Department of Health Policy & Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
Community Dent Oral Epidemiol. 2023 Oct;51(5):896-907. doi: 10.1111/cdoe.12782. Epub 2022 Aug 14.
Dental fear and anxiety are known determinants of delaying or avoiding dental care and vary considerably based on factors such as age and gender. However, little is known about dental fear and anxiety in racial/ethnic minority populations, which bear a disproportionate burden of poor oral health outcomes. Structural and social pathways responsible for producing these disparities are also understudied. Experiences of racism over the lifecourse may contribute to poor oral health outcomes through a pathway of dental fear and anxiety. This paper aimed to evaluate perceived experiences with racism, dental fear and anxiety, and the utilization of dental services, in the Black Women's Health Study (BWHS), a United States-based prospective cohort.
Analysis of prospective data obtained from a geographic subset of participants in the BWHS was conducted. In 2014, BWHS participants residing in Massachusetts responded to a mailed oral health questionnaire that included the Index of Dental Anxiety and Fear (IDAF-4C+) instrument (N = 484; 69% response rate). Previously collected demographic and health information, along with reported experiences of everyday and lifetime racism, obtained from national BWHS questionnaires between 1995 and 2009, were merged with the Massachusetts-based sub-sample. Associations between high dental anxiety (HDA) (mean IDAF-4C+ score ≥2.5 on the dental fear and anxiety module) and oral health outcomes and perceived racism and HDA were explored via prevalence ratios (PR) calculated using log-binomial regression models, including adjustment for potential confounders.
Reported exposures to everyday racism occurred weekly on average for the top 25% of the sample, while 13% of participants reported exposure to multiple (n = 3) experiences of unfair treatment due to their race over their lifetime. HDA was prevalent among 17.8% of the sample and was significantly associated with indicators of poor oral health status. High exposures to everyday and lifetime experiences of racism were positively associated with HDA (PR = 1.08; 95% CI: 0.90, 1.58 and PR = 1.72; 95% CI: 1.03, 2.88, respectively).
Significant associations between racism and HDA, and between HDA and poor oral health and reduced utilization of dental care were observed. Dental anxiety may be a pathway through which perceived experiences with racism may impact oral health outcomes.
众所周知，牙科恐惧和焦虑是导致人们延迟或回避牙科护理的决定因素，其程度因年龄和性别等因素而异。然而，关于少数族裔人群的牙科恐惧和焦虑知之甚少，而这些人群的口腔健康状况不佳的负担不成比例。导致这些差异的结构和社会途径也研究不足。一生中经历的种族主义可能会通过牙科恐惧和焦虑的途径导致口腔健康状况不佳。本文旨在评估在黑人妇女健康研究（BWHS）中，经历种族主义、牙科恐惧和焦虑以及牙科服务利用情况与黑人妇女健康研究（BWHS）的前瞻性队列研究中的参与者。
对 BWHS 中地理亚组参与者的前瞻性数据进行了分析。2014 年，居住在马萨诸塞州的 BWHS 参与者对邮寄的口腔健康问卷做出了回应，该问卷包括牙科焦虑和恐惧指数（IDAF-4C+）工具（N=484；69%的回复率）。先前从 1995 年至 2009 年的全国 BWHS 问卷中收集的人口统计学和健康信息，以及报告的日常和终生种族主义经历，与马萨诸塞州的子样本合并。通过使用对数二项回归模型计算的患病率比（PR），探索高牙科焦虑症（HDA）（牙科恐惧和焦虑模块的 IDAF-4C+得分≥2.5）与口腔健康结果以及感知到的种族主义和 HDA 之间的关联，该模型包括对潜在混杂因素的调整。
报告的日常种族主义暴露每周平均发生在样本的前 25%，而 13%的参与者报告说，他们一生中曾因种族而经历过多次（n=3）不公平待遇。HDA 在样本中占 17.8%，与口腔健康状况不佳的指标显著相关。高日常和终生种族主义经历与 HDA 呈正相关（PR=1.08；95%CI：0.90，1.58 和 PR=1.72；95%CI：1.03，2.88）。
观察到种族主义与 HDA 之间以及 HDA 与口腔健康不良和牙科保健利用率降低之间存在显著关联。牙科焦虑可能是感知到的种族主义经历影响口腔健康结果的途径之一。
