Conceptualizing inequities and oppression in oral health research

Fleming, Eleanor; Bastos, João Luiz; Jamieson, Lisa; Celeste, Roger Keller; Raskin, Sarah; Gomaa, Noha; McGrath, Coleman; Tiwari, Tamanna

doi:10.1111/cdoe.12822

Cited by 7 publications

(10 citation statements)

References 51 publications

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“…Racism, sexism, and income inequality across not only the labor and political spheres but also the criminal justice system and the housing market all contribute to a broader cultural environment where health care professionals are more likely to discriminate against groups of patients (Reskin 2012; Bastos et al 2021). Previous experiences with or anticipation of discrimination by a health care provider are established determinants of the decision to seek or forgo oral (Fleming et al 2023) and general (Bastos et al 2018) health care. Such mechanisms likely underlie the associations between structural oppressions and access to dental services that we presently report.…”

Section: Discussionmentioning

confidence: 99%

The Relations between Systems of Oppression and Oral Care Access in the United States

et al. 2023

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We applied a structural intersectionality approach to cross-sectionally examine the relationships between macro-level systems of oppression, their intersections, and access to oral care in the United States. Whether and the extent to which the provision of government-funded dental services attenuates the emerging patterns of associations was also assessed in the study. To accomplish these objectives, individual-level information from over 300,000 respondents of the 2010 US Behavioral Risk Factor Surveillance System was linked with state-level data for 2000 and 2010 on structural racism, structural sexism, and income inequality, as provided by Homan et al. Using multilevel models, we investigated the relationships between systems of oppression and restricted access to oral health services among respondents at the intersections of race, gender, and poverty. The degree to which extended provision of government-funded dental services weakens the observed associations was determined in models stratified by state-level coverage of oral care. Our analyses bring to the fore intersectional groups (e.g., non-Hispanic Black women and men below the poverty line) with the highest odds of not seeing a dentist in the previous year. We also show that residing in states where high levels of structural sexism and income inequality intersect was associated with 1.3 greater odds (95% confidence interval, 1.1–1.5) of not accessing dental services in the 12 mo preceding the survey. Stratified analyses demonstrated that a more extensive provision of government-funded dental services attenuates associations between structural oppressions and restricted access to oral health care. On the basis of these and other findings, we urge researchers and health care planners to increase access to dental services in more effective and inclusive ways. Most important, we show that counteracting structural drivers of inequities in dental services access entails providing dental care for all.

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Section: Discussionmentioning

confidence: 99%

The Relations between Systems of Oppression and Oral Care Access in the United States

et al. 2023

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“…Across multiple domains, theory has been energized in the behavioural and social oral health sciences, as demonstrated in a number of articles in this special issue 19,59–62 . As shown in the various figures presented here, existing behavioural and cognitive‐behavioural theories and models continue to be utilized in oral health research.…”

Section: Conclusion and Directions For The Futurementioning

confidence: 93%

“…Across multiple domains, theory has been energized in the behavioural and social oral health sciences, as demonstrated in a number of articles in this special issue. 19,[59][60][61][62] As shown in the various figures presented here, existing behavioural and cognitivebehavioural theories and models continue to be utilized in oral health research. Conceptualizations that are newer (or new to oral health research), such as Salutogenesis and the BCW, COM-B and TDW are energizing the research effort.…”

Section: Con Clus I On S and D Irec Ti On S For The Futurementioning

confidence: 98%

“…Individual difference factors, not just the average or typical behaviours of groups, must be incorporated into our theories and models. Moreover, oral and other health and social inequalities and inequities (see Tsakos et al 59 ) are evidence of the need for inclusion of cultural, racial, ethnic, religious, socioeconomic and other factors that lead to marginalization and oppression of societal groups (see Fleming et al 60 ). There is a crucial need to focus on systemic factors that lead to health outcome differences among groups.…”

Section: Conclusion and Directions For The Futurementioning

confidence: 99%

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Behavioural and cognitive‐behavioural theories in oral health research: Current state and future directions

McNeil

2023

Comm Dent Oral Epid

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Conceptualizing about the reasons why people (e.g. in the population at large, dental patients, oral healthcare practitioners, policymakers, funders and others) engage in behaviour to maintain or improve oral health guides us in trying to understand and predict it. A basic distinction, of course, is between internal (i.e. intrinsic) and external (i.e. extrinsic) forces on behaviour. 1,2 It is well-established that the tendency is for most of us to assume internal causes for our successes, external causes for our failures and internal causes for the behaviour of others. 3 In the oral health domain, most behavioural and cognitive-behavioural approaches have focused on the individual patient or person, or perhaps on parents or caregivers. There have been initiatives addressing the behaviour of oral healthcare

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“…Reducing racial/ethnic inequities requires a justice‐driven conceptual framework to investigate their causes and to assess which interventions are most effective (Williams & Purdie‐Vaughns, 2016). In fact, recent articles call for the inclusion of oppression and discrimination as important drivers of racial/ethnic oral health inequities (Fleming et al, 2023; Raskin & Fleming, 2022). Although such a call may represent a change in approaches to explain racial/ethnic inequities in oral health, much research still adopts questionable frameworks that divert time and resources from more socially responsible models (Celeste et al, 2023).…”

Section: Introductionmentioning

confidence: 99%

Research on racial/ethnic inequities in oral health over the past 80 years: The role of racism

Celeste,

Goulart,

Bastos

et al. 2023

J Clinic Periodontology

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AimThis study aims to (1) describe trends in explanations provided for racial/ethnic inequities in dental caries and periodontitis, and (2) explore the patterns of relatedness among explanations for these inequities.Materials and MethodsHighly cited publications based on studies indexed in the Scopus database were retrieved and assessed for eligibility. Explanations for racial/ethnic inequities were classified into eight different, but interrelated domains. We assessed trends and examined the relations among explanations using multiple correspondence analysis.ResultsA total of 200 articles among the most cited publications were selected. The proportion of studies invoking racism as an explanation for racial inequities in oral health increased from 0% to 14.3%, from 1937 to 2020. The proportions of individual socio‐economic factors increased from 52.0% to 82.9%, and dental care from 28.0% to 62.9%. The remaining explanations were stable: psychological/behavioural processes (62.5%), biological factors (49.5%), contextual/area‐level effects (24.0%) and immigrant paradox (4.0%). Multiple correspondence analysis revealed a smaller axial distance between racism and the following categories: studies from Brazil, recent publications and Blacks/Hispanics/mixed‐race groups. Publications about immigrants were axially closer to the high‐income countries category.ConclusionsOur findings call on dental researchers to consider racism as a cause for existing racial/ethnic inequities in oral health.

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Conceptualizing inequities and oppression in oral health research

Cited by 7 publications

References 51 publications

The Relations between Systems of Oppression and Oral Care Access in the United States

The Relations between Systems of Oppression and Oral Care Access in the United States

Behavioural and cognitive‐behavioural theories in oral health research: Current state and future directions

Research on racial/ethnic inequities in oral health over the past 80 years: The role of racism

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