Semester

Fall

Date of Graduation

2012

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Epidemiology

Committee Chair

Richard J. Crout

Committee Co-Chair

Daniel W. McNeil

Committee Member

Matthew Gurka

Committee Member

Michael Hendryx

Committee Member

Daniel W. McNeil

Committee Member

Anoop Shankar

Abstract

Appalachian has many social, economic, and biologic factors impacting dental health over the life-course.;Purpose: This study examined dental caries experience and family structure, dental fear, and fatalism in West Virginia and Pennsylvania.;Method: Using a cross-sectional study design, 2002-2009 Center for Oral Health Research in Appalachia data were analyzed utilizing the World Health Organization definitions for caries experience, dichotomized into low and high. Three groups were studied: 1) children, 11-13 years (N=237); 2) adolescents, 14-17 years (N=191); and 3) adults, 18 years and above (N=1125). For multivariable model development, generalized estimating equations with exchangeable working structures accounted for family clusters.;Results. For children, family (second biological child vs. first biological child and niece/nephew/step-/grandchild/other vs. first biological child) Fatalism Scale, Dental Fear Survey, and Short Form Fear of Pain Questionnaire failed to reach a significant difference with caries experience. There were 38.0% reporting fear on the Dental Fear Survey, and 80.2% on the Short Form Fear of Pain Survey. There were 62.0% reporting fatalism. There were 44.7% first biological children, 32.1% second biological children, and 23.2% with other family relationships.;Overall, for adolescents, family (single parent vs. both parents, same home; and second biological child vs. first biological child and niece/nephew/step-/grandchild/other vs. first biological child) failed to reach a significant difference with caries experience. However, in gender sub-group analysis, living with a single parent was protective for males, with an adjusted odds ratio (AOR) of 0.08 (95% Confidence Interval [CI]: 0.01, 0.42; p = 0.0249). The Fatalism Scale failed to reach a significant difference with caries experience in the overall model. For females, there was an AOR of 6.60 (95% CI: 1.89, 9.64; p = 0.0076). Although the Short Form Fear of Pain Questionnaire failed to reach a significant difference with caries experience in the overall model, for males, the AOR was 12.86 (95% CI: 1.71, 96.59; p = 0.0130) and for females, the AOR was 0.08 (95% CI: 0.01, 0.55; p = 0.100). There were 36.1% reporting fear on the Dental Fear Survey; 63.9% on the Short Form Fear of Pain Survey; and 43.5% reporting fatalism on the Fatalism Scale. There were 54.6% first biological children; 20.6% second biological children, and 24.8% with other family relationships; 53.5% lived in single parent homes.;For adults, a high Dental Fear Survey score was associated with a high caries experience. The AOR was 1.76 (95% CI: 1.29, 2.40; p = .0003). It remained significant for females (AOR= 2.11[95% CI: 1.41, 3.14; p = 0.0003]). For males, those never married, divorced, widowed, separated, or had other living arrangements vs. married/domestic partnering had an AOR of 0.12 (95% CI: 0.04, 0.36; p = .0002).;Conclusion: Caries is a complex disease with many influences. Gender differences exist in age categories in terms of family relationships, fear, and fatalism. Further exploration of these factors is needed to aid in the development of successful interventions to decrease caries severity.

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