An ethnographic study of Latino preschool children's oral health in rural California: Intersections among family, community, provider and regulatory sectors

Abstract

BackgroundLatino children experience a higher prevalence of caries than do children in any other racial/ethnic group in the US. This paper examines the intersections among four societal sectors or contexts of care which contribute to oral health disparities for low-income, preschool Latino1 children in rural California.MethodsFindings are reported from an ethnographic investigation, conducted in 2005–2006, of family, community, professional/dental and policy/regulatory sectors or contexts of care that play central roles in creating or sustaining low income, rural children's poor oral health status. The study community of around 9,000 people, predominantly of Mexican-American origin, was located in California's agricultural Central Valley. Observations in homes, community facilities, and dental offices within the region were supplemented by in-depth interviews with 30 key informants (such as dental professionals, health educators, child welfare agents, clinic administrators and regulatory agents) and 47 primary caregivers (mothers) of children at least one of whom was under 6 years of age.ResultsCaregivers did not always recognize visible signs of caries among their children, nor respond quickly unless children also complained of pain. Fluctuating seasonal eligibility for public health insurance intersected with limited community infrastructure and civic amenities, including lack of public transportation, to create difficulties in access to care. The non-fluoridated municipal water supply is not widely consumed because of fears about pesticide pollution. If the dentist brought children into the clinic for multiple visits, this caused the accompanying parent hardship and occasionally resulted in the loss of his or her job. Few general dentists had received specific training in how to handle young patients. Children's dental fear and poor provider-parent communication were exacerbated by a scarcity of dentists willing to serve rural low-income populations. Stringent state fiscal reimbursement policies further complicated the situation.ConclusionSeveral societal sectors or contexts of care significantly intersected to produce or sustain poor oral health care for children. Parental beliefs and practices, leading for example to delay in seeking care, were compounded by lack of key community or economic resources, and the organization and delivery of professional dental services. In the context of state-mandated policies and procedures, these all worked to militate against children receiving timely care that would considerably reduce oral health disparities among this highly disadvantaged population.

Oral health attitudes, knowledge and practice among school children in Chennai, India

“…Our observation is similar to Linn, in which only few children knew periodontal played a major role in infl uencing their children' s oral health and access to care. [30] Only 19.1% of the children in this study used dental services once in every 6 months, which is still far less than the Canadian schools where 50% of the school children used the dental service once in every 6 months. [31] However, the data collection method may have certain limitations.…”

“Stains” on their self‐discipline: Public health, hygiene, and the disciplining of undocumented immigrant parents in the nation's internal borderlands

“…To understand immigrant mothers' interpretations of and responses to the discourses of these citizen-making agencies, the first author conducted multiple interviews with 26 Mexican immigrant mothers about their interactions with the health care and welfare bureaucracies in the area. Mothers were randomly selected from a list of addresses and names generated by a partner study of farmworker occupational health; women were eligible for inclusion in the study if they were Latina and had a child under the age of five (see Barker and Horton 2008). Primarily undocumented, these immigrant mothers had been in the United States a mean of nine years; their children had variable citizenship status.…”

“…Their low incomes prevented regular and preventive dental checkups, and the seasonal nature of their work led to fluctuating eligibility for California's state-subsidized dental care program (Denti-Cal). The organization of the dental public health care system itself discouraged access, as Denti-Cal reimbursements made it more profitable for area dentists to encourage families to bring children back for multiple dental visits rather than to perform all treatment at once (see Barker and Horton 2008). Finally, many immigrant parents came to the United States from rural areas with economies based on subsistence farming and thus enjoyed a low incidence of oral disease despite few preventive oral health behaviors (see Horton and Barker 2009).…”

Away from Home: Experiences of Mexican American Families in Pediatric Palliative Care

“…Although there is a growing body of evidence regarding the disparities in end-of-life care for minority adult patients in a variety of settings (Anderson, Mendoza, & Valero, 2000;Cleeland, Gonin, Baez, Loehrer, & Pandya, 1997;Crawley, Marshall, Lo, & Koenig, 2002;Todd, 2001), few studies have focused on the care of minority children with life-limiting illnesses and their families. An incipient body of knowledge suggests that significant barriers to children receiving optimal medical care emerge when health care providers neither understand the family's cultural background nor speak the same language (Barker & Horton, 2008;Contro, Larson, Scofield, Sourkes, & Cohen, 2002;Doty & Ives, 2001;Flores et al, 2002).…”