Perceived experiences of racism linked to dental fear and anxiety among Black women

Abstract

Objectives: Dental fear and anxiety are known determinants of delaying or avoiding dental care and vary considerably based on factors such as age and gender. However, little is known about dental fear and anxiety in racial/ethnic minority populations, which bear a disproportionate burden of poor oral health outcomes. Structural and social pathways responsible for producing these disparities are also understudied. Experiences of racism over the lifecourse may contribute to poor oral health outcomes through a pathway of dental fear and anxiety. This paper aimed to evaluate perceived experiences with racism, dental fear and anxiety, and the utilization of dental services, in the Black Women's Health Study (BWHS), a United States-based prospective cohort.

Methods: Analysis of prospective data obtained from a geographic subset of participants in the BWHS was conducted. In 2014, BWHS participants residing in Massachusetts responded to a mailed oral health questionnaire that included the Index of Dental Anxiety and Fear (IDAF-4C+) instrument (N = 484; 69% response rate). Previously collected demographic and health information, along with reported experiences of everyday and lifetime racism, obtained from national BWHS questionnaires between 1995 and 2009, were merged with the Massachusetts-based sub-sample. Associations between high dental anxiety (HDA) (mean IDAF-4C+ score ≥2.5 on the dental fear and anxiety module) and oral health outcomes and perceived racism and HDA were explored via prevalence ratios (PR) calculated using log-binomial regression models, including adjustment for potential confounders.

Results: Reported exposures to everyday racism occurred weekly on average for the top 25% of the sample, while 13% of participants reported exposure to multiple (n = 3) experiences of unfair treatment due to their race over their lifetime. HDA was prevalent among 17.8% of the sample and was significantly associated with indicators of poor oral health status. High exposures to everyday and lifetime experiences of racism were positively associated with HDA (PR = 1.08; 95% CI: 0.90, 1.58 and PR = 1.72; 95% CI: 1.03, 2.88, respectively).

Conclusions: Significant associations between racism and HDA, and between HDA and poor oral health and reduced utilization of dental care were observed. Dental anxiety may be a pathway through which perceived experiences with racism may impact oral health outcomes.

Keywords: dental anxiety; dental fears; healthcare utilization; minority health; oral health; racial discrimination; racism.

FIGURE 1

Directed acyclic graph depicting potential confounders of the association between racism and high dental anxiety. Figure depicts the hypothesized relationships believed to underlie the observed data. The relationship between oral health (OH), racism (R) and high dental anxiety (HDA) is believed to be cyclical over time. ‘t_0’ represents an initial time point, ‘t₁’ a subsequent time point, and so on. Grey shading enclose time points within these cyclical relationships at which the data used in this analysis may have been collected for OH, R, HDA and confounders (C). The vector C depicted at t₀ represents potential confounding factors: age, education, annual household income, marital status, US born, parity, body mass index, diabetic diagnosis and hypertension diagnosis, all of which has prior observed associations with R and OH. Statistical control is depicted by boxing C_t0, preventing a ‘backdoor’ path from R to HDA.