Sociocultural Determinants of Children’s Oral Health Among Immigrants: Developing and Testing a Conceptual Model

Abstract

Background: The Canadian Collaboration for Immigration and Refugee Health highlights oral health diseases among the top 11 health challenges for immigrants and refugees. Foreign-born individuals face higher vulnerability due to migration-related disruptions and limited dental access. Cultural shifts, known as "acculturation," impact immigrants' health, varying in degree. Understanding this requires considering post-migration socio-cultural context. Social connections change post-migration, affecting oral health, well-being, and quality of life. Recognizing these shifts is crucial for stakeholders: dentists, community workers, and researchers. Social support is vital for new immigrants, aiding adaptation, and healthcare access. Both parental acculturation and support shape children's oral health. Their combined impact on oral health remains underexplored in existing literature.

Objective: The overarching objective of this research was to construct and assess a conceptual model aimed at predicting oral health behaviors and caries experience of immigrants’ children. The goal was to develop a model that explains the sociocultural factors influencing children’s oral health among immigrants, using Structural Equation Modeling (SEM).

Methods: This study unfolded in three phases, beginning with ethics approval from the University of Alberta Research Ethics Board (Protocol # Pro00072345). The first phase encompassed two systematic reviews: one focused on acculturation's impact on oral health among immigrants and ethnic minorities, while the other explored social support's influence on oral health in these groups. The second phase, a cross-sectional study, investigated how parental acculturation and perceived social support affected their children's oral health behaviors and caries experience. Participants included first-generation immigrant parents residing in Canada for two or more years, with children aged 2–12 years. Data collection took place in convenient community settings through multilingual community workers using non-probability snowball sampling. Parents provided demographic, perceived social support, acculturation, and children's oral health behavior data. Trained dentists conducted dental exams and used the DMFT/dmft index to assess caries experience. Oral health behaviors were measured with an eight-item questionnaire. The main independent variables were parents' perceived social support (PSS),measured using the validated Personal Resource Questionnaire (PRQ2000) and parents' acculturation and strategies were evaluated with the Asian American Multidimensional Acculturation Scale (AAMAS). The data collected in the second phase informed the creation of a conceptual model in the third phase, aimed at predicting immigrant children’s oral health behaviors and caries experience through Structural Equation Modeling (SEM), examining parental acculturation and perceived social support's influences.

Results: A total of 336 parent/child pairs participated in the study. The average parental acculturation level was 10.46, and the average perceived social support (PSS) score was 63.27. Factors like length of residency, parents' education, and household income significantly predicted acculturation level. Parents with higher Canadian cultural knowledge reported more frequent children's toothbrushing. Parents of children consuming >1 sugary item/day had higher acculturation levels, English language proficiency, and Canadian food adoption. Parents of recent dental visitors reported higher assimilation and lower separation scores, while those visiting due to problems had higher marginalization scores. Parental acculturation wasn't significantly linked to children's dental decay (DMFT/dmft). Household income predicted parental PSS (B = -5.69). Children of parents with higher PSS brushed teeth ≥2/day. Parental education predicted social integration and nurturance; income predicted social integration, worth, and assistance. Parents with more intimacy and social integration were more aware of children's oral health. Parental social integration scores were higher when children consumed ≥1 sugary snack/day. All domain scores were higher when children brushed teeth ≥2/day. Structural Equation Modeling (SEM) indicated 77% of DMFT/dmft variance was explained by parental PSS, acculturation, predisposing/enabling factors, and children's oral health (OH) behaviors. Parental PSS had a direct effect on reduced dental caries and sugar consumption. Parental acculturation mediated by positive OH behaviors increased caries risk.

Conclusions: The SEM analysis found significant variance in immigrants’ children's caries experience. Findings highlight parental acculturation and PSS levels predicting oral health behaviors and caries. Recognizing sociocultural factors is vital for stakeholders—dentists, community workers, and researchers. Immigrants' vulnerability to oral health issues underscores the need for deeper exploration and expanding the model.