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Hispanic Oral Health: A Rural And Urban Ethnography
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Principal Investigator: Judith C. Barker, PhD

Brief Summary:

This four year, qualitative study, will use standard anthropological techniques to examine in-depth, parents behaviors around and beliefs about oral health and dental care needs, especially those targeted at children aged birth to five years.

Study Design & Objectives:

The study will used ethnographic techniques (participant-observation) to study how low-income parents (or other adult family caregivers) in a Hispanic community generally manage children's oral health. This was followed by in-depth interviews with a select sample of caregivers to young children along with a sample of dentists and other health professionals in the study location, preschool teachers, community leaders, County dental advocacy organizations and State-level Medicaid (Denti-Cal) fiscal and policy administrators. :

(a) the nature, range and diversity of parental knowledge and beliefs about oral health and dental care needs for young children especially those from birth to five years of age

(b) how these beliefs relate to the kinds of dental care practices undertaken in the home with respect to children, such as use of bedtime bottles, or tooth brushing.

(c) the relationship between beliefs and practices and (i) expressed willingness and (ii) demonstrated ability of caregivers to seek and use dental services for young children

(
d) the impact of family life circumstances (eg, insurance, migrant status, language preference, etc) on parents seeking and using care for children's oral health

(e) how well and why/why not preventative messages and advice given on oral health, especially about Early Childhood Careis, are

(i) accepted and
i (ii) incorporated into oral health practices for young children

(f) differences between rural and urban caregivers’ beliefs, practices and life circumstances that affect children's oral health

Study Type:
Qualitative research - ethnography

Intervention:
Not applicable

Study Locations:
One urban (San Jose) and one rural (Mendota) site in Northern California

Study phase:
Data collected 2005-2007; data now in analysis
Study Accrual: Both Sites
95 mothers and 20 fathers of young children
35 dentists
40 community leaders, preschool teachers, oral health advocates, and Denti-Cal regulatory administrators

Inclusion Criteria for Parent/Caregiver Sample:
●Self-identify as Mexican or Latino
●Be first- or second- generation immigrant
●Be low-income with an annual income at or below federal poverty level
● Be the primary caregiver on a daily basis for at least one child aged five or younger
● Be aged 18 years or older

Main Findings (as of December 2008):
1) While parents desire their children to have good oral health, they generally do not recognize early signs of caries in children, nor understand what substances (other than candy) or habits can lead to ECC

2) Parents do not initiate oral hygiene routines as early as recommended by oral health professionals, but do regard tooth brushing as an important habit for children to develop

3) Many low-income Hispanic families in rural areas experience transportation difficulties. This can be a barrier to dental care, especially if specialty care is necessary.

4) Even if municipal water supplies were fluoridated, Hispanics in both the rural and urban area prefer to drink bottled water, believing it to be safer.

5) Parents experience difficulty in accessing dental care for young children, because so few providers accept Medicaid payment. There is also a general shortage of dental providers in rural areas.

6) Access to specialty care providers who accept Denti-Cal insurance is especially difficult.

7) State policy and reimbursement practices shape low-income children's access to oral care and the type of treatment they receive, often resulting in sub-optimal care.

Presentations and Publications:

Horton S & JC Barker “Rural Latino immigrant caregivers’ conceptions of their children’s oral disease.” Society for Applied Anthropology. Vancouver, Canada, March 2007

Horton S & JC Barker “Embodied inequalities: Oral health and social stigma among farmworker youth.” Latin American Studies Association. Toronto, Canada, November 2007.

Chaffee, B., S. Horton, J. Stevenson & J.C. Barker “The dento-enamel junction and clinical decision-making among dentists participating in Denti-Cal.” School of Dentistry Research Day, University of California San Francisco, October 2007

Barker, J.C. & S. Horton “Structural and policy influences sustaining oral health disparities for rural Latino children” Society for Applied Anthropology & Society for Medical Anthropology combined annual meetings, Memphis , TN, March 2008

Hoeft, K.S. J.C., Barker & E. E. Masterson. “Mexican-American caregivers’ understanding of initiating home oral hygiene for their young children.” Society for Applied Anthropology & Society for Medical Anthropology combined annual meetings, Memphis , TN, March 2008

Masterson E, K. Hoeft & J.C. Barker. “Shades of decay: Mexican immigrants’ perceptions of tooth discoloration and dental care seeking.” National Oral Health Conference, Miami. FL, April 2008

Hoeft, K.S, J.C. Barker & E. Masterson. “Dental care seeking behavior and conceptualization of dental problems among Latino immigrant caregivers of young children.” National Oral Health Conference, Miami. FL, April 2008

Weintraub, J A., J. C. Barker, R. Mendoza, K. S. Hoeft & H. Pollick. “Bottled, filtered or tap? Implications for fluoridated water exposure.” American Association of Dental Research. Annual meeting, Dallas, TX, April 2008.

Hoeft K.S., E. E. Masterson & J. C. Barker, “Latino caregivers’ conception of cavity causes” American Public Health Association annual meeting, San Diego, CA, Oct 2008

Masterson, E. E., K. S. Hoeft & J. C. Barker. “Treating Latino children with public insurance: The dentist’s perspective.” American Public Health Association, San Diego, October 2008

Hoeft, KS, J.C. Barker & E. Masterson. “Dental care seeking behavior and conceptualization of dental problems among Latino immigrant caregivers of young children.” Second Annual Health Disparities Conference, University of California San Francisco, October 2008

Swan, M.A, & J. C. Barker. “Rural Latino farmworker fathers’ understanding of children’s oral hygiene practices.” School of Dentistry Research Day, University of California San Francisco, October 2008

Hoeft, K.S, J.C. Barker & E. Masterson. “Dental care seeking behavior and conceptualization of dental problems among Latino immigrant caregivers of young children.” Hispanic Dental Association, Carefree, Arizona, November 2008

Barker, J.C. “Children’s oral health: A rural and urban ethnography” Invited speaker and symposium discussant, Hispanic Dental Health Association, Carefree, AZ, November, 2008

S. Horton & J. C. Barker Rural Latino immigrant caregivers’ conceptions of their children’s oral disease. Journal of Public Health Dentistry 68: 22-29, 2008 (E- pub 31-January 2008).

J. C. Barker & S. Horton. An ethnographic study of rural Latino children’s oral health: Intersections among individual, community, provider and regulatory sectors BMC Oral Health 8: 8, 2008 (e-pub 31 March 2008)

S. Horton & J. C. Barker. Mexican immigrant parents’ interpretation of children’s dental symptoms in California’s Central Valley. Community Dental Health (in press – 2009)

S. Horton & J.C. Barker. Embodied inequalities: The lasting effects of market-based dental public health care systems. In Spanish. Revista Palimpsestvs no. 6, Universidad Nacional de Colombia (in press – 2009)

K. S. Hoeft, J. C. Barker & E. E. Masterson. Mexican-American caregivers’ initiation and understanding of home oral hygiene for young children. Pediatric Dentistry (in press - 2009).

Funding:
●Main funding for “Hispanic Oral Health: A Rural and Urban Ethnography,” came from NIH, NIDCR grant # U54 DE 12451.

● A 2006-2007 research grant from the University of California Institute for Mexico and the U.S. (UCMexus), titled “California’s Public Dental Health Insurance Program: Creating Disparities in Oral Health Care for Disadvantaged Latino Children” enabled investigation of the effects of the regulatory sector and state Medicaid (Denti-Cal) policy.

Study contact information:

Judith C. Barker, PhD.
3333 California St., Suite 485
University of California, San Francisco
San Francisco, CA. 94118-0850
415 476-7241
barker j@dahsm.ucsf.edu

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