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Identifying Opportunities to Improve Oral Health Care Services AccessResearch Proposal

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Improving Access to Oral Health Care in Westside, Jersey City

Why oral health care for low-income residents of Westside in Jersey City is an important topic

The timely provision of oral health care is an important part of keeping people healthy. Oral health constitutes an important part of general health. For instance, the U.S. Surgeon General's report on oral health emphasizes that oral health represents an essential element of health that must be included in the provision of other health care services (Ravaghi & Quinonez, 2013). According to these researchers, though, "Despite this, there are differences in provision of general and oral health care in many developed countries" including the United States (Ravaghi & Quinonez, 2013, p. 467). This assertion is based on an analysis of 3,413 men and women aged 18-79 (men=1,601; women=1,812) using the oral health indicator of the total number of decayed and missing teeth. Based on their analysis, Ravaghi and Quinonez (2013) identified significant income-related disparities in oral and general health.

Likewise, the Academy of General Dentistry reports that, "The health of your mouth mirrors the condition of your body as a whole. For example, when your mouth is healthy, chances are your overall health is good, too. On the other hand, if you have poor oral health, you may have other health problems" (The importance of oral health, 2015, para. 2). A growing body of research confirms the association between poor oral health and other conditions including stroke, heart disease, diabetes, leukemia, oral cancer, pancreatic cancer and kidney disease (The importance of oral health, 2015). Moreover, women who suffer from poor oral health conditions such as gum disease are at higher risk of delivering pre-term, low birth-weight babies (The importance of oral health, 2015). While residents in many other American communities have experienced improvements in their oral health care services, low-income residents in any community are faced with severe constraints to their access to these services (Petersen, 2007)..

Consequently, the low-income residents of Westside, Jersey City, are confronted with a number of constraints in their access to oral health care services, including a lack of available dental resources and an inability to pay for these services when they are available. In addition, providing oral health care to the elderly and cognitively impaired residents of Westside represents an especially challenging enterprise. For instance, using a non-randomized convenience sample of 100 nursing home residents who lacked organized access to oral health care services, Matear and Barbaro (2008) conducted a series of structured interviews with 40 family members using questions designed to explore the importance and priorities of dental services for institutionalized elderly.

Based on their findings, Matear and Barbaro (2008) conclude that, "The provision of dental services to elderly populations is a complicated area" (p. 29). Although many elderly residents may suffer from age-related conditions that adversely affect their cognitive abilities, whenever residents are cognitively impaired, providing oral health care becomes far more difficult. In this regard, Matear and Barbaro add that, "When clients are cognitively impaired, a new set of variables are introduced as care can be influenced by designated family members, caregivers or administrators, who are responsible for the oral health care of the client and may influence the types of treatment the client will receive" (p. 30). Taken together, it is clear that improving access to oral health care represents a timely and valuable enterprise for the residents of West Side, Jersey City. To this end, this systematic review of the peer-reviewed literature was guided by the research question set forth below.

Research question

This study was guided by the following research question: "How do low-income residents of Westside in Jersey City currently get access to oral health care?"

Literature Review

Overview of Westside, Jersey City

Today, Westside Jersey City (hereinafter alternatively "Westside") has a population of about 20,000 with a median age of 36.3 years compared to 33.1 years for Jersey City (Westside livability score, 2015). Westside is situated geographically in the southwest corner of Jersey City, the second-largest city in the state of New Jersey following Newark, and is comprised of a number of discrete communities located adjacent to West Side Avenue (Living in Westside, 2015). The Westside community is demarcated to the east by John F. Kennedy Boulevard and McGinley Square, to the north by the Pulaski Skyway and Newark Avenue (also known as County Road 644); to the south by Communipaw Avenue and West Bergen; and to the west by U.S. 1 and the waterway beyond (Living in Westside, 2015, para. 3).

The demographic composition of Westside is highly diverse, with about 27% white, 32% African-American and around 27% Asian; although Hispanics are not categorized separately, about 27.9% of the entire Jersey City area population are regarded as Hispanic (Westside livability score, 2015). At present, the median household income in Westside is $54,636 (about 6% lower than Jersey City) (Westside livability score, 2015). At $297,146, the median housing value in Westside is also about 12% lower than Jersey City proper (Westside livability score, 2015). The cost of living is rated at 135 out of an average of 100 for the country, but the cost of living in the Westside is about 4% lower than Jersey City (Westside livability score, 2015). In addition, the crime rate in Westside is approximately 15% higher compared to Jersey City (Westside livability score, 2015).

A breakdown of the median income for Westside is set forth in Table 1 below.

Table 1

Westside household income distribution

Income category

Percentage of residents

$200K plus

2.8%

$150-$200K

9.7%

$100-$150K

14.5%

$60-$100K

24.9%

$40-$60K

15.6%

$25-$40K

12.3%

$10-$25K

16.2%

$10K or less

8.6%

Source: Adapted from bar graph, Westside livability score, 2015

As can be seen from Table 1 above, more than one-third (37.1%) of the residents of Westside earn $40,000 a year or less, with a significant percentage (8.6%) earning less than $10,000 a year. Furthermore, although the median age of Westside residents is 36.3 years, there are larger numbers of young children living in married families in this community (Westside livability score, 2015) and all of these young people need timely oral health care services to facilitate their normal development (Taylor & Marino, 2014). A new industrial park and increasing investments from outside the community, though, are projected to result in increased employment opportunities for Westside residents in the foreseeable future (Mathis, 2007). In the meantime, though, significant numbers of Westside residents remain mired in impoverished conditions where oral health care services assume a low priority.

Importance of Oral Health Care for Low-Income Westside Residents

Disparities in access to affordable oral health care services can have an enormous impact on low-income consumers in terms of their general health as well as their general appearance (Dolgin, 2013). The situation is far different for those who are able to afford these services, though. For instance, Dolgin (2013) advises that, "For people with financial resources, dental care in the United States provides not only for patients' health needs, but also, often, for their aesthetic yearnings" (p. 1421). Although there are significant health care issues related to good oral health, there are also some stigmatization issues that can adversely affect people who lack good oral health in terms of their ability to secure gainful employment or to successfully develop and maintain interpersonal relationships (Dolgin, 2013). In this regard, Dolgin emphasizes that, "A person's dental condition can signal poverty and low socioeconomic status. For those without teeth or with visibly mangled teeth, social and economic opportunities can be significantly limited" (2013, p. 1422). Conversely, good oral health and teeth can also connote affluence (Dolgin, 2013). These findings suggest that the low-income residents of Westside also experience obstacles to their access to adequate oral health care services.

This assertion is supported by findings from a study by Modifi, Rozier and King (2002) that noted obtaining adequate oral health care services for low-income residents can be especially challenging due to inadequate family resources. limited choices in providers and inadequate transportation (Mofidi, Rozier & King, 2002). Moreover, many low-income residents report being treated disrespectfully and even discriminated against by health care providers, further discouraging their attempts to attain services (Mofidi et al., 2002). Using criterion-purposive sampling, Mofidi et al. (2002) recruited 77 caregiver participants for 11 focus groups conducted in North Carolina.

Based on their analysis of these qualitative data, Modifi et al. determined that many focus group caregivers had been discouraged from obtaining dental services for their children who were insured by Medicaid. The researchers also provide rationale in support of their selection of research methodologies citing a dearth of previous studies using empirical observations from focus groups. Based on their content analysis of these focus groups, Mofidi and his associates concluded that negative experiences, including inordinately lengthy wait times and discriminatory behavior on the part of providers, were major barriers to dental care system access.

In fact, the expectation of poor oral health among many low-income residents has been identified as one of the barriers to access to adequate oral health care services,… [END OF PREVIEW]

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