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Rural-urban differences in oral health indicators in children living in Northern Appalachia

MacKinnon, Anna (2023) Rural-urban differences in oral health indicators in children living in Northern Appalachia. Master Essay, University of Pittsburgh.

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This study used the Andersen behavioral model as a conceptual framework to compare rural-urban differences in oral health outcomes and risk indicators in children living in Northern Appalachia.
Participants were residents of Northern Appalachia aged 0-17 years (N=1696) from the Center for Oral Health Research in Appalachia. Residences were classified as rural or urban using Rural-Urban Continuum codes. Rural-urban differences in oral health outcomes and risk indicators were tested in a mixed models framework and adjusted for sociodemographic factors (age, sex, race, household income), perceived socioeconomic status, educational attainment, and dental insurance. Analyses were performed separately by age; 0-5 (N=676), 6-11 (N=615), and 12-17 (N=405) years, roughly representing stages of primary, mixed, and permanent dentitions.
Poorer oral health outcomes (e.g., more decay) were observed for rural than urban children. Two themes were observed related to how differences in oral health outcomes and risk indicators changed across age strata. First, disparities in oral health outcomes increased across age strata, with small but significant rural-urban differences apparent in children ages 0-5 years and increasing differences apparent in the older age strata. Second, differences in risk indicators (e.g., unmet dental care needs and fluoride exposures) showed the opposite trend, with greater rural-urban differences observed in the youngest children, significant but generally smaller differences observed for those 6-11 years, and no differences observed for those 12-17 years. Oral hygiene (e.g., toothbrushing) did not differ between rural and urban children for any age strata.
This study showed significant rural-urban differences in oral health outcomes and risk indicators in children of Northern Appalachia. The trends across age strata suggest that differences in risk indicators are present early in life, and that resulting differences in oral health outcomes appear later and increase across childhood.
Public Health Significance The public health significance of this project is identifying specific oral health disparities faced by children living in Northern Appalachia. By determining specific barriers that prevent children from accessing dental care and maintaining healthy behaviors, these issues can be addressed directly. These results may be applicable to other communities facing similar oral health issues.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
MacKinnon, Annaahm62@pitt.eduahm62
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairShaffer, John Rjohn.r.shaffer@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberManna, Samantha Lslr61@pitt.eduslr61UNSPECIFIED
Date: 17 May 2023
Date Type: Completion
Submission Date: 25 April 2023
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 39
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Human Genetics
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: Appalachia, disparities, oral health, rurality, children
Date Deposited: 17 May 2023 19:18
Last Modified: 17 May 2023 19:18


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