Understanding the Influence of State Policy Environment on Dental Service Availability, Access, and Oral Health in America's Underserved Communities

dc.contributor.advisorWright, Eric
dc.contributor.authorMaxey, Hannah L.
dc.contributor.otherHalverson, Paul K.
dc.contributor.otherWilliams, John N.
dc.contributor.otherLiu, Ziyue
dc.date.accessioned2015-03-03T17:27:37Z
dc.date.available2015-08-02T09:30:41Z
dc.date.issued2014
dc.degree.date2014en_US
dc.degree.disciplineRichard N. Fairbanks School of Public Health
dc.degree.grantorIndiana Universityen_US
dc.degree.levelPh.D.en_US
dc.descriptionIndiana University-Purdue University Indianapolis (IUPUI)en_US
dc.description.abstractOral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.en_US
dc.identifier.urihttps://hdl.handle.net/1805/5993
dc.identifier.urihttp://dx.doi.org/10.7912/C2/2825
dc.language.isoen_USen_US
dc.subjectHealth Policyen_US
dc.subjectHealth Workforceen_US
dc.subjectOral Healthen_US
dc.subjectCommunity Health Centersen_US
dc.subjectFQHCen_US
dc.subjectAccess to Careen_US
dc.subjectUDSen_US
dc.subject.lcshMedically underserved areas -- States -- Research -- United Statesen_US
dc.subject.lcshPoor -- Medical care -- United States -- Financeen_US
dc.subject.lcshHealth services accessibility -- United States -- Statesen_US
dc.subject.lcshCommunity dental services -- United States -- Statesen_US
dc.subject.lcshOral medicine -- States -- Research -- United Statesen_US
dc.subject.lcshPreventive dentistry -- United Statesen_US
dc.subject.lcshPoor -- Health and hygiene -- United Statesen_US
dc.subject.lcshMedical policy -- United Statesen_US
dc.subject.lcshPoverty -- Government policy -- United Statesen_US
dc.subject.lcshDental hygienists -- Legal status, laws, etc. -- United Statesen_US
dc.subject.lcshDental economics -- United Statesen_US
dc.subject.lcshHealth behavior -- United Statesen_US
dc.subject.lcshDental personnel -- United States -- Statesen_US
dc.subject.lcshMultilevel models (Statistics) -- Researchen_US
dc.subject.lcshHealth promotion -- United Statesen_US
dc.subject.lcshDental care -- United States -- Statesen_US
dc.subject.lcshPatient advocacy -- United Statesen_US
dc.subject.lcshUnited States. Department of Health and Human Servicesen_US
dc.subject.lcshState University of New York at Albany. Center for Health Workforce Studiesen_US
dc.subject.lcshUnited States. Health Resources and Services Administration. Bureau of Primary Health Careen_US
dc.subject.lcshNational Health and Nutrition Examination Survey (U.S.)en_US
dc.titleUnderstanding the Influence of State Policy Environment on Dental Service Availability, Access, and Oral Health in America's Underserved Communitiesen_US
dc.typeThesisen_US
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