Advancing Oral Health Equity Through School-Based Oral Health Programs: An Ecological Model and Review

Abstract

In the United States and elsewhere, children are more likely to have poor oral health if they are homeless, poor, and/or members of racial/ethnic minority and immigrant populations who have suboptimal access to oral health care. As a result, poor oral health serves as the primary marker of social inequality. Here, the authors posit that school-based oral health programs that aim to purposefully address determinants of health care access, health and well-being, and skills-based health education across multiple levels of influence (individual/population, interpersonal, community, and societal/policy) may be more effective in achieving oral health equity than programs that solely target a single outcome (screening, education) or operate only on the individual level. An ecological model is derived from previously published multilevel frameworks and the World Health Organization (WHO) concept of a health-promoting school. The extant literature is then examined for examples of evaluated school-based oral health programs, their locations and outcomes(s)/determinant(s) of interest, the levels of influence they target, and their effectiveness and equity attributes. The authors view school-based oral health programs as vehicles for advancing oral health equity, since vulnerable children often lack access to any preventive or treatment services absent on-site care provision at schools. At the same time, they are incapable of achieving sustainable results without attention to multiple levels of influence. Policy solutions that improve the nutritional quality of children's diets in schools and neighborhoods and engage alternative providers at all levels of influence may be both effective and equitable.

Assessing School-Based Oral Health Interprofessionalism through Public School Nurse Perceptions

“…There are multiple factors that contribute to child oral health outcomes, including intrapersonal, interpersonal, institutional/organizational, community, and environmental factors (McLeroy et al, 1988). School nurses can act as champions within the school-based setting with the opportunity to impact preventive oral health services and dental care access (Albert, McManus, & Mitchell, 2005;Gargano, Mason, & Northridge, 2019). We conducted a formative evaluation using a survey to examine the community level of influence by exploring perspectives of school-based nurses (McLeroy et al, 1988;Meadow & Edelstein, 1981;Mouradian, Wehr & Crall, 2000).…”

A Technical Assistance Curriculum for Expanding Sustainable School-Based Oral Health Programs in the Carolinas’ Dental Safety Net

“…School-based oral health programs (SBOHPs) provide opportunities to address many socio-economic influences on oral health by providing alternative, convenient access points for care (Gargano et al, 2019 ). A synthesis of comprehensive care models demonstrated oral health improvements as barriers such as transportation, broken appointments, and parent disengagement were ameliorated.…”

Does A Multiple-Sport Intervention Based on the TGfU Pedagogical Model for Physical Education Increase Physical Fitness in Primary School Children?

“…In order to trigger health benefits within schools, researchers and practitioners have implemented various strategies aiming at increasing the different domains of health. These strategies have included dietary programs [ 9 ], mental health literacy [ 10 ], social inclusion and equity [ 11 ], or stress reduction [ 12 ] among others. Although a variety of areas have been investigated, a considerable body of research and practice focuses on in-school physical activity (PA), due to the essential role played by an active lifestyle in building healthy behaviors at early ages [ 13 ].…”