Alex Espinoza, M.P.H, Donald K. Hayes, M.D., M.P.H, Sarah Uehara, M.H.M.S., Deborah Mattheus, Ph.D, M.S.N., C.P.N.P, A.P.R.N.- Rx, Jennifer Domagalski, D.D.S.
Abstract
BACKGROUND : Multiple underlying risk factors are hypothesized to adversely affect oral health outcomes, but the relationship between youth risk behaviors and oral health is still unclear. The objective of this study is to examine differences in the likelihood of dental visit among public high school students in Hawaii by number of adverse behavioral risk factors and demographic factors.
METHODS: Aggregated 2013 and 2015 Hawaii High School Youth Risk and Behavior Survey (YRBS) data including 10,720 students was used to examine the association between multiple risk factors, demographics and likelihood of a dental visit in the past 12 months using binomial logistic regression to estimate risk ratios. Demographic factors included race/ethnicity, age, and sex. Risk factors (soda and alcohol consumption, non-adherence to physical activity recommendations, overweight/obese status, and tobacco, marijuana and illicit drug use) were consolidated into an index that measured the presence of 0, 1, 2, 3, 4, and ≥5 risk factors.
RESULTS: Overall, 77.1% of students reported a dental visit in the past 12 months. After adjusting for age, sex, and race/ethnicity, those having either 4 risk factors (RR = 0.88, 95% CI 0.81-0.96) or ≥ 5 risk factors (RR = 0.85, 95% CI 0.75-0.96) were less likely to report a dental visit in the past 12 months, compared to those with no risk factors. Additionally, Hispanics (RR = 0.83, 95% CI 0.74-0.94), Native Hawaiians (RR = 0.87, 95% CI 0.82-0.92), Filipinos (RR = 0.91, 95% CI 0.86-0.97), Other Pacific Islanders (RR = 0.78, 95% CI 0.71-0.86), and those who identified as more than one race/ethnicity (RR = 0.90, 95% CI 0.85-0.96) were less likely to visit the dentist than their white counterparts.
CONCLUSIONS: The results of this study support the presence of disparities in oral health care utilization among high school students in Hawaii. In particular, high school students in Hawaii with 4 or ≥ 5 risk factors or those who identified as Hispanic, Native Hawaiian, Filipino, Other Pacific Islander, and more than one race or ethnicity are less likely to utilize dental services.