This study examined the relationship between racial discrimination and use of dental services among American adults. We used data from the 2014 Behavioral Risk Factor Surveillance System, a health-related telephone cross-sectional survey of a nationally representative sample of adults in the United States. Racial discrimination was indicated by two items, namely perception of discrimination while seeking healthcare within the past 12 months and emotional impact of discrimination within the past 30 days. Their association with dental visits in the past year was tested in logistic regression models adjusting for predisposing (age, gender, race/ethnicity, income, education, smoking status), enabling (health insurance), and need (missing teeth) factors. Approximately 3% of participants reported being discriminated when seeking healthcare in the past year, whereas 5% of participants reported the emotional impact of discrimination in the past month. Participants who experienced emotional impact of discrimination were less likely to have visited the dentist during the past year (Odds Ratios (OR): 0.57; 95% CI 0.44–0.73) than those who reported no emotional impact in a crude model. The association was attenuated but remained significant after adjustments for confounders (OR: 0.76, 95% CI 0.58–0.99). There was no association between healthcare discrimination and last year dental visit in the fully adjusted model. Emotional impact of racial discrimination was an important predictor of use of dental services. The provision of dental health services should be carefully assessed after taking account of racial discrimination and its emotional impacts within the larger context of social inequalities.

The objective of this study was to quantify the magnitude of absolute and relative oral health inequality in countries with similar socio-political environments, but differing oral health care systems such as Canada, the United States (US), and the United Kingdom (UK), in the first decade of the new millennium. Clinical oral health data were obtained from the Canadian Health Measures Survey 2007–2009, the National Health and Nutrition Examination Survey 2007–2008, and the Adult Dental Health Survey 2009, for Canada, the US and UK, respectively. The slope index of inequality (SII) and relative index of inequality (RII) were used to quantify absolute and relative inequality, respectively. There was significant oral health inequality in all three countries. Among dentate individuals, inequality in untreated decay was highest among Americans (SII:28.2; RII:4.7), followed by Canada (SII:21.0; RII:3.09) and lowest in the UK (SII:15.8; RII:1.75). Inequality for filled teeth was negligible in all three countries. For edentulism, inequality was highest in Canada (SII: 30.3; RII: 13.2), followed by the UK (SII: 10.2; RII: 11.5) and lowest in the US (SII: 10.3; and RII: 9.26). Lower oral health inequality in the UK speaks to the more equitable nature of its oral health care system, while a highly privatized dental care environment in Canada and the US may explain the higher inequality in these countries. However, despite an almost equal utilization of restorative dental care, there remained a higher concentration of unmet needs among the poor in all three countries.

Objectives: To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium. Methods: Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009 and two American (HANES 1971-1974 and NHANES 2007-2008. The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated. Results: Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries. Conclusions: There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.

METHODS:We recruited children 10-18 years of age with CHD. Baseline testing included cardiopulmonary exercise testing and measurement of activity using an accelerometer (GT3X+ Acti-Graph LLC; 15s epoch). Physical activity was assessed using the FITT (frequency, intensity, time and type) principle. Participants were randomised; those in the intervention group were given an exercise prescription and activity tracker (MOVband, Cleveland, OH) for 16 weeks. The control group did not receive exercise prescription or activity trackers. Exercise physiologists monitored the intervention group's physical activity online and provided support on a bi-weekly basis. MVPA was assessed with an accelerometer after 16 weeks. We included those who met usual wear time criteria (!2 days with !600 minutes wear time/day, allowing non-wear of 60 minutes of zeros, 2 minutes spike allowance <100 counts per minute (cpm)). Vertical acceleration counts were categorised into sedentary (<100cpm) and MVPA (! 2296cpm) reported as mean daily minutes of MVPA and % sedentary time (sedentary minutes relative to wear time). RESULTS: Eight children (age 13-16 years) participated in the study with 4 randomly allocated to the intervention group. Two were excluded due to wear time <2 days with the accelerometers; both in the control group. Three of four children in the intervention group increased MVPA (2.5 to 24.8 minutes) and decreased %sedentary time (2.3% to 6.1%), while the two control children decreased MVPA (6.9 and 9.6 minutes) and sedentary behaviour was unchanged (0%) or increased (4.0%). CONCLUSION: The use of exercise prescription with an activity tracker is feasible and associated with increases in MVPA and decreases in sedentary time in children with CHD. This new technology provides unique opportunities to promote and remotely monitor activity levels in this population. There is good compliance and tolerability of this device in children with CHD. A larger scale randomised trial is warranted to confirm the results of this pilot study and determine the impact of changes in activity levels on exercise capacity in children with CHD.