| Exploring the association between neighborhoods and dental caries could provide a way to address oral health inequalities in a population by developing multilevel oral health community interventions. This study examines neighborhood effects on the severity of caries among African Americans, selected in a multistage probability sample of African-American families living in Detroit.; This study used cross sectional data on 1,021 adults obtained in the first wave of interviews and examinations conducted in 2002--2003 by the Detroit Center for Research on Oral Health Disparities. Multilevel analyses focused on 27 neighborhood clusters derived from the original sample and involved a combination of individual (level-1) and neighborhood data including Census and geocoded information (level-2).; There is statistically significant variation in the severity of caries (DS and DFS scores) among low-income neighborhood clusters; however, the magnitude of this variation is less than 3%. On average, 36% of the neighborhood level variance in caries severity was explained by level-2 predictors. Direct effects on caries severity, after accounting for individual risk factors, were observed with the number of churches and grocery stores in the clusters. In particular, lower mean DS and DFS are associated with an increasing number of churches in neighborhood clusters, while there is an increase in untreated dental caries with a higher number of grocery stores in the neighborhoods. Individual predictors such as age, socioeconomic status, total sugar intake, oral hygiene and oral health self-perception explained approximately 15% of the caries variance within the neighborhood clusters. The great inter-individual variability in caries is still mostly unexplained by classical risk factors for this condition.; This study suggests that neighborhoods contribute something unique to the oral health status of caregivers, beyond their own socioeconomic position and individual risk factors, and adds to growing evidence that community and individual-based interventions are necessary to reduce disparities among African-Americans. Churches may offer a promising venue in which to conduct these strategies. |
