RECENT MASTER'S THESES AND DOCTORAL DISSERTATIONS
 

Di, Y. Essays on socioeconomic disparities in dental health
Doctoral dissertation (Ph.D.)., State University of New York at Stony Brook 2008
DAI, 69, no. 11A (2008): p. 4424
ISBN: 978-0-549-92623-8
Abstract: This dissertation examines the determinants of preventive dental care use and dental health outcomes, and it contributes to our understanding of forces behind the phenomenon of socioeconomic disparities in health. We explore the role of socioeconomic factors, dental health insurance and dental health preferences on the decision to use preventive dental care services. In addition, the impact of preventive care on dental outcomes is identified and quantified.
Access to quality care is a key suspect in explaining differences in outcomes, but measuring this access has not been easy. Insurance status is an obvious indicator of access to care. The dental health market is ideal for studying the role of access in producing efficient outcomes for a number of reasons: the ability to accurately measure access to care and the significant evidence base surrounding the benefits of preventive care, the wider disparities in quantity and quality of dental insurance coverage, as well as relatively high coinsurance rates in general.
Using data from the dental health market we study utilization patterns by socioeconomic status and access to care. We examine the role of socioeconomic factors, dental health insurance and dental health preferences on the decision to use preventive dental care services. Estimated effects of dental health insurance are potentially biased by an adverse selection problem where the demand for services and insurance are simultaneous and driven by health need and preferences. We construct an indicator of preferences to directly purge the bias. We take into account heterogeneity in dental health preferences that may drive the propensity to insure, as well as the propensity to use dental health services (adverse selection). Using self-assessments from the National Health and Nutrition Examination Survey (NHANES), we construct indicators of preferences by taking advantage of the subjectivity incorporated in them. Using this survey we are able to test the factors of interest on the propensity to use preventive dental care, conditional on heterogeneous preferences. We find that dental insurance has a persistent effect in driving the behavior of investing in preventive dental care, even after controlling for dental care preferences. Frequency of preventive care visits are also influenced by socioeconomic status and dental insurance coverage, even after conditioning on dental preference and perceptions. Conditional on having positive visits, people of high socioeconomic status, with dental insurance, and with stronger dental health preferences, all significantly increase their frequency of care. While preferences and other factors explain some of the variation in utilization disparities, economic barriers, with lack of insurance in particular, do exist.
We also examine the determinants of dental health measured by dental caries by accounting for the endogeneity of routine dental care use. Routine dental visits decrease the probability of having caries. Therefore, preventive dental care indeed translates into better health outcomes measured by dental caries. We also identify and quantify the magnitude of the separate effects of racial differences in observed characteristics such as income, education, occupation, and health behaviors, taking into account of dental care use. We find that routine dental care utilization and income explain a large portion of racial disparities among whites, African-Americans, and Hispanics.

Clark-Alexander, B. Dental hygienists' beliefs, norms, attitudes, and intentions toward treating HIV/AIDS patients
Doctoral Dissertation (Ph.D), University of South Florida; 2008
DAI, 69, no. 08B (2008):
ISBN: 978-0-549-77400-6
Abstract: There is a great demand and need for oral health care during the course of HIV disease (HIV Costs and Services Utilization Study; Marcus et al., 2005). HIV+ patients identified three key barriers to obtaining oral health treatment: (1) beliefs and attitudes of dental health care providers (DHCPs) may have lead to their unwillingness to treat HIV/AIDS patients; (2) the existence of racial and ethnic disparities in health care in the United States, and (3) how DHCPs perceive their risk of contracting HIV. The fear and stigma associated with treating patients with HIV further compromises their access to care and their health status. Oral health conditions associated with HIV disease are frequently more severe than those of the general population, making access to both dental and medical care imperative. Plus, Florida has some of the highest numbers of HIV/AIDS patients in the nation.
This study was descriptive, cross-sectional and used quantitative methods to explore the dental hygienists’ behavioral and normative beliefs, attitudes, and intentions toward treating patients with HIV/AIDS. A three-phase pilot study was conducted to assess the validity and reliability of the survey instrument. An email delivery method was used to implement the survey, and a 22% response rate was achieved (n=219). The majority of respondents were female (96%), white (89%), married (77%), currently working (86%), and had treated HIV/AIDS patients in private practice (80%). Bivariate analysis showed that dental hygienists’ intentions toward treating HIV/AIDS patients were significantly associated with five independent variables, and binary logistic regression confirmed the significance of two of these associations. Overall, study participants indicated that they were willing to, and had positive attitudes toward, clinically treating HIV/AIDS patients; they were confident in their ability to treat them, and their normative beliefs did not hinder their intention to do so, and they did not worry about acquiring HIV in the workplace.
Three recommendations were made: increase access to oral health care for HIV/AIDS patients within community settings by removing barriers to care, incorporate cultural/sensitivity training in all dental/dental hygiene school curriculums, and mandate Florida HIV/AIDS continuing education requirements every biennium for dentists and dental hygienists.

Hoffman, Linda A. Trust, betrayal, and reconciliation in dentistry: A study of cognitions, affects, and behaviors among the betrayed
Doctoral - EdD Thesis, Pepperdine University 2008
Source: DAI, 69, no. 05A (2008): p. 1871
ISBN: 978-0-549-55719-7
While the concepts of interpersonal trust and trustworthiness within the organizational environment have been reviewed and discussed by researchers and scholars, less attention has been dedicated to the understanding of interpersonal dynamics following a violation of trust. The purpose of this phenomenological study is to examine the self reported cognitions, affects, and behaviors of individuals as they engage in a trust relationship with a supervisor or peer in the organizational environment, experience a perceived incident of workplace betrayal, and make the decision not to reestablish trust with their perceived transgressor following the trust violation.
    Working with a sample front office administrators and managers employed within the dental industry—each of whom reported on an experience of workplace betrayal by a supervisor or peer—individual in-depth interviews were conducted to obtain data about the participants' lived experience with the subject matter.
    Employing Moustakas' 7 step method for phenomenological data analysis, the researcher developed a list of invariant constituents pertaining to 3 themes: (a) cognitions of participants who did not reestablish trust following an incident of workplace betrayal, (b) affects of participants who did not reestablish trust following an incident of workplace betrayal, and (c) behaviors of participants who did not reestablish trust following an incident of workplace betrayal.
    Of the 19 invariant constituents identified, 6 were globally reported among study participants. The 6 constituents universally experienced by the study participants include (a) thinking poorly of the betrayer, (b) thinking the betrayal was wrong or unfair, (c) experiencing hurt, (d) experiencing anger, (e) reduced trust for the betrayer, and (f) confronting the betrayer. All invariant constituents are addressed in the discussion on the study results.
    The findings of this study indicate that initial trust building and assessment of trustworthiness involve elements of objectivity and subjectivity. The unexpected, and undeserved, nature of the betrayal as reported through the participants' narratives suggests that trust violations within the organizational environment may have complicated implications for both truster and trustee. Finally, the findings illustrate how a betrayer's acknowledgment of the violation, and active participation in the trust repair process, may create opportunities for reconciliation.

Petrou, Christiana Savva. Use of text mining to predict patient compliance
Ph.D. Thesis, University of Louisville; 2008
Source: DAI, 69, no. 03B (2008): p. 1719
Standard No: ISBN: 978-0-549-54924-6
    The purpose of this study is to examine standards of care in the Dental School of the University of Louisville. The central theme is to consider issues of compliance on behalf of the patients and how to define it in an unbiased way. We will examine the relationship of visit intervals, treatment needs, and patient compliance.
    With the use of SAS 9.1.3 software, data mining techniques such as clustering, kernel density, linear models and mixed models estimation will be used to define and analyze compliance. Statistical methods such as text mining were used to examine the severity of patient conditions. Confidence interval estimation and bootstrapping were explored to assist with the allocation of patients to compliance levels. Patients who were within the 95% confidence interval of the median for visit intervals at least 80% of the time were defined as fully compliant, with decreasing levels of compliance as the percentage decreases to 60%, 40%, 20% and 0%
    Approximately 82% of the patient population was classified as least compliant, and in the least compliant group, approximately 60% are in the two most severe condition categories with regards to their dental condition. The general trend indicates that patients with severe dental conditions tend not to be compliant, whereas patients that suffer from not so severe conditions tend to be more compliant.
    The treatment needs, treatment schedules, clinic group, entry point, and socioeconomic status are all variables that affect patient compliance. This study can be extended to private dental practices for comparison purposes.

Varcasio, Anne M. P. Overview of the paradigm for oral health care for children: A focus on social constructs
M.A. Thesis. State University of New York Empire State College, 2008
Source: MAI, 46, no. 05 (2008): p. 2673
Standard No: ISBN: 978-0-549-52642-1
    The goal of this paper is to highlight that policy and program approaches to oral health care for children is no longer limited to epidemiology, but also linked to social factors and social frameworks. Chapter I provides an overall view of what I hope to accomplish in this paper. Chapters II and III provide supporting evidence found in literature and government actions supporting the focus of social factors to reform oral health. Chapter IV provides evidence to support school based oral health programs, shows an example of a socially linked oral health policy in action and explores school based oral health programs as a viable alternative delivery system for children. Chapter V offers guideposts for navigating oral health policy in social policy paradigms in support of considering social factors, to increase the understanding of the complexities surrounding social problems, social frameworks, and oral health needs of children.
    The social problems and policy actions that surround oral health for children are found to be complex and embedded in social frameworks such as: scarce resources, increasing numbers of low-income families. The need for a more diverse pool of dental professionals and expansion of pediatric programs for dental students, less restrictive regulations, and quality evaluation measures for oral health outcomes need to be considered.
    The literature reviewed in this paper concludes that oral health reforms that consider social problems have the greatest chance for becoming the most helpful and lasting programs as opposed to disregarding social factors and maintaining the status quo. Future work that shifts oral health and epidemiology into social realms is considered to have the greatest potential to reduce oral health disparities, and a worthwhile course of study. It is the intent of this paper to increase interest in social theory and test these theories in the design of oral health programs and educational curriculums for oral health professionals.

Wright Langston, R. The Web site said what? The effects of parent-provided Internet information on the depth of cognitive processing of pediatric dentists
Doctoral dissertation (Ph.D), Northwestern University 2008
DAI, 69, no. 03A (2008): p. 817
ISBN: 978-0-549-50562-4
Abstract: Parents are visiting the Internet in increasing numbers for guidance about the dental health of their children and are bringing this information into appointments with their children's pediatric dentists. Since the impact of this phenomenon on dental discussions is largely unknown, this study was conducted to discover what factors influence the level of cognitive processing by pediatric dentists of parent-provided Internet information.
This research project conducted an online survey with a convenience sample of 119 U.S. pediatric dentists recruited through listservs of the American Academy of Pediatric Dentistry. The survey asked pediatric dentists to respond to a scenario in one of four conditions related to parent-provided Internet information in a dental consultation, manipulating the variables of perceived plausibility or implausibility and high or low familiarity of Internet dental health information. Based on those conditions, it assessed the level of cognitive processing by pediatric dentists of the Internet information. In addition, the research measured the pediatric dentists' perceptions of the Internet as a source of dental information, their attitudes toward shared decision-making, and their preferences for sharing control of dental information with parents. The survey also collected demographic data on the participants regarding gender, age, and years in the practice of dentistry.
The results of the study showed that the perceived quality of Internet information provided by a parent during a dental consultation was the most important factor in determining the level of cognitive processing of that information by pediatric dentists. However, the familiarity of the Internet information did not influence the pediatric dentists' level of cognitive processing. The findings demonstrated that pediatric dentists will more carefully process online information provided by parents if they have a higher respect for the Internet as a source of dental knowledge, and if they hold attitudes about sharing control of information with parents. The results did not find a significant relationship between the degree to which pediatric dentists reported following a model of shared decision-making and the degree to which they carefully process parent-provided Internet information. The study also showed a lack of support for age and gender as predictors of attitudes about the Internet, shared decision-making, and information control.
From a theoretical perspective, this study demonstrated that the elaboration likelihood model proves viable for research in the field of pediatric dentistry by offering a framework to understand the differing levels of cognitive processing by pediatric dentists of parent-provided Internet information. The research revealed that the plausibility of Internet information has a direct effect on the level of cognitive processing of pediatric dentists, and supported that the perceived credibility of the Internet as a source of dental information acts as a relevant cue to increase cognitive processing.
As more parents seek dental information online, pediatric dentists need to be prepared to engage in discussions with parents about Internet information. It will become increasingly important for pediatric dentists to discover which parents in their practices seek online dental information, why they seek it, and how they use the information to make decisions about their children's dental health. Pediatric dentists should guide parents toward web sites offering accurate dental information, collaborate with them in evaluating Internet information, dedicate resources to the development of educational standards for dental health web sites, and publish sites offering quality pediatric dental information. If pediatric dentists and their staff members assist parents in their Internet research and carefully consider parent-provided Internet information, the dentist-parent relationship can be improved, and children will be more likely to enjoy the benefits of good dental health.