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Caregiver Burden and Preventive Dental Care Use for US Children with Special Health Care Needs: A Stratified Analysis Based on Functional Limitation

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Abstract

The objectives of this study were to evaluate the association between caregiver burden and preventive dental care use for children with special health care needs (CSHCN) and assess if caregiver burden explains the relationship between child- and family-level characteristics and preventive dental care use. Samples of US CSHCN ages 3–17 years with a functional limitation (n = 7,559) and those without (n = 26,345) were derived from the 2005–2006 National Survey of CSHCN. We generated structural equation models, stratified by functional limitation, to describe the relationships between caregiver burden and preventive dental utilization. We measured caregiver burden using six items on whether the child’s health condition impacted work, time spent on health management, and finances. About 80.9 % of CSHCN used preventive dental care. Higher levels of caregiver burden were associated with significantly lower odds of preventive dental care use for CHSCN with a functional limitation (β = −0.06; P < 0.001) and those without (β = −0.07; P < 0.001). For CSHCN with a functional limitation, family poverty and being uninsured were significantly associated with greater caregiver burden and less preventive dental use. Findings were similar for CSHCN without a functional limitation, except that lower caregiver education was also associated with greater caregiver burden and less preventive dental care use. Caregiver burden is potential barrier to preventive dental care use for CSHCN and explains the relationship between child- and family-level characteristics and preventive dental care use. Interventions to improve the oral health of CSHCN should include strategies to reduce caregiver burden, especially within socioeconomically vulnerable families.

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References

  1. Institute of Medicine (IOM) and National Research Council (NRC). (2011). Improving access to oral health care for vulnerable and underserved populations. Washington, DC: The National Academies Press.

    Google Scholar 

  2. Newacheck, P. W., & Kim, S. E. (2005). A national profile of health care utilization and expenditures for children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 159(1), 10–17.

    Article  PubMed  Google Scholar 

  3. Lewis, C., Robertson, A. S., & Phelps, S. (2005). Unmet dental care needs among children with special health care needs: Implications for the medical home. Pediatrics, 116(3), e426–e431.

    Article  PubMed  Google Scholar 

  4. Iida, H., Lewis, C., Zhou, C., Novak, L., & Grembowski, D. (2010). Dental care needs, use and expenditures among US children with and without special health care needs. Journal of the American Dental Association, 141(1), 79–88.

    Article  PubMed  Google Scholar 

  5. Chi, D. L., Momany, E. T., Neff, J., Jones, M. P., Warren, J. J., Slayton, R. L., et al. (2011). Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children. Medical Care, 49(2), 180–192.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Lewis, C. W. (2009). Dental care and children with special health care needs: A population-based perspective. Academic Pediatrics, 9(6), 420–426.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Lewis, C., & Stout, J. (2010). Toothache in US children. Archives of Pediatrics and Adolescent Medicine, 164(11), 1059–1063.

    Article  PubMed  Google Scholar 

  8. Lewis, C., Lynch, H., & Johnston, B. (2003). Dental complaints in emergency departments: A national perspective. Annals of Emergency Medicine, 42(1), 93–99.

    Article  PubMed  Google Scholar 

  9. Chi, D. L., Momany, E. T., Neff, J., Jones, M. P., Warren, J. J., Slayton, R. L., et al. (2010). Impact of chronic condition status and severity on dental treatment under general anesthesia for Medicaid-enrolled children in Iowa state. Pediatric Anesthesia, 20(9), 856–865.

    Article  PubMed Central  PubMed  Google Scholar 

  10. McManus, B. M., Carle, A., Acevedo-Garcia, D., Ganz, M., Hauser-Cram, P., & McCormick, M. (2011). Modeling the social determinants of caregiver burden among families of children with developmental disabilities. American Journal on Intellectual and Developmental Disabilities, 116(3), 246–260.

    Article  PubMed  Google Scholar 

  11. Perrin, J. M. (2002). Health services research for children with disabilities. Milbank Quarterly, 80, 303–324.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Green, S. E. (2007). ‘‘We’re tired, not sad’’: Benefits and burdens of mothering a child with a disability. Social Science and Medicine, 64, 150–163.

    Article  PubMed  Google Scholar 

  13. Canning, R. D., Harris, E. S., & Kelleher, K. J. (1996). Factors predicting distress among caregivers to children with chronic medical conditions. Journal of Pediatric Psychology, 21, 735–749.

    Article  CAS  PubMed  Google Scholar 

  14. Murphy, N. A., Christian, B., Caplin, D. A., & Young, P. C. (2006). The health of caregivers for children with disabilities: Caregiver perspectives. Child: Care, Health and Development, 33, 180–187.

    Google Scholar 

  15. Kuo, D. Z., Cohen, E., Agrawal, R., Berry, J. G., & Casey, P. H. (2011). A national profile of caregiver challenges among more medically complex children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 165(11), 1020–1026.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Raina, P., O’Donnell, M., Schwellnus, H., Rosenbaum, P., King, G., Brehaut, J., et al. (2004). Caregiving process and caregiver burden: Conceptual models to guide research and practice. BMC Pediatrics, 14(4), 1.

    Article  Google Scholar 

  17. Allik, H., Larsson, J., & Smedje, H. (2006). Health-related quality of life in parents of school-age children with Asperger syndrome or high-functioning autism. Health and Quality of Life Outcomes, 4, 1–8.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Kuhlthau, K., Kahn, R., Hill, K. S., Gnanasekaran, S., & Ettner, S. L. (2010). The well-being of parental caregivers of children with activity limitations. Maternal and Child Health Journal, 14, 155–163.

    Article  PubMed  Google Scholar 

  19. Bussing, R., Zima, B. T., Gary, F. A., Mason, D. M., Leon, C. E., Sinha, K., et al. (2003). Social networks, caregiver strain, and utilization of mental health services among elementary school students at high risk for ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 42(7), 842–850.

    Article  PubMed  Google Scholar 

  20. Garland, A. F., Aarons, G. A., Brown, S. A., Wood, P. A., & Hough, R. L. (2003). Diagnostic profiles associated with use of mental health and substance abuse services among high-risk youths. Psychiatric Services, 54(4), 562–564.

    Article  PubMed  Google Scholar 

  21. Garland, A. F., Lau, A. S., Yeh, M., McCabe, K. M., Hough, R. L., & Landsverk, J. A. (2005). Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry, 162(7), 1336–1343.

    Article  PubMed  Google Scholar 

  22. María Brannan, A., & Heflinger, C. A. (2005). Child behavioral health service use and caregiver strain: Comparison of managed care and fee-for-service Medicaid systems. Mental Health Services Research, 7(4), 197–211.

    Article  PubMed  Google Scholar 

  23. Chavira, D. A., Garland, A., Yeh, M., McCabe, K., & Hough, R. L. (2009). Child anxiety disorders in public systems of care: Comorbidity and service utilization. The Journal of Behavioral Health Services & Research, 36(4), 492–504.

    Article  Google Scholar 

  24. Shin, S. H., & Brown, T. A. (2009). Racial and ethnic disparities in caregiver strain and the use of child mental health services: A structural equation model. Psychiatric Services, 60(8), 1039–1045.

    Article  PubMed  Google Scholar 

  25. Larson, J. J., Yoon, Y., Stewart, M., & dosReis, S. (2011). Influence of caregivers’ experiences on service use among children with attention-deficit hyperactivity disorder. Psychiatric Services, 62(7), 734–739.

    Article  PubMed  Google Scholar 

  26. Data Resource Center for Child and Adolescent Health Website. Available at: http://www.childhealthdata.org/. Accessed on April 9, 2012.

  27. Blumberg, S. J., Welch, E. M., Chowdhury, S. R., Upchurch, H. L., Parker, E. K., & Skalland, B. J. (2008). Design and operation of the National Survey of Children with Special Health Care Needs, 2005–2006. National Center for Health Statistics. Vital Health Statistics, 45, 11188.

    Google Scholar 

  28. Kanellis, M. J., Damiano, P. C., & Momany, E. T. (1997). Utilization of dental services by Iowa Medicaid-enrolled children younger than 6 years old. Pediatric Dentistry, 19, 310–314.

    CAS  PubMed  Google Scholar 

  29. Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1302.

    CAS  PubMed Central  PubMed  Google Scholar 

  30. The Child and Adolescent Health Measurement Initiative. (2009). Measuring medical home for children and youth: A resource manual for child health program leaders, researchers, and analysts. Portland, OR: Data Resource Center on Child and Adolescent Health.

    Google Scholar 

  31. Pedlow, S., Luke, J. & Blumberg, S. (2007). Multiple imputation values for National Survey of Children With Special Health Care Needs, 2001, and National Survey of Children’s Health, 2003. US Centers for Disease Control and Prevention, Division of Health Interview Statistics, Survey Planning and Special Surveys Branch. Available at: http://www.cdc.gov/nchs/data/slaits/mimp01_03.pdf. Accessed on April 9, 2012.

  32. Bollen, K. A. (1989). Structural equations with latent variables. Wiley series in probability and mathematical statistics. New York: Wiley.

    Google Scholar 

  33. Hu, L., & Bentler, P. M. (1995). Evaluating model fit. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications. Thousand Oaks, CA: Sage.

    Google Scholar 

  34. MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York, NY: Erlbaum.

    Google Scholar 

  35. Canning, R. D., Harris, E. S., & Kelleher, K. J. (1996). Factors predicting distress among caregivers to children with chronic medical conditions. Journal of Pediatric Psychology, 21(5), 735–749.

    Article  CAS  PubMed  Google Scholar 

  36. American Academy of Pediatric Dentistry (AAPD). (2011). Guideline on caries-risk assessment and management for infants, children, and adolescents. Pediatric Dentistry, 33(special issue), 110–117.

    Google Scholar 

  37. Wertlieb, D. (2003). Converging trends in family research and pediatrics: Recent findings for the American academy of pediatrics task force on the family. Pediatrics, 111(1572), 1587.

    Google Scholar 

  38. Liu, J., Probst, J. C., Martin, A. B., Wang, J. Y., & Salinas, C. F. (2007). Disparities in dental insurance coverage and dental care among US children: The National Survey of Children’s Health. Pediatrics, 119(Suppl 1), S12–S21.

    Article  PubMed  Google Scholar 

  39. Brannan, A. M., & Heflinger, C. A. (2006). Caregiver, child, family, and service system contributors to caregiver strain in two child mental health service systems. The Journal of Behavioral Health Services & Research, 33(4), 408–422.

    Article  Google Scholar 

  40. Sheiham, A., & Watt, R. G. (2000). The common risk factor approach: A rational basis for promoting oral health. Community Dentistry and Oral Epidemiology, 28(6), 399–406.

    Article  CAS  PubMed  Google Scholar 

  41. Watt, R. G., & Sheiham, A. (2012). Integrating the common risk factor approach into a social determinants framework. Community Dentistry and Oral Epidemiology, 40(4), 289–296.

    Article  PubMed  Google Scholar 

  42. Perlick, D. A., Miklowitz, D. J., Lopez, N., Chou, J., Kalvin, C., Adzhiashvili, V., et al. (2010). Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disorder, 12(6), 627–637.

    Article  Google Scholar 

  43. Farmer, J. E., Clark, M. J., Sherman, A., Marien, W. E., & Selva, T. J. (2005). Comprehensive primary care for children with special health care needs in rural areas. Pediatrics, 116(3), 649–656.

    Article  PubMed  Google Scholar 

  44. Cook, J. R., & Kilmer, R. P. (2010). The importance of context in fostering responsive community systems: supports for families in systems of care. The American Journal of Orthopsychiatry, 80(1), 115–123.

    Article  PubMed  Google Scholar 

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Acknowledgments

All phases of this study were supported by NIH/NIDCR Grant Number K08DE020856 awarded to Dr. Donald L. Chi.

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Authors and Affiliations

  1. Department of Oral Health Sciences, School of Dentistry, University of Washington, Box 357475, Seattle, WA, 98195, USA

    Donald L. Chi

  2. Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado, Denver, CO, USA

    Beth M. McManus

  3. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Adam C. Carle

  4. Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA

    Adam C. Carle

  5. Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA

    Adam C. Carle

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  1. Donald L. Chi
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  2. Beth M. McManus
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Correspondence to Donald L. Chi.

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Chi, D.L., McManus, B.M. & Carle, A.C. Caregiver Burden and Preventive Dental Care Use for US Children with Special Health Care Needs: A Stratified Analysis Based on Functional Limitation. Matern Child Health J 18, 882–890 (2014). https://doi.org/10.1007/s10995-013-1314-x

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  • DOI: https://doi.org/10.1007/s10995-013-1314-x

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