Behavioral Pathways of Oral Health Disparity in Children

Understanding and reducing health disparity is pivotal for health promotion worldwide. Although some theoretical frameworks have suggested the behavioral pathways leading to oral health disparity, they have not been systematically tested. As a result, this has hampered the development of evidence-based strategies for reducing oral health disparity. Objective: This study is aimed to test the theoretical frameworks, incorporating mainstream ideologies with multilevel behavioral pathways to explain the oral health disparity. Methods: Oral examinations were conducted among 1,782 randomly selected preschoolers (3-5 years of age) at a 12-month interval, for registering dental caries according to the World Health Organization (WHO) methods. Parents were surveyed for their knowledge (K), attitude (A) and practice (P) on children's oral health homecare (infant feeding, diet, and oral hygiene) and dental attendance. The hypothesized multilevel behavioral pathways were tested through Partial Least Square (PLS), a component-based method of structural equation modeling. Results: The links between the specific KA and corresponding practices were supported (p<0.05), while the generic KA did not affect practices in either oral health homecare or dental attendance (p>0.05). The prominent oral health disparity in ethnic and socioeconomic groups was partly explained by the KA-P pathways. Not mediated by KA, deprivation had a direct effect on dental attendance (p<0.001), but not on oral health homecare (p>0.05); ethnicity directly affected oral health homecare practice (p<0.001), but not dental attendance (p>0.05). The hypothesized behavioral pathways have explained 47%, 60%, and 15% of the variance for P-homecare, P-attendance, and caries, respectively. Conclusion: The behavioral pathways revealed in this study, furthering our understanding of health disparity, may have practical implications on health promotion and policy-making.