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Pathways to Oral Health Among Low-income Pregnant Urban Women

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Project Summary/Abstract Racial/ethnic minority and low-income women are most vulnerable to poor oral health during pregnancy. These vulnerable women are less likely than White and higher-income women to utilize dental care during pregnancy. However, pregnancy is often the only time when these women can access dental care through the Medicaid program. National evidence-based guidelines advocate for dental care during pregnancy to improve oral health. However, prenatal oral health programs designed to increase dental utilization among vulnerable pregnant women have had disappointing results. The major obstacle to identifying upstream barriers to downstream dental care utilization during pregnancy is the lack of longitudinal data on factors that predict dental care utilization and oral health in vulnerable women. This study is informed by the Theory of Constrained Choice (Bird & Rieker, 1999), which posits that women?s opportunities to create a healthy lifestyle are constrained due to social and gender-related processes that interact with biological processes (e.g., pregnancy). This study will leverage an ongoing interprofessional collaboration between the New York University College of Dentistry and the Bellevue Hospital Obstetrics and Gynecology Service. We will collect survey data on socio-behavioral and psychosocial factors common in these vulnerable women during the first trimester of pregnancy. We will conduct clinical oral examinations to evaluate tooth loss, dental caries, gingivitis and periodontitis and will refer all women for dental care. We will re-survey and re-examine these women during the third trimester of pregnancy and will use Medicaid claims to evaluate dental care utilization. We will use cross-sectional and longitudinal structural equation modeling to identify socio-behavioral and psychosocial predictors of dental care utilization and oral health during pregnancy. This project explicitly addresses RFA-OD-19-029?s call to examine sex and gender influences on oral health and oral disease and expand research on female-specific conditions and diseases, including reproductive stages and maternal and gynecologic health. This research will elucidate which factors must be addressed when designing interventions to improve dental care utilization and oral health outcomes among pregnant women at elevated risk for oral disease. This study is the first step in addressing our long-term goal to improve the oral health of vulnerable women by intervening during pregnancy.
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