Objectives We examined the associations of oral health literacy (OHL) with oral health status (OHS) and dental neglect (DN), and explored whether self-efficacy (SE) mediated or modified these associations, among a sample of female clients of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Methods We used interview data that were collected from 1280 female WIC clients as part of the Carolina Oral Health Literacy (COHL) Project between 2007 and 2009. OHL was measured with a validated word recognition test (REALD-30) and oral health status with the self-reported NHANES item. Analyses relied upon descriptive, bivariate, and multivariate methods. Results Less than one-third of participants rated their oral health as very good or excellent. Higher OHL was associated with better oral health status (multivariate PR=1.29; 95% CL=1.08, 1.54, for 10-unit REALD increase). OHL was not correlated with DN but SE showed a strong negative correlation with DN. SE remained significantly associated with DN in a fully-adjusted model that included OHL. Conclusions Increased OHL was associated with better OHS but not DN. Self-efficacy was a strong correlate of DN and may mediate the effects of literacy on oral health status.

Objectives-To determine oral health literacy (OHL) levels and explore potential racial differences in a low-income population.Methods-This was a cross-sectional study of caregiver/child dyads who completed a structured 30-minute, in-person interview conducted by two trained interviewers in seven counties in North Carolina. Socio-demographic, OHL, and dental health related data were collected. OHL was measured with a dental word recognition test (REALD-30). Descriptive, bivariate and multivariate methods were used to examine the distribution of OHL and explore racial differences.Results-Of 1,658 eligible subjects, 1,405 (85%) participated and completed the interviews. The analytic sample (N=1,280) had mean age 26.5 (SD=6.9) years with 60% having a high school degree or less. OHL varied between racial groups as follows: Whites-mean score=17.4 (SE=0.2); African American (AA)-mean score=15.3 (SE=0.2); American Indian (AI)-mean score=13.7 (SE=0.3). Multiple linear regression revealed that after controlling for education, county of residence, age and Hispanic ethnicity, Whites had 2.0 points (95%CI=1.4, 2.6) higher adjusted REALD-30 score versus AA and AI.Conclusions-Differences in OHL levels between racial groups persisted after adjusting for education and socio-demographic characteristics.

Objectives To investigate the association of caregivers’ oral health literacy (OHL) with their children's oral health related-quality of life (C-OHRQoL) and explore literacy as a modifier in the association between children's oral health status (COHS) and C-OHRQoL. Methods We relied upon data from structured interviews with 203 caregivers of children ages 3-5 from the Carolina Oral Health Literacy (COHL) Project. Data were collected for OHL using REALD-30, caregiver-reported COHS using the NHANES-item, and COHRQoL using the Early Childhood Oral Health Impact Scale (ECOHIS). We also measured oral health behaviors (OHBs) and socio-demographic characteristics and calculated overall/stratified summary estimates for OHL and C-OHRQoL. We computed Spearman's rho and 95% confidence limits (CL) as measures of correlation of OHL/COHS with C-OHRQoL. To determine whether OHL modified the association between COHS and C-OHRQoL, we compared literacy-specific summary and regression estimates. Results Reported COHS was: excellent—50%, very good—28%, good—14%, fair—6%, poor—2%. The aggregate C-OHRQoL mean score was 2.0 (95% CL:1.4, 2.6), and the mean OHL score 15.9 (95% CL:15.2, 16.7). There was an inverse relationship between COHS and C-OHRQoL: rho=-0.32 (95% CL:-0.45, -0.18). There was no important association between OHL and C-OHRQoL; however, deleterious OHBs were associated with worse C-OHRQoL. Literacy-specific linear and Poisson regression estimates of the association between COHS and C-OHRQoL departed from homogeneity (Wald X2 P<0.2). Conclusion In this community-based sample of caregiver/child dyads, we found a strong correlation between OHS and C-OHRQoL. The association's magnitude and gradient were less pronounced among caregivers with low literacy.

BackgroundOur previous research (Pediatrics 2010:126) found a strong association between caregiver oral health literacy (OHL) and children’s oral health status; however, we found a weak association with oral health behaviors (OHBs). We hypothesize that this may be due to social desirability bias (SDB). Our objectives were to compare caregivers’ responses to traditional OHB items and newer SDB-modulating items, and to examine the association of caregiver literacy with OHBs.MethodsWe performed a cross-sectional study of 102 caregiver-child dyads, collecting data for OHBs using both traditional and new SDB-modulating items. We measured OHL using REALD-30, a validated word recognition test. We relied upon percent agreement and Cohen’s kappa (k) to quantify the concordance in caregivers’ responses and multivariate log-binomial regression to estimate the impact of OHL on OHBs.ResultsCaregivers’ mean REALD-30 score was 20.7 (SD = 6.0), range 1-30. We found an association between OHL and 4 of 8 OHBs examined. A subset of behavior questions compared traditional versus SDB-modulating items: history of bottle-feeding: agreement = 95%, k = 0.83 (95% CL:0.68,0.99); daily tooth brushing: agreement = 78%, k = 0.25 (95% CL:0.04,0.46); fluoridated toothpaste use: agreement = 88%, k = 0.67 (95% CL:0.49,0.85). After controlling for caregivers’ race, marital status and study site, higher literacy scores remained associated with a decreased prevalence of parental report of “decided not brush the child’s teeth because it would be frustrating”.ConclusionsAgreement between responses was high for 2 of 3 behavior items. Item 3 (tooth brushing frequency) revealed discordance, likely due to SDB. Use of the SDB-modulating items appears to yield a better estimate of OHB.

Background The authors conducted an observational cohort study to determine the levels of and examine the associations of oral health literacy (OHL) and oral health knowledge in low-income patients who were pregnant for the first time. Methods An analytic sample of 119 low-income patients who were pregnant for the first time completed a structured 30-minute, in-person interview conducted by two trained interviewers in seven counties in North Carolina. The authors measured OHL by means of a dental word recognition test and assessed oral health knowledge by administering a six-item knowledge survey. Results The authors found that OHL scores were distributed normally (mean [standard deviation], 16.4 [5.0]). The percentage of correct responses for each oral health knowledge item ranged from 45 to 98 percent. The results of bivariate analyses showed that there was a positive correlation between OHL and oral health knowledge (P < .01). Higher OHL levels were associated with correct responses to two of the knowledge items (P < .01). Conclusions OHL was low in the study sample. There was a significant association between OHL and oral health knowledge. Clinical Implications Low OHL levels and, thereby, low levels of oral health knowledge, might affect health outcomes for both the mother and child. Tailoring messages to appropriate OHL levels might improve knowledge.