The Research Connections series features original research by occupational therapy practitioners related to the experiences, culture, occupations, and/or health outcomes of underrepresented and minority populations.
Title: A Mixed Methods Study of the Intersection of Oral Health, Culture, and Autism in African American Families
Principal Investigator: Dominique H. Como, EdM, OTR/L
About the Researcher: Prior to my career change to occupational therapy, I was in the field of education, with a specific concentration on guiding underserved and underrepresented populations through the educational pipeline. My educational and professional background have provided a solid framework upon which to pursue the goal of reducing barriers for marginalized populations. Since becoming an occupational therapist, I have focused on alleviating the barriers that prevent individuals from accessing and participating in health experiences and activities that are meaningful and necessary. As a I step into the role of researcher, my primary aim remains to serve the many vulnerable and marginalized populations who experience social injustices by improving the quality of care they receive. I hope to be an agent of change for the transformation of healthcare for underserved, marginalized, and vulnerable populations.
Dissertation Committee: Sharon A. Cermak, EdD, OTR/L, FAOTA (Chair); Brandi P. Jones, EdD, Mary Lawlor, ScD, OTR/L, FAOTA; José C. Polido, DDS, MS; Leah I. Stein Duker, PhD, OTR/L
Oral health is one of the most common unmet healthcare needs in the United States. Oral health is an often neglected component of overall health. Despite its importance, daily oral care activities, such as tooth brushing and flossing are habitual occupations often perceived as mundane. However, research indicates that good oral health actually impacts and improves quality of life by increasing a person’s ability to engage with others, express emotions, and adequately smell, taste, touch, chew, and swallow. Unfortunately, oral healthcare disparities persist for children from ethnic minorities, as well as for children with special health care needs, like autism spectrum disorder (ASD).
Black/African American families encounter many barriers to quality oral healthcare. These obstacles can be seen across different levels of influence, including familial, societal, and structural (Como, Stein Duker, Polido, & Cermak, 2019). Well documented structural factors that impact the oral health of Black/African American families are limited access to specialty services, decreased awareness of available public services, and cost-prohibitive pricing for dental services (Fisher-Owens et al., 2013). Although public policies have attempted to address these obstacles, disparities persist. Despite significantly increased access to care and high rates of public insurance coverage among minorities, Black/African American children and adolescents continue to have poorer oral health outcomes (Calderon et al, 2014; Dye, Li, & Thornton-Evans, 2012).
Similarly, many families with children with ASD, encounter significant barriers to oral care. Evidence indicates that impairments in communication, sensory processing sensitivities, uncooperative behaviors, restrictive eating habits, and dental fear and anxiety contribute to the diminished oral care in this population (Friedlander, Yagiela, Paterno, & Mahler, 2006; Koritsas & Iacono, 2011; Marshall, Sheller, & Mancl, 2010; Stein, Polido, Najera, & Cermak, 2012). In home oral care can also be challenging for parents to implement, which can lead to feelings of incompetence and defeat. This is exacerbated by the fact that parents report that locating dental practitioners who are both willing and qualified to treat their children with ASD is challenging (Newacheck, Hung, & Wright, 2002; Weil & Inglehart, 2012). As a result, many children with ASD have delayed intervention and/or require the use of sedation or general anesthesia for routine dental procedures.
The oral health disparities that exist for Black/African American children with and without ASD deserve a greater spotlight because of the importance of oral care to overall health, engagement, and function. Health disparities are often the result of several interconnected and complex factors; I am determined to identify factors that have the potential to improve oral health disparities for vulnerable populations and develop evidence-based interventions to minimize barriers that contribute to health disparities for underserved populations. In this mixed-method project, I will identify the facilitators and barriers that inform oral health practices, through survey and interviews, and examine the intersection of ASD, Black/African American culture, and oral health. I am currently recruiting participants and hope to use the information collected to improve oral health outcomes for Black/African American families.
Participant Criteria: Parents/Caregivers of children with OR without autism spectrum disorders (ASD) age 4-14 years, who identify as African American/Black.
To complete the study, click here: https://redcap.med.usc.edu/surveys/index.php?s=XHXH774FKN
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Calderon, S. J., & Mallory, C. (2014). A systematic review of oral health behavior research in American adolescents. Journal of School Nursing, 30(6), 396-403. doi:10.1177/1059840514544034
Como, D.H., Stein Duker, L.I., Polido, J.C., & Cermak, S.A. (2019). The persistence of oral health disparities for African American children: A scoping review. International Journal of Environmental Research and Public Health, 16(5), 710-726. https://doi.org/10.3390/ijerph16050710
Dye, B.A., Li, X., & Thornton-Evans, G. (2012). Oral health disparities as determined by selected Healthy People 2020 oral health objectives for the United States, 2009–2010. NCHS data brief. Hyattsville, MD: National Center for Health Statistics.
Fisher-Owens, S., Isong, I. A., Soobader, M., Gansky, S. A., Weintraub, J. A., Platt, L. J., & Newacheck, P. W. (2013). An examination of racial/ethnic disparities in children's oral health in the United States. Journal of Public Health Dentistry, 73(2), 166-174. http://dx.doi.org/10.1111/j.1752-7325.2012.00367.x
Friedlander, A. H., Yagiela, J. A., Paterno, V. I., & Mahler, M. E. (2006). The neuropathology,
medical management and dental implications of autism. The Journal of the American Dental Association, 137(11), 1517-1527. https://doi.org/10.14219/jada.archive.2006.0086
Koritsas, S., & Iacono, T. (2011). Secondary conditions in people with developmental disability. American Journal of Intellectual and Developmental Disabilities, 116(1), 36-47. https://doi.org/10.1352/1944-7558-116.1.36 [PMID21291309]
Marshall, J., Sheller, B., & Mancl, L. (2010). Caries-risk assessment and caries status of children with autism. Pediatric Dentistry, 32(1), 69-75. [PMID20298657]
Newacheck, P. W., Hung, Y. Y., & Wright, K. K. (2002). Racial and ethnic disparities in access to care for children with special health care needs. Ambulatory Pediatrics, 2(4), 247-254. doi:10.1367/15394409(2002)002<0247:RAEDIA>2.0.CO;2.
Stein, L.I., Polido, J.C., Najera, S. O., & Cermak, S.A. (2012). Oral care experiences and challenges in children with autism spectrum disorders. Pediatric Dentistry, 34(5), 387-39.
Weil, T. N., & Inglehart, M. R. (2012). Three-to 21-year-old patients with autism spectrum disorders: Parents' perceptions of severity of symptoms, oral health, and oral health-related behavior. Pediatric Dentistry, 34(7), 473-479.