visit a dentist; individuals living in Chinatown were 45% less likely; and individuals with perceived oral health needs were 2.5 times more likely. Findings illustrate the importance of understanding social relations, immigration-related factors, and perceived oral health needs in dental care utilization in older immigrants.

Acculturation and Dental Care-Related Anxiety: An Exploratory Assessment from the Hispanic Community Health Study / Study of Latinos

This study aimed to determine the associations between acculturation, dental anxiety, and dental utilization among Hispanics/Latinos living in the US. A proxy measure of dental anxiety was available for 7539 adults who had not visited a dentist within the last year. All completed the Short Acculturation Scale for Hispanics (SASH). Bivariate logistic regression and adjusted multivariable logistic regression analysis were conducted. Approximately 22% of the sample was dentally anxious. Dental anxiety was significantly associated with SASH language scale score (OR 1.09, 95%CI 1.02, 1.18, p = 0.04), years in US (OR 1.53, 95%CI 1.23, 1.91, p < 0.0001), and preferred Spanish language (OR 1.30, 95%CI 1.05, 1.63, p = 0.0192); lower acculturation corresponded to higher dental anxiety. Adjusting for sex, age, education, income, insurance, and oral health status, level of acculturation was associated with dental anxiety (AOR 0.87, 95%CI 0.75, 0.91, p = 0.009), but neither were associated with utilization. Acculturation may be an important predictor of dental anxiety for Hispanics/Latinos living in the US.

Dental health status, dentist visiting, and dental insurance of Asian immigrants in Canada

OBJECTIVE

This study examined the dental care utilization and self-preserved dental health of Asian immigrants relative to non-immigrants in Canada. Factors associated with oral health-related disparities between Asian immigrants and other Canadians were further examined.

METHODS

We analyzed 37,935 Canadian residents aged 12 years and older in the Canadian Community Health Survey 2012-2014 microdata file. Factors (e.g., demographics, socioeconomic status, lifestyles, dental insurance coverage, and year of immigration) associated with disparities in dental health (e.g., self-perceived teeth health, dental symptoms during past one month, and teeth removed due to decay in past one year) and service utilization (e.g., visiting dentist within the last three years, visiting dentist more than once per year) between Asian immigrants and other Canadians were examined using multi-variable logistic regression models.

RESULTS

The frequency of dental care utilization was significantly lower in Asian immigrants than their non-immigrant counterparts. Asian immigrants had lower self-perceived dental health, were less likely to be aware of recent dental symptoms, and more likely to report tooth extractions due to tooth decay. Low education (OR = 0.42), male gender(OR = 1.51), low household income(OR = 1.60), non-diabetes(OR = 1.87), no dental insurance(OR = 0.24), short immigration length (OR = 1.75) may discourage Asian immigrants from dental care utilization. Additionally, a perceived lack of necessity to dentist-visiting was a crucial factor accounting for the disparities in dental care uptake between Asian immigrants and non-immigrants.

CONCLUSION

Asian immigrants showed lower dental care utilization and oral health than native-born Canadians.

Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed-methods systematic review

OBJECTIVES

Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers.

METHODS

Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed-method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review.

RESULTS

A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual-family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial-system, provider and individual-family levels and illustrated in the rainbow model of CALD oral health.

CONCLUSION

The review strengthens evidence for multilayered, system-related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.

Ethnic identity and mental health stigma among Black adults in the United States

Objectives –

Mental illness stigma is a barrier to engagement in mental health services. This study assesses our hypothesis that specific ethnic identity dimensions influences mental health behavior including stigma.

Methods –

We performed an online cross sectional observational study among Black adults (n = 248, ages 18-65). We examined the relationship between an individual's approach to their racial identity in the community and stigma behavior towards mental health; generalized linear models were performed. We assessed demographic characteristics as moderators of the primary association.

Results –

Black adults with higher centrality reported lower past stigma behavior (RR=1.57, CI: 1.11-2.21, P = 0.01), but higher future intended stigma behavior (RR=0.93, CI: 0.88-0.99, P = 0.02). Majority of respondents reported high centrality and high assimilation; however, assimilation did not appear to correlate with mental health stigma behavior. Age, education and ethnicity appeared to have a limited moderating effect on the association between centrality and stigma behavior.

Conclusions –

Centrality was associated with mental health stigma behavior. By understanding the intersecting characteristics that may increase the likelihood for mental illness stigma, we will be better able to reduce mental illness stigma and optimize engagement in mental health services.

Acculturation and leisure-time physical activity among Asian American adults in the United States

ABSTRACTObjectives: To examine the association between acculturation and leisure-time physical activity among Asian Americans.Design: Data came from the 2011-2016 National Health and Nutrition Examination Survey, restricting to non-Hispanic Asian adults aged 20 years and older (n = 1989). Acculturation was assessed by language preference at home, birth locations, and length of residency in the United States (US). Self-reported physical activity was used to estimate leisure-time moderate-to-vigorous physical activity (MVPA) in MET-minutes/week and meeting the World Health Organization's physical activity guidelines. Multiple linear and logistic regression models were used to model MVPA as continuous and categorical variables, respectively.Results: A quarter of Asian Americans spoke only English and 47.8% spoke only non-English at home; 13.0% were born in the US. Asians who spoke only English (adjusted prevalence ratio [aPR]:1.5) and Asians who spoke both English and non-English at home (aPR: 1.4) had greater proportions of meeting physical activity guidelines compared to those who spoke only non-English at home. The US-born Asians had higher a proportion of meeting the physical activity guidelines (aPR:1.4) and performed 547.6 more MET-minutes of MVPA each week than foreign-born Asians; they also had a higher proportion of meeting the physical activity guidelines than foreign-born Asians who stayed in US for ≤10 years (aPR:1.5). Length of time staying in the US was associated with a higher proportion of meeting physical activity guidelines. Among foreign-born Asian Americans, higher acculturation measures were also positively associated with meeting physical activity guidelines.Conclusions: Acculturation was positively associated with physical activity levels among Asian Americans. More acculturated Asian Americans such as those who spoke more English at home and US-born Asians, performed more MVPA than less acculturated Asian Americans. Interventions are needed to promote physical activity among non-English speaking Asian immigrants and recent immigrants.

Acculturation and dental sealant use among US children

OBJECTIVES

Healthcare (including dental care) service use is influenced by predisposing, enabling and need factors. One area with limited research is the association of acculturation (defined as behavioural changes in the adaptation to another culture) as a predisposing factor for dental care preventive service use. Preventive service use is a primary objective of Healthy People, 2030. The purpose of this study was to determine the association of acculturation with the preventive dental service use of dental pit-and-fissure sealant placement, among children in the United States, ages 6-18 years.

METHODS

A cross-sectional, secondary data analysis study was completed using National Health and Nutrition Examination Survey (NHANES), 2013-2016 data. NHANES is a nationally representative survey of noninstitutionalized individuals across the United States. In the data set, children, ages 6-18 years, had been evaluated for pit-and-fissure dental sealant use. Information that served as proxies for acculturation was length of stay in the United States (a citizen at the time of the survey; not a citizen and in the country <5 years; or not a citizen and in the country ≥5 years) and whether English was spoken at home (yes; no). Data were analysed for descriptive statistics. Multivariable logistic regressions were used to examine strength of the associations. Odds ratios for pit-and-fissure sealants among groups were determined.

RESULTS

There were 2220 children participants whose data were used for this study. Less than half (45.5%) had received dental pit-and-fissure sealants. A majority (53.3%) were white and were ages 12-18 years (51.6%). The mean number of dental pit-and-fissure sealants among all children was 5.5. There was a lower percentage of children living in the United States <5 years who had received pit-and-fissure sealants than children who were citizens of the United States (22.2% vs 48.9%, respectively). The adjusted odds ratio was lower for dental pit-and-fissure sealants among children who were in the United States <5 years than children who were citizens of the United States (adjusted odds ratio, 0.38; 95% Confidence Interval: 0.24, 0.58).

CONCLUSIONS

In this study, children who had lived in the United States <5 years were less likely to have pit-and-fissure sealants than children who were citizens of the United States. There is a need to reach all children with preventive services to improve dental quality of life, reduce the need for dental restorations and decrease overall financial burden regardless of time in the United States.

Oral Health in Migrants: An Observational Study on the Oral Health Status of a Migrant Cohort Coming from Middle- and Low-Income Countries

Introduction. The oral health conditions of migrants coming from middle- and low-income countries to developed countries have been shown to be poorer than those of the host population. Since the phenomenon of migration has continued to grow over the past five decades, the oral health status of migrant populations should be an issue of great concern. Objectives. The objective of our observational study was to analyse the periodontal health status and the prevalence of dental caries and lesions of the oral mucosa in a migrant cohort resident in Italy, assessing the association between the oral health status and the educational level of the included patients. Materials and Methods. Our research was conducted at the dental department of Policlinico Tor Vergata (Rome, Italy). A sample of 200 migrants coming from middle- and low-income countries, aged between 3 and 37, was included in our study. Each patient underwent a physical examination of the oral cavity, recording the DMFT/dmft index, Community Periodontal Index of Treatment Needs (CPI), and lesions of the oral mucosa. The one-way ANOVA test was used to establish the correlation between the oral health status and the educational level of the participants. Results. Many participants (62.5%) showed a DMFT/dmft Index ≥ 4; only 27% of the migrants had a DMFT/dmft Index lower than 4, and only 21 of them (10.5%) were recorded at 0. A CPI equal to 0 or 1 was observed in 131 patients (65.5%), while only 30 participants presented a CPI equal to or higher than 4 (15%), and 19.5% (39 patients) were assigned to code 2 and 3. Significant statistical differences were found in the CPI after adjusting data for the educational level of the included participants (p-value < 0.01). Conclusions. The data obtained in our research highlighted poor oral conditions among the analysed migrant population, recording a high prevalence of dental caries and inadequate oral hygiene habits.

Dental Caries Prevalence and Experience (ICDAS II Criteria) of 5-, 12- and 15-Year-Old Children and Adolescents with an Immigrant Background in Greece, Compared with the Host Population: A Cross-Sectional Study

Evidence regarding disparities in oral health among native and immigrant child and adolescent populations in Europe is scarce. The present study aimed to determine the caries status of 5-, 12-, and 15-year-olds with an immigrant background in Greece in relation to their sociodemographic characteristics and compare their caries levels with those of their native Greek peers. A sample of 707 immigrants underwent clinical examination for caries (ICDAS II criteria), followed by a calculation of caries prevalence and experience estimates (2013-2014). Multivariable regression models assessed the effect of ethnic background on the caries experience (d_3-6mfs/D_3-6MFS) of the total (707 immigrants and 3702 Greeks) population, and the association between parental education level and the immigrants' d_3-6mfs/D_3-6MFS. Among the 5- and 12-year-olds, those with an immigrant background demonstrated higher caries rates and had unfulfilled treatment needs at higher proportions. Among 15-year-old adolescents, no considerable differences in caries status were observed according to ethnic background (native Greek or immigrant). The strength of the association between immigrant background and caries experience levels attenuated gradually with increasing age (IRR = 1.61, 1.27 and 1.10, and p = 0.001, p = 0.006 and p = 0.331 for 5-, 12- and 15-year-olds, respectively). Among the immigrants, adolescents with less educated mothers exhibited elevated caries levels. Public health strategies should prioritize immigrant children and early adolescents in order to reduce the existing ethnic disparities in oral health.

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.

Self-Efficacy Mediates Acculturation and Respite Care Knowledge of Immigrant Caregivers

Past studies have shown that acculturation and self-efficacy can affect respite care knowledge, which are notable issues among immigrant caregivers due to the rapid increasing aging family members. The aim of this study was to investigate relationships among acculturation, self-efficacy, and respite care knowledge in immigrant caregivers, and to determine the mediating effects of self-efficacy on the relationship between acculturation and respite care knowledge. A cross-sectional design was used. We enrolled 134 female immigrant caregivers who had married Taiwanese men and lived with care recipients who used LTC services. Based on Baron and Kenny' mediating analytic framework, multiple regression and Sobel tests were used to examine whether self-efficacy mediated the relationship between acculturation and respite care knowledge. The findings showed that after controlling for confounding factors, acculturation and self-efficacy separately affected respite care knowledge (B = 0.229, standard error (SE) = 0.084; B = 0.123, SE = 0.049, respectively). Acculturation had a positive impact on respite care knowledge through self-efficacy (B = 0.181, SE = 0.084). Therefore, self-efficacy partially mediated the effect of acculturation on respite care knowledge, and accounted for 20.9% of the total mediating effect in this study. Acculturation predicted immigrant caregiver' respite care knowledge partially through self-efficacy. The association between acculturation and respite care knowledge was partially mediated by immigrant caregivers' self-efficacy. As a result, it was proposed that boosting self-efficacy could increase and drive immigrant caregivers' respite care knowledge. To assist this population in obtaining enough resources, targeted educational programs to promote immigrant caregivers' self-efficacy should be designed and implemented. Furthermore, health care practitioners should be aware of the relevance of immigrant caregivers' acculturation.

The Intersections of Ethnicity, Nativity Status and Socioeconomic Position in Relation to Periodontal Status: A Cross-Sectional Study in London, England

The role of migration as a social determinant of periodontitis has been overlooked. Intersectionality theory could help understand how immigration status interacts with other social determinants of health to engender inequalities in periodontitis. The objective of the present study was to evaluate whether ethnicity, nativity status and socioeconomic position intersect to structure social inequalities in periodontal status. Data from 1936 adults in a deprived and multi-ethnic area of London were analysed. The numbers of teeth with probing depth and clinical attachment loss were determined from clinical examinations. A matrix with 51 intersectional strata, defined according to ethnicity, nativity status and education, was created. A cross-classified multilevel analysis, with participants clustered within intersectional social strata, was performed to assess the extent to which individual differences in periodontal measures were at the intersectional strata level. A complex pattern of social inequalities in periodontal status was found, which was characterised by high heterogeneity between strata and outcome-specificity. The variance partition coefficient of the simple intersectional model, which conflated additive and interaction effects, indicated that 3-5% of the observed variation in periodontal measures was due to between-stratum differences. Moreover, the percentual change in variance from the simple intersectional to the intersectional interaction model indicated that 73-74% of the stratum-level variance in periodontal measures was attributed to the additive effects of ethnicity, nativity status and education. This study found modest evidence of intersectionality among ethnicity, nativity status and education in relation to periodontal status.

Dental service utilization and immigrant family structure

OBJECTIVES

To determine the patterns and time trends of dental services received and access to dental care among immigrant and US-born children living in the United States.

METHODS

We analyzed the nationally representative Medical Expenditure Survey data for 2007-2015. Survey weighted mean and frequency were calculated for all the years and for each year for the complete cohort and for the four subgroups of children categorized based on the child's and parents' birthplace (United States or Foreign). These groups were compared to detect differences in dental service received.

RESULTS

Overall 34,482 children aged <18 years were included in the analysis representing the weighted sample size of 564,255,643. Utilization of preventive dental services increased from 37.2 percent in 2007 to 44.4 percent in 2015 overall (P < 0.0001), with similar trend seen within all subgroups. Immigrant children compared to US-born children had higher numbers of surgical and restorative procedures (17 versus 16 per 100-person years, P = 0.03), fewer had at least one preventive dental visit in a year (32.8 percent versus 43.0 percent, P < 0.0001) and were less likely be unable to access dental care (3.0 percent versus 1.7 percent, P = 0.005). Fewer children had delayed access to dental care in recent years (2.0 percent in 2007 to 1.5 percent in 2015) and the decline was consistent in all the subgroups.

CONCLUSION

Stratification into the different subgroups allowed for improved understanding of dental procedure utilization and dental services utilization in all subgroups increased over time. Immigrant children had lower utilization of preventive procedures and higher utilization of surgical and restorative procedures.

Regular Dental Care Utilization: The Case of Immigrants in Ontario, Canada

Considering the critical role of oral health on people's well-being, access to regular dental care to improve oral health may be a useful medium for improving immigrant integration and settlement in Canada. Using the 2013-14 Canadian Community Health Survey, this study contributes to the literature and policy by examining if there are disparities in regular utilization of dental care among recent immigrants, established immigrants, and the native-born in Ontario, Canada. Adopting Andersen's behavioural model of health services use as a conceptual framework, we introduce three sets of variables in our statistical analysis including predisposing, need, and enabling factors. At the bivariate level, recent (OR = 0.42, p < 0.001) and established immigrants (OR = 0.81, p < 0.001) are less likely to use dental care at least once a year than their native-born counterparts. Once accounting for enabling characteristics, however, we observe that the direction of the association becomes positive for established immigrants (OR = 1.15, p < 0.05). The difference between recent immigrants and the native-born is partially attenuated when we control for enabling characteristics but remains statistically significant (OR = 0.73, p < 0.05). Based on these findings, we provide several implications for policymakers and future research.

Oral Health Status, Oral Health Behaviours and Oral Health Care Utilisation Among Migrants Residing in Europe: A Systematic Review

As the reported data on oral health status among the migrants in Europe is fragmented, we systematically reviewed the published literature on the oral health status, behaviours and care utilisation among migrants residing in Europe. For this, we retrieved publications from PubMed and EMBASE, supplemented by manual citation screening and grey literature search on Google scholars. Two independent reviewers screened the studies, extracted data and critically appraised the publications. A total of 69 studies included showed higher dental caries among migrant children. But some studies on adolescents and adults reported similar or even better oral health among migrants compared to the host population, while other reported the opposite. Poor oral health behaviours were generally reported among the migrants and they frequently made use of emergency service utilisation compared to the host population. We shed light on the gaps in dental literature and make some recommendations for the future.

Barriers and facilitators to oral health care utilization in culturally and linguistically diverse mothers: a mixed methods systematic review protocol

OBJECTIVE

The objective of the review is to synthesize existing literature examining the barriers and facilitators to preventive oral health care utilization experienced by culturally and linguistically diverse mothers.

INTRODUCTION

Preventive oral health care in the absence of pain is underutilized in culturally and linguistically diverse groups. Culturally and linguistically diverse mothers experience oral health care utilization barriers compared to their host country counterparts. Much of the current evidence is focused on oral health care knowledge, attitudes, and beliefs of culturally and linguistically diverse groups. To date, it remains unclear as to which barriers or facilitators impact preventive oral health care utilization in culturally and linguistically diverse mothers.

INCLUSION CRITERIA

This review will consider studies that explore oral health care utilization in culturally and linguistically diverse mothers (with children younger than 18 years) who are either born in a different country or who have one parent born in a country that differs culturally and/or linguistically to the host population. Papers that explore barriers and facilitators to oral health care utilization will be included. Quantitative and qualitative studies will be included.

METHODS

A three-step search strategy will be conducted within the following databases: MEDLINE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Central, and Scopus. The search will be supplemented with gray literature and reference searching from collected articles. No date limitation will be applied. Two reviewers will assess papers against the inclusion criteria. A convergent integrated approach using the JBI mixed methods methodology will be followed for critical appraisal, data extraction, and data synthesis and integration.

Acculturation and Subsequent Oral Health Problems Among Foreign-Born Older Chinese Americans: Does Neighborhood Disorder Matter?

OBJECTIVES

To investigate the relationship between acculturation and subsequent oral health problems in older Chinese Americans and to further test the moderating role of neighborhood disorder in such a relationship.

METHODS

The working sample included 2,706 foreign-born community-dwelling older Chinese Americans aged 60 years or older who participated in the Population Study of Chinese Elderly in Chicago at baseline between 2011 and 2013 and the 2-year follow-up between 2013 and 2015. Stepwise Poisson regressions with lagged dependent variable were conducted.

RESULTS

Behavioral acculturation was protective against subsequent oral health problems, and the protective role was stronger among individuals reporting lower levels of neighborhood disorder. Residence in Chinatown was associated with an increase in the risk of subsequent oral health problems.

DISCUSSION

To reduce oral health symptoms and related burdens, it is important to consider, in practice and policy, the role of acculturation and the neighborhood on subsequent oral health outcomes.

A Qualitative Study of the Health Perceptions in the Venezuelan Immigrant Population in Medellín (Colombia) and Its Conditioning Factors

This study explored the general and oral health perceptions in the Venezuelan immigrant population in Medellín (Colombia) and its conditioning factors. A qualitative study involving Venezuelan immigrants ≥18 years with a minimum stay of six months in Colombia was conducted. Dentists, dental students, and other health professionals also participated. Semi-structured interviews (n = 17), focus groups (n = 2), and key informants' interviews (n = 4) were utilized. The interviews and focus groups were recorded and transcribed for later narrative content analysis. A high degree of vulnerability of participants was found due to the precarious living conditions from the premigratory moment and the lack of job placement possibilities at the time of settling in Colombia, where the migratory status played a fundamental role. Among the perceived needs, the mitigation of noncommunicable diseases stood out. Poor mental health symptoms (depression and anxiety) were perceived, and oral health was not a priority. Barriers to accessing health and dental care were found. The migrant condition was found to be a determinant that affected physical, mental, and oral health and the provision of health care. This situation is of interest to the construction of public health policies that guarantee access to fundamental rights.

Prevalence and Patterns of Dental Care Utilization among US-Born and Non-US Born Hispanics in the Hispanic Community Health Study/Study of Latinos

OBJECTIVES

Access to routine dental services is important to maintaining good oral health. The aims of this study were to describe the dental care utilization patterns of a diverse group of Hispanic/Latino men and women and assess differences in dental care utilization by perceived need for dental care and proxy measures of acculturation.

METHODS

Data from 13,792 participants of the Hispanic Community Health Study were analyzed with SAS 9.4. Time since last dental visit was dichotomized into <1 and ≥1 y. Acculturation measures included the language and social subscales of the Short Acculturation Scale for Hispanics, the Multiethnic Study of Atherosclerosis nativity subscore, and immigrant generation. Survey logistic regression adjusted for demographic (age and sex) and health-related variables, estimated associations among perceived need for dental care, acculturation measures, and dental care utilization.

RESULTS

About a quarter (23%) of the participants were born in the 50 US states, excluding territories, while 77% were non-US born. Overall, 74% perceived a need for dental care. Upon covariate adjustment, perceiving a need for dental care was associated with reduced odds of reporting a past-year dental visit (odds ratio, 0.32; 95% CI, 0.28 to 0.37), while there appeared to be no meaningful association between proxy measures of acculturation and past-year dental visit. Having health insurance was significantly associated with a past-year dental visit (odds ratio, 2.23; 95% CI, 1.99 to 2.49) for all groups combined and among the different Hispanic/Latino background groups.

CONCLUSIONS

Acculturation affects general health and contributes to general health disparities; however, its role in dental care utilization remains questionable. Given that acculturation is a process that occurs over several years, longitudinal studies that evaluate oral health trajectories along the acculturation continuum are needed.

KNOWLEDGE TRANSFER STATEMENT

The results of this study are valuable for dental public health program planning and implementation for minority groups, as it describes the varying patterns of dental care utilization among US-born and non-US born Hispanics/Latinos and identifies factors that may partly explain dental care utilization patterns, such as acculturation.

Association of Acculturation and Latino Parents' Oral Health Beliefs and Knowledge

The purpose of our study was to explore the association of acculturation and Latino parent behavioral and psychosocial characteristics. A cross-sectional survey was conducted with 197 parent-children triads. Participating parents completed survey questions encompassing oral health knowledge, behaviors and beliefs from a validated oral health instrument. The mean score for acculturation in this sample was 3.8, where acculturation was dichotomized to a categorical variable. The bivariate associations between the independent variables (caregiver psychosocial factors and socio-economic factors (SES) factors) and acculturation (more/less acculturated) were conducted using logistic regression analysis, and for the final model a multivariate logistic regression model was used. In the bivariate analyses, less acculturated parents reported lower oral health knowledge (p = 0.02), higher social support (p = 0.028) and chronic stress (p = 0.015) and lower perceived susceptibility to dental caries in their children (p = 0.039). The bivariate analysis demonstrated that less acculturated parents had less education and employment (p < 0.0001) than more acculturated parents. The multivariate logistic model demonstrated that social support (p = 0.028), chronic stress (p = 0.015) and health beliefs as barriers to access dental care (p = 0.039) were higher in less acculturated parents compared to more acculturated parents. Less acculturated parents demonstrated lower oral health knowledge, higher stress and more barriers to accessing oral health care for their children. Oral health interventions for Latino families should incorporate strategies that include consideration of parental oral health beliefs.

Immigration and Oral Health in Older Adults: An Integrative Approach

The aim of this study was to develop an integrative framework on aging, immigration, and oral health. The methodology was a critical review that used immigration as a social determinant framework through which to evaluate its impact on the oral health of older immigrants. We reviewed recent empirical evidence on factors related to oral health in older immigrants. In a systematic search across multiple databases, we identified 12 eligible studies in this review. Among the eligible studies, most were conducted among East Asian immigrants (8 articles), followed by non-Hispanic White/European origin (2 articles), Mexican origins (1 article), and Iran and other Middle East regions (1 article). The research revealed knowledge gaps in the evidence base, including the dynamic relationship between acculturation and oral health, the role of environmental factors on oral health for immigrants, psychosocial stressors and their relationship with oral health, and oral health literacy, norms, and attitude to dental care utilization and oral hygiene practices. The development of the integrative framework suggests the pathways/mechanisms through which immigration exerts influences on oral health in later life. This provides opportunities for researchers, practitioners, and policy makers to gain greater insights into the complex associations between immigration and oral health among older adults.

Neighborhood Cohesion and Oral Health Problems Among Older Chinese American Immigrants: Does Acculturation Make a Difference?

BACKGROUND AND OBJECTIVES

Despite an increasing, yet still limited amount of research on social determinants of oral health, the influences of neighborhood characteristics remain understudied, especially within the context of immigration. Acculturation is multidimensional, and its influences on the oral health of immigrants vary across age and ethnic groups. This study investigated the relationship between neighborhood cohesion and oral health problems among older Chinese American immigrants, and whether and to what extent acculturation indicators moderate the relationship between such cohesion and oral health.

METHODS

The research design and working sample included 3,157 older Chinese American immigrants aged 60 years or older from the baseline of the Population Study of Chinese Elderly in Chicago. Neighborhood cohesion was measured by a six-item scale. Oral health problems were measured by the presence or absence of such problems. Acculturation included residence in ethnic enclaves, length of stay, and behavioral acculturation. Stepwise logistic regression models with interaction terms (Neighborhood cohesion × Acculturation) were conducted to examine the association between neighborhood cohesion and oral health problems, accounting for sociodemographics, health conditions, and health behaviors.

RESULTS

Individuals experiencing higher levels of neighborhood cohesion reported a lower likelihood of having oral health problems. The protective effect of neighborhood cohesion against having oral health problems was stronger when individuals resided in ethnic enclaves such as Chinatown.

DISCUSSION AND IMPLICATIONS

To promote optimal oral health, interventions need to account for individuals' perceptions and levels of integration into their neighborhoods and communities.

Relationships of Acculturative Stress, Perceived Stress, and Social Support with Oral Health-related Quality of Life among International Students in Malaysia: A Structural Equation Modelling

AIM

This study aimed to investigate the relationships between acculturative stress, perceived stress, social support, and subjective oral health outcomes among international graduate students in Malaysian public universities.

MATERIALS AND METHODS

A total of 312 international graduate students completed a web-based questionnaire, including measures of acculturative stress (ASSIS-36), perceived stress scale (PSS-4), social support (MSPSS-12), oral health perceptions (global rating item), and oral health-related quality of life (OHRQoL, OIDP-8). The hypotheses of the conceptual model were tested using structural equation modeling-partial least squares (SEM-PLS) with the support of SmartPLS.

RESULTS

Twenty-seven percent (27.1%) of the variance in OHRQoL was explained by acculturative stress, perceived stress, social support, and oral health perceptions. The path coefficient between oral health perception and OHRQoL was the strongest (β = -0.385, P < 0.001). Acculturative stress directly influenced OHRQoL (β = 0.20, P = 0.009) and indirectly through perceived stress (β = 0.05, P = 0.019). Social support mediated the relationship between perceived stress and OHRQoL (β = 0.046, P = 0.02). The overall predictive power of the model was 23%.

CONCLUSION

Results indicated that acculturative stress, perceived stress, and social support are among the predictors of OHRQoL. Oral health perceptions and acculturative stress were the most significant predictors that contributed the largest amount to the model. The findings emphasize the potential role of psychosocial factors in relation to oral health. The empirical evidence of this study could facilitate the planning of targeted strategies that address stress reduction and social support. Such strategies might be a new promising way to enhance OHRQoL as these elements can be modified and response to interventions.

Acculturation and the oral health of a nationally representative sample of Hispanic children in the United States: an analysis of 2011-2012 National Survey of Children's Health data

BACKGROUND

Oral disease is a serious public health issue, and Hispanic children in the United States (US) are more likely than children of other racial/ethnic groups to experience dental caries. Although Hispanic children are a growing segment of the US population there is limited research on the association between acculturation and oral health outcomes in this population. This study examined the associations between household acculturation and pediatric oral health in the Hispanic population using a nationally representative sample of children.

METHODS

Data from the 2011-2012 National Survey of Children's Health were analyzed; analyses included Hispanic children ages 1 to 17. Household acculturation was assessed with a combination of language and parental nativity, while oral health was assessed via parents'/guardians' reports of children's dental caries. Logistic regression was used to examine the association between acculturation and oral health, adjusting for other demographic and social determinants of pediatric oral health. We assessed significance at the p < 0.05 level, and all analyses accounted for the survey's complex sample design.

RESULTS

Analyses included 9143 Hispanic children. In total, 24.9% (95% CI: 22.9-27.0%) experienced dental caries, and there were significant associations between household acculturation and oral health. In unadjusted analyses, 32.0% (95% CI: 28.9-35.4%) of children in low acculturation households, 20.3% (95% CI: 16.0-25.4%) of children in moderate acculturation households, and 16.9% (95% CI: 14.2-20.0%) of children in high acculturation households experienced dental caries (p < 0.001). In adjusted analyses, children in high acculturation households were significantly less likely than those in low acculturation households to experience dental caries (p < 0.001; OR = 0.50; 95% CI: 0.35-0.70). The difference between children in moderate and low acculturation households approached but did not reach statistical significance (p = 0.057; OR = 0.69; 95% CI: 0.48-1.01).

CONCLUSIONS

A dose-response relationship was observed between household acculturation and the oral health of Hispanic children in the US. As acculturation increases, the likelihood of a child experiencing dental caries decreases. These findings suggest that public health and community-based interventions intended to reduce oral health disparities in Hispanic children would likely be most impactful if the acculturation levels of the children's households are considered during program development.

The effects of ethnic identity and acculturation in mental health of immigrants: A literature review

OBJECTIVES

The purpose of this literature review was to highlight the studies on mental health in relation to acculturation and ethnic identity and to identify research gaps. The results can be used to help inform future immigrant mental health workers and policy makers as well as provide information about the implications of immigrant mental health.

METHODS

The literature search was conducted electronically, directed by a variety of key words. The search focused on five areas of immigrant mental health importance: (1) acculturation; (2) acculturation and mental health; (3) ethnic identity; (4) ethnic identity and mental health; and (5) acculturation, ethnic identity and mental health. A total of 171 articles were examined and 110 were included in the review.

RESULTS

The information is presented in the following categories: acculturation; acculturation and mental health; ethnic identity; ethnic identity and mental health; and acculturation, ethnic identity and mental health. Research gaps are also presented.

CONCLUSION

Overall, literature shows that acculturation, ethnic identity and mental health are closely related to one another affecting both, individuals and communities. This literature review will help to better inform practitioners who may encounter immigrants experiencing mental health issues due to acculturation and ethnic identity pressure. This review may also help policy makers identify specific obstacles that are not addressed in immigration policies which can affect the implementation of these policies. In addition, the information presented can be used as an instrument for researchers in the field. Despite the limited amount of information about immigrant mental health challenges, much work remains to fully support the affected individuals and their families.

Application of the Theory of Planned Behavior to Predict Dental Attendance and Caries Experience among Children of Newcomers

Background: This study aimed to explore the predictors of regular dental attendance behavior and caries experience among children of newcomers to Canada using the Theory of Planned Behavior (TPB). Methods: A total of 274 newcomer parents with a child aged 1 to 12 years old who had lived in Canada for 10 years or less participated in this cross-sectional study. Children underwent a dental examination to measure their deft/DEFT, and parents completed a self-administered questionnaire. Parental attitudes, subjective norms, perceived behavioral control (PBC), and intention were examined using Structural Equation Modeling (SEM) as predictors of dental attendance behavior and caries experience using the TPB model. Results: Out of all the components of the model, attitude and PBC significantly predicted the intention (p < 0.05) while the subjective norm had no statistical effects on the loading of the model (p > 0.05). Intention significantly predicted behavior, but behavior could not predict caries experience. Although 51.6% of the variance of intention was predicted by this model, only 0.2% of the variance for dental attendance behavior was explained. Conclusions: The theory of planned behavior was successful in predicting dental attendance intention and behavior for children among newcomers, but this behavior could not predict caries experience in children.

Psycho-social predictors of acculturative stress and adjustment in Pakistani Institutions

Objectives:

The main objective of study was to investigate the effect of psycho-social predictors on acculturative stress and adjustment in Pakistani institutions.

Methods:

The study was carried out from November 15, 2016 to January 18, 2019. For this purpose data was collected from 450 international students who were studying in public and private sector universities of Pakistan and who experienced acculturative stress. The instruments include Relationship Assessment Scale, Acculturative Stress Scale for International, Psychological Adaptation Scale, and Revised Socio Cultural Adaptation Scale. The proposed model was tested by using SPSS (Version-23) and AMOS (Version-9).

Results:

Findings of the study revealed that relationship satisfaction (p<0.05), length of stay (p<0.05), and financial support (p<0.05) significantly negatively predicted acculturative stress. Financial support significantly positively predicted psychological adjustment (p<0.05). Employment status did not predict acculturative stress, psychological and socio-cultural adjustment (p>0.05). Moreover, all psycho-social predictors did not show effect on socio-cultural adjustment among international students (p>0.05).

Conclusion:

It can be concluded that general relationship satisfaction, more length of stay in host country, and financial support are very important for international students to manage their acculturative stress and to adjust better in a new cultural environment.