Violence Exposure and Dental Care Utilization Over the Lifespan

ABSTRACT. Dental care utilization is a critical component of oral health and overall health over the lifespan. However, nearly 2 in 5 American adults have not had a dental care visit in the past year. Interpersonal violence—including firearm violence—is a serious public health issue in the United States that impacts millions of Americans' lives and directly impacts health and the utilization of health care services. While prior research finds that specific forms of violence exposure, including certain adverse childhood experiences and intimate partner violence, are associated with lower dental care utilization and greater unmet dental needs, there is limited research on the role of exposure to community violence and dental care utilization. Moreover, research on violence and dental care is limited by exclusively using cross-sectional data and, therefore, cannot observe patterns of violence and dental care utilization over time and throughout life course stages. The proposed study fills these gaps and provides the first comprehensive investigation into the relationship between violence exposure and dental care utilization from multiple perspectives, including individual experiences with violence, vicarious community violence exposure, and ecological research on community firearm violence and dental care utilization rates. We use three rich longitudinal data sources that measure violence and dental care utilization in the United States: (1) the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 7,295)—an ongoing, nationally representative longitudinal study of persons in the United States followed over 25 years (ages 12-44) which includes data on violent victimization, and dental care utilization, (2) the Future of Families and Child Wellbeing Study (FFCWS; N = 3,000)—an ongoing longitudinal study of children born in large US cities (population over 200,000) followed from birth to age 22, which includes comprehensive measures of vicarious community violence exposure and dental care, and (3) the Neighborhood Gun Violence and Health in 100 Cities (NGVH-100; N = 15,882)—a novel dataset from 15,882 urban census tracts in the United States from 2014-2021 measuring every incident of fatal and nonfatal firearm shootings and rates of dental care utilization. This study has three aims. Aim 1 will use the Add Health data to determine the relationship between personal violent victimization and dental care utilization from adolescence to adulthood (ages 12-44), including variations by race/ethnicity and socioeconomic status (SES). Aim 2 will use the FFCWS data to determine the relationship between vicarious community violence exposure and dental care utilization from childhood to emerging adulthood (ages 5-22), including race/ethnicity and SES variations. Aim 3 will use the NGVH-100 data to determine the relationship between exposure to fatal and nonfatal firearm violence and dental care utilization rates in urban census tracts, including race/ethnicity and SES variations. The findings from this study can facilitate novel translational research and inform the development of violence reduction interventions in real-world dental care settings.