Barriers in accessing dental care during pregnancy in racial/ethnic groups of women: Retrospective Secondary Data Analysis on Pregnancy Risk Assessment Monitoring System (PRAMS) 2016- 2019

Problems: Pregnancy is a critical period in women's lifespan to secure their oral health and their children's oral health. Mother's poor oral health affects young children's oral health and increases caries risk by vertically transferring cariogenic bacteria. A mother's oral health knowledge and beliefs also significantly affect diet and home oral hygiene practice among her young children. However more than half of women in the U.S. do not or cannot access dental care during pregnancy and women from minor racial/ethnic groups are isproportionately affected with various challenges in accessing dental care. Previous studies showed that Black and Hispanic women are significantly less likely to have a dental visit for cleaning during pregnancy than White women. There was a lack of research on Asian/Pacific Islanders and indigenous women. This study is directly aligned with MCHB/s strategic plan focusing on health equity; oral health is one of 15 Title V MCH Services Block Grant National Performance Measures which is under cross-cutting/life course domain.

Goals and objectives:

This proposed secondary data analysis aims to investigate barriers to accessing dental care during pregnancy. Aligning with MCHB's strategic plan to assure access to high quality and equitable health services to optimize health and well-being and to achieve health equity for all MCH populations the study aims to 1. identify barriers to accessing dental care during pregnancy 2. examine how the association between these barriers to accessing dental care is modified by each race/ethnicity and 3. assess how these barriers to finding dental providers during pregnancy are related to Dental Health Professional Shortage Area (D-HPSA) score at the state level. Proposed data sets and target populations(s): This study will analyze oral health-related core and standard questions from the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 dataset (2016-2019) a nationally representative dataset of women with recent pregnancy experience. Women aged 20 and older with recent birth histories will be included in the study. Race/ethnicity will be categorized into non-Hispanic White non-Hispanic Black Hispanic Asian/Pacific Islanders and indigenous individuals.

Products:

We plan to publish two peer-reviewed articles and a short brief on primary findings that HRSA/MCHB can highlight on its SNS/webpage

Evaluation:

Multivariate logistic regression and interaction analysis will be performed to detect any significant differences in dental service utilization during pregnancy between women who reported various barriers in accessing dental care and women who did not report such barriers. These barriers include dental coverage primary language perceived oral health benefits safety concerns about dental care during pregnancy and provider availability. Then we will assess how race/ethnicity modifies these associations between barriers in accessing dental care and dental service utilization during pregnancy. Lastly we will focus on the provider availability barrier and examine if this barrier is associated with state-level D-HPSA scores. This study intends to inform policymakers and practitioners to understand specific barriers in accessing dental care during pregnancy among various racial/ethnic groups of women to design policies and programs to eliminate such barriers. The study goal is also closely related to multiple Healthy People (HP) 2030 objectives on dental service access and utilization including OH-8 AHS-2 and AHS-5.