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Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 August 2019) | Viewed by 57127

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Special Issue Editors

Prof. Dr. Gerardo Maupomé

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Guest Editor

Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., suite R6054, Health Sciences Building, Indianapolis, IN 46202, USA
Interests: oral health; dental epidemiology; health services research; minority health; immigrant health; health disparities; social-behavioral sciences

Dr. Tamanna Tiwari

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Guest Editor

School of Dental Medicine, University of Colorado Anschutz Medical Campus, Mail Stop F843, 13065 East 17th Avenue, Room 104F, Aurora, CO 80045, USA
Interests: oral health disparities, early childhood caries

Prof. Judith Albino

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Guest Editor

Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Building 500, 3rd Floor, Suite 3000, Anschutz Medical Campus, Aurora, CO 80045, USA
Interests: oral health disparities; community health interventions

Special Issue Information

Dear Colleagues,

A Special Issue on “Oral health and dental care access disparities: The contexts of immigrant health and minority health”, is being organized in the International Journal of Environmental Research and Public Health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

The substantial movement of people across borders currently makes up the diverse mosaic of migration. Embodying many minority health phenomena, the health of immigrants is often affected by changing social and cultural norms, differential access to clinical care, and the coexistence of new and preexisting health conditions. Oral health and dental care access disparities constitute prime examples of the challenges that new and recent immigrants face in the long process of adapting to new environments: physical, dietary, health systems, and many more aspects. An emerging body of research continues to characterize the features of such a complex landscape, but the rapid pace of change requires an up-to-date, sophisticated examination of the underlying factors. Such a knowledge base will inform strategies to ameliorate risk factors; improve culturally appropriate access to care and prevention; alleviate acute and long-term complications of poor oral health; and supply objective data to support social and health policies addressing disparities in the contexts of immigrant health and minority health.

This Special Issue is open to the subject area of “Oral health and dental care access disparities”. The keywords listed below provide an outline of some of the possible areas of interest.

Prof. Gerardo Maupome
Dr. Tamanna Tiwari
Prof. Judith Albino
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

Immigrant health
Minority health
Oral health
Access to dental care
Prevention and elimination of health disparities
Dental treatment and prevention
Oral epidemiology
Community dentistry
Social and behavioral sciences
Oral health related quality of life
Dental insurance
Dental treatment, funding
Oral disease risk factors
Health care settings
Experience and perception (patients, caregivers, and practitioners)
Community engagement
Social norms

Published Papers (12 papers)

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13 pages, 473 KiB

Open AccessArticle

Validation of Psychosocial Measures Assessing American Indian Parental Beliefs Related to Control over Their Children’s Oral Health

by Anne R. Wilson, Tamanna Tiwari, Jacob F. Thomas, William G. Henderson, Patricia A. Braun and Judith Albino

Int. J. Environ. Res. Public Health 2020, 17(2), 403; https://doi.org/10.3390/ijerph17020403 - 08 Jan 2020

Cited by 3 | Viewed by 2697

Abstract

Objectives: To validate questionnaire items assessing American Indian (AI) parental beliefs regarding control over their children’s oral health within the context of psychosocial measures and children’s oral health status. Methods: Baseline questionnaire data were collected as part of a randomized controlled trial (n = 1016) addressing early childhood caries. Participants were AI parents with preschool-age children in the Navajo Nation Head Start program. Questionnaire items assessed parental oral health locus of control (OHLOC) and agreement with beliefs indicating that they were in control of their children’s oral health (internal), the dentist was in control (external powerful others), or children’s oral health was a matter of chance (external chance). Exploratory factor analysis was conducted, and convergent validity was assessed using linear regression. Results: Parents with more education (p < 0.0001) and income (p = 0.001) had higher scores for internal OHLOC. Higher internal OHLOC scores were associated with higher scores on knowledge (p < 0.0001), perceived seriousness and benefits (p < 0.0001), higher self-efficacy, importance, sense of coherence (p < 0.0001 for all), and lower scores for perceived barriers (p < 0.0001) and distress (p = 0.01). Higher scores for both types of external OHLOC were associated with lower scores on knowledge (p < 0.0001), perceived seriousness (p < 0.0001), and higher scores on perceived susceptibility (p = 0.01 external chance; <0.0001 powerful others) and barriers (<0.0001). Higher scores for external powerful others were associated with lower scores for importance (p = 0.04) and sense of coherence (p = 0.03). Significant associations were not found for OHLOC beliefs and children’s oral health status. Conclusions: Questionnaire items addressing OHLOC functioned in accordance with the theoretical framework in AI participants. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

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10 pages, 2634 KiB

Open AccessArticle

Periodontal Disease Status among Adults from South Africa—Prevalence and Effect of Smoking

by Usuf Chikte, Carla Cruvinel Pontes, Innocent Karangwa, Faheema Kimmie-Dhansay, Rajiv T. Erasmus, Andre P. Kengne and Tandi E. Matsha

Int. J. Environ. Res. Public Health 2019, 16(19), 3662; https://doi.org/10.3390/ijerph16193662 - 29 Sep 2019

Cited by 19 | Viewed by 3862

Abstract

Periodontal diseases are among the six most prevalent non-communicable diseases (NCDs) worldwide, constituting a burden for oral and general health. There is a shortage of epidemiological data on periodontal diseases in Africa. The aim of the present cross-sectional study was to present the periodontal status and cotinine levels of a South African population of adults. This study included individuals living in the Belville South area. Bleeding on probing (BOP) and pocket depth were recorded for each tooth, and clinical attachment loss (CAL) was recorded as the highest score per sextant. Cotinine levels were measured in ng/mL. A total of 951 individuals were included. More than one third of all subjects had BOP. Regarding pocket depth, over 50% of the subjects had shallow pockets (4–5 mm), and almost 6% had deep pockets. CAL ≥ 4 mm was present in 40.1% of the subjects. Males presented worse periodontal conditions than females. In total, 52.7% of the participants had serum cotinine levels of ≥15 ng/mL. Cotinine levels had no effect on periodontal variables. Periodontal diseases were highly prevalent, and periodontal conditions were worse in males. Preventive and restorative public health programs are required to improve oral health in this population. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

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9 pages, 1043 KiB

Open AccessArticle

Application of the Theory of Planned Behavior to Predict Dental Attendance and Caries Experience among Children of Newcomers

by Maryam Amin, Maryam Elyasi, Babak Bohlouli and Mohamed ElSalhy

Int. J. Environ. Res. Public Health 2019, 16(19), 3661; https://doi.org/10.3390/ijerph16193661 - 29 Sep 2019

Cited by 10 | Viewed by 3202

Abstract

Background: This study aimed to explore the predictors of regular dental attendance behavior and caries experience among children of newcomers to Canada using the Theory of Planned Behavior (TPB). Methods: A total of 274 newcomer parents with a child aged 1 to 12 years old who had lived in Canada for 10 years or less participated in this cross-sectional study. Children underwent a dental examination to measure their deft/DEFT, and parents completed a self-administered questionnaire. Parental attitudes, subjective norms, perceived behavioral control (PBC), and intention were examined using Structural Equation Modeling (SEM) as predictors of dental attendance behavior and caries experience using the TPB model. Results: Out of all the components of the model, attitude and PBC significantly predicted the intention (p < 0.05) while the subjective norm had no statistical effects on the loading of the model (p > 0.05). Intention significantly predicted behavior, but behavior could not predict caries experience. Although 51.6% of the variance of intention was predicted by this model, only 0.2% of the variance for dental attendance behavior was explained. Conclusions: The theory of planned behavior was successful in predicting dental attendance intention and behavior for children among newcomers, but this behavior could not predict caries experience in children. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

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8 pages, 411 KiB

Open AccessArticle

Oral Health Behavior Change in Mexican-American Caregivers: A Community-Based Intervention Study

by Nayanjot K Rai and Tamanna Tiwari

Int. J. Environ. Res. Public Health 2019, 16(18), 3409; https://doi.org/10.3390/ijerph16183409 - 14 Sep 2019

Cited by 3 | Viewed by 2462

Abstract

An oral health prevention intervention was conducted with Mexican-American (MA) caregivers, focused on improving their oral health knowledge, behavior, and self-efficacy. Five in-person intervention sessions were conducted with caregivers, followed by a 15 min skill-building exercise. A goal-setting sheet was provided, and two goals were chosen for fulfilment during the three month intervention period. The data on parental oral health knowledge, behavior, and self-efficacy were collected pre- and post-intervention using a portion of Basic Factors Research Questionnaire (BRFQ). Paired t-tests were conducted to test significant differences in the means of pre- and post-intervention oral health behavior, knowledge, and self-efficacy scores, and pre- and post-intervention individual item scores. Forty six primary caregivers were enrolled. There were significant differences in the means of pre- and post-intervention oral health knowledge (p = 0.003), oral health behavior (p = 0.0005), and self-efficacy scores (p = 0.001). The individual item mean scores showed that there was a significant increase in the number of times caregivers checked for spots (p = 0.016) and a significant decrease in the consumption of sweet or sugary drinks (p = 0.032) post-intervention. Most of the caregivers believed that cavities were caused by germs in the mouth (p = 0.001), sharing utensils with children was bad for their teeth (p < 0.001), and fluoride toothpaste was best for a child’s teeth (p < 0.001). The intervention resulted in improved caregiver oral health knowledge, behavior, and self-efficacy. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

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14 pages, 341 KiB

Open AccessArticle

Oral Care Experiences of Latino Parents/Caregivers with Children with Autism and with Typically Developing Children

by Lucía I. Floríndez, Daniella C. Floríndez, Francesca M. Floríndez, Dominique H. Como, Elizabeth Pyatak, Lourdes Baezconde-Garbanati, Jose C. Polido and Sharon A. Cermak

Int. J. Environ. Res. Public Health 2019, 16(16), 2905; https://doi.org/10.3390/ijerph16162905 - 14 Aug 2019

Cited by 14 | Viewed by 3774

Abstract

As a result of various barriers, several pediatric populations are at risk for poor oral health, including children with disabilities and children from under-represented populations, such as Latinos. To this end, this study aimed to better understand the factors that affect the oral health experiences of 32 Latino parents/caregivers from 18 families (n = 8 with a typically developing child and n = 10 with a child with Autism). Using a qualitative descriptive methodology, each family was interviewed twice. Interviews were audio-recorded, transcribed verbatim, and coded thematically to identify the individual, social, systemic, and culturally rooted factors contributing to oral health disparities in the families. The three themes that arose were “Why would I want to start trouble?”: Latino parents’ dissatisfaction with dental treatments, costs, and fear of the dentist and health care providers because of their ethnic minority status as key factors inhibiting receipt of dental care; “We have to put our children first”: prioritizing the oral care activities of their children over their own individual oral care needs; and “We always keep baking soda around”: familial and cultural influences on oral care habits. Understanding the oral health beliefs and experiences of Latino parents and caregivers of children with and without autism is critical for developing targeted prevention and intervention programs and reducing oral health disparities. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

17 pages, 733 KiB

Open AccessArticle

Out-Of-Pocket Expenditures on Dental Care for Schoolchildren Aged 6 to 12 Years: A Cross-Sectional Estimate in a Less-Developed Country Setting

by Carlo Eduardo Medina-Solís, Leticia Ávila-Burgos, María de Lourdes Márquez-Corona, June Janette Medina-Solís, Salvador Eduardo Lucas-Rincón, Socorro Aida Borges-Yañez, Miguel Ángel Fernández-Barrera, América Patricia Pontigo-Loyola and Gerardo Maupomé

Int. J. Environ. Res. Public Health 2019, 16(11), 1997; https://doi.org/10.3390/ijerph16111997 - 05 Jun 2019

Cited by 15 | Viewed by 4079

Abstract

Aim: The objective of this study was to estimate the Out-Of-Pocket Expenditures (OOPEs) incurred by households on dental care, as well as to analyze the sociodemographic, economic, and oral health factors associated with such expenditures. Method: A cross-sectional study was conducted among 763 schoolchildren in Mexico. A questionnaire was distributed to parents to determine the variables related to OOPEs on dental care. The amounts were updated in 2017 in Mexican pesos and later converted to 2017 international dollars (purchasing power parities–PPP US $). Multivariate models were created: a linear regression model (which modeled the amount of OOPEs), and a logistic regression model (which modeled the likelihood of incurring OOPEs). Results: The OOPEs on dental care for the 763 schoolchildren were PPP US $53,578, averaging a PPP of US $70.2 ± 123.7 per child. Disbursements for treatment were the principal item within the OOPEs. The factors associated with OOPEs were the child’s age, number of dental visits, previous dental pain, main reason for dental visit, educational level of mother, type of health insurance, household car ownership, and socioeconomic position. Conclusions: The average cost of dental care was PPP US $70.2 ± 123.7. Our study shows that households with higher school-aged children exhibiting the highest report of dental morbidity—as well as those without insurance—face the highest OOPEs. An array of variables were associated with higher expenditures. In general, higher-income households spent more on dental care. However, the present study did not estimate unmet needs across the socioeconomic gradient, and thus, future research is needed to fully ascertain disease burden. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

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14 pages, 350 KiB

Open AccessArticle

by Andrés A. Agudelo-Suárez, Annie M. Vivares-Builes, Natalia Muñoz-Pino, José Miguel Martínez-Martínez, Alison Reid and Elena Ronda-Pérez

Int. J. Environ. Res. Public Health 2019, 16(10), 1796; https://doi.org/10.3390/ijerph16101796 - 21 May 2019

Cited by 10 | Viewed by 2867

Abstract

Quality of life and its relationship to oral health is an important consideration in the determinants of health of vulnerable groups. The aim of this study is to assess oral health-related quality of life (OHRQoL) and its related factors in native and immigrant population families from the Platform of Longitudinal Studies on Immigrant Families (PELFI) study in Spain. A cross-sectional study was conducted in a sample of 401 adults aged 18 years and older from Spain, Ecuador, Colombia, and Morocco. The OHIP-14 instrument was applied, and three summary variables were used (prevalence, extent, and severity). Sociodemographic and self-perceived health variables were included. Bivariate analyzes were carried out to summarize the variables of the OHIP-14 according to sociodemographic and health variables, and bivariate analyzes of the OHIP-14 dimensions was conducted by country of origin. Multivariate linear models were used to investigate predictors for the dimensions of the OHIP-14. Multivariate logistic models were used to estimate the association of OHRQoL with immigration status using crude and adjusted odds ratios with 95% confidence intervals (OR-95% CI). It was found that 14.8% of men and 23.8% of women reported negative impacts in terms of OHRQoL (statistically significant differences: p < 0.05). There were statistically significant differences according to the country of origin in the prevalence and severity outcomes of the OHIP-14 in women (p < 0.05), and severe outcomes were observed in Moroccan women. In women, statistically significant differences (p < 0.05) in OHRQoL were observed according to age and marital status. There were some differences between OHIP-14 summary outcomes according to the health variables. Some sociodemographic and health variables were predictors for the OHIP-14 and their dimensions with differences by sex. Multivariate analysis showed a statistically significant association between OHRQoL and immigration status for Moroccan women. Differences in OHRQoL were found according to sociodemographic and health variables. Further research could clarify the predictors of OHRQoL through epidemiological surveillance and longitudinal studies. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

11 pages, 304 KiB

Open AccessArticle

Place of Birth Inequalities in Dental Care Use before and after the Economic Crisis in Spain

by Elena Rodriguez-Alvarez, Nerea Lanborena and Luisa N. Borrell

Int. J. Environ. Res. Public Health 2019, 16(10), 1691; https://doi.org/10.3390/ijerph16101691 - 14 May 2019

Cited by 2 | Viewed by 2446

Abstract

This study evaluates inequalities in the use of dental services according to place of birth before and after the economic crisis in Spain. A cross-sectional study was performed in adults aged 18 to 65 years in Spain. We used data from three Spanish National Health Surveys for the years 2006 (before the crisis), 2014, and 2017 (after the crisis). Log-binomial regression was used to quantify the association between place of birth and use of dental care services before and after controlling for the selected covariates. In 2006, we found a greater probability of not using dental care services in immigrants from Asia (PR: 1.36, 95% CI: 1.10–1.67) and Africa (PR: 1.16, 95% CI: 1.05–1.28) compared to the natives. For 2014, the probability of not using dental care services was greater for all immigrants relative to natives, with the greatest probability for those from Africa (PR: 1.71, 95% CI: 1.46–2.01) and Asia (PR: 1.3, 95% CI: 1.23–1.47). The associations for 2017 were weaker in magnitude than the ones observed for 2014, although stronger than for 2006. This study suggests that the economic recovery did not have the same impact for natives and immigrants regardless of regions of origin, given the observed inequalities in use of dental services. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

8 pages, 294 KiB

Open AccessArticle

Racial Discrimination and Uptake of Dental Services among American Adults

by Wael Sabbah, Aswathikutty Gireesh, Malini Chari, Elsa K. Delgado-Angulo and Eduardo Bernabé

Int. J. Environ. Res. Public Health 2019, 16(9), 1558; https://doi.org/10.3390/ijerph16091558 - 04 May 2019

Cited by 35 | Viewed by 4205

Abstract

This study examined the relationship between racial discrimination and use of dental services among American adults. We used data from the 2014 Behavioral Risk Factor Surveillance System, a health-related telephone cross-sectional survey of a nationally representative sample of adults in the United States. Racial discrimination was indicated by two items, namely perception of discrimination while seeking healthcare within the past 12 months and emotional impact of discrimination within the past 30 days. Their association with dental visits in the past year was tested in logistic regression models adjusting for predisposing (age, gender, race/ethnicity, income, education, smoking status), enabling (health insurance), and need (missing teeth) factors. Approximately 3% of participants reported being discriminated when seeking healthcare in the past year, whereas 5% of participants reported the emotional impact of discrimination in the past month. Participants who experienced emotional impact of discrimination were less likely to have visited the dentist during the past year (Odds Ratios (OR): 0.57; 95% CI 0.44–0.73) than those who reported no emotional impact in a crude model. The association was attenuated but remained significant after adjustments for confounders (OR: 0.76, 95% CI 0.58–0.99). There was no association between healthcare discrimination and last year dental visit in the fully adjusted model. Emotional impact of racial discrimination was an important predictor of use of dental services. The provision of dental health services should be carefully assessed after taking account of racial discrimination and its emotional impacts within the larger context of social inequalities. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

Review

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29 pages, 1169 KiB

Open AccessReview

Oral Health and Its Associated Factors Among Older Institutionalized Residents—A Systematic Review

by Florence M. F. Wong, Yannies T. Y. Ng and W. Keung Leung

Int. J. Environ. Res. Public Health 2019, 16(21), 4132; https://doi.org/10.3390/ijerph16214132 - 26 Oct 2019

Cited by 111 | Viewed by 12861

Abstract

The oral health of an ageing population, especially that of the institutionalized elderly population, constitutes a significant concern because it is closely linked to general health and the quality of life. Shared common risk factors drive the development and worsening of poor oral health and non-communicable diseases, which eventually lead to self-care inability. Several studies have reported on the poor oral health of the institutionalized elderly population. However, few comprehensive reports exist regarding the relationship between poor oral health, the oral health-related quality of life (OHRQoL) and the associated factors in this specific population. Objective: The objective is to describe recently reported oral health levels, the OHRQoL and the associated factors among older institutional residents. Methods: Studies published between July 2009 and June 2019 in MEDLINE, EMBASE and CINAHL were searched. The population, intervention, comparison and outcome (PICO) strategy was used as a guide. The reported factors related to poor oral health were identified (i.e., age, gender, educational level, acquired systemic conditions or dementia/cognitive impairment). Results: Twenty-five surveys (or study series) from 19 countries were included. The level of evidence reported by these studies was generally moderate to strong. The reported oral cleanliness and health of the surveyed institutionalized elderly were poor (>50% of residents had calculus; denture hygiene index > 80%). Gum (approximately 30% of dentate residents had moderate to severe periodontitis), teeth (decayed, missing or filled teeth >20), mucosa (>10% had mucosal lesions) and denture problems (up to 40%) were prevalent and were associated with a poor OHRQoL, especially in females, socially deprived residents or those with mild or above cognitive impairment. Those with a poor OHRQoL might show signs of poor nutrition. Conclusions: This report reviewed evidence-based knowledge on oral health, the OHRQoL and the associated factors among elderly institutional residents. Further research is needed to confirm these observations. For improved oral health, a better OHRQoL and the general well-being of older residents, clinical trials are needed, targeting modifiable factors, such as social inequality, oral healthcare accessibility, and/or nursing home service quality. The relationship between oral health, the OHRQoL and nutrition in this at-risk population also warrants exploration. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

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16 pages, 822 KiB

Open AccessReview

The Persistence of Oral Health Disparities for African American Children: A Scoping Review

by Dominique H. Como, Leah I. Stein Duker, José C. Polido and Sharon A. Cermak

Int. J. Environ. Res. Public Health 2019, 16(5), 710; https://doi.org/10.3390/ijerph16050710 - 27 Feb 2019

Cited by 41 | Viewed by 9161

Abstract

Oral health is an important yet often neglected component of overall health, linked to heart disease, stroke, and diabetic complications. Disparities exist for many groups, including racial and ethnic minorities such as African Americans. The purpose of this study was to examine the potential factors that perpetuate oral health care disparities in African American children in the United States. A systematic search of three literature databases produced 795 articles; 23 articles were included in the final review. Articles were analyzed using a template coding approach based on the social ecological model. The review identified structural, sociocultural, and familial factors that impact the ability of African Americans to utilize oral care services, highlighting the importance of the parent/caregiver role and the patient–provider relationship; policy-level processes that impact access to quality care; the value of autonomy in treatment and prevention options; and the impact of sociocultural factors on food choices (e.g., food deserts, gestures of affection). In conclusion, oral health care remains an underutilized service by African American children, despite increasing access to oral care secondary to improvements in insurance coverage and community-based programs. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

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Other

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12 pages, 1021 KiB

Open AccessProtocol

The Oral Health of Refugees and Asylum Seekers in Canada: A Mixed Methods Study Protocol

by Mary Ellen Macdonald, Mark T. Keboa, Nazik M. Nurelhuda, Herenia P. Lawrence, Franco Carnevale, Mary McNally, Sonica Singhal, Khady Ka and Belinda Nicolau

Int. J. Environ. Res. Public Health 2019, 16(4), 542; https://doi.org/10.3390/ijerph16040542 - 13 Feb 2019

Cited by 6 | Viewed by 4682

Abstract

Canada received over 140,000 refugees and asylum seekers between 2015 and 2017. This paper presents a protocol with the purpose of generating robust baseline data on the oral health of this population and build a long-term program of research to improve their access to dental care in Canada. The three-phase project uses a sequential mixed methods design, with the Behavioral Model for Vulnerable Populations as the conceptual framework. In Phase 1a, we will conduct five focus groups (six to eight participants per group) in community organizations in Ontario, Canada, to collect additional sociocultural data for the research program. In Phase 1b, we will use respondent-driven sampling to recruit 420 humanitarian migrants in Ontario and Quebec. Participants will complete a questionnaire capturing socio-demographic information, perceived general health, diet, smoking, oral care habits, oral symptoms, and satisfaction with oral health. They will then undergo dental examination for caries experience, periodontal health, oral pain, and traumatic dental injuries. In Phase 2, we will bring together all qualitative and quantitative results by means of a mixed methods matrix. Finally, in Phase 3, we will hold a one-day meeting with policy makers, dentists, and community leaders to refine interpretations and begin designing future oral health interventions for this population. Full article

(This article belongs to the Special Issue Oral Health and Dental Care Access Disparities: The Contexts of Immigrant Health and Minority Health)

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