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标题：Oral Health Disparities and Psychosocial Correlates of Self-Rated Oral Health in the National Survey of American Life
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作者：Tracy L. Finlayson ; David R. Williams ; Kristine Siefert 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：Suppl 1
页码：S246-S255
DOI：10.2105/AJPH.2009.167783
语种：English
出版社：American Public Health Association
摘要：Objectives. We sought to better understand the determinants of oral health disparities by examining individual-level psychosocial stressors and resources and self-rated oral health in nationally representative samples of Black American, Caribbean Black, and non-Hispanic White adults. Methods. We conducted logistic regression analyses on fair or poor versus better oral health using data from the National Survey of American Life (n = 6082). Results. There were no significant racial differences. Overall, 28% of adults reported having fair or poor oral health. Adults with lower income and less than a high school education were each about 1.5 times as likely as other adults to report fair or poor oral health. Higher levels of chronic stress, depressive symptoms, and material hardship were associated with fair or poor oral health. Adults living near more neighborhood resources were less likely to report fair or poor oral health. Higher levels of self-esteem and mastery were protective, and more-religious adults were also less likely to report fair or poor oral health. Conclusions. Social gradients in self-rated oral health were found, and they have implications for developing interventions to address oral health disparities. Oral health disparities are most pronounced among socioeconomically disadvantaged and racial-minority groups in the United States.¹ A social gradient in adult self-reported oral health has been documented in this country and others,^{2 , 3} illustrating that poor oral health is attenuated by higher levels of income and education. Similar social gradient patterns have been found using more-objective indicators of oral health as well, including periodontal disease, gingival bleeding, and loss of attachment of tissue supporting teeth, after sociodemographics were controlled.^{2 , 4 – 6} Studies have also shown that Black adults have worse oral health when compared with Whites across several dimensions of oral health.^{6 – 12} Although research supports that lower socioeconomic status (SES) adults disproportionately bear the burden of oral disease,¹³ it is unclear how social stratification contributes to poor oral health, especially among racial minorities. Income and education do not fully explain racial disparities in oral health, and research on disparities in general health suggests that there are additional likely causes.⁶ Most prior oral health research has focused primarily on biological and behavioral health risk factors. Recently, researchers have been exploring the psychosocial determinants of oral health in an effort to better understand and address the processes underlying documented inequities.^{14 – 16} A small but growing body of research has explored the associations between oral health and select psychosocial factors that may influence biological processes and health behavior, such as depressive symptoms,^{17 – 20} different types of stress,^{21 , 22} and various neighborhood characteristics.^{12 , 23 , 24} Few studies have explored any positive psychosocial resources, like self-esteem.²⁵ Collectively, these studies have shown that experiencing depressive symptoms, higher levels of stress, and living in disadvantaged neighborhoods are each positively associated with worse oral health outcomes. However, many of these studies are limited by small, nonrepresentative samples. An additional gap in the literature is the failure to explore several possible types of both positive and negative psychosocial factors. For instance, no studies have examined how mastery (extent to which individuals believe they have control over aspects of their life) or religiosity might relate to oral health. Therefore, we sought to determine whether multiple individual psychosocial stressors and resources are associated with self-rated oral health in a large national sample of Black American, Caribbean Black, and non-Hispanic White adults. The conceptual framework for this analysis was derived from epidemiological theories of the social production of disease, which posit that individuals’ relative economic and social positioning—that is, their race/ethnicity, gender, and SES—determine their exposure to health-damaging stressors as well as their access to resources that can help them avoid risks or minimize the impact of disease.^{26 – 28} Risk factors and resources can be either ongoing or acute and can occur at both the individual and neighborhood levels. All of these factors should be considered as providing the context of an individual's life circumstances, and exposures can vary by SES. Low SES often exposes individuals to more stressors (such as material hardships, financial worries, discrimination, an unsafe neighborhood, unemployment, housing and transportation problems) and access to fewer resources (such as money for goods and services, community and institutional supports) with which to cope.²⁹ Given past research findings, we hypothesized that there may be associations between self-rated oral health perceptions and psychosocial stressors and resources: (1) adults with lower levels of both income and education and who are racial minorities regardless of income and education levels will be more likely than their higher-income and more-educated counterparts to report fair or poor oral health status; (2) adults exposed to each potential stressor will be more likely to report fair or poor oral health status; and (3) adults with access to each potential resource will be less likely to report fair or poor oral health status. We further hypothesized that access to psychosocial resources would help attenuate the negative effects of exposure to stressors.