Dental service utilization among children in the child welfare system

Objective: To report on past-year dental utilization by a vulnerable group of children in the child welfare system.

Methods: Data from the National Survey of Child and Adolescent Well-Being (NSCAW-II) collected in 2008-9 were analyzed. Children age 3-17 were included in this analysis (n=2569). The analytical approach followed Andersen’s Behavioral Model of Health Services Utilization.  Predisposing factors included child socio-demographics, current emotional/behavioral problems, and maltreatment type. Enabling factors included child’s insurance and source of care, along with caregiver income, education, and employment. Need factors included whether the child had dental problems, and needed but could not afford care in the past year. The main outcome was whether the child had a dental visit during the past year (caregiver-reported). Descriptive and logistic regression analyses were performed in STATA v12, accounting for complex sampling and weighting.

Results: Two-thirds of children reportedly had a dental visit during the past year. In the final regression model, older children and children of more educated caregivers were more likely to have a past year dental visit. Need factors were significantly associated with utilization. Children with reported dental problems were twice as likely as those without problems to have a recent visit (Odds Ratio (OR)=2.00, 95% Confidence Interval (CI)=1.19-3.36, p<0.01). Children with reported unmet needs who could not afford care were much less likely to have a recent visit compared to their counterparts (OR=0.27, CI=0.16-0.46, p<0.001).

Conclusions: Child age, caregiver education, and need factors were significantly associated with dental service utilization in this vulnerable group of children.