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  1. M A DiMarco1,
  2. S M Ludington2
  1. 1The University of Akron, Akron, OH, USA
  2. 2Case Western Reserve University, Cleveland, OH, USA


Homelessness in the United States has significantly increased with homeless women/children representing the fastest growing group. The Surgeon General’s report, Oral Health in America, declared dental caries the “silent epidemic” with the worst oral health found among the poor. A prospective repeated measures study elucidated predictors of oral health access, utilization, and oral health status for children in female-headed homeless families, and determined whether shelter-based care increased utilization. A convenience sample of 120 homeless families was recruited from a shelter. Predictor factors based on the Behavioral Model for Vulnerable Populations were measured. The families were followed up one month later and outcomes were measured. The level of health/oral health status of homeless children was also measured.

The level of health (the number of health conditions) found each homeless child (N = 236) had an average of 2–3 health conditions with only 24 children having no health conditions. Dental caries (n = 98) was the number one health problem of homeless children. Ten independent variables explained 33% of the variance in the dependent variable access barriers to care. Seven independent variables were significant; and the three most influential were mental health (B = −0.426), oral health beliefs (B = 0.243), and victimization (B = 0.185). Ten independent variables explained 24.3% of the variance of oral health status. Mother’s age (B = 0.351), no. of children at access (B = 0.337), and race (B = 0.154) had the most influence. Shelter-based care was effective in improving access because 43% of families were able to secure appointments and perceived access barriers decreased after shelter-based care (p<0.001).

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