Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.

February 15, 2008

1. NEW EDITION OF ORAL HEALTH KNOWLEDGE PATH AVAILABLE

Knowledge Path: Oral Health and Pregnant Women, Infants, Children, and Adolescents is an electronic guide to recent resources that analyze data, describe programs, and report on policy and research aimed at improving access to and the quality of oral health care. The knowledge path, produced by the MCH Library and the National Maternal and Child Oral Health Resource Center, contains information on Web sites and resources from national and state organizations, distance education resources, databases, and newsletters and online discussion lists. Separate sections identify resources for professionals, resources for consumers, and resources on specific aspects of oral health. Topics include child care and Head Start, dental sealants, early childhood caries, fluoride varnish, K-12 education, pregnancy, and school-based care. The knowledge path is available at http://www.mchlibrary.info/KnowledgePaths/kp_oralhealth.html.

• Who Pays for Oral Health Care? Although roughly 10 percent of children lack health insurance; 23 percent lack dental insurance. Full dental benefits are required for children in Medicaid; however, in 2004, only about 20 percent of infants and children from birth through age 5 and 30 percent of all children enrolled in Medicaid received oral health services. As of 2006, 22 states provided either no benefits or emergency benefits only to adults; 20 provided limited benefits; and only 8, plus the District of Columbia, offered full dental benefits.
• Challenges - Many states are grappling with shortages of dentists and other health professionals. Given the structure of state professional regulations, dentists have influence over increases in supply (i.e., allowing midlevel oral health providers similar to nurse practitioners or physician assistants to practice) that put the interests of members of the profession above the needs of the public.
• Common Misperceptions - Research has shown that ignoring oral health problems is not seen as serious and that most people consider poor oral hygiene to be a personal or family responsibility. Thus, there has been little support for programs to address oral health problems. In addition, policymakers and foundations may perceive dentists as part of the problem rather than part of the solution, and this may also contribute to the weak response.
• The Foundation Response - Foundation investment has been limited, compared with both the need and total grantmaking.
• How Could Foundations Make a Difference? Health foundations have played a critical role in advancing the health care system in the United States. Foundations can spur improvement in oral health in many ways, including defining the problem, developing policy solutions, and building political support.

• Participants - Teams from 14 academic institutions were selected from applications submitted in response to a call for proposals. Proposed projects were to be conducted by interprofessional teams of students in their local communities, with a focus on prevention areas cited in Healthy People 2010 and Steps to a Healthier U.S., and had to include both a curricular component and a community-based, service learning component. Institute attendees included faculty (and several students) from the following fields: nursing, medicine, pharmacy, public health, health care management, physical therapy, occupational therapy, clinical psychology, and dental medicine. Area Health Education Center staff were also represented.
• Structure - Plenary sessions addressed ways to create an academic environment conducive to advancing IPE, interprofessional approaches to improving patient safety and clinical effectiveness, and evaluation strategies for identifying and measuring IPE initiative outcomes. Small group sessions following each plenary session were designed to provide teams with an opportunity to (1) reflect on insights gained from each plenary, (2) receive consultation on their proposal from other participants, (3) modify their proposals, and (4) critique each other's modified proposals.
• Related Resources - A variety of resource materials were made available to the attendees to further develop their interprofessional prevention initiatives. For example, attendees received information about the Prevention Education Resource Center, a Web site developed by APTR to assist with curricular change.
• Post-Institute Activities - Following the institute, teams were encouraged to revise their proposals based on insights gained, apply for funds to help implement their projects, participate in conference calls within and between teams and APTR staff and submit progress reports, and present information about their projects in professional publications and at meetings.

• Approximately 40% of the children were from families with low incomes, 32% lived in a household where no resident had an education beyond high school, 55% had two or more social risk factors, and 24% had four or more.
• Low maternal mental health, black race or Hispanic ethnicity, family income less than 200% of the FPL, low household education, unsafe neighborhoods, and lack of health insurance increased the odds for less than very good child health.
• Low maternal mental health, black race or Hispanic ethnicity, family income less than 200% of the FPL, low household education, unsafe neighborhoods, lack of health insurance, and family conflict increased the odds for less than very good oral health.
• For child socioemotional problems, low maternal mental health, not residing in a two-parent household, and family conflict were strong independent correlates, along with unsafe neighborhoods and family income less than 200% of the FPL.
• All the risk factors except lack of insurance increased the odds for overweight.
• When risks were combined into a social risk index, controlling for child age, gender, and number of children in the household, there was a 17-fold increase in the odds for less than very good health and an almost 11-fold increase in the odds for less than very good oral health for children with six or more vs. zero social risks; the respective figure for child socioemotional well-being and overweight status was about four.