Evaluation of San Francisco School Based Sealant Program from 2007-2015

Objectives: School based sealant programs (SBSPs) are strongly endorsed by the CDC and have been successfully implemented nationwide to address oral health disparities. This study describes the San Francisco Department of Public Health (SFDPH) SBSP reach and utilization over eight years, and examines factors and/or disparities associated with sealant non-receipt in 2014-2015.
Methods: Data from 2007-2015 of the SFDPH SBSP, which offers no-cost sealants to second graders attending select low-income San Francisco Unified School District (SFUSD) schools, were used for this analysis. Annual program reach and utilization were quantified by number of schools, children screened, and sealant placement rate. Unadjusted and multivariable logistic regression analyses were used to examine relationships between sealant receipt and race-ethnicity, school-mean income, and school for the 2014-2015 sample.
Results: Between 2007-2015, the SFDPH Sealant Program screened 4,658 second graders total (5-13 schools/year, 260-753 children/year). Sealants were recommended to 4,024 (86%), of which 2,499 (62%) received sealants. Over time, the number of second graders screened by year declined, while the percentage of children not sealed, despite being recommended sealants, remained stable (between 33-40% of children).

In 2014-2015, non-receipt of sealants was associated with ethnicity. Black children were 12 times more likely to not receive sealants than Asian children (unadjusted OR=11.8, CI: 7.9-17.6). School and school-mean income partially explained this association; control for these variables reduced the magnitude of association to 9.9 (5.7-17.2). Hispanic children were 2 times more likely to not receive sealants than Asian children (unadjusted OR=2.2, CI: 1.3-3.6), independent of school variables. The primary reasons for non-receipt were consent form not returned (46%) and parent actively declining sealants (30%).
Conclusions: The SFDPH SBSP serves a small portion of second graders attending low-income schools in San Francisco. Program expansion and improved sealant receipt rates could help further address oral health disparities.