摘要：Objectives. We sought to understand the role of Latino acculturation in dental care utilization in Iowa children. Methods. We used logistic regression to evaluate factors associated with having a previous-year dental check-up with 2005 Iowa Child and Family Household Health Survey data. We constructed models to examine the association with race/ethnicity and used chosen interview language to measure Latino acculturation. Results. After we controlled for several factors, having a regular dental care source, having a dental need, dental insurance status, family income, children's dental health rating, children's age, and brushing habits were associated with having a previous-year dental check-up. Race/ethnicity was indirectly associated with use of dental services through other related factors with significant differences for less-acculturated Latinos. Conclusions. Policymakers and health planners should implement strategies to address individual, community, and system factors affecting racial/ethnic minorities. A regular source of dental care for Latino children that will enhance their access to services should be ensured. Ignoring the needs of the fastest growing segment of children with the poorest oral health and the least access to care will lead to future increase of oral diseases in this population. Latinos, the largest and fastest growing ethnic minority group in the United States, accounted for 16% of the nation's population in 2010, and by 2050 are projected to represent 30% of the population. 1,2 The increasing proportion of Latinos has been seen not only in metropolitan areas of the United States, but also in rural areas. 3 Although Latinos are mostly settled in the Southwest and West regions of the country, between 1990 and 2000, the Midwest experienced the largest percentage increase in Latino population (81%). 4 In Iowa, a predominantly White state, Latinos accounted for 4% of the population in 2007 and are projected to account for 9% of the population by 2030. It is interesting that Latino children younger than 5 years account for 11.5% of Latinos living in Iowa, representing the highest concentration of preschoolers in the state among any racial/ethnic group. 5 Although the oral health of Americans has improved greatly in the past 50 years, disparities have been found among Latino children nationwide. 6 For example, Mexican American children have higher caries experience than Whites. 7,8 In addition, Latino children have lowest attendance for dental care and highest proportion of children with untreated tooth decay. 8,9 Some studies suggest that Latinos’ difficulties in accessing dental care are greatly affecting their oral health. Barriers to care include the lack of a regular source of care, lack of dental insurance, low family income, and lower parental education. 10–12 These difficulties can be even greater for Latinos who have been living in the United States for shorter periods of time or those who have not adjusted to the new culture. These immigrants may be less knowledgeable about available programs for receiving insurance or services, may be less familiar with expectations related to making a dental visit, and may have concerns about citizenship issues when trying to access services. Few studies have been conducted using any measure of acculturation that will help us to understand difficulties to access care between more- and less-acculturated Latinos. Therefore, we sought to identify the factors that were related to having a dental check-up in the previous year by Iowa children, with special emphasis in identifying disparities affecting more- or less-acculturated Latino children. We used a conceptual framework for the receipt of oral health care among Latinos in the United States as a guide to identify factors that were considered for inclusion in the analysis. 13
