Preventive Dental Care Utilization in Asian Americans: Does Neighborhood Matter?

Background: Although dental care is an essential component of comprehensive health care, a substantial proportion of the U.S. population lacks access to dental care. Disparities in dental care are more pronounced in racial/ethnic minorities. In particular, community-based ethnic samples of Asian Americans present adverse status in oral health and dental care. Given that a growing body of literature suggests that the characteristics of the neighborhood in which people live have an impact on health and health service use, the present study explored how individual-level variables (age, gender, marital status, education, dental insurance, length of stay in the U.S., and self-rated oral health) and neighborhood-level variables (poverty level, Asian population, dentist availability, and Asian-related resources and services) contribute to predicting the use of preventive dental care in a sample of Asian Americans.

Methods: Survey data were drawn from the Asian American Quality of Life Study funded by the City of Austin, TX. The data structure of the current study included 2,337 individual respondents (at level 1) nested within 226 Census Tracts (at level 2). Because of the nested nature of the data (e.g., individuals within the Census Tract), we used Multi-Level Model, which allows for the disentanglement of individual effects from contextual effects in the use of nested data. To construct neighborhood level variables, Geographic Information Systems (GIS) served as a methodological tool. First, survey participants’ reported residential addresses were geo-coded to determine their Census Tract and then linked with Census and related data. Four variables in neighborhood-level were derived from the 2014 American Community Survey (e.g., poverty level and proportion of Asian American population), the Area Resource File from the U.S. Health Resources and Services Administration (e.g., dentist availability), and the direct community assessment (e.g., Asian-related resources and services).

Results: At the individual-level, the odds of using preventive dental care services were higher among those who were female, stayed longer in the U.S., had dental insurance, and had positive self-ratings of oral health status. At the neighborhood-level, living in the areas with a greater availability of dentists and with lower levels of Asian-related resources and services was associated with the increased odds of using preventive dental care services. 

Conclusions: As anticipated, dental insurance is the most critical enabler for the use of preventive dental care services at the individual-level, but a substantial proportion of Asian Americans in the current study lacks such coverage. Such finding underscores the importance of increasing access to dental care for the uninsured and the underserved. This study also adds to the growing literature on the effect of neighborhood-level factors on health care as sources of disparities. Those living in the Census area with higher level of available dentists were more likely to use preventive dental care services. Such findings, therefore, imply the importance of the location (proximity or accessibility) of dental clinics. In a planning perspective for health care policy, identifying the neighborhood with limited healthcare services could be a priority to diminish the disparity of the access.